Typhlitis complicating autologous blood stem cell transplantation for breast cancer

Abstract

Summary:Three cases of typhlitis occurring during autologous blood stem cell transplantation (ABSCT) for metastatic breast cancer are described. Typhlitis is a rare complication of neutropenia and has uncommonly been reported in the autologous transplant setting. Although it has been most commonly described in children with leukemia, typhlitis has increasingly been reported in adult leukemias and in association with neutropenia secondary to chemotherapy for a number of solid tumors. Only five previous cases of typhlitis in the setting of ABSCT have been described. Whereas diarrhea and fever are common toxicities associated with high-dose chemotherapy, it is likely that many cases of typhlitis go unrecognized. Bone Marrow Transplantation (2000) 25, 321-326. Keywords: typhlitis; neutropenic enterocolitis; breast cancer; stem cell transplantation Typhlitis was initially described in 1970 as a life-threatening condition occurring in children with leukemia.1 This condition is characterized by a necrotizing colitis usually localized to the cecum. Although most reports involve children with leukemia or aplastic anemia, 2-7 in recent years cases involving adults with hematologic malignancies have been described. [8][9][10][11][12][13] In addition, reports of typhlitis in patients with solid tumors treated with myelosuppressive doses of chemotherapy have appeared in the literature. [14][15][16] To date there have been five reported cases of typhlitis occurring in patients undergoing high-dose chemotherapy with autologous blood stem cell transplant (ABSCT), three from Hadassah University Hospital [17][18][19] and two from the Beth Israel-Deaconess Medical Center. 20 We describe our experiences with three additional cases of typhlitis complicating ABSCT for metastatic breast cancer. The frequency of typhlitis is likely to be underestimated given that Case 1A 33-year-old athletic white female with stage IV carcinoma of the breast was treated with three cycles of adriamycin and cyclophosphamide (AC) chemotherapy with good response. She was randomized to receive GM-CSF (Immunex, Seattle, WA, USA) 375 g/m 2 /day after cyclophosphamide for mobilization of peripheral blood progenitor cells (PBPC). Given the marginal numbers of total CD34 ϩ cells that were collected with two attempts at mobilization, a bone marrow harvest was performed to serve as a backup in the event of engraftment failure. She then received the STAMP V high-dose regimen (carboplatin, cyclophosphamide, thiotepa) with daily itraconazole and acyclovir for infection prophylaxis. After infusion of the PBPC, the patient received PIXY321 (Immunex) (a recombinant GM-CSF/IL3 fusion protein) 375 g/m 2 twice a day. On day ϩ2, she was noted to be neutropenic and febrile (38.3°C) with loose stools, and was placed on broad spectrum antibiotics. On day ϩ3, she developed abdominal pain with copious diarrhea (3 liters/day). Physical examination revealed diminished bowel sounds and a diffusely tender abdomen without rebound tenderness. A radiograph of the abdomen (Figure 1) on...

GI complications in pediatric patients post-BMT

“…The majority of the published data regarding these complications comes from adult studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] A paucity of information exists in the published literature regarding the incidence, range and severity of gastrointestinal (GI) complications in pediatric patients in the immediate post-BMT period. 19,20 The majority of the pediatric studies examined specific complications such as veno-occlusive disease (VOD), acute pancreatitis or typhilitis in fairly homogeneous patient populations.…”

Typhlitis in breast cancer patient using Docetaxel­based chemotherapy: case report

“…It is believed to be caused by the proliferation of myelotoxic chemotherapeutic regimens in adult leukemia and the use of combined chemotherapy in solid tumors. It also occurs in immunocompromised patients due to organ transplantation 6,7 .…”

“…However, other microorganisms such as species of Pseudomonas and E. Coli, among other bacteria, fungi and viruses, have also been reported. Predilection for the cecum is possibly related to its unique properties, including greater distensibility, lower vascular perfusion, and increased lymphatic drainage [3][4][5][6][7][8][9][10][11][12] .…”

Cancer Chemotherapy: A Review Update of the Mechanisms of Actions, Prospects, and Associated Problems

“…Another serious problem of immune compromised patients, caecitisis-infection of the gut-includes diarrhea, nausea, vomiting, fever and distended abdomen etc (Keidan et al, 2009). Prolonged autoinfection manifests as systemic disease conditions like sepsis (Boggio et al, 2000).…”