ICU intervention during induction chemotherapy for adult patients with newly diagnosed acute myeloid leukemia

CADTH recommends that Venclexta in combination with azacitidine should be reimbursed for the treatment of patients with newly diagnosed acute myeloid leukemia (AML) who are 75 years or older, or who have comorbidities that preclude use of intensive induction chemotherapy, only if certain conditions are met. Venclexta plus azacitidine should only be reimbursed if prescribed by clinicians who have expertise in managing patients with AML and are familiar with the toxicity profile of this regimen, and if the costs of Venclexta and azacitidine are reduced. Venclexta plus azacitidine should only be covered to treat adult patients who are considered ineligible for standard intensive induction chemotherapy and have not been treated with venetoclax or chemotherapy for myelodysplastic syndrome.

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Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

Journal of Fungi ◽

10.3390/jof7090761 ◽

2021 ◽

Vol 7 (9) ◽

pp. 761

Author(s):

Anastasia I. Wasylyshyn ◽

Kathleen A. Linder ◽

Carol A. Kauffman ◽

Blair J. Richards ◽

Stephen M. Maurer ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Induction Chemotherapy ◽

Myeloid Leukemia ◽

Proportional Hazards ◽

Invasive Fungal Disease ◽

Fungal Disease ◽

Antifungal Prophylaxis ◽

Cell Transplant ◽

Newly Diagnosed ◽

Acute Myeloid

This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or secondary AML (n = 27, 11%). Seventy-five patients (30%) received an allogeneic hematopoietic cell transplant within the first year after induction chemotherapy. Proven/probable IFD occurred in 17 patients (7%). Twelve of the 17 (71%) were mold infections, including aspergillosis (n = 6), fusariosis (n = 3), and mucomycosis (n = 3). Eight breakthrough IFD (B-IFD), seven of which were due to molds, occurred in patients taking antifungal prophylaxis. Patients with proven/probable IFD had a significantly greater number of cumulative neutropenic days than those without an IFD, HR = 1.038 (95% CI 1.018–1.059), p = 0.0001. By cause-specific proportional hazards regression, the risk for IFD increased by 3.8% for each day of neutropenia per 100 days of follow up. Relapsed/refractory AML significantly increased the risk for IFD, HR = 7.562 (2.585–22.123), p = 0.0002, and Kaplan-Meier analysis showed significantly higher mortality at 1 year in patients who developed a proven/probable IFD, p = 0.02. IFD remains an important problem among patients with AML despite the use of antifungal prophylaxis, and development of IFD is associated with increased mortality in these patients.

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Epidemiology and risk factors for invasive fungal infections during induction chemotherapy for newly diagnosed acute myeloid leukemia: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0197851 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0197851 ◽

Cited By ~ 18

Author(s):

Ming-Yu Lien ◽

Chia-Hui Chou ◽

Ching-Chan Lin ◽

Li-Yuan Bai ◽

Chang-Fang Chiu ◽

...

Keyword(s):

Risk Factors ◽

Acute Myeloid Leukemia ◽

Cohort Study ◽

Induction Chemotherapy ◽

Retrospective Cohort Study ◽

Myeloid Leukemia ◽

Retrospective Cohort ◽

Fungal Infections ◽

Newly Diagnosed ◽

Acute Myeloid

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Multisystem Inflammatory Syndrome in Children During Induction Chemotherapy in a Newly Diagnosed Pediatric Acute Myeloid Leukemia and Concurrent COVID-19

Journal of Pediatric Hematology/Oncology ◽

10.1097/mph.0000000000002236 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Girmay H. Tekle-Yohannes ◽

Esther Mann ◽

Michal A. Miller

Keyword(s):

Acute Myeloid Leukemia ◽

Induction Chemotherapy ◽

Myeloid Leukemia ◽

Newly Diagnosed ◽

Pediatric Acute Myeloid Leukemia ◽

Inflammatory Syndrome ◽

Acute Myeloid

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AML Subtype M5 Linked to Pulmonary Leukemic Infiltrates and Respiratory Failure and the Importance of Early Induction Chemotherapy

