1
|
Wang Y, Cai W, He P, Cai Q, Huang J, Liu S, Chen M, Chen L, Lin Y, Hou J, Li J, Fu C, Han Z, Han H, Lin S, Xu C, Fu F, Wang C. Clinical outcomes of coronavirus disease in patients with breast cancer treated with granulocyte colony-stimulating factor following chemotherapy: Triangulation of evidence using population-based cohort and Mendelian randomization analyses. Int J Cancer 2024. [PMID: 38561936 DOI: 10.1002/ijc.34914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Recombinant human granulocyte colony-stimulating factor (G-CSF) administration in patients with cancer and coronavirus disease (COVID-19) remains controversial. Concerns exist that it may worsen COVID-19 outcomes by triggering an inflammatory cytokine storm, despite its common use for managing chemotherapy-induced neutropenia (CIN) or febrile neutropenia post-chemotherapy. Here, we determined whether prophylactic or therapeutic G-CSF administration following chemotherapy exacerbates COVID-19 progression to severe/critical conditions in breast cancer patients with COVID-19. Between December 2022 and February 2023, all 503 enrolled breast cancer patients had concurrent COVID-19 and received G-CSF post-chemotherapy, with most being vaccinated pre-chemotherapy. We prospectively observed COVID-19-related adverse outcomes, conducted association analyses, and subsequently performed Mendelian randomization (MR) analyses to validate the causal effect of genetically predicted G-CSF or its associated granulocyte traits on COVID-19 adverse outcomes. Only 0.99% (5/503) of breast cancer patients experienced COVID-19-related hospitalization following prophylactic or therapeutic G-CSF administration after chemotherapy. No mortality or progression to severe/critical COVID-19 occurred after G-CSF administration. Notably, no significant associations were observed between the application, dosage, or response to G-CSF and COVID-19-related hospitalization (all p >.05). Similarly, the MR analyses showed no evidence of causality of genetically predicted G-CSF or related granulocyte traits on COVID-19-related hospitalization or COVID-19 severity (all p >.05). There is insufficient evidence to substantiate the notion that the prophylactic or therapeutic administration of G-CSF after chemotherapy for managing CIN in patients with breast cancer and COVID-19 would worsen COVID-19 outcomes, leading to severe or critical conditions, or even death, especially considering the context of COVID-19 vaccination.
Collapse
Affiliation(s)
- Yali Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Weifeng Cai
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Peng He
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Qindong Cai
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jinhua Huang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Shougui Liu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Minyan Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Lili Chen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yuxiang Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jialin Hou
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jing Li
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chengbin Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhonghua Han
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hui Han
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Shunguo Lin
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chunsen Xu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Fangmeng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chuan Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Breast Cancer Institute, Fujian Medical University, Fuzhou, Fujian Province, China
| |
Collapse
|
2
|
Chean D, Windsor C, Lafarge A, Dupont T, Nakaa S, Whiting L, Joseph A, Lemiale V, Azoulay E. Severe Community-Acquired Pneumonia in Immunocompromised Patients. Semin Respir Crit Care Med 2024; 45:255-265. [PMID: 38266998 DOI: 10.1055/s-0043-1778137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Due to higher survival rates with good quality of life, related to new treatments in the fields of oncology, hematology, and transplantation, the number of immunocompromised patients is increasing. But these patients are at high risk of intensive care unit admission because of numerous complications. Acute respiratory failure due to severe community-acquired pneumonia is one of the leading causes of admission. In this setting, the need for invasive mechanical ventilation is up to 60%, associated with a high hospital mortality rate of around 40 to 50%. A wide range of pathogens according to the reason of immunosuppression is associated with severe pneumonia in those patients: documented bacterial pneumonia represents a third of cases, viral and fungal pneumonia both account for up to 15% of cases. For patients with an undetermined etiology despite comprehensive diagnostic workup, the hospital mortality rate is very high. Thus, a standardized diagnosis strategy should be defined to increase the diagnosis rate and prescribe the appropriate treatment. This review focuses on the benefit-to-risk ratio of invasive or noninvasive strategies, in the era of omics, for the management of critically ill immunocompromised patients with severe pneumonia in terms of diagnosis and oxygenation.
Collapse
Affiliation(s)
- Dara Chean
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Camille Windsor
- Medical Intensive Care Unit, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Antoine Lafarge
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Thibault Dupont
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Sabrine Nakaa
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Livia Whiting
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Adrien Joseph
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, AP-HP Saint-Louis University Hospital, Paris, France
| |
Collapse
|
3
|
Patel A, Pathak A, Sarin A, Shelly D, Ranjan R, Singh A, Kala T, PV B. Phase 1/2 Study of the Timing and Efficacy of 3 mg Peg-GCSF in Neo/Adjuvant Dose Dense Breast Cancer Treatment Protocols. South Asian J Cancer 2023; 12:238-244. [PMID: 38047054 PMCID: PMC10691905 DOI: 10.1055/s-0042-1757599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Amol PatelBackground Peg-GCSF has similar efficacy at a dose of 60 µg/kg and 100 µg/kg. The conventional 6 mg SC dose was based on the maximum tolerable dose. In Japan, 3.6 mg dose was approved on the basis of dose finding studies. Peg-GCSF is an integral part of dose-dense chemotherapy protocols. Dose finding and scheduling study of peg-GCSF have not been conducted in Indian patients. Materials and Methods We conducted two-center phase 1/2 clinical study addressing the timing and efficacy of peg-GCSF in Indian breast cancer patients (CTRI no: 2021/07/034751). Three groups of timing administration were studied, namely 1, 6, and 24 hours post chemotherapy. The phase 2 part was the expansion of the best timing group. The primary objective was dose density, which was defined as receiving chemotherapy on < 3 days of scheduled date. Adriamycin/epirubicin cyclophosphamide (AC/EC) was administered q2 weeks. The total leucocyte (TLC) and absolute neutrophil (ANC) kinetics were studied. Other outcomes were incidence of grade 4 neutropenia, febrile neutropenia (FN), and requirement of additional doses of G-CSF. Bone pain, fever, and myalgia were studied for adverse effects. Results From November 20 to December 21, 36 patients were enrolled. Patient characteristics are depicted in Table 1. Initially, three patients received the peg-GCSF in each timing group. One patient in each 1-hour and 6 hours needed G-CSF support for maintaining the dose density. The 24-hour group was carried to phase 2 part. Dose density was maintained in 97% of patients. None of the patient in 24-hour group had FN. Also, 4/30 patients had grade 4 neutropenia and required an additional dose of GCSF. Grade 3 or 4 bone pain was not noticed by any of the patients. During the first cycle, the mean ANC (cells/μL) was 5284, 20704, 3010, 6954 on D0, D + 3, D + 7, and D + 13, respectively (Fig. 1A-TLC and 1B-ANC). The mean ANC (cells/μL) rise on D + 3 in cycles 1, 2, 3, 4 was 23810, 29209, 32428,22455, respectively. Conclusion Dose density of AC/EC breast cancer protocol is maintained with peg-GCSF 3 mg. Post chemotherapy 24-hour timing of peg-GCSF administration remains as the standard. A phase 3 trial of 6 mg versus 3 mg is warranted.
Collapse
Affiliation(s)
- Amol Patel
- Indian Naval Hospital Ship, Asvini, Mumbai, Maharashtra, India
| | | | - Arti Sarin
- Western Naval Command, Mumbai, Maharashtra, India
| | - Divya Shelly
- Indian Naval Hospital Ship, Asvini, Mumbai, Maharashtra, India
| | | | - Arashdeep Singh
- Indian Naval Hospital Ship, Asvini, Mumbai, Maharashtra, India
| | - Tripti Kala
- Day Care Chemotherapy Centre, INHS, Asvini, Mumbai, Maharashtra, India
| | - Babitha PV
- Day Care Chemotherapy Centre, INHS, Asvini, Mumbai, Maharashtra, India
| |
Collapse
|
4
|
Rarani FZ, Rashidi B, Jafari Najaf Abadi MH, Hamblin MR, Reza Hashemian SM, Mirzaei H. Cytokines and microRNAs in SARS-CoV-2: What do we know? MOLECULAR THERAPY. NUCLEIC ACIDS 2022; 29:219-242. [PMID: 35782361 PMCID: PMC9233348 DOI: 10.1016/j.omtn.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic constitutes a global health emergency. Currently, there are no completely effective therapeutic medications for the management of this outbreak. The cytokine storm is a hyperinflammatory medical condition due to excessive and uncontrolled release of pro-inflammatory cytokines in patients suffering from severe COVID-19, leading to the development of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) and even mortality. Understanding the pathophysiology of COVID-19 can be helpful for the treatment of patients. Evidence suggests that the levels of tumor necrosis factor alpha (TNF-α) and interleukin (IL)-1 and IL-6 are dramatically different between mild and severe patients, so they may be important contributors to the cytokine storm. Several serum markers can be predictors for the cytokine storm. This review discusses the cytokines involved in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, focusing on interferons (IFNs) and ILs, and whether they can be used in COVID-19 treatment. Moreover, we highlight several microRNAs that are involved in these cytokines and their role in the cytokine storm caused by COVID-19.
Collapse
Affiliation(s)
- Fahimeh Zamani Rarani
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahman Rashidi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mirzaei
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran
| |
Collapse
|
5
|
Hematology Emergencies in Adults With Critical Illness. Chest 2022; 162:120-131. [DOI: 10.1016/j.chest.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
|
6
|
Zhang AW, Morjaria S, Kaltsas A, Hohl TM, Parameswaran R, Patel D, Zhou W, Predmore J, Perez-Johnston R, Jee J, Daniyan AF, Perales MA, Taur Y. The Effect of Neutropenia and Filgrastim (G-CSF) on Cancer Patients With Coronavirus Disease 2019 (COVID-19) Infection. Clin Infect Dis 2022; 74:567-574. [PMID: 34111237 PMCID: PMC8406899 DOI: 10.1093/cid/ciab534] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neutropenia is commonly encountered in cancer patients. Recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim), a cytokine that initiates proliferation and differentiation of mature granulocytes, is widely given to oncology patients to counteract neutropenia, reducing susceptibility to infection. However, the clinical impact of neutropenia and G-CSF use in cancer patients with coronavirus disease 2019 (COVID-19) remains unknown. METHODS An observational cohort of 379 actively treated cancer patients with COVID-19 was assembled to investigate links between concurrent neutropenia and G-CSF administration on COVID-19-associated respiratory failure and death. These factors were encoded as time-dependent predictors in an extended Cox model, controlling for age and underlying cancer diagnosis. To determine whether the degree of granulocyte response to G-CSF affected outcomes, the degree of response to G-CSF, based on rise in absolute neutrophil count (ANC) 24 hours after growth factor administration, was also incorporated into a similar Cox model. RESULTS In the setting of active COVID-19 infection, outpatient receipt of G-CSF led to an increased number of hospitalizations (hazard ratio [HR]: 3.54, 95% confidence interval [CI]: 1.25-10.0, P value: .017). Furthermore, among inpatients, G-CSF administration was associated with increased need for high levels of oxygen supplementation and death (HR: 3.56, 95% CI: 1.19-10.2, P value: .024). This effect was predominantly seen in patients that exhibited a high response to G-CSF based on their ANC increase post-G-CSF administration (HR: 7.78, 95% CI: 2.05-27.9, P value: .004). CONCLUSIONS The potential risks versus benefits of G-CSF administration should be considered in neutropenic cancer patients with COVID-19, because G-CSF administration may lead to worsening clinical and respiratory status.
