thioguanine-anhydrous and Pseudomonas-Infections

Although definite improvement in the treatment of acute myelogenous leukemia has taken place, the outlook for patients remains grim. The current aggressive approach to treatment, entailing a program of chemotherapy which almost invariably produces bone marrow aplasia and considerable toxicity, has been the subject of some controversy. Selected aspects of management are discussed.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Antineoplastic Agents; Blood Transfusion; Cell Division; Cyclophosphamide; Cytarabine; Drug Evaluation; Drug Synergism; Drug Therapy, Combination; Humans; Infection Control; Kinetics; Leukemia, Myeloid, Acute; Mercaptopurine; Methotrexate; Mycoses; Prednisone; Pseudomonas Infections; Remission, Spontaneous; Thioguanine; Vincristine

Implications and course of fever were evaluated during hospitalization of 24 patients with acute myelogenous leukemia. Forty-five febrile episodes were identified. Fever present at admission was usually associated with a diagnosable and treatable infection; fever shortly after induction was self-limited; and fever during granulocytopenia was more likely to be associated with bacteremia. Bacteremia and pneumonia were the most common types of infection. Only Gram-negative bacteria and Candida were identified as causes of infection during life, with Pseudomonas and Klebsiella the most frequently isolated pathogens. Invasive candidiasis was a major postmortem finding. A delay in initiation of empirical treatment beyond the third day of fever was associated with an increase in mortality as was continuation of treatment for longer than 14 days.

Topics: Agranulocytosis; Anti-Bacterial Agents; Candidiasis; Cytarabine; Daunorubicin; Fever; Humans; Klebsiella Infections; Leukemia, Myeloid, Acute; Pseudomonas Infections; Thioguanine