Infectious complications during remission induction therapy in 577 patients with acute myeloid leukemia in the Japan Adult Leukemia Study Group studies between 1987 and 1991

The Japan Adult Leukemia Study Group analyzed infectious episodes in 577 pa tients with acute myeloid leukemia during remission induction therapy betwe en 1987 and 1991. 542 patients (93.9%) experienced at least one infectious episode, 121 (21.0%) had microbiologically documented infection; there was clinically documented infection in 184 (31.9%) and unexplained fever in 237 (41.1%). Among 121 microbiologically documented infections, bacteremia/fun gemia was observed in 68, pneumonia in 33, and other types of infections in 20. Among the bacteremia/fungemia, gram-negative bacteria accounted for 41 .2% (Pseudomonas aeruginosa was the most common), gram-positive bacteria fo r 39.7%,fungi for 16.2% (Candida spp. being most frequent), and polymicrobi al for 2.9%. The most frequent isolates among pneumonia were Pseudomonas ae ruginosa and Aspergillus. A total of 70 patients (12.1%) died during remiss ion induction. Mortality of 68 patients with bacteremia/fungemia was 26.5%; in these patients, mortality with concomitant pneumonia increased to 41.4% ; without pneumonia, mortality was 15.4% (P < 0.05). Mortality according to the isolated microbes was 17.2% for gram-negative bacteria, 25% for gram-p ositive bacteria, and 54.5% for fungi. Mortality of 113 patients with pneum onia (33 microbiologically documented and 80 clinically documented), 20 wit h other microbiologically documented infections, 104 with other clinically documented infections, and 237 with unexplained fever was 25.7%, 5.0%, 5.8% , and 5.1%, respectively. (C) 1999 The Japanese Society of Hematology.