No description available.

Autoimmune neutropenia (AIN) is characterized by antibody mediated peripheral destruction of neutrophils. Since there is no effective treatment, antibiotics have to be used frequently for recurrent infections. Five selected patients with serologically proven AIN were treated with r-metHuG- CSF at 5-8 μg/kg body weight (300-480 μg) daily: the dose and frequency of r-metHuG-CSF was reduced after neutrophil counts above 1.0 x 109/l were obtained. R-metHuG-CSF is effective in AIN and causes a sustained rise in ANC which can he maintained on a low dose administered twice or thrice weekly.

Introduction Neutropenia is a life-threatening and dose-limiting toxicity of palliative lung cancer chemotherapy. Whilst some neutropenias are inevitable, evidence suggests that patients with a previous neutropenic event are 50% more likely to have a further neutropenic event. The aim of this research is to evaluate the variables associated with the risk of secondary neutropenic events and the role of chemotherapy dose reductions. Methods A retrospective analysis was carried out on 361 biochemical neutropenic events in palliative lung cancer patients across 5 sites in South Yorkshire and Bassetlaw. Predictors for a secondary neutropenic event were investigated in univariate and multivariate logistic regression analysis. The predictive model was validated through discrimination statistics, described by Receiver Operating Characteristic Area Under Curve (ROC-AUC). Results The incident rate for secondary neutropenic events was 32.7%. Patients with a successful intervention received a higher mean Relative Dose Intensity (RDI) of 75.65% compared to 65.05%, across the 2 chemotherapy cycles. The univariate analysis found that the biochemical type of neutropenia (depth and length of suppression) (p=0.003), dose reduction of drug 1 (p=0.042), average dose reduction (p=0.019), and cumulative dose reduction (p=0.018) were significant at reducing the risk of secondary neutropenia. Granulocyte-Colony Stimulating Factor did not offer a protective effect. The final logistic regression model evaluated 357 events and included all variables due to significant interrelationship. The model had a ROC-AUC of 0.76 (0.71-0.81) (p= 0.0021), explaining 27% of the variance. Conclusion Appropriate dose reductions play a vital role in preventing secondary neutropenic events and delivering optimal RDIs. The results of this study can aid in identifying high-risk patients.

Febrile neutropenia is a potentially life-threatening oncologic emergency characterized by a dangerously low neutrophil count that places the patient at great risk. In these patients, fever may be the only sign of infection, which requires prompt treatment. With the increasing focus in shifting health care from inpatient centers to outpatient arenas, home health care clinicians will likely have an increased role in the care of neutropenic fever patients in the future. The article describes both the pharmacologic treatment and nonpharmacologic support required of these patients with particular attention to treatment that may be required in the patient?s home.

No description available.