Collapse
Affiliation(s)
- Allen W Zhang
- MD/PhD Program, Faculty of Medicine, University of British
Columbia, Vancouver, BC, Canada
| | - Sejal Morjaria
- Infectious Disease, Department of Medicine, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
- Department of Medicine, Weill Cornell Medical
College, New York, New York, USA
| | - Anna Kaltsas
- Infectious Disease, Department of Medicine, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
- Department of Medicine, Weill Cornell Medical
College, New York, New York, USA
| | - Tobias M Hohl
- Infectious Disease, Department of Medicine, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
- Department of Medicine, Weill Cornell Medical
College, New York, New York, USA
- Immunology Program, Sloan Kettering Institute, Memorial
Sloan Kettering Cancer Center, New York, New
York, USA
| | - Rekha Parameswaran
- Hematology Service, Department of Medicine, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
| | - Dhruvkumar Patel
- Department of Quality and Safety, Memorial Sloan Kettering
Cancer Center, New York, New York, USA
| | - Wei Zhou
- Operation Excellence, Memorial Sloan Kettering Cancer
Center, New York, New York, USA
- Advanced Practice Provider Department, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
| | - Jacqueline Predmore
- MD/PhD Program, Faculty of Medicine, University of British
Columbia, Vancouver, BC, Canada
| | - Rocio Perez-Johnston
- Hematology Service, Department of Medicine, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
- Department of Radiology, Memorial Sloan Kettering Cancer
Center, New York, New York, USA
| | - Justin Jee
- Department of Medicine, Memorial Sloan Kettering Cancer
Center, New York, New York, USA
| | - Anthony F Daniyan
- Department of Medicine, Weill Cornell Medical
College, New York, New York, USA
- Leukemia Service, Memorial Sloan Kettering Cancer
Center, New York, New York, USA
- Cellular Therapeutics Center, Memorial Sloan Kettering
Cancer Center, New York, New York, USA
| | - Miguel-Angel Perales
- Department of Medicine, Weill Cornell Medical
College, New York, New York, USA
- Adult Bone Marrow Transplantation Service, Department of
Medicine, Memorial Sloan Kettering, New York, New
York, USA
| | - Ying Taur
- Infectious Disease, Department of Medicine, Memorial Sloan
Kettering Cancer Center, New York, New
York, USA
- Department of Medicine, Weill Cornell Medical
College, New York, New York, USA
| |
Collapse
|
7
|
Doig C, Cooke R, Chua C, Leung T. Acute respiratory distress syndrome precipitated by granulocyte colony-stimulating factor in undiagnosed Pneumocystis jirovecii pneumonia. BMJ Case Rep 2022; 15:15/2/e242316. [PMID: 35115328 PMCID: PMC8814741 DOI: 10.1136/bcr-2021-242316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We present the case of a 62-year-old man with rheumatoid arthritis who developed a leukaemoid reaction and acute respiratory distress syndrome (ARDS) following granulocyte colony-stimulating factor (G-CSF) administration that had been given to treat neutropenia secondary to methotrexate and leflunomide toxicity. Later it was established that he had Pneumocystis jirovecii pneumonia, which was treated to complete resolution with a course of corticosteroids and antibiotics. This case highlights the potential risk of G-CSF administration in an immune compromised individual in the midst of bone marrow recovery in the context of active infection. Recognition of immune escape syndromes is vital and requires an understanding of potential triggers and risk factors.
Collapse
Affiliation(s)
- Christopher Doig
- Department of Haematology, Northern Health Research and Education, Epping, Victoria, Australia
| | - Rachel Cooke
- Department of Haematology, Northern Health Research and Education, Epping, Victoria, Australia
| | - Chyn Chua
- Department of Haematology, Northern Health Research and Education, Epping, Victoria, Australia
| | - Teresa Leung
- Department of Haematology, Northern Health Research and Education, Epping, Victoria, Australia
| |
Collapse
|
8
|
Fitch T, Myers KC, Dewan M, Towe C, Dandoy C. Pulmonary Complications After Pediatric Stem Cell Transplant. Front Oncol 2021; 11:755878. [PMID: 34722309 PMCID: PMC8550452 DOI: 10.3389/fonc.2021.755878] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
The number of disorders that benefit from hematopoietic stem cell transplantation (HSCT) has increased, causing the overall number of HSCT to increase accordingly. Disorders treated by HSCT include malignancy, benign hematologic disorders, bone marrow failure syndromes, and certain genetic diagnoses. Thus, understanding the complications, diagnostic workup of complications, and subsequent treatments has become increasingly important. One such category of complications includes the pulmonary system. While the overall incidence of pulmonary complications has decreased, the morbidity and mortality of these complications remain high. Therefore, having a clear differential diagnosis and diagnostic workup is imperative. Pulmonary complications can be subdivided by time of onset and whether the complication is infectious or non-infectious. While most infectious complications have clear diagnostic criteria and treatment courses, the non-infectious complications are more varied and not always well understood. This review article discusses pulmonary complications of HSCT recipients and outlines current knowledge, gaps in knowledge, and current treatment of each complication. This article includes some adult studies, as there is a significant paucity of pediatric data.
Collapse
Affiliation(s)
- Taylor Fitch
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Maya Dewan
- Division of Critical Care, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Christopher Towe
- Division of Pulmonology, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Christopher Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center (CCHMC), University of Cincinnati School of Medicine, Cincinnati, OH, United States
| |
Collapse
|
9
|
Lasagna A, Muzzana M, Pedrazzoli P. Lights and shadows on the role of rhG-CSF in cancer patients during the COVID-19 pandemic and future perspectives of research. Immunotherapy 2021; 13:1369-1372. [PMID: 34585970 PMCID: PMC8544616 DOI: 10.2217/imt-2021-0219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Marta Muzzana
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, 27100, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy.,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, 27100, Italy
| |
Collapse
|
10
|
Kolben Y, Darawshy F, Barhoum B, Abutbul A, Kuint R. Diffuse alveolar hemorrhage in a healthy stem cell donor following administration of granulocyte colony - stimulating factor. Int Immunopharmacol 2021; 99:108019. [PMID: 34426109 DOI: 10.1016/j.intimp.2021.108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Granulocyte colony - stimulating factor (G-CSF) is frequently used in healthy adults prior to stem cell donation in order to mobilize stem cells to peripheral blood. Adverse events of G-CSF occur in about 30% and mainly include bone pain, fatigue, and headache. Pulmonary adverse events are rare. CASE PRESENTATION Here, we describe a case of a healthy donor who developed diffuse alveolar hemorrhage after G-CSF administration. We suggest the underlying mechanism of this injury. CONCLUSION Diffuse alveolar hemorrhage can occur following G-CSF administration. Treating physicians should be aware of this infrequent but often life-threatening pulmonary side effect of G-CSF.
Collapse
Affiliation(s)
- Yotam Kolben
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Fares Darawshy
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Barhoum Barhoum
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avraham Abutbul
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Rottem Kuint
- Institute of Pulmonary Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| |
Collapse
|
11
|
Pulmonary toxicity following administration of granulocyte colony-stimulating factor during chemotherapy for breast cancer: a case report and literature review. Anticancer Drugs 2021; 32:1142-1145. [PMID: 34232946 DOI: 10.1097/cad.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this report, we aim to present a case of pulmonary toxicity in a patient that received neoadjuvant chemotherapy treatment with doxorubicin and cyclophosphamide for triple-negative breast cancer that was followed with granulocyte colony-stimulating factor (G-CSF) for prevention neutropenia, our patient presented with chest discomfort and dyspnea, with radiologic evidence of radiologic investigations showed acute respiratory distress syndrome, after investigation and follow up we came to the conclusion that it was G-CSF adverse effect.
Collapse
|
12
|
Sahu KK, Cerny J. A review on how to do hematology consults during COVID-19 pandemic. Blood Rev 2021; 47:100777. [PMID: 33199084 PMCID: PMC7648889 DOI: 10.1016/j.blre.2020.100777] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023]
Abstract
The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.
Collapse
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Jan Cerny
- Division of Hematology and Oncology, Department of Medicine, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA, USA.
