JALSGAML201study

HideakiKato+81-45-787-2800ext5430/6248

ekato@mac.com

1018Background:Remissioninduc/on(RI)chemotherapyforacutemyeloidleukemia(AML)isoneofthemostintensivechemotherapyavailable.An/bio/cprophylaxisandprompttreatmentforinfec/ouscomplica/onsduringRIchemotherapyplaysamajorroleinsuppor/vecare.Methods:Weretrospec/velyanalyzedtheinfec/ouscomplica/onsassociatedwithRIchemotherapylistedintheJapanAdultLeukemiaStudyGroupAML201protocol,ana/onwidestudyofde-novoAMLs,conductedbetween2001and2005inJapan.Ofthe1057casesini/allyincludedintheAML201study,980caseswithdataoninfec/ouscomplica/onsduringRIchemotherapywereanalyzed.Theincidencesofinfec/ouscomplica/onsandthecausa/vepathogenswerecomparedwithpreviousstudies[(periodA)1987–1991,577cases;(B)1992–1995,669cases;(C)1995–1997,531cases;(D)1997–2001,808cases;(E)2001–2005,980cases].Results:InstudyperiodE,thecausa/vepathogensofbacteremia/fungemiawereStaphylococcusepidermidis(20.9%),S.aureus(11.6%),Streptococcussp.(14.0%),andotherGram-posi/vebacteria(12.6%);P.aeruginosa(12.8%)andotherGram-nega/vebacteria(10.5%);andfungi(9.3%).Pathogenscausingpulmonaryinfec/onswereAspergillussp.(15.8%),P.aeruginosa(7.9%),andotherGram-nega/vebacteria(6.9%)andGram-posi/vebacteria(3.0%).Pulmonaryaspergillosiswasdiagnosedmainlyusingserologicaltest.Theprevalenceofbacteremia/fungemiawasreportedin11.8%,9.4%,8.7%,9.2%and8.3%ofcasesandpulmonaryinfec/onswerereportedin24.6%,16.9%,13.9%,12.9%,and10.3%ofcasesinthestudyperiodsA,B,C,DandE,respec/vely.TheincidenceofGram-nega/vebacteremiawassignificantlylowerinperiodEcomparedwiththeperiodsA,B,andC(2.0%vs.4.9%,3.7%,and3.4%).Conclusions:TheprevalenceofGram-posi/vebacteremiaandpulmonaryaspergillosiswashigherinperiodEthanintheperiodsA–D.Thistrendwaspossiblyduetothewideuseoffluoroquinoloneprophylaxisinneutropenicpa/entsandhighperformanceoftheserologicaltestforaspergillosis.SufficientmonitoringforGram-posi/vebacterialinfec/onandmoldinfec/onisthereforeessen/alduringRIchemotherapyforAML.

PrevalenceofBacteremia/FungemiaandPneumoniainRemissionInducIonChemotherapyforAdultAcuteMyeloidLeukemiafrom1987to2005:JapanAdultLeukemiaStudyGroup(JALSG)

HideakiKato1,HiroyukiFujita2,NobuAkiyama3,Shun-IchiKimura4,NobuhiroHiramoto5,NaokoHosono6,TsutomuTakahashi7,KazuyukiShigeno8,HitoshiMinamiguchi9,JunichiMiyatake10,HiroshiHanda11,YoshinobuKanda12,MinoruYoshida13,

ShuichiMiyawaki14,ShigekiOhtake15,TomokiNaoe16,HitoshiKiyoi17,ItaruMatsumura18,YasushiMiyazaki19

Affilia/ons:1Dept.ofHematologyandClinicalImmunology,YokohamaCityUniv.2Dept.ofHematology,SaiseikaiYokohamaNanbuHospital,Yokohama3Dept.ofInternalMedicine,TeikyoUniv.SchoolofMedicine,Tokyo4DivisionofHematology,SaitamaMedicalCenter,JichiMedicalUniv.5Dept.ofHematology,KobeCityMedicalCenterGeneralHosp.,Kobe6Dept.ofHematologyandOncology,Univ.ofFukui7Dept.ofOncology/Hematology,ShimaneUniv.Hosp.,Izumo8Dept.ofHematologyandOncology,HamamatsuMedicalCenter9Dept.ofGastroenterologyandHematology,ShigaUniv.

