Metzner Bernd, Grüneisl Ricarda, Gebauer Wolfgang, Reschke Daniel, Ost Ekkehard, Müller Thomas H, Reichert Dietmar, Rosien Bernd, Del Valle Francisco, Zirpel Iris, Kohse Klaus Peter, Schunter Friedrich, Illiger Hans-Jochen
Klinik für Innere Medizin II, Klinikum Oldenburg, Germany.
Med Klin (Munich). 2002 Nov 15;97(11):650-8. doi: 10.1007/s00063-002-1208-y.
Only a few data on frequency and character of late infectious complications after high-dose therapy (HDT) and autologous blood stem cell transplantation (ASCT) have been published. This prospective study was carried out to identify potential predictive factors for late infections (occurring after discharge following HDT) and to clarify the usefulness of prophylactic measures.
Clinical data of 192 consecutive patients treated with HDT and ASCT in a single hospital were analyzed on late infectious complications. After discharge following HDT, the 166 evaluable patients (84 with hematologic malignancies, 82 with solid tumors) had been examined and interviewed on infections every 4-12 weeks after ASCT. For Pneumocystis carinii prophylaxis, inhalation with pentamidine or oral cotrimoxazole was used for 3-4 months following ASCT.
In the first 6 months following ASCT (after discharge) we saw on average one infectious episode per patient (median, range 0-6), usually light infections (mostly banal upper airway infections). 17 patients had to be treated in hospital for infectious (15 of whom with hematologic malignancies), three of whom (only with hematologic malignancies) died in spite of intensive care as a result of pneumonias due to opportunistic causative agents (mainly Pneumocystis carinii [PcP]). In the second half of the year after ASCT, five patients (with hematologic malignancies) had to be hospitalized due to infections. No further infection-related death occurred. Early documented infections (pneumonia, bacteremia or Clostridium difficile colitis) were associated with an increased risk for late serious infections. Zoster occurred in 18% of patients within 12 months, more frequently after increased pretreatment (25% vs. 11% after less pretreatment), most frequently in patients with relapsed lymphomas (32%).
Significant late infectious complications after ASCT are uncommon. Patients with hematologic malignancies have a significantly increased risk of more serious infections and should be observed carefully. For risk patients with hematologic malignancies and possibly solid tumors, a strict PcP prophylaxis is required. Patients with relapsed lymphomas could possibly be treated preventively against zoster with low-dose aciclovir to reduce the extent of zoster disease. Each patient should be informed carefully that early signs of zoster require an effective zoster treatment as soon as possible.
关于大剂量治疗（HDT）和自体造血干细胞移植（ASCT）后晚期感染并发症的发生率和特征，仅有少量数据发表。本前瞻性研究旨在确定晚期感染（HDT出院后发生）的潜在预测因素，并阐明预防措施的有效性。
分析了一家医院连续接受HDT和ASCT治疗的192例患者的临床数据，以了解晚期感染并发症情况。HDT出院后，对166例可评估患者（84例血液系统恶性肿瘤患者，82例实体瘤患者）在ASCT后每4 - 12周进行感染方面的检查和访谈。对于卡氏肺孢子虫预防，ASCT后3 - 4个月使用戊烷脒吸入或口服复方新诺明。
在ASCT后的前6个月（出院后），我们平均每位患者观察到1次感染发作（中位数，范围0 - 6次），通常为轻度感染（大多为普通上呼吸道感染）。17例患者因感染需住院治疗（其中15例为血液系统恶性肿瘤患者），其中3例（仅为血液系统恶性肿瘤患者）尽管接受了重症监护，但因机会性病原体（主要是卡氏肺孢子虫[PcP]）引起的肺炎死亡。在ASCT后的下半年，5例（血液系统恶性肿瘤患者）因感染需住院治疗。未再发生与感染相关的死亡。早期记录的感染（肺炎、菌血症或艰难梭菌结肠炎）与晚期严重感染风险增加相关。18%的患者在12个月内发生带状疱疹，预处理增加后更常见（预处理增加后为25%，预处理较少后为11%），最常见于复发淋巴瘤患者（占32%）。
ASCT后显著的晚期感染并发症并不常见。血液系统恶性肿瘤患者发生更严重感染的风险显著增加，应仔细观察。对于血液系统恶性肿瘤以及可能的实体瘤风险患者，需要严格预防PcP。复发淋巴瘤患者可能可用低剂量阿昔洛韦预防性治疗带状疱疹，以减轻带状疱疹疾病的程度。应仔细告知每位患者，带状疱疹的早期迹象需要尽快进行有效的带状疱疹治疗。
