TNFα and IFNγ, EARLY KINETICS DURING FEVER IN PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES AND NEUTROPENIA

Patients with hematological malignancies often experience long periods of profound neutropenia and in 20 - 40% of febrile episodes bacteria grow in blood culture. An altered cytokine response to bacterial infections may be anticipated in those patients.
The aim of this study is to define the levels of early TNFα and IFNγ release in febrile neutropenic patients and relate this information to blood culture results and clinical findings. In this work serum concentrations of TNFα and lFNγ were studied in 31 patients with haematological malignancies presented with fever. Blood samples were collected for TNF α and IFNγ analysis at time 0 and after 24 hours of start of fever. Blood cultures were performed for all patients at time 0. Increased levels of TNFα and IFNγ were detected at start of fever with peak values for both cytokines after 24 hours for Gram negative bacilli (Gm-ve) infections (P = 0.0) for both cytokines compared to 0 time levels). In neutropenic patients, there was a highly significant rise in both TNF α and IFNγ levels after 24 hrs (P= 0.007 & 0.001 respectively) compared to 0 time levels. There were also significant rise in both cytokines levels in cases with septic shock (P = 0.02 for TNF α and P = 0.04 for IFNγ) compared to 0 time levels.
TNF α and IFNγ can be used as early diagnostic tools in neutropenic patients with Gm-ve bacteraemia who may develop septic shock before results of blood cultures are available and this may have important therapeutic implications.
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