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Giuseppe Leone
Livio Pagano


Myelodysplastic Syndrome, Infections, Azacitidine, Decitabine, Chemotherapy


Infections remain a significant problem in myelodysplastic syndromes in treated as well in non-treated patients and assume a particular complexity. The susceptibility to infections is due, in the absence of intensive chemotherapies, mainly to functional defects in the myeloid lineage with or without neutropenia. Furthermore, MDS include a heterogeneous group of patients with very different prognosis, different therapy and various risk factors regarding survival and infections. You should distinguish risk factors related to the disease, like as neutrophils function impairment, neutropenia, unfavorable cytogenetics and bone marrow insufficiency; factors related to the patient, like as age and comorbidities, and factors related to the therapy. When the patients with MDS are submitted to intensive chemotherapy with and without HSCT, they have a risk factor for infection very similar to that of patients with AML, and mostly related to neutropenia. Patients with MDS treated with supportive therapy only or with demethylating agent or lenalidomide or immunosuppressive drugs should have a tailored approach. Most of the infections in MDS originate from bacteria, and the major risk factors are represented by neutropenia, thrombocytopenia, and unfavorable cytogenetics. Thus it is reasonable to give antibacterial prophylaxis in patients who start the therapy with demethylating agents with a number of neutrophils <500, or with thrombocytopenia and unfavorable cytogenetics. The antifungal prophylaxis is not considered cost/benefit adequate and should be taken into consideration only when there is an antecedent fungal infection or presence of filamentous fungi in the surveillance cultures. Subjects submitted to immunosuppression with ATG+CSA have a high number of infections, and when severely neutropenic should ideally be nursed in isolation, should be given prophylactic antibiotics and antifungals, regular mouth care including an antiseptic mouthwash. 



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1. Goldberg SL, Chen E, Corral M, Guo A, Mody-Patel N, Pecora AL, Laouri M. Incidence and clinical complications of myelodysplastic syndromes among United States Medicare beneficiaries. J Clin Oncol. 2010 Jun 10;28(17):2847-52. doi:10.1200/JCO.2009.25.2395.
2. Neukirchen J, Nachtkamp K, Schemenau J, Aul C, Giagounidis A, Strupp C, Kuendgen A, Kobbe G, Haas R, Germing U. Change of prognosis of patients with myelodysplastic syndromes during the last 30 years. Leuk Res. 2015 Jul;39(7):679-83. doi: 10.1016/j.leukres.2015.04.001.
3. Nachtkamp K, Stark R, Strupp C, Kündgen A, Giagounidis A, Aul C, Hildebrandt B, Haas R, Gattermann N, Germing U. Causes of death in 2877 patients with myelodysplastic syndromes. Ann Hematol. 2016 May;95(6):937-44. doi:10.1007/s00277-016-2649-3.
4. Prodan M, Tulissi P, Perticarari S, Presani G, Franzin F, Pussini E, Pozzato G (1995) Flow cytometric assay for the evaluation of phagocytosis and oxidative burst of polymorphonuclear leukocytes and monocytes in myelodysplastic disorders. Haematologica 80:212–218
5. Fuhler GM, Drayer AL, Olthof SG, Schuringa JJ, Coffer PJ, Vel- lenga E (2008) Reduced activation of protein kinase B, Rac, and F-actin polymerization contributes to an impairment of stromal cell derived factor-1 induced migration of CD34+ cells from patients with myelodysplasia. Blood 111:359–368. doi:10.1182/ blood-2006-11-060632
6. Fianchi L, Leone G, Posteraro B, Sanguinetti M, Guidi F, Valentini CG, Voso MT, Pagano L (2012) Impaired bactericidal and fungicidal activities of neutrophils in patients with mye- lodysplastic syndrome. Leuk Res 36:331–333. doi:10.1016/j. leukres.2011.11.012
7. Wesa KM, Cunningham-Rundles S, Klimek VM, Vertosick E, Coleton MI, Yeung KS,Lin H, Nimer S, Cassileth BR. Maitake mushroom extract in myelodysplastic syndromes (MDS): a phase II study. Cancer Immunol Immunother. 2015Feb;64(2):237-47. doi: 10.1007/s00262-014-1628-6. Epub 2014 Oct 29.
8. Merkel D, Filanovsky K, Gafter-Gvili A, Vidal L, Aviv A, Gatt ME, Silbershatz I, Herishanu Y, Arad A, Tadmor T, Dally N, Nemets A, Rouvio O, Ronson A, Herzog-Tzarfati K, Akria L, Braester A, Hellmann I, Yeganeh S, Nagler A, Leiba R, Mittelman M, Ofran Y. Predicting infections in high-risk patients with myelodysplastic syndrome/acute myeloid leukemia treated with azacitidine: a retrospective multicenter study. Am J Hematol. 2013 Feb;88(2):130-4. doi: 10.1002/ajh.23368. PubMed PMID: 23345248.
9. Sullivan LR, Sekeres MA, Shrestha NK, Maciejewski JP, Tiu RV, Butler R, Mossad
SB. Epidemiology and risk factors for infections in myelodysplastic syndromes.
Transpl Infect Dis. 2013 Dec;15(6):652-7. doi: 10.1111/tid.12130.
