Neutropenic enterocolitis after high-dose chemotherapy and autologous stem cell transplantation: incidence, risk factors, and outcome
Neutropenic enterocolitis after high-dose chemotherapy and autologous stem cell transplantation: incidence, risk factors, and outcome
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DOI：
10.1111/j.1399-3062.2012.00777.x
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发表时间：
2013-02-01
影响因子：
2.6
通讯作者：
Komarnicki, M.
中科院分区：
文献类型：
--
作者：
Gil, L.;Poplawski, D.;Komarnicki, M.
背景。中性粒细胞减少性小肠结肠炎（NE）是强化化疗后发生的一种危及生命的并发症；然而，尚无造血干细胞移植（SCT）后 NE 发展的数据。本研究的目的是确定大剂量化疗和自体 SCT (autoSCT) 后 NE 的发生率、危险因素和结果。方法。共有 297 名符合 autoSCT 资格的非霍奇金淋巴瘤 (NHL)、霍奇金病、多发性骨髓瘤和急性髓系白血病成年患者进行了分析。患者接受卡莫司汀、依托泊苷、阿糖胞苷、美法仑 (BEAM) 调节；单独使用马法兰；或白消安和环磷酰胺(BuCy2)，并移植外周血或骨髓CD34(+)细胞。如果出现中性粒细胞减少性发热、腹痛或腹泻，以及腹部超声检查肠壁增厚 > 4 毫米，即可诊断 NE。 结果。 262 名患者 (88%) 发生中性粒细胞减少感染。 32 名患者 (12%) 在 SCT 后平均+3 (1-5) 天被诊断为 NE。 18 名患者出现血流感染，11 名患者出现革兰氏阴性菌感染。所有患者均接受碳青霉烯类药物和全肠外营养以及肠道休息的保守治疗。 9 例患者病程并发肠梗阻或感染性休克，其中 3 例（9.6%）患者死亡。在单变量分析中，NHL 的初始诊断（P = 0.017）和 BEAM 调节（P = 0.043）具有预后价值。在多变量分析中，只有NHL的初始诊断（P = 0.017）具有预后意义。结论。 NE 是接受 autoSCT 患者的一种罕见但严重的并发症。革兰氏阴性菌仍然是主要的致病病原体。腹部超声检查可以进行早期诊断和治疗，对大多数无需手术的患者有效。在我们的分析中，NE 在接受 BEAM 方案治疗的 NHL 患者中更为常见。
Background. Neutropenic enterocolitis (NE) is a life-threatening complication occurring after intensive chemotherapy; however, no data are available on NE development after hematopoietic stem cell transplantation (SCT). The aim of this study was to determine the incidence, risk factors, and outcome of NE after high-dose chemotherapy and autologous SCT (autoSCT).Methods. A total of 297 adult patients who qualified for autoSCT with non-Hodgkin's lymphoma (NHL), Hodgkin's disease, multiple myeloma, and acute myeloid leukemia were analyzed. Patients were conditioned with carmustine, etoposide, cytarabine, melphalan (BEAM); melphalan alone; or busulfan and cyclophosphamide (BuCy2), and transplanted with peripheral blood or bone marrow CD34(+) cells. Diagnosis of NE was established in case of neutropenic fever, abdominal pain or diarrhea, and bowel wall thickening >4 mm on abdominal sonography.Results. Neutropenic infections occurred in 262 patients (88%). NE was diagnosed in 32 patients (12%), a median +3 (1-5) days after SCT. Bloodstream infections were present in 18 patients, with gram-negative bacteria in 11 patients. All patients were treated conservatively with carbapenems and total parenteral nutrition with bowel rest. The course of disease was complicated by ileus or septic shock in 9 patients, and was fatal for 3 (9.6%) patients. In univariate analysis, the initial diagnosis of NHL (P = 0.017) and conditioning with BEAM (P = 0.043) had prognostic value. In multivariate analysis, only initial diagnosis of NHL (P = 0.017) had prognostic significance.Conclusions. NE is a rare but severe complication in patients undergoing autoSCT. Gram-negative bacteria remain the main causative pathogen. Abdominal sonography allows early diagnosis and treatment, effective in most of patients without surgery. In our analysis, NE was seen more often in NHL patients treated with a BEAM regimen.