Degree of mucositis and duration of neutropenia are the major risk factors for early post-transplant febrile neutropenia and severe bacterial infections after reduced-intensity conditioning

• Published in: European journal of haematology Vol. 88; no. 1; pp. 46 - 51
• Main Authors: Facchini, Luca, Martino, Rodrigo, Ferrari, Angela, Piñana, José L., Valcárcel, David, Barba, Pere, Granell, Miguel, Delgado, Julio, Briones, Javier, Sureda, Anna, Brunet, Salut, Sierra, Jorge
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2012
• Subjects: Adult; allogeneic hematopoietic stem cell transplantation; Bacteria; Bacterial Infections - epidemiology; Bacterial Infections - etiology; Busulfan - administration & dosage; Busulfan - adverse effects; early post-transplant infections; febrile neutropenia; Female; Graft vs Host Disease - epidemiology; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; intermediate post-transplant infections; Male; Melphalan - administration & dosage; Melphalan - adverse effects; Middle Aged; Mucositis - epidemiology; Mucositis - etiology; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - adverse effects; Mycophenolic Acid - analogs & derivatives; Myeloablative Agonists - administration & dosage; Myeloablative Agonists - adverse effects; Neutropenia - epidemiology; Neutropenia - etiology; reduced-intensity conditioning; Retrospective Studies; Risk Factors; severe bacterial infections; Time Factors; Transplantation Conditioning; Transplantation, Homologous
• ISSN: 0902-4441; 1600-0609; 1600-0609
• DOI: 10.1111/j.1600-0609.2011.01724.x

Background and objectives: Whether the intensity of the conditioning regimen affects febrile neutropenia (FN) and severe bacterial infections (SBIs) is not well established. We analyzed the risk factors (RFs) for the development of FN and SBI in the first 100 d post‐transplant in 195 consecutive adult recipients of a reduced‐intensity conditioning allogeneic hematopoietic stem cell transplantation (RIC‐allo). Materials and methods: The RIC regimens consisted of fludarabine plus melphalan (62%) or busulphan (38%) (FluMel or FluBu). SBIs include pneumonia, urinary tract infections, and bacteremia. Results: FN occurred in 141 patients (72%), always in the first 30 d post‐allo‐RIC. However, a SBI occurred in only 27 patients (14%) during this early post‐transplant period (<day +30), while 29 evaluable patients (15%) developed a SBI in the intermediate post‐transplant period (days +31 to +100). In multivariate analysis, RFs for the development of FN included onset of neutropenia before day +5 after allo‐RIC (P < 0.02) and NCI CTC grade III–IV mucosal damage in the first 10 d post‐transplantation (P = 0.03). RFs identified to SBI by multivariate analysis included corticosteroid therapy before day +100 (P < 0.01), mycophenolate mofetil‐based graft‐versus‐host disease (GVHD) prophylaxis (P < 0.01), and previous SBI before day +30 (P < 0.01). The rate of SBI from day +30 to +100 varied according to the number of RFs; thus, the rate of SBI was 1% in patients without any RF, 17% in patients with one RF, 29% with one RFs, and 53% in those with all three RFs. Conclusions: After an RIC‐allo, FN and early SBI occurred mostly in patients with severe mucositis and early‐onset neutropenia, while postengraftment high‐dose steroid therapy for acute GVHD was the major RF.