Development of early neutropenic fever, with or without bacterial infection, is still a significant complication after reduced-intensity stem cell transplantation.
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.
Hori
Akiko
A
Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan.
Kami
Masahiro
M
Kim
Sung-Won
SW
Chizuka
Aki
A
Kojima
Rie
R
Imataki
Osamu
O
Sakiyama
Michiyo
M
Hamaki
Tamae
T
Onishi
Yasushi
Y
Usubuchi
Noriko
N
Kishi
Yukiko
Y
Murashige
Naoko
N
Tajima
Kinuko
K
Miyakoshi
Shigesaburo
S
Heike
Yuji
Y
Masuo
Shigeru
S
Taniguchi
Shuichi
S
Takaue
Yoichi
Y
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*
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D017338:Cladribine; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine