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[Effects of cepharanthin on leukopenia and thrombocytopenia induced by chemotherapy in lung cancer patients].

We studied the effects of Cepharanthin (CEP) on bone marrow suppression induced by chemotherapy in 18 primary lung cancer patients (14 NSCLC, 4 SCLC). NSCLC patients received IP (IFM+CDDP) therapy and SCLC patients received ION (IFM+VCR+ACNU) therapy. For the control, we chose the first course and we administered CEP (1 mg/kg) during the second course. The rate of leukopenia and neutropenia was significantly lower during the CEP course than during the control (p less than 0.01). The recovery rate (at 3 weeks) of leukopenia and neutropenia was significantly higher during the CEP course than during the control (p less than 0.05). But, obvious effects of CEP for lymphopenia and thrombocytopenia were not obtained. Side effects by CEP were not observed in this study. These data suggest that the large dose of CEP contributes to the prevention of leukopenia, especially neutropenia, in patients who receive a sufficient amount of anticancer drugs.

Adult↗

[Clinical efficacy of Z-100 for the treatment of leukopenia caused by radiotherapy--a multi-center double-blind comparative study with L-cysteine].

The clinical usefulness of Z-100 (Z group) for the treatment of leukopenia caused by radiotherapy for malignant tumors was evaluated by comparing it with that of L-cysteine (L group) by the double-blind method. For 178 complete cases, there were no significant differences in the time-course of the WBC during radiotherapy between the two group. However, for cases with a large field of irradiation (15 X 15 cm = 225 cm2), the mean WBC count in the L group decreased more than that in the Z group. The Z group showed comparable or superior efficacy for the treatment of leukopenia in the L group although there were no significant differences. Adverse reactions were observed in 5.66% and 2.94% in the Z and L groups, respectively, without any significant difference between the groups. The utility rate, useful or better, was 73.9% and 69.2% in the Z and L groups, respectively, showing a slightly higher rate in the Z group than in the L group, although the difference between the two groups was not significant. These results confirmed that Z-100 has comparable or superior efficacy to L-cysteine for the treatment of leukopenia caused by large field radiotherapy for malignant tumors.

Adjuvants, Immunologic↗

Prevention of the toxic action of tumor necrosis factor by cyclooxygenase inhibitor and leukopenia.

The interactions between leukopenia induced by vinblastine and the cyclooxygenase inhibitor indomethacin on the toxicity of tumor necrosis factor (TNF) were studied. When indomethacin was injected 60 min before the administration of recombinant TNF, it provided significant protection against rapid killing by TNF; leukopenia also prevented the toxic action of TNF. However, their inhibition of the activity of TNF was not sufficient, and 17-25% of the rats died within 48 hr following TNF administration. Every rat that received peritoneal polymorphonuclear leukocytes (PMNLs) died within 24 hr following the administration of TNF. On the other hand, administration of indomethacin to the rats in leukopenia prevented the toxic action of TNF completely, and all rats lived for 48 hr and showed no changes, compared to normal rats, in hematocrit, plasma transaminase, and body temperature. From these findings, the toxic action of TNF seems to result from increases in synthesis of prostaglandins (PGs) and activation of PMNLs.

Animals↗

[The effect of lithium carbonate against leukopenia during systemic chemotherapy in patients with small cell carcinoma of the lung].

To investigate whether lithium carbonate ameliorates the leukopenia and infectious complication that accompany systemic chemotherapy, we studied 19 patients with small cell carcinoma of the lung receiving combination chemotherapy. Eight patients received systemic chemotherapy and lithium carbonate and 11 patients received systemic chemotherapy alone. The mean leukocyte count nadir during chemotherapy was significantly higher in the patients of the lithium group than in the patients of the control group (p less than 0.05). Percentage of infectious complication related to leukopenia was lower in the lithium group than in the control group, although there was no significant difference between these two groups. There was almost no significant side effect except for liver dysfunction in one patient. We therefore believe that lithium carbonate is an effective and safe drug against leukopenia during cytotoxic chemotherapy.

Aged↗

Beneficial effect of muroctasin on experimental leukopenia induced by cyclophosphamide or irradiation in mice.

Subcutaneous injection of N2-[N-acetylmuramoyl)-L-alanyl-D-isoglutaminyl]-N6-stearoyl-L-lysine (MDP-Lys(L18), muroctasin), a synthetic muramyl dipeptide derivative, favoured recovery of mice from experimental leukopenia induced by cyclophosphamide or by irradiation with X-rays. These effects were observed only when MDP-Lys(L18) treatment occurred after cyclophosphamide injection or X-ray irradiation. Prophylactic treatment resulted in neither preventive nor restorative efficacy on leukopenia. In contrast, glutathione was hardly effective on leukopenia in both models, irrespective of treatment timing. The restorative efficacy of muroctasin was found to be dose-dependent and to be attributable at least to its augmenting effect on colony-stimulating factor production, followed by the marked proliferation and differentiation of myeloblasts towards mature granulocytes in the bone marrow. These beneficial effects of MDP-Lys(L18) warrant further evaluation of its clinical usefulness.

Acetylmuramyl-Alanyl-Isoglutamine↗

Adult respiratory distress-like syndrome during hemodialysis: relationship between activation of complement, leukopenia, and release of granulocyte elastase.

Twelve patients with terminal uremia (8 females and 4 males) treated with chronic maintenance hemodialysis, were extensively studied during two successive dialyses with alternate use of either a Cuprophan (CP) based membrane, or a Polycarbonate (PC) membrane. Arterial plasma levels of total hemolytic complement, complement factors C3d and C5a, and granulocyte derived elastase were determined immediately before dialysis and sequentially during the entire procedure. Effluent line from the hemodialyzer was similarly sampled. Collected samples were centrifuged immediately at the bedside and instantly frozen in liquid nitrogen in order to preserve labile plasma components of complement. Analysis of the overall results shows that initial arterial leukopenia and generation of C5a in the hemodialyzer, as well as maximal values of hemodialysis-induced free plasma C3d and granulocyte elastase are related. Reflecting differences in biocompatibility, CP membranes were shown to induce significantly more leukopenia, increase in plasma free C3d, generation of C5a, and release of granulocyte-derived elastase. These results indicate that activation of complement, leukopenia, and release of granulocyte derived elastase are interlinked pathophysiological mechanisms of importance for acute deterioration of pulmonary function during hemodialysis, and that this condition is closely related to adult respiratory distress syndrome (ARDS).

Adult↗

Leukopenia due to penicillin and cephalosporin homologues.

Leukopenia is an infrequently recognized complication of penicillin-related antibiotic and cephalosporin therapy. We describe our experience with nine individuals and reviewed reports of 11 cases from the literature. Seventy-six percent of cases occurred in individuals receiving 150 mg/kg/day or more of the various penicillin and cephalosporin homologues; 67% received these high doses for two or more weeks before the onset of leukopenia. Leukopenia was unusual within the first week of antibiotic treatment. Standard medical texts often recommend blind administration with 12 to 23 g/day of these antibiotics regardless of weight. It is suggested that these antibiotics be administered according to a maximum milligram per kilogram per day dosage as is done in children. Beyond the first week of administration, careful monitoring of the blood cell count should be conducted for those receiving high doses of these antibiotics.

Adolescent↗

Beneficial effect of pre-transplant splenectomy for leukopenia in primary cadaver kidney transplants.

Pre-transplant splenectomy is controversial. We compared 21 nondiabetic, transfused recipients of first cadaver kidney grafts who underwent pre-transplant splenectomy for steroid-resistant leukopenia to 114 without steroid-resistant leukopenia. Kidney graft survivals at 2 years were 80.2 plus or minus 8.9 and 48.5 plus or minus 5.3 per cent, respectively (p less than 0.05). The 2-year actuarial patient survivals were not significantly different (89.6 plus or minus 7.0 versus 87.8 plus or minus 3.9 per cent). Azathioprine doses and serum creatinine levels at 1 year were not significantly different. Pre-transplant splenectomy for steroid-resistant leukopenia resulted in a significant decrease in kidney graft losses owing to rejection without an increased risk of death of sepsis or thromboembolism.

Azathioprine↗

Leukopenia in anorexia nervosa. Lack of increased risk of infection.