| |
Collapse
|
13
|
Lasagna A, Ferraris E, Rizzo G, Tancredi RJ, Pedrazzoli P. Reply to Y. Ergun et al. JCO Oncol Pract 2021; 17:457. [PMID: 33797956 DOI: 10.1200/op.21.00154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Angioletta Lasagna
- Angioletta Lasagna, MD, Elisa Ferraris, MD, Gianpiero Rizzo, MD, Richard J. Tancredi, MD, and Paolo Pedrazzoli, MD, Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Elisa Ferraris
- Angioletta Lasagna, MD, Elisa Ferraris, MD, Gianpiero Rizzo, MD, Richard J. Tancredi, MD, and Paolo Pedrazzoli, MD, Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Gianpiero Rizzo
- Angioletta Lasagna, MD, Elisa Ferraris, MD, Gianpiero Rizzo, MD, Richard J. Tancredi, MD, and Paolo Pedrazzoli, MD, Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Richard J Tancredi
- Angioletta Lasagna, MD, Elisa Ferraris, MD, Gianpiero Rizzo, MD, Richard J. Tancredi, MD, and Paolo Pedrazzoli, MD, Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Paolo Pedrazzoli
- Angioletta Lasagna, MD, Elisa Ferraris, MD, Gianpiero Rizzo, MD, Richard J. Tancredi, MD, and Paolo Pedrazzoli, MD, Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| |
Collapse
|
14
|
Ergun Y, Esen SA, Ucar G, Acikgoz Y, Karacin C. Is It Safe to Use Long-Acting G-CSF for Febrile Neutropenia Prophylaxis in COVID-19 Pandemic? JCO Oncol Pract 2021; 17:455-456. [PMID: 33797950 DOI: 10.1200/op.20.01091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yakup Ergun
- Yakup Ergun, MD, Medical Oncology Unit, Batman Training and Research Hospital, Batman, Turkey; Selin Akturk Esen, MD, Gokhan Ucar, MD, Yusuf Acikgoz, MD, Medical Oncology Unit, Ankara City Hospital, Ankara, Turkey; and Cengiz Karacin, MD, Medical Oncology Unit, RTE Training and Research Hospital, Rize, Turkey
| | - Selin Akturk Esen
- Yakup Ergun, MD, Medical Oncology Unit, Batman Training and Research Hospital, Batman, Turkey; Selin Akturk Esen, MD, Gokhan Ucar, MD, Yusuf Acikgoz, MD, Medical Oncology Unit, Ankara City Hospital, Ankara, Turkey; and Cengiz Karacin, MD, Medical Oncology Unit, RTE Training and Research Hospital, Rize, Turkey
| | - Gokhan Ucar
- Yakup Ergun, MD, Medical Oncology Unit, Batman Training and Research Hospital, Batman, Turkey; Selin Akturk Esen, MD, Gokhan Ucar, MD, Yusuf Acikgoz, MD, Medical Oncology Unit, Ankara City Hospital, Ankara, Turkey; and Cengiz Karacin, MD, Medical Oncology Unit, RTE Training and Research Hospital, Rize, Turkey
| | - Yusuf Acikgoz
- Yakup Ergun, MD, Medical Oncology Unit, Batman Training and Research Hospital, Batman, Turkey; Selin Akturk Esen, MD, Gokhan Ucar, MD, Yusuf Acikgoz, MD, Medical Oncology Unit, Ankara City Hospital, Ankara, Turkey; and Cengiz Karacin, MD, Medical Oncology Unit, RTE Training and Research Hospital, Rize, Turkey
| | - Cengiz Karacin
- Yakup Ergun, MD, Medical Oncology Unit, Batman Training and Research Hospital, Batman, Turkey; Selin Akturk Esen, MD, Gokhan Ucar, MD, Yusuf Acikgoz, MD, Medical Oncology Unit, Ankara City Hospital, Ankara, Turkey; and Cengiz Karacin, MD, Medical Oncology Unit, RTE Training and Research Hospital, Rize, Turkey
| |
Collapse
|
15
|
Rapoport BL, Cooksley T, Johnson DB, Anderson R, Shannon VR. Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC). Expert Rev Clin Pharmacol 2021; 14:295-313. [PMID: 33517803 DOI: 10.1080/17512433.2021.1884067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Patients with hematological and advanced solid malignancies have acquired immune dysfunction, often exacerbated by treatment, posing a significant risk for the development of infections. This review evaluates the utility of current clinical and treatment guidelines, in the setting of management of infections in cancer patients. AREAS COVERED These include causes of infection in cancer patients, management of patients with high-risk and low-risk febrile neutropenia, management of low-risk patients in an outpatient setting, the role of granulocyte colony-stimulating factor (G-CSF) in the prevention and treatment of neutropenia-related infections, management of lung infections in various clinical settings, and emerging challenges surrounding the risk of infection in cancer patients treated with novel treatments. The literature search was performed by accessing PubMed and other databases, focusing on published clinical trials of relevant anti-cancer agents and diseases, primarily covering the recent past, but also including several key studies published during the last decade and, somewhat earlier in a few cases. EXPERT REVIEW Notwithstanding the promise of gene therapy/gene editing in hematological malignancies and some types of solid cancers, innovations introduced in clinical practice include more discerning clinical management such as the generalized use of biosimilar formulations of G-CSF and the implementation of novel, innovative immunotherapies.
Collapse
Affiliation(s)
- Bernardo L Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,The Medical Oncology Centre of Rosebank, Saxonwold, Johannesburg, South Africa.,The Multinational Association for Supportive Care in Cancer (MASCC), Chair of the Neutropenia, Infection and Myelosuppression Study Group
| | - Tim Cooksley
- Manchester University Foundation Trust, Manchester, United Kingdom. The Christie, University of Manchester, Manchester, UK.,The Multinational Association for Supportive Care in Cancer (MASCC), Infection and Myelosuppression Study Group
| | - Douglas B Johnson
- Douglas B. Johnson, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee, USA
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW The spread of the novel coronavirus SARS-CoV-2 and its associated disease, coronavirus disease of 2019 (COVID-19), has significantly derailed cancer care. Patients with leukemia are more likely to have severe infection and increased rates of mortality. There is paucity of information on how to modify care of leukemia patients in view of the COVID-19 risks and imposed restrictions. We review the available literature on the impact of COVID-19 on different types of leukemia patients and suggest general as well as disease-specific recommendations on care based on available evidence. RECENT FINDINGS The COVID-19 infection impacts leukemia subtypes in variable ways and the standard treatments for leukemia have similarly, varying effects on the course of COVID-19 infection. Useful treatment strategies include deferring treatment when possible, use of less intensive regimens, outpatient targeted oral agents requiring minimal monitoring, and prioritization of curative or life-prolonging strategies. Reducing health care encounters, rational transfusion standards, just resource allocation, and pre-emptive advance care planning will serve the interests of leukemia patients. Ad hoc modifications based on expert opinions and extrapolations of previous well-designed studies are the way forward to navigate the crisis. This should be supplanted with more rigorous prospective evidence.
Collapse
|
17
|
Patel DR, Fonseca X, Patel AM. Filgrastim-Associated Pneumonitis in Cancer Patient Undergoing Hematopoietic Stem Cell (HSC) Mobilization for Autologous-HSC Transplantation. Cureus 2020; 12:e12114. [PMID: 33489529 PMCID: PMC7810180 DOI: 10.7759/cureus.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Filgrastim is a granulocyte-colony stimulating factors (G-CSF) used for multiple indications in cancer patients. We present a case of a 65-year-old man with non-Hodgkin’s lymphoma who was undergoing mobilization of hemopoietic stem cells for autologous-hematopoietic stem cell transplantation (auto-HSCT) with filgrastim who developed dyspnea and non-productive cough. Chest imaging showed left lower lobe consolidation, new ground-glass opacities and small right-sided pleural effusion. Bronchoscopy with bronchoalveolar lavage (BAL) and infectious evaluation were completely negative. He was admitted for further evaluation and management. Antibiotics weren’t started immediately given the clinical stability, multiple probable causes of fever and the intent of not confounding future thoracentesis results with antibiotic use. Thoracentesis occurred draining serous exudative pleural fluid; with follow-up chest imaging demonstrating no re-accumulation. His symptoms resolved and he was discharged in stable condition. The symptoms were hypothesized to be the probable adverse effects of filgrastim. We suggest close monitoring of pulmonary toxicities while administering this drug to patients to minimize such complications.
Collapse
Affiliation(s)
- Drashti R Patel
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Xavier Fonseca
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, USA
| | | |
Collapse
|
18
|
Laiakis EC, McCart EA, Deziel A, Rittase WB, Bouten RM, Jha J, Wilkins WL, Day RM, Fornace AJ. Effect of 3,3'-Diindolylmethane on Pulmonary Injury Following Thoracic Irradiation in CBA Mice. HEALTH PHYSICS 2020; 119:746-757. [PMID: 32384373 PMCID: PMC8579862 DOI: 10.1097/hp.0000000000001257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The molecule 3,3'-diindolylmethane (DIM) is small, a major bioactive metabolite of indole-3 carbinol (13C), and a phytochemical compound from cruciferous vegetables released upon exposure to the gut acid environment. DIM is a proposed anti-cancer agent and was previously demonstrated to prevent radiation damage in the bone marrow and the gastrointestinal tract. Here we investigated the effect of DIM on radiation-induced injury to the lung in a murine model through untargeted metabolomics and gene expression studies of select genes. CBA mice were exposed to thoracic irradiation (17.5 Gy). Mice were treated with vehicle or DIM (250 mg kg, subcutaneous injection) on days -1 pre-irradiation through +14 post-irradiation. DIM induced a significant improvement in survival by day 150 post-irradiation. Fibrosis-related gene expression and metabolomics were examined using lung tissue from days 15, 45, 60, 90, and 120 post-irradiation. Our qRT-PCR experiments showed that DIM treatment reduced radiation-induced late expression of collagen Iα and the cell cycle checkpoint proteins p21/waf1 (CDKN1A) and p16ink (CDKN2A). Metabolomic studies of lung tissue demonstrated a significant dampening of radiation-induced changes following DIM treatment. Metabolites associated with pro-inflammatory responses and increased oxidative stress, such as fatty acids, were suppressed by DIM treatment compared to irradiated samples. Together these data suggest that DIM reduces radiation-induced sequelae in the lung.
Collapse
Affiliation(s)
- Evagelia C. Laiakis
- Department of Oncology, Georgetown University, Washington, DC 20057, USA
- Department of Biochemistry and Molecular & Cellular Oncology, Georgetown University, Washington, DC 20057, USA
| | - Elizabeth A. McCart
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Annabella Deziel
- Department of Oncology, Georgetown University, Washington, DC 20057, USA
| | - W. Bradley Rittase
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Roxane M. Bouten
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jyoti Jha
- Current address: Rise Therapeutics, Rockville, MD 20850, USA
| | - W. Louis Wilkins
- Division of Comparative Pathology, the Armed Forces Radiobiology Research Institute/Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Regina M. Day
- Department of Pharmacology and Molecular Therapeutics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Albert J. Fornace
- Department of Oncology, Georgetown University, Washington, DC 20057, USA
- Department of Biochemistry and Molecular & Cellular Oncology, Georgetown University, Washington, DC 20057, USA
| |
Collapse
|
19
|
Morjaria S, Zhang A, Kaltsas Md A, Parameswaran R, Patel D, Zhou W, Predmore J, Perez Johnston R, Jee J, Perales M, Daniyan A, Taur Y, Mailankody S. The Effect of Neutropenia and Filgrastim (G-CSF) in Cancer Patients With COVID-19 Infection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.08.13.20174565. [PMID: 32817981 PMCID: PMC7430626 DOI: 10.1101/2020.08.13.20174565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
BACKGROUND Neutropenia is commonly encountered in cancer patients, and recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim) is widely given to oncology patients to counteract neutropenia and prevent infection. G-CSF is both a growth factor and cytokine that initiates proliferation and differentiation of mature granulocytes. However, the clinical impact of neutropenia and G-CSF use in cancer patients, who are also afflicted with coronavirus disease 2019 (COVID-19), remains unknown. METHODS An observational cohort of 304 hospitalized patients with COVID-19 at Memorial Sloan Kettering Cancer Center was assembled to investigate links between concurrent neutropenia (N=55) and G-CSF administration (N=16) on COVID-19-associated respiratory failure and death. These factors were assessed as time-dependent predictors using an extended Cox model, controlling for age and underlying cancer diagnosis. To determine whether the degree of granulocyte response to G-CSF affected outcomes, a similar model was constructed with patients that received G-CSF, categorized into high- and low-response, based on the level of absolute neutrophil count (ANC) rise 24 hours after growth factor administration. RESULTS Neutropenia (ANC < 1 K/mcL) during COVID-19 course was not independently associated with severe respiratory failure or death (HR: 0.71, 95% Cl: 0.34-1.50, P value: 0.367) in hospitalized COVID-19 patients. When controlling for neutropenia, G-CSF administration was associated with increased need for high oxygen supplementation and death (HR: 2.97, 95% CI: 1.06-8.28, P value: 0.038). This effect was predominantly seen in patients that exhibited a high response to G-CSF based on their ANC increase post-G-CSF administration (HR: 5.18, 95% CI: 1.61-16.64, P value: 0.006). CONCLUSION Possible risks versus benefits of G-CSF administration should be weighed in neutropenic cancer patients with COVID-19 infection, as G-CSF may lead to worsening clinical and respiratory status in this setting.
