Mucositis not neutropenia determines bacteremia among hematopoietic stem cell transplant recipients
- 13 March 2014
- journal article
- research article
- Published by Wiley in Transplant Infectious Disease
- Vol. 16 (2), 279-285
- https://doi.org/10.1111/tid.12195
Abstract
Background In the 1960s, it was reported that infectious complications were the main cause of fever during neutropenia that followed hematopoietic stem cell transplant (HSCT). More recently, mucositis has become recognized as an important determinant of the inflammatory response and infectious complications. Methods The objective of this prospective study was to determine the impact of intestinal mucositis, as measured by plasma citrulline, and neutropenia on the systemic inflammatory response (C‐reactive protein) and the occurrence of bacteremia among 2 cohorts of HSCT recipients: 1 composed of 18 patients who had been treated with a myeloablative (MA) regimen (high‐dose melphalan) and the other involving 19 patients who had received the non‐myeloablative (NMA) regimen (fludarabine and cyclophosphamide). Blood cultures were obtained for surveillance from admission onwards as well as at the onset of fever. Results The MA regimen induced severe intestinal mucositis manifest by citrullinemia <10 μmol/L, which was accompanied by an inflammatory response, and bacteremia affected 8 (44%) of 18 patients and coincided with the nadir of citrullinemia. By contrast, those who had been treated with the NMA regimen did not develop severe intestinal mucositis, had a moderate inflammatory response, and only 2 (11%) of the 19 patients developed bacteremia. However, both groups experienced profound neutropenia and its duration was significantly longer for those receiving the NMA regimen. Conclusion This study suggests that severe intestinal mucositis, i.e., citrullinemia <10 μmol/L, defines the period of risk of bacteremia better than does neutropenia, and that measuring plasma citrulline may prove useful in deciding who needs empirical antimicrobial therapy and when.Keywords
This publication has 21 references indexed in Scilit:
- 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumoursEuropean Journal of Cancer, 2011
- Intestinal Damage Determines the Inflammatory Response and Early Complications in Patients Receiving Conditioning for a Stem Cell TransplantationPLOS ONE, 2010
- Citrulline-based assessment score: first choice for measuring and monitoring intestinal failure after high-dose chemotherapyAnnals of Oncology, 2010
- Defining the Intensity of Conditioning Regimens: Working DefinitionsTransplantation and Cellular Therapy, 2009
- Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global PerspectiveTransplantation and Cellular Therapy, 2009
- A randomized comparison of empiric or pre-emptive antibiotic therapy after hematopoietic stem cell transplantationBone Marrow Transplantation, 2007
- Colonization and molecular epidemiology of coagulase-negative Staphylococcal bacteremia in cancer patients: A pilot studyAmerican Journal of Infection Control, 2006
- The pathobiology of mucositisNature Reviews Cancer, 2004
- Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haemopoietic progenitor rescueBritish Journal of Haematology, 2000
- From the Immunocompromised Host Society: The Design, Analysis, and Reporting of Clinical Trials on the Empirical Antibiotic Management of the Neutropenic Patient: Report of a Consensus PanelThe Journal of Infectious Diseases, 1990