Akpek Gorgun, Knight Robert D, Wright Daniel G
Castle Hematology Research Laboratory of the Section of Hematology and Oncology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts 02118, USA.
Am J Hematol. 2003 Jan;72(1):13-9. doi: 10.1002/ajh.10250.
Severe neutropenia following cytotoxic, anti-cancer chemotherapy is well-known to be associated with an increased risk of infections that may be life-threatening, particularly if not treated immediately. Consequently, serial measurements of neutrophil counts in peripheral blood are done routinely following the administration of high-dose myelosuppressive chemotherapy in order to monitor the onset, severity, and duration of iatrogenic neutropenia. We have studied a non-invasive method of quantifying neutrophils recoverable from the oral mucosa, a normal tissue site of neutrophil turnover, as an alternative approach for monitoring severe, chemotherapy-induced neutropenia. This method is based on the quantification of fluorochrome-stained neutrophils present in timed mouthwash specimens. Blood neutrophil (ANC) and mucosal neutrophil counts (MNC) were measured repeatedly in 23 patients who had been treated with dose-intensive chemotherapy for a variety of indications. All 23 patients developed profound neutropenia (ANC < 100/mm3), and 19 developed neutropenic fever (>101 degrees F) during the 2 weeks following treatment. Nadirs of neutropenia defined by MNC were significantly less prolonged than those defined by the ANC. Furthermore, the onset and resolution of neutropenic fever coincided more precisely with nadirs of neutropenia defined by the MNC than with those defined by the ANC. Our findings indicate that oral mucosal neutrophil counts predict the timing of clinical events associated with neutropenia (e.g., the onset and resolution of fever) with significantly greater accuracy than blood neutrophil counts.
细胞毒性抗癌化疗后出现的严重中性粒细胞减少症，众所周知与可能危及生命的感染风险增加有关，尤其是在未立即治疗的情况下。因此，在给予大剂量骨髓抑制性化疗后，通常会定期对外周血中的中性粒细胞计数进行连续测量，以监测医源性中性粒细胞减少症的发生、严重程度和持续时间。我们研究了一种非侵入性方法，用于量化可从口腔黏膜（中性粒细胞更新的正常组织部位）中回收的中性粒细胞，作为监测严重化疗诱导的中性粒细胞减少症的替代方法。该方法基于对定时漱口水标本中荧光染色的中性粒细胞进行定量。对23例因各种适应症接受剂量密集化疗的患者反复测量血液中性粒细胞（ANC）和黏膜中性粒细胞计数（MNC）。所有23例患者在治疗后的2周内均出现了严重的中性粒细胞减少症（ANC<100/mm³），其中19例出现了中性粒细胞减少性发热（>101华氏度）。由MNC定义的中性粒细胞减少症最低点持续时间明显短于由ANC定义的最低点持续时间。此外，中性粒细胞减少性发热的发生和消退与由MNC定义的中性粒细胞减少症最低点更为精确地一致，而不是与由ANC定义的最低点一致。我们的研究结果表明，与血液中性粒细胞计数相比，口腔黏膜中性粒细胞计数能更准确地预测与中性粒细胞减少症相关的临床事件的时间（如发热的发生和消退）。
