AML-294: Predictors of Short-Term and Long-Term Mortality in Leukemia Patients with Neutropenic Fever

Context Infections cause substantial morbidity and mortality in acute leukemia patients. Neutropenic fever (NF) frequently complicates leukemia chemotherapy, but the mortality rate of NF and predictors of mortality are not fully defined for adult leukemia patients. We examined factors that influence mortality and type of infection in NF patients admitted to the hematologic malignancy service of a referral hospital. Design Retrospective chart review of NF patients admitted to University of Louisville from April 2016 to July 2018 who had AML, ALL, CML, CLL, or MDS, excluding active transplant patients. We used logistic regression and Cox proportional hazard analysis to evaluate mortality predictors and the Kaplan-Meier method for survival. Median follow-up was 16.6 months. Results Sixty-two patients had 101 episodes of NF. Median age was 56. Frequent primary diagnoses were AML (70%), ALL (24%), CML (2%), and CLL (2%). Infections and bacteremia occurred in 72% and 54% of episodes, respectively. Mean length of stay was 19 +/- 12 days. Refractory/relapsed (R/R) disease (RR 1.53, p=0.034) and ANC nadir of 0 (RR 2.64, p=0.001) correlated with bacteremia. Thirty-day mortality was 14% and increased for R/R disease (OR 3.13, CI=0.99–9.92), bacteremia (OR 3.58, CI=0.94-13.7), and ICU-level care (OR 15.24, CI=4.11-56.5) in univariate analysis. ICU-level care (OR 29.1, CI=5.42–156) and R/R disease (OR 7.30, CI=1.43–37.4) retained significance in multivariate logistic regression. Gram +/- status, resistance pattern, neutropenia severity, age, and neutropenia duration did not influence short-term mortality. Eighty-six episodes had a high-risk MASCC score ( 60 (HR 2.16, CI=1.22–3.84), R/R disease (HR 5.58, CI=2.74–11.4) and ICU-level care (HR 4.96, CI=2.14–11.5) predicted long-term mortality. High-risk MASCC approached significance for OS; median OS 7.8 months (high-risk) versus not reached (low-risk, p=0.076). Conclusions Bacteremia occurred in the majority of NF episodes we recorded. Thirty-day NF mortality was 14%. Mortality increases for patients with age > 60, R/R disease, and ICU-level care. Identification of high-risk factors in NF may guide the study of interventions such as myeloid growth factor support in appropriate populations.