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

To define the incidence and spectrum of pulmonary complications following autologous bone marrow transplantation (BMT), we retrospectively reviewed the course of 77 consecutive patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) who failed conventional therapy and underwent autologous BMT. Forty-five percent of the 77 patients developed respiratory complications with a mortality from pulmonary causes of 26%. A total of 38 episodes of respiratory compromise occurred in 35 patients. Infections accounted for 15 episodes (39%) and included bacterial (16%), Aspergillus (8%) cytomegalovirus (8%), Herpes simplex (3%), and other (5%) pneumonias. The spectrum of infections was similar to that reported following allogeneic BMT, but cytomegalovirus pneumonia was not as frequent a problem in those with autologous transplant. Mortality from pulmonary infections was 33%. Noninfectious disorders accounted for 23 episodes (61%) and included recurrent HD (18%), radiation/drug toxicity (16%), and acute respiratory failure thought secondary to pulmonary alveolar hemorrhage (26%). This latter entity developed acutely within 2 wk following BMT and was associated with use of thoracic radiation for treatment of malignant disease in the chest just prior to BMT (p < 0.05). It was not associated with the age of the patient or presence of thrombocytopenia, coagulopathy, renal insufficiency or neutropenia (p NS). Mortality from noninfectious causes was 65%, but in those with pulmonary hemorrhage it was 100%. In conclusion, pulmonary complications are a major source of morbidity and mortality in patients with HD and NHL undergoing autologous BMT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonary complications in lymphoma patients treated with high-dose therapy autologous bone marrow transplantation. 148 45

Oral cyclophosphamide and prednisone are standard treatment for some neoplasms and necrotizing systemic vasculitis and are advocated with increasing frequency for idiopathic interstitial lung disease. During a 15-month period, we observed four cases of acute respiratory failure from Pneumocystis carinii pneumonia (PCP) in patients treated with oral cyclophosphamide and prednisone. One patient each had polyarteritis nodosa, Wegener's granulomatosis, bronchiolitis obliterans with organizing pneumonia, and chronic lymphocytic leukemia with red blood cell aplasia. Hypoalbuminemia (serum albumin level less than 3.0 g/dl) and daily therapy were associated with increased risk for development of PCP (p less than 0.05). None of the patients had leukopenia (less than 3,500/cu mm) or neutropenia (less than 1,000/cumm) at diagnosis. All were negative for the human immunodeficiency virus. Patients receiving oral cyclophosphamide and prednisone may be at higher or increasing risk for PCP. A high index of suspicion and aggressive evaluation for opportunistic infection are needed in these patients; consideration for trimethoprim-sulfamethoxazole prophylaxis and development of more quantitative measures of immunosuppression are needed.
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PMID:Pulmonary complications of combination therapy with cyclophosphamide and prednisone. 167 Jun 29

An analysis of 80 immunocompromised patients who were admitted to the intensive care unit (ICU) was made. It was 3 different groups: those treated chronically with more than 20 mg of prednisone or it's equivalent, patients with severe neutropenia (-500 PMN'S/mm3) and patients with AIDS. The reasons for admittance to the ICU were: pneumonia (51.2%), postoperative care (30%) extrapulmonary sepsis (8.7%) and other causes in 10%. Mortality was 62.5%. It was statistically higher in those that were admitted for pneumonia, developed respiratory failure, and required postoperative care after emergency surgery (80%, 89.5% and 70% respectively). Also in patients with multiple organic failure (3.2 +/- 1.6 vs 0.9 +/- 1.2 in survivors) and with higher APACHE II score (24 +/- 7 vs 15.4 +/- 6 in survivors). The mortality for acute respiratory failure, the principal organic failure observed, according to the primary diagnosis was: AIDS 100%, severe neutropenia 85.7% and chronic use of steroids in 85.7% of the patients.
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PMID:[The prognosis for the immunocompromised host in an intensive care unit. A report of 80 cases]. 179 Aug 38

