Original Study
Higher Infection Rate After 7- Compared With 5-Day Cycle of Azacitidine in Patients With Higher-Risk Myelodysplastic Syndrome Yishai Ofran,1,2 Kalman Filanovsky,3 Anat Gafter-Gvili,4 Liat Vidal,4 Ariel Aviv,5 Moshe E. Gatt,6 Itay Silbershatz,7 Yair Herishanu,8 Ariela Arad,9 Tamar Tadmor,2,10 Najib Dally,11 Anatoly Nemets,12 Ory Rouvio,13 Aharon Ronson,14 Katrin Herzog-Tzarfati,15 Luiza Akria,16 Andrei Braester,16 Ilana Hellmann,17 Shay Yeganeh,18 Arnon Nagler,19 Ronit Leiba,20 Moshe Mittelman,21 Drorit Merkel19 Abstract Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. We herein report on a correlation between AZA dose and infection complications in high-risk myelodysplastic syndrome and leukemia patients. Infectious events were more frequent after doses of 75 mg/m2 for 7 days than 75 mg/m2 for 5 days, regardless of the patient’s age. Reduction of AZA dose should therefore be considered in patients with high infection risk. Introduction: Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. However, a correlation between AZA dose and infection complications has never been studied. Patients and Methods: 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. Results: After the first AZA cycle, infectious events were more frequent after doses of 75 mg/m2 for 7 days than 75 mg/m2 for 5 days (36/106 [34%] and 10/67 [14.9%], respectively; P ¼ .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 ¼ .012) and poor risk cytogenetics (40.7% vs. 19.8%; P ¼ .008). Conclusion: Reduction of AZA dose might decrease infection rate and therefore should be considered in patients with high infection risk. Clinical Lymphoma, Myeloma & Leukemia, Vol. 15, No. 6, e95-9 ª 2015 Elsevier Inc. All rights reserved. Keywords: Azacitidine, Cytogenetics, Dose adjustment, Infection, Myelodysplastic syndrome 1 Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel 2 Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel 3 Department of Hematology, Kaplan Medical Center, Rehovot, Israel 4 Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Tel Aviv University, Tel Aviv, Israel 5 Department of Hematology, Emek Medical Center, Afula, Israel 6 Hematology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel 7 Hematology Institute, Wolfson Medical Center, Holon, Israel 8 Hematology Institute, Sourasky Medical Center, Tel Aviv, Israel 9 Department of Hematology, Sanz Medical Center e Laniado Hospital, Netanya, Israel 10 Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel 11 Department of Hematology, Ziv Medical Center, Zefat, Israel 12 Department of Hematology, Barzilai Medical Center, Ashkelon, Israel 13 Institution of Hematology, Soroka University Medical Center, Beer-Sheba, Israel 14 Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
2152-2650/$ - see frontmatter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clml.2015.02.030
15
Hematology Unit, Assaf Harofe Medical Center, Zerifin, Israel Department of Hematology, Western Galilee Hospital, Nahariya, Israel Hematology Unit, Meir Medical Center, Kfar Saba, Israel 18 Hematology Unit, Poria Medical Center, Hedera, Israel 19 Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel 20 Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel 21 Department of Medicine, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel 16 17
Submitted: Oct 14, 2014; Revised: Feb 16, 2015; Accepted: Feb 26, 2015; Epub: Mar 5, 2015 Address for correspondence: Yishai Ofran, MD, Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8 Ha’Aliya St, Haifa 31096, Israel Fax: 972-4-7772343; e-mail contact: [email protected]
Clinical Lymphoma, Myeloma & Leukemia June 2015
- e95
Azacitidine Dose and Infection Risk Introduction
Review of medical charts showed that 43 patients had an IPSS score of < 1.5 or received AZA doses < 75*5. We herein report the analysis of data on 173 patients, 106 of whom received the 75*7 dose and 67 who received the 75*5 dose (Figure 1). The groups were comparable in terms of pretreatment characteristics (Table 1). Patient age, sex, hemoglobin level, platelet, and neutrophil counts, transfusion dependence, cytogenetics, and percentage of blasts in the BM were similar in both groups. Infection was defined as any event diagnosed as such by the treating physician. The study included patients with microbiologically documented infection along with cases of neutropenic fever that required antibiotic therapy. A full 75*7 AZA dose was prescribed to 80 of 134 (60%) patients who presented with platelet counts > 20,000 cells/mL, and to 26 of 39 (67%) patients who presented with platelet counts < 20,000 cells/mL.
