Otolog kök hücre nakli sonrası nötropenik enterokolit sıklığı, kliniği ve sağkalımının rektospektif belirlenmesi
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Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Nötropenik enterokolit (NE) hematolojik maligniteler nedeniyle kemoterapi uygulanan ve kök hücre nakli ile tedavi edilen hastalarda ateş ve karın ağrısı ile karakterize bir klinik sendromdur. Bu çalışmanın amacı, otolog kök hücre nakli sonrası NE'in insidansını, risk faktörlerini ve sonuçlarını belirlemektir. GEREÇ VE YÖNTEM: Ocak 2013 ve Aralık 2017 yılları arasında merkezimizde otolog kök hücre nakli uygulanan non-Hodgkin Lenfoma (NHL), Hodgkin lenfoma (HL) ve multipl miyelomalı (MM) 290 hasta geriye dönük olarak değerlendirildi. Hazırlama rejimi olarak lenfomalı hastalarda karmustin, etoposid, sitarabin, melfalan (BEAM) veya tiyotepa, etoposid, sitarabin, siklofosfamid, melfalan (TECAM) , multipl miyelomalı hastalarda melfalan kullanıldı. Nötropenik enterekolit tanısı nötropenik ateş, karın ağrısı ve abdominal ultrasonografi ve BT de > 4 mm kalınlıkta barsak duvarı kalınlaşması olarak belirlendi. BULGULAR: Febril nötropeni, 258 hastada (% 88,96) görüldü. NE, tüm nötropenik hastaların 27 sinde (% 9.31) görüldü. Otolog kök hücre naklinden sonra NE için medyan zaman 7 gün (Aralık: 2-10 gün) idi. Medyan nötrofil engraftman zamanı 12 gün (Aralık: 9-18 gün) idi. Yirmi beş hastada (% 92,5) diyare vardı. İleus saptanan beş (% 17,2) hasta mevcuttu, 2 hastada (% 7,4) septik şok gelişti. 27 hastanın altısında (% 22.2) kan kültürlerinde üreme oldu. Tanı abdominal ultrasonografi ve bilgisayarlı tomografi ile median 7 günde (Aralık: 2-9) konuldu. Yirmi beş (% 92) hasta iyi bir destek tedavi ve uygun antibiyoterapi ile iyileşti. İki (% 7,4) hasta septik şok nedeniyle kaybedildi. SONUÇ: NE, otolog kök hücre nakli hazırlığında yüksek doz kemoterapi uygulanan hastalarda nadir görülen ancak ciddi bir komplikasyondur. En önemli etken gram negatif patojenlerdir. Bilgisayarlı Tomografi tanıda, takipte ve prognoz belirlemede gün geçtikçe önem kazanmaktadır.
Introduction: Neutropenic enterocolitis (NE) is a clinical syndrome characterized by fever and abdominal pain in patients who received chemotherapy for hematological malignancies and who treated with stem cell transplantation (SCT). The aim of this study was to determine the incidence, risk factors and outcome of NE after autologous SCT (auto-SCT). Materials and methods: We retrospectively evaluated 290 patients with Non-Hodgkin Lymphoma (NHL), Hodgkin lymphoma (HL) and multiple myeloma (MM) who underwent auto-SCT between January 2013 and December 2017 in our center. Patients with lymphoma were conditioned with carmustine, etoposide, cytarabine, melphalan (BEAM) or thiotepa, etoposide, cytarabine, cyclophosphamide, melphalan (TECAM). Patients with multiple myeloma were treated with melphalan as conditioning. Diagnosis of NE was established in case of neutropenic fever, abdominal pain and bowel wall thickening >4 mm on abdominal ultrasonography. Results: Febrile neutropenia was seen in 258 (88,96%) patients of all. NE occurred in 27 (9.31%) in all neutropenic patients. The median time to NE after auto-SCT was 7 days (range; 2- 10 days). The median neutrophil engraftment time was 12 days (range; 9-18 days). Twenty five patients (92,5%) had diarrhea. Ileus was seen in 5 (17,2%) patient and septic shock was developed in 2 (7,4%) patients. Six (22.2%) of 27 patients had bloodstream infection. Diagnosis was made by abdominal ultrasonography and computed tomography at a day of median 7 days (range; 2- 9). Twenty five (92%) patients were resolved completely with good supportive care and proper antibiotherapy. Two (7,4%) patients died of septic shock and ileus. Discussion: NE is a rare but serious complication in patients underwent high dose chemotherapy followed by auto-SCT. Gram-negative bacteria are the main causative pathogens. Computed tomography is becoming increasingly important in diagnosis, follow-up and prognosis.
Introduction: Neutropenic enterocolitis (NE) is a clinical syndrome characterized by fever and abdominal pain in patients who received chemotherapy for hematological malignancies and who treated with stem cell transplantation (SCT). The aim of this study was to determine the incidence, risk factors and outcome of NE after autologous SCT (auto-SCT). Materials and methods: We retrospectively evaluated 290 patients with Non-Hodgkin Lymphoma (NHL), Hodgkin lymphoma (HL) and multiple myeloma (MM) who underwent auto-SCT between January 2013 and December 2017 in our center. Patients with lymphoma were conditioned with carmustine, etoposide, cytarabine, melphalan (BEAM) or thiotepa, etoposide, cytarabine, cyclophosphamide, melphalan (TECAM). Patients with multiple myeloma were treated with melphalan as conditioning. Diagnosis of NE was established in case of neutropenic fever, abdominal pain and bowel wall thickening >4 mm on abdominal ultrasonography. Results: Febrile neutropenia was seen in 258 (88,96%) patients of all. NE occurred in 27 (9.31%) in all neutropenic patients. The median time to NE after auto-SCT was 7 days (range; 2- 10 days). The median neutrophil engraftment time was 12 days (range; 9-18 days). Twenty five patients (92,5%) had diarrhea. Ileus was seen in 5 (17,2%) patient and septic shock was developed in 2 (7,4%) patients. Six (22.2%) of 27 patients had bloodstream infection. Diagnosis was made by abdominal ultrasonography and computed tomography at a day of median 7 days (range; 2- 9). Twenty five (92%) patients were resolved completely with good supportive care and proper antibiotherapy. Two (7,4%) patients died of septic shock and ileus. Discussion: NE is a rare but serious complication in patients underwent high dose chemotherapy followed by auto-SCT. Gram-negative bacteria are the main causative pathogens. Computed tomography is becoming increasingly important in diagnosis, follow-up and prognosis.
Açıklama
Anahtar Kelimeler
Nötropenik Enterokolit, Otolog Kök Hücre Nakli, Neutropenic Enterocolitis, Autologous Transplantation
