title: Infectious complications in patients receiving mobilization chemotherapy for autologous peripheral blood stem cell collection.
abstract: The purpose of this retrospective study was to evaluate infectious complications in patients receiving mobilization chemotherapy for stem cell collection prior to autologous peripheral blood stem cell transplantation. An additional goal was to evaluate risk factors associated with the development of infectious complications. At the Medical College of Georgia BMT center, 54 patients were administered mobilization chemotherapy for the purpose of collecting stem cells between June, 1997, and May, 2002. All patients received Filgrastim in addition to chemotherapy, and 50 of 54 patients received prophylactic acyclovir, fluconazole, and ciprofloxacin until neutrophil recovery. The median duration to neutrophil recovery was 11 days. Fourteen of 54 (26%) patients developed fever/infections during the mobilization phase. One patient developed both a catheter-related infection and Clostridium difficile colitis, increasing the total number of infectious episodes to 15. Twelve patients had a documented site of infection whereas 2 patients had neutropenic fever with no identifiable source. Eight of the 15 (55%) infections were Gram-positive catheter infections. All the patients were treated successfully with antibiotics. No systemic fungal infections were identified and none of the patients died from complications related to mobilization chemotherapy. Logistic regression was applied for univariate and multivariate analysis and showed that age, sex, diagnosis, neutrophil recovery, disease status, use of salvage chemotherapy, and mobilization regimen used did not affect the infection rate. In our series of 54 patients, 14 patients developed fever/infections during mobilization. Although there is a substantial risk of infectious complications among patients who receive mobilization chemotherapy, it is not clear that prophylactic antibiotics decrease infectious complications. Because the vast majority of infections are Gram-positive catheter infections, it appears reasonable to employ Gram-positive prophylaxis. Controlled studies should be conducted to define the optimum mobilization regimens as well as the optimum combination of prophylactic antibiotics.
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, Medical College of Georgia, Augusta 30912, USA. jillelap@TUHS.Temple.edu
authors.forename: Anand P
authors.initials: AP
authors.lastname: Jillella
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.forename: Eric
authors.initials: E
authors.lastname: Robach
authors.forename: Durdu
authors.initials: D
authors.lastname: Sertkaya
authors.forename: Cecily
authors.initials: C
authors.lastname: DiPiro
authors.forename: Andre M
authors.initials: AM
authors.lastname: Kallab
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Brick
authors.forename: Paul M
authors.initials: PM
authors.lastname: Dainer
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kutlar
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Townsend
authors.forename: Russell E
authors.initials: RE
authors.lastname: Burgess
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects*; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous
chemical_list: D000890:Anti-Infective Agents; D000970:Antineoplastic Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim