1990 Volume 64 Issue 6 Pages 653-660
Two hundred and sixty-two patints (actual number 162) of hemalotogical malignancies were admitted to our department from November 1977 to December 1986. Fourty-three of them (16.4%) were demonstrated to be accompanied with sepsis by blood culture. In acute non-lymphocytic leukemias (AML, APL, AMoL) the rate of sepsis was 33.8%(27 patients), while in lymphocytic malignancies (ML, HD, ATL) it was 11.7%(16 patients), particularly being 3.0% in ATL.
Among the detected pathogenic microorganisms, gram-negative bacilli were 86.2% in the former and 50.0% in the latter. Especially, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli occupied 58.6% of the total in the former.
Laboratory examination, when sepsis occured, revealed peripheral neutropenia in acute nonlymphocytic leukemias (mean 831/cmm) but not in lymphocytic malignancie (mean 4, 420/cmm). And 20 of the 27 cases showed remarkable neutropenia of below 500/cmm in the former. On the other hand in the latter, out of 16 only one with ATL was the case.
Hypogammaglobulinemia was one of the characteristic features in lymphocytic malignancies but not in acute non-lymphocytic leukemias. Hypogammaglobulinemia in lymphocyic malignancies might be affected by long-term immunodepressant therapy.
Immunologic skin rection was demonstrated to be decreased in lymphocytic maliganacies on admission.
From the findings mentioned above, affecting factors to infections may be mainly neutropenia in acute non-lymphocytic leukemias and immunodeficiency in lymphocytic malignancies. And sepsis can occur frequently under neutropenic condition. In ATL both of humoral-and cellular-immunologic disturbance were detected before therapy. But peripheral neutrophil count was maintained to be normal and this could be the reason for the low septic incidence in ATL despite of total immunodepression.
