ABSTRACT
BACKGROUND: Neutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients' morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia. DESIGN AND METHODS: This observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for "transfer to intensive care" and "death" were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients. RESULTS: The incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (P<0.001; OR 4.753; 95% CI 2.297-9.833, and P=0.003; OR 1.061/d; 95% CI 1.021-1.103). Chemotherapy-associated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573-13.515 and P=0.026; OR 3.628; 95% CI 1.169-11.256). CONCLUSIONS: The occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients' outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications.
Subject(s)
Antineoplastic Agents/adverse effects , Inflammatory Bowel Diseases/chemically induced , Inflammatory Bowel Diseases/mortality , Mitoxantrone/adverse effects , Neoplasms/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/administration & dosage , Female , Humans , Incidence , Male , Middle Aged , Mitoxantrone/administration & dosage , Neoplasms/drug therapy , Neutropenia/chemically induced , Neutropenia/mortality , Risk Factors , Syndrome , Time FactorsABSTRACT
Infections may require discontinuation of antineoplastic chemotherapy, which, in turn, renders patients vulnerable to disease progression or relapse. We identified six patients with acute leukemia in whom antineoplastic treatment had to be discontinued because of chronic disseminated candidiasis (CDC). However, despite minimal antileukemic treatment, all patients remained in complete remission. Immunologic mechanisms associated with CDC might have had an antileukemic effect.
