Infections following peripheral blood progenitor cell transplantation for lymphoproliferative malignancies: etiology and potential risk factors.
OBJECTIVE
We sought to describe the infections that occur after large-dose chemotherapy, which was followed by autologous peripheral blood progenitor cell transplantation, and to determine their risk factors.


METHODS
We retrospectively analyzed the occurrence and the characteristics of infections in 277 consecutive patients who received intensive chemotherapy for non-Hodgkin's lymphoma (n = 207), Hodgkin's disease (n = 27), or multiple myeloma (n = 43) in a single institution. Conditioning regimens included total body irradiation in 47% of the cases. Infections occurring within the 30 days after transplant were defined as early infections, whereas infections after that time in patients who had achieved a neutrophil count greater than 1.0 x 10(9)/L (1,000 per microL) were considered as late infections.


RESULTS
Within the first 30 days, 172 patients had unexplained fever (62%); infections were documented in 83 patients (30%), most commonly bacteremia (57 patients). Late infections occurred in 64 (26%) of 244 evaluable patients and consisted mainly of varicella zoster virus infections (n = 36) and pneumonia (n = 16). Administration of total body irradiation [odds ratio (OR) = 2.50; 95% confidence interval (CI) 1.4 to 4.5; P = 0.002) and previous use of fludarabine (OR 2.5; CI 1.2 to 5.2; P = 0.02) and a diagnosis of myeloma (OR 2.6; CI 1.2 to 5.6; P = 0.04) were significantly associated with late infections.


CONCLUSIONS
This study confirms that infectious toxicity after peripheral blood progenitor cell transplantation is usually moderate, although bacteremia remains a serious problem. Late infections are encountered in about 25% of patients and are more common in those with myeloma, or those who received total body irradiation or fludarabine.
Ketterer
N
N
Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon and UPRES-JE 1879 Hémopathies Lymphoïdes malignes, Université Claude Bernard, Pierre-Bénite, France.
Espinouse
D
D
Chomarat
M
M
Dumontet
C
C
Moullet
I
I
Rieux
C
C
Neidhardt-Berard
E M
EM
Bouafia
F
F
Coiffier
B
B
Salles
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia / Q000209:etiology; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000209:etiology*; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000970:Antineoplastic Agents