title: Low infectious morbidity after intensive chemotherapy and autologous peripheral blood progenitor cell transplantation in the outpatient setting for women with breast cancer.
abstract: Autologous peripheral blood progenitor cell (PBPC) transplantation is increasingly employed in the outpatient setting, yet data on early complications following PBPC transplantation are scant. We evaluated 105 women with high-risk primary or metastatic breast cancer who were treated at a single institution during 1996--1997. The mean duration of neutropenia (absolute neutrophil count, <500 cells/mm(3)) was 7.5 days. Twenty-nine percent of women remained afebrile throughout the neutropenic period. Of the remaining 71%, most (64 of 75) had fever of unknown origin. Infections, mostly of mild severity, occurred in 34% of women; these infections included bacteremia due to gram-positive organisms, catheter site infection, cellulitis, pneumonia, oral candidiasis, herpes simplex virus infection, and vaginitis. Fifty percent of PBPC transplant recipients required hospital admission, usually because of persistent fever; the mean duration of hospitalization was 3 days. No deaths or serious adverse events occurred. Such reduced infectious morbidity may be a consequence of minimal oral and/or gastrointestinal mucositis associated with the conditioning regimen and broad-spectrum antimicrobial prophylaxis used for this patient population.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA. pchandrasekar@intmed.wayne.edu
authors.forename: P H
authors.initials: PH
authors.lastname: Chandrasekar
authors.forename: O C
authors.initials: OC
authors.lastname: Abraham
authors.forename: J
authors.initials: J
authors.lastname: Klein
authors.forename: G
authors.initials: G
authors.lastname: Alangaden
authors.forename: G
authors.initials: G
authors.lastname: Chalasani
authors.forename: L
authors.initials: L
authors.lastname: Cassells
authors.forename: R
authors.initials: R
authors.lastname: Dansey
authors.forename: S
authors.initials: S
authors.lastname: Abella
authors.forename: C
authors.initials: C
authors.lastname: Karanes
authors.forename: W
authors.initials: W
authors.lastname: Peters
authors.forename: R
authors.initials: R
authors.lastname: Baynes
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000628:therapy*; D002330:Carmustine / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D008875:Middle Aged; D009017:Morbidity; D014182:Transplantation, Autologous
chemical_list: D000890:Anti-Infective Agents; D003520:Cyclophosphamide; D002945:Cisplatin; D002330:Carmustine