1099. Neutropenic Enterocolitis Complicating Taxane-Based Chemotherapy in Cancer Patients
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

Neutropenic enterocolitis (NEC) has been usually associated with patients with hematologic malignancy treated with agents such as idarubicin. However, recently NEC has increasingly been recognized in solid tumor patients receiving taxane-based chemotherapy.

Methods: 

Retrospective study of clinical, epidemiological, microbiological features of NEC in patients who received taxane-based chemotherapy at a comprehensive cancer center. Reviewing billing codes, we identified patients with colitis during a predetermined 14-month study period (01/01/2009 to 03/31/2010), which were matched with pharmacy data regarding taxane therapy. Inclusion criteria: (1) cancer patients with diarrhea who received taxanes; (2) neutropenia; and (3) radiological evidence of colitis. Patients <18 years were excluded.

Results: 

Over 14 month period, we reviewed 591 patients who received taxane-based chemotherapy, only 7 cases of NEC (1.19%) were identified. 4 patients were male. Median age was 43.5 (range, 11-60) y.o. 3 had breast cancer, 2 non-small cell lung cancer, 1 nasopharyngeal cancer, and 1 metastatic rhabdoid brain cancer. 2 received paclitaxel and 5 received docetaxel-based chemotherapy. 4 received concurrent anthracyline treatment (doxorubicin: 3; epirubicin: 1). Median ANC at time of diagnosis was 0.15 (0-0.48) K/UL. Median time to diagnosis after taxane exposure was 6 (3-10) days. Diagnosis based on neutropenic status, imaging, and clinical presentation. All were tested for enteric pathogens in stools, including EIA for C. diff toxins A/B, and were negative. All cases responded to bowel rest and different combinations of metronidazole, meropenem, piperacillin/tazobactam, ciprofloxacin, vancomycin, and linezolid. 2 required ICU admission and TPN, only 1 underwent hemi-colectomy. Overall mortality at 30 days was 0%.

Conclusion: 

Previous case reports have associated NEC with taxane-based chemotherapy. Our review, which is the largest to date, suggests that NEC is not only uncommon among this patient population but also is a clinical entity with good clinical response to conservative medical management. In contrast, most previous published reports associated NEC with dire outcomes. Further studies warranted to confirm our findings.


Subject Category: O. Transplant infectious diseases

Jorge Zuniga, MD1, Javier A. Adachi, MD, FIDSA1 and Kenneth V. I. Rolston, M.D.2, (1)Dept. of Infectious Diseases, Infection Control and Employee Health, The University of Texas - MD Anderson Cancer Center, Houston, TX, (2)Dept. of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX

Disclosures:

J. Zuniga, None

J. A. Adachi, None

K. V. I. Rolston, None

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