Cytotoxic therapy-induced D-xylose malabsorption and invasive infection during remission-induction therapy for acute myeloid leukemia in adults.

Bow, Eric J.; Loewen, Ruth; Cheang, Mary; Shore, Tsiporah B.; Rubinger, Morel; Schacter, Brent

doi:10.1200/jco.1997.15.6.2254

Cited by 94 publications

(47 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…49 Although it is possible to assess gut mucosal damage by both sugar permeability tests and serum citrulline, these functional tests remain abnormal despite clinical resolution and full anatomic and functional recovery of the affected portions of the intestine. 50 The reason for this is not known.…”

Section: Pathogenesismentioning

confidence: 97%

Mucositis in patients with hematologic malignancies: an overview

Niscola¹,

Romani²,

Cupelli³

et al. 2007

Haematologica

View full text Add to dashboard Cite

Decision Making and Problem SolvingMucosal barrier injury (mucositis) is a common complication of many treatments used in hematologic malignancies, affecting most patients whose neoplasms are treated with intensive chemotherapy, and virtually all those receiving myeloablative conditioning regimens prior to hematopoietic stem cell transplantation. Mucositis has been identified as a critical risk factor for infections and is a major driver of analgesic and total parenteral nutrition use. Patients with this complication require careful analgesic therapy, additional nursing care and longer hospitalization. To date, the measures to prevent and treat this potentially devastating complication are inadequate and limited to the control of pain, infections, bleeding and nutrition. Nevertheless, in the last decade, a better insight into the pathogenesis of the mucosal damage has led to the development of novel therapeutic options which potentially could allow a targeted approach to mucositis.Key words: mucositis, pain, hematologic malignancies, graft-versus-host disease, hematopoietic stem cell transplantation.

show abstract

Section: Pathogenesismentioning

confidence: 97%

Mucositis in patients with hematologic malignancies: an overview

Niscola¹,

Romani²,

Cupelli³

et al. 2007

Haematologica

View full text Add to dashboard Cite

show abstract

“…Malabsorption of D-xylose was also found to be an independent predictor of neutropenic enterocolitis and hepatosplenic candidosis and also correlated well with bacteraemia. 80,81 As yet, there are no objective means of determining gut MBI in use routinely and none has been validated for use in clinical trials to assess gut toxicity although the data available suggest SATs may be useful for helping adapt supportive care regimens for selected patients in order to reduce morbidity and perhaps mortality.…”

Section: Sugar Absorption Testsmentioning

confidence: 99%

Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview

Blijlevens¹,

Donnelly²,

Pauw³

2000

Bone Marrow Transplant

236

153

View full text Add to dashboard Cite

Summary:Mucositis is an inevitable side-effect of the conditioning regimens used for haematopoietic stem cell transplantation. The condition is better referred to as mucosal barrier injury (MBI) since it is primarily the result of toxicity and is a complex and dynamic pathobiological process manifested not only in the mouth but also throughout the entire digestive tract. A model has been proposed for oral MBI and consists of four phases, namely inflammatory, epithelial, ulcerative and healing phases. A variety of factors are involved in causing and modulating MBI including the nature of the conditioning regimen, the elaboration of pro-inflammatory and other cytokines, translocation of the resident microflora and their products, for example, endotoxins across the mucosal barrier, exposure to antimicrobial agents and whether or not the haematopoietic stem cell graft is from a donor. Neutropenic typhlitis is the most severe gastrointestinal manifestation of MBI, but it also influences the occurrence of other major transplant-related complications including acute GVHD, veno-occlusive disease and systemic infections. The pathobiology, clinical counterparts and the means of measuring MBI are discussed together with potential approaches for prevention, amelioration and, perhaps, even cure. Bone Marrow Transplantation (2000) 25, 1269-1278. Keywords: mucositis; mucosal barrier injury; diagnosis; risk factors; treatment Mucositis is an inevitable side-effect of the intensive conditioning therapy used for haematopoietic stem cell transplantation 1 and usually refers to the mucosal ulceration of mouth and throat. However, it is generally accepted that oral mucositis is in reality the most obvious manifestation of damage or injury elsewhere particularly that of the gut. Hence, mucosal barrier injury (MBI) may be a more appropriate term for this biological process. There exists no clear definition of MBI which is defined by a constellation of signs and symptoms that vary in their clinical expression. Oral MBI is reported to affect 60% to 100% of transplant recipients 2,3 and is characterised by pain, oedema, erythema, lesions, pseudomembrane formation, excessive mucous production, reduced saliva and bleeding, all of which reduce the patient's ability to eat and drink. In contrast, there are no reliable data on the incidence of gut MBI although intestinal symptoms affect almost every transplant recipient to some extent and include nausea, vomiting, abdominal cramping and watery diarrhoea occasionally accompanied by macroscopic blood loss. The exact course and severity of bowel symptoms of MBI are also difficult to ascertain because many patients are in such pain due to oral MBI that they only gain relief from narcotic analgesia which induces constipation as a result of reduced gut motility. There are also a number of scoring systems for oral MBI 4 although none is universally accepted and all lack standardisation. As yet, there is no system for registering gut MBI although there are published definitions for grading toxicity o...

