NEUTROPENIC TYPHLITIS - AN OFTEN MISSED C OMPLICATION OF TUMOR-THERAPY WITH A POSSIBLE ASSOCIATION TO ETOPOSIDE AND HIGH-DOSE CYTOSINE-ARABINOSIDE COMBINATION THERAPY

Neutropenic typhlitis (NPT) was observed in 4 of 5 adult patients with acute leukemia treated with etoposide (VP16;100 mg/m(2)/d for 6 days) and high-dose cytosine-arabinoside (HD ARA-C, 2 g/m(2) twice daily fo r 6 days) in a period of 11 months. One additional patient developed N PT after combination therapy with amsacrine (mAMSA, 120 mg/m(2)/d for 5 days) and etoposide (80 mg/m(2)/d for 5 days) during the same period . These 5 cases of NPT meant a drastic rise in the incidence of NPT at our institution, where a careful retrospective review of the charts o f the 128 adult patients with leukemia treated during the preceding 5 years revealed only one case of NPT. Nonsurgical treatment led to reco very in all cases. No recurrence of NPT was observed during 3 further courses of aplasia with the use of selective (2 patients) or complete (1 patient) bowel decontamination. Etoposide may potentiate the gastro intestinal toxicity of high-dose cytosine-arabinoside with a higher in cidence of NPT.