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Rebecca Olin, MD, MS

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Pilot Study in AML: Can Biomarkers Predict Chemotherapy-Related Infection?

By: Anna Nowogrodzki
Posted: Friday, May 14, 2021

Human neutrophil elastase, blood nucleosome concentrations, and interleukin 8 (IL-8) may prove to be biomarkers for early indications of neutrophil recovery, fungal infections, and infection-related ICU admission in patients with acute myeloid leukemia (AML) These findings of a recent pilot study, conducted by Taco W. Kuijpers, MD, PhD, of the Academic Medical Center in Amsterdam, and colleagues, were published in the British Journal of Haematology.

“These results are promising enough to continue with a larger validation cohort to confirm that these biomarkers may enable physicians to provide more patient‐tailored care during febrile neutropenia to reduce infection‐related morbidity and mortality,” the authors wrote.

The prospective pilot study included 26 patients whose median age was 60. Their blood was sampled two to three times per week for neutropenic episodes. The authors analyzed five potential biomarkers: C‐reactive protein, IL-8, human neutrophil elastase, myeloid‐related protein 8/14, and nucleosomes. They assessed whether they might help predict infection, ICU admission, or bone marrow recovery. Of the 26 patients, 5 experienced invasive fungal infections.

An increase in human neutrophil elastase without an increase in myeloid‐related protein 8/14 appeared to be associated with a greater chance of neutrophil recovery (hazard ratio = 6.3) and was detectable before circulating neutrophils were. Blood nucleosome concentrations seemed to distinguish patients with fungal infections from those with fevers from other causes; these concentrations were elevated 24 to 48 hours before any fungus was detectable. Nucleosome levels also tended to discriminate between ICU and non‐ICU patients, with a sensitivity of 100% and a specificity of 75%. According to the authors, IL-8 in patients with febrile neutropenia distinguished between bloodstream infections and infections from other causes and between infectious and non-infectious inflammation.

Of note, the study is limited by its small sample size. Validation in a more extensive study is necessary.

Disclosure: The study authors reported no conflicts of interest.


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