Collapse
|
20
|
Miśkiewicz-Migoń I, Miśkiewicz-Bujna J, Rosa M, Kubica-Cielińska A, Bladowska J, Janczar S, Ussowicz M. Severe, Reversible Acute Lung Injury During Autologous Hematopoietic Stem Cell Mobilization After Filgrastim in a Child With Neuroblastoma: A Case Report. Transplant Proc 2020; 52:2849-2853. [PMID: 32713816 DOI: 10.1016/j.transproceed.2020.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
Peripheral blood hematopoietic stem cell mobilization is widely performed in a variety of clinical facilities and is believed to be a safe outpatient procedure. In this report, we describe a child with neuroblastoma who developed an extremely severe acute lung injury after granulocyte colony-stimulating factor was used for peripheral hematopoietic stem cell mobilization. A 3-year-old boy with a medical history of patent foramen ovale and secundum atrial septal defect was diagnosed with an MYCN-amplified neuroblastoma and treated with chemotherapy. During stem cell mobilization with filgrastim, the boy was in very good clinical condition, with a peripheral white blood cell (WBC) count of 57.17 K/μL, but he suddenly deteriorated, and nausea, seizures, and nystagmus were observed. The patient developed dyspnea with hemoptysis, and lung computed tomography showed bilateral asymmetrical pulmonary opacification demonstrating an anteroposterior density gradient. Because of rapidly progressing circulatory and respiratory failure, the child was hospitalized in the intensive care unit. Corticosteroid therapy, broad-spectrum antibiotic therapy, and cardiovascular support with mechanical ventilation were immediately instituted, and the child recovered without sequelae. The presented case emphasizes that life-threatening complications can occur during granulocyte colony-stimulating factor administration, and patient surveillance is warranted, especially if high leukocyte counts are observed or the patient exhibits cardiopulmonary signs.
Collapse
Affiliation(s)
- Izabella Miśkiewicz-Migoń
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Justyna Miśkiewicz-Bujna
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Rosa
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kubica-Cielińska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Marek Ussowicz
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland.
| |
Collapse
|
21
|
Muthumalage T, Lucas JH, Wang Q, Lamb T, McGraw MD, Rahman I. Pulmonary Toxicity and Inflammatory Response of E-Cigarette Vape Cartridges Containing Medium-Chain Triglycerides Oil and Vitamin E Acetate: Implications in the Pathogenesis of EVALI. TOXICS 2020; 8:toxics8030046. [PMID: 32605182 PMCID: PMC7560420 DOI: 10.3390/toxics8030046] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022]
Abstract
Recently, there has been an outbreak of a condition named e-cigarette or vaping products-associated lung injury (EVALI). The primary components of vaping products include tetrahydrocannabinol (THC), vitamin E acetate (VEA) and medium-chain triglycerides (MCT), may be responsible for acute lung toxicity. Currently, little information is available on the physiological and biological effects of exposure to these products. We hypothesized that these CBD/counterfeit vape cartridges and their constituents (VEA and MCT) induce pulmonary toxicity, mediated by oxidative damage and inflammatory responses, leading to acute lung injury. We studied the potential mechanisms of CBD/counterfeit vape cartridge aerosol induced inflammatory response by evaluating the generation of reactive oxygen species by MCT, VEA, and cartridges and their effects on the inflammatory state of pulmonary epithelium and immune cells both in vitro and in vivo. Cells exposed to these aerosols generated reactive oxygen species, caused cytotoxicity, induced epithelial barrier dysfunction, and elicited an inflammatory response. Using a murine model, the parameters of acute toxicity to aerosol inhalation were assessed. Infiltration of neutrophils and lymphocytes was accompanied by significant increases in IL-6, eotaxin, and G-CSF in the bronchoalveolar lavage fluid (BALF). In mouse BALF, eicosanoid inflammatory mediators, leukotrienes, were significantly increased. Plasma from e-cig users also showed increased levels of hydroxyeicosatetraenoic acid (HETEs) and various eicosanoids. Exposure to CBD/counterfeit vape cartridge aerosols showed the most significant effects and toxicity compared to MCT and VEA. In addition, we determined SARS-CoV-2 related proteins and found no impact associated with aerosol exposures from these tested cartridges. Overall, this study demonstrates acute exposure to specific CBD/counterfeit vape cartridges induces in vitro cytotoxicity, barrier dysfunction, and inflammation and in vivo mouse exposure induces acute inflammation with elevated proinflammatory markers in the pathogenesis of EVALI.
Collapse
Affiliation(s)
- Thivanka Muthumalage
- Department of Environmental Medicine, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.M.); (J.H.L.); (Q.W.); (T.L.)
| | - Joseph H. Lucas
- Department of Environmental Medicine, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.M.); (J.H.L.); (Q.W.); (T.L.)
| | - Qixin Wang
- Department of Environmental Medicine, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.M.); (J.H.L.); (Q.W.); (T.L.)
| | - Thomas Lamb
- Department of Environmental Medicine, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.M.); (J.H.L.); (Q.W.); (T.L.)
| | - Matthew D. McGraw
- Division of Pediatric Pulmonology, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Irfan Rahman
- Department of Environmental Medicine, School of Medicine & Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.M.); (J.H.L.); (Q.W.); (T.L.)
- Correspondence: ; Tel.: +1-(585)-275-6911
| |
Collapse
|
22
|
Zeidan AM, Boddu PC, Patnaik MM, Bewersdorf JP, Stahl M, Rampal RK, Shallis R, Steensma DP, Savona MR, Sekeres MA, Roboz GJ, DeAngelo DJ, Schuh AC, Padron E, Zeidner JF, Walter RB, Onida F, Fathi A, DeZern A, Hobbs G, Stein EM, Vyas P, Wei AH, Bowen DT, Montesinos P, Griffiths EA, Verma AK, Keyzner A, Bar-Natan M, Navada SC, Kremyanskaya M, Goldberg AD, Al-Kali A, Heaney ML, Nazha A, Salman H, Luger S, Pratz KW, Konig H, Komrokji R, Deininger M, Cirici BX, Bhatt VR, Silverman LR, Erba HP, Fenaux P, Platzbecker U, Santini V, Wang ES, Tallman MS, Stone RM, Mascarenhas J. Special considerations in the management of adult patients with acute leukaemias and myeloid neoplasms in the COVID-19 era: recommendations from a panel of international experts. LANCET HAEMATOLOGY 2020; 7:e601-e612. [PMID: 32563283 PMCID: PMC7302757 DOI: 10.1016/s2352-3026(20)30205-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/28/2023]
Abstract
The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 is a global public health crisis. Multiple observations indicate poorer post-infection outcomes for patients with cancer than for the general population. Herein, we highlight the challenges in caring for patients with acute leukaemias and myeloid neoplasms amid the COVID-19 pandemic. We summarise key changes related to service allocation, clinical and supportive care, clinical trial participation, and ethical considerations regarding the use of lifesaving measures for these patients. We recognise that these recommendations might be more applicable to high-income countries and might not be generalisable because of regional differences in health-care infrastructure, individual circumstances, and a complex and highly fluid health-care environment. Despite these limitations, we aim to provide a general framework for the care of patients with acute leukaemias and myeloid neoplasms during the COVID-19 pandemic on the basis of recommendations from international experts.
Collapse
Affiliation(s)
- Amer M Zeidan
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Prajwal C Boddu
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Jan Philipp Bewersdorf
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Maximilian Stahl
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raajit K Rampal
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rory Shallis
- Section of Hematology, Yale School of Medicine, Yale University, New Haven, CT, USA; Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - David P Steensma
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael R Savona
- Department of Hematology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Mikkael A Sekeres
- Leukemia Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Gail J Roboz
- Department of Hematology and Oncology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daniel J DeAngelo
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andre C Schuh
- Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada
| | - Eric Padron
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Joshua F Zeidner
- Division of Hematology and Oncology, Lineberger Comprehensive Care Center, University of North Carolina, Chapel Hill, NC, USA
| | - Roland B Walter
- Division of Hematology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Francesco Onida
- Department of Hematology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Amir Fathi
- Department of Hematology, Centre for Leukemia, Massachusetts General Hospital, Boston, MA, USA
| | - Amy DeZern
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Gabriela Hobbs
- Department of Hematology, Centre for Leukemia, Massachusetts General Hospital, Boston, MA, USA
| | - Eytan M Stein
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paresh Vyas
- MRC Molecular Haematology Unit, BRC Oxford Department of Haematology, University of Oxford, Oxford, UK
| | - Andrew H Wei
- Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
| | - David T Bowen
- Department of Haematology, Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Pau Montesinos
- Department of Haematology, Hospital Universitario y Politecnico La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, University of Valencia, Madrid, Spain
| | - Elizabeth A Griffiths
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amit K Verma
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Alla Keyzner
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michal Bar-Natan
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shyamala C Navada
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marina Kremyanskaya
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron D Goldberg
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aref Al-Kali
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark L Heaney
- Department of Hematology, Herbert Irving Comprehensive Care Centre, Columbia University, New York, NY, USA
| | - Aziz Nazha
- Department of Hematology, Cleveland Clinic-Taussig Cancer Institute, Cleveland, OH, USA
| | - Huda Salman
- Department of Internal Medicine, Stony Brook University Cancer Center, Stony Brook, NY, USA
| | - Selina Luger
- Department of Medicine, Hematology and Oncology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith W Pratz
- Department of Medicine, Hematology and Oncology Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Heiko Konig
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Division of Hematology and Oncology, Indiana University, Indianapolis, IN, USA
| | - Rami Komrokji
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Deininger
- Huntsman Cancer Institute, Department of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, UT, USA
| | - Blanca Xicoy Cirici
- Clinical Haematology Department, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vijaya Raj Bhatt
- Fred and Pamela Buffett Cancer Center, Department of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lewis R Silverman
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Harry P Erba
- Duke Cancer Institute, Department of Medicine, Division of Hematologic Malignancies and Cellular Therapies, Durham, NC, USA
| | - Pierre Fenaux
- Department of Hematology, Hôpital St Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Haematology, Paris University, Paris, France
| | - Uwe Platzbecker
- Department of Medicine, Division of Translational Hematology, Leipzig University Hospital, Leipzig, Germany
| | - Valeria Santini
- Department of Medicine, University of Florence Medical School, Florence, Italy
| | - Eunice S Wang
- Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martin S Tallman
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard M Stone
- Department of Hematology, Division of Leukemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John Mascarenhas
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
23
|
Muthumalage T, Lucas JH, Wang Q, Lamb T, McGraw MD, Rahman I. Pulmonary toxicity and inflammatory response of e-cigarettes containing medium-chain triglyceride oil and vitamin E acetate: Implications in the pathogenesis of EVALI but independent of SARS-COV-2 COVID-19 related proteins. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2020. [PMID: 32587960 DOI: 10.1101/2020.06.14.151381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recently, there has been an outbreak associated with the use of e-cigarette or vaping products, associated lung injury (EVALI). The primary components of vaping products, vitamin E acetate (VEA) and medium-chain triglycerides (MCT) may be responsible for acute lung toxicity. Currently, little information is available on the physiological and biological effects of exposure to these products. We hypothesized that these e-cig cartridges and their constituents (VEA and MCT) induce pulmonary toxicity, mediated by oxidative damage and inflammatory responses, leading to acute lung injury. We studied the potential mechanisms of cartridge aerosol induced inflammatory response by evaluating the generation of reactive oxygen species by MCT, VEA, and cartridges, and their effects on the inflammatory state of pulmonary epithelium and immune cells both in vitro and in vivo. Cells exposed to these aerosols generated reactive oxygen species, caused cytotoxicity, induced epithelial barrier dysfunction, and elicited an inflammatory response. Using a murine model, the parameters of acute toxicity to aerosol inhalation were assessed. Infiltration of neutrophils and lymphocytes was accompanied by significant increases in IL-6, eotaxin, and G-CSF in the bronchoalveolar lavage fluid (BALF). In mouse plasma, eicosanoid inflammatory mediators, leukotrienes, were significantly increased. Plasma from e-cig users also showed increased levels of hydroxyeicosatetraenoic acid (HETEs) and various eicosanoids. Exposure to e-cig cartridge aerosols showed the most significant effects and toxicity compared to MCT and VEA. In addition, we determined at SARS-COV-2 related proteins and found no impact associated with aerosol exposures from these tested cartridges. Overall, this study demonstrates acute exposure to specific e-cig cartridges induces in vitro cytotoxicity, barrier dysfunction, and inflammation and in vivo mouse exposure induces acute inflammation with elevated pro-inflammatory markers in the pathogenesis of EVALI.
