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Boire A, Burke K, Cox TR, Guise T, Jamal-Hanjani M, Janowitz T, Kaplan R, Lee R, Swanton C, Vander Heiden MG, Sahai E. Why do patients with cancer die? Nat Rev Cancer 2024; 24:578-589. [PMID: 38898221 PMCID: PMC7616303 DOI: 10.1038/s41568-024-00708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
Cancer is a major cause of global mortality, both in affluent countries and increasingly in developing nations. Many patients with cancer experience reduced life expectancy and have metastatic disease at the time of death. However, the more precise causes of mortality and patient deterioration before death remain poorly understood. This scarcity of information, particularly the lack of mechanistic insights, presents a challenge for the development of novel treatment strategies to improve the quality of, and potentially extend, life for patients with late-stage cancer. In addition, earlier deployment of existing strategies to prolong quality of life is highly desirable. In this Roadmap, we review the proximal causes of mortality in patients with cancer and discuss current knowledge about the interconnections between mechanisms that contribute to mortality, before finally proposing new and improved avenues for data collection, research and the development of treatment strategies that may improve quality of life for patients.
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Affiliation(s)
- Adrienne Boire
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katy Burke
- University College London Hospitals NHS Foundation Trust and Central and North West London NHS Foundation Trust Palliative Care Team, London, UK
| | - Thomas R Cox
- Cancer Ecosystems Program, The Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
| | - Theresa Guise
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariam Jamal-Hanjani
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
- Department of Oncology, University College London Hospitals, London, UK
- Cancer Research UK Lung Centre of Excellence, University College London Cancer Institute, London, UK
| | - Tobias Janowitz
- Cold Spring Harbour Laboratory, Cold Spring Harbour, New York, NY, USA
- Northwell Health Cancer Institute, New York, NY, USA
| | - Rosandra Kaplan
- Paediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Lee
- Tumour Cell Biology Laboratory, The Francis Crick Institute, London, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Charles Swanton
- Department of Oncology, University College London Hospitals, London, UK
- Cancer Research UK Lung Centre of Excellence, University College London Cancer Institute, London, UK
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Erik Sahai
- Tumour Cell Biology Laboratory, The Francis Crick Institute, London, UK.
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2
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Bowen J, Cross C. The Role of the Innate Immune Response in Oral Mucositis Pathogenesis. Int J Mol Sci 2023; 24:16314. [PMID: 38003503 PMCID: PMC10670995 DOI: 10.3390/ijms242216314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Oral mucositis (OM) is a significant complication of cancer therapy with limited management strategies. Whilst inflammation is a central feature of destructive and ultimately ulcerative pathology, to date, attempts to mitigate damage via this mechanism have proven limited. A relatively underexamined aspect of OM development is the contribution of elements of the innate immune system. In particular, the role played by barriers, pattern recognition systems, and microbial composition in early damage signaling requires further investigation. As such, this review highlights the innate immune response as a potential focus for research to better understand OM pathogenesis and development of interventions for patients treated with radiotherapy and chemotherapy. Future areas of evaluation include manipulation of microbial-mucosal interactions to alter cytotoxic sensitivity, use of germ-free models, and translation of innate immune-targeted agents interrogated for mucosal injury in other regions of the alimentary canal into OM-based clinical trials.
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Affiliation(s)
- Joanne Bowen
- School of Biomedicine, University of Adelaide, Adelaide 5005, Australia;
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Satheeshkumar PS, Blijlevens N, Sonis ST. Application of big data analyses to compare the impact of oral and gastrointestinal mucositis on risks and outcomes of febrile neutropenia and septicemia among patients hospitalized for the treatment of leukemia or multiple myeloma. Support Care Cancer 2023; 31:199. [PMID: 36869162 DOI: 10.1007/s00520-023-07654-1] [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: 10/27/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Oral ulcerative mucositis (UM) and gastrointestinal mucositis (GIM) have been associated with increased likelihood of systemic infection (bacteremia and sepsis) in patients being treated for hematological malignancies. To better define and contrast differences between UM and GIM, we utilized the United States 2017 National Inpatient Sample and analyzed patients hospitalized for the treatment of multiple myeloma (MM) or leukemia. METHODS We utilized generalized linear models to assess the association between adverse events-UM and GIM-among hospitalized MM or leukemia patients and the outcome of febrile neutropenia (FN), septicemia, burden of illness, and mortality. RESULTS Of 71,780 hospitalized leukemia patients, 1255 had UM and 100 GIM. Of 113,915 MM patients, 1065 manifested UM and 230 had GIM. In an adjusted analysis, UM was significantly associated with increased risk of FN in both the leukemia (aOR = 2.87, 95% CI = 2.09-3.92) and MM cohorts (aOR = 4.96, 95% CI = 3.22-7.66). Contrastingly, UM had no effect on the risk of septicemia in either group. Likewise, GIM significantly increased the odds of FN in both leukemia (aOR = 2.81, 95% CI = 1.35-5.88) and MM (aOR = 3.75, 95% CI = 1.51-9.31) patients. Similar findings were noted when we restricted our analysis to recipients of high-dose condition regimens in preparation for hematopoietic stem-cell transplant. UM and GIM were consistently associated with higher burden of illness in all the cohorts. CONCLUSION This first use of big data provided an effective platform to assess the risks, outcomes, and cost of care of cancer treatment-related toxicities in patients hospitalized for the management of hematologic malignancies.