<p>Uvod: Febrilna neutropenija, kao prvi znak infekcije, je česta komplikacija u fazi postterapijske aplazije kostne srži u obolelih od akutne nelimfoblastne leukemije. Klinička slika febrilne neutropenije može biti suptilna, a progresija u stanje septičnog &scaron;oka znatno brža nego kod imunokompetentnih bolesnika. Rana predikcija rizika od komplikacija febrilne neutropenije i uvođenje empirijske antibiotske terapije može da pobolj&scaron;a prognozu bolesnika. Insulinska rezistencija, dislipidemija i inflamacija masnog tkiva se javljaju u sklopu sistemske inflamacije. Njihova uloga i značaj kao potencijalnih faktora predikcije toka i ishoda febrilne neutropenije nisu ispitani. Ciljevi istraživanja: Ustanoviti promene pokazatelja stepena insulinske senzitivnosti, ukupnog holesterola, triglicerida, HDL - holesterola, LDL - holesterola, apolipoproteina A-I, lipoproteina (a) i adiponektina pre i u fazi febrilne neutropenije kod bolesnika sa akutnom nelimfoblastnom leukemijom. Uporediti vrednosti pokazatelja stepena insulinske senzitivnosti, ukupnog holesterola, triglicerida, HDL - holesterola, LDL - holesterola, apolipoproteina A-I, lipoproteina (a) i adiponektina bolesnika sa akutnom nelimfoblastnom leukemijom pre početka febrilne neutropenije i kontrolne grupe gojaznih. Uporediti vrednosti pokazatelja stepena insulinske senzitivnosti, ukupnog holesterola, triglicerida, HDL - holesterola, LDL - holesterola, apolipoproteina A-I, lipoproteina (a) i adiponektina bolesnika sa akutnom nelimfoblastnom leukemijom u fazi febrilne neutropenije i kontrolne grupe gojaznih. Utvrditi da li su pokazatelj stepena insulinske senzitivnosti, ukupni serumski holesterol, trigliceridi, HDL - holesterol, LDL - holesterol, apolipoprotein A-I, lipoprotein (a) i adiponektin bolesnika sa akutnom nelimfoblastnom leukemijom u fazi febrilne neutropenije u korelaciji sa vrednostima parametara inflamacije, njenim tokom i ishodom. Materijal i metode: Istraživanje je sprovedeno u Klinici za hematologiju i Klinici za endokrinologiju, dijabetes i bolesti metabolizma. Obuhvatilo je 60 ispitanika, od kojih je 30 ispitanika obolelo od akutne nelimfoblastne leukemije, a 30 ispitanika je činilo kontrolnu grupu gojaznih. Nakon uključivanja u istraživanje, ispitanicima su urađeni predviđeni pregledi i laboratorijske analize u cilju procene insulinske senzitivnosti, metaboličkog statusa i serumskog adiponektina. Navedena merenja su urađena pre hemioterapije i u febrilnoj neutropeniji. Zdravstveno stanje ispitanika je praćeno do kraja prve hospitalizacije. Statistička obrada je izvr&scaron;ena uz pomoć statističkog paketa Statistica. Podaci su predstavljeni tabelarno i grafički, a statistička značajnost je odreĎivana na nivou p &lt; 0.05. Rezultati: U febrilnoj neutropeniji bolesnika sa akutnom leukemijom je do&scaron;lo do razvoja insulinske rezistencije (t = - 2.43, p = 0.021), dislipidemije sa značajnim sniţenjem ukupnog holesterola (t = 3.59, p = 0.0012), LDL &ndash; holesterola (t = 3.56, p = 0.0013) i apoA &ndash; I (t = 2.27, p = 0.03). Oboleli od akutne nelimfoblastne leukemije u febrilnoj neutropeniji su razvili metaboličke promene viđene kod gojaznih osoba sa insulinskom rezistencijom. Nastanak i progresija insulinske rezistencije je bila u pozitivnoj korelaciji sa fibrinogenom kao pokazateljem težine inflamacije (r = 0.59, p &lt; 0.05) dok je apoA - I negativno korelirao sa CRP (r = - 0.37, p &lt; 0.05). Ispitanici sa nižom insulinemijom i vrednostima HDL - holesterola pre hemoterapije su imali značajno bolji tok febrilne neutropenije (t = -2.38, p = 0.024 vs. t = - 2.87, p = 0.007). Ispitanici sa većim indeksom telesne mase (BMI) i obimom struka imali su povoljniji ishod febrilne neutropenije (r = - 0.47, p &lt; 0.05 vs. r = - 0.40, p &lt; 0.05). Drugi pokazatelji insulinske senzitivnosti, metaboličkog statusa i adiponektin nisu značajno uticali na tok i ishod febrilne neutropenije. Normalna telesna masa pre hemioterapije, a u febrilnoj neutropeniji temperatura u trajanju dužem od 7 dana, niže vrednosti MASCC indeksa rizika, vi&scaron;e vrednosti CRP, vi&scaron;e vrednosti adiponektina, niže vrednosti Lp(a) i komplikovan tok febrilne neutropenije su bili prediktori lo&scaron;ije prognoze febrilne neutropenije. Zaključak: Pored klasičnih hematolo&scaron;kih parametara potrebno je uzeti u obzir antropometrijske karakteristike, redistribuciju masne mase, disfunkcionalnost masne mase, insulinsku rezistenciju i metaboličke parametre u cilju praćenja i predviđanja mogućih komplikacija i komorbiditeta.</p> / <p>Introduction: Febrile neutropenia is a common complication in posttreatment aplasia in patients with acute nonlymphoblastic leukemia. Its clinical manifestation can be subtle. However, it can progress to septic shock more quickly than in immunocompetent patients. Early prediction of complications and recognition of risk factors can improve outcome. Systemic inflammation is characterized by insulin resistance, dyslipidemia and adipocyte dysfunction. However, their importance in predicting complications and outcome of febrile neutropenia is not entirely known.<br />Aims: To determine changes in HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in patients before chemotherapy and during febrile neutropenia. To compare HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in patients before chemotherapy and the obese. To compare HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in patients during febrile neutropenia and the obese. To determine whether HOMA-IR, total cholesterol, triglycerides, HDL - cholesterol, LDL - cholesterol, apolipoprotein A-I, lipoprotein (a) and adiponectin in febrile neutropenia are in correlation with the severity of the infection, appearance of complications and outcome. Materials and methods: The study was conducted at the Clinic for hematology and Clinic for endocrinology, diabetes, and metabolic disorders. 60 patients who fulfilled the inclusion criteria were included in the study. 30 patients had acute leukemia, and 30 were obese. Clinical and laboratory examination to assess insulin sensitivity, metabolic disorders and adiponectin was done before chemotherapy and during febrile neutropenia. Patients were followed up until the end of the first hospitalization. Data were analyzed with Statistica software and presented in tables and graphs. Statistical significance was set at p&lt;0.05. Results: During febrile neutropenia, patients with acute leukemia developed insulin resistance (t = - 2.43, p = 0.021), alongside significant decline of total cholesterol (t = 3.59, p = 0.0012), LDL &ndash; cholesterol (t = 3.56, p = 0.0013) and apoA &ndash; I (t = 2.27, p = 0.03). In acute inflammation, metabolic changes in patients with acute leukemia resembled those in the obese with insulin resistance. HOMA-IR values were in positive correlation with fibrinogen (r = 0.59, p &lt; 0.05) whereas apoA-I was in negative correlation to CRP (r = - 0.37, p &lt; 0.05). Patients with higher body mass index and waist circumference had better course and outcome of febrile neutropenia (r = - 0.47, p &lt; 0.05 vs. r = - 0.40, p &lt; 0.05). Patients with lower insulin levels and HDL - cholesterol prior to chemotherapy had a significantly better course of febrile neutropenia (t = -2.38, p = 0.024 vs. t = - 2.87, p = 0.007). Other parameters of insulin sensitivity, metabolic status, and adiponectin did not influence the course and outcome of inflammation significantly. Normal body weight, duration of febrile neutropenia for longer than 7 days, lower MASCC risk index, higher CRP and adiponectin, low Lp(a) in febrile neutropenia and a complicated course od febrile neutropenia were predictors of a worse outcome. Conclusion: Besides known hematological risk factors for complications in febrile neutropenia, anthropometric characteristics, fat mass distribution and disfunction, insulin resistance and metabolic parameters are useful predictors of the course and outcome of febrile neutropenia.</p>

