9 research outputs found

    Infectious complications of induction treatment for acute myeloid leukaemia using the "7 + 3" protocol without antibiotic prophylaxis - 15 years of experience of one clinical site

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    Background. Infectious complications during induction chemotherapy of acute myeloid leukaemia are very common. Prophylactic use of antibiotics however is an ongoing challenge in this situation due to bacterial multi-drug resistance. The aim of this study was to provide a comprehensive overview of the incidence of infectious complications in patients with AML undergoing induction therapy using the "7+3" protocol without routine antibiotic prophylaxis at one clinical site providing specialised haematological care in the Czech Republic, over a period of 15 years. The study also evaluates the aetiological spectrum of causative agents and the development of antibiotic resistance in the context of the use of the various classes of antibiotics. The analysis includes evaluation of the importance of risk factors for infectious complications and their impact on treatment of the underlying disease. The data are compared with published figures for similar cohorts of patients. Patients and Methods. This study presents a retrospective analysis of infectious complications in 242 patients with acute myeloid leukaemia undergoing the first cycle of induction therapy without routine antibiotic prophylaxis in one clinical site in Czech Republic during years 2006-2020. Results. A total of 363 febrile episodes (FE) were recorded. At least 1 FE during the induction was detected in 229 (94.6%) patients. Clinically defined infection was the cause in 96 (26.4%) FEs and blood stream infection in 69 (19.0%) FEs. Both complications occurred simultaneously in 29 (8.0%) FEs. 169 (46.6%) FEs were evaluated as fever of unknown origin (FUO). The achievement of complete remission had a significant effect on the duration of the FE (6 vs. 9 days, P=0.0005) and on the overall survival duration (79.3 vs. 6.5 months, P<0.0001). Patients diagnosed with infection or FUO at diagnosis were significantly more likely to suffer from colonisation by multi-drug resistant bacterial strains at discharge (29.2% vs. 16.3%, P=0.022). This group of patients used antibiotic therapy for a significantly longer time (35 vs. 23 days, P<0.0001). Infection was a contributing cause of death in 18 (7.4%) patients. Mortality was significantly related to the failure to achieve complete remission (P<0.0001). Conclusion. Infectious mortality during induction treatment without routine antibiotic prophylaxis was comparable to the published cohorts with prophylaxis. Regular microbiology surveillance with adequate initial antibiotic treatment can compensate routine antibiotic prophylaxis with slower development of antibiotic resistance

    Outcomes of SARS-CoV-2 infection in Ph-neg chronic myeloproliferative neoplasms: results from the EPICOVIDEHA registry

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    Background:Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) typically incur high rates of infections and both drugs and comorbidities may modulate infection risk. Objectives:The present study aims to assess the effect of immunosuppressive agents on clinical outcomes of MPN patients affected by the coronavirus disease 2019 (COVID-19). Design:This is an observational study. Methods:We specifically searched and analyzed MPN patients collected by EPICOVIDEHA online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020. Results:Overall, 398 patients with MPN were observed for a median of 76 days [interquartile range (IQR): 19-197] after detection of SARS-CoV2 infection. Median age was 69 years (IQR: 58-77) and 183 individuals (46%) had myelofibrosis (MF). Overall, 121 patients (30%) of the whole cohort received immunosuppressive therapies including steroids, immunomodulatory drugs, or JAK inhibitors. Hospitalization and consecutive admission to intensive care unit was required in 216 (54%) and 53 patients (13%), respectively. Risk factors for hospital admission were identified by multivariable logistic regression and include exposure to immunosuppressive therapies [odds ratio (OR): 2.186; 95% confidence interval (CI): 1.357-3.519], age > 70 years, and comorbidities. The fatality rate was 22% overall and the risk of death was independently increased by age > 70 years [hazard ratio (HR): 2.191; 95% CI: 1.363-3.521], previous comorbidities, and exposure to immunosuppressive therapies before the infection (HR: 2.143; 95% CI: 1.363-3.521). Conclusion:COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals. Plain language summaryEPICOVIDEHA registry reports inferior outcomes of COVID-19 in patients with Philadelphia-negative chronic myeloproliferative neoplasms receiving immunosuppressive therapies.Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) incur high rates of infections during the course of their disease.The present study was aimed at assessing which patient characteristics predicted a worse outcome of SARS-COV-2 infection in individuals with MPN.To pursue this objective, the researchers analyzed the data collected by EPICOVIDEHA, an international online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.The database provided clinical data of 398 patients with MPN incurring COVID-19: Patients were mostly elderly (median age was 69 years);Forty-six percent of them were affected by myelofibrosis, which is the most severe MPN;Moreover, 32% were receiving immunosuppressive therapies (JAK inhibitors, such as ruxolitinib, steroids, or immunomodulatory IMID drugs, such as thalidomide) before COVID-19. Hospitalization was required in 54% of the patients, and the risk of being hospitalized for severe COVID-19 was independently predicted by Older age;Comorbidities;Exposure to immunosuppressive therapies. Overall, 22% of MPN patients deceased soon after COVID-19 and the risk of death was independently increased over twofold by Older age;Comorbidities;Exposure to immunosuppressive therapies before the infection. In conclusion, COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents, including JAK inhibitors, or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals

    Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

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    Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after antisevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P <.001), active HM (P <.001), and severe and critical COVID-19 (P =.007 and P <.001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P <.001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P <.001) or combined with antivirals (P =.009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals

    Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from EPICOVIDEHA survey

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    Limited data have been published on the epidemiology and outcomes of breakthrough COVID-19 in patients with hematological malignancy (HM) after anti-SARS-CoV-2 vaccination. Adult HM who received at least one dose of anti-SARS-CoV-2 vaccine and diagnosed with breakthrough COVID-19 between January 2021 and March 2022 and registered in EPICOVIDEHA were included in this analysis. A total of 1548 cases were included, mainly with lymphoid malignancies (1181 cases, 76%). After viral genome sequencing in 753 cases (49%), Omicron variant was prevalent (517, 68.7%). Most of the patients received at least two vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received specific treatment for COVID-19. After 30-days follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with Omicron variant was of 7.9%, comparable to that reported for the other variants. The 30-day mortality rate was significantly lower than in the pre-vaccine era (31%). In the univariable analysis, older age (p&amp;lt;0.001), active HM (p&amp;lt;0.001), severe and critical COVID-19 (p=0.007 and p&amp;lt;0.001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (p&amp;lt;0.001). In the multivariable model, older age, active disease, critical COVID-19 and at least 2-3 comorbidities were correlated with a higher mortality, whereas the administration of monoclonal antibodies, alone (p&amp;lt;0.001) or combined with antivirals (p=0.009), was observed protective. While mortality is significantly lower than in the pre-vaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals. EPICOVIDEHA (www.clinicaltrials.gov; National Clinical Trials identifier NCT04733729) is an international open web-based registry for patients with HMs infected with SARS-CoV-2.</jats:p

    Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

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    Abstract Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), the Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with the Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P < .001), active HM (P < .001), and severe and critical COVID-19 (P = .007 and P < .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P < .001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P < .001) or combined with antivirals (P = .009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals

    Breakthrough COVID-19 in vaccinated patients with hematologic malignancies: results from the EPICOVIDEHA survey

    No full text
    Limited data are available on breakthrough COVID-19 in patients with hematologic malignancy (HM) after anti–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Adult patients with HM, ≥1 dose of anti-SARS-CoV-2 vaccine, and breakthrough COVID-19 between January 2021 and March 2022 were analyzed. A total of 1548 cases were included, mainly lymphoid malignancies (1181 cases, 76%). After viral sequencing in 753 cases (49%), the Omicron variant was prevalent (517, 68.7%). Most of the patients received ≤2 vaccine doses before COVID-19 (1419, 91%), mostly mRNA-based (1377, 89%). Overall, 906 patients (59%) received COVID-19-specific treatment. After 30-day follow-up from COVID-19 diagnosis, 143 patients (9%) died. The mortality rate in patients with the Omicron variant was 7.9%, comparable to other variants, with a significantly lower 30-day mortality rate than in the prevaccine era (31%). In the univariable analysis, older age (P &lt; .001), active HM (P &lt; .001), and severe and critical COVID-19 (P = .007 and P &lt; .001, respectively) were associated with mortality. Conversely, patients receiving monoclonal antibodies, even for severe or critical COVID-19, had a lower mortality rate (P &lt; .001). In the multivariable model, older age, active disease, critical COVID-19, and 2-3 comorbidities were correlated with a higher mortality, whereas monoclonal antibody administration, alone (P &lt; .001) or combined with antivirals (P = .009), was protective. Although mortality is significantly lower than in the prevaccination era, breakthrough COVID-19 in HM is still associated with considerable mortality. Death rate was lower in patients who received monoclonal antibodies, alone or in combination with antivirals

    COVID-19 infection in adult patients with hematological malignancies: a European Hematology Association Survey (EPICOVIDEHA)

