Factors Affecting The Duration Of Neutropenia Which Occur After Induction Chemotherapy In Patıents With Acute Myeloid Leukemia

Year 2015, Volume: 4 Issue: 4, 371 - 377, 01.11.2015

Nevzat Bulut İlhami Kiki Gülden Sincan Rahşan Yıldırım Murat Polat Yusuf Bilen Mehmet Gündoğdu

https://doi.org/10.5505/abantmedj.2015.66933

Abstract

INTRODUCTION: OBJECTIVE: Infections due to neutropenia play an important role in mortality in acute myeloid leukemia. Therefore; we aimed to determine the factors that affect duration of neutropenia in patients who are given induction chemotherapy because of acute myeloid leukemia.METHODS: We examined medical records of the 60 patients retrospectively. We recorded comorbid conditions, body mass index, initial labaratory findings, immunophenotypic and cytogenetic characteristics. Effects of all these parameters on duration of neutropenia were investigated. RESULTS: Leukocyte value of patients was 42.525 ± 101.364 μL, platelets count was 58.735 ± 49.104 μL. Number of days with neutropenia was 21 ± 8.3. HLA-DR and CD34 positivity rate was 24.9 ± 28.5% and 28.5 ± 33.4% respectively. CD117 and myeloperoxidase positivity rate was 30.6 ± 27.2% and 53.4 ± 37.5% respectively. A significant positive corrrelation was found between duration of neutropenia and platelets value and positivity rate of CD34. A significant negative corrrelation was found between duration of neutropenia and initial lactate dehydrogenase levels and positivity rate of myeloperoxidase. DISCUSSION AND CONCLUSION: CONCLUSION: When positivity rate of early myeloid markers increased an increasing on duration of neutropenia was observed. Therefore; patients with early myeloid markers should be monitored more carefully because of the risk of infection.

Keywords

Acute myeloid leukemia, febrile neutropenia, risk factors

Akut Myeloid Lösemili Hastalarda İndüksiyon Kemoterapisi Sonrası Gelişen Nötropeni Süresini Etkileyen Faktörler

Abstract

GİRİŞ ve AMAÇ: AMAÇ: Akut myeloid lösemide nötropeniye bağlı gelişen enfeksiyonlar mortalitede önemli rol oynar. Bu nedenle, biz bu çalışmada akut myeloid lösemi nedeniyle indüksiyon kemoterapisi verilmiş hastalarda tedavi sonrası gelişen nötropeni süresini etkileyen faktörleri belirlemeyi amaçladık. YÖNTEM ve GEREÇLER: YÖNTEMLER: Bu çalışmada 60 hastanın tıbbi kayıtları retrospektif olarak incelendi. Komorbid durumlar, vücut kitle indeksi, başlangıç labaratuvar parametreleri, sitogenetik özellikler, immünfenotipik özellikler gibi parametreler kaydedildi. Bu parametrelerin nötropeni süresi üzerine etkileri araştırıldı. BULGULAR: Hastaların başlangıç lökosit değeri 42.525±101.364 mm³ , platelet sayısı 58.735±49.104 mm³ , nötropenik gün sayısı 21±8,3 gün, HLA-DR ve CD34 pozitiflik oranı sırasıyla 24,9±28,5% ve 28,5±33,4% idi. CD 117 pozitiflik oranı 30,6±27,2%, myeloperoksidaz pozitiflik oranı 53,4±37,5 % idi. Nötropenide kalış süresi ile platelet sayısı ve CD34 pozitiflik oranı ile anlamlı pozitif korelasyon, laktat dehidrogenaz düzeyi ve myeloperoksidaz pozitiflik oranı ile anlamlı negatif korelasyon saptandı. TARTIŞMA ve SONUÇ: SONUÇ: Erken myeloid belirteçlerin pozitifliğinin oranı arttıkça hastaların nötropenide kalış süresinin arttığı görüldü. Bu nedenle erken myeloid belirteci pozitif olan hastalar enfeksiyon riski nedeniyle daha dikkatli takip edilmelidir.

