Infectious complications in breast cancer patients undergoing peripheral blood stem cell transplantation: a single center retrospective analysis towards outpatient strategy

Infectious complications were retrospectively analyzed in 129 transplants, performed in 90 patients, to identify characteristics that qualify breast c ancer patients for outpatient-based PBSCT. Thirty-one cases (24%) did not d evelop fever. Of the remaining 98 cases, 84.7% developed fever during sever e neutropenia. On univariate analysis, disease stages II-III, first PBSCT, mucositis grades II-IV and the use of two alkylators were associated with a higher risk of fever development. The latter two factors also affected fev er occurrence on multivariate analysis. A longer median time to fever onset was observed in patients conditioned with single as compared to double alk ylating agent-containing regimens (respectively 8th vs 6th day, P < 0.00001 ). As compared with metastatic breast cancer (MBC), high risk breast cancer showed a 2.3-fold increased risk of developing early fever during neutrope nia (CI 2.3-3.8), remaining the only variable still significant on multivar iate analysis (P = 0.0039). Combination antibiotic therapy was equivalent t o single agent therapy. Patients suffering from microbiologically documente d fever were at higher risk of undergoing second-line antibiotic therapy. I n conclusion, MBC patients treated with a conditioning regimen containing o nly one alkylating agent and adequate prophylaxis for mucositis may qualify for outpatient-based PBSCT on the basis of a lower risk of infection.