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首页> 外文期刊>Journal of Blood Medicine >Inflammatory response following neutrophil recovery postchemotherapy in acute myeloid leukemia cases without evidence of infection: role of homing of neutrophils
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Inflammatory response following neutrophil recovery postchemotherapy in acute myeloid leukemia cases without evidence of infection: role of homing of neutrophils

机译：无感染证据的急性粒细胞白血病患者化疗后中性粒细胞恢复后的炎症反应：中性粒细胞归巢的作用

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Abstract: Neutropenic sepsis is a common clinical entity occurring in postchemotherapy patients. Infection may not be the cause of fever in such patients after neutrophil-count recovery. Herein, we present two patients who developed fever during the neutropenic phase of induction chemotherapy and were treated with broad-spectrum antibiotics until they were no longer febrile and had recovered their neutrophil count. Being off antibiotics, they redeveloped fever within 48–72 hours. These fevers seemed to be secondary to postinfectious inflammatory response and not infection, supported by the fact that adequate antibiotic treatment was given and the collected fluid contained neutrophils but the cultures were negative. We hypothesize an explanation for this phenomenon based on the “homing of neutrophils” to bone marrow, which involves chemoattraction of CXC chemokine receptor (CXCR)-4 expressed on neutrophils towards the chemokine stromal cell-derived factor (SDF)-1 (CXCL12) expressed constitutively by bone marrow. Literature has shown that elevation of SDF-1 levels at injured/inflamed sites might create a similar gradient. This gradient results in the migration of neutrophils to the sites of previous injury/inflammation, leading to the formation of sterile abscesses. Based on our cases, we also conclude that antibiotics do not prevent the formation or treat such sterile “abscesses”; however, the drainage of these “abscesses” and treatment with anti-inflammatory agents are useful in such cases.
机译：摘要：中性粒细胞减少性败血症是发生在化疗后患者中的常见临床实体。中性粒细胞计数恢复后，感染可能不是这类患者发烧的原因。在此，我们介绍了两名患者，它们在诱导化疗的中性粒细胞减少阶段发烧，并接受了广谱抗生素治疗，直到不再发热并恢复了中性粒细胞计数。由于不使用抗生素，它们在48-72小时内重新发烧。这些发烧似乎是继发于感染后的炎症反应，而不是感染，是受到以下事实支持的：给予了足够的抗生素治疗，收集的液体中含有中性粒细胞，但培养物为阴性。我们基于对骨髓的“嗜中性粒细胞归巢”假设对此现象做出解释，这涉及嗜中性粒细胞上表达的CXC趋化因子受体（CXCR）-4向趋化因子基质细胞衍生因子（SDF）-1（CXCL12）的趋化作用由骨髓组成型表达。文献表明，受伤/发炎部位的SDF-1水平升高可能会产生相似的梯度。该梯度导致嗜中性粒细胞迁移到先前的损伤/发炎部位，导致形成无菌脓肿。根据我们的病例，我们还得出结论，抗生素不能预防或治疗这种无菌的“脓肿”。然而，在这些情况下，引流这些“脓肿”并用抗炎药治疗是有用的。

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