Lakatos Botond, Szabó Helga, Csordás Katalin, Tatai Gábor, Nikolova Radka, Csomor Judit, Reményi Péter, Masszi Tamás, Vályi-Nagy István, Sinkó János
Országos Hematológiai és Infektológiai Intézet, Infektológiai Osztály, Dél-pesti Centrumkórház Budapest.
Radiológiai és Onkoterápiás Klinika, Semmelweis Egyetem Budapest.
Orv Hetil. 2020 Jan;161(3):103-109. doi: 10.1556/650.2020.31638.
Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.
自体造血干细胞移植在某些恶性和非恶性疾病中仍然是一种有前景的治疗方法。然而，该手术会增加并发症的风险，最显著的是早期和晚期感染。分析移植后早期（< +100天）感染的病原体频率和种类，并评估死亡风险因素。对2007年至2014年在我们中心接受自体造血干细胞移植的699例患者的前瞻性收集数据进行回顾性分析。699例患者的中位年龄为56岁（四分位间距：43 - 62岁），54%（376例）为男性。25例患者已转至其他中心，19例患者失访。69.8%（488例）的患者发生了中性粒细胞减少性发热。此外，在96例患者中发现了102次感染发作。最常见的是菌血症（49次发作），中位发病时间为7天（5 - 11天）。大多数（33/49）菌血症发生在植入前期。与浆细胞疾病患者相比，恶性淋巴瘤患者的菌血症发生率更高（p = 0.0005，OR：2.41，95% CI：1.49 - 3.99）。已确定12次病毒感染发作和8例确诊或可能的侵袭性真菌病病例。在655例有完整随访的患者中，16例（2.4%）住院死亡，其中8例与感染有关。早期感染对生存有不利影响（p = 0.0001）。在自体干细胞移植中，微生物学未确诊的中性粒细胞减少性发热很常见。然而，有记录的早期菌血症并不常见。与浆细胞疾病患者相比，淋巴瘤患者发生血流感染的机会显著更高。早期感染会降低生存机会；因此，有效的预防和治疗仍然至关重要。《匈牙利医学周报》。2020年；161(3)：103 - 109。
