[Infection in patients with neutropenia that undergo an autologous peripheral blood stem cell transplant due to breast cancer].
BACKGROUND
The extent and duration of neutropenia and the characteristics of the underlying disease are determinant factors for the prognosis of febrile syndromes. Despite the fact that traditionally the peripheral blood stem cell transplantation (PBSCT) were considered to cause high risk neutropenia, in all probability the neutropenia observed in the PBSCT in some solid tumours could be considered moderate risk. Febrile episodes in patients with these characteristics were evaluated.


METHODS
We prospectively analysed 132 autologus PBSCT in patients with breast cancer (1994-1999). Conditioning regime: STAMP V. Antibacterial prophylaxis: ofloxacin (400 mg/12 hrs PO). Classification of the febrile syndrome: bacteremia, microbiologically documented infection withut bacteremia, clinical infection and a fever of unknown origin.


RESULTS
122 patients had a fever (92%), mean age: 45 years (range: 27-61). There were 32 (26%) bacteremias, 13 (11%) microbiologically documented infections without bacteremia and 54 (44%) clinical infections. The mean number of days with a neutrophil count of <1x109/1 was 14 (range: 11-20). In the 74 patients (61%) that had a granulocyte colony stimulating factor (G-CSF), the mean number of days to reach a 0,5x109/I neutrophil count (7,6) and the average number of days in hospital (26) were significantly less. There was a main infectious point in 80 patients (65%): the most frequent being oropharynx in 33 cases (46%) and digestive in 29 cases (41%). 48 gram negative (GN) 29 gram positive (GP) bacteria were isolated (71% of the GN's were resistant to ofloxacin). Between 1997-1999 the GN/GP ratio was 2,3. There were no deaths related to the infection.


CONCLUSIONS
Given the excellent evolution of our patients we can consider their neutropenia to be moderate or low risk, and they are a long way from the death rates caused by infections published by other types of hemopoietic transplants. The predominance of GN over the last few years and their limited sensitivity to quinolones means that their prophylactic use in these patients should be reconsidered.
Palau
J
J
Unidad de Trasplante de Médula Osea, Fundación Instituto Valenciano de Oncología, Valencia, Spain. jpalau@ene.es
Picón
I
I
Angel Climent
M
M
Martí
R
R
Aznar
E
E
Carmen Sanjuán
M
M
Máiquez
J
J
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004351:Drug Resistance; D005260:Female; D005334:Fever / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D017053:Infection Control; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D015242:Ofloxacin / Q000494:pharmacology / Q000627:therapeutic use; D011292:Premedication; D011446:Prospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D000935:Antifungal Agents; D000998:Antiviral Agents; D016179:Granulocyte Colony-Stimulating Factor; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D003520:Cyclophosphamide; D015242:Ofloxacin; D016190:Carboplatin; D000212:Acyclovir