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Affiliation(s)
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stephen T Sonis
- Dana Faber Cancer Institute, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.,Primary Endpoint Solutions, Waltham, MA, USA
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4
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Suzuki K, Sasada S, Nishi H, Kimura Y, Shintani T, Emi A, Masumoto N, Kadoya T, Kawaguchi H, Okada M. Impact of oral hygiene on febrile neutropenia during breast cancer chemotherapy. Breast Cancer 2023; 30:151-155. [PMID: 36271187 DOI: 10.1007/s12282-022-01410-9] [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: 07/21/2022] [Accepted: 10/16/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Oral hygiene is crucial in the management of oral and febrile complications during chemotherapy for cancer. This study aimed to investigate the impact of oral hygiene on the incidence of febrile neutropenia (FN) throughout the course of chemotherapy for breast cancer. METHODS A total of 137 patients with breast cancer who underwent four cycles of adjuvant chemotherapy with docetaxel and cyclophosphamide (TC) combination therapy or docetaxel alone were assessed for oral hygiene by quantifying the number of oral bacteria they harbored. These patients received professional oral health care (POHC). Eighteen patients underwent primary prophylaxis with granulocyte colony-stimulating factors. The relationship between oral bacteria count and FN incidence was retrospectively assessed. RESULTS The FN incidence rate was 47.4% throughout all treatment cycles (32.8%, 13.5%, 14.3%, and 14.4% in cycles 1, 2, 3, and 4, respectively). The oral bacteria count decreased with each treatment cycle (cycle 1: 9.10 × 106 colony-forming units (CFU)/mL, cycle 2: 5.89 × 106 CFU/mL, cycle 3: 4.61 × 106 CFU/mL, cycle 4: 5.85 × 106 CFU/mL, P = 0.004). Among 281 treatment cycles, FN occurred in 63 (22.4%). In the treatment cycle-based analysis, high oral bacteria count was an independent risk factor for FN. CONCLUSION FN incidence decreased with each treatment cycle and was associated with changes in oral bacteria counts. The oral bacterial count was one of risk factors for FN development in breast cancer.
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Affiliation(s)
- Kanako Suzuki
- Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinsuke Sasada
- Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan. .,Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Hiromi Nishi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuri Kimura
- Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan.,Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomoaki Shintani
- Center of Oral Examination, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiko Emi
- Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan.,Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Norio Masumoto
- Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan.,Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takayuki Kadoya
- Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan.,Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Kawaguchi
- Department of General Dentistry, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Paret R, Le Bourgeois A, Guillerm G, Tessoulin B, Rezig S, Gastinne T, Couturier MA, Boutoille D, Lecomte R, Ader F, Le Gouill S, Ansart S, Talarmin JP, Gaborit B. Safety and risk of febrile recurrence after early antibiotic discontinuation in high-risk neutropenic patients with haematological malignancies: a multicentre observational study. J Antimicrob Chemother 2022; 77:2546-2556. [PMID: 35748614 DOI: 10.1093/jac/dkac190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/16/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies. METHODS A retrospective multicentre observational study was conducted over 2 years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence. RESULTS Among 147 included patients in the ECIL-4 cohort, mainly diagnosed with acute leukaemia (n = 104, 71%), antibiotics were discontinued during 170 post-chemotherapy neutropenic episodes. In comparison with the historical cohort of 178 episodes of neutropenia without antibiotic discontinuation, no significant differences were observed regarding febrile recurrences [71.2% (121/170) versus 71.3% (127/178), P = 0.97], admission in ICUs [6.5% (11/170) versus 11.2% (20/178), P = 0.17], septic shock [0.6% (1/170) versus 3.9% (7/178), P = 0.07] and 30 day mortality [1.4% (2/147) versus 2.7% (4/150), P = 0.084]. In the ECIL-4 cohort, the rate of bacteraemia in case of febrile recurrence was higher [27.1% (46/170) versus 11.8% (21/178), P < 0.01] and antibiotic consumption was significantly lower (15.5 versus 19.9 days, P < 0.001). After early antibiotic discontinuation according to ECIL-4 recommendations, enterocolitis was associated with febrile recurrence [HR = 2.31 (95% CI = 1.4-3.8), P < 0.001] and stage III-IV oral mucositis with bacteraemia [HR = 2.26 (95% CI = 1.22-4.2), P = 0.01]. CONCLUSIONS After an FUO episode in high-risk neutropenia, compliance with ECIL-4 recommendations for early antibiotic discontinuation appears to be safe and mucosal damage was associated with febrile recurrence and bacteraemia. Prospective interventional studies are warranted to assess this strategy in high-risk neutropenic patients.
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Affiliation(s)
- Raphael Paret
- Department of Infectious Diseases, University Hospital of Brest, Brest, France
| | - Amandine Le Bourgeois
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Gaëlle Guillerm
- Department of Haematology, University Hospital of Brest, Brest, France
| | - Benoit Tessoulin
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Schéhérazade Rezig
- Department of Infectious Diseases, University Hospital of Brest, Brest, France
| | - Thomas Gastinne
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | | | - David Boutoille
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France.,Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
| | - Raphael Lecomte
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France
| | - Florence Ader
- Department of Infectious Diseases, University Hospital of Lyon, Lyon, France
| | - Steven Le Gouill
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Séverine Ansart
- Department of Infectious Diseases, University Hospital of Brest, Brest, France
| | - Jean Philippe Talarmin
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
| | - Benjamin Gaborit
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France.,Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
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6
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Tsuboi K, Tsuboi N, Sakamoto K, Takebayashi A, Tomizawa D, Nishimura N, Nakagawa S. Life-threatening oral mucositis following chemotherapy in a pediatric patient. Clin Case Rep 2021; 9:e04356. [PMID: 34136255 PMCID: PMC8190677 DOI: 10.1002/ccr3.4356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
Severe oral mucositis as a complication of chemotherapy may lead to airway obstruction and require prolonged intubation. As its course is consistent with the course of neutropenia, airway management strategies should be determined individually.
