Evaluation of the bone marrow transplantation recipient patients regarding fever onset, fever permanence, risk factors, and underlying causes, during pre-engraftment phase
,
Abstract
Background: Patients undergoing bone marrow transplantation (BMT) are at higher risk of immune system deficiency. The immunosuppression, followed by pre-transplant chemotherapy makes patients vulnerable to a variety of infections, and fever is one of the first symptoms, which could develop as a result of infectious or non-infectious diseases. In the present study, the features of the fever during the pre-engraftment stage in BMT receiving patients have been investigated. Materials and Methods: Sixty-four patients receiving BMT were prospectively evaluated during the pre-engraftment phase to evaluate the evidence of the febrile reaction. Data concerning the cause of fever, microbiological test, the treatments and fever onset pattern, and treatment outcomes were recorded and analyzed. Results: 73.4% of the patients had an autologous transplant, and the others received allogeneic. After transplantation, 75% of patients encountered fever during the pre-engraftment period. Of the 48 patients, 47.9% of the patients suffered fever of unknown origin (FUO). Age, gender, underlying malignancy, type of transplantation, and acute phase reactants levels before transplantation were not associated with fever development. Among febrile patients, patients with autologous transplantation were significantly more likely to develop FUO (p-value = 0.036) There was also no significant difference in the onset of fever between patients with infectious fever and who suffered FUO. Conclusion: During BMT, half of the patients developed a fever of unknown origin; nevertheless, it seems that patients undergoing allogeneic transplantation are at higher risk of FUO compared to patients who received an autologous transplant.
1.Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematologi¬cal malignancies and solid neoplasms in hospitals in the United States. Clinical infectious diseases : an of¬ficial publication of the Infectious Diseases Society of America. 2003;36(9):1103-10. Epub 2003/04/26. doi: 10.1086/374339. PubMed PMID: 12715303.
2.Chawla R, Greenstein S. Infections after bone marrow transplantation. Medscape reference. 2013.
3.Sharma A, Lokeshwar N. Febrile neutropenia in hae¬matological malignancies. Journal of postgraduate medicine. 2005;51(5):42.
4.Dykewicz CA. Guidelines for preventing opportun¬istic infections among hematopoietic stem cell trans¬plant recipients: focus on community respiratory virus infections. Biology of Blood and Marrow Trans¬plantation. 2001;7(12):19S-22S.
5.Nemunaitis J, Rabinowe SN, Singer JW, Bierman PJ, Vose JM, Freedman AS, et al. Recombinant granu¬locyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lym¬phoid cancer. New England Journal of Medicine. 1991;324(25):1773-8.
6.Dickout WJ, Chan CK, Hyland RH, Hutcheon MA, Fraser IM, Morgan CD, et al. Prevention of acute pul¬monary edema after bone marrow transplantation. Chest. 1987;92(2):303-9.
7.Peña E, Souza CA, Escuissato DL, Gomes MM, Allan D, Tay J, et al. Noninfectious pulmonary complica¬tions after hematopoietic stem cell transplantation: practical approach to imaging diagnosis. Radio¬graphics. 2014;34(3):663-83.
8.Florida H. Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: an indi¬vidual patient data meta-analysis of nine randomized trials. J Clin Oncol. 2005;23:5074-87.
9.Busca A, Saroglia EM, Giacchino M, Vai S, Vassallo E, Fagioli F, et al. Analysis of early infectious com¬plications in pediatric patients undergoing bone marrow transplantation. Supportive care in cancer. 1999;7(4):253-9.
10.Matinato C, Lunghi G, Orlandi A, Melotti S, Zoc¬coli A, Picicco D, et al. Evaluation of reactivation of HSV1, HHV6, CMV and EBV in a population of patients undergoing allogeneic bone marrow trans¬plantation. Microbiologia Medica. 2011;26(2).
