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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors reviewed the clinical course of 31 consecutive patients with hairy cell leukemia seen at the University of California Los Angeles. The clinical presentation included varying degrees of pancytopenia, splenomegaly, and bone marrow infiltration with hairy cells. Ten patients were identified as having an "atypical" disease, which is defined as absence of palpable splenomegaly and/or marrow cellularity of less than 45%. These atypical patients had clinically milder disease and significantly less anemia than the usual patient (mean hemoglobin, 12.1 g/dl versus 9.4 g/dl; P = 0.016), although neutropenia and thrombocytopenia were comparable. Mortality and infection rates were similar in both groups. Infections were common in all patients, but opportunistic infections and septicemia were rare in patients prior to initiation of therapy. Two thirds of the patients who received corticosteroids and/or cytotoxic agents had serious infections, with a 50% mortality rate. Nearly 70% of the neutropenic patients (leukocyte count less than 1000) who received any form of treatment had a serious infection. The most important factors predicting mortality were chemotherapy and an age older than 50 years. Patients who survived 2 years with their disease had an excellent prognosis, and four patients in this series are alive and well with their disease for more than 10 years.
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PMID:Hairy cell leukemia. Disease pattern and prognosis. 673 79

A prospective, randomized trial of two antibiotic combinations (amikacin plus either ampicillin or cephalotin) was performed on 39 consecutive episodes of fever in 30 patients with neutropenia and hematological malignancy. Infections were documented as the cause of fever in 37 episodes (95%): in 21 episodes (54%) bacteria or a virus (n = 1) were isolated, and in 16 (41% of all episodes) the infection was documented clinically but no pathogen was isolated. The most frequently isolated bacteria were Staph. aureus (38% of all strains), E. coli (13%), and Pseudomonas aeruginosa (13%). Bacteremia occurred in 18% of the febrile episodes. Improvement followed treatment with the combination amikacin plus ampicillin in 73% of 19 cases, and with amikacin plus cephalotin in 55% of 20 cases (p less than 0.05), giving a total improvement rate of 64%. Failure of therapy was seen in episodes caused by multiple bacteria or Pseudomonas infections. Mild signs of nephrotoxicity were noted in 13% during both regimens. Audiograms were normal in all but two patients who showed slight high-frequency hearing loss. A second infection occurred in 7 episodes (18%). Thus, the combination of amikacin plus ampicillin was as efficient (but less expensive) as amikacin plus cephalotin in the initial treatment of febrile episodes in neutropenic patients with hematological malignancies.
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PMID:Combination of amikacin and either ampicillin or cephalotin as initial treatment of febrile neutropenic patients. 676 Jun 76

An autopsy study of 218 cases of lymphoproliferative disease was performed to establish the cause of death. It covered 144 cases of malignant nonHodgkin's lymphoma, 23 cases of Hodgkin's disease and 51 cases of myeloma. It was established that infection is by far the most frequent cause (34% of cases) followed by tumor invasion (11.5% of cases), hemorrhage (9% of cases) and other pathologies linked to the basic process (10% of cases). The proportion of patients who die from intercurrent illness is still considerable (62 cases, 28%). Infection is most often pulmonary or systemic; gram-negative bacteria play a predominant role. Toxicity of treatment is obvious in causing neutropenia and thrombocytopenia among other side effects with fatal consequences.
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PMID:[Causes of death in cases of lymphoma, myeloma and Hodgkin disease. Study of 218 cases]. 686 58

In this study among children with acute lymphoblastic leukemia, more febrile episodes occurred during induction of remission and relapse than during remission. Infection was mainly responsible for fever during remission, regardless of the neutrophil count. However, during induction and relapse, evidence suggests that the underlying malignancy is the more likely cause of fever if the neutrophil count exceeds 200 per mm3. For all cases, the risk of serious infection was high with severe neutropenia (neutrophil count less than 200 per mm3). Of the organisms identified, gram-positive and gram-negative bacteria were equally represented. Infection remains a serious problem in the management of children with leukemia.
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PMID:Fever in children with acute lymphoblastic leukemia. 693 73

In disseminated candidiasis, various organs frequently become involved, usually as a consequence of hematogenous spread of the organism. However, involvement of the joints is rare even with dissemination. Nineteen cases of joint involvement have previously been reported in adults and 21 cases in children. The most commonly involved joint has been the knee; in such cases, amphotericin B has been effective in controlling the infection. Five patients with cancer developed septic arthritis due to Candida species at the M. C. Anderson Hospital and Tumor Institute in the past five years. Four of these patients were seen in 1980. Candida albicans was isolated from three patients and Candida tropicalis from two. All five patients had predisposing conditions - e.g., intravenous and/or urinary catheterization, neutropenia, and previous treatment with steroids and antibiotics. The knee was the affected joint in all five. Different modalities of treatment were used, including intravenous miconazole, oral ketoconazole, and systemic and local amphotericin B; adequate levels of these drugs were found in the joint fluid when measured. Infection was cured in two patients. The condition of the third patient improved. The fourth patient died of disseminated disease despite therapy, and the fifth died of malignancy without the benefit of antifungal therapy. For treatment of such infections, the use of an antifungal agent is recommended in addition to frequent evacuation of the joint fluid. Some new compounds may prove useful alternatives to amphotericin B. Arthritis can be resolved even in the presence of unresolved disseminated disease.
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PMID:Septic arthritis due to Candida species on patients with cancer: report of five cases and review of the literature. 695 Dec 37

