Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 68-year old Japanese male with alcohol related rhabdomyolysis, hepatitis, and hematological disorders is presented. Biochemical data showed markedly elevated levels of serum hepatobiliary enzymes, lactate dehydrogenase and myoglobin, and decreased levels of serum sodium and phosphate. The serum creatine kinase level was approximately 40 times higher than the normal upper limit with 97% of MM fraction. Clinical manifestations of rhabdomyolysis, such as myalgia, muscle weakness and acute renal failure, were not recognized. Hematological examinations revealed mild neutropenia, lymphopenia, monocytopenia and thrombocytopenia but no anemia or macrocytosis. Initial treatment of an intravenous infusion of saline (30 mL/Kg body weight) and subsequent low sodium diet was successfully completed without severe complications. All the abnormal laboratory data were normalized within three weeks of his hospitalization. We suggest that hyponatremia and hypophosphatemia may be involved in the development of rhabdomyolysis, hepatitis and hematological disorders.
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PMID:Rhabdomyolysis, hepatitis and multiple hematological disorders associated with alcohol abuse: a case report. 1293 2

Non-Hodgkin's lymphoma is primarily a disease of the elderly, with 61% of the new cases reported in patients 60 years old or older. Aggressive combination chemotherapy can cure some patients, but there are frequently treatment failures and overall survival is low. Retrospective studies have found that treatment with less than standard chemotherapy doses is associated with lower survival, and surveys of practice patterns have found that many patients, especially elderly ones, are treated with substandard regimens and doses. Neutropenia is the major dose-limiting toxicity of chemotherapy in patients with non-Hodgkin's lymphoma. First-cycle use of colony-stimulating factor (CSF) can reduce the incidence of neutropenia and its complications and help maintain the chemotherapy doses. Researchers have investigated risk factors in patients with non-Hodgkin's lymphoma to determine which patients are at highest risk for neutropenia and would benefit from targeted first-cycle CSF support. It has been shown in several studies that advanced age, poor performance status, and high chemotherapy dose intensity are risk factors. Other trials suggest that low serum albumin levels, elevated lactate dehydrogenase levels, bone marrow involvement, and high levels of soluble tumor necrosis factor receptor are also risk factors. Dose intensity has also been shown in many studies to be an important predictor of survival in patients with non-Hodgkin's lymphoma. Managing the toxicity of chemotherapy with CSF has facilitated the delivery of planned dose on time, as well as dose-intensified chemotherapy regimens. The promising results from recent clinical trials of dose-dense regimens with CSF support suggest that this could prove to be the best strategy for improving patient outcomes.
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PMID:Risk models for chemotherapy-induced neutropenia in non-Hodgkin's lymphoma. 1468 15

The aim of this phase II trial was to assess the efficacy and tolerability of docetaxel/vinorelbine as second-line therapy. Thirty-two patients with a performance status (PS) of <or= 2 (5 with locally advanced and 27 with metastatic non-small-cell lung cancer [NSCLC]) who were previously treated with platinum-based chemotherapy, were recruited. Docetaxel 75 mg/m2 on day 1 and vinorelbine 20 mg/m2 on days 1 and 5 were administered every 3 weeks with dexamethasone premedication but without prophylactic granulocyte colony-stimulating factor and antibiotics. The overall response rate (intent-to-treat analysis) was 9.5%, including 3 patients with a partial response, 15 (47%) with stable disease, and 9 (28%) with progressive disease. Myelosupression was the limiting toxicity, with 8 episodes of febrile neutropenia and 3 deaths due to sepsis. Median overall survival and progression-free survival were 25 weeks and 13 weeks, respectively. Patients with a PS of 2 (P < 0.02) and elevated lactate dehydrogenase (P < 0.01) had a worse prognosis. Histology of adenocarcinoma appeared to positively influence survival (P = 0.09). Our study confirms that the docetaxel/vinorelbine schedule has activity in NSCLC patients pretreated with platinum-based therapies.
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PMID:Phase II study of docetaxel/vinorelbine in patients with non-small-cell-lung cancer previously treated with platinum-based chemotherapy. 1470 66

Brucellosis is a disease that may lead to changes in hematologic parameters such as anemia, neutropenia, and thrombocytopenia; however, thrombotic microangiopathy (TMA) is a rare finding. Severe TMA may be associated with life-threatening hematologic, renal, and neurologic disorders. To prevent this mortality caused by brucellosis, prompt recognition of this complication and prompt therapy are essential. A patient with TMA associated with Brucella melitensis is presented who initially presented with fever, skin purpura, epistaxis, confusion, microangiopathic hemolytic anemia, and thrombocytopenia. TMA was treated with plasmapheresis with cryosupernatant plasma replacement, energetically. A rapid improvement in platelet count, lactate dehydrogenase level, hemolytic anemia, and neurologic symptoms was observed with this treatment. For cases with infection-induced thrombotic microangiopathy, short-term plasmapheresis may be applied as an urgent therapy in addition to antimicrobial therapy.
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PMID:Severe thrombotic microangiopathy associated with brucellosis: successful treatment with plasmapheresis. 1567 81