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Affiliation(s)
- Kaoru Tsuboi
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Norihiko Tsuboi
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Kenichi Sakamoto
- Children’s Cancer CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Akira Takebayashi
- Children’s Cancer CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Daisuke Tomizawa
- Children’s Cancer CenterNational Center for Child Health and DevelopmentTokyoJapan
| | - Nao Nishimura
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Satoshi Nakagawa
- Department of Critical Care MedicineNational Center for Child Health and DevelopmentTokyoJapan
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7
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Translational model of melphalan-induced gut toxicity reveals drug-host-microbe interactions that drive tissue injury and fever. Cancer Chemother Pharmacol 2021; 88:173-188. [PMID: 33877390 PMCID: PMC8236460 DOI: 10.1007/s00280-021-04273-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Conditioning therapy with high-dose melphalan (HDM) is associated with a high risk of gut toxicity, fever and infections in haematopoietic stem cell transplant (HSCT) recipients. However, validated preclinical models that adequately reflect clinical features of melphalan-induced toxicity are not available. We therefore aimed to develop a novel preclinical model of melphalan-induced toxicity that reflected well-defined clinical dynamics, as well as to identify targetable mechanisms that drive intestinal injury. METHODS Male Wistar rats were treated with 4-8 mg/kg melphalan intravenously. The primary endpoint was plasma citrulline. Secondary endpoints included survival, weight loss, diarrhea, food/water intake, histopathology, body temperature, microbiota composition (16S sequencing) and bacterial translocation. RESULTS Melphalan 5 mg/kg caused self-limiting intestinal injury, severe neutropenia and fever while impairing the microbial metabolome, prompting expansion of enteric pathogens. Intestinal inflammation was characterized by infiltration of polymorphic nuclear cells in the acute phases of mucosal injury, driving derangement of intestinal architecture. Ileal atrophy prevented bile acid reabsorption, exacerbating colonic injury via microbiota-dependent mechanisms. CONCLUSION We developed a novel translational model of melphalan-induced toxicity, which has excellent homology with the well-known clinical features of HDM transplantation. Application of this model will accelerate fundamental and translational study of melphalan-induced toxicity, with the clinical parallels of this model ensuring a greater likelihood of clinical success.
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de Mooij CEM, van Groningen LFJ, de Haan AFJ, Biemond BJ, Bakker M, van der Velden WJFM, Blijlevens NMA. Anakinra: efficacy in the management of fever during neutropenia and mucositis in autologous stem cell transplantation (AFFECT-2)-study protocol for a multicenter randomized double-blind placebo-controlled trial. Trials 2020; 21:948. [PMID: 33225965 PMCID: PMC7681989 DOI: 10.1186/s13063-020-04847-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023] Open
Abstract
Background Since decades, fever and infections have been the most important complications of intensive chemotherapy and hematopoietic stem cell transplantation (HSCT) in the treatment of hematologic malignancies. Neutropenia has long been considered to be the most important risk factor for these complications. However, recent studies have shown that not neutropenia, but the development of mucositis is the most important cause of these complications. Currently, limited options for the prevention and treatment of mucositis are available, of which most are only supportive. The pro-inflammatory cytokine interleukin-1 (IL-1) plays a crucial role in the pathogenesis of mucositis. Pre-clinical studies of chemotherapy-induced mucositis have shown that recombinant human IL-1 receptor antagonist anakinra significantly ameliorated intestinal mucositis. In our pilot study AFFECT-1, we examined the safety and maximal tolerated dose of anakinra in patients with multiple myeloma, treated with high-dose melphalan (HDM) and autologous HSCT, selecting a dose of 300 mg daily for the phase IIb trial. The aim of the AFFECT-2 study is to determine the efficacy of anakinra in preventing fever during neutropenia (FN) and mucositis in this study population. Methods/design A multicenter, randomized, placebo-controlled, double-blind phase IIb trial will be conducted. Ninety patients with multiple myeloma scheduled for treatment with HDM and autologous HSCT will be included. Patients will be randomized between intravenous treatment with anakinra (300 mg) or placebo. Each group will be treated from day − 2 (day of HDM; day 0 is HSCT) up until day + 12. Outcome measures will be assessed at baseline, during admission, at discharge or day + 30, at day + 90, and + 1 year. The primary outcome will be reduction of FN. Secondary outcome measures include mucositis scores, bloodstream infections, citrulline levels, quality of life, and fatigue severity. Discussion The AFFECT-2 trial will examine the efficacy of anakinra in the management of fever during neutropenia and mucositis in patients with multiple myeloma treated with HDM and autologous HSCT. The results of this study may provide a new treatment option for these important complications. Also, this study will give us more insight in the pathophysiology of mucositis, including the role of IL-1 and the role of the microbiota in mucositis. Trial registration Clinicaltrials.gov NCT04099901. Registered on September 23, 2019. EudraCT: 2018-005046-10.
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Affiliation(s)
- Charlotte E M de Mooij
- Radboud Institute of Health Sciences, Department of Hematology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Lenneke F J van Groningen
- Radboud Institute of Health Sciences, Department of Hematology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Anton F J de Haan
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart J Biemond
- Department of Hematology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Martijn Bakker
- Department of Hematology, University Medical Center Groningen, Groningen, the Netherlands
| | - Walter J F M van der Velden
- Radboud Institute of Health Sciences, Department of Hematology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Nicole M A Blijlevens
- Radboud Institute of Health Sciences, Department of Hematology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, the Netherlands
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Pattanakitsakul P, Chongviriyaphan N, Pakakasama S, Apiwattanakul N. Effect of vitamin A on intestinal mucosal injury in pediatric patients receiving hematopoietic stem cell transplantation and chemotherapy: a quasai-randomized trial. BMC Res Notes 2020; 13:464. [PMID: 33008464 PMCID: PMC7532573 DOI: 10.1186/s13104-020-05307-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022] Open
Abstract
Objective Vitamin A is involved in maintenance of gut mucosal integrity and normal immune function. However, it is unclear whether these functions of vitamin A have any beneficial effects in patients undergoing hematopoietic stem cell transplantation (HSCT). In this study, we aimed to examine the potential protective effect of vitamin A supplementation on gastrointestinal (GI) mucosal integrity in HSCT recipients using plasma citrulline as a surrogate marker of intestinal integrity. Results We performed a quasi-randomized trial in 30 pediatric patients undergoing HSCT. Half (n = 15) of the patients received a single high dose of vitamin A (200,000 IU) before the conditioning regimen was given, and half (n = 15) did not. Clinical data of patients who developed post-transplant complications were recorded for 60 days after HSCT. There were no significant differences in mean plasma citrulline levels on day 7 after HSCT between the treatment and control groups (5.8 vs. 5.9 µmol/L, respectively). The incidence of mucositis and other complications were not different between the two groups within 60 days of HSCT. Vitamin A supplementation prior to HSCT in pediatric patients had no clinical benefit in protecting GI mucosal integrity.
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Affiliation(s)
- Ploy Pattanakitsakul
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Nalinee Chongviriyaphan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Samart Pakakasama
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand
| | - Nopporn Apiwattanakul
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand.
