HIGH-INCIDENCE OF INFECTIOUS GASTROINTESTINAL COMPLICATIONS OBSERVED IN PATIENTS WITH ACUTE MYELOID-LEUKEMIA RECEIVING INTENSIVE CHEMOTHERAPY FOR FIRST INDUCTION OF REMISSION

An increased incidence of severe infections, in particular gastrointes tinal complications, was observed in our institution among 35 consecut ive patients with acute myelogenous leukemia submitted to their first intensive pilot protocol for induction of remission containing idarubi cin, etoposide and cytosine arabinoside. Ten patients presented fever and severe diarrhea (4 or more loose stools/day for at least 4 consecu tive days) 3 of these developed ileothyphlitis, which proved fatal in 2 cases, 7 needed amphotericin B addition to antibacterial treatment a nd, in 6 cases, a fungal infection was documented. We have compared th ese 10 patients with the other 25 submitted to the same chemotherapeut ic protocol and the incidence of candidemias (5/10 compared to 0/25), the early use of systemic fluconazole from the onset of fever (0/10 co mpared to 9/25) and the pre-emptive use of total parenteral nutrition (0/10 compared to 8/25) differed in the two groups, We conclude that d uring this chemotherapeutic protocol the incidence of severe gastroint estinal infectious complications was particularly high (28.5%) and, ev en though only a small number of patients were studied, our results su ggest an important role for Candida spp. in the pathogenesis of this d isease.