10. Santini V. Treatment of low-risk myelodysplastic syndromes. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):462-469. Review
11. Dayyani F, Conley AP, Strom SS, Stevenson W, Cortes JE, Borthakur G, Faderl S,O'Brien S, Pierce S, Kantarjian H, Garcia-Manero G. Cause of death in patients with lower-risk myelodysplastic syndrome. Cancer. 2010 May 1;116(9):2174-9. doi: 10.1002/cncr.24984.
12. Toma A, Fenaux P, Dreyfus F, Cordonnier C (2012) Infections in myelodysplastic syndromes. Haematologica 97:1459–1470. doi:10.3324/haematol.2012.063420
13. Pagano L, Caira M. Risks for infection in patients with myelodysplasia and
acute leukemia. Curr Opin Infect Dis. 2012 Dec;25(6):612-8. doi: 10.1097/QCO.0b013e328358b000. Review. PubMed PMID: 22964946.
14. Caira M, Latagliata R, Girmenia C. The risk of infections in patients with myelodysplastic syndromes in 2016. Expert Rev Hematol. 2016 Jun;9(6):607-14. doi:10.1080/17474086.2016.1181540. Epub 2016 May 5. Review.
15. Greenberg P, Cox C, LeBeau MM, et al: International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89:2079-2088, 1997
16. Greenberg PL, Tuechler H, Schanz J, et al: Revised international prognostic scoring system for myelodysplastic syndromes. Blood 2012; 120:2454-2465,
17. Hellstrom-Lindberg E, Ahlgren T, Beguin Y, et al. Treatment of anemia in myelodysplastic syndromes with granulocyte colony-stimulating factor plus erythropoietin: results from a randomized phase II study and long-term follow-up of 71 patients. Blood. 1998;92(1):68-75
18. Park S, Grabar S, Kelaidi C, et al; GFM group (Groupe Francophone des Myelodysplasies). Predictive factors of response and survival in myelodysplastic syndrome treated with erythropoietin and G-CSF: the GFM experience. Blood. 2008;111(2):574-582
19. Pellagatti A., Boultwood J. Recent Advances in the 5q- Syndrome. Mediterr J Hematol Infect Dis 2015, 7(1): e2015037, DOI:
20. List A, Dewald G, Bennett J, Giagounidis A, Raza A, Feldman E, Powell B,Greenberg P, Thomas D, Stone R, Reeder C, Wride K, Patin J, Schmidt M, Zeldis J, Knight R; Myelodysplastic Syndrome-003 Study Investigators. Lenalidomide in the myelodysplastic syndrome with chromosome 5q deletion. N Engl J Med. 2006 Oct 5;355(14):1456-65
21. Fenaux P, Giagounidis A, Selleslag D, Beyne-Rauzy O, Mufti G, Mittelman M, Muus P, Te Boekhorst P, Sanz G, Del Cañizo C, Guerci-Bresler A, Nilsson L,Platzbecker U, Lübbert M, Quesnel B, Cazzola M, Ganser A, Bowen D, Schlegelberger B, Aul C, Knight R, Francis J, Fu T, Hellström-Lindberg E; MDS-004 Lenalidomide del 5q Study Group. A randomized phase 3 study of lenalidomide versus placebo in RBC transfusion-dependent patients with Low-/Intermediate-1-risk myelodysplastic syndromes with del5q. Blood. 2011 Oct 6;118(14):3765-76. doi:10.1182/blood-2011-01-330126
22. Giagounidis A, Mufti GJ, Mittelman M, Sanz G, Platzbecker U, Muus P, SelleslagD, Beyne-Rauzy O, te Boekhorst P, del Cañizo C, Guerci-Bresler A, Nilsson L, Lübbert M, Quesnel B, Ganser A, Bowen D, Schlegelberger B, Göhring G, Fu T Benettaib B, Hellström-Lindberg E, Fenaux P. Outcomes in RBC transfusion-dependent patients with Low-/Intermediate-1-risk myelodysplastic syndromes with isolated deletion 5q treated with lenalidomide: a subset analysis from the MDS-004 study. Eur J Haematol. 2014 Nov;93(5):429-38. doi:10.1111/ejh.12380.
23. Sloand EM, Wu CO, Greenberg P, Young N, Barrett J. Factors affecting response and survival in patients with myelodysplasia treated with immunosuppressive therapy. J Clin Oncol. 2008 May 20;26(15):2505-11. doi: 10.1200/JCO.2007.11.9214.
24. Passweg JR, Giagounidis AA, Simcock M, Aul C, Dobbelstein C, Stadler M, Ossenkoppele G, Hofmann WK, Schilling K, Tichelli A, Ganser A. Immunosuppressive therapy for patients with myelodysplastic syndrome: a prospective randomized multicenter phase III trial comparing antithymocyte globulin plus cyclosporine with best supportive care--SAKK 33/99. J Clin Oncol. 2011 Jan 20;29(3):303-9. doi: 10.1200/JCO.2010.31.2686.
25. Hata T, Tsushima H, Baba M, Imaizumi Y, Taguchi J, Imanishi D, Nagai K,Tomonaga M, Miyazaki Y. Long-term outcome of immunosuppressive therapy for Japanese patients with lower-risk myelodysplastic syndromes. Int J Hematol. 2013 Dec;98(6):687-93. doi: 10.1007/s12185-013-1468-8.
