Quantitative Relationships Between Circulating Leukocytes and Infection in Patients with Acute Leukemia

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Abstract
The granulocyte and lymphocyte levels of 52 patients with acute leukemia were tabulated during their entire illness. A total of 17, 743 patient days were considered. The patients were in bone marrow remission of their acute leukemia during 62% of the time. Granulocytopenia (less than 1000 per cu mm) and lymphopenia occurred frequently, even during remission. The percentage of time spent with identified infection decreased with increasing granulocyte levels. This relationship applied both during relapse and remission, but the proportion of time spent with infection at every granulocyte level was greater during relapse. Similar relationships existed for lymphocytes. The proportion of time spent with low granulocyte or lymphocyte levels (less than 500 per cu mm) increased with increasingly severe types of infection. Although the risk of developing infection was related to both granulocyte and lymphocyte levels, the granulocyte level was clearly more important. Infection occurred more often with granulocytopenia alone than with lymphopenia alone. Thirty-six per cent of severe infectious episodes (pneumonias, urinary tract infections, septicemias, disseminated fungal infections, etc.) were associated with a fall in granulocyte level during the preceding week. Twelve per cent of all episodes of falling granulocyte levels during any one-week period terminated in severe infection. Any episode of granulocytopenia, regardless of its duration, had a 39% chance of resulting in identified infection. As the duration of granulocytopenia lengthened, the risk increased. Severe infection caused a subsequent fall in the granulocyte level as frequently as it caused an increase. The granulocyte response to infection was similar during relapse and remission. The fatality rate for severe infection was highest for patients who had granulocyte levels persistently less than 100 per cu mm. The fatality rate was lower for patients who responded to infection with a rise in their granulocyte level.

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