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    195sinoneBackground: Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods: The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results: The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value &lt; 0.0001). In the multivariable analysis, age, active malignancy, chronic cardiac disease, liver disease, renal impairment, smoking history, and ICU stay correlated with mortality. Acute myeloid leukemia was a higher mortality risk than lymphoproliferative diseases. Conclusions: This survey confirms that COVID-19 patients with HM are at high risk of lethal complications. However, improved COVID-19 prevention has reduced mortality despite an increase in the number of reported cases.nonePagano L.; Salmanton-Garcia J.; Marchesi F.; Busca A.; Corradini P.; Hoenigl M.; Klimko N.; Koehler P.; Pagliuca A.; Passamonti F.; Verga L.; Visek B.; Ilhan O.; Nadali G.; Weinbergerova B.; Cordoba-Mascunano R.; Marchetti M.; Collins G.P.; Farina F.; Cattaneo C.; Cabirta A.; Gomes-Silva M.; Itri F.; van Doesum J.; Ledoux M.-P.; Cernan M.; Jaksic O.; Duarte R.F.; Magliano G.; Omrani A.S.; Fracchiolla N.S.; Kulasekararaj A.; Valkovic T.; Poulsen C.B.; Machado M.; Glenthoj A.; Stoma I.; Racil Z.; Piukovics K.; Navratil M.; Emarah Z.; Sili U.; Maertens J.; Blennow O.; Bergantim R.; Garcia-Vidal C.; Prezioso L.; Guidetti A.; del Principe M.I.; Popova M.; de Jonge N.; Ormazabal-Velez I.; Fernandez N.; Falces-Romero I.; Cuccaro A.; Meers S.; Buquicchio C.; Antic D.; Al-Khabori M.; Garcia-Sanz R.; Biernat M.M.; Tisi M.C.; Sal E.; Rahimli L.; Colovic N.; Schonlein M.; Calbacho M.; Tascini C.; Miranda-Castillo C.; Khanna N.; Mendez G.-A.; Petzer V.; Novak J.; Besson C.; Dulery R.; Lamure S.; Nucci M.; Zambrotta G.; Zak P.; Seval G.C.; Bonuomo V.; Mayer J.; Lopez-Garcia A.; Sacchi M.V.; Booth S.; Ciceri F.; Oberti M.; Salvini M.; Izuzquiza M.; Nunes-Rodrigues R.; Ammatuna E.; Obr A.; Herbrecht R.; Nunez-Martin-Buitrago L.; Mancini V.; Shwaylia H.; Sciume M.; Essame J.; Nygaard M.; Batinic J.; Gonzaga Y.; Regalado-Artamendi I.; Karlsson L.K.; Shapetska M.; Hanakova M.; El-Ashwah S.; Borbenyi Z.; Colak G.M.; Nordlander A.; Dragonetti G.; Maraglino A.M.E.; Rinaldi A.; De Ramon-Sanchez C.; Cornely O.A.; Finizio O.; Fazzi R.; Sapienza G.; Chauchet A.; Van Praet J.; Prattes J.; Dargenio M.; Rossi C.; Shirinova A.; Malak S.; Tafuri A.; Ommen H.-B.; Bologna S.; Khedr R.A.; Choquet S.; Joly B.; Ceesay M.M.; Philippe L.; Kho C.S.; Desole M.; Tsirigotis P.; Otasevic V.; Borducchi D.M.M.; Antoniadou A.; Gaziev J.; Almaslamani M.A.; Garcia-Pouton N.; Paterno G.; Torres-Lopez A.; Tarantini G.; Mellinghoff S.; Grafe S.; Borschel N.; Passweg J.; Merelli M.; Barac A.; Wolf D.; Shaikh M.U.; Thieblemont C.; Bernard S.; Funke V.A.M.; Daguindau E.; Khostelidi S.; Nucci F.M.; Martin-Gonzalez J.-A.; Landau M.; Soussain C.; Laureana C.; Lacombe K.; Kohn M.; Aliyeva G.; Piedimonte M.; Fouquet G.; Rego M.; Hoell-Neugebauer B.; Cartron G.; Pinto F.; Alburquerque A.M.; Passos J.; Yilmaz A.F.; Redondo-Izal A.