Neutropenic enterocolitis following treatment with cytosine arabinoside-containing regimens for hematological malignancies: a potentiating role for amsacrine.
A retrospective clinical study was performed to determine the clinical impact of neutropenic enterocolitis (NE) in adult patients with acute leukemia and non-Hodgkin's lymphoma treated with cytosine arabinoside (Ara-C)-containing regimens. The diagnosis of NE was restricted to conditions with clinical signs of peritonitis, ileus, or intestinal hemorrhage. Forty episodes of NE were noted during 461 Ara-C-containing courses (8.6%) in 36 of 211 patients (17%) over a 6-year period. Clinically, 18 cases of ileus, 16 cases of peritonitis, and 6 cases of intestinal hemorrhage were recognized as the most important presentation of NE. NE started about 2 weeks after the initiation of the chemotherapy and lasted for an average of 1 week. All patients had a profound neutropenia. The incidence of septicemia was higher during courses complicated by NE (p less than 0.001). All cases of NE were treated with conservative measures. The mortality was 22.5% and represented one third of all therapy-related deaths during the pancytopenic period. The incidence of NE was significantly higher in courses consisting of high-dose Ara-C for 6 consecutive days when the drug was combined with amsacrine for 3 consecutive days (p less than 0.0001).
Vlasveld
L T
LT
Department of Internal Medicine, Leiden University, Center, The Netherlands.
Zwaan
F E
FE
Fibbe
W E
WE
Tjon
R T
RT
Tham
T A
TA
Kluin
P M
PM
Willemze
R
R
D000328:Adult; D003561:Cytarabine / Q000009:adverse effects* / Q000627:therapeutic use; D004760:Enterocolitis / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000188:drug therapy*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology
D003561:Cytarabine