26. Neukirchen J, Platzbecker U, Sockel K, Tsamaloukas A, Haas R, Germing U. Real life experience with alemtuzumab treatment of patients with lower-risk MDS and a hypocellular bone marrow. Ann Hematol. 2014 Jan;93(1):65-9. doi:10.1007/s00277-013-1859-1.
27. Parikh AR, Olnes MJ, Barrett AJ. Immunomodulatory treatment of myelodysplastic
syndromes: antithymocyte globulin, cyclosporine, and alemtuzumab. Semin Hematol.
2012 ;49(4):304-11. doi: 10.1053/j.seminhematol.2012.07.004. Review.
28. Haider M, Al Ali N, Padron E, Epling-Burnette P, Lancet J, List A, Komrokji R. Immunosuppressive Therapy: Exploring an Underutilized Treatment Option for Myelodysplastic Syndrome. Clin Lymphoma Myeloma Leuk. 2016 Aug;16 Suppl:S44-8.doi: 10.1016/j.clml.2016.02.017
29. Komrokji RS, Mailloux AW, Chen DT, Sekeres MA, Paquette R, Fulp WJ, Sugimori C, Paleveda-Pena J, Maciejewski JP, List AF, Epling-Burnette PK. A phase II multicenter rabbit anti-thymocyte globulin trial in patients with myelodysplastic syndromes identifying a novel model for response prediction. Haematologica. 2014;99:1176-83. doi: 10.3324/haematol.2012.083345.
30. Raza A, Reeves JA, Feldman EJ, Dewald GW, Bennett JM, Deeg HJ, Dreisbach L,Schiffer CA, Stone RM, Greenberg PL, Curtin PT, Klimek VM, Shammo JM, Thomas D, Knight RD, Schmidt M, Wride K, Zeldis JB, List AF. Phase 2 study of lenalidomide in transfusion-dependent, low-risk, and intermediate-1 risk myelodysplastic syndromes with karyotypes other than deletion 5q. Blood. 2008 Jan 1;111(1):86-93.
31. Filì C, Malagola M, Follo MY, Finelli C, Iacobucci I, Martinelli G, Cattina F, Clissa C, Candoni A, Fanin R, Gobbi M, Bocchia M, Defina M, Spedini P, Skert C, Manzoli L, Cocco L, Russo D. Prospective phase II Study on 5-days azacitidine for treatment of symptomatic and/or erythropoietin unresponsive patients with low/INT-1-risk myelodysplastic syndromes. Clin Cancer Res. 2013 Jun15;19(12):3297-308. doi: 10.1158/1078-0432.
32. Komrokji R, Swern AS, Grinblatt D, Lyons RM, Tobiasson M, Silverman LR, Sayar H, Vij R, Fliss A, Tu N, Sugrue MM. Azacitidine in Lower-Risk Myelodysplastic Syndromes: A Meta-Analysis of Data from Prospective Studies. Oncologist. 2017 Nov8. pii: theoncologist.2017-0215. doi: 10.1634/theoncologist.2017-0215
33. Sibon D, Cannas G, Baracco F, Prebet T, Vey N, Banos A, Besson C, Corm S Blanc M, Slama B, Perrier H, Fenaux P, Wattel E; Groupe Francophone des Myélodysplasies. Lenalidomide in lower-risk myelodysplastic syndromes with karyotypes other than deletion 5q and refractory to erythropoiesis-stimulating agents. Br J Haematol. 2012 Mar;156(5):619-25. doi:10.1111/j.1365-2141.2011.08979.x.
34. Hutzschenreuter F, Monsef I, Kreuzer KA, Engert A, Skoetz N. Granulocyte and granulocyte macrophage colony stimulating factors for newly diagnosed patients with myelodysplastic syndromes. Cochrane Database Syst Rev. 2016 Feb 16;2:CD009310. doi: 10.1002/14651858.CD009310.pub2. Review.
35. Neukirchen J, Fox F, Kündgen A, Nachtkamp K, Strupp C, Haas R, Germing U, Gattermann N. Improved survival in MDS patients receiving iron chelation therapy - a matched pair analysis of 188 patients from the Düsseldorf MDS registry. Leuk Res. 2012 ;36(8):1067-70. doi: 10.1016/j.leukres.2012.04.006.
36. Angelucci E, Urru SA, Pilo F, Piperno A. Myelodysplastic Syndromes and Iron Chelation Therapy. Mediterr J Hematol Infect Dis. 2017 Mar 1;9(1): e2017021. doi: 10.4084/MJHID.2017.021. eCollection 2017. Review.
37. Ganz T. Iron and infection. Int J Hematol. 2018 ;107(1):7-15. doi:10.1007/s12185-017-2366-2. Epub 2017 Nov 16. Review. Erratum in: Int J Hematol.2017 Dec 2;:. PubMed PMID: 29147843.
38. Chan GC, Chan S, Ho PL, Ha SY. Effects of chelators (deferoxamine, deferiprone and deferasirox) on the growth of Klebsiella pneumoniae and Aeromonas hydrophila isolated from transfusion-dependent thalassemia patients. Hemoglobin. 2009;33(5):352-60. doi: 10.3109/03630260903211888.
