ABSTRACT
OBJECTIVES: Infections are the major cause of morbidity and mortality in patients with acute myeloid leukaemia (AML). They primarily occur during the first course of induction chemotherapy and may increase the risk of leukaemia relapse, due to a significant delay in consolidation therapy. The intensification of induction chemotherapy and the use of non-conventional drugs such as fludarabine are considered responsible for the increased risk of infections. METHODS: In this study, we retrospectively analysed the infections occurred in 224 newly diagnosed AML patients
Subject(s)
Antineoplastic Agents/adverse effects , Gram-Negative Bacterial Infections/mortality , Gram-Positive Bacterial Infections/mortality , Leukemia, Myeloid, Acute/mortality , Mycoses/mortality , Vidarabine/analogs & derivatives , Adult , Antineoplastic Agents/administration & dosage , Bacteremia/chemically induced , Bacteremia/mortality , Female , Fever/chemically induced , Fever/mortality , Gram-Negative Bacterial Infections/chemically induced , Gram-Positive Bacterial Infections/chemically induced , Humans , Incidence , Leukemia, Myeloid, Acute/drug therapy , Male , Middle Aged , Mycoses/chemically induced , Retrospective Studies , Risk Factors , Survival Rate , Vidarabine/administration & dosage , Vidarabine/adverse effectsABSTRACT
One hundred and six patients aged /= 6) vs. 75% among the MDR-Pgp-negative (neg(ve)) ones (MFI < 6) (P = 0.16). Conversely, in the controls, the CR rate was 44% among the MDR-Pgp-pos(ve) patients vs. 67% among the MDR-Pgp-neg(ve) ones (P = 0.02). The 4-year disease-free survival (DFS) and overall survival (OS) of MDR-Pgp-pos(ve) cases were significantly longer than those of MDR-Pgp-pos(ve) controls (DFS, 28.1% vs. 6.5%, P = 0.004; OS, 33.5% vs. 9.6%, P = 0.01). This difference was not found among the MDR-Pgp-neg(ve) patients. By univariate (P = 0.007) and multivariate (P = 0.007) analysis, the MDR-Pgp-pos(ve) phenotype was negatively correlated with CR and it emerged as the most important independent negative prognostic factor, after cytogenetics. Our study confirms the prognostic impact of the MDR phenotype in AML and strongly suggests fludarabine-based induction treatments as a promising strategy for MDR-Pgp-pos(ve) AML patients. In this setting of patients, large prospective randomised studies should be planned.