Patients and Methods
Infectious Events and Outcome
The former survey was designed to include all higher-risk MDS or acute myeloid leukemia (AML) patients treated with AZA in 18 Israeli hospitals between the years 2008 and 2011. The study was approved by institutional review boards of participating medical centers. All adult patients diagnosed with higher-risk MDS or AML who received AZA were included in the analysis. Excluded were those who were found to have an International Prognosis Scoring System (IPSS) score of < 1.5. Data on 216 of 223 (97%) patients who received AZA in Israel during the study period were collected including multiple clinical, demographic, and laboratory data, on the first day of the first AZA cycle. Parameters selected for assessment in univariate analysis were: age, sex, serum creatinine level, cytogenetics, percentage of blasts in the bone marrow (BM) aspirate, transfusion dependence, and neutrophil, platelet, and hemoglobin levels measured on the first day of therapy. Doses of AZA were grouped into 3 categories: a standard dose of 75 mg/m2 for 7 days with a total dose of 525 mg/m2 (75*7), a lower dose of 75 mg/m2 for 5 days with a total dose of 375 mg/m2 (75*5) and a total dose of < 350 mg/m2 for a cycle (low). The analysis was limited to comparison of infectious outcome between 75*7 and 75*5 doses; thus, patients who received lower doses of AZA at the first cycle were excluded.
All patients underwent extensive microbiology investigation as per their institution guidelines to identify the infectious pathogen responsible for the reported event. Of 173 patients, infectious events were reported in 46 (26.6%) during the 4 weeks that followed the first AZA dose. Of these events, the pathogen was identified as bacterial in 25 (54.3%) and as viral or fungal in an additional 2 (4.3%) and 2 (4.3%) cases, respectively. No pathogen was identified in 17 (37%) cases (Table 2). Infections were significantly more prevalent among patients who received a standard dose of AZA versus the reduced dose (34% vs. 14.9%; P ¼ .008) and in patients who presented with platelet counts < 20,000
Statistical Analysis
e96
-
and infection incidence. Pearson correlation was used to estimate linear correlation between quantitative variables (hemoglobin, neutrophil, creatinine, White blood cells, platelets). The logistic regression model was applied for prediction of the relation of infection rate and several independent parameters.
Patients who suffer from higher risk myelodysplastic syndrome (MDS) were found to benefit from azacitidine (AZA) therapy. Given at a dose of 75 mg/m2 for 7 days every 4 weeks, AZA was shown to improve patients’ blood counts, delay leukemic transformation, and prolong overall survival.1 The most common life-threatening adverse events after administration of hypomethylation agents (AZA or decitabine), are infections that are more prevalent after the initial 2 cycles of therapy.1-4 Based on a retrospective study, patients who presenting with low platelet counts, poor cytogenetics, and neutropenia were previously identified as prone to infections during AZA therapy.4 When the infection risk was reevaluated before each AZA cycle, a platelet count < 20,000 cells/mL and poor cytogenetics remained the only significant predicting factors. Although in that analysis, infection risk was not found to correlate with an AZA dose, it was suggested that current clinical practice to reduce the AZA dose in subsequent cycles after an infectious event could mask such correlation. To unveil the potential dose-dependent effect of AZA, we analyzed data of the previously reported series of 184 patients with MDS, with a focus on the 4-week period after the first AZA cycle only. The incidence of infections of any cause after 7- or 5-day AZA cycles was compared.
Data were analyzed using SPSS (IBM, Chicago, IL) for Windows version 18. Normal distributions of the quantitative variables were evaluated with the Kolmogorov-Smirnov tests. Continuous parameters were presented using means and standard deviations (SDs), and categorical parameters were presented using frequencies and percentages. The t test and Mann-Whitney U tests were used to assess differences between the groups. Fisher exact test or Pearson c2 was used to determine the relationship between several parameters
Clinical Lymphoma, Myeloma & Leukemia June 2015
Results Patient Characteristics
Figure 1 Patient Selection for the Study
PaƟents
PaƟents
PaƟents
PaƟents
PaƟents
Abbreviations: AZA ¼ Azacitidine; IPSS ¼ International Prognosis Scoring System.
Yishai Ofran et al received the standard or reduced AZA dose (19.4% vs. 17.9%; P ¼ .84) and was not affected by the higher infection rate. The most common pathogens identified were Gram-negative bacteria (E. coli, Pseudomonas, and Klebsiella) identified in 9 cases (3 cases of each bacteria), no mycobacterial infections were diagnosed.
Table 1 Patient Characteristics
Parameter
Low Dose, Standard Dose, 75 mg/m2 for 75 mg/m2 for 7 Days 5 Days
Age
P NS
70
63 (59.4)
47 (70.1)
Male
64 (60.4)
44 (65.7)
Female
42 (39.6)
23 (34.3)
3 (3.1)
2 (3.2)
Intermediate
58 (59.8)
43 (68.3)
Poor
36 (37.1)
18 (28.6)
18 (17.0)
7 (10.6)
Predictors for Infection After the Initial AZA Dose and the Use of Prophylactic Antibiotics
Sex
In a univariate analysis, the standard AZA dose (75*7), platelet counts < 20,000 cells/mL, and poor cytogenetics were found to be associated with doubling of infection rate (Table 3). Surprisingly, neither age, BM percentage of blasts, peripheral neutrophil count, hemoglobin level, nor a history of multiple blood transfusions, were associated with an increased infection rate. Multivariate analysis including all these parameters identified only the 75*7 AZA dose and platelet counts of < 20,000 cells/mL as significant predictors for infections during the first cycle of AZA therapy (Table 4). The likelihood of infection increased by 3.7 if a 75*7 dose was administrated versus the lower 75*5 dose and by 3.75 if a platelet count was < 20,000 cells/mL. Prophylactic antibiotics were prescribed to 23 of 173 (13.3%) patients, with ciproxin being prescribed to 20 patients and penicillin derivates to 3 patients. Infections were recorded in 5 of 23 (22%) patients despite antibiotic prophylaxis, a rate that is similar to the total infection rate in the whole cohort. Granulocyte-colony stimulating factor (G-CSF) was rarely used in our cohort as an infection prophylaxis agent (5 cases).
NS
Cytogenetic
NS
Good
Blasts
NS
0%-5% 6%-10%
31 (29.2)
17 (25.8)
11%-20%
46 (43.4)
29 (43.9)
21%
11 (10.4)
13 (19.7)
Yes
75 (84.3)
43 (74.1)
No
14 (15.7)
15 (25.9)
0.98 0.35
1.08 0.46
500 cells/mL
73 (70.2)
50 (75.8)
Transfusion Dependent
Creatinine Neut
NS NS
PLT
Discussion
NS
20,000 cells/mL
80 (75.5)
54 (80.6)
>10
70 (66.0)
46 (68.7)
70
110 (63.6)
23.6
.28
500
123 (72.4)
23.6
10
57 (32.9)
19.3
20,000 cells/mL
134 (77.5)
21.6
4 PC in 4 months
118 (80.3)
24.1
Higher Infection Rate After 7- Compared With 5-Day Cycle of Azacitidine in Patients With Higher-Risk Myelodysplastic Syndrome Yishai Ofran,1,2 Kalman Filanovsky,3 Anat Gafter-Gvili,4 Liat Vidal,4 Ariel Aviv,5 Moshe E. Gatt,6 Itay Silbershatz,7 Yair Herishanu,8 Ariela Arad,9 Tamar Tadmor,2,10 Najib Dally,11 Anatoly Nemets,12 Ory Rouvio,13 Aharon Ronson,14 Katrin Herzog-Tzarfati,15 Luiza Akria,16 Andrei Braester,16 Ilana Hellmann,17 Shay Yeganeh,18 Arnon Nagler,19 Ronit Leiba,20 Moshe Mittelman,21 Drorit Merkel19 Abstract Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. We herein report on a correlation between AZA dose and infection complications in high-risk myelodysplastic syndrome and leukemia patients. Infectious events were more frequent after doses of 75 mg/m2 for 7 days than 75 mg/m2 for 5 days, regardless of the patient’s age. Reduction of AZA dose should therefore be considered in patients with high infection risk. Introduction: Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. However, a correlation between AZA dose and infection complications has never been studied. Patients and Methods: 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. Results: After the first AZA cycle, infectious events were more frequent after doses of 75 mg/m2 for 7 days than 75 mg/m2 for 5 days (36/106 [34%] and 10/67 [14.9%], respectively; P ¼ .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 ¼ .012) and poor risk cytogenetics (40.7% vs. 19.8%; P ¼ .008). Conclusion: Reduction of AZA dose might decrease infection rate and therefore should be considered in patients with high infection risk. Clinical Lymphoma, Myeloma & Leukemia, Vol. 15, No. 6, e95-9 ª 2015 Elsevier Inc. All rights reserved. Keywords: Azacitidine, Cytogenetics, Dose adjustment, Infection, Myelodysplastic syndrome 1 Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel 2 Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel 3 Department of Hematology, Kaplan Medical Center, Rehovot, Israel 4 Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Tel Aviv University, Tel Aviv, Israel 5 Department of Hematology, Emek Medical Center, Afula, Israel 6 Hematology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel 7 Hematology Institute, Wolfson Medical Center, Holon, Israel 8 Hematology Institute, Sourasky Medical Center, Tel Aviv, Israel 9 Department of Hematology, Sanz Medical Center e Laniado Hospital, Netanya, Israel 10 Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel 11 Department of Hematology, Ziv Medical Center, Zefat, Israel 12 Department of Hematology, Barzilai Medical Center, Ashkelon, Israel 13 Institution of Hematology, Soroka University Medical Center, Beer-Sheba, Israel 14 Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
