Infections after reduced-intensity conditioning for allogeneic blood stem cell transplantation in metastatic solid tumours

L. Barkholt, M. Blomkvist, P. Hentschke, L. Klingspor, I. Lewensohn-Fuchs, J. Mattsson, R. Milosavljevic, P. Pisa, M. Remberger, P. Svenberg, A. Thörne, P. Wersäll, O. Ringdén

Author address: 

Karolinska Institutet (Stockholm, S)

Abstract: 

Objective: What is the incidence of infections in patients with metastatic solid tumors during the first year after reduced intensity conditioning (RIC) and allogeneic stem cell transplantation (SCT)? Methods and Patients: In total 20 patients, 8 with metastatic colorectal, 12 with renal carcinoma, and metastases in all, underwent allogeneic SCT. RIC included Flu 30 mg/m2 for 3 days, using sibling donors and 5 days using unrelated donors followed by 2 Gy TBI or Cy (60mg/kg for 2 days). Antithymoglobuline 4 mg/kg was administrated to patients with unrelated donors (n=6). Peripheral blood stem cells were collected after G-CSF stimulation of all donors. The CD34+ cell dose was median 7.5x106/kg (1.7-21.8). Immunosuppression was by CyA, combined with MMF (n=16) or MTX. Results: Bacterial septicemia was found in 6 patients within 6 months after SCT, associated with central venous line (Staph. epidermidis 4 cases), urosepticemia (Enterococcus faecalis 1 case) or acute GVHD of the bowel (Pseudomonas aeruginosa, E.coli 1 case each). Fungal infection was diagnosed by PCR in 11 patients (Candida albicans in 8 or aspergillus fumigatus in 9 patients), but only one patient suffered from fungal septicemia. CMV infection and syndrome developed in 13 and 3 patients, respectively. In 6 patients, CMV reactivated after the initial preemptive antiviral therapy. No organ invasive fungal or CMV disease developed. No infections were seen after 6 months. The cumulative incidence of grades II-IV acute GVHD was 57%. CMV disease was associated with aGVHD (p=.05). Thirteen patients died =
2004

abstract No: 

P769

Full conference title: 

30th Annual Meeting of the European Group for Blood and Marrow Transplantation
    • EBMT 2004