What is a common complication of neutropenia, specifically neutropenic enterocolitis, in relation to chemotherapy agents such as cytarabine (Cytarabine), cyclophosphamide (Cyclophosphamide), doxorubicin (Doxorubicin), or cisplatin (Cisplatin)?

From the Guidelines

Neutropenic enterocolitis is a complication of cytarabine (option a). This serious gastrointestinal complication, also known as typhlitis, occurs most commonly in patients receiving intensive chemotherapy for acute leukemia, particularly with high-dose cytarabine regimens 1. Cytarabine directly damages the rapidly dividing cells of the intestinal mucosa, causing inflammation and necrosis. When combined with severe neutropenia (low white blood cell count) from the chemotherapy, this mucosal damage allows bacterial invasion of the bowel wall, typically affecting the cecum and ascending colon. Some key points to consider in the management of neutropaenic enterocolitis include:

• The initial treatment is medical, with the administration of broad-spectrum antibiotics, granulocyte colony-stimulating factors (G-CSFs), nasogastric decompression, i.v. fluids, bowel rest and serial abdominal examinations 1.
• The administered antibiotics should cover enteric gram-negative organisms, gram-positive organisms and anaerobes 1.
• Anticholinergic, antidiarrhoeal and opioid agents should be avoided since they may aggravate ileus 1. Patients present with fever, abdominal pain, and diarrhea, sometimes with life-threatening complications like perforation or sepsis. While other chemotherapeutic agents can occasionally cause this condition, cytarabine has the strongest association due to its direct cytotoxic effect on intestinal epithelium and its profound myelosuppressive properties that lead to severe neutropenia.

From the FDA Drug Label

Infections:The following manifestations have been associated with myelosuppression and immunosuppression caused by cyclophosphamide: increased risk for and severity of pneumonias (including fatal outcomes), other bacterial, fungal, viral, protozoal and, parasitic infections; reactivation of latent infections, (including viral hepatitis, tuberculosis), Pneumocystis jiroveci, herpes zoster, Strongyloides, sepsis and septic shock. The answer is (b) cyclophosphamide. Neutropenic enterocolitis is a complication that can occur due to myelosuppression and immunosuppression caused by cyclophosphamide, which increases the risk of infections, including those that can lead to neutropenic enterocolitis 2.

From the Research

Neutropenic Enterocolitis Complications

• Neutropenic enterocolitis is a life-threatening gastrointestinal complication of chemotherapy, most often associated with leukemia or lymphoma 3, 4.
• The condition can result from various chemotherapy agents, but the provided studies do not specifically mention cytarabine, cyclophosphamide, doxorubicin, or cisplatin as the cause 3, 5, 4, 6, 7.
• Neutropenic enterocolitis is characterized by an inflammatory process involving the colon and/or small bowel, which can lead to ischemia, necrosis, bacteremia, hemorrhage, and perforation 5, 6.

Chemotherapy Association

• While the studies do not directly link neutropenic enterocolitis to the specified chemotherapy agents, they do emphasize that the condition is a complication of chemotherapy in general 3, 4, 7.
• The lack of specific information on cytarabine, cyclophosphamide, doxorubicin, or cisplatin in the provided studies makes it difficult to determine which option is the most accurate answer.
• However, it is clear that neutropenic enterocolitis is a serious complication of chemotherapy, and its management is crucial for patient survival 3, 5, 4, 6, 7.