How does the presence of concurrent infections or wound issues affect your choice and timing of induction in patients with AML or MDS with excess blasts?

Many patients are diagnosed with AML or MDS with excess blasts after presenting with acute infections. In these circumstances, early recognition and initiation of broad spectrum antibiotics to prevent sepsis is essential. We typically delay induction chemotherapy until the infection is under control (i.e. no longer febrile, clear improvement in wound healing), typically a few days. However, we have found that it is critical not to delay chemotherapy too long (such as to complete an entire course of 7-14 days of antibiotics) as patients may succumb to other adverse events due to the aggressive myeloid neoplasm if treatment is not initiated.