Naslov
Infectious complications following peripheral blood stem cell transplantation in patients with relapsed or refractory malignant lymphoma

Autori
Vrhovac, Radovan ; Minigo, Hrvoje ; Kalac, Matko ; Tambić-Andrašević, Arjana ; Jakšić, Branimir

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Bone Marrow Transplantation ; 39 (Suppl 1) ; 289. / - , 2007

Skup
33rd Annual Meeting of the European Group for Blood and Marrow Transplantation

Mjesto i datum
Lyon, Francuska, 25.03.2007. - 28.03.2007

Vrsta sudjelovanja
Ostalo

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
infections; transplantation; lymphoma

Sažetak
Forty six consecutive patients (median age 45, range 19-65 yrs) with relapsed or refractory Non-Hodgkin's Lymphoma (NHL, n=33) and Hodgkin's Disease (HD, n=13) treated with autologous peripheral blood stem cell transplantation (PBSCT) have been evaluated for infectious complications following PBSCT. Patients received an average of 17.28 (range 1.64-98.13, SD 18.02) x 10^6/kg CD34+ cells, followed by filgrastim (median 10 days, range 6-50, SD 7.2) during the leukopenic (<1x10^9/L) period. Transplant related mortality was 0%. Febrile neutropenia occurred in 30 (65.2%) patients at a mean of 5 days after PBSC reinfusion (range 1-9, SD 2.1). In these patients, clinical and microbiological workup was done and empiric antibiotic treatment was started (piperacillin and tazobactam in all but 3 patients). Seven patients (23.3%) had proven bacteremias, 4 (13.3%) had other microbiologically documented infections (MDIs) and 19 (63.3%) had clinically documented infections (CDIs). Gram+ microorganisms were responsible for 54.5% of all documented infections (42.8% of bacteremias and 75% of other MDIs) and Gram- for 27.3% of all documented infections (28.6% of bacteremias and 25% of other MDIs). An anaerobic microorganism was isolated from blood cultures in one patient, and a fungus in another patient (14.3% of bacteremias, each). Empirical antimicrobial therapy was modified in 13 (43.3%) patients, including addition of vancomycin in 9 (30%) patients, a systemic antifungal agent in 5 (16.6%) or both in 3 (10%) patients. Correlations of a number of variables available at time of febrile neutropenia onset with the duration of febrile episode have also been investigated. Patients with higher CRP levels at febrile neutropenia onset and those with earlier onset of fever following PBSCT had significantly longer (p=0.05 and p=0.007, respectively) duration of febrile episodes. Other variables, including patients' age, gender, disease (NHL vs. HD), No. of previous lines of therapy, previous treatment with rituximab, No. of reinfused CD34+ cells, mean arterial pressure, pulse, ESR, hemoglobin, neutrophil, monocyte or platelet counts as well as peak temperature values at day of fever onset did not show significant correlations with duration of the febrile episode in this group of patients. We conclude that infectious episodes are serious but managable complications of PBSCT. Early empirical therapy is justified, and should be tailored according to local microbiological epidemiology.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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