mercaptopurine and Pneumonia

Bleomycin, busulphan, and methotrexate are by far the commonest cytotoxic drugs to cause interstitial pneumonitis. However, many other cytotoxic drugs have been reported to produce similar lung damage. Combined effects of these drugs, and of the drugs with other agents that cause lung damage, such as oxygen and radiation, may result in enhancement of lung damage. Early diagnosis, made possible by awareness of this complication and its correct investigation, may reduce severe morbidity and mortality. In some instances, factors that predispose to lung damage are known, and these have been studied in experimental animals.

Topics: Antineoplastic Agents; Azathioprine; Bleomycin; Busulfan; Carmustine; Chlorambucil; Cyclophosphamide; Drug Therapy, Combination; Humans; Lung; Melphalan; Mercaptopurine; Methotrexate; Mitomycins; Oxygen Inhalation Therapy; Pneumonia; Procarbazine; Radiation Injuries

Topics: Adolescent; Adult; Antilymphocyte Serum; Azathioprine; Dactinomycin; Female; Histocompatibility Testing; Humans; Hydrocortisone; Immunosuppressive Agents; Lung Diseases; Lung Transplantation; Male; Mediastinum; Mercaptopurine; Methods; Middle Aged; Pneumonia; Postoperative Complications; Prednisolone; Respiration; Respiratory Insufficiency; Thymus Gland; Time Factors; Tissue Donors; Transplantation Immunology; Transplantation, Homologous

The aim of this study was to analyse postoperative infection in patients undergoing surgery for Crohn's disease (CD) according to the use of preoperative immunosuppressants, including infliximab.. With IRB approval, the records of all patients with CD who underwent abdominal surgery between 2001 and 2008 were reviewed for comorbidity, preoperative medication, type of surgery, stoma construction and postoperative complications. Patients were divided into three categories according to the preoperative medication within 90 days of surgery as follows: infliximab (IFX), other drugs including steroids and/or immunosuppressive agents (OD) and no drugs (ND).. Two hundred and twenty-five patients were identified. Preoperative comorbidity, surgical indication and type of surgery were not significantly different among the three groups. Ileocolic resection was the most common procedure [50.8%, IFX group; 61.2%, OD group; 41.3%, ND group (P = 0.09)]. Other procedures included total colectomy (16%), protectomy (15%) and others (18%). Laparoscopic surgery was performed in 47.7%, 45.9% and 29.3% of patients in the IFX, OD and ND groups, respectively (P = 0.04). There were no differences in postoperative rates of infection [pneumonia (P = 0.14), wound infection (P = 0.35), abscess (P = 0.34) or anastomotic leakage (P = 0.44)]. Reoperation was needed in 3.0%, 8.2% and 2.6% of patients in the IFX, OD and ND groups, respectively. Multiple logistic regression found no relationship between infliximab use and infection.. There was no difference in the rate of postoperative complications among the groups of patients undergoing surgery for CD pretreated with IFX or other immunosuppressive drugs.

Topics: Adolescent; Adult; Aged; Anastomotic Leak; Antibodies, Monoclonal; Azathioprine; Colectomy; Crohn Disease; Drug Therapy, Combination; Female; Humans; Ileum; Immunosuppressive Agents; Infliximab; Male; Mercaptopurine; Middle Aged; Pneumonia; Prednisone; Rectum; Retrospective Studies; Surgical Wound Infection; Young Adult