2152-2650/$ - see frontmatter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clml.2015.02.030
15
Hematology Unit, Assaf Harofe Medical Center, Zerifin, Israel Department of Hematology, Western Galilee Hospital, Nahariya, Israel Hematology Unit, Meir Medical Center, Kfar Saba, Israel 18 Hematology Unit, Poria Medical Center, Hedera, Israel 19 Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel 20 Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel 21 Department of Medicine, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel 16 17
Submitted: Oct 14, 2014; Revised: Feb 16, 2015; Accepted: Feb 26, 2015; Epub: Mar 5, 2015 Address for correspondence: Yishai Ofran, MD, Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, 8 Ha’Aliya St, Haifa 31096, Israel Fax: 972-4-7772343; e-mail contact: [email protected]
Clinical Lymphoma, Myeloma & Leukemia June 2015
- e95
Azacitidine Dose and Infection Risk Introduction
Review of medical charts showed that 43 patients had an IPSS score of < 1.5 or received AZA doses < 75*5. We herein report the analysis of data on 173 patients, 106 of whom received the 75*7 dose and 67 who received the 75*5 dose (Figure 1). The groups were comparable in terms of pretreatment characteristics (Table 1). Patient age, sex, hemoglobin level, platelet, and neutrophil counts, transfusion dependence, cytogenetics, and percentage of blasts in the BM were similar in both groups. Infection was defined as any event diagnosed as such by the treating physician. The study included patients with microbiologically documented infection along with cases of neutropenic fever that required antibiotic therapy. A full 75*7 AZA dose was prescribed to 80 of 134 (60%) patients who presented with platelet counts > 20,000 cells/mL, and to 26 of 39 (67%) patients who presented with platelet counts < 20,000 cells/mL.
Patients and Methods
Infectious Events and Outcome
The former survey was designed to include all higher-risk MDS or acute myeloid leukemia (AML) patients treated with AZA in 18 Israeli hospitals between the years 2008 and 2011. The study was approved by institutional review boards of participating medical centers. All adult patients diagnosed with higher-risk MDS or AML who received AZA were included in the analysis. Excluded were those who were found to have an International Prognosis Scoring System (IPSS) score of < 1.5. Data on 216 of 223 (97%) patients who received AZA in Israel during the study period were collected including multiple clinical, demographic, and laboratory data, on the first day of the first AZA cycle. Parameters selected for assessment in univariate analysis were: age, sex, serum creatinine level, cytogenetics, percentage of blasts in the bone marrow (BM) aspirate, transfusion dependence, and neutrophil, platelet, and hemoglobin levels measured on the first day of therapy. Doses of AZA were grouped into 3 categories: a standard dose of 75 mg/m2 for 7 days with a total dose of 525 mg/m2 (75*7), a lower dose of 75 mg/m2 for 5 days with a total dose of 375 mg/m2 (75*5) and a total dose of < 350 mg/m2 for a cycle (low). The analysis was limited to comparison of infectious outcome between 75*7 and 75*5 doses; thus, patients who received lower doses of AZA at the first cycle were excluded.
All patients underwent extensive microbiology investigation as per their institution guidelines to identify the infectious pathogen responsible for the reported event. Of 173 patients, infectious events were reported in 46 (26.6%) during the 4 weeks that followed the first AZA dose. Of these events, the pathogen was identified as bacterial in 25 (54.3%) and as viral or fungal in an additional 2 (4.3%) and 2 (4.3%) cases, respectively. No pathogen was identified in 17 (37%) cases (Table 2). Infections were significantly more prevalent among patients who received a standard dose of AZA versus the reduced dose (34% vs. 14.9%; P ¼ .008) and in patients who presented with platelet counts < 20,000
Statistical Analysis
e96
-
and infection incidence. Pearson correlation was used to estimate linear correlation between quantitative variables (hemoglobin, neutrophil, creatinine, White blood cells, platelets). The logistic regression model was applied for prediction of the relation of infection rate and several independent parameters.