No description available.

Lilja, C & Svensson, K. Omvårdnad vid neutropeni orsakat av cytostatika. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2008.Neutropeni är en allvarlig komplikation hos patienter som behandlas med cytostatika och är förenat med risk för vårdrelaterade infektioner och sepsis som kan vara livshotande. Ibland behövs skyddsisolering på sjukhus med risk för vårdrelaterade infektioner. Syftet var att ur ett sjuksköterskeperspektiv belysa omvårdnaden under skyddsisoleringen samt vilka infektionsförebyggande åtgärder som är av betydelse. Metoden var en litteraturstudie som bygger på 17 vetenskapliga artiklar. Resultatet visar olika omvårdnadsaspekter som är betydelsefulla vid neutropeni. Olika infektionsförebyggande åtgärder för att hindra endogen och exogen smitta belystes. Smittspridningen förhindras genom användning av basala hygienrutiner och handdesinfektion. Patienter med neutropeni som skyddsisoleras på sjukhus är en utsatt och svårt sjuk patientgrupp vilket gör det svårt att randomisera tillräckligt stora, väldesignade och jämförbara studier. Det saknas forskning inom omvårdnaden. Säkra rekommendationer med hög trovärdighet kan inte ges med denna bakgrund. Behov finns att kritiskt utvärdera de insatser som görs idag och att utveckla forskningen av omvårdnaden av patienter med cytostatikaorsakad neutropeni. / Lilja, C & Svensson, K. Chemically induced neutropenia: The need of nursing care. A literature review. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2008.Neutropenia is a serious complication among cancer patients who receive chemotherapy and can cause life threatening cross infections and sepsis. Protective care at hospital is sometimes needed with risk for cross infections. The purpose of this review was to highlight the nursing care of patients in protective care and to indicate the most important actions to prevent cross infections. A literature review was used as method based on seventeen scientific articles. The result showed actions of nursing care that are important during protective care at hospitals. The result also showed interventions to prevent cross infections caused of endogenous and exogenous source. There are few well designed studies and there is a lack of comparable empirical evidence. These patients are very ill and vulnerable and it is difficult to perform randomized studies with enough sample size to get well designed and comparable studies. Therefore recommendations can not be given that are based on high level of evidence. There is a need to develop evidence based nursing methods and to identify and evaluate nursing interventions so that the best possible care of patients with chemically induced neutropenia in protective care is given.

