International Journal of Infectious Diseases
Volume 14, Issue 2 , Pages e132-e140, February 2010

Infectious complications in patients with acute myeloid leukemia treated according to the protocol with daunorubicin and cytarabine with or without addition of cladribine. A multicenter study by the Polish Adult Leukemia Group (PALG)☆

  • Ewa Lech-Maranda

      Affiliations

    • Department of Hematology, Medical University of Lodz, Copernicus Hospital, Ciolkowskiego 2 str, 93-510 Lodz, Poland
    • ,
  • Marek Seweryn

      Affiliations

    • Department of Hematology and BMT, Silesian Medical University, Katowice, Poland
    • ,
  • Sebastian Giebel

      Affiliations

    • Department of Hematology and BMT, Silesian Medical University, Katowice, Poland
    • ,
  • Jerzy Holowiecki

      Affiliations

    • Department of Hematology and BMT, Silesian Medical University, Katowice, Poland
    • ,
  • Beata Piatkowska-Jakubas

      Affiliations

    • Department of Hematology, Jagiellonian University, Cracow, Poland
    • ,
  • Joanna Wegrzyn

      Affiliations

    • Department of Hematology, Jagiellonian University, Cracow, Poland
    • ,
  • Aleksander Skotnicki

      Affiliations

    • Department of Hematology, Jagiellonian University, Cracow, Poland
    • ,
  • Marek Kielbinski

      Affiliations

    • Department of Hematology, Wroclaw Medical Academy, Poland
    • ,
  • Kazimierz Kuliczkowski

      Affiliations

    • Department of Hematology, Wroclaw Medical Academy, Poland
    • ,
  • Monika Paluszewska

      Affiliations

    • Department of Hematology and Oncology, Medical University of Warsaw, Poland
    • ,
  • Wieslaw Wiktor Jedrzejczak

      Affiliations

    • Department of Hematology and Oncology, Medical University of Warsaw, Poland
    • ,
  • Magdalena Dutka

      Affiliations

    • Department of Hematology, Medical University of Gdansk, Poland
    • ,
  • Andrzej Hellmann

      Affiliations

    • Department of Hematology, Medical University of Gdansk, Poland
    • ,
  • Marcin Flont

      Affiliations

    • Department of Hematology, Pomeranian Medical University, Szczecin, Poland
    • ,
  • Barbara Zdziarska

      Affiliations

    • Department of Hematology, Pomeranian Medical University, Szczecin, Poland
    • ,
  • Grazyna Palynyczko

      Affiliations

    • Department of Internal Medicine and Hematology, Institute of Hematology, Warsaw, Poland
    • ,
  • Lech Konopka

      Affiliations

    • Department of Internal Medicine and Hematology, Institute of Hematology, Warsaw, Poland
    • ,
  • Tomasz Szpila

      Affiliations

    • Department of Hematology, Institute of Hematology, Warsaw, Poland
    • ,
  • Krzysztof Gawronski

      Affiliations

    • Department of Clinical Hematology, Military Medical Academy, Warsaw, Poland
    • ,
  • Kazimierz Sulek

      Affiliations

    • Department of Clinical Hematology, Military Medical Academy, Warsaw, Poland
    • ,
  • Jaroslaw Sokolowski

      Affiliations

    • Department of Hematology, Bialystok Medical Academy, Poland
    • ,
  • Janusz Kloczko

      Affiliations

    • Department of Hematology, Bialystok Medical Academy, Poland
    • ,
  • Krzysztof Warzocha

      Affiliations

    • Department of Hematology, Institute of Hematology, Warsaw, Poland
    • ,
  • Tadeusz Robak

      Affiliations

    • Department of Hematology, Medical University of Lodz, Copernicus Hospital, Ciolkowskiego 2 str, 93-510 Lodz, Poland
    • Corresponding Author InformationCorresponding author. Tel.: +48 42 6895191; fax: +48 42 6895192.

Received 14 February 2008; received in revised form 22 September 2008; accepted 4 February 2009. published online 08 July 2009.

Corresponding Editor: Dean Fergusson, Ottawa, Canada

Summary 

Objectives

The addition of cladribine to the standard regimen consisting of daunorubicin and cytarabine has been reported to increase the efficacy of induction therapy in acute myeloid leukemia (AML). The goal of this study was to determine the effect of this modification on the incidence and spectrum of infectious complications.

Methods

Case report forms of 309 patients with newly diagnosed AML who had been enrolled in the prospective, randomized ‘DAC-7 vs. DA-7’ trial were reviewed. The frequency, etiology, localization, severity, and outcome of infections were compared for patients receiving only daunorubicin and cytarabine (DA-7) and those additionally treated with cladribine (DAC-7).

Results

A total of 443 febrile episodes were reported with no significant difference between the treatment groups. A trend towards a higher frequency of bacteremias was observed among DA-7 patients compared to those in the DAC-7 group (31% vs. 21%; p=0.08). The treatment arms did not differ in terms of the distribution of the isolated Gram-positive, Gram-negative, fungal, and viral organisms. However, when bacteremias were considered, Gram-positive blood cultures tended to be more frequent in the DA-7 compared to the DAC-7 group (16% vs. 8.5%; p=0.07). This difference reached statistical significance when major blood bacteremias were analyzed separately (13% vs. 5%; p=0.02). Complete recovery from infections was observed in the majority of patients across both treatment arms and no significant difference was noted regarding infection-related mortality.

Conclusions

The addition of cladribine to standard induction chemotherapy has no impact on the incidence and spectrum of infectious complications in newly diagnosed AML patients.

Keywords: Acute myeloid leukemia, Infections, Chemotherapy, Cladribine, Neutropenia

 

☆ This study was presented in part at the 12th Congress of the European Hematology Association, Vienna, Austria, June 7–10, 2007.

PII: S1201-9712(09)00193-3

doi:10.1016/j.ijid.2009.02.021

International Journal of Infectious Diseases
Volume 14, Issue 2 , Pages e132-e140, February 2010

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