EARLY INFECTIOUS COMPLICATIONS IN AUTOLOGOUS BONE-MARROW TRANSPLANTATION - A REVIEW OF 219 PATIENTS

The objective of this study was to define the incidence, type and timi ng of early infectious complications, occurring within the first 30 da ys, in autologous bone marrow transplant (autoBMT) recipients over a 4 5-month period, and in addition to assess the effects of growth factor s and primed peripheral blood progenitor cells on the rate of infectio us complications. The paper describes a retrospective and observationa l study, carried out at the bone marrow transplantation unit at a tert iary referral center, The subjects were two hundred and nineteen patie nts who underwent autologous bone marrow transplantation for a variety of indications from April 1989 to December 1992. The median duration of neutropenia after autologous bone marrow transplantation was 12 day s, There was a direct correlation between the duration of neutropenia and the incidence of infectious complications. The overall incidence o f infections and isolated febrile episodes was 35%. Septicemia occurre d in 7.8% of patients, pneumonia in 2.7%, skin infection in 1.8%, othe r infections in 2.7% and isolated febrile episodes in 20.1%, Viridans streptococci were the most common cause of septicemia. Invasive fungal infections occurred in only 2.3% of patients. There were no documente d viral infections. The use of growth factors and primed peripheral bl ood progenitor cells was associated with a shorter duration of neutrop enia; a decrease in the overall incidence of infections, particularly septicemia and fungal infections; a shorter length of stay in the hosp ital and a lower mortality rate in the first 30 days after transplanta tion. We found a lower incidence of bacterial and fungal infections co mpared to previous studies, The critical factor associated with the oc currence of any early infection was the duration of neutropenia, which was significantly shortened by the use of growth factors and peripher al blood progenitor cells, Septicemia was uncommon in our population a nd viridans streptococci were the most common bloodstream isolates.