Background Neutropenic enterocolitis (NE) is a serious complication in patients receiving intensive chemotherapy for the treatment of onco-haematological diseases. Yet, the relative incidence of the disease and its risk factors among patients treated with different regimen is not well defined.
Methods The development of NE was analysed in 1223 neutropenic episodes from 692 onco-hematological patients receiving chemotherapy at the isolation Unit of CHUV who signed an informed consent (Swissethics 2017-01975). NE was defined by the presence abdominal signs and symptoms during neutropenic fever together with bowel wall thickening >4mm in any bowel segment by computed tomography or ultrasound. The incidence of NE and risk factors known at hospitalization baseline were analysed by using uni- and multivariate regression models according to the chemotherapy regimen, including those used for the induction of acute myeloblastic (AML) or lymphoblastic (ALL) leukemia and autologous hematopoietic cell transplantation (HCT).
Results. A total of 72 episodes of radiologically-proven NE (5.9%) occurred; the percentage of NE was 16.3% for AML induction (e.g. HOVON based protocol), 5.6% for autologous HCT using the BEAM protocol, 4.8% for ALL induction, 2.9% for AML salvage (e.g. CLAG or FLAG +/- idarubicin), 1.9% for autologous HCT using a non-BEAM protocol (e.g. melphalan) and 1.9% for the other types of chemotherapy (Figure 1). In the HCT population, the single independent risk factor for NE was the BEAM versus non-BEAM protocol (Odd ratio [OR]=3.40, 95% confidence interval [CI] 1.14-10.1, P=0.03). In AML patients, independent risk factors for NE included induction versus salvage chemotherapy (OR=3.87, CI 1.31-11.4, P=0.01),
chemotherapy with amsacrine (OR=2.94, CI 1.40-6.21, P=0.005) and triple intrathecal chemotherapy (OR=2.03, CI 1.01-4.08, P=0.048).
Conclusions. Susceptibility to NE is strongly influenced by the type of chemotherapy. Patients receiving salvage therapy for AML have a surprisingly low rate of NE, possibly due to the concomitant use of G-CSF or an immunomodulaor effect of fludarabine or cladribine. Intrathecal chemotherapy has probably not a direct effect on NE but reflect the patients with high-risk AML quickly neutropenic or presenting a leukemic digestive infiltration.