Complications after high-dose therapy and autologous blood stem cell transplantation: Retrospective analysis in a cohort of unselected patients

Background: High-dose therapy (HDT) with autologous blood stem cell transpl antation (ASCT) has become the therapy of choice for patients with specific hematologic neoplasms. Although pancytopenia after HDT with Stem cell supp ort is of relatively short duration, complications may be severe and life-t hreatening. In unselected patients with hematologic and solid tumor maligna ncies, only few data have been published regarding complications. We theref ore analyzed the rate of infection and toxicity in patients with different neoplasms undergoing HDT and ASCT. Patients and Methods: From 6/96 to 12/99 42 patients received 54 HDT and AS CT (nine tandem transplants and one triple transplant). The median age was 55 years (range 25-74 years) with equal sex distribution. 30 patients suffe red from hematologic malignancies and twelve from solid tumors. Results: Infections were the major cause for complications followed by muco sitis, pain and diarrhea. In four patients a positive cytomegalovirus polym erase chain reaction (CMV-PCR) was detected. In two patients this positive test result was accompanied by clinical symptoms of CMV infection. One pati ent developed lung fibrosis due to busulfan (WHO 4 degrees) and additionall y a veno-occlusive disease (VOD) of the liver (WHO 4 degrees). Two patients (4%) died due to CMV pneumonia and multiple organ failure after idiopathic pneumonia, respectively. Four patients developed secondary neoplasms (two patients myelodysplastic syndromes, two patients solid tumors). Three of th em had been heavily pretreated. We further analyzed whether the following p arameters had an influence on the rate of complications: tumor diagnosis (h ematologic vs. solid), number of pretreatment protocols (< 2 vs. <greater t han or equal to> 2), CD34(+) cell count (< median CD34(+) cell count vs. <g reater than or equal to> median CD34(+) cell count), age (less than or equa l to 55 years vs. > 55 years), mucositis (WHO 1-2 degrees vs. 3-4 degrees) and conditioning regimen (myeloablative vs. myelosuppressive). The infectio n rate was higher in patients receiving myeloablative therapy compared to p atients with myelosuppressive conditioning and the platelet count recovery was slower. In patients receiving a higher CD34(+) cell count, time until p latelets reached > 50/nl was shorter than in patients with a lower CD34(+) cell count. Patients with < 2 pretreatment protocols had a higher infection rate than patients with < 2 pretreatments. Patients suffering from severe mucositis (WHO 3-4 degrees) exhibited a slower platelet recovery and a high er infection rate. No difference was noted in the complication rate for the other parameters (tumor diagnosis, age). Conclusion: Complication rate and mortality in this heteregeneous patient g roup were not different front the data of other authors describing selected patients receiving a uniform conditioning regimen or having a distinct dis ease. The complication rate is influenced by the number of pretreatment pro tocols, conditioning regimens and the number of transplanted CD34(+) cells.