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. 2023 Nov 1:13:1272072.
doi: 10.3389/fonc.2023.1272072. eCollection 2023.

Impact of different chemotherapy regimens on intestinal mucosal injury assessed with bedside ultrasound: a study in 213 AML patients

Edoardo Benedetti  1 , Ginevra Traverso  1 , Giulia Pucci  1 , Riccardo Morganti  2 , Emilia Bramanti  3 , Piero Lippolis  4 , Maria Chiara Susini  1 , Elisa Mazzantini  1 , Rachele Giubbolini  5 , Fabrizio Mavilia  1 , Enrico Capochiani  5 , Emanuele Neri  6 , Chiara Arena  6 , Francesca Cerri  6 , Luigi De Simone  7 , Katia Valentini  7 , Salvatore Massimo Stella  8 , Vittorio Ricchiuto  9 , Benedetto Bruno  10 , Sara Galimberti  11
Affiliations

Impact of different chemotherapy regimens on intestinal mucosal injury assessed with bedside ultrasound: a study in 213 AML patients

Edoardo Benedetti et al. Front Oncol. .

Abstract

Introduction: Neutropenic enterocolitis (NEC) is a life-threatening complication reported in patients with acute myeloid leukemia (AML) following chemotherapy (CHT). Intensive induction and consolidation CHT may damage intestinal mucosa leading to a NEC episode (NECe). NEC reported mortality may be up to 30-60%. Early US-guided bed-side diagnosis and prompt treatment may substantially improve the survival. An emerging worldwide concern is the intestinal colonization by multi-drug-resistant bacteria especially when patients are exposed to chemotherapy regimens potentially correlated to mucosal damage.

Methods: In our study we prospectively enrolled all AML patients admitted in our leukemia unit to receive intensive induction and consolidation chemotherapy and experiencing chemotherapy-induced-neutropenia (CHTN).

Results and discussion: Overall, we enrolled N=213 patients from 2007 to March 2023. We recorded N=465 CHTN, and N=42 NECe (9.0% incidence). The aim of our study was to assess which chemotherapy regimens are more associated with NEC. We found that ALM1310, followed by 7 + 3 (daunorubicin), 7 + 3 (idarubicin), 5 + 3 + 3 (cytarabine, etoposide, idarubicin), and AML1310 (consolidation) were associated with a statistically higher incidence of NEC. We did not detect NEC episodes in patients treated with CPX-351, 5 + 2 (cytarabine, idarubicine), and high-dose cytarabine. Thus, we found that cytarabine could determine mucosal damage when associated with an anthracycline but not if delivered either alone or as dual-drug liposomal encapsulation of daunorubicin/cytarabine. We also describe NEC mortality, symptoms at diagnosis, intestinal sites involvement, and prognostic significance of bowel wall thickening.

Keywords: NEC; acute myeloblastic leukemia; chemotherapy; neutropenic enterocolitis; ultrasound sonography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Outcome of patients correlated with BWT < 10 mm or ≥ 10 mm. There was a statistically significant difference in mortality rate between the two groups of patients (p=0.001, with OR=42).
Figure 2
Figure 2
(A) Descending colon with BWT. White arrow indicates the lumen; white arrowheads indicate preserved haustra. (B) NEC involving the descending colon: BWT 10.1 mm (white arrowhead). Haustra are poorly recognizable. The whole colon measures 29.6 mm. The 5 layers are indicated by white arrows (1 = serosa, 2= muscolaris mucosa, 3=submucosa, 4=mucosa, 5= mucosa-lumen interface).
Figure 3
Figure 3
Chemotherapy-related diarrhea. Two ileum loops with bowel wall measuring 3.0 mm (white arrow); white arrowhead 1 indicates the lumen liquid-filled; white arrowhead 2 indicates valvulae conniventes.
See this image and copyright information in PMC

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