Impact Of Neutropenia Research Articles

Impact of Neutropenia on Clinical Outcomes after Lung Transplantation.

Neutropenia is a frequent complication among solid organ transplant (SOT) recipients receiving immunosuppressive therapy and antimicrobial prophylaxis. However, there are limited studies analysing the frequency and impact of neutropenia in lung transplant recipients (LTRs). Our aim was to analyse the frequency of neutropenia, the need for granulocyte colony-stimulating factor (GCSF) treatment within the first 18 months post-transplant and its association with acute rejection, chronic lung allograft dysfunction (CLAD), overall survival and the development of infections. This observational and retrospective study recruited 305 patients who underwent lung transplantation between 2009 and 2019, with outpatient quarterly follow-up during the first 18 months post-surgery. During this period, 51.8% of patients experienced at least one episode of neutropenia. Neutropenia was classified as mild in 50.57% of cases, moderate in 36.88% and severe in 12.54%. GCSF treatment was indicated in 23.28% of patients, with a mean dose of 3.53 units. No statistically significant association was observed between neutropenia or its severity and the development of acute rejection, CLAD or overall survival. However, the patients who received GCSF treatment had a higher mortality rate compared to those who did not. Sixteen patients (5.25%) developed infections during neutropenia, with bacterial infections being the most common. Neutropenia is common in the first 18 months after lung transplantation and most episodes are mild. We did not find an association between neutropenia and acute rejection, CLAD, or mortality. However, the use of GCSF were associated with worse post-transplant survival.

(1249) Impact of Neutropenia and Granulocyte Colony-Stimulating Factor Treatment in Lung Transplant Recipients

(1249) Impact of Neutropenia and Granulocyte Colony-Stimulating Factor Treatment in Lung Transplant Recipients

Neutropenia Following Heart Transplantation: More Than a Nuisance?

<h3>Purpose</h3> Neutropenia following heart transplant (HT) is prevalent and may be driven by bone marrow suppression due to medications (immunosuppression, viral prophylaxis). The impact of neutropenia on outcomes such as rejection and infection is not fully known. We reviewed the incidence of neutropenia in our HT population and assessed correlation with 1 year outcomes. <h3>Methods</h3> This retrospective cohort study included adult HT recipients from February 2016 to September 2019 at a single center. We excluded multi-organ transplants and patients who died during index hospitalization. Patients were divided into 2 cohorts: neutropenia (absolute neutrophil count [ANC] 1500 cells/mL or less) and non-neutropenia, and followed for 1 year post-transplant for outcomes. <h3>Results</h3> Of 92 patients evaluated, 78 were included. Neutropenia occurred in 51 (65%) patients at a median of 112 (IQR: 83,174.5) days post-transplant. Baseline characteristics (Table 1) were similar between cohorts. Modifications for neutropenia included mycophenolate reduction (33/51, 65%) and discontinuation (10/51, 20%) as well as valganciclovir reduction (11/51, 22%) and discontinuation (23/51, 45%). Granulocyte colony stimulating factor (G-CSF) was used in 7 patients (14%). Results are shown in Table 2. Incidence of treated rejection was numerically but non-statistically higher in the neutropenia cohort, particularly following neutropenia, with a trend toward later occurrence. There was also a non-statistically significant higher incidence of CMV and other infections requiring hospitalization in the neutropenia cohort. Rejection occurred in only 1 patient who received G-CSF. <h3>Conclusion</h3> The results suggest a potential increase in late rejection following neutropenia in HT recipients, which may warrant heightened surveillance for these patients. Neutropenia may also be a risk for CMV and other infections requiring hospitalizations. Standardization of neutropenia management and continued assessment may reveal opportunities to minimize adverse effects.

