Ketterer N, Espinouse D, Chomarat M, Dumontet C, Moullet I, Rieux C, Neidhardt-Berard E M, Bouafia F, Coiffier B, Salles G
Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon and UPRES-JE 1879 Hémopathies Lymphoïdes malignes, Université Claude Bernard, Pierre-Bénite, France.
Am J Med. 1999 Feb;106(2):191-7. doi: 10.1016/s0002-9343(98)00409-4.
We sought to describe the infections that occur after large-dose chemotherapy, which was followed by autologous peripheral blood progenitor cell transplantation, and to determine their risk factors.
We retrospectively analyzed the occurrence and the characteristics of infections in 277 consecutive patients who received intensive chemotherapy for non-Hodgkin's lymphoma (n = 207), Hodgkin's disease (n = 27), or multiple myeloma (n = 43) in a single institution. Conditioning regimens included total body irradiation in 47% of the cases. Infections occurring within the 30 days after transplant were defined as early infections, whereas infections after that time in patients who had achieved a neutrophil count greater than 1.0 x 10(9)/L (1,000 per microL) were considered as late infections.
Within the first 30 days, 172 patients had unexplained fever (62%); infections were documented in 83 patients (30%), most commonly bacteremia (57 patients). Late infections occurred in 64 (26%) of 244 evaluable patients and consisted mainly of varicella zoster virus infections (n = 36) and pneumonia (n = 16). Administration of total body irradiation [odds ratio (OR) = 2.50; 95% confidence interval (CI) 1.4 to 4.5; P = 0.002) and previous use of fludarabine (OR 2.5; CI 1.2 to 5.2; P = 0.02) and a diagnosis of myeloma (OR 2.6; CI 1.2 to 5.6; P = 0.04) were significantly associated with late infections.
This study confirms that infectious toxicity after peripheral blood progenitor cell transplantation is usually moderate, although bacteremia remains a serious problem. Late infections are encountered in about 25% of patients and are more common in those with myeloma, or those who received total body irradiation or fludarabine.
我们试图描述大剂量化疗后接受自体外周血祖细胞移植所发生的感染情况，并确定其危险因素。
我们回顾性分析了在单一机构中连续接受强化化疗的277例患者的感染发生情况及特征，这些患者分别患有非霍奇金淋巴瘤（n = 207）、霍奇金病（n = 27）或多发性骨髓瘤（n = 43）。预处理方案中47%的病例包括全身照射。移植后30天内发生的感染定义为早期感染，而在中性粒细胞计数大于1.0×10⁹/L（每微升1000个）的患者中，在此时间之后发生的感染被视为晚期感染。
在最初30天内，172例患者出现不明原因发热（62%）；83例患者（30%）有感染记录，最常见的是菌血症（57例）。244例可评估患者中有64例（26%）发生晚期感染，主要包括水痘带状疱疹病毒感染（n = 36）和肺炎（n = 16）。全身照射（比值比[OR]=2.50；95%置信区间[CI]1.4至4.5；P = 0.002）、既往使用氟达拉滨（OR 2.5；CI 1.2至5.2；P = 0.02）以及骨髓瘤诊断（OR 2.6；CI 1.2至5.6；P = 0.04）与晚期感染显著相关。
本研究证实，外周血祖细胞移植后的感染毒性通常为中度，尽管菌血症仍是一个严重问题。约25%的患者会发生晚期感染，在骨髓瘤患者、接受全身照射或氟达拉滨治疗的患者中更常见。
