Epidemiology, Risk Factors and Outcome of Neutropenic Enterocolitis in Onco-Hematological Patients according to Chemotherapy Regimen.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2025-03-20 DOI:10.1093/cid/ciaf134

Anne-Sophie Brunel, Claire Seydoux, Sabine Schmidt, Siham Ahlyege, Aurélie Guillet, Katerina Mandralis, Mapi Fleury, Anne Cairoli, Sabine Blum, Olivier Spertini, Oscar Marchetti, Mathilde Gavillet, Pierre-Yves Bochud

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Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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背景：众所周知，中性粒细胞减少性小肠结肠炎（NEC）是强化化疗期间威胁生命的并发症：众所周知，中性粒细胞减少性小肠结肠炎（NEC）是强化化疗期间一种危及生命的并发症，但其发病率、对特定高危人群的影响和结局仍不明确：我们报告了1259名急性髓性（AML）或淋巴性（ALL）白血病或因淋巴瘤或多发性骨髓瘤接受自体造血干细胞移植（auto-HCT）的成年患者在1963个髓质消融化疗疗程中发生的178次NEC。风险因素通过多变量逻辑回归模型进行评估：大多数NEC病例（93.3%）发生在急性髓细胞白血病诱导期（92例，占化疗疗程的13.8%）和自身造血干细胞移植期（74例，占9.5%）。在急性髓细胞性白血病诱导过程中发生 NEC 的独立风险因素包括：大剂量皮质类固醇（OR=2.07，95%CI 1.29-3.30，P=0.002）、诊断时循环血细胞增高（>50 G/L，OR=2.02，95%CI 1.15-3.56，P=0.02）和使用阿扎胞苷（OR=2.45，95%CI 1.01-5.90，P=0.05）；基于嘌呤的治疗方案（如 FLAG-Ida）是一个独立的保护因素（OR=0.27，95%CI 0.15-0.47，PConclusions：NEC的发生率取决于化疗方案，在标准 "7+3 "AML诱导和BEAM自身血液透析调理期间发生率较高。NEC与住院时间延长和发病率增加有关，但30天死亡率低于之前的报道。

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.