Frequency of neutropenic enterocolitis in acute leukemia patients and evaluation of its impact on disease prognosis

Koksoy B., Frequency of Neutropenic Enterocolitis in Acute Leukemia Patients and Evaluation of Its Impact on Disease Prognosis, Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, 2024. Neutropenic enterocolitis (NEC) is defined as a disease that develops secondary to neutropenia after cytotoxic chemotherapy, mainly in cancer patients. In patients with a neutrophil count <500 cells/mm3, the diagnosis is made in the presence of radiological findings accompanied by abdominal pain and diarrhea. The aim of our study is to investigate the frequency of NEC, its clinical characteristics and its effect on survival in acute leukemia patients. For this purpose, adult patients who were followed up with a diagnosis of acute leukemia in our center between January 2005 and December 2022 were included in the study. In addition to the demographic, clinical and laboratory characteristics of the patients, the treatments applied and survival results were examined retrospectively. The mean age at diagnosis of 511 patients included in the study [288 (56.4%) males and 223 (43.6%) females] was 49±17.6 years. During a median follow-up period of 13 (0.1-120) months, the incidence of NEC was found to be 15.1% (n = 77). There was no significant relationship between the development of NEC and mean age at diagnosis, gender, presence of comorbid disease, or type of acute leukemia. On the other hand, NEC was associated with increased rates of oral mucositis (p=0.046), diarrhea (p<0.001), sepsis (p=0.003) and intensive care unit admission (p=0.030). The intestinal segment most commonly affected by NEC was the cecum (50.6%), and the median NEC episode duration was 8 (2-65) days. NEC occurred during the induction treatment process in 79.2% of the patients, and developed secondary to idarubicin–cytarabine (3+7) in 33.8% of the patients. The development of NEC in AML patients was not associated with overall [18 months (95% CI: 6.9-29.1) vs. 24 months (95% CI: 6.3-41.6), p=0.801] and disease-free survival [39.2 months (95% CI: 24.4-48.9) vs. 19.7 months (95% CI: 7.8-35.0), p=0.113]. In contrast, the development of NEC in ALL patients was associated with lower overall [54 months (95% CI: 50.0-62.3) vs. 37 months (95% CI: 5.5-68.5), p=0.044] and disease-free survival [32 months (95% CI: 28.2-39.4) vs. 15.4 months (95% CI: 0.1-30.9), p=0.047] rates. When the last chemotherapies received before the development of NEC in AML patients were analyzed, it was observed that none of the patients received a combination of BCL2 inhibitor and Hypomethylating agent (HMA). In conclusion, our study reveals that induction therapy is the most risky part of acute myeloid leukemia treatment in terms of NEC. To reduce the risk of NEC in these patients, a combination of BCL2 inhibitors and HMA may be preferred instead of 3+7 chemotherapy. In acute lymphoblastic leukemia patients, there was no difference between chemotherapy regimens in terms of NEC.