11.Xiong S-D, Pu L-F, Wang H-P, Hu L-H, Ding Y-Y, Li M-M, et al. Neutrophil CD64 Index as a superi¬or biomarker for early diagnosis of infection in fe¬brile patients in the hematology department. Clin¬ical Chemistry and Laboratory Medicine (CCLM). 2017;55(1):82-90.
12.Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic pa¬tients with cancer: 2010 update by the infectious dis¬eases society of america. Clinical infectious diseases : an official publication of the Infectious Diseases Soci¬ety of America. 2011;52(4):e56-93. Epub 2011/01/25. doi: 10.1093/cid/cir073. PubMed PMID: 21258094.
13.Spitzer T. Engraftment syndrome: double-edged sword of hematopoietic cell transplants. Bone mar¬row transplantation. 2015;50(4):469-75.
14.Lee Y-H, Rah W-J. Pre-engraftment syndrome: clinical significance and pathophysiology. Blood research. 2016;51(3):152-4.
15.Gil L, Styczynski J, Komarnicki M. Infectious complication in 314 patients after high-dose therapy and autologous hematopoietic stem cell transplan¬tation: risk factors analysis and outcome. Infection. 2007;35(6):421-7. Epub 2007/10/11. doi: 10.1007/ s15010-007-6350-2. PubMed PMID: 17926001.
16.Reich G, Mapara MY, Reichardt P, Dorken B, Maschmeyer G. Infectious complications after high-dose chemotherapy and autologous stem cell trans¬plantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant. 2001;27(5):525-9. Epub 2001/04/21. doi: 10.1038/sj.bmt.1702822. PubMed PMID: 11313687.
17.Safayi SR, Shahi F, Ghalamkari M, Mirzania M, Khatuni M, Hirmandi Niasar F. A Survey of Infec¬tion in Allogenic Hematopoietic Stem Cell Trans¬plantation in Patients with Acute Myeloid Leukemia. International journal of organ transplantation med¬icine. 2018;9(3):112-6. Epub 2018/11/30. PubMed PMID: 30487958; PubMed Central PMCID: PMCP¬MC6252176.
18.Cho SY, Choi HY. Opportunistic fungal infec¬tion among cancer patients. A ten-year autop¬sy study. American journal of clinical pathology. 1979;72(4):617-21. Epub 1979/10/01. PubMed PMID: 495566.
19.Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Infectious Disease Clinics. 2010;24(2):257-72.
20.Auner HW, Sill H, Mulabecirovic A, Linkesch W, Krause R. Infectious complications after autologous hematopoietic stem cell transplantation: compari¬son of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Annals of hematology. 2002;81(7):374-7. Epub 2002/08/20. doi: 10.1007/s00277-002-0484-1. PubMed PMID: 12185506.
21.Rolston KV. Challenges in the treatment of infections caused by gram-positive and gram-negative bacteria in patients with cancer and neutropenia. Clinical infectious diseases : an official publication of the In¬fectious Diseases Society of America. 2005;40 Suppl 4:S246-52. Epub 2005/03/16. doi: 10.1086/427331. PubMed PMID: 15768330.
22.Holland T, Fowler VG, Jr., Shelburne SA, 3rd. Invasive gram-positive bacterial infection in cancer patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014;59 Suppl 5:S331-4. Epub 2014/10/30. doi: 10.1093/cid/ ciu598. PubMed PMID: 25352626; PubMed Central PMCID: PMCPMC4303051.
23.Fernandez-Mosteirin N, Salvador-Osuna C, Gimeno Lozano JJ, Marco Lamata ML, Blasco Alberdi M, Rubio Felix D, et al. [Incidence of febrile episodes in patients with multiple myeloma undergoing autol¬ ogous peripheral blood stem cell transplantation]. Anales de medicina interna (Madrid, Spain : 1984). 2005;22(5):213-6. Epub 2005/07/09. PubMed PMID: 16001935.