Collapse
|
24
|
Alkan A, Uncu A, Taşkıran I, Tanrıverdi Ö. Double-edged sword: Granulocyte colony stimulating factors in cancer patients during the COVID-19 era. Clinics (Sao Paulo) 2020; 75:e2033. [PMID: 32638908 PMCID: PMC7330715 DOI: 10.6061/clinics/2020/e2033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ali Alkan
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
- *Corresponding author. E-mail:
| | - Asaf Uncu
- Internal Medicine, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Irmak Taşkıran
- Internal Medicine, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Özgür Tanrıverdi
- Medical Oncology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| |
Collapse
|
25
|
Abstract
Pneumonia is a highly prevalent disease with considerable morbidity and mortality. However, diagnosis and therapy still rely on antiquated methods, leading to the vast overuse of antimicrobials, which carries risks for both society and the individual. Furthermore, outcomes in severe pneumonia remain poor. Genomic techniques have the potential to transform the management of pneumonia through deep characterization of pathogens as well as the host response to infection. This characterization will enable the delivery of selective antimicrobials and immunomodulatory therapy that will help to offset the disorder associated with overexuberant immune responses.
Collapse
Affiliation(s)
- Samir Gautam
- Pulmonary Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Yale University, 300 Cedar Street, TACS441, New Haven, CT 06520-8057, USA
| | - Lokesh Sharma
- Pulmonary Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Yale University, 300 Cedar Street, TACS441, New Haven, CT 06520-8057, USA
| | - Charles S Dela Cruz
- Pulmonary Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Yale University, 300 Cedar Street, TACS441, New Haven, CT 06520-8057, USA.
| |
Collapse
|
26
|
Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheidt D, Hentrich M, Henze L, Kiehl M, Liebregts T, von Lilienfeld-Toal M, Classen A, Mellinghoff S, Penack O, Piepel C, Böll B. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98:1051-1069. [PMID: 30796468 PMCID: PMC6469653 DOI: 10.1007/s00277-019-03622-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.
Collapse
Affiliation(s)
- Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany.
| | - E Schalk
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - M von Bergwelt-Baildon
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Medical Department III, University Medical Center & Comprehensive Cancer Center Munich, Munich, Germany
| | - G Beutel
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany
| | - D Buchheidt
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany
| | - M Hentrich
- Department of Medicine III - Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - L Henze
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - M Kiehl
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Internal Medicine I, Clinic Frankfurt (Oder), Frankfurt, Germany
| | - T Liebregts
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - M von Lilienfeld-Toal
- Department for Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - A Classen
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Mellinghoff
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - O Penack
- Department for Hematology, Oncology and Tumorimmunology, Campus Virchow Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Piepel
- Department of Hematology, Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany
| | - B Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
| |
Collapse
|
27
|
Influence of neutropenia on mortality of critically ill cancer patients: results of a meta-analysis on individual data. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:326. [PMID: 30514339 PMCID: PMC6280476 DOI: 10.1186/s13054-018-2076-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/21/2018] [Indexed: 12/13/2022]
Abstract
Background The study objective was to assess the influence of neutropenia on outcome of critically ill cancer patients by meta-analysis of individual data. Secondary objectives were to assess the influence of neutropenia on outcome of critically ill patients in prespecified subgroups (according to underlying tumor, period of admission, need for mechanical ventilation and use of granulocyte colony stimulating factor (G-CSF)). Methods Data sources were PubMed and the Cochrane database. Study selection included articles focusing on critically ill cancer patients published in English and studies in humans from May 2005 to May 2015. For study selection, the study eligibility was assessed by two investigators. Individual data from selected studies were obtained from corresponding authors. Results Overall, 114 studies were identified and authors of 30 studies (26.3% of selected studies) agreed to participate in this study. Of the 7515 included patients, three were excluded due to a missing major variable (neutropenia or mortality) leading to analysis of 7512 patients, including 1702 neutropenic patients (22.6%). After adjustment for confounders, and taking study effect into account, neutropenia was independently associated with mortality (OR 1.41; 95% CI 1.23–1.62; P = 0.03). When analyzed separately, neither admission period, underlying malignancy nor need for mechanical ventilation modified the prognostic influence of neutropenia on outcome. However, among patients for whom data on G-CSF administration were available (n = 1949; 25.9%), neutropenia was no longer associated with outcome in patients receiving G-CSF (OR 1.03; 95% CI 0.70–1.51; P = 0.90). Conclusion Among 7512 critically ill cancer patients included in this systematic review, neutropenia was independently associated with poor outcome despite a meaningful survival. Neutropenia was no longer significantly associated with outcome in patients treated by G-CSF, which may suggest a beneficial effect of G-CSF in neutropenic critically ill cancer patients. Systematic review registration PROSPERO CRD42015026347. Date of registration: Sept 18 2015 Electronic supplementary material The online version of this article (10.1186/s13054-018-2076-z) contains supplementary material, which is available to authorized users.
Collapse
|
28
|
Mignard X, Biard L, Lemiale V, Mokart D, Pène F, Kouatchet A, Mayaux J, Vincent F, Nyunga M, Bruneel F, Rabbat A, Lebert C, Perez P, Meert AP, Benoit D, Hamidfar R, Darmon M, Azoulay E, Zafrani L. Granulocyte colony-stimulating factor and respiratory status of critically ill neutropenic patients with hematologic malignancies. Leuk Lymphoma 2018; 60:1156-1163. [PMID: 30277108 DOI: 10.1080/10428194.2018.1516874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In patients with hematologic malignancies, respiratory status may deteriorate during neutropenia recovery. This multicenter, observational study aims to evaluate granulocyte colony-stimulating factor (G-CSF) impact on respiratory status in critically ill neutropenic patients. Among 1011 critically ill patients with hematologic malignancies, 288 were neutropenic and included in this study. 201 (70%) did not receive G-CSF at day 1 or 2. After propensity score matching for the probability of receiving G-CSF at day 1 or 2, there was no association between G-CSF and respiratory deterioration at day 14 (OR =1.19; 95%CI (0.57-2.51); p = .64). Additional sensitivity analysis in patients admitted for acute respiratory failure showed similar results (OR =1.34; 95%CI (0.5-3.59); p = .57). Among patients who recovered from neutropenia, 75% experienced respiratory deterioration during neutropenia recovery. This study confirms that neutropenia recovery is a situation at risk of respiratory deterioration. However, whether G-CSF is an aggravating factor cannot be supported by our results.
Collapse
Affiliation(s)
- Xavier Mignard
- a Medical ICU , Saint-Louis Teaching Hospital , Paris , France
| | - Lucie Biard
- b Department of Biostatistics , Saint-Louis Teaching Hospital , Paris , France
| | | | - Djamel Mokart
- c ICU , Paoli Calmette Institute , Marseille , France
| | | | | | - Julien Mayaux
- f Medical ICU , Pitié-Salpétrière Teaching Hospital , Paris , France
| | | | | | | | - Antoine Rabbat
- j Respiratory Unit , Cochin Teaching Hospital , Paris , France
| | | | - Pierre Perez
- l ICU , Brabois Teaching Hospital , Nancy , France
| | - Anne-Pascale Meert
- m Service soins intensifs et urgences oncologiques , Institut Jules Bordet , Brussels , Belgium
| | | | - Rebecca Hamidfar
- o ICU , Albert Michallon University Hospital , Grenoble , France
| | - Michael Darmon
- p ICU , Saint-Etienne University Hospital , Saint-Etienne , France
| | - Elie Azoulay
- a Medical ICU , Saint-Louis Teaching Hospital , Paris , France
| | - Lara Zafrani
- a Medical ICU , Saint-Louis Teaching Hospital , Paris , France
| |
Collapse
|
29
|
Kiehl MG, Beutel G, Böll B, Buchheidt D, Forkert R, Fuhrmann V, Knöbl P, Kochanek M, Kroschinsky F, La Rosée P, Liebregts T, Lück C, Olgemoeller U, Schalk E, Shimabukuro-Vornhagen A, Sperr WR, Staudinger T, von Bergwelt Baildon M, Wohlfarth P, Zeremski V, Schellongowski P. Consensus statement for cancer patients requiring intensive care support. Ann Hematol 2018; 97:1271-1282. [PMID: 29704018 PMCID: PMC5973964 DOI: 10.1007/s00277-018-3312-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/19/2018] [Indexed: 02/06/2023]
Abstract
This consensus statement is directed to intensivists, hematologists, and oncologists caring for critically ill cancer patients and focuses on the management of these patients.
