INFECTIOUS COMPLICATIONS DEVELOPED DURING NEUTROPENIA IN 88 PATIENTS TREATED BY HIGH DOSE CHEMOTHERAPY AND SUBSEQUENT AUTOLOGOUS BLOOD STEM CELL TRANSPLANT (BSCT)
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 <500/Âµl) in our population was 9 days and 5.5 days the mean time of defervescence. In comparing the maximum CRP value, the length of severe neutropenia and the duration of fever for the four different groups, we obtained the following results. For the maximum CRP value there was no difference (p = 0.32) between pts with septicemia and/or disseminated infection (Group I) and those with a localized infection (Group II). There was however a statistically significant difference between infected pts (Group I & II) and pts with a FUO (Group III): Group I-III p = 0.00045 and Group II-III p = 0.017. Furthermore, pts with a FUO had a significantly different (p = 0.001) CRP value from the non-febrile pts (Group IV). The duration of fever was similar in Group I and Group II (p = 0.23) but different for infected pts (Group I & II) and pts with a FUO: Group I-III p = 0.0089 and Group II-III p = 0.00089. Finally, there was no difference in the duration of neutropenia when comparing the four groups (p = 0.51). Our results confirm the low morbidity and mortality associated with infectious complications arising after autologous BSCT.
- ASH 40th (1999)
Full conference title:
40th Annual Meeting of the American Society of Hematology.