Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiplemyeloma and patients with solid tumors

From November 1994 to May 1998, 117 patients (66 with solid tumor, 36 with lymphoma, 14 with multiple myeloma, one with acute leukemia) underwent 178 cycles of high-dose chemotherapy and autologous stem cell transplantation ( ASCT) at our institution. We retrospectively analyzed the infectious compli cations that occurred after ASCT, Median duration of neutropenia (granulocy te count <0.5 x 10(9)/l) was 8 days, the overall incidence of fever requiri ng antimicrobial treatment was 63%. 35.4% of patients had fever of unknown orign (FUO), whereas primary bacteremia occurred in 21.3%, pneumonia in 3.4 % and severe skin infection in 1.1% of patients. Invasive fungal infections occurred in three, and enterocolitis in one patient. Infection was fatal i n three patients (2.6%), in each case due to septic shock. The most frequen tly isolated pathogens were Grampositive cocci, Median time to defervescenc e with antimicrobial therapy was 4 days (6 days in patients with bacteremia or other severe infection, and 3 days in patients with FUO), First-line an timicrobial therapy was successful in 65% of patients with FUO and 30.6% of patients with documented infections. With respect to the incidence, type a nd clinical course of infection, no significant differences between patient s with Lymphoma or multiple myeloma and those with solid tumors were detect ed.