Early infectious complications after high-dose-therapy and autologous blood stem cell transplantation

Background: Only few data have been published regarding the frequency and t ype of infectious complications after high-dose therapy (HDT) and autologou s blood stem cell transplantation (ASCT). The purpose of this study was to evaluate early infectious complications after this type of treatment and to identify predictive factors. Patients and Methods: The clinical data of 10 0 patients (50 with hematologic neoplasms, 50 with solid tumors) treated wi th 133 HDT-courses in a single institution were analyzed retrospectively. F or 34 courses CD34+ cells were positively enriched. Results: In 86% of the courses fever occurred during neutropenia. In response to an empirical anti biotic therapy with ceftazidime and either vancomycin or flucloxacillin the patients defervesced after a median of 3 days. No invasive fungal infectio n was diagnosed. There was no infection-related death. Comparing hematologi c neoplasms and solid tumors, a significant difference in the duration of f ever was found: median 4 vs. 2 days. We observed a correlation between the duration of fever and the duration of morphin needing mucositis. Apart from a group of 'myeloablative' busulfan- and/or TBI-containing regimens we sep arated two different aggressive groups of HDT-regimens using duration of se vere neutropenia and morphine-needing mucositis. A multivariate analysis de monstrated that the type of HDT-regimen is a predictive factor for the numb er of fever days and freedom from infection. The diagnosis (hematologic neo plasia vs. solid tumor) is predictive only for pneumonia/pneumonitis. Concl usion: Early infectious complications after HDT and ASCT are usually not se vere. The application of first-line vancomycin and amphotericin B is genera lly not necessary. The type of HDT-regimen has to be considered in further prospective investigations of predictive infection-related factors.