c-D-index is a risk factor for prolonged febrile neutropenia during chemotherapy in patients with acute myeloid leukemia

  • Hiroyuki Kubo
  • Osamu ImatakiEmail author
  • Yukiko Hamasaki Kubo
  • Makiko Uemura
  • Norimitsu Kadowaki
Original Article



D-index is a recently established clinical tool for assessing neutropenia severity. This study examined whether the D-index can predict the onset of various infections in patients with febrile neutropenia (FN).


We retrospectively investigated FN events in consecutive patients aged < 65 years who were treated for newly diagnosed acute myeloid leukemia at our institution. We collected data on all FN events during chemotherapy and evaluated the association of FN severity with infectious events. Results: This study included 35 patients (18 women and 17 men; median age, 51 years [range 18–65 years]) with 122 FN events. The response rate to induction chemotherapy was 60% (21/35), and all but one patient survived the treatment. The D-index did not predict FN onset. However, in multivariate analysis, high-dose cytarabine and total D-index were statistically significant explanatory factors for microbiological-proven infections. In addition, multivariate analysis showed that diabetes mellitus is the only risk factor for FN onset. Furthermore, older age, consolidation therapy, and cumulative D-index (c-D-index) were risk factors for prolonged FN. The FN period was the longest in patients with respiratory infections.


The D-index did not predict the onset of infection. However, FN duration might be prolonged during consolidation therapy in elderly patients with diabetes mellitus, and it is important to manage respiratory infections. These findings indicate the c-D-index is a useful tool to predict prolonged FN.


Acute myeloid leukemia Consolidation chemotherapy D-index Febrile neutropenia Induction chemotherapy Invasive fungal infection 



Acute myeloid leukemia


Cumulative D-index


Eastern Cooperative Oncology Group




Febrile neutropenia


Japan Adult Leukemia Study Group


Lymphocyte index


Performance status


Author contributions

OI and HK managed the patient cases, contributed to the literature search, and wrote the manuscript. YHK made substantial contributions to the concept and design of this report. MU qualified the patient data, suggested important intellectual content. YHK and MU took part in critical discussions. NK was involved in supervision of the manuscript and managed the research. All authors approved the final version of the manuscript.


The authors declare that there are no funding sources to disclose concerning to this study, which was supported by internal funding.

Compliance with ethical standards

Ethics approval

Institutional review board approved the clinical study and submission of medical literature.

Ethics, consent, and permissions

We have obtained consent to participate under our institutional review board.

Consent to publish

We have obtained consent to publish from the participant.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Division of Hematology, Department of Internal Medicine, Faculty of MedicineKagawa UniversityKagawaJapan

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