Impact of neutropenia on clinical manifestations and outcome of Staphylococcus aureus bloodstream infection: a propensity score-based overlap weight analysis in two large, prospectively evaluated cohorts

ObjectivesThis study aimed to investigate whether neutropenia influenced mortality and long-term outcomes of Staphylococcus aureus bloodstream (SAB) infection. MethodsData from two prospective, multicentre cohort studies (INSTINCT and ISAC) conducted at 20 tertiary care hospitals in six countries between 2006 and 2015 were analyzed. Neutropenic and severely neutropenic patients (defined by proxy of total white blood cell count <1000/μl and <500/μl, respectively, at onset of SAB infection) were compared with a control group using a propensity score model and overlapping weights to adjust for baseline characteristics. Overall survival and time to SAB infection-related late complications (SAB infection recurrence, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed with Cox regression and competing risk analyses, respectively. ResultsOf the 3187 included patients, 102 were neutropenic and 70 severely neutropenic at the time of SAB infection onset. Applying overlap weights yielded two groups of 83 neutropenic and 220 nonneutropenic patients, respectively. The baseline characteristics of these groups were exactly balanced. In the Cox regression analysis, we observed no significant difference in survival between the two groups (death during follow up: 36.1% in neutropenic vs. 30.6% in nonneutropenic patients; hazard ratio (HR): 1.21; 95% CI, 0.79–1.83). This finding remained unchanged when we considered severely neutropenic patients (HR: 1.08; 95% CI, 0.60–1.94). A competing risk analysis showed a cause-specific HR of 0.39 (95% CI, 0.11–1.39) for SAB infection-related late complications in neutropenic patients. DiscussionNeutropenia was not associated with a higher survival rate during follow up. The lower rate of SAB infection-related late complications in neutropenic patients should be validated in other cohorts.

Incidental occurrence of neutropenia in children hospitalised for COVID-19

BackgroundInvestigations on haematological alterations in paediatric COVID-19 have been focused mostly on lymphocytes and clotting profiles. Neutropenia has been occasionally reported and its course and impact on the disease have not been elucidated. The aim of this study was to describe the epidemiology, course, and impact of neutropenia in children with COVID-19 hospitalised in a tertiary care referral paediatric ward.MethodsA single-centre retrospective study was conducted. Hospitalised children between 1 month and 18 years with confirmed COVID-19 and neutropenia were included and compared to non neutropenic patients. Complete blood picture with differential blood count, serum biochemistry, clotting profiles were performed; clinical data, length of hospitalisation, and prescription of drugs were collected.ResultsTwelve out of 95 patients (12.63%) with documented SARS-CoV-2 infection were neutropenic and met the inclusion criteria. The mean age was 161 days (range 38—490 days). The mean duration of symptoms in neutropenic children was 3.82 days, while the mean length of hospitalisation was 7.67 days. These findings were not significantly different in the two study groups. All patients had mild clinical manifestations and were discharged without sequelae.ConclusionsWe provided the first comprehensive study on neutropenia in mild paediatric COVID-19 infection. Our findings show that the main features of this haematological disorder in COVID-19 are analogous to the well-known transient benign neutropenia associated with other common viral infections. In our setting, neutropenia does not emerge as a potential negative prognostic factor in paediatric COVID-19.

Clinical impact of neutropenia and febrile neutropenia in mCRC pts treated with FOLFOXIRI/bevacizumab (bev): A pooled analysis of TRIBE and TRIBE2 studies.

11591 Background: FOLFOXIRI/bev is a valid option as first-line therapy for unresectable mCRC. TRIBE and TRIBE2 trials reported better activity and efficacy of the triplet/bev when compared with doublets/bev at the price of a higher incidence of chemo-related toxicities, including neutropenia (N). Here we aim at providing a detailed description of this adverse event, including the occurrence of febrile neutropenia (FN) and the use of granulocyte-colony stimulating factors (G-CSFs), in order to estimate the clinical relevance of N during FOLFOXIRI/bev. Methods: Safety data of 1175 pts enrolled in the TRIBE and TRIBE2 studies were reviewed. The incidence of N, the incidence and severity of FN, and the use of G-CSF in the triplet/bev and in the doublets/bev arms were compared using the Chi-square or the Fisher exact test as appropriate. Results: Out of 1175 pts included in the final analysis, 586 (49.8%) were treated with FOLFOXIRI/bev. Five pts (0.8%) in the doublets/bev arms and 29 (4.9%) in the triplet/bev arms received a primary prophylaxis with G-CSF. Among other pts, 118 (20.2%) in the doublets/bev arms and 276 (49.9%) in the triplet/bev arms experienced ≥ G3 N (p &lt; 0.001). FN occurred in 25 (4.3%) and 41 (7.4%) cases respectively (p=0.041). Out of 78 FN episodes, 4 (13.3%) out of 30 in the doublets/bev arms and 13 out of 48 (27.1%) in the triplet/bev arms were associated with a poor MASCC score (&lt;21) (p=0.17). G-CSF was used in 1069 (10.8%) cycles, 270 (5.3%) in doublets/bev and 799 (16.6%) in triplet/bev arms. In both arms, the majority of N and FN episodes were observed in the first two months (318 ≥ G3 N episodes out of 675 (47.1%), and 54 FN episodes out of 78 (69.2%)). Conclusions: FOLFOXIRI/bev was associated with a higher risk of N and FN than doublets/bev. However, the risk of FN was lower than 10%, thus not requiring a systematic use of primary G-CSF prophylaxis. The majority of FN episodes was associated with a good MASCC score, thus having a limited clinical impact. The vast majority of FN episodes occurred in the first two months of treatment, suggesting a closer monitoring of this adverse event during the first courses of therapy.