To determine whether patients with anorexia nervosa (AN) and leukopenia have an increased risk of infection, we reviewed the incidence of leukopenia and infection in 68 cases of AN and studied the mechanism of profound neutropenia in one. Compared with controls, patients with AN had substantially lower total leukocyte counts and absolute neutrophil, lymphocyte, and monocyte counts. Despite frequent and often severe panleukopenia, the patients with AN had no more infections than did the control subjects. The patient with severe neutropenia ahd a hypocellular bone marrow biopsy specimen showing relative myeloid hyperplasia, normal distribution of neutrophils between the marginal and circulating pools, and normal bone marrow neutrophil reserves as estimated by response to hydrocortisone sodium succinate. We conclude that patients uith AN and associated leukopenia do not have increased infection propensity.

Adolescent↗

The effect of granulocyte colony stimulating factor in patients with leukopenia due to sepsis.

The use of granulocyte stimulating factor (G-CSF) (Neupogen, Amgen Inc., Thousand Oaks, Calif.) has become acceptable for treating both primary and acquired leukopenia. Leukopenia associated with infection is an ominous sign of overwhelming sepsis. In this article, we present two cases of infection that were related to leukopenia which were successfully treated with G-CSF.

Aged↗

[Clinical study of recombinant human granulocyte-macrophage colony-stimulating factor on chemotherapy-induced leukopenia].

We have studied the efficacy and safety of recombinant human granulocyte-macrophate colony-stimulating factor (rhGM-CSF, leucomax) to treat leukopenia and neutropenia induced by chemotherapy with regimen CE (Carboplatin, Etoposide) and regimen CEA (Carboplatin, Etoposide, Adriamycin) on patients in a randomized comparative, cross-over clinical trial. Twenty-one patients enrolled were randomly divided into A(n = 8) and B group(n = 13). Each patient received two cycles of treatment. In group A, chemotherapy and rhGM-CSF were given in the first cycle and in the second cycle only chemotherapy was given. In group B, only chemotherapy was given in the first cycle and chemotherapy and rhGM-CSF were given in the second cycle. The results showed that rhGM-CSF significantly increased the total white cell count (WBC) and absolute neutrophil count (ANC) at nadir, decreased the incidence of leukopenia and neutropenia, and shortened the duration of leukopenia with WBC < 4.0 x 10(9)/L and ANC < 2.5 x 10(9)/L, and the number of days for recovery to WBC > 4.0 x 10(9)/L and ANC 2.5 x 10(9)/L. However, rhGM-CSF displayed little effect on platelets. The main side-effect of rhGM-CSF was fever (43%), as well as skin rashes and influenzalike symptoms.

Adult↗

The epidemiology of benign leukopenia in Yemenite Jews.

Blood counts of 372 Yemenite Jews of all ages were reviewed in order to clarify the epidemiology of benign leukopenia. Twenty-one percent of the total leukocyte counts were below 5.0 x 10(3) cells/mm3. Neutropenia < 2.0 x 10(3) was present in 15.4% of the blood counts, significantly lowering the average neutrophil count in the population. There was no significant variation in the prevalence of neutropenia with age. In contrast, the average lymphocyte and erythrocyte counts were normal. We conclude that leukopenia among Yemenite Jews should be defined as neutropenia rather than leukopenia, and that the phenomenon is only half as common as was previously noted. Since the prevalence of neutropenia remains constant across all age-groups, in immigrants as well as among the Israeli-born, it is unlikely to be an acquired condition.

Adolescent↗

Ritodrine-induced leukopenia: a case report and literature review.

Ritodrine hydrochloride, a beta 2-adrenergic receptor agonist, has been widely applied in the treatment of premature labor for many years and generally considered as a safe medication. It can however induce some serious side effects, such as pulmonary edema, myocardial ischemia, ketoacidosis, miscellaneous metabolic alterations, and leukopenia. This report presents a rare case of leukopenia in a Chinese woman as a result of low dose continuous intravenous infusion of ritodrine, in which the white blood cell count dropped rapidly and recovered quickly following the cessation of administration. The rapid and spontaneous reversal of leukopenia was most probably due to early recognition and intervention of this drug-induced side effect.

Adolescent↗

Infection After Gynecologic Surgery: Implications of Racial Leukopenia in Black Women.

