Autologous stem cell transplantation in Kuwait cancer control centre: Review of infections in the first thirty days post-transplant

Abstract

Autologous peripheral blood stem cells (PBSC) following high-dose chemotherapy is established in Kuwait Cancer Control Center since 2000. We studied the incidence of microbial infections during the first 30 days following autologous PBSC transplantation in 120 consecutive patients with non-Hodgkin’s lymphomas, Hodgkin’s lymphoma, multiple myeloma, and acute myeloid leukemia. The incidence and consequences of these infections are reported. All the patients received antibiotic prophylaxis and hematopoietic growth factors during neutropenia. The mean duration of severe neutropenia was 7 days (range 5-9) in all the patients, and the median time to myeloid engraftment was 11 days. The incidence of culture-proven infections in non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, and multiple myeloma patients was similar. Infections could be documented clinically only in 67 patients (72.8%) where they had culture-negative infections. In 25 patients clinical infection was supported by positive cultures. The isolated organisms included Gram-negative organisms in 56%, Gram positive in 24%, and both Gram negative and Gram positive in 16% of the patients. In 4% of the patients fungi were isolated. The most common sites of infections were central line (catheter) infection (68%). Among central line infections, isolates were Gram positive in 35.3%, Gram negative in 41.2%, both Gram negative and Gram positive in one patient and fungi in one patient. Although the overall incidence of infections among autologous SCT recipients is modest, because patients tended to have rapid recovery of their immune system, infections remain a significant cause of morbidity stressing the importance of prevention and management of infectious diseases.