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10
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Gebri E, Kiss A, Tóth F, Hortobágyi T. Female sex as an independent prognostic factor in the development of oral mucositis during autologous peripheral stem cell transplantation. Sci Rep 2020; 10:15898. [PMID: 32985512 PMCID: PMC7522228 DOI: 10.1038/s41598-020-72592-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/28/2020] [Indexed: 11/11/2022] Open
Abstract
Oral mucositis (OM) is a frequent complication of stem cell transplantation-associated toxicity in haematological malignancies, contributing to mortality. Therapy still remains mainly supportive. We assessed risk factors in retrospective analysis of 192 autologous peripheral stem cell transplantation patients with lymphoma and multiple myeloma (MM), respectively. Futhermore, we examined the hormone levels both in serum and saliva during transplantation in 7 postmenopausal female patients with lymphoma compared to healthy controls using electrochemiluminescence immunoassay (ECLIA). Multivariable analysis revealed neutrophil engraftment (p < 0.001; p = 0.021) and female sex (p = 0.023; p = 0.038) as independent predictive factors in the combined patient group and in the lymphoma group, and neutrophil engraftment (p = 0.008) in the MM group. Of the 85 female participants 19 were pre- and 66 postmenopausal. Fifteen of the pre-, and 49 of the postmenopausal women developed ulcerative mucositis (p = 0.769), more often with lymphoma than MM (p = 0.009). Serum estrogen decreased significantly both in postmenopausal controls and transplantated patients compared to premenopausals, with no difference in saliva. Serum progesterone level was significantly (p = 0.026) elevated at day + 7 of transplantation, while salivary progesterone increased at day + 7 and + 14. Our results indicate a predominantly negative effect of female sex hormones on oral immunity with role in the aetiopathogenesis of OM.
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Affiliation(s)
- Enikő Gebri
- Department of Dentoalveolar Surgery and Dental Outpatient Care, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Attila Kiss
- Department of Haematopoietic Transplantation Centre, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ferenc Tóth
- Department of Biomaterials and Prosthetic Dentistry, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Tibor Hortobágyi
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- Faculty of Medicine, Institute of Pathology, University of Szeged, Állomás utca 2, Szeged, 6725, Hungary.
- Department of Old Age Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
- Centre for Age-Related Medicine, SESAM, Stavanger University Hospital, Stavanger, Norway.
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Laheij AMGA, Raber-Durlacher JE, Koppelmans RGA, Huysmans MCDNJM, Potting C, van Leeuwen SJM, Hazenberg MD, Brennan MT, von Bültzingslöwen I, Johansson JE, de Soet JJ, Haverman TM, Buijs MJ, Brandt BW, Rozema FR, Blijlevens NMA, Zaura E. Microbial changes in relation to oral mucositis in autologous hematopoietic stem cell transplantation recipients. Sci Rep 2019; 9:16929. [PMID: 31729407 PMCID: PMC6858439 DOI: 10.1038/s41598-019-53073-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/26/2019] [Indexed: 11/12/2022] Open
Abstract
The aim of this prospective, two center study was to investigate the dynamics of the microbial changes in relation to the development of ulcerative oral mucositis in autologous SCT (autoSCT) recipients. Fifty-one patients were diagnosed with multiple myeloma and treated with high-dose melphalan followed by autoSCT. They were evaluated before, three times weekly during hospitalization, and three months after autoSCT. At each time point an oral rinse was collected and the presence or absence of ulcerative oral mucositis (UOM) was scored (WHO scale). Oral microbiome was determined by using 16S rRNA amplicon sequencing and fungal load by qPCR. Twenty patients (39%) developed UOM. The oral microbiome changed significantly after autoSCT and returned to pre-autoSCT composition after three months. However, changes in microbial diversity and similarity were more pronounced and rapid in patients who developed UOM compared to patients who did not. Already before autoSCT, different taxa discriminated between the 2 groups, suggesting microbially-driven risk factors. Samples with high fungal load (>0.1%) had a significantly different microbial profile from samples without fungi. In conclusion, autoSCT induced significant and reversible changes in the oral microbiome, while patients who did not develop ulcerative oral mucositis had a more resilient microbial ecosystem.
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Affiliation(s)
- Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Renée G A Koppelmans
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Carin Potting
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mette D Hazenberg
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, United States of America
| | | | - Jan-Erik Johansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johannes J de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thijs M Haverman
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark J Buijs
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernd W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Egija Zaura
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Garzón JR, Isaza N, Posada A, Mendez R, Arenas J, Ardila MP, Cardenas F, Barrera V, Moreno P, Córdoba I, Rodríguez MN. Características clínicas y microbiológicas de pacientes con neutropenia febril en un hospital universitario. INFECTIO 2019. [DOI: 10.22354/in.v23i4.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San IgnacioMétodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos.Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.
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13
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Zecha JAEM, Raber-Durlacher JE, Laheij AMGA, Westermann AM, Epstein JB, de Lange J, Smeele LE. The impact of the oral cavity in febrile neutropenia and infectious complications in patients treated with myelosuppressive chemotherapy. Support Care Cancer 2019; 27:3667-3679. [PMID: 31222393 PMCID: PMC6726710 DOI: 10.1007/s00520-019-04925-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022]
Abstract
Febrile neutropenia (FN) is an inflammatory response causing fever that may develop during cancer therapy-induced neutropenia. FN may herald life-threatening infectious complications and should therefore be considered a medical emergency. Patients presenting with FN are routinely subjected to careful history taking and physical examination including X-rays and microbiological evaluations. Nevertheless, an infection is documented clinically in only 20-30% of cases, whereas a causative microbial pathogen is not identified in over 70% of FN cases. The oral cavity is generally only visually inspected. Although it is recognized that ulcerative oral mucositis may be involved in the development of FN, the contribution of infections of the periodontium, the dentition, and salivary glands may be underestimated. These infections can be easily overlooked, as symptoms and signs of inflammation may be limited or absent during neutropenia. This narrative review is aimed to inform the clinician on the potential role of the oral cavity as a potential source in the development of FN. Areas for future research directed to advancing optimal management strategies are discussed.
