Development of early neutropenic fever, with or without bacterial infection, is still a significant complication after reduced-intensity stem cell transplantation

Abstract

Little information is available on the clinical characteristics of infectious complications that occur in the early period after reduced-intensity stem cell transplantation (RIST). We retrospectively investigated the clinical features of neutropenic fever and infectious episodes within 30 days after RIST in 76 patients who had received fluoroquinolones as part of their antibacterial prophylaxis. Preparative regimens included cladribine 0.66 mg/kg or fludarabine 180 mg/m2 plus busulfan 8 mg/kg. All but 1 patient survived 30 days after transplantation, and 75 patients (99%) became neutropenic within a median duration of 9 days. Neutropenic fever was observed in 29 patients (38%), and bacterial infection was confirmed in 15 (20%) of these, including bacteremia (n = 13), bacteremia plus pneumonia (n = 1), and urinary tract infection (n = 1). The causative organisms were gram-positive (n = 9) and gram-negative organisms (n = 7), with a mortality rate of 6%. Neither viral nor fungal infection was documented. Multivariate analysis showed that the presence of neutropenia at the initiation of preparative regimens was an independent risk factor for subsequent documented bacterial infections (P =.026; 95% confidence interval, 1.25-35.1). We conclude that neutropenic fever and bacteremia remain common complications in RIST.

Reduced-intensity hematopoietic stem-cell transplantation for malignant lymphoma: a retrospective survey of 112 adult patients in Japan

“…[26][27][28][29] RIST seemed to be associated with less infections due to the shorter duration of neutropenia and less damage to mucosal barriers. However, we showed that opportunistic infection is the second leading cause of death in RIST.…”

Short-term methotrexate could reduce early immune reactions and improve outcomes in umbilical cord blood transplantation for adults

“…[32][33][34][35] Little is known about the clinical usefulness of additional steroid use in CBT. A previous study reported that corticosteroid use was not a significant risk factor for infection in RI-CBT.…”

Infections after allogeneic hematopoietic stem cell transplantation with a nonmyeloablative conditioning regimen

“…Compared to myeloablative regimens, nonmyeloablative conditioning is associated with less myelotoxicity and produces fewer extra-haematological toxicities, in particular less damage to the mucosal barriers of the gastrointestinal tract [9][10][11]24 . However, the relative intensity of these treatments ranges from the reducedintensity conditioning (RIC) regimens that still induce severe neutropenia and are carried out in inpatient protected units 10,15,25,26 , to the truly nonmyeloablative regimen developed by the Seattle team that causes little neutropenia, can be performed as outpatient and cause much less morbidity 9,12,13,24 . Using the Seattle regimen, we indeed encountered virtually no toxic mucositis and no gastrointestinal toxicity.…”

“…However, it is not yet clear whether NMSCT would indeed result in a reduced risk of infection compared to standard myeloablative allogeneic transplantation. Available data have sometimes indicated a reduced incidence of infection after NMSCT 9, 10 but other studies have observed similar rates of infection after the two forms of allogeneic transplantation 11,12,[15][16][17][18] . We therefore conducted a retrospective study to describe the incidence and types of infection in 62 recipients of a NMSCT in our institution.…”