Post-transplant infections: single center experience from the developing world.
OBJECTIVE
To describe our experience of post-transplant infections in allogeneic stem cell transplants at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.


METHODS
From July 2001 to September 2006, patients with malignant and non-malignant hematological disorders having human leukocyte antigen (HLA)-matched sibling donors were selected for transplant. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. After admission to the hospital, patients were kept in protective isolation rooms, equipped with a HEPA filter positive-pressure laminar airflow ventilation system. Bone marrow and/or peripheral blood stem cells were used as the stem cell source. Cyclosporin and prednisolone were used as prophylaxis against graft-versus-host disease (GVHD). The engraftment was monitored with cytogenetic/molecular analysis and change of blood group. Survival was calculated from the date of transplant to death or last follow-up.


RESULTS
One hundred and fifty-four patients received allogeneic stem cell transplants from HLA-matched siblings for various hematological disorders at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan between July 2001 and September 2006. Indications for transplant included aplastic anemia (n=66), beta-thalassemia major (n=40), chronic myeloid leukemia (n=33), acute leukemia (n=8), and miscellaneous disorders (n=7). One hundred and twenty patients were male and 34 were female. The median age of the patient cohort was 14 years (range 1 1/4-54 years). One hundred and thirty-six patients and 135 donors were cytomegalovirus (CMV) IgG-positive. One hundred and forty patients (90.9%) developed febrile episodes in different phases of post-transplant recovery. Infective organisms were isolated in 150 microbiological culture specimens out of 651 specimens from different sites of infections (23.0% culture positivity). Post-transplant infections were confirmed in 120 patients (77.9%) on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections was 13.0%. Fatal infections included CMV disease (100% mortality, 6/6), disseminated aspergillosis (66.7% mortality, 4/6), pseudomonas septicemia (42.9% mortality, 9/21), and tuberculosis (25% mortality, 1/4).


CONCLUSIONS
More than 90% of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively, however CMV, aspergillosis, and pseudomonas infections remained problematic with high mortality.
Ullah
Khalil
K
Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan. dr_khalil58@yahoo.com
Raza
Shahid
S
Ahmed
Parvez
P
Chaudhry
Qamar-Un-Nisa
QU
Satti
Tariq Mahmood
TM
Ahmed
Suhaib
S
Mirza
Sajjad Hussain
SH
Akhtar
Fahim
F
Kamal
Khalid
K
Akhtar
Farrukh Mahmood
FM
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D006086:Graft vs Host Disease / Q000517:prevention & control; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006402:Hematologic Diseases / Q000628:therapy*; D006772:Hospitals, Military; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology*; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology*; D016016:Proportional Hazards Models; D035781:Siblings; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods; D014780:Viruses / Q000302:isolation & purification
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents