Early T-Cell Precursor Leukemia Has a Higher Risk of Induction-Related Infection among T-Cell Acute Lymphoblastic Leukemia in Adult

Abstract EN

Background.

Infections are an important cause of morbidity and mortality for acute lymphoblastic leukemia (ALL).

However, the reports regarding risk factors of induction-related infection are roughly unknown/limited in adult T-ALL during induction chemotherapy.

Methods.

We performed a retrospective cohort study for the prevalence and risk predictors of induction-related infection among consecutive T-ALL patients (N=97) enrolled in a PDT-ALL-LBL clinical trial.

Of 97 patients with T-ALL enrolled in the trial, 46 were early T-cell precursor (ETP) ALL and 51 were non-ETP ALL.

Results.

When compared with non-ETP, ETP ALL subtype was characterized with lower neutrophil count (1.35×109/L vs.

8.7×109/L, P<0.001) and lower myeloid percentage in the bone marrow (13.35% vs.

35.31%, P=0.007).

Additionally, ETP ALL had longer neutropenia before diagnosis (P<0.001), as well as during induction chemotherapy (P<0.001).

Notably, the ETP cohort experienced higher cumulative incidence of clinically documented infections (CDI; 33.33%, P=0.001), microbiologically documented infections (MDI; 45.24%, P=0.006), resistant infection (11.9%, P=0.013), and mixed infection (21.43%, P=0.003), respectively, than those of the non-ETP cohort.

Furthermore, multivariable analysis revealed that T-ALL mixed infection was more likely related to chemotherapy response (OR, 0.025; 95% CI 0.127-0.64; P=0.012) and identified myeloid percentage as a predictor associated with ETP-ALL mixed infection (OR, 0.915; 95% CI 0.843-0.993; P=0.033), with ROC-defined cut-off value of 2.24% in ETP cohorts.

Conclusions.

Our data for the first time demonstrated that ETP-ALL characterized with impaired myelopoiesis were more susceptible to induction-related infection among T-ALL populations.