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Pre-treatment blood inflammatory markers as predictors of systemic infection during induction chemotherapy: results of an exploratory study in patients with acute myeloid leukemia

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Abstract

Purpose

The purpose of this study is to evaluate the role of C-reactive protein (CRP) and ferritin blood levels in predicting the incidence of systemic infection among adult patients with acute myeloid leukemia (AML) treated with induction chemotherapy.

Methods

Adult patients with newly diagnosed AML who were initially treated with conventional 3 + 7 induction chemotherapy within 5 days of their diagnosis were included. Patients with previous cytotoxic chemotherapy <3 years, acute promyelocytic leukemia diagnosis, human immunodeficiency virus infection, or significant systemic infection at the time of diagnosis were excluded. Patients were treated with an institutional policy of substantial identity with negligible differences regarding supportive care.

Results

Among 110 patients (median age 54.5 years), 39 infectious events in 38 patients were reported, along with 21 episodes of infectious treatment-related mortality (TRM; 19.1 %). Elevated pre-treatment CRP (p = 0.032) and ferritin (p = 0.002) were related to the incidence of systemic infection. The degree of increase of blood CRP and ferritin level was correlated with the extent of leukocytosis. However, patients with elevated inflammatory markers above normal range had increased risk of infection irrespective of whether they had leukocytosis or not, suggesting that expansion of leukemic blast is another factor affecting the elevation of the markers independent to infection propensity and therefore the magnitude of the elevation does not quantitatively predict the risk of infection.

Conclusions

Modest elevation of baseline blood inflammatory markers above the normal range could be an indicator for predicting the incidence of systemic infection in patients with AML.

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Sources of support

This study was supported in part by Grants-in-Aid from Jeil Pharmaceutical Co., Ltd, Seoul, Korea. The company was not involved in any stage of the study (concept, design, conduct, or interpretation) or authorship.

Conflict of interest

Dr. Jae Hoon Lee has received research funding from Jeil Pharmaceutical. The other authors have no conflicts of interests. We have full control of all primary data and would allow the journal to review the data if requested.

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Author notes

    Authors and Affiliations

    1. Division of Hematology and Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon Regional Cancer Center, Gachon University School of Medicine, 21 Namdongdae-ro 774-gil, Namdong-gu, Incheon, 405-760, Republic of Korea

      Junshik Hong, Hyun Seon Woo, Hee Kyung Ahn, Sun Jin Sym, Jinny Park, Eun Kyung Cho, Dong Bok Shin & Jae Hoon Lee

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    1. Junshik Hong
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    2. Hyun Seon Woo
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    Corresponding authors

    Correspondence to Jinny Park or Jae Hoon Lee.

    Additional information

    Jinny Park and Jae Hoon Lee contributed equally to this work.

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    Hong, J., Woo, H.S., Ahn, H.K. et al. Pre-treatment blood inflammatory markers as predictors of systemic infection during induction chemotherapy: results of an exploratory study in patients with acute myeloid leukemia. Support Care Cancer 24, 187–194 (2016). https://doi.org/10.1007/s00520-015-2762-1

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    • DOI: https://doi.org/10.1007/s00520-015-2762-1

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