Febrile neutropenia during acute myeloid leukemia therapy: Single institution experience from a developing country

Abstract

Background: Febrile neutropenia poses a major challenge during treatment of acute myeloid leukaemia (AML). Methods: Episodes of febrile neutropenia in 104 consecutive patients of AML admitted to the medical oncology ward between May 2001 and December 2006 were studied. There were 62 males and 42 females, median age 28 years (2–61 years). Results: 402 febrile episodes including 363 episodes of febrile neutropenia (180 in induction, 183 in consolidation) and 39 non-neutropenic episodes (18 in induction, 21 in consolidation) occurred. Clinical, microbiological and radiological foci could be detected in 51.1%, 22.2 %, and 31.1% episodes of febrile neutropenia during induction and 31.1%, 19.1% and 12.7% episodes during consolidation. Rates of documented infections during induction and consolidation were 74% and 52%. Respiratory (39.2%) and ear, nose, and throat ( 23.9%) were the commonest clinical sites during induction. Respiratory (21%) and central line infections (19.2%) were commonest during consolidation. Gram negative infections predominated (Pseudomonas aeruginosa, Klebsiella pneumoniae: major isolates). 32.5% of microbiologically proven infections during induction and 14.2% during consolidation were polymicrobial. Bronchopneumonia was the commonest radiological focus. There were 60 episodes of fungal infections (47 in induction, 13 in consolidation). There were: 1 definite: mucormycosis, 3 probable (1 case each: Candida krusei, Candida tropicalis in blood, 1 chronic disseminated hepatosplenic candidiasis), and 56 possible infections. Halo sign was seen in 18, sinusitis with bone erosion in 7. Infections accounted for 85% of the 20 deaths (induction: 18). Fungal infections and bronchopneumonia were major causes of mortality (p = 0.001). 3/4 enterococcal bacteremias were associated with mortality (p = 0.001). 6 cases of tuberculosis (5 pneumonias with necrotic mediastinal nodes, 1 Pott's spine) and 3 cases of malaria (1 cerebral malaria) were also detected. Conclusions: Induction was associated with greater morbidity and mortality. Prompt and proper institution of antibiotics and antifungals besides considering alternative diagnosis peculiar to the region (e.g. tuberculosis, malaria) may aid in better management.