Impact of Infectious Complications Should be Considered When Choosing Chemotherapy for Elderly Acute Myeloid Leukemia Fit Patients: Results of a Large Monocentric Retrospective Study
Abstract
Background. In elderly acute myeloid leukemia (AML) patients (pts) the debate about the use of intensive chemotherapy (cht) as opposed to non-intensive therapy or best supportive care is a hot topic, particularly after the introduction of the new effective non-cytostatic drugs. Geriatric assessment and fitness criteria may help to determine the treatment tolerance, but it is unclear if the impact of the profound neutropenia and the related infectious toxicity caused by intensive cht is higher in elderly pts. Aims. The prognosis of infectious complications and their impact on the outcome of AML fit pts were evaluated in all consecutive newly diagnosed (ND) AML pts treated with intensive cht and in the subgroups of pts aged >65 during an observation period of 8 years. Patients and Methods. Between 2016 and 2023, all ND AML pts consecutively admitted and treated with intensive cht at the Hematology Unit of the Spedali Civili of Brescia were analyzed. Incidence of bloodstream infections (BSI), pneumonia and proven/probable invasive fungal infections (p/p IFI) occurring after cht (induction, consolidation and reinduction) and their impact on outcome were evaluated. Antibacterial (levofloxacin) and antifungal (posaconazole during induction or reinduction cht, itraconazole during consolidation) prophylaxis during neutropenia was given to all the pts. Logistic regression models were conducted to estimate the risk of infectious complications and of disease relapse. Overall survival…
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