39. Gokarn K, Pal RB. Activity of siderophores against drug-resistant Gram-positive and Gram-negative bacteria. Infect Drug Resist. 2018 Jan 9;11:61-75. doi: 10.2147/IDR.S148602. eCollection 2018.
40. Leitch HA, Parmar A, Wells RA, Chodirker L, Zhu N, Nevill TJ, Yee KWL, Leber B, Keating MM, Sabloff M, St Hilaire E, Kumar R, Delage R, Geddes M, Storring JM, Kew A, Shamy A, Elemary M, Lenis M, Mamedov A, Ivo J, Francis J, Zhang L, Buckstein R. Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis. Br J Haematol. 2017;179(1):83-97. doi: 10.1111/bjh.14825.
41. Lyons RM, Marek BJ, Paley C, Esposito J, McNamara K, Richards PD, DiBella N, Garcia-Manero G. Relation between chelation and clinical outcomes in lower-risk patients with myelodysplastic syndromes: Registry analysis at 5 years. Leuk Res. 2017 May; 56:88-95. doi: 10.1016/j.leukres.2017.01.033.
42. Wong CAC, Wong SAY, Leitch HA. Iron overload in lower international prognostic scoring system risk patients with myelodysplastic syndrome receiving red blood cell transfusions: Relation to infections and possible benefit of iron chelation therapy. Leuk Res. 2018 Feb 10; 67: 75-81. doi: 10.1016/j.leukres.2018.02.005
43. Stefanova D, Raychev A, Arezes J, Ruchala P, Gabayan V, Skurnik M, Dillon BJ, Horwitz MA, Ganz T, Bulut Y, Nemeth E. Endogenous hepcidin and its agonist mediate resistance to selected infections by clearing non-transferrin-bound iron. Blood. 2017 Jul 20;130(3):245-257. doi: 10.1182/blood-2017-03-772715.
44. Fenaux P, Giagounidis A, Selleslag D, Beyne-Rauzy O, Mittelman M, Muus P,Nimer SD, Hellström-Lindberg E, Powell BL, Guerci-Bresler A, Sekeres MA, Deeg HJ,Del Cañizo C, Greenberg PL, Shammo JM, Skikne B, Yu X, List AF. Clinical characteristics and outcomes according to age in lenalidomide-treated patients with RBC transfusion-dependent lower-risk MDS and del(5q). J Hematol Oncol. 2017 Jun 26;10(1):131. doi: 10.1186/s13045-017-0491-2.
45. Toma A, Kosmider O, Chevret S, Delaunay J, Stamatoullas A, Rose C, Beyne-RauzyO, Banos A, Guerci-Bresler A, Wickenhauser S, Caillot D, Laribi K, De Renzis B,Bordessoule D, Gardin C, Slama B, Sanhes L, Gruson B, Cony-Makhoul P, Chouffi B, Salanoubat C, Benramdane R, Legros L, Wattel E, Tertian G, Bouabdallah K, Guilhot F, Taksin AL, Cheze S, Maloum K, Nimuboma S, Soussain C, Isnard F, Gyan E, Petit R, Lejeune J, Sardnal V, Renneville A, Preudhomme C, Fontenay M, Fenaux P,Dreyfus F. Lenalidomide with or without erythropoietin in transfusion-dependenterythropoiesis-stimulating agent-refractory lower-risk MDS without 5q deletion. Leukemia. 2016 Apr;30(4):897-905. doi: 10.1038/leu.2015.296. Epub 2015 Oct 26.PubMed PMID: 26500139.
46. Santini V, Almeida A, Giagounidis A, Gröpper S, Jonasova A, Vey N, Mufti GJ,Buckstein R, Mittelman M, Platzbecker U, Shpilberg O, Ram R, Del Cañizo C,Gattermann N, Ozawa K, Risueño A, MacBeth KJ, Zhong J, Séguy F, Hoenekopp A, Beach CL, Fenaux P. Randomized Phase III Study of Lenalidomide Versus Placebo in RBC Transfusion-Dependent Patients With Lower-Risk Non-del(5q) Myelodysplastic Syndromes and Ineligible for or Refractory to Erythropoiesis-Stimulating Agents. J Clin Oncol. 2016 Sep 1;34(25):2988-96. doi: 10.1200/JCO.2015.66.0118.
47. Park S, Hamel JF, Toma A, Kelaidi C, Thépot S, Campelo MD, Santini V, Sekeres MA, Balleari E, Kaivers J, Sapena R, Götze K, Müller-Thomas C, Beyne-Rauzy O,Stamatoullas A, Kotsianidis I, Komrokji R, Steensma DP, Fensterl J, Roboz GJ,Bernal T, Ramos F, Calabuig M, Guerci-Bresler A, Bordessoule D, Cony-Makhoul P,Cheze S, Wattel E, Rose C, Vey N, Gioia D, Ferrero D, Gaidano G, Cametti G, Pane F, Sanna A, Germing U, Sanz GF, Dreyfus F, Fenaux P. Outcome of Lower-RiskPatients With Myelodysplastic Syndromes Without 5q Deletion After Failure of Erythropoiesis-Stimulating Agents. J Clin Oncol. 2017 May 10;35(14):1591-1597. doi: 10.1200/JCO.2016.71.3271
48. Almeida A, Fenaux P, Garcia-Manero G, Goldberg SL, Gröpper S, Jonasova A, Vey N, Castaneda C, Zhong J, Beach CL, Santini V. Safety profile of lenalidomide in patients with lower-risk myelodysplastic syndromes without del(5q): results of a phase 3 trial. Leuk Lymphoma. 2018 Jan 11:1-9. doi:10.1080/10428194.2017.1421758.