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Affiliation(s)
- Judith A E M Zecha
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Judith E Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Anneke M Westermann
- Department of Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joel B Epstein
- Cedars-Sinai Health System, Los Angeles and City of Hope Cancer Center, Duarte, CA, USA
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Centre for Dentistry, (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Centre for Dentistry, (ACTA), University of Amsterdam, Amsterdam, The Netherlands.,Department of Head & Neck Oncology & Surgery, Netherlands Cancer Institute- Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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14
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Abstract
Oncology patients are a unique patient population in the emergency department (ED). Malignancy and associated surgical, chemotherapeutic, or radiation therapies put them at an increased risk for infection. The most ominous development is neutropenic fever, which happens often and may not present with signs or symptoms other than fever. A broad differential diagnosis is essential when considering infectious disease pathology in both neutropenic and non-neutropenic oncology patients in the ED.
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Affiliation(s)
- Lauren Cantwell
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24014, USA
| | - Jack Perkins
- Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24014, USA.
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15
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Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, Langston AA, Nastoupil LJ, Rajotte M, Rolston KV, Strasfeld L, Flowers CR. Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol 2018; 36:3043-3054. [PMID: 30179565 DOI: 10.1200/jco.18.00374] [Citation(s) in RCA: 303] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment. METHODS ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel. RESULTS Six new or updated meta-analyses and six new primary studies were added to the updated systematic review. RECOMMENDATIONS Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus-seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at www.asco.org/supportive-care-guidelines .
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Affiliation(s)
- Randy A Taplitz
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Erin B Kennedy
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Eric J Bow
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Jennie Crews
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Charise Gleason
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Douglas K Hawley
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Amelia A Langston
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Loretta J Nastoupil
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Michelle Rajotte
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Kenneth V Rolston
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Lynne Strasfeld
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
| | - Christopher R Flowers
- Randy A. Taplitz, UC San Diego Health, La Jolla, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Eric J. Bow, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Jennie Crews, Seattle Cancer Care Alliance, Seattle, WA; Charise Gleason, Winship Cancer Institute; Amelia A. Langston and Christopher R. Flowers, Emory University School of Medicine, Atlanta, GA; Douglas K. Hawley, University of Cincinnati; Veterans Affairs Medical Center, Cincinnati, OH; Loretta J. Nastoupil and Kenneth V. Rolston, MD Anderson Cancer Center, Houston, TX; Michelle Rajotte, The Leukemia and Lymphoma Society, Rye Brook, NY; and Lynne Strasfeld, Oregon Health and Science University, Portland, OR
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16
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Moody KM, Baker RA, Santizo RO, Olmez I, Spies JM, Buthmann A, Granowetter L, Dulman RY, Ayyanar K, Gill JB, Carroll AE. A randomized trial of the effectiveness of the neutropenic diet versus food safety guidelines on infection rate in pediatric oncology patients. Pediatr Blood Cancer 2018; 65. [PMID: 28696047 DOI: 10.1002/pbc.26711] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/19/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The neutropenic diet (ND) is prescribed to avoid introduction of bacteria into a host's gastrointestinal tract and reduce infection. Due to a lack of evidence to support the ND, there continues to be debate among pediatric oncologists regarding its usefulness. This prospective randomized controlled trial evaluated the difference in neutropenic infection rates in pediatric oncology patients randomized to Food and Drug Administration approved food safety guidelines (FSGs) versus the ND plus FSGs during one cycle of chemotherapy. PROCEDURE Pediatric patients receiving cancer treatment with myelosuppressive chemotherapy were eligible. Neutropenic infection was the primary outcome and defined as (i) fever with neutropenia or (ii) hospital admission and treatment for clinical infection and neutropenia. The rate of neutropenic infection was compared with Student's t-test for independent samples. Documented infections were identified by comprehensive chart review and compared between groups using a χ2 test. RESULTS One hundred fifty patients were randomly assigned to FSGs (n = 73) or ND + FSGs (n = 77). The most common diagnoses were acute lymphoblastic leukemia (32%) and sarcoma (32%). There was no significant difference between the groups in the percentage of patients who developed neutropenic infection: FSGs 33% versus ND + FSGs 35% (P = 0.78). Patients randomized to ND + FSGs reported that following the diet required more effort than those on FSGs alone. CONCLUSION The ND offers no benefit over FSGs in the prevention of infection in pediatric oncology patients undergoing myelosuppressive chemotherapy and adherence requires more effort for patients and families. Institutions caring for children with cancer should consider replacing ND guidelines with FSGs.
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Affiliation(s)
- Karen M Moody
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rebecca A Baker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ruth O Santizo
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Inan Olmez
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Jeanie M Spies
- Rady Children's Hospital, Peckham Center for Cancer and Blood Disorders, San Diego, California
| | - Amanda Buthmann
- The Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders, New York
| | - Linda Granowetter
- Department of Pediatrics, New York University School of Medicine, New York
| | - Robin Y Dulman
- Pediatric Specialists of Virginia and Inova Fairfax Hospital, Virginia
| | | | - Jonathan B Gill
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron E Carroll
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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17
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Kuiken NSS, Rings EHHM, Blijlevens NMA, Tissing WJE. Biomarkers and non-invasive tests for gastrointestinal mucositis. Support Care Cancer 2017; 25:2933-2941. [PMID: 28536886 PMCID: PMC5527064 DOI: 10.1007/s00520-017-3752-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/12/2017] [Indexed: 02/07/2023]
Abstract
Gastrointestinal mucositis is a complex inflammatory reaction of the mucous membranes, a side effect of both chemotherapy and radiotherapy. Currently, assessment scales are used to diagnose mucositis. However, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. This will give the opportunity to evaluate studies, to determine risk factors and incidence, and it will make it possible to compare studies. Moreover, this biomarker might improve clinical management for patients. In this paper, we reviewed studies concerning potential biomarkers in blood samples and fecal samples, and potential tests in breath samples and urine samples. We include biomarkers and tests studied in animal models and/or in clinical trials, and discuss the validity, diagnostic accuracy, and applicability.