Collapse
Affiliation(s)
- M G Kiehl
- Department of Internal Medicine I, Clinic Frankfurt/Oder GmbH, Müllroser Chaussee 7, 15236, Frankfurt (Oder), Germany.
| | - G Beutel
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B Böll
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Buchheidt
- III. Medical Clinic, Medical Faculty Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Forkert
- Johanniter-Hospital, Johanniterstr. 3-5, 53113, Bonn, Germany
| | - V Fuhrmann
- Clinic for Intensive Care Medicine, University Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - P Knöbl
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Kochanek
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Kroschinsky
- Department of Internal Medicine I, University Hospital, Fetschertstr. 74, 01307, Dresden, Germany
| | - P La Rosée
- Department of Internal Medicine III, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany
| | - T Liebregts
- Clinic for Stem Cell Transplantation, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Lück
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - U Olgemoeller
- Department of Cardiology and Pulmonary Medicine, University Hospital, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - E Schalk
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Shimabukuro-Vornhagen
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - W R Sperr
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Staudinger
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M von Bergwelt Baildon
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - P Wohlfarth
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - V Zeremski
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - P Schellongowski
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | |
Collapse
|
30
|
Doukhan L, Bisbal M, Chow-Chine L, Sannini A, Brun JP, Cambon S, Nguyen Duong L, Faucher M, Mokart D. Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request. PLoS One 2017; 12:e0181808. [PMID: 28749989 PMCID: PMC5531489 DOI: 10.1371/journal.pone.0181808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/09/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Prognostic impact of delayed intensive care unit(ICU) admission in critically ill cancer patients remains debatable. We determined predictive factors for later ICU admission and mortality in cancer patients initially not admitted after their first ICU request. METHODS All cancer patients referred for an emergency ICU admission between 1 January 2012 and 31 August 2013 were included. RESULTS Totally, 246(54.8%) patients were immediately admitted. Among 203(45.2%) patients denied at the first request, 54(26.6%) were admitted later. A former ICU stay [OR: 2.75(1.12-6.75)], a request based on a clinical respiratory event[OR: 2.6(1.35-5.02)] and neutropenia[OR: 2.25(1.06-4.8)] were independently associated with later ICU admission. Survival of patients admitted immediately and later did not differ at ICU(78.5% and 70.4%, respectively; p = 0.2) or hospital(74% and 66%, respectively; p = 0.24) discharge. Hospital mortality of patients initially not admitted was 29.7% and independently associated with malignancy progression[OR: 3.15(1.6-6.19)], allogeneic hematopoietic stem cell transplantation[OR: 2.5(1.06-5.89)], a request based on a clinical respiratory event[OR: 2.36(1.22-4.56)] and severe sepsis[OR: 0.27(0.08-0.99)]. CONCLUSION Compared with immediate ICU admission, later ICU admission was not associated with hospital mortality. Clinical respiratory events were independently associated with both later ICU admission and hospital mortality.
Collapse
Affiliation(s)
- Laure Doukhan
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Magali Bisbal
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | | | - Antoine Sannini
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Jean Paul Brun
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Sylvie Cambon
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Lam Nguyen Duong
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
| | - Djamel Mokart
- Intensive Care Unit, Institut Paoli Calmettes, Marseille, France
- * E-mail:
| |
Collapse
|
31
|
Banuelos J, Cao Y, Shin SC, Bochner BS, Avila P, Li S, Jiang X, Lingen MW, Schleimer RP, Lu NZ. Granulocyte colony-stimulating factor blockade enables dexamethasone to inhibit lipopolysaccharide-induced murine lung neutrophils. PLoS One 2017; 12:e0177884. [PMID: 28542361 PMCID: PMC5438114 DOI: 10.1371/journal.pone.0177884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/04/2017] [Indexed: 01/13/2023] Open
Abstract
Glucocorticoids promote neutrophilic inflammation, the mechanisms of which are poorly characterized. Using a lipopolysaccharide (LPS)-induced acute murine lung injury model, we determined the role of granulocyte colony-stimulating factor (G-CSF) in mouse lung neutrophil numbers in the absence and presence of dexamethasone, a potent glucocorticoid. G-CSF was blocked using a neutralizing antibody. Airway neutrophil numbers, cytokine levels, and lung injury parameters were measured. Glucocorticoid treatment maintained LPS-induced airway G-CSF while suppressing TNF and IL-6. The addition of anti-G-CSF antibodies enabled dexamethasone to decrease airway G-CSF, neutrophils, and lung injury scores. In LPS-challenged murine lungs, structural cells and infiltrating leukocytes produced G-CSF. In vitro using BEAS 2B bronchial epithelial cells, A549 lung epithelial cells, human monocyte-derived macrophages, and human neutrophils, we found that dexamethasone and proinflammatory cytokines synergistically induced G-CSF. Blocking G-CSF production in BEAS 2B cells using shRNAs diminished the ability of BEAS 2B cells to protect neutrophils from undergoing spontaneous apoptosis. These data support that G-CSF plays a role in upregulation of airway neutrophil numbers by dexamethasone in the LPS-induced acute lung injury model.
Collapse
Affiliation(s)
- Jesus Banuelos
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Yun Cao
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Soon Cheon Shin
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Bruce S. Bochner
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Pedro Avila
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Shihong Li
- Department of Pharmacology and Human Tissue Resource Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Xin Jiang
- Department of Pharmacology and Human Tissue Resource Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Mark W. Lingen
- Department of Pharmacology and Human Tissue Resource Center, The University of Chicago, Chicago, Illinois, United States of America
| | - Robert P. Schleimer
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nick Z. Lu
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| |
Collapse
|
32
|
Prise en charge du patient neutropénique en réanimation (nouveau-nés exclus). Recommandations d’un panel d’experts de la Société de réanimation de langue française (SRLF) avec le Groupe francophone de réanimation et urgences pédiatriques (GFRUP), la Société française d’anesthésie et de réanimation (Sfar), la Société française d’hématologie (SFH), la Société française d’hygiène hospitalière (SF2H) et la Société de pathologies infectieuses de langue française (SPILF). MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
33
|
Lebon D, Biard L, Buyse S, Schnell D, Lengliné E, Roussel C, Gornet JM, Munoz-Bongrand N, Quéro L, Resche-Rigon M, Azoulay E, Canet E. Gastrointestinal emergencies in critically ill cancer patients. J Crit Care 2017; 40:69-75. [PMID: 28363097 DOI: 10.1016/j.jcrc.2017.03.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/09/2017] [Accepted: 03/20/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe gastrointestinal emergencies in cancer patients. METHODS All cancer patients admitted to the medical ICU of Saint-Louis Hospital for an acute abdominal syndrome during the study period (1997-2011) were included. RESULTS A total of 164 patients were included. The most common diagnoses were: neutropenic enterocolitis (NE) (n=54, 33%), infectious colitis and peritonitis (n=51, 31%), bowel infiltration by malignancy (n=14, 9%), and mucosal toxicity of chemotherapy (n=12, 7%). Microbiologically documented infections were reported in 82 patients (50%), including 12 fungal infections. Twenty-seven patients (16%) underwent urgent surgery. The hospital mortality rate was 35%. Five factors were independently associated with hospital mortality: the Simplified Acute Physiology Score II (SAPS II) score on day 1 (OR 1.03/SAPS II point, 95% CI 1.01 to 1.05), microbiological documentation (OR 0.27, 95% CI 0.11 to 0.64), neutropenia (OR 0.42, 95% CI 0.19 to 0.95), allogenic hematopoietic stem-cell transplantation (HSCT) (OR 5.13, 95% CI 1.71 to 15.4), and mechanical ventilation (OR 3.42, 95% CI 1.37 to 8.51). CONCLUSIONS Gastrointestinal emergencies in cancer patients are associated with significant mortality. Mortality correlated both with the severity of organ failure upon ICU admission and the underlying diagnosis. Interestingly, patients admitted to the ICU with neutropenia had better survival.
Collapse
Affiliation(s)
- Delphine Lebon
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Lucie Biard
- Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Sophie Buyse
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - David Schnell
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Etienne Lengliné
- Adult Hematology Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Camille Roussel
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Nicolas Munoz-Bongrand
- Department of Digestive and Endocrine Surgery, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Laurent Quéro
- Radiation-Oncology Department, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Matthieu Resche-Rigon
- Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
| |
Collapse
|
34
|
Abstract
Filgrastim is a granulocyte colony-stimulating factor commonly used in the prophylaxis and treatment of neutropenia associated with chemotherapy in cancer patients. It is a well-tolerated and safe drug but some unusual serious adverse effects may occur. We expose a case of a 37-year-old woman who was hospitalized with severe pancitopenia after the first cycle of chemotherapy with a cisplatin doublet and bevacizumab. Filgrastim was administered for 3 days with the aim of increasing neutrophils and not delay the next chemotherapy cycle. Due to acute respiratory failure she was transferred to the Intensive Care Unit for symptomatic control where required oxygen therapy. Fungal and bacterial culture were made and so blood serologies, all of them were negative. It was diagnosed as pneumonitis secondary to a probable side effect of filgrastim. Although the case was resolved properly it is important monitor the administration of filgrastim because of the severity of these events.
Collapse
|
35
|
Shimabukuro-Vornhagen A, Böll B, Kochanek M, Azoulay É, von Bergwelt-Baildon MS. Critical care of patients with cancer. CA Cancer J Clin 2016; 66:496-517. [PMID: 27348695 DOI: 10.3322/caac.21351] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state-of-the-art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016;66:496-517. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Alexander Shimabukuro-Vornhagen
- Consultant, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Head of Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Matthias Kochanek
- Member, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Éli Azoulay
- Director, Medical Intensive Care Unit, St. Louis Hospital, Paris, France
- Professor of Medicine, Teaching and Research Unit, Department of Medicine, Paris Diderot University, Paris, France
- Chair, Study Group for Respiratory Intensive Care in Malignancies, St. Louis Hospital, Paris, France
| | - Michael S von Bergwelt-Baildon
- Founding Member, Intensive Care in Hemato-Oncologic Patients (iCHOP), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Program Director, Medical Intensive Care Program, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- Professor, Cologne-Bonn Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
36
|
Schnell D, Azoulay E, Benoit D, Clouzeau B, Demaret P, Ducassou S, Frange P, Lafaurie M, Legrand M, Meert AP, Mokart D, Naudin J, Pene F, Rabbat A, Raffoux E, Ribaud P, Richard JC, Vincent F, Zahar JR, Darmon M. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). Ann Intensive Care 2016; 6:90. [PMID: 27638133 PMCID: PMC5025409 DOI: 10.1186/s13613-016-0189-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023] Open
Abstract
Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
Collapse
Affiliation(s)
| | | | | | - Benjamin Clouzeau
- Medical Intensive Care Unit, Pellegrin University Hospital, Bordeaux, France
| | - Pierre Demaret
- Paediatric Intensive Care Unit, Centre Hospitalier Chrétien, Liège, Belgium
| | - Stéphane Ducassou
- Pediatric Hematological Unit, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Frange
- Microbiology Laboratory & Pediatric Immunology - Hematology Unit, Necker University Hospital, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, Saint-Louis University Hospital, Paris, France
| | - Matthieu Legrand
- Surgical ICU and Burn Unit, Saint-Louis University Hospital, Paris, France
| | - Anne-Pascale Meert
- Thoracic Oncology Department and Oncologic Intensive Care Unit, Institut Jules Bordet, Brussels, Belgium
| | - Djamel Mokart
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmette, Marseille, France
| | - Jérôme Naudin
- Pediatric ICU, Robert Debré University Hospital, Paris, France
| | | | - Antoine Rabbat
- Respiratory Intensive Care Unit, Cochin University Hospital Hospital, Paris, France
| | - Emmanuel Raffoux
- Department of Hematology, Saint-Louis University Hospital, Paris, France
| | - Patricia Ribaud
- Department of Stem Cell Transplantation, Saint-Louis University Hospital, Paris, France
| | | | | | - Jean-Ralph Zahar
- Infection Control Unit, Angers University Hospital, Angers, France
| | - Michael Darmon
- University Hospital, Saint-Etienne, France. .,Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, 42270, Saint-Etienne, Saint-Priest-En-Jarez, France.