49. Tobiasson M, Dybedahl I, Holm MS, Karimi M, Brandefors L, Garelius H, Grövdal M, Högh-Dufva I, Grønbæk K, Jansson M, Marcher C, Nilsson L, Kittang AO, Porwit A, Saft L, Möllgård L, Hellström-Lindberg E. Limited clinical efficacy of azacitidine in transfusion-dependent, growth factor-resistant, low- and Int-1-risk MDS: Results from the nordic NMDSG08A phase II trial. Blood Cancer J. 2014 Mar 7;4:e189. doi: 10.1038/bcj.2014.8.
50. Sanchez-Garcia J, Falantes J, Medina Perez A, Hernandez-Mohedo F, Hermosin L, Torres Sabariego A, Bailen A, Hernandez-Sanchez JM, Solé Rodriguez M, Casaño FJ, Calderon C, Labrador M, Vahí M, Serrano J, Lumbreras E, Hernández-Rivas JM; Grupo Andaluz SMD. Prospective randomized trial of 5 days azacitidine versus supportive care in patients with lower-risk myelodysplastic syndromes without 5q deletion and transfusion-dependent anemia. Leuk Lymphoma. 2017 Aug 24:1-10. doi:10.1080/10428194.2017.1366998
51. Jabbour E, Short NJ, Montalban-Bravo G, Huang X, Bueso-Ramos C, Qiao W, Yang H, Zhao C, Kadia T, Borthakur G, Pemmaraju N, Sasaki K, Estrov Z, Cortes J, Ravandi F, Alvarado Y, Komrokji R, Sekeres MA, Steensma DP, DeZern A, Roboz G, Kantarjian H, Garcia-Manero G. Randomized phase 2 study of low-dose decitabine vs low-dose azacitidine in lower-risk MDS and MDS/MPN. Blood. 2017 Sep 28;130(13):1514-1522. doi: 10.1182/blood-2017-06-788497.
52. Park S, Hamel JF, Toma A, Kelaidi C, Thépot S, Campelo MD, Santini V, Sekeres MA, Balleari E, Kaivers J, Sapena R, Götze K, Müller-Thomas C, Beyne-Rauzy O, Stamatoullas A, Kotsianidis I, Komrokji R, Steensma DP, Fensterl J, Roboz GJ, Bernal T, Ramos F, Calabuig M, Guerci-Bresler A, Bordessoule D, Cony-Makhoul P, Cheze S, Wattel E, Rose C, Vey N, Gioia D, Ferrero D, Gaidano G, Cametti G, Pane F, Sanna A, Germing U, Sanz GF, Dreyfus F, Fenaux P. Outcome of Lower-Risk Patients With Myelodysplastic Syndromes Without 5q Deletion After Failure of Erythropoiesis-Stimulating Agents. J Clin Oncol. 2017 May 10;35(14):1591-1597 doi: 10.1200/JCO.2016.71.3271.
53. Silverman LR, McKenzie DR, Peterson BL, Holland JF, Backstrom JT, Beach CL, Larson RA; Cancer and Leukemia Group B. Further analysis of trials with azacitidine in patients with myelodysplastic syndrome: studies 8421, 8921, and 9221 by the Cancer and Leukemia Group B. J Clin Oncol. 2006 Aug 20;24(24):3895-903.
54. Fenaux P, Mufti GJ, Hellstrom-Lindberg E, et al: Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: A randomised, open-label, phase III study. Lancet Oncol 10: 223-232, 2009
55. Garcia-Manero G, Fenaux P. Hypomethylating agents and other novel strategies in myelodysplastic syndromes. J Clin Oncol. 2011 Feb 10;29(5):516-23. doi:10.1200/JCO.2010.31.0854. Epub 2011 Jan 10. Review
56. Odenike O. Incorporating novel approaches in the management of MDS beyond conventional hypomethylating agents. Hematology Am Soc Hematol Educ Program. 2017 Dec 8;2017(1):460-469. doi: 10.1182/asheducation-2017.1.460. Review.
57. Voso MT, Leone G, Piciocchi A, Fianchi L, Santarone S, Candoni A, Criscuolo M,Masciulli A, Cerqui E, Molteni A, Finelli C, Parma M, Poloni A, Carella AM, SpinaF, Cortelezzi A, Salvi F, Alessandrino EP, Rambaldi A, Sica S. Feasibility of allogeneic stem-cell transplantation after azacitidine bridge in higher-riskmyelodysplastic syndromes and low blast count acute myeloid leukemia: results of the BMT-AZA prospective study. Ann Oncol. 2017 Jul 1;28(7):1547-1553. doi:10.1093/annonc/mdx154.