Infection resulting in transient reticulocytopenia and anemia, the so called "aplastic crisis," has frequently been documented in patients with congenital hemolytic anemia. However, this association with hematologically normal patients has been less well recognized. Its occasional severity is illustrated by this report of two cases of marked reticulocytopenic anemia in association with probable viral infections. These were previously health children whose anemias could be explained only by a temporary interruption of erythropoiesis. These patients recovered spontaneously and were in good health one year later. A subsequent separate survey of leukopenic patients with a wide variety of viral infections demonstrated significant reticulocytopenia in seven of 35 patient (20 percent). It is concluded that in addition to the more widely appreciated neutropenia and thrombocytopenia of viral infections, reticulocytopenia is a common manifestation of many viral infections and may occasionally result in profound anemia.
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PMID:Transient reticulocytopenia in viral illness. 709 70

29 episodes of suspected septicaemia in patients with acute leukemia were treated empirically with tobramycin 180--240 mg/day intravenously together with cephalothin 12 g/day. Patients without documented infection who did not respond to antibiotics and whose fever developed after a course of cytotoxic drugs, were given the provision of high dose corticosteroid therapy. Infection was documented microbiologically or clinically in 13/29 episodes. Septicaemia was proven in 7, and 6 had pneumonia. Neutropenia was present in 18/29 episodes. A satisfactory response to initial therapy was achieved in 7/13 with documented infection and in 9/16 without proven infection. The overall good response was 55%, 5/7 cases with septicaemia, but only 2/6 with pneumonia responded well. The 2 septicaemia patients who did not respond had Pseudomonas aeruginosa sepsis. In 16 episodes without documented infection 7 did not respond to initial therapy. To 4 of them, who were subject to recent cytotoxic drug administration, high dose corticosteroid therapy was given, and 3 of them responded well. Of the remaining 3 non-responders, one became afebrile after cytostatic and one after prednisolone treatment. Serum assays of tobramycin were done on the 1st and 5th day of therapy and no difference in concentration was observed on these 2 occasions. Five patients developed renal failure, but this was attributed to antibiotic therapy only in 1, who initially had an elevated serum creatinine. It is concluded, that in hospitals where pseudomonas is not a dominating pathogen, tobramycin--cephalothin may be a good combination to start empiric therapy with. In patients without proven infection, who have recently been subjected to cytotoxic therapy, and who do not respond to the initial course of antibiotics, a high dose of corticosteroids may be tried, provided the patient is monitored for the hazard of bacterial infection.
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PMID:Empiric treatment of fever in acute leukaemia with tobramycin-cephalothin, and the escape clause provision of corticosteroids. 737 25

Between January 1973 and October 1977, 166 patients who died of breast cancer were autopsied. The examination revealed consistently more tumor involvement than had been clinically suspected. Unsuspected areas of tumor involvement included the endocrine organs (40%), lungs (28%), cardiovascular system (21%), and the genitourinary system (21%). The error in diagnosis was smaller with metastasis to the bones (10%) and central nervous system (14%). The major causes of death included pulmonary insufficiency (26%), infection (24%), cardiac disease (15%), hepatic insufficiency (14%), hemorrhage (9%), central nervous system disease (9%), and hypercalcemia (3%). The most common cause of death was metastatic disease to various organs, accounting for 42% of all deaths. Infection was the second most common cause of death; however, only 27% of the patients with infection had significant neutropenia. In patients dying of hemorrhage, only 9% were thrombocytopenic. In conclusion, although many clinicians have expressed concern that chemotherapy would add to early mortality in cancer, our study shows that this is not the case for patients with breast cancer. Deaths due to chemotherapy were rare and the rise in the infection rate did not correlate with the advent of chemotherapy.
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PMID:Causes of death in breast cancer: a clinicopathologic study. 738 58

Invasive fungal infections have become an increasing problem in severely immunocompromised hosts. We here report a case of septicemia, caused by Trichosporon beigelii, an unusual pathogen of systemic infections. This infection was acquired during a period of severe neutropenia after chemotherapy for relapsed acute myelogenous leukemia following allogeneic bone marrow transplantation. The patient recovered from a life-threatening T. beigelii septicemia due to early intensified treatment with amphotericin B and a rapid neutrophil recovery, enhanced by granulocyte colony-stimulating factor (G-CSF). According to the current literature, amphotericin B is the treatment of choice for systemic T. beigelii infections. In patients with severe granulocytopenia, the rapid recovery of neutrophils remains the most important factor for the outcome of this infection.
Infection
PMID:Successful treatment of a Trichosporon beigelii septicemia in a granulocytopenic patient with amphotericin B and granulocyte colony-stimulating factor. 752 73

Recombinant granulocyte colony-stimulating factor (rHuG-CSF) is a hematopoietic growth factor that acts selectively on the neutrophil lineage, and has had a major impact on clinical practice. Two forms are in clinical use: filgrastim has been approved for use in more than 45 countries for the amelioration of chemotherapy-induced neutropenia and restoration of granulopoiesis following bone-marrow transplantation and lenograstim has been approved in Europe and Japan. In some countries, rHuG-CSF is also approved for various other indications, such as severe chronic neutropenia. Infection and neutropenia are a major cause of morbidity and mortality following cytotoxic chemotherapy, and there is a known correlation between neutropenia and the risk of infection. Hematopoietic growth factors have been used successfully in the prevention and treatment of neutropenia. There is evidence to suggest that use of rHuG-CSF before the onset of neutropenia allows patients to receive the maximum benefit; however, patients who do not receive rHuG-CSF prophylactically still benefit from the use of rHuG-CSF for the treatment of febrile neutropenia. These patients have an accelerated neutrophil recovery and a shorter duration of febrile neutropenia. These effects seem to translate into a significant reduction in the number of patients requiring prolonged hospitalization. This paper reviews the use of rHuG-CSF in the treatment of febrile neutropenia and describes how it is routinely used by hematologists and oncologists in non-clinical trial settings.
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PMID:The clinical utility of granulocyte colony-stimulating factor: early achievements and future promise. 753 47


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