DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214413

Incidence of neutropenic fever and sepsis in patients receiving induction chemotherapy in acute leukemia

Prasoon Sebastian, Abdul Majeed Kuruvadangal, Hitha Babu

Abstract


Background: Acute leukemias are treated with intensive chemotherapy protocols which are associated with increased risk of infections. The objective of this study was to determine the incidence of febrile neutropenia and sepsis in acute leukemia patients during induction chemotherapy.

Methods: In this prospective study we analysed the data of febrile neutropenia of forty-four patients of acute leukemia treated with intensive chemotherapy protocols. Study was conducted in hemato-oncology unit of Government Medical College, Kozhikode from January 2018 to December 2018. Events of the first month of induction were assessed, data entered in Microsoft excel and analysed with SPSS software.

Results: Febrile neutropenia developed in all patients with AML induction therapy and 21.4% patients with ALL induction therapy. Causative organism was identified in 41.6% of febrile neutropenia episodes. Major focus of infection was lower respiratory tract followed by gastrointestinal tract. Fungal infection was identified in 6.8% cases. Mortality in AML induction was 31% and that of ALL induction was 3.57%. Infection was the most common cause of mortality. No clinical or laboratory parameters were found significant to predict outcome during induction chemotherapy in acute leukemia.

Conclusions: Neutropenic fever and sepsis are the major cause of mortality in acute leukemia during induction chemotherapy. Early initiation of appropriate antibiotics will help to improve outcome in the treatment of leukemia.


Keywords


Neutropenia, Fever, Acute leukemia, Chemotherapy

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References


Hämäläinen S, Kuittinen T, Matinlauri I, Nousiainen T, Koivula I, Jantunen E. Neutropenic fever and severe sepsis in adult acute myeloid leukemia (AML) patients receiving intensive chemotherapy: Causes and consequences. Leuk Lymphoma. 2008;49(3):495-501.

Koistinen P, Räty R, Itälä M, Jantunen E, Koivunen E, Nousiainen T, et al. Long-term outcome of intensive chemotherapy for adults with de novo acute myeloid leukaemia (AML): the nationwide AML-92 study by the Finnish Leukaemia Group. Eur J Haematol. 2007;78(6):477-86.

Koistinen P, Räty R, Itälä M, Jantunen E, Koivunen E, Nousiainen T, et al. Long-term outcome of intensive chemotherapy for adults with de novo acute myeloid leukaemia (AML): the nationwide AML-92 study by the Finnish Leukaemia Group. Eur J Haematol. 2007;78(6):477-86.

DiNubile MJ. Fever and neutropenia: still a challenge. Contemp Intern Med. 1995;7(1):35-7.

Rolston KV. The Infectious Diseases Society of America 2002 guidelines for the use of antimicrobial agents in patients with cancer and neutropenia: salient features and comments. Clin Infect Dis. 2004;39.

Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64(2):328-40.

Shah A, Andersson TM, Rachet B, Björkholm M, Lambert PC. Survival and cure of acute myeloid leukaemia in England, 1971-2006: a population-based study. Br J Haematol. 2013;162(4):509-16.

Biswal S, Godnaik C. Incidence and management of infections in patients with acute leukemia following chemotherapy in general wards. Ecancermedicalscience. 2013;7:310.

Malkan UY. Pediatric Chemotherapeutic Regimen (BFM-95) is Superior for Overall Survival in Adult Acute Lymphoblastic Leukemia. Int J Hematol. Oncol. 2018;28(4):254-60.

Iqbal M, Phan M, Machiorlatti M, Vesely SK, Morton JM, Holter J, et al. Impact of Duration of Neutropenia and Lymphopenia on AML Patients Undergoing Induction Chemotherapy. Blood. 2016;128(22):5178-82.

Singer M, Deutschman CS, Seymour CW, Shankar HM, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.

Hämäläinen S, Kuittinen T, Matinlauri I, Nousiainen T, Koivula I, Jantunen E. Neutropenic fever and severe sepsis in adult acute myeloid leukemia (AML) patients receiving intensive chemotherapy: Causes and consequences. Leuk Lymphoma. 2008;49(3):495-501.

Chang JE, Medlin SC, Kahl BS, Longo WL, Williams EC, Lionberger J, et al. Augmented and standard Berlin-Frankfurt-Munster chemotherapy for treatment of adult acute lymphoblastic leukemia. Leuk Lymphoma. 2008;49(12):2298-307.

Möricke A, Reiter A, Zimmermann M, Gadner H, Stanulla M, Dördelmann M, et al. Risk-adjusted therapy of acute lymphoblastic leukemia can decrease treatment burden and improve survival: treatment results of 2169 unselected pediatric and adolescent patients enrolled in the trial ALL-BFM 95. Blood. 2008;111(9):4477-89.