INFECTIOUS COMPLICATIONS DEVELOPED DURING NEUTROPENIA IN 88 PATIENTS TREATED BY HIGH DOSE CHEMOTHERAPY AND SUBSEQUENT AUTOLOGOUS BLOOD STEM CELL TRANSPLANT (BSCT)

J. Frankard*, A. Kentos*, W. Feremans

Abstract: 

In order to characterize the various infections acquired by neutropenic patients in the framework of BSCT, we retrospectively reviewed 97 grafts performed in 88 cancer patients (hematological tumors n = 73; solid tumors n = 15). The mean value of CD34 infused was 4.1 x 106 cells/kg and all patients received G-CSF the day after the graft. Bacterial prophylaxis consisted of ciprofloxacine, yeast prevention of fluconazole and anti-viral cover of acyclovir. The first episode of febrile neutropenia (FN) was empirically treated with a large spectrum b-lactamine (ceftazidim/imipenem/meropenem) and amikacin. Finally, we investigated the variations in the maximum CRP value, duration of neutropenia and of fever according to the type of infection by dividing our patients into four groups: Group I pts with septicemia and/or disseminated infection, Group II pts with localized infection clinically or microbiologically demonstrated, Group III pts with a fever of undetermined origin (FUO) and Group IV non-febrile pts. FN developed in 83% of the grafts and 55% of these episodes were attributed to a clinically or microbiologically documented infection. Bacteremia was by far the most frequent infectious complication [22%; 68% of Gram(+) Vs 32% of Gram(-)]. Streptococcus viridans (n = 9) and Staphylococcus epidermidis (n = 4) were the Gram(+) predominantly isolated. Pneumopathy occurred with an incidence of 12% but only three agents were identified: Pneumococcus (n = 1), Influenza A (n = 1) and Aspergillus terreus (n = 1). We had three cases of disseminated infections: CMV viremia, hepato-splenic candidiasis and generalized toxoplasmosis. The other infectious complications included HSV1 and/or Candida mucositis (n = 7), Clostridium difficile diarrhea (n = 7), maxillary sinusitis (n = 1), ethmoidal sinusitis (n = 1) and cellulitis (n = 1). A total of four patients died in an infectious context. The mean length of severe neutropenia (PMN
1998

abstract No: 

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Full conference title: 

40th Annual Meeting of the American Society of Hematology.
    • ASH 40th (1999)