Patients who suffer from higher risk myelodysplastic syndrome (MDS) were found to benefit from azacitidine (AZA) therapy. Given at a dose of 75 mg/m2 for 7 days every 4 weeks, AZA was shown to improve patients’ blood counts, delay leukemic transformation, and prolong overall survival.1 The most common life-threatening adverse events after administration of hypomethylation agents (AZA or decitabine), are infections that are more prevalent after the initial 2 cycles of therapy.1-4 Based on a retrospective study, patients who presenting with low platelet counts, poor cytogenetics, and neutropenia were previously identified as prone to infections during AZA therapy.4 When the infection risk was reevaluated before each AZA cycle, a platelet count < 20,000 cells/mL and poor cytogenetics remained the only significant predicting factors. Although in that analysis, infection risk was not found to correlate with an AZA dose, it was suggested that current clinical practice to reduce the AZA dose in subsequent cycles after an infectious event could mask such correlation. To unveil the potential dose-dependent effect of AZA, we analyzed data of the previously reported series of 184 patients with MDS, with a focus on the 4-week period after the first AZA cycle only. The incidence of infections of any cause after 7- or 5-day AZA cycles was compared.
Data were analyzed using SPSS (IBM, Chicago, IL) for Windows version 18. Normal distributions of the quantitative variables were evaluated with the Kolmogorov-Smirnov tests. Continuous parameters were presented using means and standard deviations (SDs), and categorical parameters were presented using frequencies and percentages. The t test and Mann-Whitney U tests were used to assess differences between the groups. Fisher exact test or Pearson c2 was used to determine the relationship between several parameters
Clinical Lymphoma, Myeloma & Leukemia June 2015
Results Patient Characteristics
Figure 1 Patient Selection for the Study
PaƟents
PaƟents
PaƟents
PaƟents
PaƟents
Abbreviations: AZA ¼ Azacitidine; IPSS ¼ International Prognosis Scoring System.
Yishai Ofran et al received the standard or reduced AZA dose (19.4% vs. 17.9%; P ¼ .84) and was not affected by the higher infection rate. The most common pathogens identified were Gram-negative bacteria (E. coli, Pseudomonas, and Klebsiella) identified in 9 cases (3 cases of each bacteria), no mycobacterial infections were diagnosed.
Table 1 Patient Characteristics
Parameter
Low Dose, Standard Dose, 75 mg/m2 for 75 mg/m2 for 7 Days 5 Days
Age
P NS
70
63 (59.4)
47 (70.1)
Male
64 (60.4)
44 (65.7)
Female
42 (39.6)
23 (34.3)
3 (3.1)
2 (3.2)
Intermediate
58 (59.8)
43 (68.3)
Poor
36 (37.1)
18 (28.6)
18 (17.0)
7 (10.6)
Predictors for Infection After the Initial AZA Dose and the Use of Prophylactic Antibiotics
Sex
In a univariate analysis, the standard AZA dose (75*7), platelet counts < 20,000 cells/mL, and poor cytogenetics were found to be associated with doubling of infection rate (Table 3). Surprisingly, neither age, BM percentage of blasts, peripheral neutrophil count, hemoglobin level, nor a history of multiple blood transfusions, were associated with an increased infection rate. Multivariate analysis including all these parameters identified only the 75*7 AZA dose and platelet counts of < 20,000 cells/mL as significant predictors for infections during the first cycle of AZA therapy (Table 4). The likelihood of infection increased by 3.7 if a 75*7 dose was administrated versus the lower 75*5 dose and by 3.75 if a platelet count was < 20,000 cells/mL. Prophylactic antibiotics were prescribed to 23 of 173 (13.3%) patients, with ciproxin being prescribed to 20 patients and penicillin derivates to 3 patients. Infections were recorded in 5 of 23 (22%) patients despite antibiotic prophylaxis, a rate that is similar to the total infection rate in the whole cohort. Granulocyte-colony stimulating factor (G-CSF) was rarely used in our cohort as an infection prophylaxis agent (5 cases).
NS
Cytogenetic
NS
Good
Blasts
NS
0%-5% 6%-10%
31 (29.2)
17 (25.8)
11%-20%
46 (43.4)
29 (43.9)
21%
11 (10.4)
13 (19.7)
Yes
75 (84.3)
43 (74.1)
No
14 (15.7)
15 (25.9)
0.98 0.35
1.08 0.46
500 cells/mL
73 (70.2)
50 (75.8)
Transfusion Dependent
Creatinine Neut
NS NS
PLT
Discussion
NS
20,000 cells/mL
80 (75.5)
54 (80.6)
>10
70 (66.0)
46 (68.7)
70
110 (63.6)
23.6
.28
500
123 (72.4)
23.6
10
57 (32.9)
19.3
20,000 cells/mL
134 (77.5)
21.6
4 PC in 4 months
118 (80.3)
24.1