-M.; Altuntas F.; Heath C.; Kolditz M.; Schalk E.; Guolo F.; Karthaus M.; Della Pepa R.; Vinh D.; Noel N.; Deau Fischer B.; Drenou B.; Mitra M.E.; Meletiadis J.; Bilgin Y.M.; Jindra P.; Espigado I.; Drgona L.; Serris A.; Di Blasi R.; Ali N.Pagano, L.; Salmanton-Garcia, J.; Marchesi, F.; Busca, A.; Corradini, P.; Hoenigl, M.; Klimko, N.; Koehler, P.; Pagliuca, A.; Passamonti, F.; Verga, L.; Visek, B.; Ilhan, O.; Nadali, G.; Weinbergerova, B.; Cordoba-Mascunano, R.; Marchetti, M.; Collins, G. P.; Farina, F.; Cattaneo, C.; Cabirta, A.; Gomes-Silva, M.; Itri, F.; van Doesum, J.; Ledoux, M. -P.; Cernan, M.; Jaksic, O.; Duarte, R. F.; Magliano, G.; Omrani, A. S.; Fracchiolla, N. S.; Kulasekararaj, A.; Valkovic, T.; Poulsen, C. B.; Machado, M.; Glenthoj, A.; Stoma, I.; Racil, Z.; Piukovics, K.; Navratil, M.; Emarah, Z.; Sili, U.; Maertens, J.; Blennow, O.; Bergantim, R.; Garcia-Vidal, C.; Prezioso, L.; Guidetti, A.; del Principe, M. I.; Popova, M.; de Jonge, N.; Ormazabal-Velez, I.; Fernandez, N.; Falces-Romero, I.; Cuccaro, A.; Meers, S.; Buquicchio, C.; Antic, D.; Al-Khabori, M.; Garcia-Sanz, R.; Biernat, M. M.; Tisi, M. C.; Sal, E.; Rahimli, L.; Colovic, N.; Schonlein, M.; Calbacho, M.; Tascini, C.; Miranda-Castillo, C.; Khanna, N.; Mendez, G. -A.; Petzer, V.; Novak, J.; Besson, C.; Dulery, R.; Lamure, S.; Nucci, M.; Zambrotta, G.; Zak, P.; Seval, G. C.; Bonuomo, V.; Mayer, J.; Lopez-Garcia, A.; Sacchi, M. V.; Booth, S.; Ciceri, F.; Oberti, M.; Salvini, M.; Izuzquiza, M.; Nunes-Rodrigues, R.; Ammatuna, E.; Obr, A.; Herbrecht, R.; Nunez-Martin-Buitrago, L.; Mancini, V.; Shwaylia, H.; Sciume, M.; Essame, J.; Nygaard, M.; Batinic, J.; Gonzaga, Y.; Regalado-Artamendi, I.; Karlsson, L. K.; Shapetska, M.; Hanakova, M.; El-Ashwah, S.; Borbenyi, Z.; Colak, G. M.; Nordlander, A.; Dragonetti, G.; Maraglino, A. M. E.; Rinaldi, A.; De Ramon-Sanchez, C.; Cornely, O. A.; Finizio, O.; Fazzi, R.; Sapienza, G.; Chauchet, A.; Van Praet, J.; Prattes, J.; Dargenio, M.; Rossi, C.; Shirinova, A.; Malak, S.; Tafuri, A.; Ommen, H. -B.; Bologna, S.; Khedr, R. A.; Choquet, S.; Joly, B.; Ceesay, M. M.; Philippe, L.; Kho, C. S.; Desole, M.; Tsirigotis, P.; Otasevic, V.; Borducchi, D. M. M.; Antoniadou, A.; Gaziev, J.; Almaslamani, M. A.; Garcia-Pouton, N.; Paterno, G.; Torres-Lopez, A.; Tarantini, G.; Mellinghoff, S.; Grafe, S.; Borschel, N.; Passweg, J.; Merelli, M.; Barac, A.; Wolf, D.; Shaikh, M. U.; Thieblemont, C.; Bernard, S.; Funke, V. A. M.; Daguindau, E.; Khostelidi, S.; Nucci, F. M.; Martin-Gonzalez, J. -A.; Landau, M.; Soussain, C.; Laureana, C.; Lacombe, K.; Kohn, M.; Aliyeva, G.; Piedimonte, M.; Fouquet, G.; Rego, M.; Hoell-Neugebauer, B.; Cartron, G.; Pinto, F.; Alburquerque, A. M.; Passos, J.; Yilmaz, A. F.; Redondo-Izal, A. -M.; Altuntas, F.; Heath, C.; Kolditz, M.; Schalk, E.; Guolo, F.; Karthaus, M.; Della Pepa, R.; Vinh, D.; Noel, N.; Deau Fischer, B.; Drenou, B.; Mitra, M. E.; Meletiadis, J.; Bilgin, Y. M.; Jindra, P.; Espigado, I.; Drgona, L.; Serris, A.; Di Blasi, R.; Ali, N
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