58. Ofran Y, Filanovsky K, Gafter-Gvili A, Vidal L, Aviv A, Gatt ME, Silbershatz I, Herishanu Y, Arad A, Tadmor T, Dally N, Nemets A, Rouvio O, Ronson A, Herzog-Tzarfati K, Akria L, Braester A, Hellmann I, Yeganeh S, Nagler A, Leiba R, Mittelman M, Merkel D. Higher infection rate after 7- compared with 5-day cycle of azacitidine in patients with higher-risk myelodysplastic syndrome. Clin Lymphoma Myeloma Leuk. 2015 Jun;15(6): e95-9. doi: 10.1016/j.clml.2015.02.030
59. Schuck A, Goette MC, Neukirchen J, Kuendgen A, Gattermann N, Schroeder T, Kobbe G, Germing U, Haas R. A retrospective study evaluating the impact of infectious complications during azacitidine treatment. Ann Hematol. 2017Jul;96(7):1097-1104. doi: 10.1007/s00277-017-3001-2.
60. Falantes JF, Calderón C, Márquez-Malaver FJ, Aguilar-Guisado M, Martín-Peña A, Martino ML, Montero I, González J, Parody R, Pérez-Simón JA, Espigado I. Patterns of infection in patients with myelodysplastic syndromes and acute myeloid leukemia receiving azacitidine as salvage therapy. Implications for primary antifungal prophylaxis. Clin Lymphoma Myeloma Leuk. 2014 Feb;14(1):80-6. doi:10.1016/j.clml. 2013.09.014.
61. Stamatoullas A, Rezine I, Mareschal S, Ménard AL, Lanic H, David M, Daliphard S, Penther D, Lemasle E, Cassuto O, Lenain P, Contentin N, Lepretre S, Jardin F, Bastard C, Tilly H. Hypoalbuminemia and hypergammaglobulinemia are associated with an increased infection risk in patients with myeloid malignancies treated with azacitidine. A 3-year monocentric retrospective study. Leuk Lymphoma. 2016;57(6):1491-3. doi: 10.3109/10428194.2015.1101096.
62. Trubiano JA, Dickinson M, Thursky KA, Spelman T, Seymour JF, Slavin MA, Worth LJ. Incidence, etiology and timing of infections following azacitidine therapy for myelodysplastic syndromes. Leuk Lymphoma. 2017 Oct;58(10):2379-2386. doi:10.1080/10428194.2017.1295141
63. Lorenzana N, Avila LF, Alonso S, Colado E, Bernal T. The impact of antimicrobial prophylaxis in morbidity and infections during azacitidine treatment. Ann Hematol. 2017 Nov;96(11):1833-1840. doi:10.1007/s00277-017-3091-x
64. Pomares H, Arnan M, Sánchez-Ortega I, Sureda A, Duarte RF. Invasive fungal infections in AML/MDS patients treated with azacitidine: a risk worth considering antifungal prophylaxis? Mycoses. 2016 Aug;59(8):516-9. doi: 10.1111/myc.12500. Epub 2016 Mar 30. PubMed PMID: 27027972.
65. Radsak M, Platzbecker U, Schmidt CS, Hofmann WK, Nolte F. Infectious
complications in patients with myelodysplastic syndromes: A review of the literature with emphasis on patients treated with 5-azacitidine. Eur J Haematol. 2017;99(2):112-118. doi: 10.1111/ejh.12883.
66. Fenaux P, Mufti GJ, Hellström-Lindberg E, Santini V, Gattermann N, Sanz G, List AF, Gore SD, Seymour JF, Backstrom J, Zimmerman L, McKenzie D, Beach CL, Silverman LB. Azacitidine prolongs overall survival and reduces infections and hospitalizations in patients with WHO-defined acute myeloid leukaemia compared with conventional care regimens: an update. Ecancermedicalscience. 2008; 2:121. doi: 10.3332/ecancer.2008.121.
67. Lübbert M, Suciu S, Baila L, Rüter BH, Platzbecker U, Giagounidis A, Selleslag D, Labar B, Germing U, Salih HR, Beeldens F, Muus P, Pflüger KH, Coens C, Hagemeijer A, Eckart Schaefer H, Ganser A, Aul C, de Witte T, Wijermans PW. Low-dose decitabine versus best supportive care in elderly patients with intermediate- or high-risk myelodysplastic syndrome (MDS) ineligible for intensive chemotherapy: final results of the randomized phase III study of the European Organisation for Research and Treatment of Cancer Leukemia Group and the German MDS Study Group. J Clin Oncol. 2011 May 20;29(15):1987-96. doi: 10.1200/JCO.2010.30.9245.
68. Ali AM, Weisel D, Gao F, Uy GL, Cashen AF, Jacoby MA, Wartman LD, Ghobadi A, Pusic I, Romee R, Fehniger TA, Stockerl-Goldstein KE, Vij R, Oh ST, Abboud CN,Schroeder MA, Westervelt P, DiPersio JF, Welch JS. Patterns of infectious complications in acute myeloid leukemia and myelodysplastic syndromes patients treated with 10-day decitabine regimen. Cancer Med. 2017 Dec;6(12):2814-2821. doi: 10.1002/cam4.1231
69. Lee JH, Lee KH, Lee JH, Kim DY, Kim SH, Lim SN, Kim SD, Choi Y, Lee SM, LeeWS, Choi MY, Joo YD. Decreased incidence of febrile episodes with antibiotic prophylaxis in the treatment of decitabine for myelodysplastic syndrome. Leuk Res. 2011 Apr;35(4):499-503. doi: 10.1016/j.leukres.2010.07.006. Epub 2010 Jul PubMed PMID: 20674021
70. Oosterveld M, Muus P, Suciu S, Koller C, Verhoef G, Labar B, Wijermans P, Aul C, Fière D, Selleslag D, Willemze R, Gratwohl A, Ferrant A, Mandelli F, Cortes J, de Witte T, Estey E; EORTC, EBMT, SAKK, GIMEMA Leukemia Groups and the MD Anderson Cancer Center. Chemotherapy only compared to chemotherapy followed by transplantation in high risk myelodysplastic syndrome and secondary acute myeloid leukemia; two parallel studies adjusted for various prognostic factors. Leukemia. 2002 Sep;16(9):1615-21.
71. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis 2011;52:e56–93.
72. Barreto JN, Beach CL, Wolf RC, Merten JA, Tosh PK, Wilson JW, Hogan WJ, Litzow MR. The incidence of invasive fungal infections in neutropenic patients with acute leukemia and myelodysplastic syndromes receiving primary antifungal prophylaxis with voriconazole. Am J Hematol. 2013 Apr;88(4):283-8. doi:10.1002/ajh.23388.
73. Walter RB, Lee SJ, Gardner KM, Chai X, Shannon-Dorcy K, Appelbaum FR, EsteyEH. Outpatient management following intensive induction chemotherapy for myelodysplastic syndromes and acute myeloid leukemia: a pilot study. Haematologica. 2011 Jun;96(6):914-7. doi: 10.3324/haematol.2011.040220.
74. Vaughn JE, Othus M, Powell MA, Gardner KM, Rizzuto DL, Hendrie PC, Becker PS, Pottinger PS, Estey EH, Walter RB. Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis. JAMA Oncol. 2015 Nov;1(8):1120-7. doi: 10.1001/jamaoncol.2015.2969.
75. Mele L, Ricci P, Nosari A, Tonso A, Fianchi L, Cudillo L, Pagano L.Filamentous fungi infection in patients with myelodysplastic syndrome. A report of twelve cases. Leuk Lymphoma. 2002 Jul;43(7):1421-5.
76. Vardiman J. The classification of MDS: from FAB to WHO and beyond. Leuk Res. 2012 Dec;36(12):1453-8. doi: 10.1016/j.leukres.2012.08.008. Epub 2012 Aug 30. Review. PubMed PMID: 22940257.
77. de Witte T, Suciu S, Verhoef G, Labar B, Archimbaud E, Aul C, Selleslag D,Ferrant A, Wijermans P, Mandelli F, Amadori S, Jehn U, Muus P, Boogaerts M, Zittoun R, Gratwohl A, Zwierzina H, Hagemeijer A, Willemze R. Intensive chemotherapy followed by allogeneic or autologous stem cell transplantation for patients with myelodysplastic syndromes (MDSs) and acute myeloid leukemia following MDS. Blood. 2001 Oct 15;98(8):2326-31.
78. Nakai K, Kanda Y, Fukuhara S, Sakamaki H, Okamoto S, Kodera Y, Tanosaki R, Takahashi S, Matsushima T, Atsuta Y, Hamajima N, Kasai M, Kato S. Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome. Leukemia. 2005 Mar;19(3):396-401.
79. Alessandrino EP, Della Porta MG, Pascutto C, Bacigalupo A, Rambaldi A. Should cytoreductive treatment be performed before transplantation in patients withhigh-risk myelodysplastic syndrome? J Clin Oncol. 2013 Jul 20;31(21):2761-2. Doi :10.1200/JCO.2012.48.0525.
80. de Witte T, Bowen D, Robin M, Malcovati L, Niederwieser D, Yakoub-Agha I, Mufti GJ, Fenaux P, Sanz G, Martino R, Alessandrino EP, Onida F, Symeonidis A, Passweg J, Kobbe G, Ganser A, Platzbecker U, Finke J, van Gelder M, van de Loosdrecht AA, Ljungman P, Stauder R, Volin L, Deeg HJ, Cutler C, Saber W, Champlin R, Giralt S, Anasetti C, Kröger N. Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel. Blood. 2017 Mar 30;129(13):1753-1762. doi: 10.1182/blood-2016-06-724500. Review.
81. Scott BL, Pasquini MC, Logan BR, Wu J, Devine SM, Porter DL, Maziarz RT,Warlick ED, Fernandez HF, Alyea EP, Hamadani M, Bashey A, Giralt S, Geller NL,Leifer E, Le-Rademacher J, Mendizabal AM, Horowitz MM, Deeg HJ, Horwitz ME. Myeloablative Versus Reduced-Intensity Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes. J Clin Oncol. 2017 ;35(11):1154-1161. doi: 10.1200/JCO.2016.70.7091.
82. Kröger N, Iacobelli S, Franke GN, Platzbecker U, Uddin R, Hübel K, Scheid C, Weber T, Robin M, Stelljes M, Afanasyev B, Heim D, Deliliers GL, Onida F, Dreger P, Pini M, Guidi S, Volin L, Günther A, Bethge W, Poiré X, Kobbe G, van Os M, Brand R, de Witte T. Dose-Reduced Versus Standard Conditioning Followed by Allogeneic Stem-Cell Transplantation for Patients With Myelodysplastic Syndrome: A Prospective Randomized Phase III Study of the EBMT (RICMAC Trial). J Clin Oncol. 2017 Jul 1;35(19):2157-2164. doi: 10.1200/JCO.2016.70.7349.
