Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China

Bone Marrow Transplantation volume 53, pages 219–222 (2018)Cite this article

Subjects

Appendicitis is a rare but life-threatening complication in patients undergoing haematopoietic stem cell transplantation (HSCT). Infectious complications arising from the gastrointestinal tract are common in immunocompromised patients with haematologic malignances.1, 2 Serious infection often occurs in neutropaenic patients, especially during HSCT. Acute appendicitis is frequently reported in leukaemia patients after chemotherapy but is rarely reported during HSCT. The Alvarado Scoring System (the MANTRELS acronym stands for ‘Migration, Anorexia-acetone, Nausea-vomiting, Tenderness in right quadrant, Reboud pain, Elevation of temperature, Leukocytosis, Shif to the left’), which is shortened to ASS-MANTRELS, has been used to diagnose acute appendicitis.3 However, acute appendicitis occurred in HSCT patients during the neutropaenic phase. The indexes of leukocytosis and shift to the left (LS) of the ASS-MANTRELS were not applicable to these patients. Therefore, a standard criterion applicable for such patients who underwent HSCT was set up. Here we report 10 cases of acute appendicitis, which were selected from 776 sequential HSCTs.

Patients who underwent HSCT from 2006 to 2016 in the Hematological Department of Nanfang Hospital at Southern Medical University were reviewed. The inclusion criteria are as follows: (1) upon diagnosis of a malignant haematologic disease, a transplant with PBSC, bone marrow (BM) or both was performed; and (2) acute appendicitis occurred during −10~+60 days. The ASS-MANTRELS was applied to diagnose acute appendicitis, which is characterized by a total score of 10. A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates probable appendicitis and a score of 9 or 10 indicates very probable appendicitis.3 We selected those cases with scores from 5 to 10. Indicators and measurements of the primary diagnosis, remission condition, underlying disease, conditioning regimen, cell resources, clinical characteristics, routine blood test, ultrasonography, therapy methods and prognosis of acute appendicitis were collected. The relationship between these factors and acute appendicitis was analysed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Forghieri F, Luppi M, Narni F, Morselli M, Potenza L, Bresciani P et al. Acute appendicitis in adult neutropenic patients with hematologic malignancies. Bone Marrow Transplant 2008; 42: 701–703.

    Article  CAS  Google Scholar 

  2. Gray T, Ooi CY, Tran D, Traubici J, Gerstle JT . Gastrointestinal complications in children with acute myeloid leukemia. Leuk Lymphoma 2010; 51: 768–777.

    Article  Google Scholar 

  3. Alvarado A . A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557–564.

    Article  CAS  Google Scholar 

  4. Xia S . Diagnosis and Treatment of Abdominal Surgical Emergency. The World Book Publishing Company: Xian, 2003, pp 309.

    Google Scholar 

  5. Warad D, Kohorst MA, Altaf S, Ishitani MB, Khan S, Rodriguez V et al. Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient. Leuk Res Rep 2015; 4: 21–23.

    PubMed  PubMed Central  Google Scholar 

  6. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 2006; 241: 83–94.

    Article  Google Scholar 

  7. Kontoyiannis DP, Mathur M, Chen YB, Shellito PC, Tse JY . Case records of the Massachusetts General Hospital. Case 13-2014. A 41-year-old man with fever and abdominal pain after stem-cell transplantation. N Engl J Med 2014; 370: 1637–1646.

    Article  CAS  Google Scholar 

  8. Aiping H . Application of ultrasound and modified Alvarado scoring system in the diagnosis of adult acute appendicitis. Med Inform 2017; 30: 281–282.

    Google Scholar 

  9. Singer J, Stringel G, Ozkaynak MF, McBride W, Pandya S, Sandoval C . Laparoscopic surgery for acute appendicitis in children with cancer. J Soc Laparoendosc Surg 2015; 19: e2015–e2066.

    Article  Google Scholar 

  10. Rodriguez EA, Lopez MA, Valluri K, Wang D, Fischer A, Perdomo T . Acute appendicitis secondary to acute promyelocytic leukemia. Am J Case Rep 2015; 16: 73–76.

    Article  Google Scholar 

  11. Kim EY, Lee JW, Chung N, Cho B, Kim H, Chung JH . Acute appendicitis in children with acute leukemia: experiences of a single institution in Korea. Yonsei Med J 2012; 53: 781–787.

    Article  Google Scholar 

  12. Chirletti P, Barillari P, Sammartino P, Cardi M, Caronna R, Arcese W et al. The surgical choice in neutropenic patients with hematological disorders and acute abdominal complications. Leuk Lymphoma 1993; 9: 237–241.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the NSFC (numbers 30901367 and 31070866), the Natural Science Foundation of Guangdong Province (2016A030313585) and the Natural Science Foundation of Nanfang Hospital (numbers 2010037 and G2011021).

Author information

Authors and Affiliations

  1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangdong, China,

    Q Zhang, Y Zhou, Q Mai, Y Zhang, Z Fan, F Huang, J Sun, Q Liu & Q Jiang

  2. Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangdong, China,

    J K Majaw

  3. First Clinical Medical College, Southern Medical University, Guangdong, China,

    J Xu, Z Wei & C Zou

Authors
  1. Q Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J K Majaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Z Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Q Mai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Y Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Z Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Q Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Q Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Q Liu or Q Jiang.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, Q., Zhou, Y., Majaw, J. et al. Acute appendicitis in leukaemia patients undergoing haematopoietic stem cell transplantation during the neutropaenic phase: a case series from a single BMT centre in China. Bone Marrow Transplant 53, 219–222 (2018). https://doi.org/10.1038/bmt.2017.209

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2017.209

Search

Advanced search

Quick links