Bone and Joint Infections in Acute Myelogenous Leukemia: A Retrospective Review of Patients at Mayo Clinic

Background:

Patients with hematologic malignancies are at higher risk for infections, and current literature on bone and joint infections (BJI) in acute myelogenous leukemia (AML) is limited to case reports. This study aimed to identify frequency and characteristics of BJI in AML.

Methods:

We retrospectively reviewed 1118 patients in the AML database at Mayo Clinic from 1/1/2005 through 1/1/2015. A computerized search of the electronic medical record utilizing diagnosis codes, pathology reports, and free text searches, followed by manual chart review, identified 18 unique patients with BJI as depicted in Figure 1.

Results:

Of the 18 patients, septic arthritis (7/18, 39%) occurred most frequently. 16/18 (89%) were male, and median age was 69 years-old (range 23-77). 12/18 (67%) were in remission from AML while 6/18 (33%) were neutropenic at the time of BJI, and 5/18 (28%) occurred after transplant. Pathogens were primarily Gram positive organisms (12/18, 67%), and 6/18 (33%) had no pathogen isolated. All patients received culture-guided induction antimicrobial therapy, and 9/18 (50%) had surgical intervention. Treatment and outcome by infection can be seen in Figure 1.

Of the 5 (28%) treatment failures (TF), 2 (40%) had vertebral osteomyelitis while 2 (40%) had prosthetic joint infection (PJI), and 1 (20%) had septic arthritis. None had prior transplants, and 2/5 (40%) were in remission from AML. Median time from diagnosis of BJI to TF was 3.4 months (range 1.8-37.6). 11/18 (61%) were alive one year after BJI, and at latest follow-up, 4/18 (22%) were alive, all of whom had BJI treated successfully. Median overall survival from diagnosis of BJI was ­­17.4 months (range 0.5-70.9) for all cases.

Conclusion:

BJI are uncommon in AML, and pathogens are similar to patients without AML. TF can occur at a high rate, particularly in vertebral osteomyelitis and PJI. However, TF may not necessarily correlate with hematologic status or overall survival.

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1: Flowchart of the AML study cohort, treatment, and outcomes

AML = Acute myelogenous leukemia; BJI = Bone and Joint Infection; I&D = Irrigation and Debridement; Abx = Antibiotic therapy alone; TF = Treatment Failure; MI = myocardial infarction