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Pneumonia during remission induction chemotherapy in patients with AML or MDS
M Wilhelm1, H M Kantarjian, S O'Brien
1Medizinische Poliklinik, University of Würzburg, Germany.
Abstract:
We analyzed the 67 of 278 patients with newly-diagnosed AML or 'high-risk' MDS, treated in 1994 and 1995, who developed pneumonia during course 1 of their induction therapy. Pneumonia responded to treatment in 66%, but outcome depended on when pneumonia was diagnosed. Patients with pneumonia diagnosed during week 1 or 2 (group 2 patients) had the lowest response rate (43%). Patients who developed pneumonia in the 3rd week after treatment initiation had the best outcome with all 16 patients recovering. Patients presenting with pneumonia had an intermediate response rate (75%). The different patient groups were comparable with regard to age, underlying disease, prophylactic therapy, and G-CSF application. Although a lower CR rate was not entirely responsible for the lower response rate in group 2, failure to achieve CR predicted unsuccessful treatment of pneumonia in all groups. Fungal pathogens appeared more common in group 2 patients. However, in these patients, administration of amphotericin B was associated with a significantly higher failure rate (15/21 failures vs 2/9 who received no amphotericin B). We conclude that patients who develop pneumonia during week 1 or 2 are a high-risk group, and that use of amphotericin B indicates a particularly poor prognosis, although we present data suggesting that earlier use of amphotericin might be beneficial. Furthermore, since achievement of CR was an important prognostic factor in all groups, WBC transfusions particularly from donors given G-CSF should be considered as a therapeutic option. Finally, since time to failure of induction therapy and time to CR were similar in high-risk patients, new chemotherapy regimens could potentially improve both the CR rate and the outcome of pneumonia.
Insights
Pneumonia in high-risk AML or MDS patients during induction therapy is serious. Early pneumonia (weeks 1-2) has poor outcomes, and amphotericin B use indicates a worse prognosis.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Pneumonia is a significant complication in patients undergoing induction therapy for acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS).
- The timing of pneumonia diagnosis during induction therapy may impact treatment outcomes.
Purpose of the Study:
- To analyze the impact of pneumonia diagnosis timing on treatment response and outcomes in AML/MDS patients.
- To identify prognostic factors for pneumonia treatment success in this patient population.
Main Methods:
- Retrospective analysis of 67 patients with newly-diagnosed AML or high-risk MDS treated between 1994-1995.
- Categorization of patients based on the week of pneumonia diagnosis during induction therapy (Course 1).
- Comparison of response rates, outcomes, and prognostic factors across different patient groups.
Main Results:
- Overall pneumonia response rate was 66%.
- Patients developing pneumonia in weeks 1-2 had the lowest response rate (43%), while those in week 3 had the best outcome (100% recovery).
- Fungal pathogens were more common in early-onset pneumonia (weeks 1-2), and amphotericin B use was associated with higher failure rates.
Conclusions:
- Pneumonia developing in the first two weeks of induction therapy identifies a high-risk group with poor prognosis.
- Amphotericin B administration in these early cases may indicate a worse outcome, though earlier use might be beneficial.
- Achievement of complete remission (CR) is a critical prognostic factor, suggesting WBC transfusions and novel chemotherapy regimens could improve outcomes.