ACUTE APPENDICITIS IN LEUKEMIA PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION DURING THE NEUTROPENIC PHASE
(Abstract release date: 05/18/17)
EHA Library. Zhang Q. 05/18/17; 182611; PB1897
Qiuxia Zhang
Contributions
Contributions
Abstract
Abstract: PB1897
Type: Publication Only
Background
Infectious complications arising from the gastrointestinal tract is common in neutropenic patients with hematologic malignances, especially during HSCT.
Aims
Sequential analysis of 776 HSCTs in single center, totally 10 cases of acute appendicitis were found out, the treatment and outcome were further analyzed.
Methods
The HSCT patients who occurred acute appendicitis during -10d~+60d in the Hematological Department of Nanfang Hospital from Jan. 2005 to July 2016 were analyzed. Patients were enrolled in our study based on the Modified Alvarado Scoring combined with ultrasonography (the MASS total score of 1-4: acute appendicitis very unlikely; Score 5-7: acute appendicitis probable; Score 8-10: acute appendicitis definite. We selected those cases with scores 5-10). And the follow-up lasted for 24 m.
Results
776 HSCT patients were analyzed, in which 10 patients (7 male, 3 female) had acute appendicitis during -1d~+7d, which included two cases of sepsis. The median age was 18.5 (10-39) years of age. 7 patients were ALL and the other 3 were CML. All patients underwent allo-HSCT. 6 patients received conditioning regimen of IDA/TBI/CY/VP-16, and 4 others were treated with TBI/CY/VP-16/Ara-c, FA/TBI/CY/VP-16, Bu/Cy and Bu/Cy/Ara-c respectively. All the cases scored range from 5 to 10 of the MASS, and 6 patients showed positive findings on ultrasonography. All the patients had a mean value of neutrophil of 0.06×109/L (Table 1). 10/10 cases were cured with conservative therapy, mainly contained different kinds of full dose broad-spectrum antibiotics, such as piperacillin/ tazobactam, imipenem cilastatin, teicoplanin, meropenem, tigecycline, et al.. Within 24 m, 8 patients did not relapse, one patient died from gastrointestinal bleeding 2 m after without recurrence of appendicitis, while one patient relapsed 1 year later and was cured by appendectomy.
Table 1. Combined with the Modified Alvarado Scoring and ultrasonography to diagnose appendicitis during the neutropenic phase of HSCT.
Symptoms* | Signs* | Total | Examination | Blood Routine Test | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Case | Migratory right ilia fossa pain | Anorexia | Nausea /vomit | Tenderness in right iliac fossa | Rebound tenderness | Elevated temperature | Score* | Ultrasound# | WBC(×109/L) | NEU(×109/L) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Case1 | 1 | 1 | 1 | 2 | 1 | 1 | 7 | - | 0.09 | 0.03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Case2 | 1 | 1 | 1 | 2 | 1 | 1 | 7 | + | 0.06 | 0.06 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Case3 | 1 | 1 | 1 | 2 | 1 | 1 | 7 | - | 0.06 | 0.06 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Case4 | 0 | 1 | 0 | 2 | 1 | 1 | Acute appendicitis occurring during the neutropenic phase in HSCT patients could be diagnosed by the MASS and ultrasonography, and such cases could be cured by conservative therapy. This study could provide a further choice for the diagnosis and treatment of acute appendicitis in leukemia patients of HSCT. Session topic: 29. Infectious diseases, supportive care Keyword(s): Infection, Hematopoietic cell transplantation, Therapy, neutropenia Abstract: PB1897 Type: Publication Only Background Infectious complications arising from the gastrointestinal tract is common in neutropenic patients with hematologic malignances, especially during HSCT. Aims Sequential analysis of 776 HSCTs in single center, totally 10 cases of acute appendicitis were found out, the treatment and outcome were further analyzed. Methods The HSCT patients who occurred acute appendicitis during -10d~+60d in the Hematological Department of Nanfang Hospital from Jan. 2005 to July 2016 were analyzed. Patients were enrolled in our study based on the Modified Alvarado Scoring combined with ultrasonography (the MASS total score of 1-4: acute appendicitis very unlikely; Score 5-7: acute appendicitis probable; Score 8-10: acute appendicitis definite. We selected those cases with scores 5-10). And the follow-up lasted for 24 m. Results 776 HSCT patients were analyzed, in which 10 patients (7 male, 3 female) had acute appendicitis during -1d~+7d, which included two cases of sepsis. The median age was 18.5 (10-39) years of age. 7 patients were ALL and the other 3 were CML. All patients underwent allo-HSCT. 6 patients received conditioning regimen of IDA/TBI/CY/VP-16, and 4 others were treated with TBI/CY/VP-16/Ara-c, FA/TBI/CY/VP-16, Bu/Cy and Bu/Cy/Ara-c respectively. All the cases scored range from 5 to 10 of the MASS, and 6 patients showed positive findings on ultrasonography. All the patients had a mean value of neutrophil of 0.06×109/L (Table 1). 10/10 cases were cured with conservative therapy, mainly contained different kinds of full dose broad-spectrum antibiotics, such as piperacillin/ tazobactam, imipenem cilastatin, teicoplanin, meropenem, tigecycline, et al.. Within 24 m, 8 patients did not relapse, one patient died from gastrointestinal bleeding 2 m after without recurrence of appendicitis, while one patient relapsed 1 year later and was cured by appendectomy. Table 1. Combined with the Modified Alvarado Scoring and ultrasonography to diagnose appendicitis during the neutropenic phase of HSCT.
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