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Affiliation(s)
- N S S Kuiken
- Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.,Department of Pediatric Gastroenterology and Hepatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E H H M Rings
- Department of Pediatrics, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.,Department of Pediatrics, Erasmus Medical Center Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - N M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Wim J E Tissing
- Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
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18
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Chua LL, Rajasuriar R, Azanan MS, Abdullah NK, Tang MS, Lee SC, Woo YL, Lim YAL, Ariffin H, Loke P. Reduced microbial diversity in adult survivors of childhood acute lymphoblastic leukemia and microbial associations with increased immune activation. MICROBIOME 2017; 5:35. [PMID: 28320465 PMCID: PMC5359958 DOI: 10.1186/s40168-017-0250-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/02/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adult survivors of childhood cancers such as acute lymphoblastic leukemia (ALL) have health problems that persist or develop years after cessation of therapy. These late effects include chronic inflammation-related comorbidities such as obesity and type 2 diabetes, but the underlying cause is poorly understood. RESULTS We compared the anal microbiota composition of adult survivors of childhood ALL (N = 73) with healthy control subjects (N = 61). We identified an altered community with reduced microbial diversity in cancer survivors, who also exhibit signs of immune dysregulation including increased T cell activation and chronic inflammation. The bacterial community among cancer survivors was enriched for Actinobacteria (e.g. genus Corynebacterium) and depleted of Faecalibacterium, correlating with plasma concentrations of IL-6 and CRP and HLA-DR+CD4+ and HLA-DR+CD8+ T cells, which are established markers of inflammation and immune activation. CONCLUSIONS We demonstrated a relationship between microbial dysbiosis and immune dysregulation in adult ALL survivors. These observations suggest that interventions that could restore microbial diversity may ameliorate chronic inflammation and, consequently, development of late effects of childhood cancer survivors.
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Affiliation(s)
- Ling Ling Chua
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Mohamad Shafiq Azanan
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Pediatric, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Noor Kamila Abdullah
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mei San Tang
- Departments of Microbiology and Medicine, New York University School of Medicine, New York, NY 10016 USA
| | - Soo Ching Lee
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne Ai Lian Lim
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Ariffin
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Pediatric, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - P’ng Loke
- Departments of Microbiology and Medicine, New York University School of Medicine, New York, NY 10016 USA
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19
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Vasconcelos RM, Sanfilippo N, Paster BJ, Kerr AR, Li Y, Ramalho L, Queiroz EL, Smith B, Sonis ST, Corby PM. Host-Microbiome Cross-talk in Oral Mucositis. J Dent Res 2016; 95:725-33. [PMID: 27053118 DOI: 10.1177/0022034516641890] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Oral mucositis (OM) is among the most common, painful, and debilitating toxicities of cancer regimen-related treatment, resulting in the formation of ulcers, which are susceptible to increased colonization of microorganisms. Novel discoveries in OM have focused on understanding the host-microbial interactions, because current pathways have shown that major virulence factors from microorganisms have the potential to contribute to the development of OM and may even prolong the existence of already established ulcerations, affecting tissue healing. Additional comprehensive and disciplined clinical investigation is needed to carefully characterize the relationship between the clinical trajectory of OM, the local levels of inflammatory changes (both clinical and molecular), and the ebb and flow of the oral microbiota. Answering such questions will increase our knowledge of the mechanisms engaged by the oral immune system in response to mucositis, facilitating their translation into novel therapeutic approaches. In doing so, directed clinical strategies can be developed that specifically target those times and tissues that are most susceptible to intervention.
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Affiliation(s)
- R M Vasconcelos
- School of Medicine, New York University, New York, NY, USA College of Dentistry, New York University, New York, NY, USA Faculdade de Odontologia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - N Sanfilippo
- School of Medicine, New York University, New York, NY, USA New York University Perlmutter Cancer Center, New York, NY, USA
| | - B J Paster
- The Forsyth Institute, Cambridge, MA, USA Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - A R Kerr
- College of Dentistry, New York University, New York, NY, USA
| | - Y Li
- College of Dentistry, New York University, New York, NY, USA
| | - L Ramalho
- Faculdade de Odontologia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - E L Queiroz
- College of Dentistry, New York University, New York, NY, USA
| | - B Smith
- School of Medicine, New York University, New York, NY, USA New York University Perlmutter Cancer Center, New York, NY, USA
| | - S T Sonis
- Biomodels, LLC, Watertown, MA, USA Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - P M Corby
- School of Medicine, New York University, New York, NY, USA College of Dentistry, New York University, New York, NY, USA
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20
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Koinis F, Nintos G, Georgoulias V, Kotsakis A. Therapeutic strategies for chemotherapy-induced neutropenia in patients with solid tumors. Expert Opin Pharmacother 2015; 16:1505-19. [DOI: 10.1517/14656566.2015.1055248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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21
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Kojouharov BM, Brackett CM, Veith JM, Johnson CP, Gitlin II, Toshkov IA, Gleiberman AS, Gudkov AV, Burdelya LG. Toll-like receptor-5 agonist Entolimod broadens the therapeutic window of 5-fluorouracil by reducing its toxicity to normal tissues in mice. Oncotarget 2015; 5:802-14. [PMID: 24583651 PMCID: PMC3996654 DOI: 10.18632/oncotarget.1773] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Myelosuppression and gastrointestinal damage are common side effects of cancer treatment limiting efficacy of DNA-damaging chemotherapeutic drugs. The Toll-like receptor 5 (TLR5) agonist Entolimod has demonstrated efficacy in mitigating damage to hematopoietic and gastrointestinal tissues caused by radiation. Here, using 5-Fluorouracil (5-FU) treated mice as a model of chemotherapy-induced side effects, we demonstrated significant reduction in the severity of 5-FU-induced morbidity and increased survival accompanied by the improved integrity of intestinal tissue and stimulated the restoration of hematopoiesis. Entolimod-stimulated IL-6 production was essential for Entolimod's ability to rescue mice from death caused by doses of 5-FU associated with hematopoietic failure. In contrast, IL-6 induction was not necessary for protection and restoration of drug-damaged gastrointestinal tissue by Entolimod. In a syngeneic mouse CT26 colon adenocarcinoma model, Entolimod reduced the systemic toxicity of 5-FU, but did not reduce its antitumor efficacy indicating that the protective effect of Entolimod was selective for normal, non-tumor, tissues. These results suggest that Entolimod has clinical potential to broaden the therapeutic window of genotoxic anticancer drugs by reducing their associated hematopoietic and gastrointestinal toxicities.
