Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients

被引:52
作者
Narimatsu, H
Matsumura, T
Kami, M
Miyakoshi, S
Kusumi, E
Takagi, S
Miura, Y
Kato, D
Inokuchi, C
Myojo, T
Kishi, Y
Murashige, N
Yugi, K
Masuoka, Y
Yoneyama, A
Wake, A
Morinaga, S
Kanda, Y
Taniguchi, S
机构
[1] Natl Canc Ctr, Hematopoiet Stem Cell Transplantat Unit, Chuo Ku, Tokyo 1040045, Japan
[2] Toranomon Gen Hosp, Dept Hematol, Tokyo, Japan
[3] Tokyo Univ Hosp, Dept Cell Therapy & Transplantat Med, Tokyo 113, Japan
关键词
bacterial infection; bacteremia; allogeneic hematopoictic stem cell transplantation; Pseudomonas aeruginosa; coagulase-negative Staphylococcus;
D O I
10.1016/j.bbmt.2005.01.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17-79 years). Preparative regimens comprised fludarabine 125 to 150 mg/m(2), melphalan 80 to 140 mg/m(2), or busulfan 8 mg/kg and total body irradiation 2 to 8 Gy. Prophylaxis against graft-versus-host disease comprised cyclosporin or tacrolimus. BSI developed within 100 days of RI-CBT in 32 patients. The cumulative incidence of BSI was 25% at day 30 and 32% at day 100. The median onset was day 15 (range, 1-98 days). Causative organisms included Pseudomonas aeruginosa (n = 12), Staphylococcus epidermidis (n = 11), Staphylococcus aureus (n = 6), Enterococcus faecium (n = 4), Enterococcus faecalis (n = 4), Stenotrophomonas maltophilia (n = 4), and others (n = 7). Of the 32 patients with BSI, 25 (84%) died within 100 days after RI-CBT. BSI was the direct cause of death in 8 patients (25%). Univariate analysis failed to identify any significant risk factors. BSI clearly represents a significant and fatal complication after RI-CBT. Further studies are warranted to determine clinical characteristics, identify patients at high risk of BSI, and establish therapeutic strategies. (c) 2005 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:429 / 436
页数:8
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