Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies

Çelebi, Harika; Akan, Hamdı; Akçağlayan, E; Üstün, Celalettin; Arat, Mutlu

doi:10.1038/sj.bmt.1702503

Cited by 53 publications

(44 citation statements)

References 7 publications

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“…In a retrospective study of the association between acute GVHD and gastrointestinal toxicity from preparative regimens, gastrointestinal bacterial infection was associated with a decreased risk of acute GVHD, while fungal infection was associated with an increased risk of acute GVHD [22]. Given that the most common microorganisms of early post-transplant infection are bacteria rather than fungi [20], early post-transplant infections should not be associated statistically with an increased incidence of acute GVHD, in agreement with our analysis. NK cell recovery after marrow transplantation occurs early after transplantation, and early post-transplant NK cells are fully functional, unlike T and B lymphocytes [7,23,24].…”

Section: Discussionsupporting

confidence: 86%

“…We could not analyze the influence of individual infectious species on the risk of GVHD in this study, as the probability of identification of a microorganism during neutropenic fever was low (23.8%), as has been previously reported [20,21]. In a retrospective study of the association between acute GVHD and gastrointestinal toxicity from preparative regimens, gastrointestinal bacterial infection was associated with a decreased risk of acute GVHD, while fungal infection was associated with an increased risk of acute GVHD [22].…”

Section: Discussionmentioning

confidence: 84%

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The influence of infection early after allogeneic stem cell transplantation on the risk of leukemic relapse and graft‐versus‐host disease

Kim¹,

Lee²,

Kim³

et al. 2008

American J Hematol

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An infection after allogeneic stem cell transplantation (SCT) can affect the activity of immune cells and increase the level of proinflammatory cytokines. Further, a post-SCT infection may influence the milieu of the graft-versus-leukemia (GVL) effect and graft-versus-host disease (GVHD). We performed a retrospective study of patients with acute leukemia who had undergone allogeneic SCT using the same preparative regimens and bone marrow as the stem cell source to determine if early post-transplant infection was associated with the risk of leukemic relapse and GVHD. The analysis revealed that patients who had a febrile infection (FI) before post-transplant day 21 (FI group) had a lower actuarial probability of leukemic relapse (P < 0.001) and a higher relapse-free survival rate (P 5 0.012) than those patients who did not have a FI before post-transplant day 21 (non-FI group). The experience of early post-transplant FI (HR 5 0.316; 95% CI 5 0.174-0.575; P < 0.001), together with the presence of chronic GVHD and high risk cytogenetics, were independent predictive factors for post-transplant leukemic relapse. The FI group had a trend towards a higher lymphocyte count on post-transplant day 21 than the non-FI group (P 5 0.063), despite the delayed recovery of the platelet count and a trend towards delayed recovery of the neutrophil count. These findings suggest that a change in the immunologic network by infectious diseases in the early post-transplant period favors the milieu of the GVL effect. The specific immunologic change during FI, which can potentiate the GVL effect, remains to be determined. Am. J. Hematol. 83:784-788, 2008. V V C 2008 Wiley-Liss, Inc. IntroductionThe graft-versus-leukemia (GVL) effect of allogeneic stem cell transplantation (SCT) is an important means by which residual hematologic malignant cells surviving pretransplant chemoradiation are eradicated. The GVL effect is mediated by a complex network of immune cells and cytokines [1][2][3]. As inflammatory events following allogeneic SCT can change the activity of the host and donor graft immune cells that release various inflammatory cytokines [4][5][6], post-transplant infection may influence the milieu of the GVL effect and, accordingly, the risk of posttransplant leukemic relapse.Post-transplant infections usually occur early after transplantation and the activation of host antigen-presenting cells and donor NK cells has been shown to occur quite early in both experimental and human allogeneic SCT [7,8]. We investigated whether a febrile infection (FI) before posttransplant day 21 was associated with a risk of leukemic relapse and graft-versus-host disease (GVHD) in patients with acute leukemia. To avoid confounding factors potentially affecting immune reconstitution after allogeneic SCT and evaluate the association between the GVL effect and the variables evaluated, we restricted the study population to 215 consecutive patients with acute leukemia who had undergone allogeneic SCT using the same preparative regimens and bone marrow as the ...