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22
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Bourdelin M, Daguindau E, Larosa F, Legrand F, Nerich V, Deconinck E, Limat S. [Mucositis after allogeneic stem cell transplantation: Risk factors, clinical consequences and prophylaxis]. ACTA ACUST UNITED AC 2014; 63:106-10. [PMID: 25555496 DOI: 10.1016/j.patbio.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/17/2014] [Indexed: 11/28/2022]
Abstract
AIM Oral mucositis is a very common complication of allograft. However, preventive treatments are still limited. The objective of this study is to identify risk factors for onset of oral mucositis in patients undergoing allogeneic hematopoietic stem cells transplantation (HSCT), to measure clinical consequences and to study their evolution according to type of prevention. PATIENTS AND METHODS All patients undergoing HSCT in hematology unit of CHU Besançon between January 2009 and August 2010 were included, and received according to their choice, either the standard protocol: solution of sodium bicarbonate 1.4% associated with chlorhexidine-chlorobutanol (Eludril(®)) (n=49), or the experimental treatment by the ionic solution, Caphosol(®) (n=42). RESULTS The overall incidence of severe mucositis and mucositis is respectively 69% and 36%. In multivariate analysis, a myeloablative conditioning (OR=11.1) and prevention of GVHD (graft-versus-host disease) including methotrexate (OR=7.5) appear such as the two significant mucositis risk factors. The presence of mucositis resulting in a significant increase in the incidence of febrile aplasia (P=0.008) and the use of opioid analgesics and parenteral nutrition (P<10(-3)). The risk of acute gastrointestinal GVHD is also increased in severe mucositis (P=0.01). The duration of post-transplant hospitalization is not changed. The type of prevention does not influence the incidence of mucositis (P=0.11). CONCLUSION The consequences of mucositis are significant and the risk factors identified. The interest of the ionic solution Caphosol(®) seems limited, the incidence of mucositis is not decreased by this prevention.
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Affiliation(s)
- M Bourdelin
- Pôle pharmaceutique, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France.
| | - E Daguindau
- Service d'hématologie, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France; Inserm UMR 1098, établissement français du sang, 25000 Besançon, France
| | - F Larosa
- Service d'hématologie, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France
| | - F Legrand
- Service d'hématologie, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France
| | - V Nerich
- Pôle pharmaceutique, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France; Inserm UMR 1098, établissement français du sang, 25000 Besançon, France
| | - E Deconinck
- Service d'hématologie, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France; Inserm UMR 1098, établissement français du sang, 25000 Besançon, France
| | - S Limat
- Pôle pharmaceutique, CHRU de Besançon, 1, boulevard Fleming, 25000 Besançon, France; Inserm UMR 1098, établissement français du sang, 25000 Besançon, France
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23
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IL-33 targeting attenuates intestinal mucositis and enhances effective tumor chemotherapy in mice. Mucosal Immunol 2014; 7:1079-93. [PMID: 24424522 PMCID: PMC4077764 DOI: 10.1038/mi.2013.124] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/16/2013] [Indexed: 02/04/2023]
Abstract
Intestinal damage and severe diarrhea are serious side effects of cancer chemotherapy and constrain the usage of most such therapies. Here we show that interleukin-33 (IL-33) mediates the severe intestinal mucositis in mice treated with irinotecan (CPT-11), a commonly used cancer chemotherapeutic agent. Systemic CPT-11 administration led to severe mucosal damage, diarrhea, and body weight loss concomitant with the induction of IL-33 in the small intestine (SI). This mucositis was markedly reduced in mice deficient in the IL-33R (ST2(-/-)). Moreover, recombinant IL-33 exacerbated the CPT-11-induced mucositis, whereas IL-33 blockade with anti-IL-33 antibody or soluble ST2 markedly attenuated the disease. CPT-11 treatment increased neutrophil accumulation in the SI and adhesion to mesenteric veins. Supernatants from SI explants treated with CPT-11 enhanced transmigration of neutrophils in vitro in an IL-33-, CXCL1/2-, and CXCR2-dependent manner. Importantly, IL-33 blockade reduced mucositis and enabled prolonged CPT-11 treatment of ectopic CT26 colon carcinoma, leading to a beneficial outcome of the chemotherapy. These results suggest that inhibition of the IL-33/ST2 pathway may represent a novel approach to limit mucositis and thus improve the effectiveness of chemotherapy.
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24
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Local and systemic pathogenesis and consequences of regimen-induced inflammatory responses in patients with head and neck cancer receiving chemoradiation. Mediators Inflamm 2014; 2014:518261. [PMID: 24757285 PMCID: PMC3976778 DOI: 10.1155/2014/518261] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/27/2014] [Indexed: 02/06/2023] Open
Abstract
Treatment-related toxicities are common among patients with head and neck cancer, leading to poor clinical outcomes, reduced quality of life, and increased use of healthcare resources. Over the last decade, much has been learned about the pathogenesis of cancer regimen-related toxicities. Historically, toxicities were separated into those associated with tissue injury and those with behavioural or systemic changes. However, it is now clear that tissue-specific damage such as mucositis, dermatitis, or fibrosis is no longer the sole consequence of direct clonogenic cell death, and a relationship between toxicities that results in their presentation as symptom clusters has been documented and attributed to a common underlying pathobiology. In addition, the finding that patients commonly develop toxicities representing tissue injury outside radiation fields and side effects such as fatigue or cognitive dysfunction suggests the generation of systemic as well as local mediators. As a consequence, it might be appropriate to consider toxicity syndromes, rather than the traditional approach, in which each side effect was considered as an autonomous entity. In this paper, we propose a biologically based explanation which forms the basis for the diverse constellation of toxicities seen in response to current regimens used to treat cancers of the head and neck.
