Acute Promyelocytic Leukemia ( APL ) - Infections

5/05/2004

Question: Which bacterial or fungal organisms present the greatest threat to patients undergoing chemotherapy for acute promyelocytic leukemia ( APL ) ?

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Unique Identifier:12750707

Authors: Girmenia C. Lo Coco F. Breccia M. Latagliata R. Spadea A. D'Andrea M. Gentile G. Micozzi A. Alimena G. Martino P. Mandelli F.

Institution: Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy.

Title: Infectious complications in patients with acute promyelocytic leukaemia treated with the AIDA regimen.

Source: Leukemia. 17(5):925-30, 2003 May.

Abstract: Infections represent a frequent complication of chemotherapy used for acute myeloid leukaemia (AML) and are associated with important toxicity frequently leading to treatment discontinuation. Acute promyelocytic leukaemia (APL) is a unique AML subset requiring tailored therapy including all-trans retinoic acid and anthracycline-based chemotherapy. We analysed in this study the incidence and type of infections complicating the clinical course of 89 consecutive APL patients receiving the AIDA protocol at a single institution. A total of 179 febrile episodes were registered during induction and consolidation, 52% of which were of unknown origin. Infections were clinically and microbiologically documented in 10.6 and 37.4% of cases, respectively. Coagulase-negative staphylococci represented the major cause of septicaemia (28%) and were more frequently isolated during induction, whereas viridans group streptococci, the second pathogen most frequently isolated from blood (27%), represented the principal pathogen detected during consolidation and were significantly associated with mucositis. Gram-negative bacteria accounted for 33.3% of all blood isolates. Fungal infections were only occasionally observed. Bloodstream infections in APL patients were compared with those documented in 271 consecutive patients affected by other subtypes of AML. The incidence of total septicaemia episodes, of staphylococcal bacteraemias and of fungaemias was significantly higher in patients with other AMLs. Empirical antibiotic therapy with ceftriaxone plus amikacin was effective in 73% of APL cases, most of the remaining cases being successfully managed by the addition of teicoplanin. One single death apparently related to infectious complication was recorded. Overall, infections led to antileukaemic treatment withdrawal in six patients, five of whom currently remain in haematologic remission for 13-106 months. These results indicate that a particular pattern of infections is observed in APL patients receiving ATRA plus anthracycline-based chemotherapy and that these appear to be effectively counteracted by standard management. CAS Registry/EC Number 0 (AIDA protocol). 0 (Anti-Bacterial Agents). 0 (Antineoplastic Combined Chemotherapy Protocols). 302-79-4 (Tretinoin). 37517-28-5 (Amikacin). 58957-92-9 (Idarubicin). 78439-06-2 (Ceftazidime).

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Unique Identifier:10214855

Authors: Girmenia C. Latagliata R. Tosti S. Morano SG. Celesti F. Coppola L. Spadea A. Breccia M. Battistini R. Tafuri A. Cimino G. Mandelli F. Alimena G.

Institution: Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy.

Title: Outpatient management of acute promyelocytic leukemia after consolidation chemotherapy.

Source: Leukemia. 13(4):514-7, 1999 Apr.

Abstract: The feasibility and safety of outpatient management of acute promyelocytic leukemia (APL) during the aplastic phase after intensive consolidation chemotherapy, the incidence and types of complications requiring readmission to hospital, and the number of hospital days spared by this policy have been prospectively evaluated. After chemotherapy administration, patients were evaluated on an ambulatory basis. In the event of any complication they referred to the Emergency Unit (EU) of our Department dedicated to outpatients with hematologic diseases. Forty patients with APL observed over a 4 year period were eligible for intensive chemotherapy. After the achievement of complete remission they received a total of 104 consolidation courses and in 98 instances they were followed on an ambulatory basis. There were 41 cases (42%) of rehospitalization for fever (40 cases) or severe anemia (one case). Only one patient died due to a brain hemorrhage. Streptococcus viridans was the organism most frequently isolated from blood. Empiric once-a-day antibacterial therapy with ceftriaxone and amikacin was effective in 87% of the cases and made possible early discharge in 28% of the cases to continue the antibiotic therapy on an outpatient setting. Patients were managed out of the hospital for 76% of the post-consolidation neutropenia period. Thanks to the availability of an EU specifically dedicated to outpatients with hematologic diseases, out-hospital management of APL patients after consolidation therapy appeared to be safe, well accepted, potentially cost-saving, and contributed to saving the risk of developing severe nosocomial infections. CAS Registry/EC Number 0 (AIDA protocol). 0 (Antibiotics, Combined). 0 (Antineoplastic Combined Chemotherapy Protocols). 302-79-4 (Tretinoin). 37517-28-5 (Amikacin). 58957-92-9 (Idarubicin). 73384-59-5 (Ceftriaxone).

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