RESUMEN
Several recent studies have addressed the management of infectious problems in patients with acute leukemia. Although those studies have served to emphasize the fundamental management principles formulated and proven almost 30 years ago, they have also contributed important new insights. This article describes recent developments in the management of infectious illnesses in patients who are neutropenic due to leukemia or its treatment. The discussion will focus on the increasing armamentarium of antimicrobial drugs and adjunctive agents. These expanding therapeutic options must be viewed in the context of newly emerging resistant organisms and special problems, such as the increased use of indwelling venous catheters.
Asunto(s)
Antiinfecciosos/uso terapéutico , Antineoplásicos/efectos adversos , Leucemia/tratamiento farmacológico , Neutropenia/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/prevención & control , Enfermedad Aguda , Antifúngicos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/prevención & control , Humanos , Micosis/tratamiento farmacológico , Micosis/prevención & control , Neutropenia/inducido químicamente , Infecciones Oportunistas/etiologíaRESUMEN
Acute leukemias that arise as a result of treatment with DNA-damaging agents exhibit distinctive molecular, genetic, and clinico-pathologic features. In this timely article, the authors dissect the pathogenetic basis of therapy-related leukemias, elucidating important molecular mechanisms through which DNA damage causes these disorders. The authors also discuss how these molecular aberrations translate into specific clinical syndromes, and in addition, point out potential molecular targets for the development of innovative treatment approaches.
Asunto(s)
Leucemia Mieloide Aguda/etiología , Neoplasias Primarias Secundarias/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiología , Deleción Cromosómica , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/etiología , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/terapia , Síndromes Mielodisplásicos/etiología , Síndromes Mielodisplásicos/genética , Síndromes Mielodisplásicos/terapia , Neoplasias Primarias Secundarias/genética , Neoplasias Primarias Secundarias/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Translocación GenéticaRESUMEN
BACKGROUND: The incidence of platelet transfusion reactions may depend partly on the length of storage. The influence of reactions on the effectiveness of platelet transfusions is not known. STUDY DESIGN AND METHODS: Platelet transfusion reactions, identified by prospective monitoring, were analyzed for the effects of component type, recipient lymphocytotoxic antibodies, bacterial contamination, and duration of storage. Posttransfusion corrected count increments (CCIs) were used to evaluate the effectiveness of transfusions associated with reactions by comparing them to those of randomly selected transfusions without reactions. RESULTS: Reactions accompanied 4 percent of the 4926 transfusions given and included 119 febrile nonhemolytic transfusion reactions, 62 allergic reactions, and 13 reactions with features of both. Platelet concentrates contained a mean of 0.5 x 10(8) white cells per unit. Lymphocytotoxic antibodies were detectable in 20 of 84 recipients tested proximate to a reaction. Bacterial cultures from 4 of 81 units were positive; 1 unit was associated with fatal Enterobacter sp. sepsis. The incidence of febrile nonhemolytic transfusion reactions but not allergic reactions was related to platelet storage duration. The CCI was not significantly different for transfusions associated with reactions (10.97 [median, range 0-72.5; n = 165]) or not so associated (13.1 [median, range 0-39.5; n = 174]) (p = 0.08). CONCLUSION: The incidence of febrile nonhemolytic transfusion reactions but not allergic reactions appears to be related to the duration of platelet storage. Transfusion reactions may not have an adverse impact on the effectiveness of platelet transfusions.