Differences in the normal peripheral white blood cell count (WBC) among people of various racial backgrounds are well recognized, and one familiar example is the decrease in the WBC of African-Americans relative to that of Caucasian subjects, a phenomenon that has been termed "racial leukopenia." Since the WBC is commonly used as an early indicator of infection, information regarding this phenomenon is pertinent: Such leukopenia could give rise to a falsely low (i.e., in the normal range) WBC during a significant infectious event. We therefore conducted a retrospective study to describe the incidence of this leukopenia among Black women in Louisiana and to follow their WBC levels in response to infection after elective gynecologic surgery. We found that 6.5% of these women exhibited a preoperative WBC < 3.5 x 10^3 cells/mm3, which represents the lower limit of normal for this measure. Although these women did exhibit a 2- to 3-fold rise in their WBC in response to infection, their peak WBC remained less than 11.0 x 10^3/mm3, a value below the upper limit of normal.

Journal Article↗

Parvovirus infection causing red cell aplasia and leukopenia in rheumatoid arthritis.

A case of acute parvovirus B19 infection causing fever, anaemia, leukopenia, and red cell aplasia, in a patient with chronic rheumatoid arthritis is described. The patient had received low doses of corticosteroids for several years, and a small dose of methotrexate recently. There was no evidence of haemolytic anaemia, iron deficiency or drug toxicity. Recovery was associated with the development of antibodies against parvovirus B19, and clearance of viraemia as detected by the polymerase chain reaction. Possible mechanisms for the development of leukopenia are discussed, but there was no evidence for haemophagocytosis.

Arthritis, Rheumatoid↗

Dialysis leukopenia and hypoxemia in a patient without measurable complement activity.

We have studied complement activity, total leukocyte counts, PO2 and acid-base balance during a single hemodialysis with cuprophan membranes in a patient with hereditary angioedema and C3NeF-positive chronic membranoproliferative glomerulonephritis. Before, during and after the dialytic procedure plasma complement activity (total hemolytic complement, classical and alternative pathway activities) was not detectable and no C3-conversion occurred, while profound leukopenia (from 8,500 to 1,800 leukocytes/microliter) and hypoxemia (from 101.8 to 86 mmHg PO2) were found within 20 min from the initiation of hemodialysis. Similar results were obtained by studying the same parameters during two additional hemodialytic procedures. In vitro experiments showed that the patient's C3 could not be converted, either by cuprophan or zymosan, a specific and potent complement activator, even under optimal experimental conditions. Our data demonstrate that complement activation is not the only possible mechanism responsible for early leukopenia (as well as hypoxemia) during dialysis with cuprophan membranes.

Acid-Base Equilibrium↗

Acute leukopenia during topical burn therapy with silver sulfadiazine.

Leukopenia, with a mean white blood cell count of 2,680/mm3, was observed in nine patients with thermal injury early in the course of topical treatment with silver sulfadiazine. All manifested absolute neutropenia with a concomitant increase in immature band forms in the peripheral blood smear. The leukocyte counts returned to within normal limits within 48 to 72 hours of discontinuation of silver sulfadiazine therapy in four patients, and also did so in five patients in whom silver sulfadiazine therapy was continued. Leukopenia secondary to silver sulfadiazine application is currently believed to be an innocuous, self-limited phenomenon.

Acute Disease↗

Serum concentrations of tumour necrosis factor-alpha during chemotherapy-induced leukopenia in patients with acute leukaemia and bacterial infections.

Serum concentrations of tumour necrosis factor-alpha (TNF-alpha) increase during septicaemia in previously healthy individuals. To investigate whether a similar increase in TNF-alpha can be seen in severely immunocompromised patients with acute leukaemia and chemotherapy-induced leukopenia, serum TNF-alpha was analysed in leukopenic patients with bacterial infections. Pretherapy serum levels of TNF-alpha were decreased in leukaemia patients compared with healthy controls, and serum TNF-alpha levels showed a further decrease when patients developed chemotherapy-induced leukopenia. When leukopenic patients developed bacterial infections, serum concentrations of TNF-alpha increased. Serum levels of TNF-alpha decreased when clinical signs of infection resolved during antibiotic therapy, but an increase occurred later in parallel with haematopoietic reconstitution.

Adolescent↗