Related Experiment Video
Updated: May 14, 2026
Comprehensive Protocol to Sample and Process Bone Marrow for Measuring Measurable Residual Disease and Leukemic Stem Cells in Acute Myeloid Leukemia
Published on: March 5, 2018
Predicting infections in high-risk patients with myelodysplastic syndrome/acute myeloid leukemia treated with
Drorit Merkel1, Kalman Filanovsky, Anat Gafter-Gvili
1Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel.
Abstract:
Hypomethylating agents have become the standard therapy for patients with high-risk myelodysplastic syndrome (MDS). In Israel, azacitidine (AZA) is routinely used. Yet, infectious complications are common during AZA therapy. The current study was aimed to evaluate the incidence and predisposing risk factors for infections in AZA-treated patients. This retrospective study included patients treated with AZA in 18 Israeli medical institutions between 2008 and 2011. Data on 184 patients [157 high-risk MDS and 27 acute myeloid leukemia (AML)], with a median age of 71.6 (range 29-92) were recorded. Overall, 153 infectious events were reported during 928 treatment cycles (16.5%) administered to 100 patients. One hundred fourteen, 114/153 (75%) events required hospitalization and 30 (19.6%) were fatal. In a univariate analysis, unfavorable cytogenetics, low neutrophil, hemoglobin (Hb) and platelet (PLT) counts were found to be associated with infections (24.4% vs. 12.9%, P < 0.0001; 27% vs. 13.5%, P < 0.0001; 20.4% vs. 11%, P < 0.0001 and 29.2% vs. 14.2%, P < 0.0001, respectively). In multivariate analysis, only low Hb level, low PLT count, and unfavorable cytogenetics remained significant. Prior to therapy, poor cytogenetics, PLT count below 20 × 10⁹/L and neutrophil count below 0.5 × 10⁹/L were predictive of the risk of infection during the first two cycles of therapy. In conclusion, patients with unfavorable cytogenetics, presenting with low neutrophil and PLT counts, are susceptible to infections. Evaluation of infection risk should be repeated prior to each cycle. Patients with poor cytogenetics in whom AZA is prescribed despite low PLT count are particularly at high risk for infections and infection prophylaxis may be considered.
Insights
Infections are common during azacitidine (AZA) therapy for high-risk myelodysplastic syndrome (MDS). Unfavorable cytogenetics and low blood counts increase infection risk, necessitating proactive management and prophylaxis.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Hypomethylating agents, including azacitidine (AZA), are standard treatment for high-risk myelodysplastic syndrome (MDS).
- Infectious complications frequently occur during AZA therapy, impacting patient outcomes.
Purpose of the Study:
- To determine the incidence of infections in patients receiving AZA treatment.
- To identify predisposing risk factors for infection in this patient population.
Main Methods:
- Retrospective analysis of 184 patients (157 high-risk MDS, 27 AML) treated with AZA across 18 Israeli institutions (2008-2011).
- Recorded data on patient demographics, treatment cycles, and infectious events.
- Statistical analysis (univariate and multivariate) to identify risk factors for infection.
Main Results:
- 153 infectious events occurred in 100 patients (16.5% of cycles), with 75% requiring hospitalization and 19.6% being fatal.
- Univariate analysis showed associations between infections and unfavorable cytogenetics, low neutrophil, hemoglobin (Hb), and platelet (PLT) counts.
- Multivariate analysis identified low Hb, low PLT count, and unfavorable cytogenetics as significant independent risk factors for infection.
Conclusions:
- Patients with unfavorable cytogenetics and low neutrophil or PLT counts are highly susceptible to infections during AZA therapy.
- Pre-therapy assessment of poor cytogenetics, low PLT (<20 × 10⁹/L), and low neutrophil counts (<0.5 × 10⁹/L) predicts infection risk within the first two cycles.
- Regular re-evaluation of infection risk before each cycle and consideration of prophylaxis for high-risk patients (e.g., poor cytogenetics with low PLT) are recommended.