Neutropenia Is an Under-Recognized Finding in Pediatric Primary Immunodeficiency Diseases: An Analysis of the United States Immunodeficiency Network Registry

Background: Neutropenia is recognized as a defining or common element in a limited number of primary immunodeficiency diseases (PIDDs) (Dotta L et al. Immunol Let 2014; Cham B et al. Semin Hematol 2002); but, the overall prevalence of neutropenia within the more than 300 known PIDDs is not well described. Many of the PIDDs rely on a high index of clinical suspicion for diagnosis which may not be readily apparent to hematologists evaluating a neutropenic patient, underscoring the importance of understanding the rate of neutropenia in PIDDs and impact on clinical outcomes. The goal of this study was to evaluate the frequency and characteristics of neutropenia in a large registry of patients with primary immunodeficiency (PID).Methods: The United States Immunodeficiency Network (USIDNET) is a research consortium that maintains a national registry for the collection of data on patients with PIDDs. The USIDNET was queried for data regarding patients aged 21 years or less. Data utilized included reported PID diagnosis, gene mutation, gender, race, status of patient (living or deceased), year of birth, age at death, age of disease diagnosis, and results of reported complete blood counts (CBCs). PID diagnoses were grouped according to the 2017 International Union of Immunological Societies (IUIS) Phenotypic Classification for Primary Immunodeficiencies (Bousfiha A et al. J Clin Immunol 2018). Mild, moderate, and severe neutropenia were defined as absolute neutrophil counts of 1000-1499 cells/μL, 500-999 cells/μL, and < 500 cells/μL, respectively. Data are presented with descriptive statistics. The frequency of neutropenia was compared between genders and by race using chi-square test analysis.Results: An initial data request resulted in information on 1577 patients; 384 patients were eliminated from analysis given insufficient recorded registry data due to a lack of a documented absolute neutrophil count. An additional 48 patients were excluded given that complete blood cell counts were only reported following hematopoietic stem cell transplantation. Data was thus available for 1145 pediatric patients with PIDDs. A total of 2058 neutrophil values were analyzed with 62.7% (719) patients having only a single neutrophil value available for review. Overall, 15.8% of PIDD pediatric patients in the USIDNET registry had neutropenia, ranging from 12.01% (combined immunodeficiencies with associated or syndromic features) to 66.67% (defects in intrinsic and innate immunity) in IUIS categories (Table 1) and in USIDNET categories from 2.94% (autoimmune lymphoproliferative syndrome) to 75.00% (susceptibility to mycobacterial infections) (Table 2). Of PID patients with neutropenia, 20.4% had severe neutropenia, 33.1% had moderate neutropenia, and 46.4% had mild neutropenia. Neutropenia was most likely to be severe in patients with predisposition to severe viral infections as well as those with a defect in intrinsic and innate immunity (Tables 1-2). There was no statistically significant difference in neutropenia between genders (p = 0.64). However, females were more likely to have severe neutropenia than males (28% versus 16%; p=0.03). Additionally, 28% of African-American patients had recorded neutropenia while only 17% of Caucasians and 2% of Asian/Pacific Islanders were neutropenic (p=0.005). There was no statistically significant difference in severity of neutropenia and death nor in the rate of bacterial and fungal infections detected between neutropenic and non-neutropenic patients with 93% of patients in the dataset living at the time of data collection.Conclusions: The frequency of neutropenia within pediatric patients diagnosed with PIDD is higher and more ubiquitous than previously suspected. Hematologists should consider a PIDD in the assessment of neutropenia, particularly if other concerning signs or symptoms are present. Although this evaluation did not detect a difference in morbidity or mortality, the data set was constrained by a limited number of CBCs per patient and the rarity of the PIDDs. The impact of neutropenia on PIDD outcomes requires further study, ideally through a prospective longitudinal study.Acknowledgments: The U.S. Immunodeficiency Network (USIDNET), a program of the Immune Deficiency Foundation (IDF), is supported by a cooperative agreement, U24AI86837, from the National Institute of Allergy and Infectious Diseases (NIAID). [Display omitted] DisclosuresDale:Athelas, Inc.: Equity Ownership; Amgen: Consultancy, Research Funding; Sanofi-Aventi: Consultancy, Honoraria; Cellerant: Other: Scientific Advisory Board; Hospira: Consultancy; Prolong: Consultancy; Beheringer-Ingelheim: Consultancy; Coherus: Consultancy.