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 84%

The influence of infection early after allogeneic stem cell transplantation on the risk of leukemic relapse and graft‐versus‐host disease

Kim¹,

Lee²,

Kim³

et al. 2008

American J Hematol

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“…In this study the rate is 47% (32/68), comparable with the literature. 13,14 Although Gram-negative microorganisms were the main cause of infections in patients with febrile neutropenia, the EORTC Group showed an increase in Gram-positive infections from 29% to 67% and decrease in Gram-negatives from 71% to 31%. 15 The GIMEMA group repeated these results and showed an increase in Gram-positive microorganisms from 64% to 89%.…”

Section: Discussionmentioning

confidence: 99%

Aerobic bacterial and fungal infections in peripheral blood stem cell transplants

Aksu

Ruhi

Akan

et al. 2001

Bone Marrow Transplant

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Summary:Allogeneic and autologous peripheral blood stem cell transplants are frequently complicated by infections. This study was performed to evaluate early and late infections in 74 patients who underwent peripheral blood stem cell transplantation (PBSCT). Fifty-eight patients received allogeneic and 16 autologous PBSCT. All patients received fluconazole, ciprofloxacin and acyclovir prophylaxis. 93.1% of alloPBSCT patients and 87.5% of autoPBSCT patients developed fever. Febrile episodes were commonly seen in the week of transplantation (66%). There was a median of 3 days with fever in alloPBSCT, and 2 days in autoPBSCT. Period of neutropenia was 15 days for AlloPBSCT and 12 days for AutoPBSCT. The microbiological identification rate was 47% (32/68). Gram-positive infections dominated the early period (50%) and Gram-negative bacterial infections dominated the late period (50%). All our patients had Hickman-type catheters and 26 infections involving catheters were seen. Sixteen occurred in the early, and 10 in the late period. Ten of 14 (71.4%) late bacterial infections were catheter-related. The dominance of Gram-positive infections and high rates of methicillin resistance warranted the use of vancomycin extensively. Surveillance cultures were found to be useful in selected patients. Although slime factor is an important virulence factor, there was no difference between slime factor positive and negative coagulasenegative staphylococci isolated during infections. In conclusion, febrile episodes are the most frequent complication of PBSCT and Gram-positive microorganisms remain the main pathogen in these patients because of catheter use, mucositis and ciprofloxacin prophylaxis. Methicillin resistance is increasing and glycopeptides remain the only choice for treating such infections. Although the infection rate is high, measures taken to prevent and treat infections result in very low rates of mortality from infection in PBSCT patients. Bone Marrow Transplantation (2001) 27, 201-205.

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“…The majority of early infectious complications in our study consisted of bacterial infections, with no difference in incidence between MR and MU/MM all0-SCT recipients. As in other reports, 8,10,19 Gram-positive bacteria, especially coagulase-negative staphylococci, were the predominant pathogens cultured in cases of microbiologically documented infections. With our prophylactic regimen of cephalotin, we found a low incidence of viridans streptococci compared to other reports, 8,10 but awareness of infection with resistant strains of viridans streptococci is necessary.…”

Section: Bone Marrow Transplantationmentioning

confidence: 58%

Early infections in adults undergoing matched related and matched unrelated/mismatched donor stem cell transplantation: a comparison of incidence

Kraaij

Verdonck

Rozenberg-Arska

et al. 2002

Bone Marrow Transplant

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Summary:We compared the incidence of early infectious complications between matched related (MR) and matched unrelated/mismatched (MU/MM) allogeneic stem cell transplant (allo-SCT) recipients in a single centre over a 6-year period in 214 consecutive adult patients. Early infections were defined as occurring from hospital admission for SCT until discharge. One hundred and fifty-nine patients received an allograft from MR donors and 55 patients received MU/MM allo-SCT. One hundred and eight of 214 patients had 147 episodes of fever. Ninety-three episodes (63%) were due to clinically or microbiologically documented infections and 54 episodes (37%) to fever not related to infection. Patients undergoing MU/MM transplantation tended to have more documented infections compared to recipients of MR allo-SCT (P = 0.06). Significantly more MU/MM transplant recipients had breakthrough infections with Herpes simplex virus type 1 (HSV-1, P = 0.003), and more CMV reactivation (P = 0.015). The mortality rate in all patients during hospitalisation post-SCT was 6.3% in MR and 18.2% in MU/MM allo-SCT recipients (P = 0.009). Early mortality was associated with infection in 70% of the patients, with a similar distribution between MR and MU/MM transplant recipients. However, MU/MM transplant recipients had significantly more early deaths due to toxic causes (P Ͻ 0.001). We conclude that early post-transplant MU/MM transplant recipients tend to have more documented infections, and have significantly more breakthrough infections with HSV-1 and more CMV reactivation. MU/MM transplant recipients are at higher risk of early mortality, especially due to toxic causes.

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Febrile neutropenia in allogeneic and autologous peripheral blood stem cell transplantation and conventional chemotherapy for malignancies

Cited by 53 publications

References 7 publications

The influence of infection early after allogeneic stem cell transplantation on the risk of leukemic relapse and graft‐versus‐host disease

The influence of infection early after allogeneic stem cell transplantation on the risk of leukemic relapse and graft‐versus‐host disease

Aerobic bacterial and fungal infections in peripheral blood stem cell transplants

Early infections in adults undergoing matched related and matched unrelated/mismatched donor stem cell transplantation: a comparison of incidence

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