title: Correlation of residual leukocyte subsets with neutropenic fever during severe leukopenia after high-dose chemotherapy and autologous stem cell transplantation.
abstract: BACKGROUND
  High-dose chemotherapy with autologous stem cell transplantation is the standard treatment of eligible patients with multiple myeloma. However, this treatment is associated with a substantial risk of infectious complications during leukopenia. The aim of our pilot study was to determine the residual leukocyte subsets during severe cytopenia after high-dose melphalan and to correlate this with the occurrence of neutropenic fever.
  
  
  METHODS
  Residual leukocyte subsets in the peripheral blood on days 4-7 following autologous stem cell transplantation were analyzed by three-color flow cytometry in 20 patients with multiple myeloma. In addition, we determined the number of T cells that were transfused with the autografts.
  
  
  RESULTS
  Absolute numbers of lymphocytes (mean 25/microL) and monocytes (mean 4/microL) were strongly reduced but rather constant during the period of severe neutropenia. Neutrophil engraftment and duration of neutropenia were very similar in patients with and without neutropenic fever. Low absolute lymphocyte counts and absolute CD4+ T-cell counts on days 4-7 after stem cell transplantation correlated with neutropenic fever. Furthermore, T-cell numbers in the autologous stem cell grafts that the patients received were significantly lower in patients with neutropenic fever.
  
  
  CONCLUSIONS
  These observations suggest that the number of T cells, and in particular CD4+ T cells, in the blood during severe cytopenia is playing a role in defense of infection. T-cell numbers in the graft could provide a predictive factor for the risk of infection in the post-transplant period. However, this needs to be confirmed in a larger study.
authors.affiliation: Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schnabel
authors.forename: R
authors.initials: R
authors.lastname: Schmidmaier
authors.forename: D
authors.initials: D
authors.lastname: Franke
authors.forename: B
authors.initials: B
authors.lastname: Emmerich
authors.forename: C
authors.initials: C
authors.lastname: Straka
mesh_terms: D000368:Aged; D005260:Female; D005334:Fever / Q000097:blood* / Q000209:etiology; D005434:Flow Cytometry / Q000379:methods; D006085:Graft Survival; D006801:Humans; D018655:Lymphocyte Count / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood / Q000150:complications / Q000628:therapy*; D009503:Neutropenia / Q000097:blood* / Q000209:etiology; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D014182:Transplantation, Autologous