Impact of Neutropenia on Survival in Lung Transplant Recipients Receiving Mycophenolate for Immunosuppression

Impact of Neutropenia on Survival in Lung Transplant Recipients Receiving Mycophenolate for Immunosuppression

Impact of neutropenia on the outcomes of critically ill patients with cancer: a matched case–control study

BackgroundThe prognostic effect of neutropenia in cancer patients admitted to intensive care units (ICUs) was addressed exclusively in cohort studies with conflicting results. Our aim was to address this question using a matched case–control study. Patients and methodsNinety-four neutropenic patients and 94 non-neutropenic controls were matched for age, cancer type, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment score, and need for mechanical ventilation and vasopressors. Conditional logistic regression was used to identify factors associated with hospital mortality. ResultsThe ICU (66% versus 66%, P=0.999) and hospital (73% versus 78%, P=0.611) mortality rates were similar in neutropenic and non-neutropenic patients. Adjusting for the type of admission and length of hospital stay before ICU admission, the characteristics associated with increased mortality were the severity of acute disease and organ failures, compromised performance status and sepsis diagnosis. The impact of both previous chemotherapy and neutropenia on the outcomes was not significant. ConclusionsUsing a matched case–control study design, our results provide additional evidence that the presence of neutropenia is no longer associated with worse outcomes in critically ill patients with cancer. Moreover, our results also corroborate that recent exposure to chemotherapy is not associated with increased risk for death.

C-reactive protein in critically ill cancer patients with sepsis: influence of neutropenia

IntroductionSeveral biomarkers have been studied in febrile neutropenia. Our aim was to assess C-reactive protein (CRP) concentration in septic critically ill cancer patients and to compare those with and without neutropenia.MethodsA secondary analysis of a matched case-control study conducted at an oncologic medical-surgical intensive care unit (ICU) was performed, segregating patients with severe sepsis/septic shock. The impact of neutropenia on CRP concentrations at admission and during the first week of ICU stay was assessed.ResultsA total of 154 critically ill septic cancer patients, 86 with neutropenia and 68 without, were included in the present study. At ICU admission, the CRP concentration of neutropenic patients was significantly higher than in non-neutropenic patients, 25.9 ± 11.2 mg/dL vs. 19.7 ± 11.4 mg/dL (P = 0.009). Among neutropenic patients, CRP concentrations at ICU admission were not influenced by the severity of neutropenia (< 100/mm3 vs. ≥ 100/mm3 neutrophils), 25.1 ± 11.6 mg/dL vs. 26.9 ± 10.9 mg/dL (P = 0.527). Time dependent analysis of CRP from Day 1 to Day 7 of antibiotic therapy showed an almost parallel decrease in both groups (P = 0.335), though CRP of neutropenic patients was, on average, always higher in comparison to that of non-neutropenic patients.ConclusionsIn septic critically ill cancer patients CRP concentrations are more elevated in those with neutropenia. However, the CRP course seems to be independent from the presence or absence of neutropenia.

Impact of neutropenia on the outcome of decitabine (DAC) treatment in patients (pts) with myelodysplastic syndrome (MDS).

