The efficacy of prophylactic outpatient antibiotics for the prevention of neutropenic fever associated with high-dose etoposide (VP-16) for stem cell mobilization.
High-dose etoposide (2 g/m(2)) plus G-CSF is a very effective regimen for peripheral blood progenitor cell (PBPC) mobilization. Unfortunately, neutropenia is common. The infectious complications associated with high-dose etoposide have not been previously described. After noting a high incidence of hospitalizations for neutropenic fever, we began a vigorous prophylactic antibiotic regimen for patients receiving high-dose etoposide plus G-CSF, attempting to reduce infectious complications. Ninety-eight patients underwent etoposide mobilization between December 1997 and June 2000. Three chronological patient groups received: (1) no specific antibiotic prophylaxis (n = 44); (2) vancomycin i.v., cefepime i.v., clarithromycin p.o., and ciprofloxacin p.o. (n = 27); and (3) vancomycin i.v., clarithromycin p.o., and ciprofloxacin p.o. (n = 27). The patients not receiving antibiotic prophylaxis had a 68% incidence of hospitalization for neutropenic fever. In the patients receiving prophylaxis, the incidence was reduced to 26% and 15% respectively, for an overall incidence of 20% (P < 0.001 for comparison between prophylaxed and unprophylaxed groups). We conclude that etoposide mobilization is associated with a significant incidence of neutropenic fever, which can be substantially reduced by a vigorous antimicrobial prophylactic program.
Avery
R K
RK
Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Pohlman
B L
BL
Mossad
S B
SB
Goormastic
M
M
Longworth
D L
DL
Kalaycio
M E
ME
Sobecks
R M
RM
Andresen
S W
SW
Kuczkowski
E
E
Bernhard
L
L
Ostendorf
H
H
Wise
K
K
Bolwell
B J
BJ
D000553:Ambulatory Care; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects; D002939:Ciprofloxacin / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D003625:Data Collection; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000517:prevention & control*; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D009894:Opportunistic Infections / Q000517:prevention & control; D014640:Vancomycin / Q000008:administration & dosage
D002511:Cephalosporins; D002939:Ciprofloxacin; D005047:Etoposide; D014640:Vancomycin; D000077723:Cefepime; D017291:Clarithromycin