Nosanchuk J D, Sepkowitz K A, Pearse R N, White M H, Nimer S D, Armstrong D
Department of Medicine, Memorial Sloan-Kettering Cancer Center, Cornell Medical Center, New York, NY, USA.
Bone Marrow Transplant. 1996 Aug;18(2):355-9.
We aimed to characterize the infectious complications of autologous bone marrow (AuBMT) and peripheral stem cell transplantation (PSCT) in patients with refractory leukemia and lymphoma. We performed a retrospective analysis of all patients (n = 56) with refractory leukemia or lymphoma treated with AuBMT or PSCT at Memorial Sloan-Kettering Cancer Center from January 1993 to July 1994. Records were available in 55, of whom 33 (60%) received AuBMT and 22 (40%) PSCT. Fifteen (27%) developed complicated infections, including 13 (39%) treated with AuBMT and two (9%) with PSCT. Complicated infections were caused by bacterial (11 episodes), fungal (four episodes), and viral (four episodes) pathogens. Five (9%) infections were fatal. In a multivariate model, only duration of neutropenia was significantly associated with development of complicated infection (P = 0.006). Thus, 27% of patients with refractory leukemia or lymphoma treated with AuBMT or PSCT developed complicated infections and 9% died of infection. Prolonged neutropenia was significantly associated with development of infection. Patients receiving PSCT had significantly lower rates of complicated infection, presumably due to the associated shorter duration of neutropenia. Future studies are needed to define the role of PSCT as treatment for refractory neoplastic disease.
我们旨在明确难治性白血病和淋巴瘤患者自体骨髓移植（AuBMT）及外周干细胞移植（PSCT）后的感染并发症情况。我们对1993年1月至1994年7月在纪念斯隆凯特琳癌症中心接受AuBMT或PSCT治疗的所有难治性白血病或淋巴瘤患者（n = 56）进行了回顾性分析。55例患者有记录可查，其中33例（60%）接受了AuBMT，22例（40%）接受了PSCT。15例（27%）发生了复杂性感染，其中13例（39%）接受AuBMT治疗，2例（9%）接受PSCT治疗。复杂性感染由细菌（11例）、真菌（4例）和病毒（4例）病原体引起。5例（9%）感染导致死亡。在多变量模型中，只有中性粒细胞减少持续时间与复杂性感染的发生显著相关（P = 0.006）。因此，接受AuBMT或PSCT治疗的难治性白血病或淋巴瘤患者中，27%发生了复杂性感染，9%死于感染。中性粒细胞减少持续时间延长与感染发生显著相关。接受PSCT的患者复杂性感染发生率显著较低，可能是由于中性粒细胞减少持续时间较短。需要进一步研究来明确PSCT作为难治性肿瘤疾病治疗方法的作用。
