Impact of the D-index deduced from duration and intensity of neutropenia following chemotherapy on the risk of invasive fungal infection in pediatric acute myeloid leukemia
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Pediatric patients with acute myeloid leukemia (AML) are at high risk of invasive fungal infection (IFI). In adult patients, the D-index, which reflects the duration and intensity of neutropenia, was reported as a predictive factor of IFI after induction therapy for AML. The aim of this study was to assess whether the D-index is a predictive factor for IFI in pediatric AML. We define the D-index as the area over the neutrophil curve during neutropenia. Ninety-two courses of chemotherapy performed for 24 consecutive patients with AML undergoing chemotherapy at Sapporo Hokuyu Hospital between April 2007 and March 2017 were analyzed. We also evaluated the utility of the cumulative D-index (c-D-index) from the start of neutropenia until the clinical manifestation of IFI in these patients. The D-index and c-D-index were compared between courses with and without IFI episodes. The median D-index and c-D-index in 6 courses with IFI episodes were 12,816 (range 9500–27,412) and 7250 (range 3987–16,273), respectively, which was not statistically higher than the median D-index [10,127 (range 3788–20,897)] in 86 courses without IFI episodes (P = 0.081 and P = 0.108, respectively). Unlike in adult cases, neither the D-index nor c-D-index reflected the risk of IFI in pediatric AML.
KeywordsAcute myeloid leukemia Invasive fungal infection Risk factor Neutropenia D-index
Area under the curve
Invasive fungal infection
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
- 4.De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–21.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Sano H, Kobayashi R, Hori D, Kishimoto K, Suzuki D, Yasuda K, et al. Prophylactic administration of voriconazole with two different doses for invasive fungal infection in children and adolescents with acute myeloid leukemia. J Microbiol Immunol Infect (in press).Google Scholar
- 8.Sato T, Kobayashi R, Yasuda K, Kaneda M, Iguchi A, Kobayashi K. A prospective, randomized study comparing cefozopran with piperacillin-tazobactam plus ceftazidime as empirical therapy for febrile neutropenia in children with hematological disorders. Pediatr Blood Cancer. 2008;51:774–7.CrossRefPubMedGoogle Scholar
- 10.Sano H, Kobayashi R, Suzuki D, Kishimoto K, Yasuda K, Kobayashi K. Comparison between piperacillin/tazobactam and cefepime monotherapies as an empirical therapy for febrile neutropenia in children with hematological and malignant disorders: a prospective, randomized study. Pediatr Blood Cancer. 2015;62:356–8.CrossRefPubMedGoogle Scholar
- 11.Sano H, Kobayashi R, Suzuki D, Hori D, Kishimoto K, Kobayashi K. A prospective randomized trial comparing piperacillin/tazobactam with meropenem as empirical antibiotic treatment of febrile neutropenic children and adolescents with hematologic and malignant disorders. Pediatr Blood Cancer. 2017;64:e26360.CrossRefGoogle Scholar