Early outcomes after allogeneic stem cell transplantation for leukemia andmyelodysplasia without protective isolation: A 10-year experience

Although it is common practice to use some form of isolation to protect all ogeneic stem cell transplant patients from infection, the necessity for the se practices in all environments has not been demonstrated. The current stu dy evaluated patterns of infection and 100-day transplant-related mortality in 288 patients with myelodysplasia and leukemia transplanted without isol ation. Patients were allowed out of hospital at any time within constraints of the medication schedule. Fever, foci of infection, and positive culture s within 28 days and death within 100 days because of the transplant proced ure were recorded. Fever occurred in 57% of patients, and 10% had a clinica l or radiographic focus of infection. Most infections were apparently endog enous; blood cultures from 24% of recipients grew organisms, 87% of which w ere gram-positive bacteria. Four patients (1%) died with aspergillus infect ion in circumstances indicating that isolation mould not have been helpful. Twenty percent of patients remained without evidence of infection througho ut. Transplant-related mortality at 100 days was 1% for 108 patients with e arly leukemia receiving transplants from matched siblings. For patients at higher risk, by virtue of donor and/or disease status, mortality was 21%. T hese figures compare favorably with those reported to the International Bon e Marrow Transplant Registry, the majority of patients having been subjecte d to some form of isolation, We conclude that allogeneic stem cell transpla ntation can be safely pet-formed in some environments without confining pat ients continuously to the hospital.