Study On The Changes Of Intestinal Immune Function And Micro - Ecology Before And After Chemotherapy In Patients With Hematological Malignancies

[Background and Objectives] In the recent years, cytotoxic chemotherapy is a common treatment for patients with hematologic malignancies. Since their immune system is compromised, the patients are vulnerable to infections which may rapidly become life-threatening if not treated appropriately and promptly. However, the sensitivity of microbial culture tests remains low which may get the situation worse or lead to death. Febrile neutropenia in hematological patients has now become a major cause of morbidity and mortality in these patients. The objective of this study was to evaluate the changes of intestinal microflora and immune function of gut in the hematological patients after chemotherapy treatment.[Design and Methods] We conducted a prospective cohort study. Patients with primary hematological malignancies in the department of hematology or oncology were included in the study, and blood and feces samples before and after chemotherapy were collected. Depending on the temperature of the patients, they were divided into neutropenia with fever group and neutropenia without fever group. The levels of D-lactic acid in the blood, immunoglobulin A and intestinal microflora in feces were examined to investigate the impact of chemotherapy.[Results] From September2012to February2013, a total of24patients were included in the study. The ages of the patients included were between31to70, and the average age is57.0years old. There were17males (37.5%) and7females (29.2%).Patients with leukemia were11(45.8%), with lymphoma were9(37.5%), and with other hematologic malignancies were4(16.7%). There were11(45.8%) patients with febrile after chemotherapy; the other13(54.2%) subjects were not. After the chemotherapy, the level of immunoglobulin A in the feces and B/E value were significance decreased. There were some changes in their intestina microflora, with more enterobacteria、pseudomonas and fungal after chemotherapy. However the, the levels of D-lactic acid were almost the same. Compared with patients without fever, the febrile neutropenia group had more increments in the number of enterobacteria and clostridia. The two groups had no significance difference in the level of immunoglobulin A in the feces and B/E value.[Conclusions] Worse immune function colonization resistance and more invasive bacteria were found after chemotherapy in hematological patients, which may become the pathogenic bacteria in febrile neutropenia patients.