show abstract

“…18 Further, SAS software (SAS Institute, Cary, NC, USA) Corr procedure was used for estimating the Spearman correlations. The minimum D-xylose serum levels and maximum lactulose:mannitol ratios and highest grades of non-haematological toxicities observed at baseline and during weeks 1-4 were used for the analysis.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Small bowel absorption of D-xylose was estimated from a sample of serum collected at a time 1 h after the oral solution was administered for serum D-xylose determinations as described previously. 18 A 1 h serum concentration of p0.6 mmol/l was considered abnormal. Gut-related non-haematological toxicities including nausea, vomiting, diarrhoea, abdominal pain and stomatitis were graded daily using the National Cancer Institute Common Toxicity Criteria.…”

Section: Intestinal Barrier Functionmentioning

confidence: 99%

“…1 More recently, functional measures of the integrity of the intestinal epithelial barrier using orally administered saccharide or radio-labelled probes have been applied to the study of gastrointestinal mucositis among haematopoietic stem cell transplant recipients 5,7,[14][15][16][17] and in acute myeloid leukaemia. [18][19][20][21] Intestinal permeability may be reflected by an elevated ratio of the concentration of lactulose to mannitol or rhamnose in fractional urinary excretion studies, 21,22 carrier-mediated transcellular absorption by the serum level of a five-carbon sugar, D-xylose, 18 and enterocyte mass by serum citrulline levels. 17,22 There is limited experience using these functional assays as outcome measures for strategies to ameliorate cytotoxic therapyinduced intestinal damage.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intestinal mucosal dysfunction and infection during remission-induction therapy for acute myeloid leukaemia

Bow

Meddings

2006

Leukemia

Self Cite

View full text Add to dashboard Cite

Intestinal barrier function was prospectively examined in the course of a clinical trial evaluating the efficacy and safety of lisofylline for reducing cytotoxic therapy-induced intestinal epithelial damage-related infectious morbidity in patients receiving standard remission-induction therapy for acute myeloid leukaemia. The absorption and permeation of oral D-Xylose, lactulose and mannitol were measured weekly from baseline until marrow recovery in adult recipients of idarubicin plus cytarabine for untreated acute myeloid leukaemia. These studies were correlated with non-haematologic chemotherapyrelated toxicities reflecting mucosal damage, including nausea, vomiting, stomatitis, diarrhoea, abdominal pain and systemic infection. D-xylose absorption decreased and lactulose:mannitol ratio reflecting intestinal permeability increased from baseline until the second and third week after the beginning of the treatment followed by recovery. These measures correlated with infection rates, nausea, vomiting, diarrhoea and increased blood product utilization. Lisofylline was associated with increased intestinal permeability, nausea, vomiting and infection-related morbidity despite a reduction in the duration of neutropaenia. These surrogates of intestinal barrier function correlated well with clinically important outcomes despite the failure to demonstrate reduced morbidity with lisofylline and represent useful objective outcome measurements for future clinical trials of products for the amelioration of the effects of cytotoxic therapy on the intestinal mucosa.

show abstract

Cytotoxic therapy-induced D-xylose malabsorption and invasive infection during remission-induction therapy for acute myeloid leukemia in adults.

Cited by 94 publications

References 32 publications

Mucositis in patients with hematologic malignancies: an overview

Mucositis in patients with hematologic malignancies: an overview

Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview

Intestinal mucosal dysfunction and infection during remission-induction therapy for acute myeloid leukaemia

Contact Info

Product

Resources

About