Journal of Hematological Malignancies ◽

10.5430/jhm.v4n1p1 ◽

2018 ◽

Vol 4 (1) ◽

pp. 1

Author(s):

Yvonne Chu

Keyword(s):

Acute Myeloid Leukemia ◽

Induction Chemotherapy ◽

Lung Tissue ◽

Complete Resolution ◽

Lung Biopsy ◽

Myeloid Leukemia ◽

Clinical Question ◽

Newly Diagnosed ◽

Acute Myeloid ◽

Lung Infiltrates

Currently there are no practice guidelines for evaluating lung infiltrates in patients with newly diagnosed acute myeloid leukemia (AML). More specifically, it remains unclear if there is a need to obtain a lung tissue biopsy prior to the initiation of induction chemotherapy. This clinical question is particularly important in instances in which obtaining a lung tissue diagnosis can potentially delay anti-leukemic treatment. Here we describe a case of such lung infiltrates in which a newly diagnosed AML patient underwent a diagnostic lung biopsy before receiving chemotherapy, was shown to have leukemic infiltration of lung tissue, and subsequently had complete resolution of lung infiltrates following initiation of chemotherapy.

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1087. Fluoroquinolone Prophylaxis vs. No Bacterial Prophylaxis in Hospitalized Neutropenic Patients Undergoing Induction Chemotherapy for Acute Myeloid Leukemia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.951 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S386-S386

Author(s):

Carley Buchanan ◽

Derek N Bremmer ◽

Anna Koget ◽

Matthew Moffa ◽

Nathan Shively ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Induction Chemotherapy ◽

Myeloid Leukemia ◽

Intervention Group ◽

Additional Treatment ◽

Newly Diagnosed ◽

Post Intervention ◽

Number Of Patients ◽

Neutropenic Patients ◽

Acute Myeloid

Abstract Background Despite evidence to support outpatient anti-pseudomonal fluoroquinolone (FQ) prophylaxis in neutropenic patients, limited data exist to support this for inpatients undergoing induction chemotherapy for acute myeloid leukemia (AML). At our institution, we implemented an initiative to replace FQ prophylaxis with a conditional order for an anti-pseudomonal β-lactam to be given if a fever occurred. Methods A retrospective chart review was conducted to analyze the outcome differences between patients receiving FQ prophylaxis (pre-intervention) and those who had a conditional order for an anti-pseudomonal β-lactam in place of FQ prophylaxis (post-intervention). Patients were included if they were ≥18 years of age and were newly diagnosed with AML undergoing induction chemotherapy. The primary outcome was 90-day all-cause mortality. Secondary outcomes included the number of patients requiring ICU admission and rate of bacteremic episodes caused by any pathogen and from a Gram-negative rod (GNR). Additionally, ciprofloxacin susceptibility of these pathogens was analyzed. Results There were 35 and 26 patients in the pre- and post-intervention groups, respectively. Between pre- and post-intervention groups, there was no difference in 90-day mortality (20.0% vs. 15.4%; P = 0.745) or ICU admissions (25.7% vs. 23.1%, P = 1), respectively. The rate of any bacteremic episode was similar between the pre- and post-intervention groups (51.4% vs. 65.4%; P = 0.307), but more patients in the post-intervention group developed GNR bacteremia (17.1% vs. 46.2%; P = 0.023). In the patients with GNR bacteremia, the number of ciprofloxacin nonsusceptible isolates was higher in the pre-intervention group (100% vs. 30.7%; P = 0.011). Conclusion Replacing FQ prophylaxis with a conditional order for an anti-pseudomonal β-lactam for inpatients newly diagnosed with AML receiving induction chemotherapy is a feasible option to decrease FQ exposure. Though increased episodes of GNR bacteremia were observed, there was no difference in total bacteremic episodes or clinical outcomes, and the improved ciprofloxacin susceptibility patterns will allow for an additional treatment option in this extremely vulnerable patient population. Disclosures All authors: No reported disclosures.

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