Degree of mucositis and duration of neutropenia are the major risk factors for early post‐transplant febrile neutropenia and severe bacterial infections after reduced‐intensity conditioning

Facchini, Luca; Martino, Rodrigo; Ferrari, A; Piñana, José Luís; Valcárcel, David; Barba, Pere; Granell, Miguel; Delgado, Julio; Briones, Javier; Sureda, Anna; Brunet, Salut; Sierra, Jorge

doi:10.1111/j.1600-0609.2011.01724.x

Cited by 24 publications

(8 citation statements)

References 31 publications

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“…Celebi et al identified neutropenic fever in 86% of all patients after allo‐SCT using ciprofloxacin 400 mg daily as prophylaxis. Facchini et al reported febrile neutropenia in 72% of all patients after reduced‐intensity conditioning including patients with ATG or alemtuzumab; in this study, ciprofloxacin prophylaxis was used in patients with mucositis only. In contrast, Meijer et al reported neutropenic fever in only 0%‐34% of all patients (non‐myeloablative vs myeloablative conditioning); this study included only HLA‐identical sibling donor transplantations and ciprofloxacin was used for prophylaxis.…”

Section: Discussionmentioning

confidence: 84%

No indication of increased infection rates using low‐dose alemtuzumab instead of anti‐thymocyte globulin as graft‐versus‐host disease prophylaxis before allogeneic stem cell transplantation

Neumann

Schneidewind

Thiele

et al. 2017

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 84%

No indication of increased infection rates using low‐dose alemtuzumab instead of anti‐thymocyte globulin as graft‐versus‐host disease prophylaxis before allogeneic stem cell transplantation

Neumann

Schneidewind

Thiele

et al. 2017

Transplant Infectious Dis

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“…[5][6][7][8][9][10][11][12][13][14] Bacterial infections early after alloHCT are associated with increased mortality. 15 Factors associated with decreased infections after alloHCT include less mucositis, [16][17][18][19] shorter duration and decreased severity of neutropenia/lymphopenia, 16 and faster immune recovery, 20 all of which are observed more frequently with RIC/NMA than with MAC. 21,22 The incidence of infections, a common and often severe complication of alloHCT, is expected to be lower after RIC/NMA compared with MAC and thus contribute to the decreased NRM.…”

Section: Introductionmentioning

confidence: 99%

Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1

Üstün

Kim

Chen³

et al. 2019

Blood Advances

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Key PointsPresumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged $40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n 5 777) compared with those receiving MAC (n 5 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P 5 .21) by day 100.The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, ,1-99 days]; RIC/NMA, 21 days [range, ,1-100 days]; P , .001). Patients receiving MAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P 5 .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95% CI, 36-42]; P 5 .046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P , .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCT was greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P , .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

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“…[5] Denudation of mucosal lining may also contribute to bacteremia and potentially delay recovery and hospital discharge. [6,7] To date, Palifermin, a human recombinant keratinocyte growth factor is the only agent approved by US food and drug administration (FDA) for prevention of OM in myeloablative transplantation. However, Palifermin is associated with significant additional costs in the peritransplant period.…”

Section: Introductionmentioning

confidence: 99%

CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation

Anand

Anandi

Jain

et al. 2015

Support Care Cancer

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Objective To evaluate the impact of ex vivo T cell depleted (TCD) by CD34+ selection on the incidence and severity of Oropharyngeal mucositis (OM) in after myeloablative allogeneic stem cell transplant (allo-SCT) with total body irradiation (TBI) conditioning. This approach has the advantage of avoiding methotrexate for graft versus host disease (GVHD) prophylaxis. Patients and Methods We analyzed the incidence and severity of OM in a cohort of 105 consecutive patients who underwent CD34+ selected (PBSC (peripheral blood stem cells) from HLA identical siblings) allo-SCT with total body irradiation (TBI) conditioning. OM was graded by the World Health organization (WHO) and the Bearman Regimen Related Toxicity (RRT) Scales. Results The incidence of WHO grade 3–4 OM was 34.3%. There were no cases of grade 3–4 OM by the RRT scale. Significant correlation was found between the severity of OM and the use of intravenous (IV) narcotic medications (r2=0.15, p=0.004), Total parenteral nutrition (TPN) (r2=0.68, p<0.001) and hospital length of stay (LOS) (r2=0.12, p=0.01). Discussion TBI-induced OM can inflict significant morbidity in the early transplant period and the incidence of WHO grade 3–4 OM can exceed 50% when methotrexate is used for GVHD prophylaxis. In the CD34+ selected setting, methotrexate is avoided and the incidence of WHO grade 3–4 OM, use of TPN, and need for narcotic analgesia appear to be lower than historic evidence from standard T-replete allogeneic transplantation. Conclusion We conclude that toxicity from OM is tolerable in CD34+ selected allo-SCT and should be prospectively measured in randomized trials comparing CD34+ selection versus T-replete transplantation.

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Degree of mucositis and duration of neutropenia are the major risk factors for early post‐transplant febrile neutropenia and severe bacterial infections after reduced‐intensity conditioning

Abstract: After an RIC-allo, FN and early SBI occurred mostly in patients with severe mucositis and early-onset neutropenia, while postengraftment high-dose steroid therapy for acute GVHD was the major RF.

Cited by 24 publications

References 31 publications

No indication of increased infection rates using low‐dose alemtuzumab instead of anti‐thymocyte globulin as graft‐versus‐host disease prophylaxis before allogeneic stem cell transplantation

No indication of increased infection rates using low‐dose alemtuzumab instead of anti‐thymocyte globulin as graft‐versus‐host disease prophylaxis before allogeneic stem cell transplantation

Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1

CD34+ selection and the severity of oropharyngeal mucositis in total body irradiation-based allogeneic stem cell transplantation

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