[Late infectious complications after high-dose therapy and autologous blood stem cell transplantation].
OBJECTIVE
Only a few data on frequency and character of late infectious complications after high-dose therapy (HDT) and autologous blood stem cell transplantation (ASCT) have been published. This prospective study was carried out to identify potential predictive factors for late infections (occurring after discharge following HDT) and to clarify the usefulness of prophylactic measures.


METHODS
Clinical data of 192 consecutive patients treated with HDT and ASCT in a single hospital were analyzed on late infectious complications. After discharge following HDT, the 166 evaluable patients (84 with hematologic malignancies, 82 with solid tumors) had been examined and interviewed on infections every 4-12 weeks after ASCT. For Pneumocystis carinii prophylaxis, inhalation with pentamidine or oral cotrimoxazole was used for 3-4 months following ASCT.


RESULTS
In the first 6 months following ASCT (after discharge) we saw on average one infectious episode per patient (median, range 0-6), usually light infections (mostly banal upper airway infections). 17 patients had to be treated in hospital for infectious (15 of whom with hematologic malignancies), three of whom (only with hematologic malignancies) died in spite of intensive care as a result of pneumonias due to opportunistic causative agents (mainly Pneumocystis carinii [PcP]). In the second half of the year after ASCT, five patients (with hematologic malignancies) had to be hospitalized due to infections. No further infection-related death occurred. Early documented infections (pneumonia, bacteremia or Clostridium difficile colitis) were associated with an increased risk for late serious infections. Zoster occurred in 18% of patients within 12 months, more frequently after increased pretreatment (25% vs. 11% after less pretreatment), most frequently in patients with relapsed lymphomas (32%).


CONCLUSIONS
Significant late infectious complications after ASCT are uncommon. Patients with hematologic malignancies have a significantly increased risk of more serious infections and should be observed carefully. For risk patients with hematologic malignancies and possibly solid tumors, a strict PcP prophylaxis is required. Patients with relapsed lymphomas could possibly be treated preventively against zoster with low-dose aciclovir to reduce the extent of zoster disease. Each patient should be informed carefully that early signs of zoster require an effective zoster treatment as soon as possible.
Metzner
Bernd
B
Klinik für Innere Medizin II, Klinikum Oldenburg, Germany. metzner.bernd@klinikum-oldenburg.de
Grüneisl
Ricarda
R
Gebauer
Wolfgang
W
Reschke
Daniel
D
Ost
Ekkehard
E
Müller
Thomas H
TH
Reichert
Dietmar
D
Rosien
Bernd
B
Del Valle
Francisco
F
Zirpel
Iris
I
Kohse
Klaus Peter
KP
Schunter
Friedrich
F
Illiger
Hans-Jochen
HJ
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D006562:Herpes Zoster; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy*; D011020:Pneumonia, Pneumocystis; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D013997:Time Factors
D000970:Antineoplastic Agents