Epidemiology, Risk Factors and Outcome of Neutropenic Enterocolitis in Onco-Hematological Patients according to Chemotherapy Regimen.
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State: Public
Version: Author's accepted manuscript
License: Not specified
Serval ID
serval:BIB_E79A4C134F1E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Epidemiology, Risk Factors and Outcome of Neutropenic Enterocolitis in Onco-Hematological Patients according to Chemotherapy Regimen.
Journal
Clinical infectious diseases
ISSN
1537-6591 (Electronic)
ISSN-L
1058-4838
Publication state
In Press
Peer-reviewed
Oui
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Publication Status: aheadofprint
Abstract
While neutropenic enterocolitis (NEC) is a well-known life-threatening complication during intensive chemotherapy, its incidence, impact and outcome on specific at-risk populations remain ill-defined.
We report 178 NEC episodes during 1963 myeloablative chemotherapy courses among 1259 adult patients with acute myeloid (AML) or lymphoid (ALL) leukemia or receiving autologous hematopoietic stem cell-transplant (auto-HCT) for lymphoma or multiple myeloma. Risk factors were assessed by multivariate logistic regression models.
Most NEC cases (93.3%) occurred during AML induction (N=92, 13.8% of chemotherapy course) and auto-HCT (N=74, 9.5%). Independent risk factors for NEC during AML induction included high-dose corticosteroids (OR=2.07, 95%CI 1.29-3.30, P=0.002), elevated circulating blasts at the time of diagnosis (>50 G/L, OR=2.02, 95%CI 1.15-3.56, P=0.02) and use of azacitidine (OR=2.45, 95%CI 1.01-5.90, P=0.05); purine-based regimens (e.g. FLAG-Ida) was an independent protective factor (OR=0.27, 95%CI 0.15-0.47, P<0.001). Independent risk factors after auto-HCT included BEAM versus another conditioning protocol (OR=3.28; 95%CI 1.98-5.43, P<0.001) and age (OR=1.03 per year, 95%CI 1.01-1.06, P=0.007). For both AML induction and auto-HCT, NEC was associated with longer hospitalization (P=0.03 and P<0.001), sepsis (quick SOFA≥2, P=0.03 and P<0.001), fungemia (P<0.001 and P=0.01) and intensive care admission (P=0.03 and P<0.001, respectively). NEC was associated with increased in-hospital mortality during AML induction (6.5% versus 2.4%, P=0.04) but not during auto-HCT (P=0.3).
The incidence of NEC depended on chemotherapeutic regimens, with higher occurrence during standard "7+3" AML induction and BEAM conditioning for auto-HCT. NEC was associated with longer hospitalization and increased morbidity, but 30-day mortality was lower than previously reported.
We report 178 NEC episodes during 1963 myeloablative chemotherapy courses among 1259 adult patients with acute myeloid (AML) or lymphoid (ALL) leukemia or receiving autologous hematopoietic stem cell-transplant (auto-HCT) for lymphoma or multiple myeloma. Risk factors were assessed by multivariate logistic regression models.
Most NEC cases (93.3%) occurred during AML induction (N=92, 13.8% of chemotherapy course) and auto-HCT (N=74, 9.5%). Independent risk factors for NEC during AML induction included high-dose corticosteroids (OR=2.07, 95%CI 1.29-3.30, P=0.002), elevated circulating blasts at the time of diagnosis (>50 G/L, OR=2.02, 95%CI 1.15-3.56, P=0.02) and use of azacitidine (OR=2.45, 95%CI 1.01-5.90, P=0.05); purine-based regimens (e.g. FLAG-Ida) was an independent protective factor (OR=0.27, 95%CI 0.15-0.47, P<0.001). Independent risk factors after auto-HCT included BEAM versus another conditioning protocol (OR=3.28; 95%CI 1.98-5.43, P<0.001) and age (OR=1.03 per year, 95%CI 1.01-1.06, P=0.007). For both AML induction and auto-HCT, NEC was associated with longer hospitalization (P=0.03 and P<0.001), sepsis (quick SOFA≥2, P=0.03 and P<0.001), fungemia (P<0.001 and P=0.01) and intensive care admission (P=0.03 and P<0.001, respectively). NEC was associated with increased in-hospital mortality during AML induction (6.5% versus 2.4%, P=0.04) but not during auto-HCT (P=0.3).
The incidence of NEC depended on chemotherapeutic regimens, with higher occurrence during standard "7+3" AML induction and BEAM conditioning for auto-HCT. NEC was associated with longer hospitalization and increased morbidity, but 30-day mortality was lower than previously reported.
Keywords
chemotherapy, hematological malignancies, neutropenic enterocolitis
Pubmed
Create date
21/03/2025 16:06
Last modification date
30/03/2025 7:24