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Increases of sICAM-1 during neutropenic pneumonia in leukemic patients
T Südhoff1, A Wehmeier, M Arning
1Department of Haematology and Oncology, Heinrich-Heine-University, Düsseldorf, Germany.
Abstract:
Aggressive chemotherapy of leukemia increases the risk of severe infections during treatment-induced myelosuppression. However, the assessment of an infectious origin of neutropenic fever is often difficult. Leukocyte adhesion molecules such as E-selectin, intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) are involved in early inflammatory response. We studied plasma concentrations of their soluble isoforms during 48 treatment courses with myeloablative chemotherapy in 32 leukemic patients. There were 35 febrile episodes during neutropenia. Pneumonia was clinically and microbiologically documented in 15 cases, six had proven infections but normal chest radiograph, and 14 were classified as fever of unknown origin. Longitudinal studies revealed a sustained increase of sICAM-1 plasma levels associated with pneumonia. Increase of sICAM-1 plasma levels distinguished patients with pneumonia from those with fever not related to pneumonia (positive predictive value 0.87, negative predictive value 0.94). Plasma levels of sICAM-1 were elevated in both, fungal and non-fungal pneumonia. Increases of sICAM-1 paralleled first radiographic evidence of pulmonary infiltrations in most cases. In contrast, no elevation of sVCAM-1 or sE-selectin was documented during febrile events prior to recovery of leukocyte counts.
Insights
Soluble intercellular adhesion molecule 1 (sICAM-1) shows promise in diagnosing pneumonia in leukemia patients with neutropenic fever. Elevated sICAM-1 levels accurately distinguish pneumonia from other causes of fever during chemotherapy.
Area of Science:
- Oncology
- Immunology
- Infectious Diseases
Background:
- Chemotherapy for leukemia can cause myelosuppression, increasing infection risk.
- Diagnosing the source of neutropenic fever is challenging.
- Leukocyte adhesion molecules (E-selectin, ICAM-1, VCAM-1) are key in inflammatory responses.
Purpose of the Study:
- To investigate plasma concentrations of soluble adhesion molecules (sE-selectin, sICAM-1, sVCAM-1) in leukemic patients with neutropenic fever.
- To determine if these molecules can help differentiate infectious causes, particularly pneumonia, of fever during chemotherapy.
Main Methods:
- Plasma levels of sE-selectin, sICAM-1, and sVCAM-1 were measured during 48 chemotherapy courses in 32 leukemia patients.
- 35 febrile episodes during neutropenia were analyzed.
- Patients were categorized based on documented pneumonia, other infections, or fever of unknown origin.
Main Results:
- A sustained increase in soluble intercellular adhesion molecule 1 (sICAM-1) plasma levels was consistently associated with pneumonia.
- Elevated sICAM-1 levels effectively distinguished pneumonia from non-pneumonia causes of fever (PPV 0.87, NPV 0.94).
- sICAM-1 levels rose with both fungal and non-fungal pneumonia, often preceding radiographic findings.
Conclusions:
- Plasma sICAM-1 is a valuable biomarker for diagnosing pneumonia in neutropenic leukemia patients.
- sICAM-1 elevation aids in identifying infectious origins of fever during intensive chemotherapy.
- sVCAM-1 and sE-selectin did not show similar diagnostic utility in this context.