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
| العنوان: | 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 |
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| المؤلفون: | Vilorio-Marqués, Laura, Castañón Fernández, Christelle, Mora, Elvira, Gutiérrez, Lorena, Rey Bua, Beatriz, Jiménez Lorenzo, Maria José, Díaz-Beyá, Marina, Vara Pampliega, Miriam, Molero, Antonieta, Sánchez-García, Joaquín, Calabuig, Marisa, Cedena, María Teresa, Chen-Liang, Tzu, Díaz Santa, Johana Alejandra, Padilla, Irene, Hernández, Francisca, Díez, Rosana, Asensi, Pedro, Xicoy, Blanca, Sanz, Guillermo, Valcárcel, David, Diez-Campelo, María, Bernal, Teresa, Institut Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona |
| المساهمون: | Institut Català de la Salut, [Vilorio-Marqués L, Castañón Fernández C] Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain. [Mora E] Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. [Gutiérrez L] Hematology Department, Hospital Universitario de Canarias, La Laguna, Spain. [Rey Bua B] Hematology Department, Hospital Clínico Universitario, Salamanca, Spain. [Jiménez Lorenzo MJ] Hematology Department, Hospital Germans Trias i Pujol, Institut Català d’Oncologia-Josep Carreras, Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. [Molero A, Valcárcel D] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus |
| المصدر: | Scientia WOS:000863670500001 Therapeutic Advances in Hematology r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe instname r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | hypomethylating agent, Neoplasms::Neoplasms by Histologic Type::Leukemia::Leukemia, Myeloid::Leukemia, Myeloid, Acute [DISEASES], Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores], acciones y usos químicos::acciones farmacológicas::usos terapéuticos::antineoplásicos [COMPUESTOS QUÍMICOS Y DROGAS], diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Hematology, acute myeloid leukemia, Other subheadings::Other subheadings::/drug therapy [Other subheadings], Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], Otros calificadores::Otros calificadores::/efectos adversos [Otros calificadores], infection, myelodysplastic syndrome, Medicaments antineoplàstics - Efectes secundaris, neoplasias::neoplasias por tipo histológico::leucemia::leucemia mieloide::leucemia mieloide aguda [ENFERMEDADES], Leucèmia mieloide aguda - Tractament, Avaluació de resultats (Assistència sanitària), Other subheadings::Other subheadings::/adverse effects [Other subheadings], treatment outcome, Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antineoplastic Agents [CHEMICALS AND DRUGS] |
| الوصف: | The authors declared the following potential conflict of interest with respect to the research, authorship, and/or publication of this article: T.B. has received support for attending meetings and/or travel from Jazz Pharmaceutical, honoraria from Jazz Pharmaceutical, BMS, and Pfizer. D.V. has received honoraria from Celgene/BMS, Amgen, Novartis, Jazz Pharmaceuticals, and Pfizer and support for attending meetings and/or travel from Amgen, BMS/Celgene, and Jazz. M.D.-C. reports honoraria and membership on entity's Board of directors or advisory committees from Novartis, BMS, and Takeda. Dr G.S. has received personal fees from AbbVie, Amgen, and Astellas and has received research funding from Celgene/BMS Janssen-Cilag, Novartis, Roche, and Takeda. 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 < 0.001). The median number of cycles was lower in patients experiencing any infection during the first four cycles (5 [3-8] versu 8 [5-16], p < 0.001). In the multivariable analysis, factors associated with lower OS were having any infection during the first four cycles (hazard ratio (HR) = 1.43 [95% CI = 1.09-1.88], p = 0.01), bone marrow blasts ⩾30% (HR = 2.13 [95% CI = 1.14-3.96], p = 0.01), adverse cytogenetics (HR = 1.70 [95% CI = 1.30-2.24], p < 0.001), and platelet count 20% (HR = 1.57 [95% CI = 1.19-2.01], p < 0.001) and adverse cytogenetics (HR = 1.7 [95% CI = 1.35-2.14], p < 0.001) were associated with infection, whereas hemoglobin >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. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 2040-6207 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b3d71fb600d405ad30c8a84cd0deda3fTest https://hdl.handle.net/10668/20232Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....b3d71fb600d405ad30c8a84cd0deda3f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20406207 |
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