It has been suggested that polymorphonuclear cells (PMNs) are required for the development of the adult respiratory distress syndrome (ARDS). We investigated the occurrence of ARDS with acute respiratory failure in 30 children with severe neutropenia (less than 500 PMNs/mm3) who met the clinical diagnostic criteria for ARDS and in whom postmortem histopathology findings were available within 7 days of the onset of ARDS. In 26 patients the histopathology was consistent with ARDS. In 12/26 children no white blood cells (WBC) were found in the lung tissue, 10/26 had moderate infiltration of mononuclear cells, 2/26 had massive tumor cell infiltration, and in 2/26 PMNs were found. Thus, in at least 22/26 patients ARDS developed without neutrophilic infiltration of the lungs. The maximum active lung infection rate was found to be 69% (18/26) by endotracheal and post mortem lung cultures and histology. Thus 5/26 children had ARDS without any WBC in the lung tissue. We conclude, as have other studies in adults that the absence of PMNs does not protect children from the development of ARDS and that the mechanism which involves PMNs is probably only one of several pathways for diffuse alveolar damage, some of which is neutrophil-independent.
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PMID:Adult respiratory distress syndrome in severely neutropenic children. 216 24

In a porcine model of severe septic acute respiratory failure produced by continuous infusion of live Pseudomonas aeruginosa, the role of the complement system was studied by pretreating animals with cobra venom factor (CVF) to deplete C3. Three groups of spontaneously breathing animals were monitored with Swan-Ganz and arterial thermodilution catheters. Group I was pretreated with 80 U/kg of CVF iv 16-18 hours before testing. Group II received Ps. aeruginosa iv (2 X 10(8)/20 kg/minute). Group III was pretreated with CVF and later given the Pseudomonas infusion. The CH50 as a measure of complement activity was less than 7% of normal level in Groups I and III. No changes in respiratory variables occurred in Group I. In Group II, the mean pulmonary artery pressure doubled, intrapulmonary shunt fraction (Qs/Qt) increased, PaO2 decreased, and extravascular lung water doubled in 4 hours. In Group III, the pulmonary hypertension, hypoxemia, increase in Qs/Qt, and increase in EVLW were all significantly less than in Group II. Neutropenia occurred with the Pseudomonas infusion in Groups II and III.
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PMID:Complement depletion in a porcine model of septic acute respiratory disease. 359 7

Extensive pneumonias are usually implicated as the sole cause for acute respiratory failure complicating severe neutropenia in hematologic malignancies and are often fatal. We report study of 11 patients investigated and treated in intensive care unit, using transtracheal aspiration, continuous positive airway pressure (CPAP) via face mask and granulocyte transfusions Two groups of patients emerged from this study. The first group with immediately diffuse pulmonary infiltrates, positive blood cultures, negative tracheal cultures, marked improvement in hypoxemia during CPAP, benefits from granulocyte transfusion without impairment in ventilatory status and may be considered as non-hemodynamic pulmonary oedema. The second group with localized pulmonary infiltrates, negative blood cultures and positive tracheal culture, slight improvement in hypoxemia during CPAP, gets no benefit from granulocyte transfusion, with additional impairment in ventilatory status and may be considered as acute extensive pneumonias.
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PMID:[Acute pulmonary infiltrates in hematologic malignancies in aplasia (author's transl)]. 704 38

Of 320 patients receiving a marrow transplant at the Hospital de Sant Pau between 1986 and 1992, 12% developed viridans streptococcal bacteremia during severe neutropenia. Five of these patients (13%) developed a rapidly progressive fatal shock syndrome characterized by bilateral pulmonary infiltrates, acute respiratory failure (ARDS) and septic shock early in the transplantation course (6 or 7 days posttransplantation). All patients were transplanted for acute leukemia in remission, and 2 received an allogeneic and 3 an autologous transplant. Four of these subjects were younger than 15 years of age and all had received cyclophosphamide and total body irradiation as conditioning regimen for marrow transplantation. All 5 patients died, and postmortem examinations revealed diffuse pulmonary lesions characteristic of the ARDS. These observations contribute to defining the clinical and pathologic characteristics of this serious complication of intensive anticancer treatment.
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PMID:Viridans streptococcal shock syndrome during bone marrow transplantation. 748 15

