Infectious complications in adult acute myeloid leukemia: analysis of the Acute Leukemia French Association-9802 prospective multicenter clinical trial

Abstract

Infections are a major complication in patients with acute myeloid leukemia undergoing intensive chemotherapy. They remain a major cause of therapy-associated morbidity and mortality, and represent a frequent cause of treatment withdrawal. An analysis of the medical charts of 459 younger adults included in the multicenter Acute Leukemia French Association (ALFA)-9802 trial showed that 1369 febrile episodes occurred among the 459 registered patients, including fever without identifiable source (23%) and clinically or microbiologically documented infections (77%). Bloodstream infections occurred in 314 episodes, including 129 documented episodes with Gram-positive and 96 with Gram-negative pathogens. Pulmonary infection was diagnosed in 144/1054 documented infectious episodes (14%). Invasive fungal infection was probable or proven in 116 patients. In all, 15 patients died of infection-associated complications, of whom seven died during early induction therapy, one during salvage therapy and seven during consolidation therapy. Better supportive care strategies may improve overall survival in patients undergoing chemotherapy for acute myeloid leukemia.

Keywords::

• Acute myeloid leukemia
• infection
• prognosis
• chemotherapy
• aspergillosis

Acknowledgements

We thank D. Chaoui for reviewing the manuscript. Schering Plough (Kenilworth, NJ, USA) and Amgen (Neuilly sur Seine, France) provided grants for central data management to the Edouard Herriot Hospital (Department of Hematology).

Potential conflict of interest:

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

Appendix

The following ALFA investigators participated in the ALFA-9802 study: X. Thomas, E. Archimbaud^†, M. Michallet, D. Fiere, C. Charrin, I. Tigaud, S. Hayette, D. Treille-Ritouet, C. Dumontet, E. Tavernier, Y. Chelghoum, A. Thiebaut, J. Troncy, F. Nicolini, E. Wattel, M. Elhamri, C. Pivot, Q. H. Le, G. Cannas (Hôpital E. Herriot, Lyon); H. Dombret, J. M. Micléa, E. Raffoux, N. Boissel, L. Degos, J. M. Cayuela, S. Chevret, A. de Labarthe, H. Espérou, E. Gluckman, T. Leblanc, V. Levy, O. Maarek, D. Réa, G. Socié, J. Soulier, C. Chomienne, M. T. Daniel, J. Delaunay, F. Treilhou, C. Parmentier (Hôpital Saint-Louis, Paris); B. Quesnel, C. Preudhomme, F. Bauters, J. P. Jouet, J. L. Lai, P. Lepelley, H. Djeda, S. Darre, A. Renneville, N. Philippe (Hôpital C. Huriez, Lille); C. Cordonnier, S. Maury, D. Bories, H. Jouault, M. Kuentz, C. Pautas, K. Yacouben, J. Beaune, C. Perot (Hôpital H. Mondor, Créteil); S. de Botton, J. H. Bourhis, P. Arnaud, C. Fermé, N. Itzhar, A. Bernheim, N. Fresnoy, M. Leste, J. M. Ventelon (Institut Gustave Roussy, Villejuif); C. Martin, B. Corront, J. Provencal (Centre Hospitalier, Annecy); O. Reman, E. Lepesant, M. Macro, G. Plessis, S. Cheze, M. Leporrier (Hôpital G. Clémenceau, Caen); S. Castaigne, P. Rousselot, C. Terré, A. L. Taksin, J. N. Bastie, F. Suzan, P. Piesvaux, S. Rigaudeau, E. Henry, D. Legrand (Hôpital A. Mignot, Versailles); T. de Revel, T. Fagot, G. Nedellec, G. Auzanneau, B. Souleau, F. Desangles, I. Garnier, J. V. Malfuson (Hôpital des Armées Percy, Clamart); P. Fenaux, C. Gardin, L. Ades, J. Briere, J. J. Kiladjian, B. Beve, V. Eclache, M. P. Lemonnier, P. Casassus (Hôpital Avicenne, Bobigny and Hôpital Beaujon, Clichy); J. O. Bay, B. Choufi, M. Legros, O. Tournilhac (Centre Jean Perrin, Clermont-Ferrand); I. Plantier, L. Detourmignies (Hôpital V. Provo, Roubaix); N. Cambier (Hôpital Saint-Vincent, Lille); C. Soussain, J. Frayfer, C. Allard (Centre Hospitalier, Meaux); M. Beaumont, P. Agape, B. Pollet (Centre Hospitalier, Boulogne sur Mer); M. Janvier, S. Glaisner, A. Bourguignat, E. Baumelou, F. Turpin (Centre René Huguenin, Saint-Cloud and Hôpital Foch, Suresnes), France.

^†E. Archimbaud, who participated in the design of the study, died on 25 March 1998.