Effective prevention, or treatment, of invasive fungal infection in the neutropenic patient has hitherto been unsatisfactory because of either an inadequate anti-fungal spectrum of the agent or important toxicity. Itraconazole is effective against a broad spectrum of the opportunistic pathogens seen in Europe and North America. Prior problems with absorption, e.g. in the marrow transplant recipient, have been overcome with the introduction of an oral solution and an i.v. preparation. The deliberations of an expert meeting held in June, 1998 include recommendations on which patient requires one of these new preparations based on clinical trials, the dose and route. Important drug interactions are also detailed. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Nous avons investigué la relation entre les polymorphismes de nucléotides simples (SNPs) chez trois gènes/loci candidats : DARC, CXCL2 et le loci ORMDL3-GSDMA-CSF3 situés sur le chromosome 17q21 et les complications neutropéniques et infectieuses qui en résultent durant la chimiothérapie chez les patients atteints de la leucémie lymphoblastique aigue. Ces loci codent pour certaines composantes du système immunitaire altérant la concentration de chémokines et leur distribution (DARC), stimulant le relâchement et la migration des neutophiles de la moelle épinière (CXCL2) et régulant la prolifération et la survie des granulocytes (G-CSF). Il est possible que des polymorphismes dans ces loci lorsqu’associés à de la chimiothérapie puissent mettre des individus suceptibles à un risque plus élevé de complication reliées à la chimiothérapie. Une sélection des marqueurs SNPs dans ces gènes ont été génotypés chez des enfants traités au CHU Ste-Justine pour une ALL entre 1989 et 2005. Après correction pour tests multiples, un polymorphisme DARC rs3027012 situé dans le 5’UTR a été associé à un compte phagocytaire peu élevé (APC<500 et <1000 cellules/µL, p=0.001 and p=0.0005, respectivement) ainsi qu’une hospitalisation due à une neutropénie (p=0.007) ou due à une infection et/ou neutropénie (p=0.007). Un effet protecteur a été identifié pour la mutation non sense Gly42Asp variant rs12075 (p=0.006). Des polymorphismes sur le chromosome 17q2 étaient associés à une hospitalisation due à une infection (rs3859192, p= 0.004) et à une neutropénie (rs17609240, p=0.006) L’infection était aussi modulée par CXCL2 (rs16850408, p=0.008) Cette étude identifie pour la première fois que les loci modulant le décompte des leucocytes et des neutrophiles pourraient jouer un rôle dans de déclenchement de complications dues à la chimiothérapie et pourraient ainsi servir de marqueurs pour un ajustement et un suivi du traitement. / We investigated the relationship between single nucleotide polymorphisms (SNPs) in 3 candidate genes/chromosomal loci: DARC, CXCL2 and ORMDL3-GSDMA-CSF3 locus on chromosome 17q21, and neutropenic and infectious complications during chemotherapy in pediatric acute lymphoblastic leukemia (ALL) patients. These loci encode the components of immune system altering chemokine concentration and distribution (DARC), stimulating neutrophil release from bone marrow and migration (CXCL2) and regulating granulocyte proliferation and survival (G-CSF). It is possible that polymorphisms of these loci when associated with chemotherapy may put susceptible individuals at higher risk of chemotherapy complications. Selected tag SNPs in these genes are genotyped in children treated at the CHU Sainte-Justine for (ALL) between 1989 and 2005. After correction for multiple testing, DARC polymorphism rs3027012 in 5’UTR was associated with low absolute phagocyte count (APC<500 and <1000 cells/µL, p=0.001 and p=0.0005, respectively) and hospitalisation due to febrile neutropenia (p=0.007) or due to infection and/or febrile neutropenia (p=0.007). A protective effect was instead noted for missense Gly42Asp variant rs12075 (p=0.006). The polymorphisms on chromosome 17q2 were associated with hospitalisation due to infection (rs3859192, p= 0.004) and neutropenia (rs17609240, p=0.006). Infection was also modulated by CXCL2 (rs16850408, p=0.008) This study identifies for the first time that the loci modulating white blood cell and neutrophil count may play a role in the onset of chemotherapy complications and may thus serve as markers for adjustment or follow-up of the treatment.