Naslov
Filgrastim dose has an impact on infectious complications in patients with lymphoma following autologous stem cell transplantation

Autori
Perić, Zinaida ; Kalac, Matko ; Jurenec, Silvana ; Kovačević, Višnja ; Bukovski-Simonoski, Suzana ; Tambić-Andrašević, Arjana ; Minigo, Hrvoje ; Jakšić, Branimir ; Vrhovac, Radovan

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

Izvornik
Haematologica 2009 ; 94(s2) / - , 2009, 188-189

Skup
14th Congress of the European Hematology Association

Mjesto i datum
Berlin, Njemačka, 04.06.2009. - 07.06.2009

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
filgrastim dose; stem cell transplantation; lymphoma; infections

Sažetak
Background: Infections represent the leading cause of morbidity and mortality in patients with lymphoma treated with autologous stem cell transplantation. Duration and depth of neutropenia following transplantation correlates with incidence and severity of infections in the post-transplant period. Filgrastim shortens the duration of neutropenia but its impact on the course and outcome of infections as well as the preferred dose remain somewhat controversial. Aims: to evaluate infectious complications in patients with lymphoma treated with autologous peripheral blood stem cell transplantation (PBSCT) and investigate possible influence of different filgrastim doses on incidence, severity and outcome of these infections. Patients and Methods: 120 consecutive patients (median age 42, range 19&#8211; 71 yrs, 63M/57F) with relapsed or refractory Non-Hodgkin&#8217; s Lymphoma (NHL, n=92) and Hodgkin&#8217; s Disease (HD, n=28) treated with PBSCT in a single center have been evaluated for infectious complications following transplantation. In the post-transplant period, all patients received filgrastim subcutaneously, starting from the day of WBC<1x106/L until the second consecutive day of WBC>1x106/L. Two different dose levels of filgrastim were used, &#8220; Low&#8221; : 300 mcg/day, administered in 58 patients ; and &#8220; Standard&#8221; : median dose 600 mcg (SD 94, average 628 mcg), administered in 61 patients. Results: Febrile neutropenia occurred in 79 (65.8%) patients at a mean of 6 days after transplantation (range 1&#8211; 9, SD 1.65), more often in patients with longer duration of neutropenia post transplant (p=0.0003). In these patients, microbiological work-up was done and empirical antibiotic therapy was initiated ; piperacillin-tazobactam was administered to all patients not having a history of penicillin allergy. Empirical therapy was modified according to recommended guidelines in 19 (24.1%) patients: vancomycin was added in 32 patients (40.5%), a systemic antifungal in 10 (12.7%) and both in 6 (7.6%) patients. Twenty-eight patients (35.4%) had proven bacteremias while 29 (36.7%) had other microbiologically documented infections (MDIs). Gram-positive microorganisms were responsible for the majority (64.3%) of all bacteremias. Patients receiving standard doses of filgrastim had significantly shorter duration of neutropenia (average of 9.06 vs. 9.82 days, p=0.02) and developed febrile neutropenia less often than the group receiving lower doses of filgrastim (57.4% vs. 75.9%, p=0.03). They also responded better to empirical therapy &#8211; addition of vancomycin was not needed as often as in the group receiving lower filgrastim doses (28.6% vs. 50%, p=0.05) and had shorter duration of antimicrobial treatment (average of 9.71 vs. 10.9 days, p=0.11). Conclusions: Infections are serious but manageable complications of PBSCT. Gram-positive microorganisms remain the major cause of documented infections. In our patients treated with two dose levels of filgrastim, standard filgrastim doses were more efficacious in both shortening the duration of neutropenia and reducing the incidence of fever during neutropenia. Also, compared to the lower filgrastim doses, patients receiving standard filgrastim doses needed shorter antimicrobial treatment and fewer modifications of empirical antimicrobial regimen.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA