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Published on: April 10, 2019
Neutropenic enteropathy: a 10-year review
J Baerg1, J J Murphy, R Anderson
1B.C. Children's Hospital, Vancouver, British Columbia, Canada.
Insights
Neutropenic enteropathy, a complication of chemotherapy, affects children with various cancers and after bone marrow transplants. Supportive care is effective, with a 94% survival rate.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Hematology
Background:
- Neutropenic enteropathy incidence is rising due to aggressive chemotherapy regimens.
- This condition requires a comprehensive understanding of affected populations and risk factors.
Purpose of the Study:
- To identify pediatric patients affected by neutropenic enteropathy.
- To determine predisposing factors for its development.
- To evaluate the effectiveness of current treatment strategies.
Main Methods:
- A retrospective 10-year review (1988-1997) of 33 children with 38 episodes of neutropenic enteropathy.
- Patients presented with fever, abdominal pain, and neutropenia.
- Treatment included fluid resuscitation, bowel rest, antibiotics; surgery was reserved for perforation.
Main Results:
- Neutropenic enteropathy occurred in children with hematologic malignancies, solid tumors, and post-bone marrow transplant.
- Cytosine arabinoside and VP16 were common chemotherapeutic agents implicated.
- Four patients required surgery with survival; overall survival was 94%.
Conclusions:
- Neutropenic enteropathy affects a broader pediatric population than previously thought.
- Certain chemotherapeutic agents and Burkitt's lymphoma increase risk.
- Supportive care is the primary effective treatment, yielding high survival rates.
Purpose:
With the advent of more aggressive chemotherapy, the incidence of neutropenic enteropathy is increasing. This review was performed to (1) determine which children are affected, (2) identify predisposing factors, and (3) assess efficacy of treatment.
Methods:
A 10-year (1988 to 1997) review identified 33 children who had 38 episodes of neutropenic enteropathy. Each presented with fever, abdominal pain, and chemotherapy-induced neutropenia. All were treated with fluid resuscitation, bowel rest, and broad-spectrum antibiotics. Surgical intervention was reserved for children with bowel perforation.
Results:
Neutropenic enteropathy occurred in 24 children with hematologic malignancies and nine with solid tumors. This disease developed in three children after bone marrow transplantation for leukemia. All five patients in whom recurrent episodes developed were receiving chemotherapy for Burkitt's lymphoma. Cytosine arabinoside and VP16 were the most commonly implicated chemotherapeutic agents. Four children required laparotomy and right hemicolectomy, and all survived. Overall survival was 94%.
Conclusions:
Although previously described in children receiving chemotherapy for hematologic malignancies, neutropenic enteropathy also occurs in children who have solid tumors and after bone marrow transplantation. The use of cytosine arabinoside and VP16 may predispose patients to this disease. Children receiving chemotherapy for Burkitt's lymphoma are at increased risk for recurrent episodes. Excellent survival rate was attained with supportive care being used as the primary treatment modality.
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