| Objective: To study the incidence of infection during the first induction chemotherapy in elderly AML patients in the era of targeted therapy and the risk factors for infection and to provide guidance for clinical diagnosis,treatment and prognosis improvement in elderly AML patients.Methods: A total of 158 elderly patients(≥60 years)with AML(non-M3)diagnosed by MICM in the Department of Hematology(General Hospital and South District)of the First Affiliated Hospital of the University of Chinese Science and Technology(Anhui Provincial Hospital)from June 2019 to June 2022 were selected.All patients were divided into three groups.(1)standard-dose group(n = 85): patients treated with IA,DA,FLAG or MA regimen;(2)Low-dose group(n = 54): patients were treated with low-intensity chemotherapy CAG regimen,HAG regimen,IAG regimen,hypomethylating agents(HMA),HMA+CAG regimen,HMA+HAG regimen,HMA+IAG regimen,etc.(3)Venetoclax group(n = 19): venetoclax combined with HMA(hypomethylating agent)was used.The duration of fever after chemotherapy can indirectly reflect the severity of infection,and the median number of fever days in the infected patients in this study was 3(0～20)days.Therefore,the investigators defined fever < 3 days as mild infection and ≥3 days as moderate-to-severe infection.This study used the retrospective research method to summarize the medical records of all elderly AML patients,and the statistical software SPSS26.0 was used to conduct univariate analysis and multivariate Logistic regression analysis of all patients,and the related risk factors of infection during the first induction chemotherapy in elderly AML patients were obtained.Results:1.Elderly patients with AML(non-M3)had a high infection rate during the first induction chemotherapy,and 149 of them had different degrees of infection,with an infection rate of 94.3%(149/158).2.In elderly patients with AML(non-M3),the main infection site during the first induction was the lung,accounting for 70.3%(128/182);The second was neutropenia with fever,accounting for 8.2%(15/182).The second infection was bloodstream infection,accounting for 6.6%(12/182).Skin and soft tissue infection,accounting for 4.4%(8/182);Upper respiratory tract infection,accounting for 3.8%(7/182);Intestinal infection accounted for 3.3%(6/182).The infection rate of two or more sites was 19.5%(29/149).3.In the three groups of elderly AML(non-M3),the rate of achieving CR/CRi after initial induction chemotherapy was 63.15%(12/19)in venetoclax group,51.7%(44/85)in standard-dose group,and 27.8%(15/54)in reduced-dose group.There were significant differences among the three groups(p < 0.05).4.Among all the elderly AML(non-M3)patients infected during the first induction chemotherapy,a total of 14 cases were found to be positive for pathogenic microorganisms,of which the most common pathogens were Gram-negative bacteria(10 cases,71.4%,10/14),Gram-positive bacteria(2 cases),fungi(1 case)and virus(1 case).In all the detected bacteria,except for one case of pathogen second-generation sequencing results,its drug sensitivity could not be determined,and the remaining 11 cases were MDR(multi drug resistance)in 7 cases,accounting for 63.6%(7/11).Of all pathogen types,the most common were Gram-negative bacteria,followed by Gram-positive bacteria,then fungi and viruses.Among Gram-negative bacteria,Escherichia coli was the most common(4 cases),followed by Klebsiella pneumoniae(2 cases),Stenotrophomonas maltophilia(2 cases)and so on.There were 2 cases of Gram-positive bacteria,1 case of Staphylococcus aureus,1 case of Enterococcus faecium,1 case of fungi,and 1 case of virus,which was EB virus.5.A total of 149 patients were infected during the initial induction treatment,including81 patients in the standard-dose group,51 patients in the reduced-dose group,and 17 patients in the venetoclax group.The moderate-to-severe infection rate was 63.1%(51/81)in the standard-dose group,followed by the reduced-dose group.The moderate and severe infection rate was 43.1%(22/51),the lowest was venetoclax group,the moderate and severe infection rate was 29.4%(5/17),there was significant difference among the three groups(p< 0.05)."Univariate analysis of other factors associated with the degree of infection during initial induction chemotherapy revealed that age,duration of agranulocytosis,and chemotherapy regimen were also associated." Effective preventive measures should be taken to avoid infection during the initial induction chemotherapy,reduce infection complications and improve the survival of patients.6.Multivariate Logistic regression analysis showed that agranulocytosis ≥7 days was an independent risk factor for the degree of infection during the first induction chemotherapy in elderly AML patients(OR=2.545,p=0.02).Conclusion:1.During the initial induction chemotherapy of AML in the elderly,the infection rate was high,and the lung was found to be the main site of infection,followed by granulation deficiency with fever,blood flow,skin soft tissue infection,upper respiratory tract,and intestinal tract.2.The highest CR/CRi was observed in venetoclax group,followed by standard-dose group and reduced-dose group.3.The most common pathogen of infection during initial induction chemotherapy was Gram-negative bacteria,followed by Gram-positive bacteria,fungi and viruses.4.Univariate analysis showed that the incidence of moderate and severe infection during induction chemotherapy was highest in standard-dose chemotherapy group,followed by reduced-dose chemotherapy group,and finally venetoclax group."We also analyzed factors associated with the degree of infection during initial induction chemotherapy,and found that age,duration of agranulocytosis,and chemotherapy regimen were also associated,with age being inversely associated with moderate-to-severe infection."5.Multivariate Logistic regression analysis showed that the duration of neutropenia ≥7days was an independent risk factor for the degree of infection during the first induction chemotherapy in elderly AML patients. |
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