24.Kollu V, Mott SL, Khan R, Farooq U, Jethava Y, Dilek I, et al. C-Reactive Protein Monitoring Predicts Neu¬tropenic Fever Following Autologous Hematopoiet¬ic Stem Cell Transplantation for Multiple Myeloma. Cureus. 2018;10(7):e2945. Epub 2018/09/12. doi: 10.7759/cureus.2945. PubMed PMID: 30202676; Pu-bMed Central PMCID: PMCPMC6128584.
25.Fujii K, Aoyama M, Shinagawa K, Matsuo K, Tak¬enaka K, Ikeda K, et al. Risk of neutropenic fever and early infectious complications after autologous peripheral blood stem cell transplantation for malig¬nant diseases. International journal of hematology. 2002;76(2):186-91. Epub 2002/09/07. PubMed PMID: 12215019.
2.Chawla R, Greenstein S. Infections after bone marrow transplantation. Medscape reference. 2013.
3.Sharma A, Lokeshwar N. Febrile neutropenia in hae¬matological malignancies. Journal of postgraduate medicine. 2005;51(5):42.
4.Dykewicz CA. Guidelines for preventing opportun¬istic infections among hematopoietic stem cell trans¬plant recipients: focus on community respiratory virus infections. Biology of Blood and Marrow Trans¬plantation. 2001;7(12):19S-22S.
5.Nemunaitis J, Rabinowe SN, Singer JW, Bierman PJ, Vose JM, Freedman AS, et al. Recombinant granu¬locyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lym¬phoid cancer. New England Journal of Medicine. 1991;324(25):1773-8.
6.Dickout WJ, Chan CK, Hyland RH, Hutcheon MA, Fraser IM, Morgan CD, et al. Prevention of acute pul¬monary edema after bone marrow transplantation. Chest. 1987;92(2):303-9.
7.Peña E, Souza CA, Escuissato DL, Gomes MM, Allan D, Tay J, et al. Noninfectious pulmonary complica¬tions after hematopoietic stem cell transplantation: practical approach to imaging diagnosis. Radio¬graphics. 2014;34(3):663-83.
8.Florida H. Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: an indi¬vidual patient data meta-analysis of nine randomized trials. J Clin Oncol. 2005;23:5074-87.
9.Busca A, Saroglia EM, Giacchino M, Vai S, Vassallo E, Fagioli F, et al. Analysis of early infectious com¬plications in pediatric patients undergoing bone marrow transplantation. Supportive care in cancer. 1999;7(4):253-9.
10.Matinato C, Lunghi G, Orlandi A, Melotti S, Zoc¬coli A, Picicco D, et al. Evaluation of reactivation of HSV1, HHV6, CMV and EBV in a population of patients undergoing allogeneic bone marrow trans¬plantation. Microbiologia Medica. 2011;26(2).
11.Xiong S-D, Pu L-F, Wang H-P, Hu L-H, Ding Y-Y, Li M-M, et al. Neutrophil CD64 Index as a superi¬or biomarker for early diagnosis of infection in fe¬brile patients in the hematology department. Clin¬ical Chemistry and Laboratory Medicine (CCLM). 2017;55(1):82-90.
12.Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic pa¬tients with cancer: 2010 update by the infectious dis¬eases society of america. Clinical infectious diseases : an official publication of the Infectious Diseases Soci¬ety of America. 2011;52(4):e56-93. Epub 2011/01/25. doi: 10.1093/cid/cir073. PubMed PMID: 21258094.
13.Spitzer T. Engraftment syndrome: double-edged sword of hematopoietic cell transplants. Bone mar¬row transplantation. 2015;50(4):469-75.
14.Lee Y-H, Rah W-J. Pre-engraftment syndrome: clinical significance and pathophysiology. Blood research. 2016;51(3):152-4.
15.Gil L, Styczynski J, Komarnicki M. Infectious complication in 314 patients after high-dose therapy and autologous hematopoietic stem cell transplan¬tation: risk factors analysis and outcome. Infection. 2007;35(6):421-7. Epub 2007/10/11. doi: 10.1007/ s15010-007-6350-2. PubMed PMID: 17926001.
