Invasive pulmonary aspergillosis resulting in respiratory failure during neutrophil recovery from postchemotherapy neutropenia in three patients with acute leukaemia

Teratani, Takuma; Okada, Kaoru; Uchida, Yoshiko; Yamagata, Atsuko; Sawae, Yoshinori

doi:10.1046/j.1365-2796.2002.01012.x

Cited by 18 publications

(14 citation statements)

References 16 publications

(28 reference statements)

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“…These include longer neutropenia duration [9], preexisting respiratory failure or infection [8,12,13,15], the need for mechanical ventilation [12], and G-CSF use [11,13,16]. Nevertheless, the pathophysiology of WRS remains debated.…”

Section: Discussionmentioning

confidence: 99%

Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study

Balsat

Xhaard²,

Lengliné³

et al. 2015

Respiration

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Background: Neutropenia recovery (NR) has been associated with worsening preexisting lung injury in up to 50% of critically ill cancer patients. However, only limited relevant data exist in the general population of hematological patients. Objectives: To assess the incidence of acute respiratory deterioration during NR in patients with hematological malignancies. Methods: Adult patients with neutropenia expected to last more than 7 days were included. Worsening of respiratory status (WRS) was defined as a decrease in oxygen saturation of ≥5%, the need for oxygen therapy for ≥24 h, an increase in oxygen flow of ≥50% in patients previously treated with oxygen, or the need for mechanical ventilation. NR was defined as the 3 days preceding or following a neutrophil count of >0.5 × 10⁹/l. Results: A total of 16 of 50 patients included in this pilot study experienced WRS during NR (32%), and 13 patients had WRS during neutropenia (26%). The incidence density of WRS was 0.53 (±0.79) episodes per 10 days during NR and 0.20 (±0.39) episodes per 10 days during neutropenia (p = 0.004). Sepsis, stem cell transplantation, preexisting pneumonia, or the use of granulocyte colony-stimulating factor were not associated with WRS during NR. Conclusion: Up to one third of noncritically ill hematological patients with expected neutropenia of more than 7 days experience WRS during NR. Clinical consequences and risk factors for WRS during NR remain to be evaluated.

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Section: Discussionmentioning

confidence: 99%

Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study

Balsat

Xhaard²,

Lengliné³

et al. 2015

Respiration

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“…Additionally, worsening chest X-ray, respiratory failure, haemoptysis, or pneumothorax during neutrophil recovery had been reported in patients with invasive aspergillosis and hematologic cancer [92,93]. The rapidity of PMN recovery was critical for the development of the above complications; patients with rapid PMN recovery were more likely to develop these complications than those without [75% (6/8) vs. 17% (2/12), P < 0.001] [93].…”

Section: Neutropenic Hostsmentioning

confidence: 99%

“…In the past, the above situations were generally ascribed to the progression of aspergillosis or the consequence of hemopoietic growth factor use [91,92]. Prompt antifungal modifications or extensive surgical debridement were the most common management strategies, although addition of corticosteroid alone improved clinical conditions in some patients [91,92].…”

Section: Neutropenic Hostsmentioning

confidence: 99%

“…Prompt antifungal modifications or extensive surgical debridement were the most common management strategies, although addition of corticosteroid alone improved clinical conditions in some patients [91,92]. Recently, despite clinical and radiologic deterioration of invasive pulmonary aspergillosis during neutrophil recovery, a study demonstrated the declining titers of sequential serum galactomannan without antifungal treatment modifications in neutropenic patients [19].…”

Section: Neutropenic Hostsmentioning

confidence: 99%

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Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients

Sun

Singh

2009

Current Opinion in Infectious Diseases

114

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Non-HIV immunocompromised hosts develop immune reconstitution inflammatory syndrome when the sudden change in the dominant T helper responses to inflammation is not well balanced by anti-inflammatory responses. Judicious manipulation of host immunity and timely recognition of immune reconstitution inflammatory syndrome as we deal with the infections in these populations is critical to limit or avoid the harm by immune reconstitution inflammatory syndrome.

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“…Many case series of ARDS developing during neutrophil recovery have also been described. 6,7,13,14 In our cohort of children with AHRF and cancer or HSCT, neutrophil recovery was not associated with worsened oxygenation in the majority of patients. However, approximately one-fourth of this cohort did develop worsening of oxygenation as reflected by a lower PaO 2 /FiO 2 .…”

Section: Discussionmentioning

confidence: 67%

Impact of Neutrophil Recovery on Oxygenation in Pediatric Oncology Patients With Acute Hypoxemic Respiratory Failure

Elbahlawan

Morrison

Jeha

et al. 2011

Journal of Pediatric Hematology/Oncology

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Neutrophil recovery has been implicated in deterioration of oxygenation and exacerbation of lung injury in pediatric oncology patients. Our objectives were to determine the impact of neutrophil recovery on oxygenation in pediatric oncology patients with acute hypoxemic respiratory failure (AHRF) and to identify risk factors that result in oxygenation worsening. A cohort of 24 neutropenic pediatric oncology patients with AHRF in whom neutrophil recovery occurred during a course of mechanical ventilation was evaluated. Oxygenation index (OI) and PaO(2)/FiO(2) ratio showed a trend of improvement after neutrophil recovery. Mean PaO(2)/FiO(2) pre-recovery was 205±48.67 versus 225±72.24 postrecovery (P=0.08), whereas mean pre-recovery OI was 9.39±0.96 compared with 8.31±1.1 postrecovery (P=0.078). Seven episodes (24% of the total episodes) of recovery were characterized by worsening of oxygenation. Tripling absolute neutrophil count on Day+2 compared with Day+1 postrecovery was associated with 28-fold increase in risk of oxygenation worsening. In conclusion, resolution of neutropenia lead to significant deterioration of oxygenation in 24% of episodes of neutrophil recovery in a pediatric oncology cohort with AHRF. Our findings suggest that a faster ANC increment in the 2 days after recovery is associated with an increased risk of oxygenation worsening.

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Invasive pulmonary aspergillosis resulting in respiratory failure during neutrophil recovery from postchemotherapy neutropenia in three patients with acute leukaemia

Abstract: Abstract. Takuma T,

Cited by 18 publications

References 16 publications

Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study

Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study

Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients

Impact of Neutrophil Recovery on Oxygenation in Pediatric Oncology Patients With Acute Hypoxemic Respiratory Failure

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