■感染是高危MDS患者死亡的最常见原因之一,正如我们小组之前报道的那样。阿扎胞苷感染风险模型(AIR),基于红细胞(RBC)输血依赖性,中性粒细胞减少<0.8×109/L,血小板计数<50×109/L,白蛋白<35g/L,和ECOG表现状态≥2已根据回顾性数据提出,以评估阿扎胞苷治疗患者的感染风险.
■前瞻性非干预研究旨在确定易感感染的因素,验证AIR分数,并评估抗菌药物预防对阿扎胞苷治疗的MDS/AML和CMML患者结局的影响。
■我们收集了307名患者的数据,57.6%男性,阿扎胞苷治疗:AML(37.8%),MDS(55.0%),和CMML(7.1%)。开始阿扎胞苷治疗时的中位年龄为71岁(范围,18-95)年。200例(65%)患者被分配到高风险AIR组。抗菌,抗真菌药,66.0%使用抗病毒预防,29.3%,和25.7%的病人,分别。总的来说,在前三个阿扎胞苷周期内,118例(38.4%)患者记录了169次感染发作(IE)。在多变量分析ECOG状态中,红细胞输血依赖性,IPSS-R评分,和CRP浓度对感染发展有统计学意义(p<0.05)。在前三个阿扎胞苷周期内,高风险AIR组的感染发生率为47.0%,而低风险组的感染发生率为22.4%(比值比(OR)3.06;95%CI1.82-5.30,p<0.05)。在多变量分析中,抗菌预防的施用对所有感染的发生没有显着影响:抗菌预防(OR0.93;0.41-2.05,p=0.87),抗真菌药OR1.24(0.54-2.85)(p=0.59),抗病毒OR1.24(0.53-2.82)(p=0.60)。
■AIR模型可有效区分阿扎胞苷治疗期间感染风险患者。抗菌药物预防不会降低感染率。
UNASSIGNED: Infections represent one of the most frequent causes of death of higher-risk MDS patients, as reported previously also by our group. Azacitidine Infection Risk Model (AIR), based on red blood cell (RBC) transfusion dependency, neutropenia <0.8 × 109/L, platelet count <50 × 109/L, albumin <35g/L, and ECOG performance status ≥2 has been proposed based on the retrospective data to estimate the risk of infection in azacitidine treated patients.
UNASSIGNED: The prospective non-intervention study aimed to identify factors predisposing to infection, validate the AIR score, and assess the impact of antimicrobial prophylaxis on the outcome of azacitidine-treated MDS/AML and CMML patients.
UNASSIGNED: We collected data on 307 patients, 57.6 % males, treated with azacitidine: AML (37.8%), MDS (55.0%), and CMML (7.1%). The median age at azacitidine treatment commencement was 71 (range, 18-95) years. 200 (65%) patients were assigned to higher risk AIR group. Antibacterial, antifungal, and antiviral prophylaxis was used in 66.0%, 29.3%, and 25.7% of patients, respectively. In total, 169 infectious episodes (IE) were recorded in 118 (38.4%) patients within the first three azacitidine cycles. In a multivariate analysis ECOG status, RBC transfusion dependency, IPSS-R score, and CRP concentration were statistically significant for infection development (p < 0.05). The occurrence of infection within the first three azacitidine cycles was significantly higher in the higher risk AIR group - 47.0% than in lower risk 22.4% (odds ratio (OR) 3.06; 95% CI 1.82-5.30, p < 0.05). Administration of antimicrobial prophylaxis did not have a significant impact on all-infection occurrence in multivariate analysis: antibacterial prophylaxis (OR 0.93; 0.41-2.05, p = 0.87), antifungal OR 1.24 (0.54-2.85) (p = 0.59), antiviral OR 1.24 (0.53-2.82) (p = 0.60).
UNASSIGNED: The AIR Model effectively discriminates infection-risk patients during azacitidine treatment. Antimicrobial prophylaxis does not decrease the infection rate.