根据化疗方案分析肿瘤血液科患者中性粒细胞减少性小肠结肠炎的流行病学、危险因素及预后
Epidemiology, Risk Factors and Outcome of Neutropenic Enterocolitis in Onco-Hematological Patients according to Chemotherapy Regimen.
作者信息
Brunel Anne-Sophie, Seydoux Claire, Schmidt Sabine, Ahlyege Siham, Guillet Aurélie, Mandralis Katerina, Fleury Mapi, Cairoli Anne, Blum Sabine, Spertini Olivier, Marchetti Oscar, Gavillet Mathilde, Bochud Pierre-Yves
机构信息
Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland.
Infectious Diseases Service, University Hospital of Besançon, France.
出版信息
Clin Infect Dis. 2025 Mar 20. doi: 10.1093/cid/ciaf134.
BACKGROUND
While neutropenic enterocolitis (NEC) is a well-known life-threatening complication during intensive chemotherapy, its incidence, impact and outcome on specific at-risk populations remain ill-defined.
METHODS
We report 178 NEC episodes during 1963 myeloablative chemotherapy courses among 1259 adult patients with acute myeloid (AML) or lymphoid (ALL) leukemia or receiving autologous hematopoietic stem cell-transplant (auto-HCT) for lymphoma or multiple myeloma. Risk factors were assessed by multivariate logistic regression models.
RESULTS
Most NEC cases (93.3%) occurred during AML induction (N=92, 13.8% of chemotherapy course) and auto-HCT (N=74, 9.5%). Independent risk factors for NEC during AML induction included high-dose corticosteroids (OR=2.07, 95%CI 1.29-3.30, P=0.002), elevated circulating blasts at the time of diagnosis (>50 G/L, OR=2.02, 95%CI 1.15-3.56, P=0.02) and use of azacitidine (OR=2.45, 95%CI 1.01-5.90, P=0.05); purine-based regimens (e.g. FLAG-Ida) was an independent protective factor (OR=0.27, 95%CI 0.15-0.47, P<0.001). Independent risk factors after auto-HCT included BEAM versus another conditioning protocol (OR=3.28; 95%CI 1.98-5.43, P<0.001) and age (OR=1.03 per year, 95%CI 1.01-1.06, P=0.007). For both AML induction and auto-HCT, NEC was associated with longer hospitalization (P=0.03 and P<0.001), sepsis (quick SOFA≥2, P=0.03 and P<0.001), fungemia (P<0.001 and P=0.01) and intensive care admission (P=0.03 and P<0.001, respectively). NEC was associated with increased in-hospital mortality during AML induction (6.5% versus 2.4%, P=0.04) but not during auto-HCT (P=0.3).
CONCLUSIONS
The incidence of NEC depended on chemotherapeutic regimens, with higher occurrence during standard "7+3" AML induction and BEAM conditioning for auto-HCT. NEC was associated with longer hospitalization and increased morbidity, but 30-day mortality was lower than previously reported.
背景
虽然中性粒细胞减少性小肠结肠炎（NEC）是强化化疗期间一种众所周知的危及生命的并发症，但其在特定高危人群中的发病率、影响和结局仍不明确。
方法
我们报告了1259例成年急性髓系白血病（AML）或淋巴细胞白血病（ALL）患者，或因淋巴瘤或多发性骨髓瘤接受自体造血干细胞移植（auto-HCT）的1963个清髓性化疗疗程中的178例NEC发作。通过多因素逻辑回归模型评估危险因素。
结果
大多数NEC病例（93.3%）发生在AML诱导期（N = 92，占化疗疗程的13.8%）和auto-HCT期（N = 74，占9.5%）。AML诱导期NEC的独立危险因素包括大剂量皮质类固醇（OR = 2.07，95%CI 1.29 - 3.30，P = 0.002）、诊断时循环母细胞升高（>50 G/L，OR = 2.02，95%CI 1.15 - 3.56，P = 0.02）以及使用阿扎胞苷（OR = 2.45，95%CI 1.01 - 5.90，P = 0.05）；基于嘌呤的方案（如FLAG-Ida）是独立的保护因素（OR = 0.27，95%CI 0.15 - 0.47，P < 0.001）。auto-HCT后的独立危险因素包括BEAM方案与另一种预处理方案相比（OR = 3.28；95%CI 1.98 - 5.43，P < 0.001）和年龄（每年OR = 1.03，95%CI 1.01 - 1.06，P = 0.007）。对于AML诱导期和auto-HCT，NEC均与住院时间延长相关（P = 0.03和P < 0.001）、脓毒症（快速序贯器官衰竭评估≥2，P = 0.03和P < 0.001）、真菌血症（P < 0.001和P = 0.01）以及入住重症监护病房相关（分别为P = 0.03和P < 0.001）。NEC与AML诱导期住院死亡率增加相关（6.5%对2.4%，P = 0.04），但与auto-HCT期间无关（P = 0.3）。
结论
NEC的发病率取决于化疗方案，在标准的“7 + 3”AML诱导期和auto-HCT的BEAM预处理期间发生率更高。NEC与住院时间延长和发病率增加相关，但30天死亡率低于先前报道。
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