Infectious Complications in Patients Receiving Mobilization Chemotherapy for Autologous Peripheral Blood Stem Cell Collection

Abstract

The purpose of this retrospective study was to evaluate infectious complications in patients receiving mobilization chemotherapy for stem cell collection prior to autologous peripheral blood stem cell transplantation. An additional goal was to evaluate risk factors associated with the development of infectious complications. At the Medical College of Georgia BMT center, 54 patients were administered mobilization chemotherapy for the purpose of collecting stem cells between June, 1997, and May, 2002. All patients received Filgrastim in addition to chemotherapy, and 50 of 54 patients received prophylactic acyclovir, fluconazole, and ciprofloxacin until neutrophil recovery. The median duration to neutrophil recovery was 11 days. Fourteen of 54 (26%) patients developed fever/infections during the mobilization phase. One patient developed both a catheter-related infection and Clostridium difficile colitis, increasing the total number of infectious episodes to 15. Twelve patients had a documented site of infection whereas 2 patients had neutropenic fever with no identifiable source. Eight of the 15 (55%) infections were Gram-positive catheter infections. All the patients were treated successfully with antibiotics. No systemic fungal infections were identified and none of the patients died from complications related to mobilization chemotherapy. Logistic regression was applied for univariate and multivariate analysis and showed that age, sex, diagnosis, neutrophil recovery, disease status, use of salvage chemotherapy, and mobilization regimen used did not affect the infection rate. In our series of 54 patients, 14 patients developed fever/infections during mobilization. Although there is a substantial risk of infectious complications among patients who receive mobilization chemotherapy, it is not clear that prophylactic antibiotics decrease infectious complications. Because the vast majority of infections are Gram-positive catheter infections, it appears reasonable to employ Gram-positive prophylaxis. Controlled studies should be conducted to define the optimum mobilization regimens as well as the optimum combination of prophylactic antibiotics.

Changing Epidemiology of Clostridium difficile–Associated Disease during Stem Cell Transplantation

“…For most studies, patient accrual was completed more than 10 years ago. Variable CDAD incidence rates, generally between 1% to 12% for auto-and allo-HSCT recipients, were observed [7][8][9][10][11][12][13]. The most recently published epidemiologic study reported by Chopra et al [13], conducted during the same time period as the present study, observed CDAD rates similar to our results.…”

review: Current status of stem cell mobilization

“…Using mobilization chemotherapy results in significant infectious morbidity (Toor et al , 2001). In one report, 26% of patients developed fever or infection during the mobilization phase, and it was not clear that the use of prophylactic antibiotics decreased infectious complications in these patients, most of whom had an indwelling central venous catheter (Jillella et al , 2003).…”

Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?

“…Jillella and colleagues 28 evaluated 54 patients for evidence of infections during the mobilization period for auto-HSCT. These investigators noted only one case of CDAD among 15 instances of infectious complications in the study population.…”