6605 Background: Pts with MDS often present with neutropenia. We investigated the effect of baseline neutropenia on outcome in pts treated with DAC for higher risk MDS. Methods: We reviewed 188 pts...

Impact of neutropenia on chemotherapy administration in elderly patients with advanced non-small cell lung cancer (NSCLC)

9624 Background: Neutropenia is an important toxicity that can lead to chemotherapy dose reductions. The purpose of this study was to quantify the impact of neutropenia on first- and second-line do...

Impact of neutropenia on delivering planned chemotherapy for solid tumours

The ability to deliver the planned dose and intensity of chemotherapy (the amount of drug administered/unit of time) is important for tumour control and survival. In clinical practice, neutropenic events are the main limiting factors towards achieving this aim. We assessed the impact of neutropenic events [defined as either hospital admission due to febrile neutropenia (FN), dose delay > or =7 days due to neutropenia or dose reduction of > or =15% due to neutropenia] on dose intensity (DI) in a random sample of 50 patients with various solid tumours. Fifty patients who received systemic chemotherapy for solid tumours were assessed as part of this study. Using a pre-programmed data collection tool via computer, retrospective data were collected. The neutropenic events were defined before data collection. The patient characteristics are as follows: breast 26 patients (stage I-6; II-3; III-17), colorectal 16 patients (stage I-6; II-3; III-7) and others 8 patients [small cell lung cancer (SCLC), ovarian, peritoneal and oesophageal cancers]. The chemotherapy regimens used are Flourouracil, Epirubicin, cyclophosphamide (FEC) 14 patients (28%); 5 Flourouracil/folinic acid (5FU/FA) 12 patients (24%); Adriamycin, cyclophosphamide (AC) 11 patients (22%); other 13 patients (26%). Neutropenic events occurred in a significant proportion of patients (overall 40%; breast 26%; colorectal 56%; others 25% of patients) and in a significant number (21%) of chemotherapy cycles. Overall, dose delay was the most common neutropenic event, occurring in 30% of patients (breast 32%; colorectal 31%; others 25%% of patients). Dose reduction due to neutropenia was noted in 20% of patients (breast 12% colorectal 38% others 13%% of patients). Hospitalizations due to FN affected 8% of patients. Only two patients had granulocyte colony-stimulating factor (GCSF) as treatment for two cycles. Relative dose intensity (RDI) in patients with neutropenic events was 81% compared with 92% in patients without an event and the results were consistent for different cancers. In total, 65% of patients who experienced one neutropenic event were likely to experience subsequent events. In conclusion neutropenic events have a significant impact on the ability to deliver planned DI. Hence, proactive use of GCSF has the potential to improve adherence to the planned schedule of chemotherapy.

Impact of neutropenia on delivering planned adjuvant chemotherapy: UK audit of primary breast cancer patients.

The UK audit was undertaken in primary breast cancer patients receiving adjuvant chemotherapy to: (1) record the incidence of neutropenic events (hospitalisation due to febrile neutropenia, dose delay of ⩾1 week or dose reduction of ⩾15% due to neutropenia); (2) evaluate the impact of neutropenic events on overall dose intensity (DI) received and (3) review the use of granulocyte colony-stimulating factor (G-CSF) in clinical practice. Data from 422 patients with Stage I–III breast cancer were collected from 15 centres. Cyclophosphamide, methotrexate and 5-fluorouracil(CMF)- or anthracycline-based regimens were the most commonly used. Only 5.2% of patients received G-CSF. Overall, 29% of patients experienced a neutropenic event, most frequently dose delay. Neutropenic events had a significant impact on the ability to deliver planned DI. Out of 422 patients, 17% did not achieve 85% of their planned DI; due to neutropenia in 11% of patients. Of the neutropenic patients receiving CMF- or anthracycline-based regimens, around 40 and 32% of patients, respectively, did not achieve 85% of their planned DI. Patients who experienced one neutropenic event had a higher risk of a second event. During adjuvant chemotherapy of primary breast cancer, neutropenic events are common, likely to occur in subsequent chemotherapy cycles, and have a significant impact on receiving planned DI.

Impact of Neutropenia on Tissue Penetration of Moxifloxacin and Sparfloxacin in Infected Mice

Impact of Neutropenia on Tissue Penetration of Moxifloxacin and Sparfloxacin in Infected Mice