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25
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Ali N, Adil S, Shaikh M. Bloodstream and central line isolates from hematopoietic stem cell transplant recipients: data from a developing country. Transpl Infect Dis 2014; 16:98-105. [DOI: 10.1111/tid.12176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/04/2013] [Accepted: 06/18/2013] [Indexed: 11/26/2022]
Affiliation(s)
- N. Ali
- Haematology; Department of Pathology and Microbiology; the Aga Khan University; Karachi Pakistan
| | - S.N. Adil
- Haematology; Department of Pathology and Microbiology; the Aga Khan University; Karachi Pakistan
| | - M.U. Shaikh
- Haematology; Department of Pathology and Microbiology; the Aga Khan University; Karachi Pakistan
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26
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Abstract
Healthy individuals possess an immune system comprising physical barriers, innate and acquired immunity as well as the indigenous microflora that populate the body surfaces. The immune system maintains constant vigilance over the body at the cellular level as well as at the interface between the host integument and the resident microflora. However, neoplastic diseases and their treatment often lead to impaired immunity resulting in an increased risk of infections due to viruses, bacteria, fungi, and protozoa. This chapter explores the various aspects of host impairment focusing on the components of immunity and the interplay between them to explain why it is that these patients succumb to infections per se. In so doing, we hope that the reader will be better equipped to understand the risks patients face so as to anticipate potential infectious complications and implement appropriate measures to help attain successful remission of the neoplastic diseases and maintain the best quality of life for the patient.
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Affiliation(s)
- Valentina Stosor
- Div. Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Teresa R. Zembower
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
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27
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Gibson RJ, Bowen JM. Biomarkers of regimen-related mucosal injury. Cancer Treat Rev 2011; 37:487-93. [PMID: 21689887 DOI: 10.1016/j.ctrv.2011.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 05/05/2011] [Accepted: 05/24/2011] [Indexed: 12/29/2022]
Abstract
Regimen-related mucosal toxicity is extremely common following cytotoxic chemotherapy and radiotherapy. The alimentary mucosa is particularly susceptible to injury and dysfunction, leading to a constellation of adverse side effects. Currently there is no "one fit" biomarker of such injury. A number of biomarkers have been investigated in the context of gastrointestinal diseases, which may prove useful in the oncology arena. Two of significant potential include citrulline and calprotectin, however more work is required to define the most appropriate settings for their use. Identification of a biomarker that is easily obtained, measured, and accurately indicates mucosal damage, would allow for improved patient diagnosis of toxicities and prompt appropriate intervention. In this review, we highlight the effectiveness of currently examined biomarkers and discuss future avenues for research in this exciting area.
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Affiliation(s)
- Rachel J Gibson
- School of Medical Sciences, University of Adelaide, North Terrace, South Australia.
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28
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Egerer G, Geist MJP. Posaconazole prophylaxis in patients with acute myelogenous leukaemia--results from an observational study. Mycoses 2011; 54 Suppl 1:7-11. [PMID: 21126266 DOI: 10.1111/j.1439-0507.2010.01979.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with acute myelogenous leukaemia (AML) and neutropenia after chemotherapy are at high risk for life-threatening invasive fungal disease (IFD), in particular, invasive aspergillosis (IA). The aim of the study was to evaluate data on characteristics, risk factors, complications and additional antifungal treatment of patients with AML receiving posaconazole prophylaxis (PP) after chemotherapy in an actual clinical setting. A retrospective single-centre observational study on 40 patients with AML, median age 66 years, was conducted. PP 200 mg three times daily was given routinely. After 76 cycles of remission induction chemotherapy followed by PP, median duration of 31 days (range 6-61 days), no fatal case occurred. The majority of patients had at least one additional risk factor for IFD and during 32 cycles (42.1%), three risk factors were present. During 40 therapy cycles (52.6%), fever of unknown origin occurred. Pneumonia was diagnosed after 23 cycles (30.3%), thereof one case of proven IA (1.3%). PP was interrupted in 25 cycles (32.9%) and was followed by systemic antifungal therapy with different agents, with a median duration 15 days (range: 6-32 days). PP appears to be an effective and well-tolerated protection against IFD for AML patients under natural clinical conditions.
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Affiliation(s)
- G Egerer
- Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany.
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29
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Lüer S, Troller R, Jetter M, Spaniol V, Aebi C. Topical curcumin can inhibit deleterious effects of upper respiratory tract bacteria on human oropharyngeal cells in vitro: potential role for patients with cancer therapy induced mucositis? Support Care Cancer 2010; 19:799-806. [DOI: 10.1007/s00520-010-0894-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 04/23/2010] [Indexed: 11/24/2022]
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30
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Abstract
Mucosal damage is one of the most common adverse effects of radiotherapy and of cytotoxic therapy for cancer. With prevalence between 10% and 100%, depending of the cytotoxic regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. In this paper we address oral mucositis and discuss its pathobiology, risk factors, impact and management in view of the most recent evidence. Despite of clear progress and the development of clinical guidelines, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.
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Affiliation(s)
- Judith E Raber-Durlacher
- Department of Periodontology, Academic Centre of Dentistry, Louwesweg 1, 1066 EA, Amsterdam, The Netherlands.
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31
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Abstract
PURPOSE OF REVIEW To review the links between oral and gastrointestinal health and discuss their implications in clinical management. RECENT FINDINGS There are many instances in which changes that occur within the oral cavity reflect systemic disease elsewhere in the body. Oral manifestations may be the first sign of gastrointestinal disease. This is definitely the case in the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis. However, although the oral manifestations are relatively well recognized, the links between pathobiology at different sites do not appear to be fully investigated in the literature. This is not the case with alimentary tract mucositis, a side effect of cancer treatment. Increasing interest in the pathobiology of mucositis and the links between changes that occur at different sites of the alimentary has changed the way that this common side effect of cancer treatment has been managed. SUMMARY Changes occurring in the oral cavity associated with systemic diseases, including gastrointestinal disease, have been long recognized. Further study into the pathobiology of oral links with inflammatory bowel disease is also recommended so that these diseases are better understood. Importantly, however, the oral manifestations of systemic disease must be highlighted so that, if they are the first manifestations that can be clinically recognized, patients can have appropriate investigations and be managed in a timely fashion. A multidisciplinary management of patients is crucial so that they receive appropriate and comprehensive healthcare.
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