Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel.
Am J Hematol. 2013 Feb;88(2):130-4. doi: 10.1002/ajh.23368.
Hypomethylating agents have become the standard therapy for patients with high-risk myelodysplastic syndrome (MDS). In Israel, azacitidine (AZA) is routinely used. Yet, infectious complications are common during AZA therapy. The current study was aimed to evaluate the incidence and predisposing risk factors for infections in AZA-treated patients. This retrospective study included patients treated with AZA in 18 Israeli medical institutions between 2008 and 2011. Data on 184 patients [157 high-risk MDS and 27 acute myeloid leukemia (AML)], with a median age of 71.6 (range 29-92) were recorded. Overall, 153 infectious events were reported during 928 treatment cycles (16.5%) administered to 100 patients. One hundred fourteen, 114/153 (75%) events required hospitalization and 30 (19.6%) were fatal. In a univariate analysis, unfavorable cytogenetics, low neutrophil, hemoglobin (Hb) and platelet (PLT) counts were found to be associated with infections (24.4% vs. 12.9%, P < 0.0001; 27% vs. 13.5%, P < 0.0001; 20.4% vs. 11%, P < 0.0001 and 29.2% vs. 14.2%, P < 0.0001, respectively). In multivariate analysis, only low Hb level, low PLT count, and unfavorable cytogenetics remained significant. Prior to therapy, poor cytogenetics, PLT count below 20 × 10⁹/L and neutrophil count below 0.5 × 10⁹/L were predictive of the risk of infection during the first two cycles of therapy. In conclusion, patients with unfavorable cytogenetics, presenting with low neutrophil and PLT counts, are susceptible to infections. Evaluation of infection risk should be repeated prior to each cycle. Patients with poor cytogenetics in whom AZA is prescribed despite low PLT count are particularly at high risk for infections and infection prophylaxis may be considered.
低甲基化剂已成为高危骨髓增生异常综合征（MDS）患者的标准治疗方法。在以色列，阿扎胞苷（AZA）被常规使用。然而，AZA 治疗期间常发生感染并发症。本研究旨在评估 AZA 治疗患者感染的发生率和易患危险因素。本回顾性研究纳入了 2008 年至 2011 年期间在以色列 18 家医疗机构接受 AZA 治疗的患者。共记录了 184 例患者[157 例高危 MDS 和 27 例急性髓系白血病（AML）]，中位年龄为 71.6（范围 29-92）岁。100 例患者共接受了 928 个 AZA 治疗周期，其中共报告了 153 例感染事件（16.5%）。114/153（75%）例感染事件需要住院治疗，30 例（19.6%）感染事件致死。单因素分析发现，不良细胞遗传学、低中性粒细胞、血红蛋白（Hb）和血小板（PLT）计数与感染相关（24.4% vs. 12.9%，P<0.0001；27% vs. 13.5%，P<0.0001；20.4% vs. 11%，P<0.0001 和 29.2% vs. 14.2%，P<0.0001）。多因素分析显示，仅 Hb 水平低、PLT 计数低和不良细胞遗传学仍有显著意义。治疗前，不良细胞遗传学、PLT 计数<20×10⁹/L 和中性粒细胞计数<0.5×10⁹/L 是预测前两个治疗周期感染风险的因素。结论：不良细胞遗传学、低中性粒细胞和 PLT 计数的患者易发生感染。在每个周期治疗前应重复评估感染风险。尽管 PLT 计数低，但仍对不良细胞遗传学患者开具 AZA 处方，这些患者感染风险高，可考虑预防感染。
