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Epidemiology, Risk Factors, and Outcomes of Neutropenic Enterocolitis in Onco-Hematological Patients According to
Anne-Sophie Brunel1,2, Claire Seydoux3, Sabine Schmidt4
1Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
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 lymphoblastic (ALL) leukemia or receiving autologous hematopoietic stem cell transplantation (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 = .002), elevated circulating blasts at the time of diagnosis (>50 Giga/L; OR = 2.02; 95% CI: 1.15-3.56; P = .02), and use of azacitidine (OR = 2.45; 95% CI: 1.01-5.90; P = .05); purine-based regimens (eg, FLAG-Ida) were an independent protective factor (OR = .27; 95% CI: .15-.47; P < .001). Independent risk factors after auto-HCT included BEAM (carmustine, etoposide, cytarabine, and melphalan) versus another conditioning protocol (OR = 3.28; 95% CI: 1.98-5.43; P < .001) and age (OR = 1.03/year; 95% CI: 1.01-1.06; P = .007). For both AML induction and auto-HCT, NEC was associated with longer hospitalization (P = .03 and <.001), sepsis (quick SOFA ≥2; P = .03 and <.001), fungemia (P < .001 and P = .01), and intensive care admission (P = .03 and <.001, respectively). NEC was associated with increased in-hospital mortality during AML induction (6.5% vs 2.4%; P = .04) but not during auto-HCT (P = .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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