Keywords

Akut myeloid lösemi, febril nötropeni, risk faktörleri

References

• 1. Febril Nötropeni Çalışma Grubu. Febril Nötropenik Hastalarda Tanı ve Tedavi Kılavuzu. Flora 2004;9(1):5-28
• 2. Karahocagil MK, Buzğan T, Irmak H, Evirgen Ö, Demir C, Durmuş A. Akut lösemili hastalarda nötropenik ateş ataklarının değerlendirilmesi. Van Tıp Dergisi 2002;9(4):104-8.
• 3. Klastersky J: Therapy of infections in cancer patients, In: Klastersky J, Schimpff SC, Senn HJ (Eds): Handbook of Supportive Care in Cancer, New York, USA 1995: 1-44.
• 4. Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. The New England journal of medicine 1993;328(18):1323-1332.
• 5. Armstrong D. Empiric therapy for the immunocompromised host. Rev infect dis 1991;13(9):763- 69.
• 6. Dale DC. Advances in the treatment of neutropenia. Curr Opin Support Palliat Care 2009;3(3):207- 12.
• 7. Wilson Royalty M, Lawless G, Palmer C, Brown R. Predictors for chemoterapy-related severe or febrile neutropenia: a review of the clinical literature. J Oncol Pharm Prac 2001;7:141-47.
• 8. Crawford J, Dale DC, Lyman GH. Chemotherapyinduced neutropenia: risks, consequences, and new directions for its management. Cancer. 2004;100(2):228-237.
• 9. Zagonel V, Tirelli U, Serraino D, Lo Re G, Merola MC, Mascarin M, Trovo M.G, Carbone A, Monfardini S. The aged patient with lung cancer: Management recommendations. Drugs&aging 1994;4(1):34-46.
• 10. Solomon D, Brown AS, Brummel-Smith K, Burgess L, D’Agostino R, Goldschmidt J. National Insti-tutes of Health Consensus Development Conference Statement: Geriatric Assessment Methods for Clinical Decisionmaking. J Am Geriatr Soc 1988;36(4):342 -347.
• 11. Nakagawa Y, Suzuki K, Masaoka T. Evaluation of the risk factors for febrile neutropenia associated with hematological malignancy. Journal of infection and chemotherapy 2009;15(3):174 -79.
• 12. Miller AA, Herndon JE, Hollis DR, Ellerton J, Langleben A, Richards F, Green MR. Schedule dependency of 21-day oral versus 3-day intravenous etoposide in combination with intravenous cisplatin in extensive -stage small -cell lung cancer: a randomized phase III study of the Cancer and Leukemia Group B. J Clin Oncol 1995;13(8):1871 -79.
• 13. Abou Saleh M, Mafiana RN, Al Za'abi M, Vaishnav R, Al Kindi S, Al-Zakwani I. Epidemiology of chemotherapy -induced neutropenia at a tertiary university hospital in Oman. Int J.Clin Pharm 2013;35(6):1036 -39.
• 14. Intragumtornchai T, Sutheesophon J, Sutcharitchan P, Swasdikul D. A predictive model for life -threatening neutropenia and febrile neutropenia after the first course of CHOP chemotherapy in patients with aggressive non -Hodgkin's lymphoma. Leukemia & lymphoma 2000;37:351 -60.
• 15. Matsui T, Nakaaki S, Murata Y, Sato J, Shinagawa Y, Tatsumi H, Furukava TA. Determinants of the quality of life in Alzheimer's disease patients as assessed by the Japanese version of the Quality of Life -Alzheimer's disease scale. Dement Geriatr Cogn Disord 2006;21(3):182 -91.
• 16. Greer JP, Baer MR, Kinney MC: Acute Myeloid leukemia in Adults, In: Greer JP, Foerster J, Kukes JN (Eds): Wintrob’s Clinical Hematology. 11th edition, Philadelphia, Lippincott Williams&Wilkins 2004: 2097 -2141.
• 17. Ruggero D, Baccarani M, Gobbi M, Tura S. Adult acute lymphoblastic leukaemia: study of 32 patients and analysis of prognostic factors. Scandinavian journal of haematology 1979;22(2):154 -64.
• 18. Polat G, Utkaner G, Yalnız E, Yılmaz U. Sisplatin vinorelbin kemoterapisinde nötropeni için risk faktörleri. Solunum hastalıkları 2003;14:176-80.
• 19. Biswal S, Godnaik C.Incidence and management of infections in patients with acute leukemia following chemotherapy in general wards. Ecancermedicalscience 2013;7:310.
• 20. Akpek G, Knight RD, Wright DG. Use of oral mucosal neutrophil counts to detect the onset and resolution of profound neutropenia following high dose myelosuppressive chemotherapy. Am J Hematol 2003;72(1):13-19