Management of septicemia and early death in acute leukemia

The frequency of fever days was measured in 67 patients with acute leukemia in the initial phase until remission was obtained or the patient died. A total of 3411 hospital days were studied. Three antibiotic schedules were examined between 1970 and 1975. There were 50% fever days when penicillin and streptomycin were combined as initial antibiotics, 37% when cephalosporin and gentamycin were used, and 31% when, in addition, semi-isolation was used prophylactically and granulocytes were given in a therapeutic attempt (0.05 greater than p greater than 0.01). The corresponding frequencies of early death were 9/21 (43%), 6/23 (26%) and 5/23 (22%). Early death occurred on an average 14, 23 and 21 days after admission. The frequencies of remission (complete and partial) were 8/21 (38%), 12/23 (52%), and 13/23 (57%). A randomized subgroup (12 patients) with intestinal sterilization was studied separately. It had 28% fever days, which is significantly less (p less than 0.01) than in the 13 patients given the same systemic antibiotics without intestinal sterilization. Fever was significantly lower (0.05 greater than p greater than 0.01) on the day after a series of granulocyte transfusions than before, although only 10(9) granulocytes were given. However, this fever reduction may have been due to concomitant antibiotics.