| |
Collapse
|
37
|
Reilly JP, Anderson BJ, Hudock KM, Dunn TG, Kazi A, Tommasini A, Charles D, Shashaty MGS, Mikkelsen ME, Christie JD, Meyer NJ. Neutropenic sepsis is associated with distinct clinical and biological characteristics: a cohort study of severe sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:222. [PMID: 27431667 PMCID: PMC4950810 DOI: 10.1186/s13054-016-1398-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/01/2016] [Indexed: 12/31/2022]
Abstract
Background Immunocompromised patients who develop sepsis while neutropenic are at high risk for morbidity and mortality; however, it is unknown if neutropenic sepsis is associated with distinct clinical and biological characteristics. Methods We conducted a prospective cohort study of patients admitted to the medical intensive care unit of an academic medical center with severe sepsis. Patients were followed for the development of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and mortality. Plasma proteins, representing the host inflammatory response, anti-inflammatory response, and endothelial leak were measured in 30 % of subjects. Clinical characteristics and plasma protein concentrations of patients with neutropenia at enrollment were compared to patients without neutropenia. Results Of 797 subjects enrolled, 103 (13 %) were neutropenic at ICU admission. The neutropenic subjects were more often in shock, admitted from the hospital ward, had higher APACHE III scores, and more likely bacteremic. Neutropenia was an independent risk factor for AKI (RR 1.28; 95 % CI 1.04, 1.57; p = 0.03), but not ARDS (RR 0.90; 95 % CI 0.70, 1.17; p = 0.42) or 30-day mortality (RR 1.05; 95 % CI 0.85, 1.31; p = 0.65). Neutropenic subjects had higher plasma interleukin (IL)-6 (457 vs. 249 pg/ml; p = 0.03), IL-8 (581 vs. 94 pg/ml; p <0.001), and granulocyte colony-stimulating factor (G-CSF) (3624 vs. 99 pg/ml; p <0.001). Angiopoietin-2 and IL-1 receptor antagonist concentrations did not differ between groups. Conclusions Neutropenic sepsis is associated with a higher AKI risk and concentrations of inflammatory mediators IL-6, IL-8, and G-CSF relative to non-neutropenic patients. These differences may have implications for future therapies targeting neutropenic sepsis. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1398-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- John P Reilly
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA.
| | - Brian J Anderson
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kristin M Hudock
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas G Dunn
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA
| | - Altaf Kazi
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA
| | - Anna Tommasini
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA
| | - Dudley Charles
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA
| | - Michael G S Shashaty
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, 19104, PA, USA
| |
Collapse
|
38
|
Wu H, Ren C, Yang F, Qin Y, Zhang Y, Liu J. Extraction and identification of collagen-derived peptides with hematopoietic activity from Colla Corii Asini. JOURNAL OF ETHNOPHARMACOLOGY 2016; 182:129-136. [PMID: 26911525 DOI: 10.1016/j.jep.2016.02.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/30/2016] [Accepted: 02/16/2016] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Colla Corii Asini is a widely used traditional Chinese medicine to treat anemia with a long history due to its stimulating effect in hematopoiesis, but the components contributing to this effect are still unknown. In this study, we aimed to establish a methodology to isolate the bioactive components and provide pharmacological basis for its usage in treating anemia. METHODS 5-FU and γ-ray radiation induced anemic mice models were generated by treating with 5-FU at 150mg/kg body weight and γ-rays by a 4MV linear accelerator by total body irradiation using female ICR mice respectively. Oral administration of fraction A was performed by gastric lavage at 1g/kg and 2g/kg body weight for 12 days and 25 days and peripheral blood sample was collected from ocular sinus red blood cell (RBC) and white blood cell (WBC) counts every 3 days and 5 days for 5-FU and radiation induced models, respectively. Next, fraction A was separated to A1 and A2 using cation exchange chromatography (IEC) based on ionic strength. Fraction A1 was further separated using reverse phase chromatography (RPC) based on the hydrophobicity first with 0-10% linear gradient, then 20%, 30%, 50% constant gradient of 60% acetonitrile in neutral Na2HPO4 buffer. Peak fractions were pooled, evaporatively dried, and dissolved in ultrapure water. Finally, fraction A11 was analyzed combining tandem mass spectrometry and proteomic tools and two peptides (peptide 11 and 16) were identified. The hematopoietic effects of multiple fractions and the two peptides were measured using colony-forming units-erythroid (CFU-E), an indication of late erythroid progenitor cells and colony-forming units granulocyte-monocyte (CFU-GM), an indication of granulocyte and monocyte progenitor cells respectively on hematopoietic progenitor cells prepared from bone marrow (Till and Mcculloch 1961). RESULTS Fraction A at 1g/kg and 2g/kg could increase RBC and WBC counts in 5-FU and radiation induced anemic mice models. Fraction A1 at 0.1mg/ml and 0.5mg/ml, exhibited stronger hematopoietic activity than fraction A2, both of which were subfractions from fraction A using IEX, by elevated CFU-E and CFU-GM of mouse bone marrow cells. Furthermore, fraction A11 at 0.1mg/ml showed stronger CFU-E and CFU-GM than fractions A12 to A14 from RPC separation. Finally, peptide 11 and peptide 16 were identified from tandem mass spectrometry and peptide 11 increased CFU-E and CFU-GM in a dose dependent manner. CONCLUSIONS We combined multiple approaches including chromatography, mass spectrometry, cell-based assays, as well as animal studies to identify and demonstrate that the hematopoietic effect of Colla Corii Asini is at least in part from the peptidic components identified using our methodology. This is the first time to isolate peptidic components from Colla Corii Asini, and to provide molecular basis for its usage in treating anemia, which may particularly have the potential to benefit cancer patients suffering from myelosuppression due to radiotherapy or chemotherapy.
Collapse
Affiliation(s)
- Hongzhong Wu
- The Pharmacology School of East China University of Science and Technology, Shanghai 200237, China; HUYA Bioscience International, Shanghai 201203, China.
| | - Chunyan Ren
- Department of Structural and Chemical Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Fang Yang
- The Pharmacology School of East China University of Science and Technology, Shanghai 200237, China; State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Yufeng Qin
- Shandong Dongeejiao Group, Shandong 252201, China
| | - Yuanxing Zhang
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Jianwen Liu
- The Pharmacology School of East China University of Science and Technology, Shanghai 200237, China
| |
Collapse
|
39
|
Diab M, ZazaDitYafawi J, Soubani AO. Major Pulmonary Complications After Hematopoietic Stem Cell Transplant. EXP CLIN TRANSPLANT 2016; 14:259-70. [PMID: 27040986 DOI: 10.6002/ect.2015.0275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Both autologous and allogeneic hematopoietic stem cell transplants are important therapeutic options for several benign and malignant disorders. Pulmonary complications, although they have become less frequent, remain a significant cause of morbidity and mortality after hematopoietic stem cell transplant. These complications range from bacterial, fungal, and viral pulmonary infections to noninfectious conditions such as diffuse alveolar hemorrhage and idiopathic pneumonia syndrome. Bronchiolitis obliterans syndrome is the primary chronic pulmonary complication, and treatment of this condition remains challenging. This report highlights the advances in the diagnosis and management of the major pulmonary complications after hematopoietic stem cell transplant. It also underscores the need for prospective and multicenter research to have a better understanding of the mechanisms behind these complications and to obtain more effective diagnostic tool and therapeutic options.
Collapse
Affiliation(s)
- Maria Diab
- From the Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | |
Collapse
|
40
|
Maschmeyer G, Donnelly JP. How to manage lung infiltrates in adults suffering from haematological malignancies outside allogeneic haematopoietic stem cell transplantation. Br J Haematol 2016; 173:179-89. [PMID: 26729577 PMCID: PMC7161791 DOI: 10.1111/bjh.13934] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/13/2015] [Indexed: 12/20/2022]
Abstract
Pulmonary complications affect up to 40% of patients with severe neutropenia lasting for more than 10 d. As they are frequently associated with fever and elevation of C‐reactive protein or other signs of inflammation, they are mostly handled as pneumonia. However, the differential diagnosis is broad, and a causative microbial agent remains undetected in the majority of cases. Pulmonary side effects from cytotoxic treatment or pulmonary involvement by the underlying malignancy must always be taken into account and may provide grounds for invasive diagnostic procedures in selected patients. Pneumocystis jirovecii (in patients not receiving co‐trimoxazole as prophylaxis), multi‐resistant gram‐negative bacilli, mycobacteria or respiratory viruses may be involved. High‐risk patients may be infected by filamentous fungi, such as Aspergillus spp., but these infections are seldom proven when treatment is initiated. Microorganisms isolated from cultures of blood, bronchoalveolar lavage or respiratory secretions need careful interpretation as they may be irrelevant for determining the aetiology of pulmonary infiltrates, particularly when cultures yield coagulase‐negative staphylococci, enterococci or Candida species. Non‐culture based diagnostics for detecting Aspergillus galactomannan, beta‐D‐glucan or DNA from blood, bronchoalveolar lavage or tissue samples can facilitate the diagnosis, but must always be interpreted in the context of clinical and imaging findings. Systemic antifungal treatment with mould‐active agents, given in combination with broad‐spectrum antibiotics, improves clinical outcome when given pre‐emptively. Co‐trimoxazole remains the first‐line treatment for Pneumocystis pneumonia, while cytomegalovirus pneumonia will respond to ganciclovir or foscarnet in most cases. The clinical outcome of acute respiratory failure can also be successful with proper intensive care, when indicated.
