Suppressed neutrophil function as a risk factor for severe infection after cytotoxic chemotherapy in patients with acute nonlymphocytic leukemia

Abstract

Severe infections are a major problem in patients suffering from acute nonlymphocytic leukemia (ANLL) undergoing myeloablative chemotherapy. Possible factors leading to infectious complications in these patients are suppressed immune defense mechanisms existing prior to therapy, including those involving the neutrophil granulocyte department. In this study we investigated whether neutrophil function as measured by oxidative burst and phagocytosis before the start of treatment correlates with the severity of infection after therapy. Forty-four patients were included, 27 men and 17 women. Their median age was 46 years (range 20-70 years). According to the development of infectious complications the patients were assigned retrospectively to group 1 (no or only mild infections, n = 29) or to group 2 (severe infection or death due to infection, n = 15). The phagocytic activity was significantly reduced in group 2 as compared with group 1 [113.7+/-13.7 (SEM) vs 170.0+/-19.2, mean channel fluorescence; p =0.04]. In contrast, the oxidative burst as measured by FMLP stimulation was pronounced but not significantly enhanced in group 2 (24.8+/-6.1 vs 14.5+/-3.4, mean channel fluorescence). In conclusion, patients with severe infections after chemotherapy might already have preactivated neutrophils with suppressed function prior to treatment. Thus, evaluating function parameters could help to estimate the individual risk of infection for a patient with ANLL.

The role of neutropenia on outcomes of cancer patients with community-acquired pneumonia

“…Secondly, the functional capabilities of phagocytes such as neutrophils, eosinophils and mononuclear cells may be intrinsically defective even before the initiation of chemotherapy. A study performed by HÜ BEL et al [11] showed cancer patients having preactivated phagocytes with suppressed function prior to initiation of treatment. Thirdly, humoral and cellular immune mechanisms mediated by B and T lymphocytes, respectively, can be profoundly altered in patients with solid cancer.…”

Pilot Study: Effects of Parenteral Glutamine Dipeptide Supplementation on Neutrophil Functions and Prevention of Chemotherapy-Induced Side-Effects in Acute Myeloid Leukaemia Patients

“…3 Suppressed neutrophil function, which has been found in patients with acute non-lymphocytic leukaemia, is believed to be related to infection after cytotoxic chemotherapy. 4,5 However, Ziegler et al 6 reported a lower incidence of infection complications in bone marrow transplant recipients receiving supplemental glutamine.…”

Evidence for bistable bacteria-neutrophil interaction and its clinical implications

“…Finally, we propose that by repeating the above-described 5-step protocol at several time points after chemotherapy (see ref. 30), separately fitting at step (e) the parameters at each time point, one may examine whether a significant change in neutrophil function has occurred.…”