Infections following peripheral blood progenitor cell transplantation for lymphoproliferative malignancies: Etiology and potential risk factors

Citation
N. Ketterer et al., Infections following peripheral blood progenitor cell transplantation for lymphoproliferative malignancies: Etiology and potential risk factors, AM J MED, 106(2), 1999, pp. 191-197
Citations number
39
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
AMERICAN JOURNAL OF MEDICINE
ISSN journal
00029343 → ACNP
Volume
106
Issue
2
Year of publication
1999
Pages
191 - 197
Database
ISI
SICI code
0002-9343(199902)106:2<191:IFPBPC>2.0.ZU;2-N
Abstract
PURPOSE: We sought to describe the infections that occur after large-dose c hemotherapy, which was followed by autologous peripheral blood progenitor c ell transplantation, and to determine their risk factors. PATIENTS AND METHODS: We retrospectively analyzed the occurrence and the ch aracteristics of infections in 277 consec utive patients who received inten sive chemotherapy for non-Hodgkin's lymphoma (n = 207), Hodgkin's disease ( n = 27), or multiple myeloma (n = 43) in a single institution. Conditioning regimens included total body irradiation in 47% of the cases. Infections o ccurring within the 30 days after transplant were defined as early infectio ns, whereas infections after that time in patients who had achieved a neutr ophil count greater than 1.0 x 10(9)/L (1,000 per mu L) were considered as late infections. RESULTS: Within the first 30 days, 172 patients had unexplained fever (62%) ; infections were documented in 83 patients (30%), most commonly bacteremia (57 patients). Late infections occurred in 64 (26%) of 244 evaluable patie nts and consisted mainly of varicella zoster virus infections (n = 36) and pneumonia (n = 16). Administration of total body irradiation (odds ratio (O R) = 2.50; 95% confidence interval (CI) 1.4 to 4.5; P = 0.002) and previous use of fludarabine (OR 2.5; CI 1.2 to 5.2; P = 0.02) and a diagnosis of my eloma (OR 2.6; CI 1.2 to 5.6; P = 0.04;) were significantly associated with late infections. CONCLUSIONS: This study confirms that infectious toxicity after peripheral blood progenitor cell transplantation is usually moderate, although bactere mia remains a serious problem. Late infections are encountered in about 25% of patients and are more common in those with myeloma, or those who receiv ed total body irradiation or fludarabine. Am I Med. 1999;106: 191-197. (C) 1999 by Excerpta Medica, Inc.