16.Reich G, Mapara MY, Reichardt P, Dorken B, Maschmeyer G. Infectious complications after high-dose chemotherapy and autologous stem cell trans¬plantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. Bone Marrow Transplant. 2001;27(5):525-9. Epub 2001/04/21. doi: 10.1038/sj.bmt.1702822. PubMed PMID: 11313687.
17.Safayi SR, Shahi F, Ghalamkari M, Mirzania M, Khatuni M, Hirmandi Niasar F. A Survey of Infec¬tion in Allogenic Hematopoietic Stem Cell Trans¬plantation in Patients with Acute Myeloid Leukemia. International journal of organ transplantation med¬icine. 2018;9(3):112-6. Epub 2018/11/30. PubMed PMID: 30487958; PubMed Central PMCID: PMCP¬MC6252176.
18.Cho SY, Choi HY. Opportunistic fungal infec¬tion among cancer patients. A ten-year autop¬sy study. American journal of clinical pathology. 1979;72(4):617-21. Epub 1979/10/01. PubMed PMID: 495566.
19.Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Infectious Disease Clinics. 2010;24(2):257-72.
20.Auner HW, Sill H, Mulabecirovic A, Linkesch W, Krause R. Infectious complications after autologous hematopoietic stem cell transplantation: compari¬son of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Annals of hematology. 2002;81(7):374-7. Epub 2002/08/20. doi: 10.1007/s00277-002-0484-1. PubMed PMID: 12185506.
21.Rolston KV. Challenges in the treatment of infections caused by gram-positive and gram-negative bacteria in patients with cancer and neutropenia. Clinical infectious diseases : an official publication of the In¬fectious Diseases Society of America. 2005;40 Suppl 4:S246-52. Epub 2005/03/16. doi: 10.1086/427331. PubMed PMID: 15768330.
22.Holland T, Fowler VG, Jr., Shelburne SA, 3rd. Invasive gram-positive bacterial infection in cancer patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014;59 Suppl 5:S331-4. Epub 2014/10/30. doi: 10.1093/cid/ ciu598. PubMed PMID: 25352626; PubMed Central PMCID: PMCPMC4303051.
23.Fernandez-Mosteirin N, Salvador-Osuna C, Gimeno Lozano JJ, Marco Lamata ML, Blasco Alberdi M, Rubio Felix D, et al. [Incidence of febrile episodes in patients with multiple myeloma undergoing autol¬ ogous peripheral blood stem cell transplantation]. Anales de medicina interna (Madrid, Spain : 1984). 2005;22(5):213-6. Epub 2005/07/09. PubMed PMID: 16001935.
24.Kollu V, Mott SL, Khan R, Farooq U, Jethava Y, Dilek I, et al. C-Reactive Protein Monitoring Predicts Neu¬tropenic Fever Following Autologous Hematopoiet¬ic Stem Cell Transplantation for Multiple Myeloma. Cureus. 2018;10(7):e2945. Epub 2018/09/12. doi: 10.7759/cureus.2945. PubMed PMID: 30202676; Pu-bMed Central PMCID: PMCPMC6128584.
25.Fujii K, Aoyama M, Shinagawa K, Matsuo K, Tak¬enaka K, Ikeda K, et al. Risk of neutropenic fever and early infectious complications after autologous peripheral blood stem cell transplantation for malig¬nant diseases. International journal of hematology. 2002;76(2):186-91. Epub 2002/09/07. PubMed PMID: 12215019.
| Files | ||
| Issue | Vol 13 No 4 (2021) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/bccr.v13i4.14401 | |
| Keywords | ||
| Bone marrow diseases Bone Marrow Transplantation Fever of unknown origin Fever Pre-engraftment | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mesgarian M, Shadvar S, Zangene M, Safaee Nodehi SR. Evaluation of the bone marrow transplantation recipient patients regarding fever onset, fever permanence, risk factors, and underlying causes, during pre-engraftment phase. Basic Clin Cancer Res. 2022;13(4):272-283.
