Predictive Factors Associated with In-Hospital Mortality in Acute Myeloid Leukemia Patients after Induction Chemotherapy
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Abstract
BACKGROUND: Induction chemotherapy is a high-intensive regimen for remission induction among those with acute myeloid leukemia. Outcomes of treatment, complications and mortality rates tend to differ between centers depending on patients’ particular conditions, medical experiences, and resources.
OBJECTIVES: This study aimed to evaluate the factors associated with in-hospital mortality after induction chemotherapy, including complications and 30-day survival rates.
METHODS: This retrospective study included adult patients diagnosed with acute myeloid leukemia who were receiving induction chemotherapy between January 2016 and December 2022. Prognostic factors were analyzed by Cox regression analysis, and survival was analyzed by Kaplan Meier.
RESULTS: Ninety patients with a mean age of 44 were enrolled. Seventy-eight patients (86.6%) received the 7+3 regimen. The average length of hospital stay was 31.8 days, and 19 patients (21%) died during hospitalization within 30 days after chemotherapy. The leading cause of death (89%) was febrile neutropenia. In 47.3% of patients, complications arose due to multidrug-resistant organisms. Lung infection and septicemia were identified in 78.9% and 68.4% of cases, respectively. According to multivariate analysis, lung infection was a predictor of in-hospital death (HR 3.42, p=0.04), while the 30-day survival rate was 78.4%.
CONCLUSIONS: Patients who developed lung infection after induction chemotherapy were associated with 30-day mortality.
Thaiclinicaltrials.org number, TCTR20240810001
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References
Kayal S, Jain H, Nayak L, Thorat J, Bhattacharyya J, Das D, et al. Induction related mortality score in acute myeloid leukemia: prospective validation study (pRISM) of the hematology cancer consortium (HCC). Blood 2022;140 (Suppl 1):3223-4.
Zeidan AM, Podoltsev NA, Wang X, Zhang C, Bewersdorf JP, Shallis RM, et al. Patterns of care and clinical outcomes with cytarabine-anthracycline induction chemotherapy for AML patients in the United States. Blood Adv 2020;4:1615-23.
Wanitpongpun C, Teawtrakul N, Lanamtieng T, Chansung K, Sirijeerachai C, Amampai W, et al. Clinical factors predictive of mortality in acute leukemia patients with febrile neutropenia. Am J Blood Res 2021;11:59-65.
Mishra K, Kumar S, Ninawe S, Bahl R, Meshram A, Singh K, et al. The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings. Ther Adv Infect Dis [Internet]. 2021 [cited 2024 Feb 14];8:20499361211036592. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8358573/pdf/10.1177_20499361211036592.pdf
Sasaki K, Kadia T, Begna K, DiNardo CD, Borthakur G, Short NJ, et al. Prediction of early (4-week) mortality in acute myeloid leukemia with intensive chemotherapy. Am J Hematol 2022;97:68-78.
Mendes FR, da Silva WF, da Costa Bandeira de Melo R, Silveira DRA, Velloso EDRP, Rocha V, et al. Predictive factors associated with induction-related death in acute myeloid leukemia in a resource-constrained setting. Ann Hematol 2022;101:147-54.
Malkan UY, Gunes G, Eliacik E, Haznedaroglu IC, Etgul S, Aslan T, et al. The factors affecting early death after the initial therapy of acute myeloid leukemia. Int J Clin Exp Med 2015;8:22564-9.
Nuñez MJ, Sgromo M, Lacal V, Nuñez S, Sabater L, Corazza R, et al. Febrile Neutropenia in Acute Myeloblastic Leukemia (AML) clinical and microbiological features of infectious episodes and evaluation of mortality. International Journal of Infectious Diseases 2018;73:84-5.
Charoenprasert K. Incidence of invasive aspergillosis in acute myeloid leukemia patients receiving intensive chemotherapy at Sisaket hospital. Journal of Hematology and Transfusion Medicine 2018;28:145-53.
Wanitpongpun C, Utchariyaprasit E, Owattanapanich W, Tantiworawit A, Rattarittamrong E, Niparuck P, et al. Types, clinical features, and survival outcomes of patients with acute myeloid leukemia in Thailand: a 3-year prospective multicenter study from the Thai Acute Leukemia Study Group (TALSG). Clin Lymphoma Myeloma Leuk [Internet]. 2021 [cited 2024 Feb 14];21(7):e635-e643. Available from: https://www.clinical-lymphoma-myeloma-leukemia.com/article/S2152-2650(21)00107-5/fulltext