Neutropenic enterocolitis: clinical diagnosis and treatment

Article Abstract:

As greater numbers of cancer and leukemia patients survive for longer periods, it is becoming more common to see various complications of chemotherapy. Among the most serious of complications is neutropenic enterocolitis. Under normal circumstances, the gut is filled with bacteria which perform an important role in the digestive process. These bacteria are prevented from entering the body by the barrier of the healthy cells lining the intestines and by immune system cells which quickly eat any invading microbes. These normal protective barriers are disrupted in neutropenic enterocolitis. The details of the development of this condition remain poorly understood. Chemotherapy can destroy healthy intestinal cells as well as cancerous cells. It is thought that if the destruction of cells lining the intestine is complicated by neutropenia, a reduction in the protective bacteria-ingesting neutrophil cells, then bacteria from the gut may gain a stronghold in the wall of the intestines perhaps progressing to necrosis (tissue death) and perforation of the intestines. The authors report the cases of 22 patients who received a diagnosis of neutropenic enterocolitis on the basis of their clinical symptoms. A total of 63 percent of these patients died. Some clinicians believe that the best treatment may be the surgical removal of the affected portion of the bowel; this opinion remains quite controversial, however. In the present series of patients, 50 percent of the patients who underwent surgery survived, in contrast to 39 percent of those who did not. While this might appear to support the notion of surgery as the superior treatment, the authors caution that neutropenic enterocolitis is a very heterogeneous condition. In nine cases of patients who were not treated surgically and were later examined at autopsy, four were found to have normal gastrointestinal tracts (indicating the original diagnosis was wrong) and none were found to have perforations or necrosis which spanned the wall of the intestines. it is unlikely that the outcome of these cases would have been any different if surgery had been used in their treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Neutropenia, Enterocolitis

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High-dose cisplatin plus dacarbazine in the treatment of metastatic melanoma

Article Abstract:

Melanoma is a highly malignant cancer that is not only common, but is increasing in incidence. This year, it is likely that 27,000 Americans will be diagnosed with melanoma, and that 6,300 of these patients will die of metastatic disease. While melanoma may be successfully treated in its early stages, once the disease has spread the prospects for successful treatment are bleak. Dacarbazine is commonly used in the treatment of melanoma, and, when used alone, the response rate achieved in advanced disease is about 20 percent. Cisplatin alone has been shown to achieve a response rate of about 15 percent, although there is some indication that the dose-response curve for this drug is very steep, suggesting that better response rates might be achieved if it were possible to administer potentially toxic doses. Some studies have indicated that dacarbazine and cisplatin together may be more effective than either drug individually. The authors conducted a Phase II study to help optimize the combination of the two drugs in the treatment of advanced melanoma. A total of 22 patients were treated. The original protocol required modification due to excessive toxicity. Three complete responses and four incomplete responses were achieved for a total response rate of 32 percent. The median duration of the responses was only six months, but for two patients the responses have persisted for over 1.5 years. These results indicate that the combined cisplatin-dacarbazine treatment is a well tolerated and effective chemotherapeutic regimen for metastatic melanoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Melanoma, Chemotherapy, Combination, Combination chemotherapy, Dacarbazine

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Cisplatin-associated hemolytic-uremic syndrome: successful treatment with a staphylococcal protein A column

Article Abstract:

Microangiopathic hemolytic anemia (MHA), a type of anemia in which red blood cells are destroyed, is associated with cancer of the stomach, lung, or breast. However, MHA is also a symptom of hemolytic-uremic syndrome (HUS), a very serious disease in which kidney dysfunction as well as hemolytic anemia and other organ dysfunction occurs. HUS has occurred in cancer patients treated with chemotherapeutic agents such as cisplatin, mitomycin-C, and others, but its diagnosis is sometimes difficult due to the known occurrence of MHA in these patients and to the variety of symptoms that can occur. Two case histories of HUS associated with cancer of the head and neck are described. One of the patients was successfully treated with a bacterial-derived protein which probably removed an immune system-associated protein from the circulation. The report cautions that HUS should be strongly considered when kidney failure occurs during cancer chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Causes of, Hemolytic-uremic syndrome, Head and neck cancer

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