A retrospective evaluation of 200 consecutive recipients of autologous peripheral blood stem cell transplantation (PBSCT) was conducted to ascertain the incidence and outcome of infection with Clostridium difficile. The diagnosis was confirmed in 14 patients with diarrhea (15 episodes) at a median of 33 days after stem cell infusion. Five patients were neutropenic at the time of diagnosis. Every individual had adverse known risk factors such as recent or current use of antibiotic, corticosteroid and antiviral therapy, recent administration of myeloablative chemotherapy and numerous, prolonged periods of hospitalization. Diarrhea, frequently hemorrhagic, was the most common presenting feature along with fever, abdominal cramps and abdominal distention. Diagnosis was established by the stool-cytotoxin test. Response to standard treatment with oral vancomycin or metronidazole was prompt despite the presence of several adverse prognostic features in these patients. There was only one instance of relapse which was also treated successfully. Several transplant-related variables such as age, sex, underlying malignancy, myelo-ablative regimen, duration of neutropenia, and prophylactic use of oral ampicillin underwent statistical analysis but failed to be predictive of C. difficile infection in such a setting. Finally, C. difficile is not uncommon after autologous PBSCT and must be included in the differential diagnosis in any such patient with diarrhea.

Summary:A retrospective evaluation of 321 consecutive recipients of high-dose chemotherapy (HDC) and autologous peripheral blood stem cell transplantation (PBSCT) was conducted to ascertain the incidence and outcome of vancomycin-resistant enterococcal (VRE) bacteremia. Ten patients developed VRE bacteremia at a median of 6 days following PBSCT. Nine isolates were Enterococcus faecium and one was E. faecalis. The median duration of bacteremia was 5 days. The central venous catheter was removed in seven individuals. Nine patients were treated with a variety of antimicrobial agents including quinupristin-dalfopristin, chloramphenicol, doxycycline, oral bacitracin, co-trimoxazole, and nitrofurantoin. Bacteremia resolved without adverse sequelae in seven patients. Two individuals who died of other causes had persistent or relapsed bacteremia at the time of death. An additional patient suffered multiple relapses of VRE bacteremia and died as a result of VRE endocarditis 605 days following PBSCT. Mortality as a direct result of VRE bacteremia was 10% in this series. The optimal type and duration of treatment of VRE bacteremia has not been clearly defined. Therefore, we perform weekly stool surveillance cultures for VRE in our hospitalized transplant population and apply strict barrier precautions in those individuals in whom stool colonization has been identified. Furthermore, the empiric use of vancomycin has been restricted. Bone Marrow Transplantation (2000) 25, 147-152.

Keywords: stem cell mobilization; tumor cytoreduction; breast cancer; cyclophosphamide; etoposide; paclitaxel Metastatic carcinoma of the breast is a fatal malignancy with a median survival of about 2 years when treated with chemo-hormonal therapy. High-dose chemotherapy with autologous peripheral blood stem cell transplantation (HDC/PBSCT) has been performed increasingly over the past decade in an effort to impact positively on the usually dismal outcome of metastatic breast cancer. Unfortunately, there is a dearth of multicenter controlled trials comparing HDC/PBSCT to conventional chemotherapy. However, one single institution study revealed a survival advantage in patients treated with HDC/PBSCT 1 whereas a recent multiinstitutional trial failed to demonstrate any such benefit. 2 In addition, a recent multi-institutional analysis of North American patients undergoing autotransplantation for metastatic breast cancer demonstrated a 4-year progression-free survival of 32% among patients who had achieved complete response to conventional chemotherapy given prior to HDC/PBSCT. The progression-free survival was 13% among partial responders, and only 7% among nonresponders. 3 Therefore, this suggests that one should attempt to induce a complete remission prior to HDC/PBSCT. An ideal regimen for this purpose should not only be highly active against breast cancer but should also be capable of mobilizing peripheral blood stem cells (PBSC) for harvesting. The current study analyzes the results of an intense chemotherapy regimen consisting of paclitaxel, etoposide and cyclophosphamide (TEC) administered to 100 consecutive women with metastatic breast cancer who were being considered for HDC/PBSCT. The aim of this study was to determine the stem cell mobilizing ability, anti-tumor effect, and toxicity of TEC in patients with metastatic breast cancer. Patients and methods PatientsPatients with metastatic carcinoma of the breast were referred to

Age, duration of neutropenia, type of underlying malignancy and type of conditioning chemotherapy regimen failed to have a significant impact on subsequent VS bacteremia. Only female sex and use of ciprofloxacin without clarithromycin as antimicrobiaL prophyLaxis predicted a significantly increased risk of VS bacteremia in both univariate and Logistic regression analyses.

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