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Infection in myelodysplastic syndromes before evolution into acute non-lymphoblastic leukemia
1Department of Internal Medicine, Faculty of Medicine, Kyoto University Hospital, Japan.
Abstract:
The frequencies, kinds, pathogens, and risk factors of infections in the myelodysplastic syndromes (MDS) were analysed in 430 cases. The overall tendency was for one infectious episode per 1023.5 patient days. The frequency of infectious episodes was highest just after diagnosis of MDS when more than 4 episodes per 1000 patient days occurred. Thereafter, the rate declined rapidly to about 0.3 episodes per 1000 patient days within 4 years. The most frequent infection was that of the respiratory tract followed by sepsis and fever of unknown origin (FUO). Among the types of infection resulting in death, sepsis and FUO comprised the highest proportion (40%) followed by respiratory tract infections (39%). The most frequent pathogen observed was Staphylococcus bacteria. The significant multivariate risk factors for fatal infections were subtype, hemoglobin, dependence on red blood cell transfusion, age, and sex. A staging system was created using these five simple variables at diagnosis.
Insights
Infections are common in myelodysplastic syndromes (MDS), particularly after diagnosis. Key risk factors for fatal infections include MDS subtype, hemoglobin levels, and transfusion dependence, aiding in a new staging system.
Area of Science:
- Hematology
- Infectious Diseases
Background:
- Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
- Infections are a major cause of morbidity and mortality in MDS patients.
Purpose of the Study:
- To analyze the frequencies, types, pathogens, and risk factors of infections in patients with myelodysplastic syndromes.
- To develop a staging system for fatal infections in MDS based on identifiable risk factors.
Main Methods:
- Retrospective analysis of 430 patients diagnosed with myelodysplastic syndromes.
- Statistical analysis to identify infection rates, common pathogens, and significant risk factors for fatal outcomes.
- Development of a multivariate risk-factor-based staging system.
Main Results:
- The overall infection rate was approximately 1 episode per 1023.5 patient days, peaking shortly after MDS diagnosis.
- Respiratory tract infections were most frequent, followed by sepsis and fever of unknown origin (FUO).
- Staphylococcus bacteria were the most common pathogens identified. Significant risk factors for fatal infections included MDS subtype, hemoglobin, red blood cell transfusion dependence, age, and sex.
Conclusions:
- Infections pose a significant threat to patients with myelodysplastic syndromes, with distinct patterns and pathogens.
- A novel staging system incorporating subtype, hemoglobin, transfusion dependence, age, and sex can predict fatal infections at diagnosis.