Early infections after autologous and allogeneic stem cell transplantation

Despite improvement of antimicrobial chemotherapy and prophylaxis, infections remain a major cause of morbidity and mortality after high-dose therapy and allogeneic or autologous stem cell transplantation. We report our single centre experience with data from 532 patients from 1990 until 1999. 483 (90.8%) were admitted for transplantation, the other indications for hospitalisation were mainly transplant related complications such as GvHD. 61.8% of the patients were allografted from related or unrelated donors. Antimicrobial prophylaxis was mainly quinolones, fluconazole plus amphotericin-B orally, aciclovir, and TMP/SMX or pentamidine. Incidence of infections was high. Fever occurred in 79.7% of patients and only 15.6% had no evidence for infection. Most frequent diagnosis was fever of unknown origin followed by septicaemia (17.6%) and pneumonia (13.6%). Infections were responsible for 61.2% of fatalities after transplantation. The morbidity of infections after autografting was low (n = 1). Organisms responsible for fatal infections were fungi (n = 22), Pseudomonas (n = 4) and Enterobacteriaceae in one case. We conclude that the incidence and morbidity of infections is high after high-dose therapy. The mortality of infections is higher after allografting. Mainly antimycotic prophylaxis and therapy must be improved.