To achieve long-term disease-free survival, high-dose therapy and autologous stem cell transplantation (ASCT) is the current standard approach in patients with relapsed or refractory Hodgkin disease (HD) or non-Hodgkin lymphoma (NHL). Because chemosensitivity is a significant factor in determining transplantation eligibility, it is critical to select a salvage chemotherapy regimen that has the potential to induce a high response rate with low nonhematologic toxicity. In this phase II study, 49 patients with relapsed or refractory HD (n = 22) and NHL (n = 27) with a median age of 42 years were treated with an IIVP salvage regimen consisting of ifosfamide, idarubicin, and etoposide. Twenty-seven percent of the patients had primary refractory disease, whereas 22% and 51% had early and late relapses, respectively. As analyzed by intention to treat, 16 patients (33%) achieved complete remission and 21 patients (43%) achieved a partial response, leading to an overall response rate of 76% (63% in NHL and 91% in HD). In the univariate analysis, diagnosis (HD versus NHL), remission duration before the initiation of IIVP, disease bulk, increased lactate dehydrogenase, and the presence of "B" symptoms were significant factors affecting the response achieved by the IIVP regimen. Of 37 responders, 31 (84%) underwent high-dose therapy and transplantation. The probability of 4-year overall survival (OS) and event-free survival (EFS) in this group of patients who underwent ASCT was 67.7% and 49.1%, respectively. When compared with the patients who achieved a partial response, patients who achieved complete remission with the IIVP regimen had a significantly higher probability of 4-year EFS (67.3% versus 30%; P = .016) and 4-year OS (92.3% versus 39.2%; P = .003). In patients with HD, 4-year EFS and 4-year OS were 54.9% and 70.6%, respectively, without a significant difference with respect to the survival rates obtained in patients with NHL (43.6% and 63.6%, respectively). Common side effects observed during 102 cycles of therapy were grade 3 to 4 neutropenia (62%) and thrombocytopenia (58%). The IIVP regimen is a highly effective salvage regimen for patients with relapsed or refractory HD or NHL who are candidates for ASCT. Furthermore, the degree of response to IIVP predicts the posttransplantation outcome. However, close follow-up is necessary because of a high incidence of grade 3 to 4 hematologic toxicity.
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PMID:Ifosfamide, idarubicin, and etoposide in relapsed/refractory Hodgkin disease or non-Hodgkin lymphoma: a salvage regimen with high response rates before autologous stem cell transplantation. 1612 39

Chemotherapy used to treat lymphoma can cause severe neutropenia. Risk models have identified factors that predict neutropenia across all chemotherapy cycles. We used clinical information obtained during pretreatment evaluation to develop a predictive model for severe neutropenia in the first cycle of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy. This case series study included lymphoma patients receiving CHOP chemotherapy with or without rituximab who did not receive pre-emptive hematopoietic growth factor. Risk factors for neutropenia were identified from previously published models and included age >or=65 years, hypoalbuminemia, renal/cardiovascular disease, anemia, abnormal bone marrow and increased lactate dehydrogenase (LDH). A composite score equal to the number of pretreatment risk factors was used to predict severe neutropenia in cycle 1. Fifty-three percent of patients (47 of 89) had severe neutropenia, with 70% of first episodes occurring during cycle 1. Eighty-two percent of first-cycle, severe neutropenia events occurred in patients >or=65-years-old. In univariate analysis, age >or=65 years and increased baseline LDH were significantly associated with increased risk for severe neutropenia in cycle 1. In logistic regression modeling, the probability of severe neutropenia in cycle 1 increased as the number of pretreatment risk factors increased, with a one-unit increase in risk score resulting in a 2.3-fold increase in severe neutropenia. The study results suggest that data obtained before initiating CHOP-based chemotherapy can be used to identify those patients who are at risk for severe neutropenia in cycle 1. If validated, our model could be used to identify patients who would benefit from early use of growth factors.
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PMID:Severe neutropenia in CHOP occurs most frequently in cycle 1: a predictive model. 1675 58

A 39-year-old patient with cervical cancer, stage Ia, was successfully treated by total hysterectomy. Then, after sustained neutropenia for more than 4 years and coincident with its exacerbation, the serum lactate dehydrogenase (LD) level started to elevate and reached a plateau. A test for antineutrophil antibody was negative and LD-3-linked IgAkappa, which may be responsible for high LD activity, was confirmed. The absolute number of blood NK cells was reduced, and a diagnosis of nonimmune chronic idiopathic neutropenia of adult was made. The successive occurrence of these 3 disorders may be based on interrelated immunological abnormalities.
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PMID:Lactate dehydrogenase-linked immunoglobulin Akappa in a patient with nonimmune chronic idiopathic neutropenia. 1695 Jun 76