Low-dose methotrexate (MTX) is used as disease-modifying therapy in severe rheumatoid arthritis and as maintenance treatment in patients with complete remission of acute lymphoblastic leukemia (ALL). It is generally well tolerated, but in 27% of patients acute pneumonitis leads to discontinuation of treatment. We describe a 56-year-old female patient with newly diagnosed pre-B-ALL. She was treated with induction chemotherapy in July 1999 which lead to complete remission. Maintenance treatment with low-dose MTX and 6-mercaptopurine (6-MP) was started in December 1999. In April 2000 she was hospitalized because of fever, cough, and rapidly progressive dyspnea. No pathogens could be cultured from blood or bronchoalveolar lavage fluid. Computed tomography of the lungs revealed interstitial infiltration and ground-glass opacities. Acute pneumonitis was diagnosed, and MTX was stopped. Prednisone therapy lead to rapid clinical amelioration of dyspnea and hypoxemia. Since for this patient there was no alternative leukemia therapy, MTX was successfully reintroduced in August 2000 without reappearance of any respiratory symptoms. We discuss risk profile, clinical and histological presentation, and therapy of MTX-induced pneumonitis. To our knowledge, this is the first patient with ALL in whom successful reintroduction of MTX after severe pneumonitis has been reported.

Topics: Acute Disease; Female; Humans; Mercaptopurine; Methotrexate; Middle Aged; Pneumonia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Remission Induction; Tomography, X-Ray Computed

A 54-year-old man was admitted with pneumonia and pancytopenia (WBC 400/microliters, RBC 297 x 10(4)/microliters, Hb 10.1g/dl, Plt 5.6 x 10(4)/microliter). Bone marrow aspiration revealed a proliferation of leukemic cells (61.6%) and led the diagnosis of AML (M2). Although no antileukemic agent had been administered previously, the combination therapy of antimicrobials and rhG-CSF for the infection not only improved pneumonia, but also induced a complete remission of AML. The short-term remission was followed by the first relapse of AML, in spite of the continuous administration of rhG-CSF. The abnormal karyotype (47, XY, +8) shown in the chromosomal analysis of the bone marrow cells at admission remained on the first remission. The second complete remission was induced by combination chemotherapy (BHAC-DMP), and the chromosomal analysis at this time showed a normal karyotype. These findings suggested that the first remission of AML in this case was caused mainly by the maturation induction effect of rhG-CSF on the leukemic cells, however, the possibility of the spontaneous remission in this case also remained.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Middle Aged; Pancytopenia; Pneumonia; Prednisolone; Recombinant Proteins; Remission Induction

Eighty-four children presenting with acute lymphoblastic leukaemia were entered into a trial designed to test the effect on host toxicity of regular drug-free periods during chemotherapy. Patients received the same total dose of drugs either continuously (daily), intermittently (a 5 d course every 3 weeks) or in an intermediate way between these two (a 14 d course followed by a 7 d gap). Mean neutrophil counts were lower in the intermittent group and fell significantly at 6 week intervals, after courses which included prednisolone and vincristine in addition to methotrexate and 6-mercaptopurine. Mean lymphocyte counts, mitotic response to phytohaemagglutinin and plasma immunoglobulin levels were significantly lower in the continuous group. The results in the intermediate group fell between those of the other two groups. All six remission deaths occurred in the 42 patients in the continuous group, who had a much higher incidence of infections (mostly viral and protozoal) than the other two groups. It is concluded that the intermittent chemotherapy schedule permits the maintenance of a lymphocyte population size and function which provides a satisfactory level of defence against infection without prejudice to its anti-leukaemic effect.

Topics: Adolescent; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Immunoglobulins; Leukemia, Lymphoid; Leukocyte Count; Lymphocytes; Mercaptopurine; Methotrexate; Mitosis; Neutrophils; Pneumonia

On a model of experimental pneumonia in mice caused by the L-forms of bacteria against the background of diminished immunity a study was made of the therapeutic efficacy of penicillin, lincomycin, lysozyme and gamma-globulin. Lincomycin, particularly in combination with biologically-active preparations, proved to be expedience for the treatment and prophylaxis of pneumonia caused by the mentioned bacteria; a rapid arrest of pneumonic process occurred and more animals survived. In the greater percentage of cases the use of penicillin was accompanied by generalization of the process.

