JALSGAML201study
HideakiKato+81-45-787-2800ext5430/6248
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.