Abstract
The objective of this study was to identify patterns of fever and neutropenia in pediatric patients undergoing initial hospitalization for hematopoietic stem cell transplantation. A retrospective review of 75 HSCTs over a 4-year period at a single institution was performed, of which 68% were allogeneic and 32% were autologous. Stem cell sources included bone marrow (29%), PBSC (52%) and umbilical cord blood (16%). Fever occurred in 74 (98%) of the episodes. Unexplained fever (FUO) occurred in 43%. Bacteremia without an anatomic focus occurred in 29%, while CVC associated infections occurred in 17%. In 49% of transplants at least one blood culture was positive. The incidence of bacteremia was higher in allogeneic HSCTs (58%) than in autologous transplants (29%). Gram-positive bacteria accounted for 71% of the isolates. Lower rates of bacteremia were observed in patients receiving oral fluoroquinolone prophylaxis. The median duration of fever was 12.5 days and time to engraftment 14 days. Regression analysis demonstrated that duration of fever was strongly associated with time to engraftment, and that time to engraftment was associated with source of cells and number of CD34+ cells/kg administered. Recipients of autologous PBSC had the shortest durations of fever and time to engraftment, while recipients of allogeneic umbilical cord blood had the longest. Bone Marrow Transplantation (2000) 25, 59–65.
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References
Rizzo JD . Current trends in BMT ABMTR Newslett 1998 5: 4–10
Chan KW, Petropoulos D, Choroszy M et al. High-dose sequential chemotherapy and autologous stem cell reinfusion in advanced pediatric solid tumors Bone Marrow Transplant 1997 20: 1039–1043
Worth LL, Tran H, Petropoulos D et al. Hematopoietic stem cell transplantation for childhood myeloid malignancies after high-dose thiotepa, busulfan, and cyclophosphamide Bone Marrow Transplant 1999 24: 947–952
Dell'Orto M, Rovelli A, Barzaghi A et al. Febrile complications in the first 100 days after bone marrow transplantation in children: a single center's experience Ped Hematol Oncol 1997 14: 335–347
Salazar R, Solá C, Maroto P et al. Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation BoneMarrow Transplant 1999 23: 27–33
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
Haahr V, Peterslund NA, Møller JK . The influence of antimicrobial prophylaxis on the microbial and clinical findings in patients after autologous bone marrow transplantation Scand J Infect Dis 1997 29: 623–626
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
Lew MA, Kehoe K, Ritz J et al. Ciprofloxacin versus trimethoprim/sulfamethoxazole for prophylaxis of bacterial infections in bone marrow transplant recipients: a randomized, controlled trial J Clin Oncol 1995 13: 239–250
Krüger W, Rüssmann B, Kröger N et al. Early infections in patients undergoing bone marrow or blood stem cell transplantation – a 7 year single centre investigation of 409 cases Bone Marrow Transplant 1999 23: 589–597
Schimpff SC . Infections in the cancer patient-diagnosis, prevention, and treatment. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and Practice of Infectious Diseases, 4 edn Churchill Livingstone: New York 1995 pp 2666–2675
Sparrelid E, Remberger M, Ringden O et al. Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection Bone Marrow Transplant 1998 22: 795–800
Ringden O, Remberger M, Lönnqvist B et al. Faster neutrophil and platelet engraftment, but no differences in acute GVHD or survival, using peripheral blood stem cells from related and unrelated donors, compared to bone marrow Bone Marrow Transplant 1998 22: 131–136
Romano V, Castagnola E, Dallorso S et al. Bloodstream infections can develop late (after day 100) and/or in the absence of neutropenia in children receiving allogeneic bone marrow transplantation Bone Marrow Transplant 1999 23: 271–275
Rackoff WR, Gonin R, Robinson C et al. Predicting the risk of bacteremia in children with fever and neutropenia J Clin Oncol 1996 14: 919–924
Lucas KG, Brown AE, Armstrong D et al. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteremia and complications of sepsis Cancer 1996 77: 791–798
Raad II, Whimbey EE, Rolston KVI et al. A comparison of aztreonam plus vancomycin and imipenem plus vancomycin as initial therapy for febrile neutropenic cancer patients Cancer 1996 77: 1386–1394
Nosanchuk JD, Sepkowitz KA, Pearse RN et al. Infectious complications of autologous bone marrow and peripheral stem cell transplantation for refractory leukemia and lymphoma Bone Marrow Transplant 1996 18: 355–359
Rubinstein P, Carrier C, Scaradavou A et al. Outcomes among 562 recipients of placental-blood transplants from unrelated donors New Engl J Med 1998 339: 1565–1577
Mullen CA, Petropoulos D, Roberts WM et al. Outpatient treatment of fever and neutropenia for low risk pediatric cancer patients Cancer 1999 86: 126–134
Mullen CA, Petropoulos D, Rytting M et al. Acute reversible arthropathy in a pediatric patient with cancer treated with a short course of ciprofloxacin for febrile neutropenia J Ped Hematol Oncol 1998 20: 516–517
Jick S . Ciprofloxacin safety in a pediatric population Ped Infect Dis J 1997 16: 130–133
Hampel B, Hullmann R, Schmidt H . Ciprofloxacin in pediatrics: worldwide clinical experience based on compassionate use–safety report Ped Infect Dis J 1997 16: 127–129
Hughes WT, Armstrong D, Bodey GP et al. 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Infectious Diseases Society of America Clin Infect Dis 1997 25: 551–573
Acknowledgements
This work was supported in part by American Cancer Society Career Development Award CDA-96–61 (CAM).
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Mullen, C., Nair, J., Sandesh, S. et al. Fever and neutropenia in pediatric hematopoietic stem cell transplant patients. Bone Marrow Transplant 25, 59–65 (2000). https://doi.org/10.1038/sj.bmt.1702109
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DOI: https://doi.org/10.1038/sj.bmt.1702109
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