Acute respiratory failure (ARF) is a typical complication of chemotherapy for hematologic malignancies. Despite the effective correction of gas exchange by mechanical ventilation, the mortality in this population is expected to be extremely high due to unavoidable fatal infection of immunocompromised host and the poor prognosis of primary malignancy. However, modern specific treatment of leukemia and lymphoma has made these conditions curable in many cases, and even severe myelotoxic neutropenia does not always lead to uniformly fatal outcome. We studied survival in 113 cases of ARF retrospectively selected according to the uniform criteria of this syndrome. No selection was made as to the diagnosis, stage, and response to the treatment of the underlying disease. The group consisted of 51% male and 49% female patients aged 34, on an average; 69% of these with acute leukemia, 22% with malignant lymphoma, and 9% with other conditions. Sixty-five (58%) patients were subjected to mechanical ventilation (MV). Forty-two were treated after a Protocol on intensive care of ARF which contained standard requirements to management of patients. Another group of 71 patients admitted to intensive care units before this Protocol was introduced were historical controls. Total survival was 19.5%. In the MV group survival was 15% with 10 cases of cure, ARF developing during severe neutropenia in 3 out of these 10 cases. The results became evidently better after the Protocol was introduced, improving from 16 to 27%. The primary disease dramatically influenced the results: long-term survival was significantly poorer in patients with relapses and resistant to chemotherapy, with 100% mortality within 8 months after discharge. A conclusion is drawn that intensive care of ARF including MV is justified in patients with hematologic malignancies, except cases when primary malignancy is not properly treated or resistant to specific chemotherapy.
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PMID:[Acute respiratory insufficiency in hemoblastoses: evaluation of treatment effectiveness by survival rate]. 853 69

Hemato-oncology patients needing mechanical ventilation for acute respiratory failure (ARF) have an extremely poor prognosis, with a mortality of more than 90%. Over an 18 month-period 17 such patients were admitted to our ICU. Diagnoses included leukemia (11 cases), lymphoma (1), and status post bone marrow transplantation for leukemia, lymphoma or breast cancer (5). Of 8 whose ARF was associated with septic complications due to neutropenia following chemotherapy, 6 survived. Of 9 who developed ARF due to toxic damage to vital organs following high-dose chemotherapy, 2 survived. Those who develop ARF during chemotherapy are expected to have an increase in granulocyte count within days, and have a surprisingly good prognosis. They should be admitted to the ICU and treated aggressively. Those who develop sepsis due their primary disease and whose general condition contraindicates chemotherapy, have an extremely grave prognosis and admission to the ICU may not be warranted.
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PMID:[Hemato-oncology patients in acute respiratory failure in the ICU]. 933 70

Pulmonary alvelolar proteinosis (PAP) is a rare cause of chronic respiratory failure due to progressive alveolar accumulation of a periodic acid-schiff (PAS) positive proteinaceous material. In some cases, the rapid accumulation of intra-alveolar material leads to acute respiratory failure (ARF). We report the causative role of secondary PAP in the case of a 26-year-old man with acute myeloid leukemia who developed fever, increased serum lactate dehydrogenase level and ARF, and required mechanical ventilation. The diagnosis of PAP was established by the examination of material obtained by bronchoalveolar lavage (BAL). Respiratory improvement occurred several days after the patient had recovered from neutropenia. This report underlines the importance of the early diagnosis of PAP as a potential cause of ARF in leukemic patients. Adequate stain on BAL fluid provides the diagnosis and avoids repeated invasive procedures and inappropriate treatments.
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PMID:Acute respiratory failure caused by secondary alveolar proteinosis in a patient with acute myeloid leukemia: a case report. 956 12


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