title: Development of early neutropenic fever, with or without bacterial infection, is still a significant complication after reduced-intensity stem cell transplantation.
abstract: Little information is available on the clinical characteristics of infectious complications that occur in the early period after reduced-intensity stem cell transplantation (RIST). We retrospectively investigated the clinical features of neutropenic fever and infectious episodes within 30 days after RIST in 76 patients who had received fluoroquinolones as part of their antibacterial prophylaxis. Preparative regimens included cladribine 0.66 mg/kg or fludarabine 180 mg/m2 plus busulfan 8 mg/kg. All but 1 patient survived 30 days after transplantation, and 75 patients (99%) became neutropenic within a median duration of 9 days. Neutropenic fever was observed in 29 patients (38%), and bacterial infection was confirmed in 15 (20%) of these, including bacteremia (n = 13), bacteremia plus pneumonia (n = 1), and urinary tract infection (n = 1). The causative organisms were gram-positive (n = 9) and gram-negative organisms (n = 7), with a mortality rate of 6%. Neither viral nor fungal infection was documented. Multivariate analysis showed that the presence of neutropenia at the initiation of preparative regimens was an independent risk factor for subsequent documented bacterial infections (P =.026; 95% confidence interval, 1.25-35.1). We conclude that neutropenic fever and bacteremia remain common complications in RIST.
authors.affiliation: Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Hori
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Aki
authors.initials: A
authors.lastname: Chizuka
authors.forename: Rie
authors.initials: R
authors.lastname: Kojima
authors.forename: Osamu
authors.initials: O
authors.lastname: Imataki
authors.forename: Michiyo
authors.initials: M
authors.lastname: Sakiyama
authors.forename: Tamae
authors.initials: T
authors.lastname: Hamaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Onishi
authors.forename: Noriko
authors.initials: N
authors.lastname: Usubuchi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Kinuko
authors.initials: K
authors.lastname: Tajima
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Heike
authors.forename: Shigeru
authors.initials: S
authors.lastname: Masuo
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D017338:Cladribine / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000209:etiology; D024841:Fluoroquinolones / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D017338:Cladribine; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine