Changes in the microbiological epidemiology of febrile neutropenia in autologous stem cell transplant recipients

Abstract The conditioning regiments for autologous stem cell transplantation (aSCT) lead to impairment of the immune system and susceptibility to infections. Although infectious complications are more prominent in allogeneic transplantation, it is also a major source of morbidity in patients undergoing aSCT. Therefore, vaccination of patients after stem cell transplantation has been recommended. We conducted a prospective follow-up study to determine quantitative and qualitative aspects of the humoral immune response to multiple vaccinations with conjugated Haemophilus influenzae type b (Hib) vaccine in autologous stem cell transplant recipients. Sixteen patients (twelve with multiple myeloma and four with non-Hodgkin’s lymphoma) received a conjugated Hib vaccine at 6, 8 and 14 months after transplantation. Antibody titres were determined by ELISA, 21 days after each vaccination. Adequate anti-Hib antibody responses (i.e. a four fold or greater increase in antibody levels in addition to a minimal titre of 50 U/ml corresponding to 18.8 μg/ml) were achieved in 7 (44%) of the patients after one vaccination. A second and third vaccination resulted in an adequate anti-Hib antibody response in 12 (75%) and 14 (88%) patients, respectively. Functionality of anti-Hib antibodies was assessed by measurement of antibody avidity. Repeated vaccination induced maturation of antibody avidity as demonstrated by increased resistance to sodium thiocyanate (NaSCN) treatment (Figure 1; the avidity index (AI) is defined as the molarity of NaSCN at which 50% of the amount of IgG antibodies bound to the coated antigen in the absence of NaSCN has been eluded. Mean AI plus range are shown after one, two and three vaccinations.). Subsequently, opsonizing activity of antibodies was determined by a phagocytosis assay. FITC-labelled Hib was incubated with serum and added to fresh polymorphonuclear cells (PMN). Mean fluorescence intensity (MFI) was measured by flowcytometry. Anti-Hib antibodies supported phagocytosis by PMN’s after multiple vaccinations (Figure 2; MFI at different time points is shown). In conclusion, multiple vaccinations with Hib-conjugate vaccine in autologous stem cell recipients result in high antibody response rates and functional maturation of antibodies.

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Invasive fungal infections in allogeneic and autologous stem cell transplant recipients: a single-center study of 166 transplanted patients

Transplant Infectious Disease ◽

10.1111/j.1399-3062.2007.00219.x ◽

2007 ◽

Vol 9 (3) ◽

pp. 189-195 ◽

Cited By ~ 66

Author(s):

M.J. Post ◽

C. Lass-Floerl ◽

G. Gastl ◽

D. Nachbaur

Keyword(s):

Stem Cell ◽

Stem Cell Transplant ◽

Fungal Infections ◽

Autologous Stem Cell Transplant ◽

Invasive Fungal Infections ◽

Cell Transplant ◽

Transplant Recipients ◽

Single Center ◽

Single Center Study ◽

Center Study

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C- reactive protein in autologous stem cell transplantation: prediction of clinical complication

JBMTCT ◽

10.46765/2675-374x.2021v2n2p44 ◽

2021 ◽

Vol 2 (2) ◽

pp. p44

Author(s):

Bruna Sabioni ◽

Eduardo Edelman Saul ◽

Rodrigo Portugal ◽

Marcia Rejane Valentim ◽

Angelo Maiolino ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Febrile Neutropenia ◽

Stem Cell Transplant ◽

Autologous Stem Cell Transplant ◽

Cell Transplant ◽

C Reactive Protein ◽

Reactive Protein ◽

Non Hodgkin Lymphoma ◽

Poor Outcomes

Objective: The aim of this study was to evaluate C-reactive protein (CRP) as a predictor of complications during autologous stem cell transplant (HSCT). Methods: We analyzed a cohort of 340 transplants. Correlation analyses were performed, including CRP obtained before HSCT, on Day+3, Day+6, Day+9, after Day+11, and at the onset of febrile neutropenia, and the following outcomes: bacteremia, severity of mucositis, length of neutropenia and hospitalization, and death. Results: the median age was 54 years old (ranging from 20 to 75), and 62% and 20% were multiple myeloma and non-Hodgkin lymphoma cases, respectively. The median CRP levels increased from D+3 to D+9 and after that decreased progressively until discharge. CRP levels were associated with bacteremia, mucositis grade, length of neutropenia and hospitalization, and death. Variation in CRP values from D+3 to D+6 predicted complications. Mortality was associated with D+9 CRP levels (19 vs. 7.9 mg/dL; p<0.01), and a ROC curve area of 0.83 (95% CI 0.7 – 0.95) to predict mortality. At a cut-off of 8.5mg/dL, D+9 CRP had 83% and 79% sensitivity and specificity, respectively. Conclusions: In this study, CRP dynamics were associated with several HSCT complications. CRP levels curve could be applied to indicate poor outcomes during HSCT.

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