Journal of Clinical Oncology, Vol 15, 2254-2261, Copyright © 1997 by American Society of Clinical Oncology

ARTICLES

Cytotoxic therapy-induced D-xylose malabsorption and invasive infection during remission-induction therapy for acute myeloid leukemia in adults

EJ Bow, R Loewen, MS Cheang, TB Shore, M Rubinger and B Schacter
Department of Medicine, University of Manitoba and The Manitoba Cancer Treatment and Research Foundation, Winnipeg, Canada.

PURPOSE: To study the sequential changes in the intestinal absorption of an oral pentose probe, D-xylose, in patients receiving therapy for untreated acute myeloid leukemia (AML), and to correlate these changes to infectious morbidity. PATIENTS AND METHODS: Serial D-xylose absorption studies were conducted in 110 consecutive adult patients admitted to a university-affiliated tertiary care hospital for remission-induction therapy for untreated newly diagnosed AML. Serial serum D-xylose levels were obtained 1 hour after a 5-g oral dose of D- xylose at baseline and weekly for 4 weeks until marrow recovery. These results were correlated with invasive infection using multivariate techniques. RESULTS: The mean (+/- SEM) serum D-xylose levels were 0.88 +/- 0.03, 0.69 +/- 0.03, 0.58 +/- 0.02, 0.53 +/- 0.02, and 0.73 +/- 0.02 mmol/L at baseline and weeks 1 to 4, respectively (P < .0001, analysis of variance [AN-OVA]). Time to malabsorption varied with induction regimen (P = .007, log-rank test). Bloodstream infections during week 2 correlated with malabsorption (P = .007). Neutropenic enterocolitis correlated independently with induction regimen (P = .009), malabsorption at week 2 (P = .02), and the development of candidemia (P = .005). Hepatosplenic fungal infection correlated with induction regimen (P = .03), malabsorption at week 2 (P = .02), and fever at diagnosis (P = .003). Malabsorption was unrelated to the duration of severe neutropenia and the administration of parenteral nutrition. CONCLUSION: Serial D-xylose absorption studies in subjects with AML produced a characteristic profile of cytotoxic therapy-related damage to the functional integrity of the intestinal epithelium that was regimen dependent, myelosuppression independent, and predictive for invasive infectious complications. Further study to validate these observations appears warranted.

This article has been cited by other articles:

				D. S. Sitar, F. Y. Aoki, and E. J. Bow Acyclovir Bioavailability in Patients With Acute Myelogenous Leukemia Treated With Daunorubicin and Cytarabine J. Clin. Pharmacol., August 1, 2008; 48(8): 995 - 998. [Full Text] [PDF]

				N Blijlevens and S Sonis Palifermin (recombinant keratinocyte growth factor-1): a pleiotropic growth factor with multiple biological activities in preventing chemotherapy- and radiotherapy-induced mucositis Ann. Onc., May 1, 2007; 18(5): 817 - 826. [Abstract] [Full Text] [PDF]

				P. Niscola, C. Romani, L. Cupelli, L. Scaramucci, A. Tendas, T. Dentamaro, S. Amadori, and P. de Fabritiis Mucositis in patients with hematologic malignancies: an overview Haematologica, February 1, 2007; 92(2): 222 - 231. [Abstract] [Full Text] [PDF]

				S. N. O'Brien, N. M.A. Blijlevens, T. H. Mahfouz, and E. J. Anaissie Infections in Patients with Hematological Cancer: Recent Developments Hematology, January 1, 2003; 2003(1): 438 - 472. [Abstract] [Full Text] [PDF]

				S. A. Khan and J. R. Wingard Infection and Mucosal Injury in Cancer Treatment J Natl Cancer Inst Monographs, October 1, 2001; 2001(29): 31 - 36. [Abstract] [Full Text] [PDF]

				M. Laverdiere, C. Rotstein, E. J. Bow, R. S. Roberts, S. Ioannou, D. Carr, N. Moghaddam, and The Canadian Fluconazole Study Group Impact of fluconazole prophylaxis on fungal colonization and infection rates in neutropenic patients J. Antimicrob. Chemother., December 1, 2000; 46(6): 1001 - 1008. [Abstract] [Full Text] [PDF]

				A. P. Rapoport, L. F. Miller Watelet, T. Linder, S. Eberly, R. F. Raubertas, J. Lipp, R. Duerst, C. N. Abboud, L. Constine, J. Andrews, et al. Analysis of Factors That Correlate With Mucositis in Recipients of Autologous and Allogeneic Stem-Cell Transplants J. Clin. Oncol., August 1, 1999; 17(8): 2446 - 2446. [Abstract] [Full Text] [PDF]