Ofran Yishai, Filanovsky Kalman, Gafter-Gvili Anat, Vidal Liat, Aviv Ariel, Gatt Moshe E, Silbershatz Itay, Herishanu Yair, Arad Ariela, Tadmor Tamar, Dally Najib, Nemets Anatoly, Rouvio Ory, Ronson Aharon, Herzog-Tzarfati Katrin, Akria Luiza, Braester Andrei, Hellmann Ilana, Yeganeh Shay, Nagler Arnon, Leiba Ronit, Mittelman Moshe, Merkel Drorit
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Department of Hematology, Kaplan Medical Center, Rehovot, Israel.
Clin Lymphoma Myeloma Leuk. 2015 Jun;15(6):e95-9. doi: 10.1016/j.clml.2015.02.030. Epub 2015 Mar 5.
Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. However, a correlation between AZA dose and infection complications has never been studied.
Higher-risk patients with myelodysplastic syndrome or acute myeloid leukemia treated with AZA in 18 Israeli hospitals between the years 2008 and 2011 were included in a former national survey. To reveal the effect of AZA dosage on infection risk we limited our analysis to the infection rate after the first AZA dose alone. We excluded subsequent cycles of AZA from the analysis, because infectious events during these cycles might be related to other cofactors such as disease response to AZA therapy.
After the first AZA cycle, infectious events were more frequent after doses of 75 mg/m(2) for 7 days than 75 mg/m(2) for 5 days (36/106 [34%] and 10/67 [14.9%], respectively; P = .008), regardless of the patient's age. Of the 46 recorded infectious events, the causative pathogen was identified as bacterial in 25 (54.3%) and as viral or fungal in 2 (4.3%) and 2 (4.3%) cases, respectively. No pathogen was identified in 17 (37%) cases. Infections were significantly more prevalent among patients who presented with platelet counts < 20,000 (43.6% vs. 23.6%; P = .012) and poor risk cytogenetics (40.7% vs. 19.8%; P = .008).
Reduction of AZA dose might decrease infection rate and therefore should be considered in patients with high infection risk.
阿扎胞苷（AZA）剂量降低是血细胞减少患者的常见做法。然而，AZA剂量与感染并发症之间的相关性从未被研究过。
2008年至2011年间在以色列18家医院接受AZA治疗的高危骨髓增生异常综合征或急性髓系白血病患者被纳入之前的一项全国性调查。为了揭示AZA剂量对感染风险的影响，我们将分析仅限于首次单独使用AZA后的感染率。我们将AZA的后续疗程排除在分析之外，因为这些疗程中的感染事件可能与其他辅助因素有关，如疾病对AZA治疗的反应。
在第一个AZA疗程后，7天给予75mg/m²剂量的感染事件比5天给予75mg/m²剂量的更频繁（分别为36/106 [34%]和10/67 [14.9%]；P = 0.008），与患者年龄无关。在46例记录的感染事件中，致病病原体在25例（54.3%）中被鉴定为细菌，在2例（4.3%）中为病毒，在2例（4.3%）中为真菌。17例（37%）病例中未鉴定出病原体。血小板计数<20,000的患者（43.6%对23.6%；P = 0.012）和预后不良的细胞遗传学患者（40.7%对19.8%；P = 0.008）中感染明显更普遍。
降低AZA剂量可能会降低感染率，因此对于感染风险高的患者应予以考虑。
