Infectious morbidity after non myeloablative allogeneic bematopoietic stem cell transplantation (AHSCT)

A. Thiebaut, D. Antal, K. Bilger, M. Michallet, D. Fiere

Author address: 

Hematology Department, E. Herriot Hospital, Lyon, France

Abstract: 

Objective: Non myeloablative conditioning regimen (NMCR) for AHSCT have been developed to reduce procedure-related toxicity. The aim of this approache is to extend indications of AHSCT to patients (pts) who are not eligible previously for high dose chemotherapy or total body irradiation. We describe infectious morbidity related to this new procedure in our unit in a retrospective study. Results: 45 AHSCT with NMCR were performed in our unit between 1997 to 2001,32 males, 13 females, with a median age of 48 years (range 18-62). Hematologic diagnosis were 8 AL, 12 MM, 2 CML, 5 NHL, 3 MDS, 6 Hodgkin diseases, 3 CLL, 6 solid tumors. Engraftment was observed in all pts with a median of 21 days (range 12119) for PNN >0.5 g/l, and 18 days (range O-201) for platelets >50 g/l. Ten pts received donor lymphocyte infusions (DLI). Nineteen pts (48.7%) presented acute GVHD: 7 without any DLI, 4 before DLI and 8 after DLI (2 grade 1,7 grade 2,4 grade 3 and 2 grade 4). Nineteen pts (42%) presented 39 infections : 1 episode, II = 7; 2 episodes, II = 7; 3 episodes, it = 3; 4 episodes, n= 1; 5 episodes, y1= 1. Twenty two infections (56.5 %) occured in 13 pts during 3 months post transplant : 18 septicemia (12 Gram-negative bacilli, 5 Gram-positive cocci, one yeast), 1 septic chock without documentation, 2 cytomegalovirus (CMV) infections, 1 zoster. Only 4 of these infections occured after engraftment (3 bacterial septicemia and 1 CMV disease). The pt with fungal septicemia died before engraftment. We observed 17 late infections (43.5%) in 11 pts : 3 septicemia, 1 septic chock without documentation, 2 CMV diseases, 6 probable invasive aspergillosis, 1 zoster, 1 Campylobacter colitis, 1 Staphylococcus aureus pneumonia, 1 EBV lymphoma and 1 enterovirus encephalitis. Overall, bacterial infections were observed in 56% of cases, viral in 20% and fungal in 18%. No infection occured in 26 pts (58%). Five pts with hematologic malignancy relapse presented a probable invasive aspergillosis. Twenty eight pts died (62%) 16 in relapse, 9 (32%) with infection : 1 fungal septicemia, 1 viral encephalitis, 1 hepatitis, 6 invasive aspergillosis. Conclusion: Most of infections observed after AHSCT with NMCR were bacterial in our experience.
2002

abstract No: 

s38

Full conference title: 

12th International Symposium on Infections in the Immunocompromised Host
    • ISIIH 12th