Neutropenic enterocolitis incidence and survival after autologous stem cell transplantation

Introduction: Neutropenic enterocolitis (NE) is a clinical syndrome characterized by fever and abdominal pain in patients who received chemotherapy for hematological malignancies and who treated with stem cell transplantation (SCT). The aim of this study was to determine the incidence, risk factors and outcome of NE after autologous SCT (auto-SCT). Materials and methods: We retrospectively evaluated 290 patients with Non-Hodgkin Lymphoma (NHL), Hodgkin lymphoma (HL) and multiple myeloma (MM) who underwent auto-SCT between January 2013 and December 2017 in our center. Patients with lymphoma were conditioned with carmustine, etoposide, cytarabine, melphalan (BEAM) or thiotepa, etoposide, cytarabine, cyclophosphamide, melphalan (TECAM). Patients with multiple myeloma were treated with melphalan as conditioning. Diagnosis of NE was established in case of neutropenic fever, abdominal pain and bowel wall thickening >4 mm on abdominal ultrasonography. Results: Febrile neutropenia was seen in 258 (88,96%) patients of all. NE occurred in 27 (9.31%) in all neutropenic patients. The median time to NE after auto-SCT was 7 days (range; 2- 10 days). The median neutrophil engraftment time was 12 days (range; 9-18 days). Twenty five patients (92,5%) had diarrhea. Ileus was seen in 5 (17,2%) patient and septic shock was developed in 2 (7,4%) patients. Six (22.2%) of 27 patients had bloodstream infection. Diagnosis was made by abdominal ultrasonography and computed tomography at a day of median 7 days (range; 2- 9). Twenty five (92%) patients were resolved completely with good supportive care and proper antibiotherapy. Two (7,4%) patients died of septic shock and ileus. Discussion: NE is a rare but serious complication in patients underwent high dose chemotherapy followed by auto-SCT. Gram-negative bacteria are the main causative pathogens. Computed tomography is becoming increasingly important in diagnosis, follow-up and prognosis. Key Words: Neutropenic enterocolitis, autologous transplantation