CYTOTOXIC THERAPY-INDUCED D-XYLOSE MALABSORPTION AND INVASIVE INFECTION DURING REMISSION-INDUCTION THERAPY FOR ACUTE MYELOID-LEUKEMIA IN ADULTS

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 infections morbidity, Patients and Methods: Serial D-xylose absorp tion studies were conducted in 110 consecutive adult patients admitted to a university-affiliated tertiary care hospital for remission-induc tion therapy for untreated newly diagnosed AML, Serial serum D-xylose levels were obtained I hour after a 5-g oral dose of D-xylose at basel ine and weekly for 4 weeks until marrow recovery, These resorts were c orrelated with invasive infection using multivariate techniques, Resul ts: 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 ba seline and weeks 1 to 4, respectively (P < .0001, analysis of variance [ANOVA]), Time to malabsorption varied with induction regimen (P = .0 07, log-rank test), Bloodstream infections during week 2 correlated wi th malabsorption (P = .007), Neutropenic enterocolitis correlated inde pendently with induction regimen (P = .009), malabsorption st week 2 ( P = .02), and the development of candidemia (P = .005). Hepatosplenic fungal infection correlated with induction regimen (P = .03), malabsor ption at week 2 (P = .02), and fever at diagnosis (P = .003), Malabsor ption was unrelated to the duration of severe neutropenia and the admi nistration of parenteral nutrition. Conclusion: Serial D-xylose absorp tion studies in subjects with AML produced a characteristic profile of cytotoxic therapy-related damage to the functional integrity of the i ntestinal epithelium that was regimen dependent, myelosuppression inde pendent, and predictive for invasive infectious complications. Further study to validate these observations appears warranted. (C) 1997 by A merican Society of Clinical Oncology.