We examined the association between chemotherapy-induced myelosuppression and prognosis in extensive-stage small cell lung cancer (ED SCLC). We retrospectively analysed 91 patients with ED SCLC who received a combination of cisplatin or carboplatin, etoposide or irinotecan between November 1995 and December 2007. Patients were categorized into two groups (grade 0 to 2 or grade 3 to 4) according to the worst neutropenia, thrombocytopenia, or anemia during first-line chemotherapy and were analysed for overall survival (OS) and time to progression (TTP). By univariate analysis, OS and TTP were significantly better in patients who developed grade 3 to 4 neutropenia than those who developed grade 0 to 2. Additionally, performance status (PS), LDH (lactate dehydrogenase), and neuron-specific enolase were prognostic factors for OS. By multivariate analysis, PS was an independent prognostic factor for OS. There were no independent prognostic factors for TTP. Myelosuppression during chemotherapy is not a prognostic factor in ED SCLC.
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PMID:[Chemotherapy-induced myelosuppression and treatment efficacy in extensive-stage small cell lung cancer]. 1992 Mar 85

Small-cell lung cancer is a rapidly progressive tumor and median survival is less than 10 months in patients with extensive stage of the disease. This study aims to evaluate the efficacy and tolerability of the carboplatin, etoposide, and irinotecan triplet as a first-line treatment in extensive small-cell lung cancer. Chemonaive patients with documented diagnosis of extensive small-cell lung cancer, performance status 0-2, and adequate organ function were eligible. Patients received triweekly carboplatin area under the curve 5 on day 1, irinotecan 150 mg/m on day 2, and etoposide 75 mg/m on days 1, 2, and 3 for up to six cycles. A total of 54 patients were enrolled. Forty-seven of 54 patients (87%) had a performance status of 0-1. The response rate was 75% and complete response was achieved in 10 of 54 patients (18%). The median time to progression was estimated at 8 months (95% confidence interval: 6.6-8.9) and median overall survival at 12 months (95% confidence interval: 10.3-13.9). Patients with one site of metastases had prolonged survival as compared with those with two or more sites. Normalization of lactate dehydrogenase values after treatment was not correlated to survival. Grade 3-4 neutropenia occurred in nine patients (16.7%) and grade 3 fetal thrombocytopenia in one patient (1.9%). Two toxic deaths (3.7%) were reported. The carboplatin, irinotecan, and etoposide triplet is a very effective and well-tolerated combination for the poor prognosis group of extensive-stage small-cell lung cancer patients.
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PMID:Triplet combination of carboplatin, irinotecan, and etoposide in the first-line treatment of extensive small-cell lung cancer: a single-institution phase II study. 2038 6

The stress profiles of the hemogram and serum biochemistry were determined in the context of heavy metal (Cd, Cu, Hg, Ni and Pb) exposure in the wild libyan jird, Meriones libycus, from one of Riyadh's polluted areas versus a reference site. Coupling the pronounced drop in platelets (PLT) (28%) and mean platelet volume (MPV) (17%) with the insignificant responses of other red blood cell indices, suggests bone marrow suppression that is characterized by thrombocytopenia as an initial abnormality. The species-specific stress leukogram for M. libycus is expressed by leukocytosis (66%), monocytosis (40%), lymphocytosis (23%) with eosinopenia (81%) and neutropenia (42%). Hyperglycemia (50%), hyper-low-density-lipoproteinemia (38%), hypocortisolism (85%) and hypotriglyceridemia (55%) depicted serum biochemistry profile. In polluted jirds, the elevated activities of pseudocholinesterase (PChE) and serum marker enzymes (alanine aminotransferase ALT, aspartate aminotransferase AST and creatine kinase CK) strongly suggest functional damage of the liver and/or heart. A potential role of PChE in low-density lipoprotein (LDL) metabolism is implied in the joint rise of both indices and in the recognized relationship between PChE and lipid metabolites. While increased utilization in lipid metabolism and energy synthesis could rationalize the inhibition of the normal patterns of triglycerides and lactate dehydrogenase (LDH), the inhibited activities of LDH could additionally be attributed to its hormetic behavior towards low and high metal concentrations. The overall findings presented here documented the relevance of M. libycus in biomonitoring and predicting the risk imposed on human populations living in polluted areas.
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PMID:Impact of heavy metal pollution on the hemogram and serum biochemistry of the Libyan jird, Meriones libycus. 2160 6


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