Reactions 1202 - 17 May 2008

SAntineoplastics

Febrile neutropenia associated with malaria: 3 casereports

Three patients with haematological malignancies developedfebrile neutropenia associated with malaria while receivingMOPP/AVB (chlormethine, vincristine, procarbazine,prednisone, doxorubicin, vinblastine and bleomycin) or CHOP(cyclophosphamide, doxorubicin, vincristine and prednisone)regimens [doses and frequencies not stated]; one subsequentlydied.

Patient 1, a 24-year-old man, started receiving MOPP/AVBfor stage III-B Hodgkin’s disease. On day 17 following the firstcycle, he developed febrile neutropenia and receivedceftriaxone, amikacin and filgrastim; his fever and neutropeniaresolved in 24 hours and 4 days, respectively. However, feverrecurred on day 23 and blood tests showed Plasmodium ovale(1% parasitaemia). He received quinine and recoveredcompletely. He completed eight cycles of chemotherapy and,at 5 years’ follow-up, was in remission.

Patient 2, a 49-year-old woman, received CHOP forstage IV-B B-cell non-Hodgkin’s lymphoma; on day 7 after thefirst chemotherapy cycle, she was admitted with febrileneutropenia. Ceftriaxone, amikacin and filgrastim wereinitiated. Blood cultures identified Pseudomonas aeruginosa.She responded to antibacterials but, on day 7, developed fever,severe hypotension and confusion. Analyses showed a plateletcount of 16/nL and a leukocyte count of 0.3/nL, with 13%Plasmodium falciparum parasitaemia (ring forms). Quininewas administered and she fully recovered, completed 8 cyclesof chemotherapy, and was in remission at 30 months’ follow-up.

Patient 3, a 21-year-old woman, received two cycles ofintensified CHOP, with RBC and platelet transfusions, foracute lymphoblastic leukaemia. On day 7 following the secondcycle, she developed febrile neutropenia. Analyses showed ahaemoglobin level of 6.1 g/dL, a platelet count of 20/nL and aleukocyte count of 0.2/nL, with 43.7% P. falciparumparasitaemia (ring forms). Bone marrow examinationidentified active residual leukaemia. Quinine and broad-spectrum antibacterials were initiated, but she failed torespond and her condition rapidly deteriorated with severehypotension and progressive renal failure. She died 36 hourslater.

Author comment: "Malaria is a very uncommonlyreported cause or complicating factor in patients with febrileneutropenia. . . [Conversely,] immune mechanisms may bedepressed following intensive chemotherapy . . . therebypredisposing a flare-up of pre-existing malaria."Rapoport BL, et al. Malaria parasitemia associated with febrile neutropenia inAfrican patients undergoing chemotherapy for haematological malignancies: areport of three patients. Chemotherapy (Basel) 54: 117-119, No. 2, 2008 - SouthAfrica 801110259

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Reactions 17 May 2008 No. 12020114-9954/10/1202-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved