- 作者：Khalil Ullah ; Shahid Raza ; Parvez Ahmed ; Qamar-un-Nisa Chaudhry ; Tariq Mahmood Satti ; Suhaib Ahmed ; Sajjad Hussain Mirza ; Fahim Akhtar ; Khalid Kamal ; Farrukh Mahmood Akhtar
- 关键词：Allogeneic stem cell transplants ; Infections ; Antimicrobials
- 刊名：International Journal of Infectious Diseases
- 出版年：2008
- 出版时间：March 2008
- 年：2008
- 卷：12
- 期：2
- 页码：203-214
- 全文大小：306 K
Summary
ObjectiveTo describe our experience of post-transplant infections in allogeneic stem cell transplants at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.Methods
From July 2001 to September 2006, patients with malignant and non-malignant hematological disorders having human leukocyte antigen (HLA)-matched sibling donors were selected for transplant. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. After admission to the hospital, patients were kept in protective isolation rooms, equipped with a HEPA filter positive-pressure laminar airflow ventilation system. Bone marrow and/or peripheral blood stem cells were used as the stem cell source. Cyclosporin and prednisolone were used as prophylaxis against graft-versus-host disease (GVHD). The engraftment was monitored with cytogenetic/molecular analysis and change of blood group. Survival was calculated from the date of transplant to death or last follow-up.
Results
One hundred and fifty-four patients received allogeneic stem cell transplants from HLA-matched siblings for various hematological disorders at the Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan between July 2001 and September 2006. Indications for transplant included aplastic anemia (n = 66), β-thalassemia major (n = 40), chronic myeloid leukemia (n = 33), acute leukemia (n = 8), and miscellaneous disorders (n = 7). One hundred and twenty patients were male and 34 were female. The median age of the patient cohort was 14 years (range years). One hundred and thirty-six patients and 135 donors were cytomegalovirus (CMV) IgG-positive. One hundred and forty patients (90.9 % ) developed febrile episodes in different phases of post-transplant recovery. Infective organisms were isolated in 150 microbiological culture specimens out of 651 specimens from different sites of infections (23.0 % culture positivity). Post-transplant infections were confirmed in 120 patients (77.9 % ) on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections was 13.0 % . Fatal infections included CMV disease (100 % mortality, 6/6), disseminated aspergillosis (66.7 % mortality, 4/6), pseudomonas septicemia (42.9 % mortality, 9/21), and tuberculosis (25 % mortality, 1/4).
Conclusions
More than 90 % of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively, however CMV, aspergillosis, and pseudomonas infections remained problematic with high mortality.