Antineoplastics
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Reactions 1210 - 12 Jul 2008 S Antineoplastics Febrile neutropenia leading to appendicitis in paediatric patients: 5 case reports Five paediatric patients treated with antineoplastic therapy for leukaemia or lymphoma experienced febrile neutropenia resulting in appendicitis. Following cytarabine-based antineoplastic therapy [see table], the patients’ absolute neutrophil counts decreased to ≤ 0.3 × 10 9 cells/L [time to reaction onset not stated]. All patients were treated with meropenem. One to 2 days after patients 1–4 presented with lower right abdominal pain and guarding (and 4–7 days after developing aplasia), ultrasonography confirmed diagnoses of appendicitis. Patient 5 was diagnosed with appendicitis 23 days after developing aplasia. All patients had a fever and an elevated C- reactive protein level, and they all required erythrocyte and platelet transfusions. The patients all received analgesia and an extension of their antibacterial therapy. The duration of aplasia ranged from 6 to 48 days. All patients experienced clinical resolution of their appendicitis with normal ultrasound findings in a median of 14 days, although recovery in patient 3 was complicated by perforation. Patient 2 subsequently underwent preventive appendectomy prior to allogeneic bone-marrow transplantation. Patients 1, 3 and 4 developed febrile neutropenia and transient lower quadrant abdominal pain during their next cycle of chemotherapy. Conservative management with meropenem resulted in rapid symptom resolution in all three patients. Patient characteristics and chemotherapy regimen Patient/ Chemotherapy regimen Therapeutic sex/age indication (years) 1/F/12 Cytarabine 1 g/m 2 × 3d a ; High-risk acute Mitoxantrone 10 mg/m 2 /d × 2d myeloid leukaemia 2/M/14 Cytarabine 2 g/m 2 /d × 5d; Relapsed acute Fludarabine 30 mg/m 2 /d × 5d; lymphoblastic Daunorubicin liposomal leukaemia [DaunoXome] 60 mg/m 2 /d × 3d 3/F/11 Cytarabine 150 mg/m 2 /d × 2d; Grade 3 B-cell Dexamethasone 10 mg/m 2 /d non-Hodgkin’s × 5d; lymphoma Etoposide 100 mg/m 2 /d × 2d; Methotrexate 5 g/m 2 × 1d; Ifosfamide 800 mg/m 2 /d × 5d 4/M/12 Cytarabine 100 mg/m 2 /d × 8d; High-risk acute Daunorubicin 80 mg/m 2 /d × 3d; myeloid Etoposide 150 mg/m 2 /d × 3d leukaemia 5/M1 Cytarabine 3 g/m 2 × 3d a ; High-risk acute Mitoxantrone 10 mg/m 2 /d × 2d myeloid leukaemia a frequency of administration not stated Wiegering VA, et al. Conservative management of acute appendicitis in children with hematologic malignancies during chemotherapy-induced neutropenia. Journal of Pediatric Hematology/Oncology 30: 464-467, No. 6, Jun 2008 - Switzerland 801117075 » Editorial comment: This report also identified two cases of severe enterocolitis with neutropenia [case details not included] among the 113 patients with haematological malignancies from which the five cases of appendicitis were identified. 1 Reactions 12 Jul 2008 No. 1210 0114-9954/10/1210-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1210 - 12 Jul 2008
SAntineoplastics
Febrile neutropenia leading to appendicitis inpaediatric patients: 5 case reports
Five paediatric patients treated with antineoplastic therapyfor leukaemia or lymphoma experienced febrile neutropeniaresulting in appendicitis.
Following cytarabine-based antineoplastic therapy[see table], the patients’ absolute neutrophil counts decreasedto ≤ 0.3 × 109 cells/L [time to reaction onset not stated]. Allpatients were treated with meropenem. One to 2 days afterpatients 1–4 presented with lower right abdominal pain andguarding (and 4–7 days after developing aplasia),ultrasonography confirmed diagnoses of appendicitis.Patient 5 was diagnosed with appendicitis 23 days afterdeveloping aplasia. All patients had a fever and an elevated C-reactive protein level, and they all required erythrocyte andplatelet transfusions.
The patients all received analgesia and an extension of theirantibacterial therapy. The duration of aplasia ranged from 6 to48 days. All patients experienced clinical resolution of theirappendicitis with normal ultrasound findings in a median of14 days, although recovery in patient 3 was complicated byperforation. Patient 2 subsequently underwent preventiveappendectomy prior to allogeneic bone-marrowtransplantation.
Patients 1, 3 and 4 developed febrile neutropenia andtransient lower quadrant abdominal pain during their nextcycle of chemotherapy. Conservative management withmeropenem resulted in rapid symptom resolution in all threepatients.
Patient characteristics and chemotherapy regimenPatient/ Chemotherapy regimen Therapeuticsex/age indication(years)
1/F/12 Cytarabine 1 g/m2 × 3da; High-risk acute Mitoxantrone 10 mg/m2/d × 2d myeloid
leukaemia2/M/14 Cytarabine 2 g/m2/d × 5d; Relapsed acute
Fludarabine 30 mg/m2/d × 5d; lymphoblastic Daunorubicin liposomal leukaemia
[DaunoXome] 60 mg/m2/d × 3d3/F/11 Cytarabine 150 mg/m2/d × 2d; Grade 3 B-cell
Dexamethasone 10 mg/m2/d non-Hodgkin’s× 5d; lymphoma
Etoposide 100 mg/m2/d × 2d; Methotrexate 5 g/m2 × 1d;
Ifosfamide 800 mg/m2/d × 5d4/M/12 Cytarabine 100 mg/m2/d × 8d; High-risk acute
Daunorubicin 80 mg/m2/d × 3d; myeloid Etoposide 150 mg/m2/d × 3d leukaemia
5/M1 Cytarabine 3 g/m2 × 3da; High-risk acute Mitoxantrone 10 mg/m2/d × 2d myeloid
leukaemiaa frequency of administration not stated
Wiegering VA, et al. Conservative management of acute appendicitis in childrenwith hematologic malignancies during chemotherapy-induced neutropenia. Journalof Pediatric Hematology/Oncology 30: 464-467, No. 6, Jun 2008 -Switzerland 801117075
» Editorial comment: This report also identified two cases ofsevere enterocolitis with neutropenia [case details not included]among the 113 patients with haematological malignancies fromwhich the five cases of appendicitis were identified.
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Reactions 12 Jul 2008 No. 12100114-9954/10/1210-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
