Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Infections Post Transplant

Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors

Abstract

From November 1994 to May 1998, 117 patients (66 with solid tumor, 36 with lymphoma, 14 with multiple myeloma, one with acute leukemia) underwent 178 cycles of high-dose chemotherapy and autologous stem cell transplantation (ASCT) at our institution. We retrospectively analyzed the infectious complications that occurred after ASCT. Median duration of neutropenia (granulocyte count <0.5 × 109/l ) was 8 days, the overall incidence of fever requiring antimicrobial treatment was 63%. 35.4% of patients had fever of unknown orign (FUO), whereas primary bacteremia occurred in 21.3%, pneumonia in 3.4% and severe skin infection in 1.1% of patients. Invasive fungal infections occurred in three, and enterocolitis in one patient. Infection was fatal in three patients (2.6%), in each case due to septic shock. The most frequently isolated pathogens were Gram-positive cocci. Median time to defervescence with antimicrobial therapy was 4 days (6 days in patients with bacteremia or other severe infection, and 3 days in patients with FUO). First-line antimicrobial therapy was successful in 65% of patients with FUO and 30.6% of patients with documented infections. With respect to the incidence, type and clinical course of infection, no significant differences between patients with lymphoma or multiple myeloma and those with solid tumors were detected. Bone Marrow Transplantation (2001) 27, 525–529.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Gratwohl A, Passweg J, Baldomero H, Hermans J . Blood and marrow transplantation activity in Europe 1997 Bone Marrow Transplant 1999 24: 231–245

    Article  CAS  Google Scholar 

  2. Mossad SB, Longworth DL, Goormastic M et al. Early infectious complications in autologous bone marrow transplantation: a review of 219 patients Bone Marrow Transplant 1996 18: 265–271

    CAS  PubMed  Google Scholar 

  3. Kolbe K, Domkin D, Derigs HG et al. Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation Bone Marrow Transplant 1997 19: 143–147

    Article  CAS  Google Scholar 

  4. Watanabe T, Takaue Y, Abe T et al. Early infectious complications after peripheral blood stem cell autografts in children Med Pediatr Oncol 1991 19: 100–105

    Article  CAS  Google Scholar 

  5. D'Antonio D, Iacone A, Pierelli L . Patterns of recovery phase infection after autologous blood progenitor cell transplantation in patients with malignancies. The Gruppo Italiano di Studio per la Manipolazione Cellulare in Ematologica Eur J Clin Microbiol Infect Dis 1995 14: 552–556

    Article  CAS  Google Scholar 

  6. Hughes WT, Armstrong D, Bodey GP et al. 1997 Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever Clin Infect Dis 1997 25: 551–573

    Article  CAS  Google Scholar 

  7. Holland HK, Dix SP, Geller RB et al. Minimal toxicity and mortality in high-risk breast cancer patients receiving high-dose cyclophosphamide, thiotepa and carboplatin plus autologous marrow/stem-cell transplantation and comprehensive supportive care J Clin Oncol 1996 14: 1156–1164

    Article  CAS  Google Scholar 

  8. Gilbert C, Meisenberg B, Vredenburgh J et al. Sequential prophylactic oral and empiric once-daily parenteral antibiotics for neutropenia and fever after high-dose chemotherapy and autologous bone marrow support J Clin Oncol 1994 12: 1005–1011

    Article  CAS  Google Scholar 

  9. Salazar R, Sola C, Maroto P et al. Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation Bone Marrow Transplant 1999 23: 27–33

    Article  CAS  Google Scholar 

  10. Ballester OF, Agaliotis DP, Hiemenz JW et al. Phase I–II study of high-dose busulfan and cyclophosphamide followed by autologous peripheral blood stem cell transplantation for hematological malignancies: toxicities and hematopoietic recovery Bone Marrow Transplant 1996 18: 9–14

    CAS  PubMed  Google Scholar 

  11. Ayash LJ, Elias A, Wheeler C et al. Double dose-intensive chemotherapy with autologous marrow and peripheral blood progenitor cell support for metatstatic breast cancer: a feasibility study J Clin Oncol 1994 12: 37–44

    Article  CAS  Google Scholar 

  12. Nosanchuk JD, Sepkowitz KA, Pearse RN et al. Infectious complications of bone marrow and peripheral stem cell transplantation for refractory leukemia and lymphoma Bone Marrow Transplant 1996 18: 355–359

    CAS  PubMed  Google Scholar 

  13. Hartmann O, Le Corroller AG, Blaise D et al. Peripheral blood stem cell and bone marrow transplantation for solid tumors and lymphomas: hematologic recovery and costs Ann Intern Med 1997 126: 600–607

    Article  CAS  Google Scholar 

  14. Starck M, Thomssen C, Kamp T et al. Early infections in patients receiving high-dose chemotherapy with autologous blood stem cell transplantation Ann Hematol 1998 77: (Suppl. II) 555

    Google Scholar 

  15. Shea TC, Mason JR, Storniolo AM et al. Sequential cycles of high-dose carboplatin administered with recombinant human granulocyte–macrophage colony-stimulating factor and repeated infusions of autologous peripheral blood progenitor cells: a novel and effective method for delivering multiple courses of dose-intensive therapy J Clin Oncol 1992 10: 464–473

    Article  CAS  Google Scholar 

  16. Valteau D, Hartmann O, Brugieres L et al. Streptococcal septicaemia following autologous bone marrow transplantation in children treated with high-dose chemotherapy Bone Marrow Transplant 1991 7: 415–419

    CAS  PubMed  Google Scholar 

  17. Rackoff WR, Weiman J, Jakobowski D . A randomised, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infections in children J Pediatr 1995 127: 147–151

    Article  CAS  Google Scholar 

  18. Raad I, Darouiche R, Dupuis J et al. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections Ann Intern Med 1997 127: 267–274

    Article  CAS  Google Scholar 

  19. Raad I, Hohn DC, Gilbreath BJ et al. Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion Infect Control Hosp Epidemiol 1994 15: 231–238

    Article  CAS  Google Scholar 

  20. Weaver CH, Schwartzberg LS, Hainsworth J et al. Treatment-related mortality in 1000 consecutive patients receiving high-dose chemotherapy and peripheral blood progenitor cell transplantation in community cancer centers Bone Marrow Transplant 1997 19: 671–678

    Article  CAS  Google Scholar 

  21. Kern WV, Cometta A, De Bock R et al. Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy New Engl J Med 1999 341: 312–318

    Article  CAS  Google Scholar 

  22. Bodey GP, Buckley M, Sathe YS, Freireich EJ . Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia Ann Intern Med 1966 64: 328–340

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reich, G., Mapara, M., Reichardt, P. et al. Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant 27, 525–529 (2001). https://doi.org/10.1038/sj.bmt.1702822

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702822

Keywords

This article is cited by

Search

Quick links