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Retroviral Infection of Murine Embryonic Stem Cell Derived Embryoid Body Cells for Analysis of Hematopoietic Differentiation
Published on: October 20, 2014
Infection Prevalence in Adolescents and Adults With Acute Myeloid Leukemia Treated in an Indian Tertiary Care Center
Hasmukh Jain1, Karthik Rengaraj1, Vibhor Sharma1
1Department of Medical Oncology, Tata Memorial Hospital, affiliated to Homi Bhabha National Institute, Mumbai, India.
Purpose:
Infections remain a major challenge in the treatment of acute myeloid leukemia (AML). Induction-related mortality reported in the literature is approximately < 5% in clinical trials. However, the real-world scenario is different, especially in developing countries, given the high incidence of multidrug-resistant (MDR) organisms, high incidence of fungal pneumonia at baseline, and significant delay before initiation of chemotherapy. We aimed to look at contemporary infections and infection-related mortality and analyze the patterns of infections.
Materials And Methods:
This retrospective study was conducted at a large tertiary care oncology center in India. Patients with newly diagnosed AML who were older than age 15 years, considered fit for intensive therapy, and treated in the general wards of the adult hematolymphoid unit from March 1, 2014, until December 31, 2015, were included.
Results:
One hundred twenty-one patients were treated during the study period. The most common presenting complaint was fever (85%). The focus of infection at presentation was found in 63% of patients, with respiratory infection being the most common (47%). MDR organisms were isolated in 55% of patients during induction from various foci. Klebsiella pneumoniae was the most common blood culture isolate (42.9%). Fungal pneumonia was diagnosed in 55% of patients during induction despite antifungal prophylaxis. Treatment-related mortality was 10.7% in all phases, with an induction mortality rate of 7.4%. Complete remission was attained in 69% of patients. Of all patients who received induction chemotherapy, 74% completed all three consolidation cycles. The 121 patients were followed up for a median period of 53 months. Four-year event-free survival was 35.8%, and 4-year overall survival was 41.5%.
Conclusion:
Infections and infection-related mortality are major challenges during AML induction. Gram-negative MDR and fungal infections are particularly common in our region.
Insights
Infections and mortality are significant challenges in acute myeloid leukemia (AML) treatment, particularly with multidrug-resistant (MDR) organisms and fungal infections common in real-world settings.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Infections pose a major challenge in acute myeloid leukemia (AML) treatment.
- Real-world infection-related mortality in AML may exceed clinical trial data, especially in developing countries due to multidrug-resistant (MDR) organisms and delayed chemotherapy initiation.
Purpose of the Study:
- To analyze contemporary infection patterns and infection-related mortality in acute myeloid leukemia (AML) patients undergoing intensive therapy.
- To evaluate the incidence of multidrug-resistant (MDR) organisms and fungal infections during AML induction.
Main Methods:
- Retrospective study of 121 newly diagnosed AML patients (age > 15) treated at a tertiary care oncology center in India from March 2014 to December 2015.
- Analysis of presenting complaints, infection foci, microbial isolates, and treatment outcomes, including mortality and survival rates.
Main Results:
- Fever was the most common presenting complaint (85%).
- Respiratory infections were the most frequent infection focus (47%), with MDR organisms isolated in 55% of patients.
- Treatment-related mortality was 10.7%, with 7.4% induction mortality. Four-year overall survival was 41.5%.
Conclusions:
- Infections and associated mortality are critical issues during AML induction.
- Gram-negative MDR and fungal infections are prevalent in this patient population, highlighting the need for targeted management strategies.
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