Febrile Neutropenia Following Autologous Stem Cell Transplantation in Patients with Lymphoma

Abstract

Background: Infections remain a major cause of morbidity and mortality in patients with lymphoma treated with autologous hematopoietic stem cell transplantation. Knowledge of local microbiological epidemiology and patients' risk factors are essential for optimal management of these infections.Aims: to determine incidence of febrile neutropenia (FN) in patients with lymphoma treated with autologous peripheral blood stem cell transplantation (PBSCT) and to investigate correlations of a number of variables available on the day of FN onset with the severity of infection.Patients and Methods: 102 consecutive patients (median age 44, range 19–68 yrs, 58M/44F) with relapsed or refractory Non-Hodgkin's Lymphoma (NHL, n=78) and Hodgkin's Disease (HD, n=24) treated with PBSCT in a single center have been evaluated for infectious complications following transplantation.Results: Febrile neutropenia occurred in 67 (65.7%) patients at a mean of 6 days after transplantation (range 1–9, SD 1.71). Microbiological work-up was done and empirical antibiotic therapy with piperacillin-tazobactam was initiated in all but 15 patients who received a carbapenem. Empirical therapy was modified in 31 (46.3%) patients. Vancomycin was added in 22 patients (32.8%), a sistemic antifungal in 4 (6.0%) and both in 6 (9.0%) patients. Three patiens died as a consequence of sepsis (TRM=2.9%). Twenty two patients (32.8%) had proven bacteremias while 27 (40.3%) had other microbiologically documented infections (MDIs). Gram+ microorganisms were responsible for the majority of all documented infections (63.6% of bacteremias and 54.5% of other MDIs). Correlations of a number of variables available at time of FN onset with the duration of febrile episode have been investigated. Patients with higher CRP levels at FN onset and those with earlier onset of fever following PBSCT had significantly longer (p=0.047 and p=0.0066, respectively) duration of fever. Other variables, including age, No. of previous lines of therapy, No. of stem cells reinfused, ANC and monocyte counts as well as peak temperature values at day of fever onset did not show statistically significant correlations with duration of fever. All patients with diabetes developed FN and, although not reaching statistical significance (p=0.09), its duration was longer in comparison to other patients.Conclusions: Infections are serious but manageable complications of PBSCT. Gram+ microorganisms remain the major cause of documented infections. Early empirical antimicrobial therapy, tailored according to local microbiological epidemiology is essential for their optimal treatment.