Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Institute for Inflammation Research, Center for Rheumatology and Spine Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur J Haematol. 2023 Jun;110(6):762-771. doi: 10.1111/ejh.13962. Epub 2023 Apr 4.
Although neutropenic fever is frequently observed during chemotherapy, only a minor proportion is caused by blood stream infections (BSI). This study investigated measurements of neutrophil chemotaxis as risk markers for BSI in children with acute lymphoblastic leukemia (ALL).
The chemokines CXCL1 and CXCL8 were measured weekly in 106 children with ALL during induction treatment. Information regarding BSI episodes was collected from the patients' medical records.
During induction treatment, 102 (96%) patients developed profound neutropenia and 27 (25%) were diagnosed with BSI, debuting on median day 12 (range: 4-29). Patients developing BSI had increased levels of CXCL1 on days 8 and 15 as well as increased CXCL8 on days 8, 15, 22, and 29 compared to patients without BSI (all p < 0.05). Patients with BSI < day 12 exhibited increased CXCL1 and CXCL8 levels as early as day 8 (81 vs. 4 pg/mL, p = 0.031 and 35 vs. 10 pg/mL, p < 0.0001, respectively), while CXCL1 and CXCL8 were increased on day 15 (215 vs. 57 pg/mL, p = 0.022 and 68 vs. 17 pg/mL, p = 0.0002) and after (all p < 0.01) in patients with BSI ≥ day 12.
The markers of neutrophil chemotaxis, CXCL1, and CXCL8 may help to identify patients at increased risk of BSI during chemotherapy-induced neutropenia.
虽然中性粒细胞减少症在化疗期间经常发生，但只有一小部分是由血流感染（BSI）引起的。本研究调查了趋化因子 CXCL1 和 CXCL8 的测量值作为儿童急性淋巴细胞白血病（ALL）BSI 的风险标志物。
在诱导治疗期间，每周对 106 例 ALL 患儿进行 CXCL1 和 CXCL8 检测。从患者的病历中收集有关 BSI 发作的信息。
在诱导治疗期间，102 例（96%）患者出现严重中性粒细胞减少症，27 例（25%）诊断为 BSI，中位发病时间为第 12 天（范围：4-29 天）。与无 BSI 的患者相比，发生 BSI 的患者在第 8 天和第 15 天 CXCL1 水平升高，在第 8 天、第 15 天、第 22 天和第 29 天 CXCL8 水平升高（均 p<0.05）。BSI<第 12 天的患者在第 8 天（81 vs. 4 pg/mL，p=0.031 和 35 vs. 10 pg/mL，p<0.0001）和第 15 天（215 vs. 57 pg/mL，p=0.022 和 68 vs. 17 pg/mL，p=0.0002）CXCL1 和 CXCL8 水平升高，而在 BSI≥第 12 天的患者中，在第 15 天（215 vs. 57 pg/mL，p=0.022 和 68 vs. 17 pg/mL，p=0.0002）和之后（均 p<0.01）CXCL1 和 CXCL8 水平升高。
趋化因子 CXCL1 和 CXCL8 的标志物可能有助于识别化疗诱导中性粒细胞减少症期间发生 BSI 的高风险患者。
