Therapeutic Advances in Hematology (Sep 2022)

Relevance of infections on the outcomes of patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, and acute myeloid leukemia treated with hypomethylating agents: a cohort study from the GESMD

  • Laura Vilorio-Marqués,
  • Christelle Castañón Fernández,
  • Elvira Mora,
  • Lorena Gutiérrez,
  • Beatriz Rey Bua,
  • Maria José Jiménez Lorenzo,
  • Marina Díaz Beya,
  • Miriam Vara Pampliega,
  • Antonieta Molero,
  • Joaquín Sánchez-García,
  • Marisa Calabuig,
  • Maria Teresa Cedena,
  • Tzu Chen-Liang,
  • Johana Alejandra Díaz Santa,
  • Irene Padilla,
  • Francisca Hernández,
  • Rosana Díez,
  • Pedro Asensi,
  • Blanca Xicoy,
  • Guillermo Sanz,
  • David Valcárcel,
  • María Diez-Campelo,
  • Teresa Bernal

DOI
https://doi.org/10.1177/20406207221127547
Journal volume & issue
Vol. 13

Abstract

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Background: The consequences of infectious toxicity of hypomethylating agents (HMAs) on overall survival (OS) of patients diagnosed with high-risk myeloid neoplasms have not been thoroughly investigated. Objectives: We aimed to evaluate whether infectious events (IEs) negatively influenced the results of HMA treatment in a real-world setting. Design: Observational study. Methods: We obtained data from 412 non-selected consecutive patients from 23 Spanish hospitals who were diagnosed with high-risk myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia and were treated with HMA. HMAs received after chemotherapy or stem cell transplant were excluded. All IEs were recorded. Outcomes included OS, modifications to the pre-planned treatment, incidence and characteristics of IEs, hospitalization, red blood cell transfusions, and factors associated with infection. Results: The rate of infection was 1.2 per patient/year. Next-cycle delay ( p = 0.001) and hospitalizations ( p = 0.001) were significantly influenced by IEs. Transfusion requirements during each cycle were significantly higher after infection compared with cycles without infection (coefficient = 1.55 [95% confidence interval (CI) = 1.26–1.84], p 20% (HR = 1.57 [95% CI = 1.19–2.01], p 9 g/dl (HR = 0.65 [95% CI = 0.51–0.82], p < 0.001) and higher platelet count (HR = 0.997 [95% CI = 0.996–0.998], p = 0.016) protected from it. Conclusion: HMA infectious toxicity worsens OS, hinders the adherence to antineoplastic treatment and results in significant morbidity. Preventive strategies are fundamental in vulnerable patients.