Changes in patient demographics have altered the spectrum of illness in patients with leukemia and neutropenic fever (NF) over time. Recent descriptive analyses detailing type of infection and their clinical impact in this population are limited. We present data describing the prevalence of common clinical diagnoses and associated outcomes in neutropenic leukemia patients.
This was a retrospective chart review of patients with leukemia and NF (absolute neutrophil count [ANC] <500 cells/mm3; temperature ≥38.3°C) who presented to the emergency center (EC) at MD Anderson Cancer Center from January 2014 to January 2015. We assessed the clinical presentation and clinical outcomes. Five clinical syndromes (pneumonia [PNA], skin/soft tissue infection [SSTI], sinusitis, urinary tract infection [UTI], and intra-abdominal infection [IAI]) were defined on established definitions present in the NF literature. Clinical outcomes assessed were disposition on admission (ward floor or intensive care unit [ICU], ICU transfer, or in-hospital mortality.
A total of 260 patients (mean age 55 ± 17 years; 37.5% female) presented to the EC 363 times. 84% of patients had neutropenia >7 days in duration and the median ANC at presentation was 0 cells/mm3 (range: 0 - 490 cells/mm3). The majority of patients had acute myeloid leukemia (64%) and 50% had relapsed disease. Fifty-eight of 363 (16%) presented with PNA, 34/363 (9.3%) with SSTI, 12/363 (3.3%) with UTI, 11/363 (3 %) with IAI, and 7/363 (2%) with sinusitis. Among patients directly admitted to the ICU, PNA occurred in 3/22 (14%). Five of 7 patients (71%) who were subsequently transferred to the ICU had PNA. PNA was more common in patients who died in hospital versus those who survived (9/20 [45%] vs 47/324 [15%], p < 0.01) and 9/56 (16%) of patients with PNA died in hospital.
PNA was the most common diagnosis in leukemia patients presenting to the EC with NF and was associated with high morbidity and mortality. These data highlight PNA as a target for further investigation in this population with regards to the role of timely diagnosis and treatment.
S. L. Aitken, None
F. P. Tverdek, None
R. Chemaly, Gilead: Consultant and Investigator , Consulting fee and Research grant
Ansun: Investigator , Research grant
GSK: Investigator , Research grant
K. R. Marx, None
K. V. I. Rolston, None
S. A. Shelburne, None