Neutropenic enterocolitis following treatment with cytosine arabinoside-containing regimens for hematological malignancies: A potentiating role for amsacrine

Vlasveld, L Th; Zwaan, F. E.; Fibbe, Willem E.; Tham, Richard; Kluin, Philip M.; Willemze, R.

doi:10.1007/bf01702926

Cited by 26 publications

(14 citation statements)

References 31 publications

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“…NEC develops in neutropenic patients due to deep wall infection or intestinal inflammation. The incidence of NEC among the lower GI bleeders in our study was 25% (three cases of 12), which is in agreement with other reports [33,34]. Solitary ulcers of the small or large intestine can result from a wide variety of cause.…”

Section: Discussionsupporting

confidence: 82%

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Incidence and Etiology of Overt Gastrointestinal Bleeding in Adult Patients with Aplastic Anemia

et al. 2009

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Patients with thrombocytopenia caused by various neoplastic and primary bone marrow diseases are susceptible to major hemorrhage. There are few reports addressing the incidence and outcome of gastrointestinal (GI) bleeding in patients with aplastic anemia characterized by long-standing thrombocytopenia. We sought to retrospectively determine the incidence, etiology, clinical outcomes, and risk factors associated with overt GI bleeding in patients with aplastic anemia. We analyzed the medical records of 508 patients with aplastic anemia after excluding patients below 15 years of age or those who underwent stem cell transplantation between January 1, 2002, and December 31, 2007. A total of 32 patients developed overt GI bleeding during this period. We evaluated the site, etiology, outcomes, and major risk factors in these patients who developed GI bleeding episodes. The incidence of GI bleeding was 6.3% (32 of 508 patients) in adult patients with aplastic anemia. The incidence increased to 12.6% (28 of 222 patients) in patients with severe disease. One patient died from massive GI bleeding. Bleeding sites included the esophagus (two patients, 6.3%), stomach (five, 16.3%), duodenum (two, 6.3%), small intestine (five, 15.6%), large intestine (seven, 21.6%), and unknown site (11, 34.4%). Lower GI bleeds mainly caused by neutropenic enterocolitis (NEC) and solitary ulcer developed more frequently than upper GI bleeds. The major risk factors for GI bleeding included old age (P = 0.004, odds ratio (OR) = 1.039), severe aplastic anemia (P < 0.001, OR = 11.934), non-response to therapy (P = 0.001, OR = 5.652), and major bleeding history in another organ (P < 0.001, OR = 6.677). Overt GI bleeding in patients with aplastic anemia more frequently develops in the lower tract than in the upper tract. The risk of GI bleeding is higher in patients with the following risk factors: older age, severe disease, poor response to treatment, and major bleeding history in another organ.

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Section: Discussionsupporting

confidence: 82%

“…The main causes of bleeding in the lower GI tract were NEC and solitary ulcers. Previous reports on immunocompromised patients have also found that NEC is a major cause of lower GI bleeding [9,33,34]. NEC develops in neutropenic patients due to deep wall infection or intestinal inflammation.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Etiology of Overt Gastrointestinal Bleeding in Adult Patients with Aplastic Anemia

et al. 2009

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“…Nausea, vomiting and diarrhea are the well-known gastrointestinal side-effects of cytosine arabinoside and the severity of these symptoms is related to both dosage and duration of treatment [2,4,7]. The ulcerations of the mucosae caused by antileukemic chemotherapy drugs, and the blunting of host defenses caused by the underlying disease, the steroids used and the prolonged deep neutropenia are all factors that may contribute to the pathogenesis and to the evolution of the gastrointestinal tract infections and, as described by others, the problem seems to be linked more to the association of drugs (cytarabine and idarubicin) than to a specific agent [4].…”

Section: Discussionmentioning

confidence: 99%

High incidence of infectious gastrointestinal complications observed in patients with acute myeloid leukemia receiving intensive chemotherapy for first induction of remission

Micozzi

Cartoni

Monaco

et al. 1996

Support Care Cancer

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An increased incidence of severe infections, in particular gastrointestinal complications, was observed in our institution among 35 consecutive patients with acute myelogenous leukemia submitted to their first intensive pilot protocol for induction of remission containing idarubicin, etoposide and cytosine arabinoside. Ten patients presented fever and severe diarrhea (4 or more loose stools/day for at least 4 consecutive days); 3 of these developed ileothyphlitis, which proved fatal in 2 cases, 7 needed amphotericin B addition to antibacterial treatment and, in 6 cases, a fungal infection was documented. We have compared these 10 patients with the other 25 submitted to the same chemotherapeutic protocol and the incidence of candidemias (5/10 compared to 0/25), the early use of systemic fluconazole from the onset of fever (0/10 compared to 9/25) and the pre-emptive use of total parenteral nutrition (0/10 compared to 8/25) differed in the two groups. We conclude that during this chemotherapeutic protocol the incidence of severe gastrointestinal infectious complications was particularly high (28.5%) and, even though only a small number of patients were studied, our results suggest an important role for Candida spp. in the pathogenesis of this disease.

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“…It is most often associated with leukemia and lymphoma [1,2]. Rarely, it has been described in patients with solid tumors.…”

Section: Introductionmentioning

confidence: 96%

Neutropenic enterocolitis (typhilitis) associated with docetaxel therapy in a patient with non-small-cell lung cancer: case report and review of literature

et al. 2004

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Neutropenic enterocolitis following treatment with cytosine arabinoside-containing regimens for hematological malignancies: A potentiating role for amsacrine

Cited by 26 publications

References 31 publications

Incidence and Etiology of Overt Gastrointestinal Bleeding in Adult Patients with Aplastic Anemia

Incidence and Etiology of Overt Gastrointestinal Bleeding in Adult Patients with Aplastic Anemia

High incidence of infectious gastrointestinal complications observed in patients with acute myeloid leukemia receiving intensive chemotherapy for first induction of remission

Neutropenic enterocolitis (typhilitis) associated with docetaxel therapy in a patient with non-small-cell lung cancer: case report and review of literature

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