Clinical Study Of Secondary Acute Myeloid Leukemia And Febrile Neutropenia

Purpose:The dismal clinical prognosis of hematological malignancies is resulted both from the complexity of the disease itself and the limitations of therapeutic strategies.The first part of this work aimed to study the epidemiology,clinical outcomes and factors affecting prognosis of secondary acute myeloid leukemia(s AML).The second part aimed to study the epidemiology of pathogenic bacteria and the effectiveness of initial empiric antibiotic therapy in patients with hematological malignancies complicated by febrile neutropenia(FN).Methods:In the first part of the study,clinical characteristics,laboratory examinations,and follow-up results of 645 adult patients with acute myeloid leukemia(AML)diagnosed and treated in our hospital from 2013 to 2017 were retrospectively analyzed.In the second part of the study,the clinical characteristics,laboratory examinations,and initial empiric antibiotic therapy of 247 patients with FN treated in our hospital for hematological malignancies from 2007 to 2017 were retrospectively analyzed.Results:Among the 645 AML patients diagnosed and treated in our hospital,treatment-related AML(t-AML)accounted for 2.5%,and antecedent hematologic disorder-AML(AHD-AML)accounted for 5.3%.The overall survival(OS)of t-AML and AHD-AML patients were 12.2 months and 21.0 months,respectively,shorter than that of de novo AML patients(28.3 months,p<0.001).However,after intensive treatments,complete remission rate and leukemia-free survival time were similar among the three groups(p=0.238 and p=0.075,respectively).In multivariate regression analysis,the patient's anterior medical history was not an independent factor affecting the OS(p=0.184),while the cytogenetic high risk group(p<0.001),white blood cells count?50x10~9/L at onset(p<0.001)and hemopoietic stem cell transplantation(p<0.001)hold more predictive significance for patients'prognosis.Of the 247 patients with FN during treatment of hematological malignancies,the most commonly detected Gram-negative pathogens were Escherichia coli(40%),Klebsiella pneumoniae(20%),and Pseudomonas aeruginosa(11%).In 176 patients,the pathogen was not sensitive to initial empirical antibiotic therapy,resulting in a higher mortality rate than the rest of the patients(37.7%vs 23.9%,p=0.038).Conclusions:s AML is not a significant predictive factor for the prognosis,therefore,patients with s AML should be given the same treatment opportunities as de novo patients.In patients with hematological malignancies,the inappropriate initial empirical antibiotic therapy is associated with higher mortality.Consequently,the current empirical antibiotic regimen needs to be further optimized.