83. Brissot E, Cahu X, Guillaume T, Delaunay J, Ayari S, Peterlin P, Le Bourgeois A, Harousseau JL, Milpied N, Bene MC, Moreau P, Mohty M, Chevallier P. Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation. Ann Hematol. 2015 Apr;94(4):663-9. doi: 10.1007/s00277-014-2259-
84. Mellinghoff SC, Panse J, Alakel N, Behre G, Buchheidt D, Christopeit M,Hasenkamp J, Kiehl M, Koldehoff M, Krause SW, Lehners N, von Lilienfeld-Toal M,Löhnert AY, Maschmeyer G, Teschner D, Ullmann AJ, Penack O, Ruhnke M, Mayer K,Ostermann H, Wolf HH, Cornely OA. Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Ann Hematol. 2018; 97(2):197-207. doi: 10.1007/s00277-017-3196-2.
85. Scott BL, Park JY, Deeg HJ, Marr KA, Boeckh M, Chauncey TR, Appelbaum FR, Storb R, Storer BE. Pretransplant neutropenia is associated with poor-risk cytogenetic features and increased infection-related mortality in patients with myelodysplastic syndromes. Biol Blood Marrow Transplant. 2008 ;14(7):799-806. doi: 10.1016/j.bbmt.2008.04.011.
86. Kontoyiannis DP, Chamilos G, Lewis RE, Giralt S, Cortes J, Raad II et al. Increased bone marrow iron stores is an independent risk factor for invasive aspergillosis in patients with high-risk hematologic malignancies and recipients of allogeneic hematopoietic stem cell transplantation. Cancer 2007; 110: 1303–1306
87. Kanda J, Mizumoto C, Ichinohe T, Kawabata H, Saito T, Yamashita K et al. Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2011; 46: 208–216
88. Tachibana T, Tanaka M, Takasaki H, Numata A, Ito S, Watanabe R et al. Pretransplant serum ferritin is associated with bloodstream infections within 100 days of allogeneic stem cell transplantation for myeloid malignancies. Int J Hematol 2011; 93: 368–374.
89. Ohmoto A, Fuji S, Miyagi-Maeshima A, Kim SW, Tajima K, Tanaka T, Okinaka K, Kurosawa S, Inamoto Y, Taniguchi H, Fukuda T. Association between pretransplant iron overload determined by bone marrow pathological analysis and bacterial infection. Bone Marrow Transplant. 2017; 52(8):1201-1203. doi: 10.1038/bmt.2017.93.
90. Hilken A, Langebrake C, Wolschke C, Kersten JF, Rohde H, Nielsen P, Kröger N. Impact of non-transferrin-bound iron (NTBI) in comparison to serum ferritin on outcome after allogeneic stem cell transplantation (ASCT). Ann Hematol. 2017 Aug;96(8):1379-1388. doi: 10.1007/s00277-017-3034-6.
91. Jacobi N, Herich L. Measurement of liver iron concentration by superconducting quantum interference device biomagnetic liver susceptometry validates serum ferritin as prognostic parameter for allogeneic stem cell transplantation. Eur J Haematol. 2016 Oct;97(4):336-41. doi: 10.1111/ejh.12734.
92. Gerds AT, Gooley TA, Estey EH, Appelbaum FR, Deeg HJ, Scott BL. Pretransplantation therapy with azacitidine vs induction chemotherapy and posttransplantation outcome in patients with MDS. Biol Blood Marrow Transplant. 2012 Aug;18(8):1211-8. doi: 10.1016/j.bbmt.2012.01.009.
93. Voso MT, Leone G, Piciocchi A, Fianchi L, Santarone S, Candoni A, Criscuolo M, Masciulli A, Cerqui E, Molteni A, Finelli C, Parma M, Poloni A, Carella AM, Spina F, Cortelezzi A, Salvi F, Alessandrino EP, Rambaldi A, Sica S. Feasibility of allogeneic stem-cell transplantation after azacitidine bridge in higher-risk myelodysplastic syndromes and low blast count acute myeloid leukemia: results of the BMT-AZA prospective study. Ann Oncol. 2017 Jul 1;28(7):1547-1553. doi:10.1093/annonc/mdx154.
94. Nishihori T, Perkins J, Mishra A, Komrokji R, Kim J, Kharfan-Dabaja MA, Perez L, Lancet J, Fernandez H, List A, Anasetti C, Field T. Pretransplantation 5-azacitidine in high-risk myelodysplastic syndrome. Biol Blood Marrow Transplant. 2014 Jun;20(6):776-80. doi: 10.1016/j.bbmt.2014.02.008.
95. Lukenbill J, Rybicki L, Sekeres MA, Zaman MO, Copelan A, Haddad H, Fraser T,DiGiorgio MJ, Hanna R, Duong H, Hill B, Kalaycio M, Sobecks R, Bolwell B, Copelan E. Defining incidence, risk factors, and impact on survival of central line-associated blood stream infections following hematopoietic cell transplantation in acute myeloid leukemia and myelodysplastic syndrome. Biol Blood Marrow Transplant. 2013 May;19(5):720-4. doi: 10.1016/j.bbmt.2013.01.022

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