engleski

Diabetes Mellitus Increases the Risk of Serious Infections Following Autologous Stem Cell Transplantation in Patients with Malignant Lymphoma

Diabetes mellitus is a well known risk factor for infections, which remain a major cause of morbidity and mortality in patients treated with autologous peripheral blood stem cell transplantation (PBSCT). We have evaluated infectious complications following transplantation in 132 consecutive patients with relapsed or refractory Non-Hodgkin’ s lymphoma (n=101) and Hodgkin’ s disease (n=31) treated with PBSCT. Febrile neutropenia occurred in 86 (65.6%) patients at a mean of 6 days after transplantation (range 1-9, SD 1.59). Patients with diabetes mellitus had a clear predisposition for infectious complications following PBSCT. All 10 patients with diabetes developed febrile neutropenia. Compared to patients not having diabetes mellitus, they also had significantly longer median time to defervescence (4 days vs. 2 days, Logrank p=0.03). Furthermore, diabetic patients had a higher incidence of serious infections: 60% of febrile episodes in these patients (vs. 30.3% in non- diabetics) were microbiologically proven bacteremias (p=0.07). Gram positive microorganisms were responsible for the majority of documented infections with Staphylococcus epidermidis being the most frequently isolated pathogen. Infections are serious but manageable complications of PBSCT, even in patients with unfavorable risk factors. Patients with lymphoma and diabetes mellitus undergoing stem cell transplantation are especially prone to infections during the neutropenic period following transplantation. Early empirical antimicrobial therapy, tailored according to local microbiological epidemiology is essential for their optimal treatment.

diabetes mellitus; infections; autologous stem cell transplantation; malignant lymphoma

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