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Neutropenic enterocolitis may be a complication of treatment for acute leukemia. It is characterized by low levels of mature white blood cells and inflammation of the bowels. A 39-year-old man was hospitalized with acute leukemia, and given chemotherapy including daunorubicin, cytarabine, methotrexate, and hydrocortisone. He reported increasing abdominal pain, and bowel sounds diminished after nine to 12 hospital days. Blood tests showed very low levels of mature white blood cells resulting from the leukemia and chemotherapy. The entire colon was removed because of the extent of inflammation.

Culturing blood-forming cells may prove to be a superior technique for reestablishing a normal blood cell population in cancer patients undergoing chemotherapy. After two cycles of chemotherapy, ten patients were given a factor that stimulates blood-cell formation. Blood was filtered to obtain the progenitor cells, which were then cultured. A third cycle of chemotherapy three weeks later was followed 24 hours later by intravenous infusion of the patient's own cultured cells. Nine out of ten patients made a rapid recovery in the number of circulating blood cells. The tenth patient died of overwhelming infection resulting from lack of white blood cells. Conventionally, large volumes of blood are filtered to obtain sufficient numbers of cells. The culturing technique allows regeneration from relatively few cells. This greatly reduces the amount of blood that is required, which is likely to reduce the number of cancerous cells that are re-infused along with the blood-forming cells.

Rapid regeneration of immunity following chemotherapy may depend on the function of the thymus, an organ located in the upper chest that produces T lymphocytes. The thymus develops and functions throughout childhood, losing its function gradually after puberty. A study of 15 patients aged 1 to 24 years who had had extensive chemotherapy found an inverse relation between age and CD4+ T lymphocyte counts. The ability of the patients' bodies to regenerate CD4+ T lymphocytes after chemotherapy seemed to diminish with age. T lymphocytes are critical to healthy functioning of the body's immune system. The findings of this study suggest that any disease or therapy that decreases CD4+ T cells may affect adults more than children, as children may regenerate their T cell counts faster because of their functioning thymus. Study results may be applicable to treatments being developed for HIV-positive patients and for persons receiving bone marrow transplants to increase their immune responses.

Vomiting caused by chemotherapy may be prevented by giving patients a combination of granisetron and dexamethasone. A study of 408 first-time chemotherapy patients found that giving them the combination of drugs in the first 24 hours of chemotherapy was more effective than giving either drug alone. The combination therapy had a 20% higher rate of protection from vomiting, nausea, or both, and was associated with a lower rate of treatment failure. Granisetron, a serotonin-receptor antagonist, was associated with less protection from nausea occurring shortly after chemotherapy. All three treatments, dexamethasone plus granisetron, dexamethasone alone, and granisetron alone, were equally well tolerated by patients. The combination treatment provided protection against delayed vomiting (vomiting 24 hours or more after chemotherapy). Dexamethasone by itself may be sufficiently able to prevent chemotherapy-induced vomiting, but future studies will need to prove this.

A patient who had recently undergone chemotherapy for cancer of the tongue and later was admitted to the hospital because of bloody diarrhea and nausea was diagnosed with hemorrhagic colitis with transmural necrosis consistent with Escherichia (E.) coli infection. Hemorrhagic colitis with transmural necrosis refers to a bleeding, inflamed colon with degenerating and dead tissues. The patient died on her eighth day in the hospital of a stroke, following peritonitis leading to shock caused by bacterial infection of the bloodstream. The E. coli infection was not detected in the patient's stool specimens until after she died. One of the doctors reviewing this case thought it more likely that she had an infection of Clostridium (C.) difficile rather than E. coli, as C. difficile has been found to cause pseudomembranous colitis associated with chemotherapy. No test for C. difficile was done on stool specimens. A pathologist who reviewed the slides also said C. difficile infection was possible.

Dose modification during anthracycline therapy due to signs of cardiac abnormalities may be harmful for young cancer patients. Anthracyclines are antibiotics used to treat cancer. Researchers reviewed studies cited by a published recommendation to reduce anthracycline therapy if heart function tests showed abnormalities. None of the studies determined, according to appropriate scientific methods, the effects of cardiac monitoring or therapy modification on heart, cancer or overall disease and mortality. The studies did not demonstrate the effectiveness of cardiac monitoring or any reductions in anthracycline dosages. In addition, screening methods for anthracycline poisoning have not been proven to predict the extent of early or late cardiac health outcomes. The recommendations may further inhibit research on the efficacy of cardiac monitoring and dose reduction.

The development of antiemetic drugs since the late 1970s appears to have reduced the number of chemotherapy-induced vomiting episodes suffered by cancer patients. Antiemetic drugs are agents that prevent or alleviate nausea and vomiting. The vomit reaction is controlled by nerve networks in the brain stem that bind vomit-inducing agents and produce physical responses. The severity of vomiting depends on the type of chemotherapy, the dose and its administration. In the 1970s, patients receiving cisplatin therapy had an average of 12 vomiting episodes in the first 24 hours. Since the discovery of neural vomit control centers, antiemetic drugs have centered on these mechanisms. The effectiveness of antiemetics depends on the dosage and administration. In combination, they have increased antiemetic effects and reduced toxicity. Corticosteroids are commonly combined with serotonin agonists and other agents to alleviate vomiting and diarrhea.

Dexamethasone and metoclopramide appear to be as effective or slightly more effective than ondansetron in reducing vomiting and nausea associated with moderately emetogenic (causing vomiting) chemotherapy. Previous studies found ondansetron to be highly effective in reducing the nausea and vomiting in patients who took strongly emetogenic chemotherapy. Of 164 women with breast cancer who were about to receive moderately emetogenic chemotherapy, 84 took odansetron and 80 took dexamethasone and metoclopramide. Overall, about 66% of the women did not vomit in the seven days after chemotherapy. There were no significant differences between groups in the number of women who did not vomit. In the first day after chemotherapy, however, the women who took dexamethasone and metoclopramide experienced significantly less nausea than women who took ondansetron.

Treatment combining ondansetron and metopimazine appears to be more effective than ondansetron alone in reducing nausea and vomiting associated with chemotherapy. Ondansetron effectively reduces acute chemotherapy-induced vomiting and nausea but is less effective in reducing delayed vomiting and nausea. Of 30 chemotherapy patients, 15 took ondansetron and placebo, and 15 took ondansetron and metopimazine. After three weeks, they switched treatments. Combination therapy significantly reduced the number of acute, delayed and overall incidences of vomiting and retching, especially the delayed incidences. Seven of the patients had severe nausea after receiving only ondansetron, but none of the patients experienced it after receiving combination therapy. Two-thirds preferred the combination therapy and 1/3 preferred treatment with ondansetron alone.

Cancer patients may develop oral complications from undergoing radiation therapy or chemotherapy. Cancer treatments can cause oral complications such as ulcerations, bone changes, developmental defects, bleeding and different types of infections. They can also affect the salivary glands and cause different dental and periodontal diseases. Radiation therapy can cause a drop in salivary gland flow and mucositis, or inflammation of the mucous membrane of the mouth. It can also cause cavities and bone changes. Complications of systemic chemotherapy include mucositis and oral infections as a result of immunosuppression. Cancer patients undergoing these types of treatments should receive special oral health care management. They should have regular treatment by a dentist to maintain tissue integrity and to prevent oral infections.

Women with advanced breast cancer who are treated with chemotherapy and radiation may have an increased risk of developing leukemia. Of 82,700 breast cancer patients followed in two states and three large cities, 90 developed leukemia within an average of five years after diagnosis. More than half had been treated with an alkylating agent compared to only 19% of a control group of women who did not develop leukemia after treatment for breast cancer. Forty-two percent of the leukemic patients had received high-dose radiation treatment compared to 27% of the controls. Higher doses of drugs and radiation and longer treatment were associated with a higher risk of leukemia. Women treated with the drug melphalan were thirty times more likely to develop leukemia. Most drugs are now given at lower dosages and for shorter periods of time.