Collapse
Affiliation(s)
- Georg Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - J Peter Donnelly
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
41
|
ZazaDitYafawi J, Soubani AO. Pulmonary Complications After Hematopoietic Stem Cell Transplantation. CLINICAL PULMONARY MEDICINE 2015; 22:230-238. [DOI: 10.1097/cpm.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
|
42
|
Oh D, Kim MH, Song TJ, Cho CJ, Nam K, Cho MK, Chun JH, Jung K, Kim KP, Kim JW. 1-Pamitoyl-2-Linoleoyl-3-Acetyl-rac-Glycerol May Reduce Incidence of Gemcitabine-Induced Neutropenia: A Pilot Case-Controlled Study. World J Oncol 2015; 6:410-415. [PMID: 28983339 PMCID: PMC5624689 DOI: 10.14740/wjon937e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chemotherapy-induced neutropenia (CIN) may compromise planned chemotherapy, resulting in severe infection, dose reduction or delayed treatment. Orally administered 1-pamitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) is a synthetic monoacetyldiglyceride, a product found in the antlers of sika deer. The aim of this study was to evaluate the effectiveness of PLAG for the prevention of CIN. METHODS A total of 48 patients with unresectable pancreatic cancer received gemcitabine-based palliative chemotherapy. Among those patients, 16 patients received PLAG (500 mg) twice daily from the start of chemotherapy to the completion. RESULTS The PLAG group showed a significantly lower incidence of neutropenia (absolute neutrophil count < 1,500 cells/mm3, grade 2-4), as compared to the control group (37.5% vs. 81.3%, P < 0.05). The absolute neutrophil counts (ANCs) of the PLAG group significantly less decreased from the baseline level compared to those of the control group (P < 0.05) and this significant difference in the reduction percentage of ANCs between the two groups was sustained throughout the courses of chemotherapy. No adverse events related to PLAG were observed. CONCLUSIONS PLAG was shown to be clinically effective and safe in reducing the incidence of CIN in pancreatic cancer patients receiving gemcitabine-based chemotherapy.
Collapse
Affiliation(s)
- Dongwook Oh
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Myung-Hwan Kim
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Charles J Cho
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kwangwoo Nam
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Keun Cho
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Hyun Chun
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoungwon Jung
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyu-Pyo Kim
- Division of Oncology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Wha Kim
- Biomedical Translational Research Center, Korea Research Institute of Bioscience and Biotechnology, Deajeon, Korea
| |
Collapse
|
43
|
[Febrile neutropenia in onco-hematology patients hospitalized in Intensive Care Unit]. Bull Cancer 2015; 102:349-59. [PMID: 25799163 DOI: 10.1016/j.bulcan.2014.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/17/2014] [Indexed: 11/20/2022]
Abstract
Febrile neutropenia in cancer patients is associated with a high mortality. Patients are frequently admitted to Intensive Care Unit (ICU) for severe sepsis or septic shock. Empirical antibiotic treatment, including monotherapy β-lactam covering Pseudomonas aeruginosa, must be prompt. The ICU management is slightly different, due to a particular microbial ecology. A standardized approach to obtain a microbiological documentation is the cornerstone in these patients, leading to an adapted antimicrobial treatment. Systematic reassessment of initial antibiotic regimen should be realised. Neutropenic patients with severe sepsis or septic shock should receive promptly a β-lactam-aminoglycoside combination, as well as glycopeptides in case of severity or absence of documented infection. Early catheter removal should be considered widely. In the actual context of growing resistance, antibiotics saving became a major concern. According to context and microbial documentation, an escalade or de-escalade approach is recommended, to take into account multi-resistant pathogens. The addition of antifugal treatment is also a major issue in these patients and has well-defined indications. In neutropenic patients admitted in the ICU for severe sepsis or septic shock, controlling local microbial epidemiology and the emergence of multi-resistant bacteria are the key issues.
Collapse
|
44
|
Prognosis of neutropenic patients admitted to the intensive care unit. Intensive Care Med 2015; 41:296-303. [DOI: 10.1007/s00134-014-3615-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/13/2014] [Indexed: 02/07/2023]
|
45
|
Balsat M, Xhaard A, Lengline E, Tavernier E, Cornillon J, Guyotat D, Darmon M. Worsening of Respiratory Status during Neutropenia Recovery in Noncritically Ill Hematological Patients: Results of a Prospective Multicenter Study. Respiration 2015; 90:229-34. [DOI: 10.1159/000433556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/25/2015] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Neutropenia recovery (NR) has been associated with worsening preexisting lung injury in up to 50% of critically ill cancer patients. However, only limited relevant data exist in the general population of hematological patients. <b><i>Objectives:</i></b> To assess the incidence of acute respiratory deterioration during NR in patients with hematological malignancies. <b><i>Methods:</i></b> Adult patients with neutropenia expected to last more than 7 days were included. Worsening of respiratory status (WRS) was defined as a decrease in oxygen saturation of ≥5%, the need for oxygen therapy for ≥24 h, an increase in oxygen flow of ≥50% in patients previously treated with oxygen, or the need for mechanical ventilation. NR was defined as the 3 days preceding or following a neutrophil count of >0.5 × 10<sup>9</sup>/l. <b><i>Results:</i></b> A total of 16 of 50 patients included in this pilot study experienced WRS during NR (32%), and 13 patients had WRS during neutropenia (26%). The incidence density of WRS was 0.53 (±0.79) episodes per 10 days during NR and 0.20 (±0.39) episodes per 10 days during neutropenia (p = 0.004). Sepsis, stem cell transplantation, preexisting pneumonia, or the use of granulocyte colony-stimulating factor were not associated with WRS during NR. <b><i>Conclusion:</i></b> Up to one third of noncritically ill hematological patients with expected neutropenia of more than 7 days experience WRS during NR. Clinical consequences and risk factors for WRS during NR remain to be evaluated.
Collapse
|
46
|
Zafrani L, Azoulay E. How to treat severe infections in critically ill neutropenic patients? BMC Infect Dis 2014; 14:512. [PMID: 25431154 PMCID: PMC4289060 DOI: 10.1186/1471-2334-14-512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022] Open
Abstract
Severe infections in neutropenic patient often progress rapidly leading to life-threatening organ dysfunction requiring admission to the Intensive Care Unit. Management strategies include early adequate appropriate empirical antimicrobial, early admission to ICU to avoid any delay in the diagnostic and therapeutic management of organ dysfunction. This review discusses the main clinical situations encountered in critically ill neutropenic patients. Specific diagnostic and therapeutic approaches have been proposed for acute respiratory failure, shock, neutropenic enterocolitis, catheter-related infections, cellulitis and primary bacteriemia. Non anti-infectious agents and recent advances will also be discussed. At present, most of large-scale studies and recommendations in neutropenic patients stem from hematological patients and will need further validation in ICU patients.
Collapse
Affiliation(s)
| | - Elie Azoulay
- AP-HP, Hôpital Saint-Louis, Medical ICU, Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique (Grrr-OH), Paris, France.
| |
Collapse
|
47
|
Penack O, Becker C, Buchheidt D, Christopeit M, Kiehl M, von Lilienfeld-Toal M, Hentrich M, Reinwald M, Salwender H, Schalk E, Schmidt-Hieber M, Weber T, Ostermann H. Management of sepsis in neutropenic patients: 2014 updated guidelines from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO). Ann Hematol 2014; 93:1083-95. [PMID: 24777705 PMCID: PMC4050292 DOI: 10.1007/s00277-014-2086-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/09/2014] [Indexed: 12/29/2022]
Abstract
Sepsis is a major cause of mortality during the neutropenic phase after intensive cytotoxic therapies for malignancies. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. Clinical guidelines on sepsis treatment have been published by others. However, optimal management may differ between neutropenic and non-neutropenic patients. Our aim is to give evidence-based recommendations for haematologist, oncologists and intensive care physicians on how to manage adult patients with neutropenia and sepsis.
Collapse
Affiliation(s)
- Olaf Penack
- Department of Hematology, Oncology and Tumourimmunology, Charité Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
The clinical management of neutropenic infections represents a great diagnostic and therapeutic challenge. Established sepsis criteria only partially reflect the neutropenic setting. Diagnostic procedures are frequently impaired by thrombocytopenia and progressive respiratory insufficiency. Increased tendency to bleed, engraftment, and fulminant progression represent major therapeutic challenges. Thus, crucial for the diagnosis and therapy of neutropenic sepsis are clear and well-communicated algorithms, rapid action, and close collaboration between oncologists and intensivists.
Collapse
|
49
|
Affiliation(s)
- Jagruti Shah
- Core Medical Trainee Cambridge University Health Partners, Addenbrookes Hospital, Cambridge
| | - Sarah J Welsh
- Academic Clinical Lecturer in Medical Oncology in the Department of Oncology, Cambridge University Health Partners, Addenbrookes Hospital, Cambridge
| |
Collapse
|
50
|
Dong W, Wang L, Kong T, He Y. Scorpion Venom Peptides Accelerate Hematopoietic Recovery of Myelosuppression in Irradiated Mice. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2012; 37:701-12. [DOI: 10.1142/s0192415x0900717x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sublethally irradiated mice were administered with scorpion venom peptides (SVP) or with PBS in the saline control group, 3 days before and 7 consecutive days after irradiation. Hematopoietic recovery was assessed by bone marrow (BM) cell proliferation index (PI) and colony forming unit-granulocyte/macrophage (CFU-GM), spleen weight index (SI) and thymus weight index (TI), colony-forming unit-spleen (CFU-S) and peripheral leukocyte counts. In addition, IL-1α and SCF levels in BM, IL-6 and GM-CSF levels in serum were determined. In SVP treated groups, PI was improved dramatically versus control mice on day 22 after irradiation. The number of CFU-GM colonies in all SVP treated groups was higher than the control groups. The difference of the number of CFU-GM colonies between SVPV group (0.2 mg/kg) and the control was significant on day 5 and 10 after irradiation ( p < 0.05). SVPIV (0.2 mg/kg) could activate the CFU-S formation on day 10 after irradiation. SI was in peak value on day 15 after irradiation in all groups and the SI value of SVPV treated group was higher than control group ( p < 0.05). Our results suggest that SVP may be valuable natural peptides that relieve myelosuppression caused by radiation. The effect of SVP accelerating the hematopoietic recovery was potentially through a mechanism of stimulating the release of cytokines.
Collapse
Affiliation(s)
- Weihua Dong
- Department of Pathophysiology, Guangzhou Medical College, Guangzhou, Guangdong, 510082, China
| | - Lina Wang
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Tianhan Kong
- Snake Venom Research Institute, Guangzhou Medical College, Guangzhou, Guangdong, 510082, China
| | - Yanjie He
- Department of Pathophysiology, Guangzhou Medical College, Guangzhou, Guangdong, 510082, China
| |
Collapse
|