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A risk analysis for bacterial and fungal infections in hospitalized patients with first-line treatment of acute myeloid leukemia based on clinical and treatment variables

Patrick Brueck, Thomas Parnavas, M. Elizabeth Ramos Lopez, Dieter Hoelzer, Mathias Rummel, Angelika Böhme

Med Sci Tech 2012; 53(2): RA67-74

ID: 883577


Background:    While bleeding events are no longer the major cause of early death during induction and consolidation treatments for acute myeloid leukemia, the fate of patients during induction therapy is nowadays mainly influenced by the type and severity of infections that occur.
    Material/Methods:    This retrospective study during first and second cycles of induction therapy for acute myeloid leukemia aimed to identify risk factors for fungal or bacterial infections and to evaluate the impact on the risk of death by analyzing a broad spectrum of patients’ general, laboratory and clinical variables.
    Results:    Pre-treatment comorbidities and the poor response to chemotherapy increase the risk for infections. Furthermore, the use of systemic steroids above the Cushing’s threshold had a negative effect for patients as it predisposed them to infections. Fungal infections imposed a higher risk of early death compared with bacterial infections.
    Conclusions:    While protective measures such as rooms with laminar air flow seem to be promising, our data demand the close clinical, microbiologic and radiologic monitoring of patients during induction therapies, the immediate initiation of anti-infective treatment, and the avoidance of systemic steroids whenever possible.

Keywords: acute myeloid leukemia (AML), risk analysis, bacterial infection, fungal infection, clinical variables, treatment variables

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