Topics: Animals; gamma-Globulins; Humans; Immunosuppression Therapy; Immunosuppressive Agents; L Forms; Leukemia, Lymphoid; Lincomycin; Mercaptopurine; Mice; Muramidase; Penicillins; Pneumonia

Topics: Acute Disease; Animals; Antilymphocyte Serum; Humans; Immunosuppression Therapy; L Forms; Leukemia; Leukocyte Count; Mercaptopurine; Mice; Muramidase; Penicillins; Pneumonia; Prednisolone

Topics: Antineoplastic Agents; Autopsy; Busulfan; Child; Female; Humans; Leukemia; Male; Mercaptopurine; Methotrexate; Middle Aged; Pneumonia; Vincristine

Topics: Agranulocytosis; Asparaginase; Blood Cell Count; Bone Marrow Examination; Child; Cyclophosphamide; Cytarabine; Daunorubicin; Hemoglobins; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Pneumonia; Prednisone; Recurrence; Vincristine

Topics: Adolescent; Adult; Arteries; Azaserine; Azathioprine; Basement Membrane; Creatine; Cryptococcosis; Dactinomycin; Epithelial Cells; Female; Fibrin; Fluorescent Antibody Technique; Follow-Up Studies; Graft Rejection; Hematuria; Humans; Immunoglobulin G; Immunoglobulin M; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Glomerulus; Kidney Papillary Necrosis; Kidney Transplantation; Male; Mercaptopurine; Pneumonia; Prednisone; Proteinuria; Thrombosis; Transplantation Immunology; Transplantation, Homologous

Topics: Adolescent; Agranulocytosis; Candida; Child; Child, Preschool; Enterocolitis, Pseudomembranous; Escherichia coli; Female; Fever; Humans; Infant; Infections; Leukemia; Male; Mercaptopurine; Methotrexate; Mycoses; Pneumonia; Prednisone; Pseudomonas aeruginosa; Remission, Spontaneous; Sepsis; Staphylococcus; Time Factors; Vincristine

Topics: Adolescent; Adult; Aged; Anemia; Blood Platelets; Blood Transfusion; Blood Urea Nitrogen; Bone Marrow Cells; Bone Marrow Examination; Chromosome Aberrations; Cytomegalovirus; Female; Fever; Hemorrhage; Humans; Jaundice; Leukemia, Myeloid; Leukocyte Count; Leukocytes; Leukopenia; Male; Mercaptopurine; Methotrexate; Middle Aged; Nocardia Infections; Pneumonia; Prednisone; Proteus Infections; Pseudomonas Infections; Sepsis; Thrombocytopenia; Vincristine

Topics: Child; Child, Preschool; Chronic Disease; Female; Humans; Male; Mercaptopurine; Pneumonia

Topics: Aged; Anemia, Hemolytic, Autoimmune; Antibodies; Cellulose; Chromatography; Complement System Proteins; Female; Heart Failure; Hemagglutination Tests; Hematocrit; Hemoglobinuria; Hemolysin Proteins; Humans; Mercaptopurine; Methicillin; Myocardial Infarction; Pneumonia; Prednisolone

Topics: Bone Marrow; Chloramphenicol; Female; Hematocrit; Hemoglobinometry; Humans; Leukemia, Myeloid, Acute; Leukocyte Count; Leukopenia; Lupus Erythematosus, Systemic; Mercaptopurine; Middle Aged; Pneumonia; Prednisone

Topics: Allergy and Immunology; Blood Group Antigens; Dactinomycin; Glomerulonephritis; Graft Rejection; Hemagglutination; Hominidae; Imidazoles; Kidney; Kidney Function Tests; Kidney Transplantation; Mercaptopurine; Nephrosclerosis; Pneumonia; Prednisone; Radioisotopes; Radionuclide Imaging; Radiotherapy; Urography

Topics: Bronchospirometry; Dogs; Gastrointestinal Hemorrhage; Imidazoles; Lung; Lung Abscess; Mediastinal Emphysema; Mercaptopurine; Methotrexate; Pneumonia; Radiography, Thoracic; Research; Transplantation; Transplantation Immunology; Transplantation, Homologous