Newlydiagnosed

adultAMLcases(exceptM3)

[n=1057]

IDAarmIDA12mg/m2x3d

Ara-C100mg/m2x7d

(2courses) �

DNRarmDNR50mg/m2x5dAra-C100mg/m2x7d

(2courses) �

randomized

remissioninducIonchemotherapy

CRrate78%

CRrate78%

HDACarm

Ara-C2g/m2x5d

(3courses) �

AML201Darm①MIT7mg/m2x3d+Ara-C200mg/m2x5d②DNR50mg/m2x3d+Ara-C200mg/m2x5d③ACR20mg/m2x3d+Ara-C200mg/m2x5d④Ara-C+ETP+VCR+vindecise

randomized

consolidaIonchemotherapy

JALSGprotocolsStudyperiod(year)

CRrate(5yrsurvival)�

Prevalenceofbacteremie/fungemia �

PrevalenceofpulmonaryinfecIon

AML87/89A(1987–1991)�

79.9/78.5%(30.1/33.5%)� 11.8% � 24.6% �

AML92B(1992–1995)�

77.2%(33.5%)� 9.4% � 16.9% �

AML95C(1995–1997)�

80.7%(44.3%)� 8.7% � 13.9% �

AML97D(1997–2001)�

78.7%(40.8%)� 9.2% � 12.9% �

AML201E(2001–2005)�

77.5%(48%)� 8.3% � 10.3% �

S.aureus,11.6

S.epidemidis,20.9

CNS,7

Streptococccussp.,

14

Enterococcussp.,7

OtherGram-posi=ve

bacteria,5.8

P.aeruginosa,12.8

E.coli,7

OtherGram-nega=ve

bacteria,2.3

Candidasp.,5.8

Otherfungi,3.5

12.8%

10.3%

9.3%

CausaKvepathogensofbacteremia/fungemia(leh)andpulmonaryinfecKon(right)inJALSGAML201remission-inducKonchemotherapy(%)

Uniden/fied,63.4

P.aeruginosa,7.9

OtherGram-

negaKve,6.9

PCP,1Aspergillus,15.8

OtherGram-

posiKve,3

Other,2

10Dept.ofHematologyandOncology,SakaiHosp.KinkiUniv.FacultyofMedicine11Dept.ofHematologyandOncology,GunmaUniv.GraduateSchoolofMedicine12DivisionofHematology,Dept.ofMedicine,JichiMedicalUniv.,Tokyo13FourthDept.ofInternalMedicine,TeikyoUniv.SchoolofMedicine,MizonokuchiHosp.14Dept.ofTransfusion,TokyoMetropolitanOhtsukaHosp.15KanazawaUniv.16Na/onalHosp.Organiza/onNagoyaMedicalCenter17Dept.ofHematologyandOncology,NagoyaUniv.GraduateSchoolofMedicine18Dept.ofHematologyandRheumatology,KinkiUniv.FacultyofMedicine19Dept.ofHematologyandMolecularMedicineUnit,NagasakiUniv.,AtomicBombDiseaseIns/tute

5.9 11.5 11.6 10.8 14.77.411.5 7.0

18.9 26.526.523.0 30.2

29.7 41.223.523.0 20.9

13.516.217.6

16.4 18.6 12.2 13.216.2 11.5 9.3 10.8 11.8

0%10%20%30%40%50%60%70%80%90%

100%

Mixedinfec/on FungiOtherGram-nega/ve P.aeruginosaOtherGram-posi/ve S.epidermidisS.aureus

5.6 3.8 2.97.9

4.9 5.7 9.8 15.8

0%10%20%30%40%50%60%70%80%90%

100%

AML87/89[A]

AML92 AML97[D]

AML201[E]

IPAOtherGram-nega/veP.aeruginosaGram-posi/veUniden/fied

[B]

CausaKvemicroorganismsinbacteremia/fungemiaduringremissioninducKonchemotherapy

CausaKvemicroorganismsinpulmonaryinfecKonduringremissioninducKonchemotherapy

*ThisstudywaspublishedinSupportCareCancer2018.