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A retrospective study evaluating the impact of infectious complications during azacitidine treatment
Anna Schuck1, Marie-Christine Goette2, Judith Neukirchen2
1Department of Hematology, Oncology and Clinical Immunology, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany. Anna.Schuck@med.uni-duesseldorf.de.
Abstract:
Azacitidine has become an available therapy for high-risk myelodysplastic syndromes. Infectious complications (IC) may impede the success of therapy. Since most patients are managed in an outpatient setting, often with low level of clinical and microbiological documentation, the impact of IC remains unclear. We retrospectively evaluated the clinical course of 77 patients with MDS treated with azacitidine between 2004 and 2015 (median age 69 years). Clinical workup included severity and type of IC, days in the hospital and with antimicrobial therapy, response to azacitidine, and overall survival (OS). In total, 614 azacitidine cycles were administered, 81 cycles with at least one IC. The median number of administered cycles was 6 (range 1-43). Median OS after the start of azacitidine was 17 months (range 1-103). Infection rates were higher in the first 3 cycles with bacterial infections leading. The better patients' hematological response to azacitidine with less IC occurred, and fewer days with antimicrobial treatment were needed. Compared to progressive disease, stable disease made no significant improvement in occurrence of IC and days in the hospital. Older age was associated with more IC and longer time in the hospital. Comorbidities or IPSS-R had no influence on IC. The incidence of IC correlated with hematological response and age. Stable disease led to longer OS, but incidence of IC was comparable to progressive disease and survival seemed to be bought by a considerable number of IC. IC rates were highest in the first 3 cycles. We recommend response evaluation after 4-6 cycles.
Insights
Infectious complications (IC) are common during azacitidine therapy for myelodysplastic syndromes (MDS). Managing IC is crucial for better treatment response and survival, with early evaluation recommended.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Azacitidine is a key therapy for high-risk myelodysplastic syndromes (MDS).
- Infectious complications (IC) can negatively impact azacitidine treatment efficacy.
- The impact of IC in outpatient MDS settings is not well-defined.
Purpose of the Study:
- To retrospectively evaluate the incidence and impact of IC in MDS patients treated with azacitidine.
- To identify factors associated with IC occurrence and their correlation with treatment response and survival.
- To provide recommendations for optimizing azacitidine therapy management.
Main Methods:
- Retrospective analysis of 77 MDS patients treated with azacitidine (2004-2015).
- Evaluation of clinical course, including IC type and severity, hospitalization, antimicrobial therapy, azacitidine response, and overall survival (OS).
- Analysis of factors such as age, comorbidities, and IPSS-R in relation to IC.
Main Results:
- A total of 614 cycles were administered, with 81 cycles experiencing at least one IC.
- Infection rates were highest in the first 3 cycles, predominantly bacterial.
- Better hematological response to azacitidine correlated with fewer IC and shorter antimicrobial treatment duration.
- Older age was associated with increased IC and longer hospital stays.
- Stable disease response did not significantly reduce IC or hospitalization compared to progressive disease.
Conclusions:
- The incidence of IC in azacitidine-treated MDS patients is significant and correlates with hematological response and patient age.
- While stable disease may prolong OS, it can be associated with a considerable number of IC.
- Early response evaluation after 4-6 cycles of azacitidine is recommended to optimize patient management and outcomes.
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