Significance of the tendency for relative bradycardia during induction therapy for acute myeloid leukemia

Ryutaro Tominaga; Shin-Ichiro Fujiwara; Seina Honda; Daizo Yokoyama; Atsuto Noguchi; Shuka Furuki; Shunsuke Koyama; Rui Murahashi; Hirotomo Nakashima; Kazuki Hyodo; Shin-Ichiro Kawaguchi; Yumiko Toda; Kento Umino; Daisuke Minakata; Masahiro Ashizawa; Chihiro Yamamoto; Kaoru Hatano; Kazuya Sato; Ken Ohmine; Yoshinobu Kanda

doi:10.1007/s12185-025-04070-5

Significance of the tendency for relative bradycardia during induction therapy for acute myeloid leukemia

Int J Hematol. 2025 Sep 18. doi: 10.1007/s12185-025-04070-5. Online ahead of print.

Authors

Ryutaro Tominaga¹, Shin-Ichiro Fujiwara^{1

2}, Seina Honda¹, Daizo Yokoyama¹, Atsuto Noguchi¹, Shuka Furuki¹, Shunsuke Koyama¹, Rui Murahashi^{1

2}, Hirotomo Nakashima¹, Kazuki Hyodo¹, Shin-Ichiro Kawaguchi¹, Yumiko Toda¹, Kento Umino¹, Daisuke Minakata¹, Masahiro Ashizawa¹, Chihiro Yamamoto^{1

2}, Kaoru Hatano¹, Kazuya Sato¹, Ken Ohmine¹, Yoshinobu Kanda³

Affiliations

¹ Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
² Division of Cell Transplantation and Transfusion, Jichi Medical University, Shimotsuke, Tochigi, Japan.
³ Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. ycanda-tky@umin.ac.jp.

PMID: 40965710
DOI: 10.1007/s12185-025-04070-5

Abstract

This study explored the relationship between body temperature (BT) and heart rate (HR) data during acute myeloid leukemia (AML) treatment, using relative bradycardia (RB) as an index. RB trends were also assessed in confirmed infections and during intensive chemotherapy. Data from AML patients who received induction therapy (anthracycline and cytarabine) at Jichi Medical University Hospital between May 2015 and December 2023 were analyzed. A total of 1000 febrile events (axillary temperature ≥ 37.8 °C) in 97 patients were included. Multivariate analysis showed an HR increase of 6.57 bpm (95% CI 4.44-8.70) per 1 °C rise in BT. RB, defined as BT ≥ 37.8 °C with HR < 90 bpm, was observed in 630 events (63.0%). RB was more likely with age ≥ 44 years, hemoglobin ≥ 6.5 g/dL, and reduced-intensity regimens. In contrast, BT ≥ 38.6 °C, diastolic BP ≥ 70 mmHg, oxygen therapy, CRP ≥ 7.13 mg/dL, and incomplete hematologic recovery decreased the likelihood of RB. In addition, RB was significantly associated with documented infection (OR = 2.32, 95% CI 1.17-4.61, p = 0.016). RB frequently occurred during AML induction therapy, and may serve as an indicator of infection.

Keywords: Acute myeloid leukemia; Febrile neutropenia; Heart rate; Infection; Relative bradycardia.