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Neutropenic enterocolitis in pediatric leukemia patients treated with intensive chemotherapy in Upper Egypt
Ereen Refaat Fouad1, Ahmed Mohammed Morsy1, Hosam Eldein Mostafa Kamel2
1Department of Pediatric Oncology South Egypt Cancer Institute Assiut University Assiut Egypt.
Insights
Intensive chemotherapy for pediatric leukemia can cause serious intestinal complications like neutropenic enterocolitis. Abdominal tenderness, prolonged neutropenia, and hemodynamic instability are key risk factors for mortality in these cancer patients.
Area of Science:
- Oncology
- Pediatric Hematology
- Gastroenterology
Background:
- Neutropenic enterocolitis is a severe complication of cancer chemotherapy, particularly in low-resource settings.
- Research on risk factors for neutropenic enterocolitis in these populations is limited.
- Pediatric leukemia patients undergoing intensive chemotherapy are at risk for intestinal complications.
Purpose of the Study:
- To investigate the incidence and patterns of intestinal complications in pediatric leukemia patients receiving intensive chemotherapy.
- To assess the outcomes of these intestinal complications.
- To identify risk factors associated with mortality in pediatric leukemia patients with intestinal complications, specifically neutropenic enterocolitis.
Main Methods:
- A prospective study conducted from June 2015 to December 2016 at South Egypt Cancer Institute.
- Included pediatric patients diagnosed with acute leukemia receiving induction/re-induction chemotherapy.
- Analyzed intestinal complication episodes, focusing on neutropenic enterocolitis, and used logistic regression to determine mortality risk factors.
Main Results:
- Out of 88 intestinal complication episodes, 58 were neutropenic enterocolitis.
- Independent risk factors for worse outcomes in neutropenic enterocolitis included abdominal tenderness (OR 4.529), longer duration of neutropenia (OR 1.215), and hemodynamic instability (OR 17.023).
- Hemodynamic instability was strongly associated with mortality (P < 0.001).
Conclusions:
- Intensive chemotherapy for acute leukemia in Upper Egypt is linked to life-threatening intestinal complications.
- A high index of clinical suspicion is crucial for early detection and management.
- Identifying risk factors like hemodynamic instability can improve patient outcomes.
Importance:
In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patients.
Objective:
To identify the pattern of intestinal complications in pediatric leukemia patients treated with intensive chemotherapy, including those with neutropenic enterocolitis; to assess the outcome; and to evaluate the risk factors associated with the mortality in these patients.
Methods:
During the period from June 2015 to December 2016, a prospective study was carried out on pediatric patients diagnosed with acute leukemia who received induction/or re-induction phases of chemotherapy at South Egypt Cancer Institute. Patients with documented episodes of intestinal complications were included in the study. Recovery or death from an episode of intestinal complication was utilized as the primary outcome measure for the study. Using univariable and multivariable methods, potential risk factors associated with mortality were delineated by logistic regression analysis, both for the entire intestinal complications episodes as a whole and for those episodes of neutropenic enterocolitis only.
Results:
Out of 88 documented episodes of intestinal complications from 77 patients; 58 episodes were identified as neutropenic enterocolitis from 47 patients. In those patients who were having episodes of neutropenic enterocolitis, the presence of abdominal tenderness (OR 4.529, 95%CI 1.062-19.317, P = 0.041); a longer duration of neutropenia (OR 1.215, 95%CI 1.030-1.434, P = 0.021); and hemodynamic instability (OR 17.023, 95%CI 4.095-70.772, P < 0.001), were found to be independently associated with worse outcome.
Interpretation:
In Upper Egypt, the use of intensive systemic chemotherapy during the induction phase of acute leukemia was found to be associated with potentially lethal intestinal complications. A high index of clinical suspicion is warranted.
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