Infections May Impact Survival, Quality of Life in Patients With MDS

Patients with myelodysplastic syndromes (MDS) may experience serious complications due to infections. However, more research regarding infections and antimicrobial prophylaxis (the use of medications to prevent infection) is needed in order to improve outcomes for patients with MDS.

“Overall, higher quality infection-related data are required to optimize care for patients with MDS,” researchers wrote in a review published in Seminars in Hematology. “The best data regarding infections and prophylaxis can be garnered from prospective trials. … Granularity regarding reporting of specific prophylaxis [antibacterial, antifungal, antiviral], category of infection [microbiologically defined, clinically defined or fever of unknown origin], severity of infection, pathogen [bacteria, fungal, viral, other], site of infection, treatment, and outcome associated with infection, would facilitate better conclusions about infections and hence antimicrobial prophylaxis for patients with MDS.

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MDS, according to the MDS Foundation, encompasses a group of bone marrow disorders in which a patient’s bone marrow doesn’t produce enough healthy blood cells, and a primary feature of MDS is low blood cell counts, referred to as cytopenias.

A low white blood cell count, known as neutropenia, in turn reduces the body’s ability to resist bacterial infection, meaning that patients may be vulnerable to skin infections, sinus infections, lung infections or urinary tract infections, which may be accompanied by fever, the MDS Foundation explains on its website.

A team of researchers from the National Institutes of Health in Bethesda, Maryland, publishing their findings in Seminars in Hematology, noted that while preventing infections “could significantly improve both [patients’] survival and quality of life,” a number of factors — including the range of disorders studied in different publications, changing definitions and lack of standardized prophylaxis practices — mean that both infections and antimicrobial prophylaxis among patients with MDS have been “incompletely assessed” over time.

What We Know

Researchers, in reviewing historical data on infections among patients with MDS as well as infection-related literature from 2017 to today and data specifically related to antimicrobial prophylaxis, were able to make some basic statements regarding MDS and infections.

Infections, researchers noted, are associated with neutropenia, and the fact that patients with lower-risk MDS (LR-MDS) generally have fewer infections than patients with higher-risk MDS (HR-MDS) “may be related to the different prevalence of neutropenia in the two groups.”

According to the Sidney Kimmel Comprehensive Cancer Center Leukemia Program at Johns Hopkins Medicine in Baltimore, LR-MDS progresses more slowly and may cause mild to moderate anemia (a low count of red blood cells) and reductions in other types of cells, while HR-MDS may cause more severe deficits in blood cell counts.

The researchers found pneumonia to be the most common form of infection, with bacteria being the most common pathogen. On the other hand, both invasive fungal infections (IFI) and reactivation of latent viruses were found to be rare.

Researchers also listed what they found to be the risk factors for infections and adverse outcomes in patients with MDS:

• Neutropenia
• Advanced age
• Co-morbidities
• Frailty
• ECOG performance status (patients’ ability to perform daily tasks)
• Hypoalbuminemia (low levels of albumin in the blood)
• Having higher-risk MDS
• Transfusion dependence (requiring red blood cell transfusions to treat anemia)
• Iron overload
• Treatment with hypomethylating agents (HMAs, a type of chemotherapy drug)

“With the limited data available, we agree that antibacterial prophylaxis can be considered in patients with HR-MDS during severe neutropenia and early cycles of therapy when infections are most likely to occur,” researchers wrote. “Given the low prevalence of IFI and viral reactivation, antimicrobial prophylaxis for these pathogens is less likely to be advantageous for most patients, although antifungal prophylaxis with activity against mold is commonly used in patients with persistent, profound neutropenia. Ultimately, improved data collection regarding infections and antimicrobial prophylaxis is needed to improve care for patients with MDS.”

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