Tissue damage caused by radiation may result from either direct damage to the structure or damage to the vascular and support structures, which causes delayed effects. Radiation retinopathy (retinal disease) is caused by damage to the retinal blood vessels. Radiation retinopathy and diabetic retinopathy appear to be identical, by both clinical examination and angiography (X-ray studies of the blood vessels). It has been suggested that patients with diabetes or high blood pressure may be more susceptible to vascular damage from radiation. Chemotherapy may also add to the damaging effects of radiation. A case is reported of a 54-year-old woman with mild diabetic retinopathy. This is a disorder of the retinal blood vessels characterized by microaneurysms, hemorrhage, exudates and formation of new vessels (neovascularization) and connective tissue. When she was 45, the women was diagnosed with breast cancer, underwent breast removal surgery, and was treated with chemotherapy. Nine years after the breast cancer diagnosis, she developed cancer spread to the choroid (the vascular tunic covering the posterior five-sixths of the eye). This choroidal metastasis was treated with radiation. Within nine months, the woman developed severe retinopathy with only hand motion vision; the other eye was unchanged. This case points out the need for radiation oncologists and ophthalmologists to be aware of the risks of radiation for patients with even minimal diabetic retinopathy who have also received chemotherapy. They may develop severe loss of vision from what is normally considered to be a safe dose of radiation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vaccines are given to boost immunity against a specific disease. For example, the measles vaccine causes the production of a type of antibody, or immune protein, directed against the measles virus; these measles antibodies will protect the immunized child from developing the disease. Some studies show that children with cancer who are being treated with chemotherapy have lower antibody levels and diminished responses to immunization. It is not known whether the intensity or duration of chemotherapy affects the production of antibodies or responses to immunization in children with cancer. The levels of antibodies directed against three types of bacteria were assessed in children with acute lymphoblastic leukemia (ALL): Clostridium tetani, which causes tetanus; Corynebacterium diphtheriae, which causes diphtheria; and Haemophilus influenzae B, which causes influenza. ALL is a blood cancer that is characterized by the overgrowth of lymphoblasts, which give rise to lymphocytes, a type of immune cell. The children were being treated with different regimens of chemotherapy, which varied in intensity. A combined tetanus-diphtheria vaccine was given to 24 children receiving maintenance chemotherapy. An influenza vaccine was then given to 19 of the 24 children one month later. All patients had protective antibody levels against tetanus; 94 percent had protective levels against diphtheria; and 84 percent had protective antibody against influenza. The levels of antibodies before and after vaccination and the responses to immunization varied with the intensity of chemotherapy, but were not influenced by the duration of chemotherapy or the numbers of blood cells. It is thus recommended that the influenza vaccine be given to children who are receiving chemotherapy for acute lymphoblastic leukemia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients with Hodgkin's disease who are treated with chemotherapy drugs called alkylating agents have a higher than normal risk of developing leukemia in the 10 years following chemotherapy. Previous studies have not evaluated the specific risk factors for leukemia in these patients. A large multicenter study was conducted at 18 hospitals and cancer registries in Europe and Canada; of 29,552 patients with Hodgkin's disease, 163 developed leukemia. The relative risk of leukemia following various treatments was found to be 9.0 for chemotherapy alone, 7.7 for chemotherapy and radiotherapy, and 1.0 for radiotherapy (radiation treatments) alone. While radiotherapy alone carried the lowest risk for leukemia, risk did increase as radiation dose increased. Specific chemotherapeutic drugs that seemed to elevate risk the most were procarbazine and mechlorethamine; when given together for more than six treatment cycles, risk was 14 times the risk of radiotherapy alone. Patients whose spleens had been removed had a risk of leukemia that was at least twice as great as patients whose spleens had not been removed. Patients with more advanced Hodgkin's disease also had a higher risk of leukemia. Chemotherapy to treat Hodgkin's disease substantially increases the risk for leukemia, and risk is related to medication dose but is not influenced by the additional use of radiation therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients with ovarian cancer who receive chemotherapy in the form of alkylating agents are at risk for developing acute leukemia. No previous study has included enough subjects to draw conclusions about the risk and probable timing of leukemia associated with the specific drugs used for chemotherapy. It is important to determine which of the chemotherapeutic regimens that are effective against ovarian cancer have the least likelihood of inducing leukemia. An international study was carried out with the cooperation of 11 cancer registries and two large cancer hospitals in Europe and Canada. Of 99,113 women who survived ovarian cancer, 114 subsequently developed leukemia. Three control subjects were matched to each patient with leukemia in order to evaluate the leukemic potential of chemotherapy and radiotherapy (radiation treatments). The relative risk for developing leukemia after ovarian cancer was 12.0 for chemotherapy alone, 9.8 for both radiotherapy and chemotherapy, 1.6 for radiotherapy alone and 1.0 for surgery only. The difference in risk between radiotherapy only and surgery only was not considered significant; they were associated with equivalent levels of risk for leukemia. The chance of developing leukemia was greatest four to five years after chemotherapy was initiated, but continued to be high for at least eight years after chemotherapy was stopped. Drugs that were associated with increased risk for leukemia were cyclophosphamide, chlorambucil, melphalan, thiotepa and treosulfan, as was the combination of cisplatin and doxorubicin hydrochloride; the degree of risk varied among these drugs. The study did not evaluate how well the effectiveness of these drugs for fighting ovarian cancer offset the increased risk for leukemia. (Consumer Summary produced by Reliance Medical Information, Inc.)