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Vol. 19. Núm. 9.
Páginas 422-427 (noviembre 2001)
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Vol. 19. Núm. 9.
Páginas 422-427 (noviembre 2001)
Acceso a texto completo
Infección en pacientes neutropénicas sometidas a trasplante autólogo de progenitores hematopoyéticos por cáncer de mama
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5190
Javier Palau1
Autor para correspondencia
jpalau@ene.es

Correspondencia: Dr. J. Palau. Fundación Instituto Valenciano de Oncología. C/ Profesor Beltrán Báguena 8 y 19. 46009 Valencia
, Isabel Picón
Unidad de Trasplante de Médula
Miguel Ángel Climenta, Roberto Martíb, Eduardo Aznarb, M. Carmen Sanjuánb, Joaquín Máiquezb
a Servicio de Oncología
b Servicio de Laboratorio y Microbiología. Fundación Instituto Valenciano de Oncología. Valencia
Este artículo ha recibido
Información del artículo
Fundamentos

La profundidad y duración de la neutropenia y las características de la enfermedad subyacente son factores determinantes en el pronóstico del syndrome febril. Aunque clásicamente se ha considerado al trasplante de progenitores hematopoyéticos (TPH) como un productor de neutropenia de alto riesgo, probablemente la neutropenia observada en el TPH en algunos tumores sólidos podría ser considerada de riesgo intermedio. Evaluamos episodios febriles en pacientes con estas características

Métodos

Analizamos prospectivamente 132 TPH autólogos, obtenidos de sangre periférica, en pacientes con cáncer de mama (1994-1999)

Acondicionamiento

Stamp V. Profilaxis antibacteriana: ofloxacino (400 mg/12 h por vía oral). Clasificación del síndrome febril: bacteriemia, microbiológicamente documentado sin bacteriemia, infección clínica y fiebre de origen incierto

Resultados

Presentaron fiebre 122 pacientes (92%), edad media: 45 años (rango: 27-61). Hubo 32 (26%) bacteriemias, 13 (11%) documentaciones microbiológicas sin bacteriemia y 54 (44%) infecciones clínicas. Mediana de días con neutrófilos <1x109/l: 14 (rango: 11-20). En los 74 pacientes (61%) que tuvieron factor estimulante de colonias de granulocitos (G-CSF), la media de días para alcanzar 0,5x109/l neutrófilos (7,6) y la media de días ingresado (26) fueron significativamente menores. Hubo foco infeccioso en 80 pacientes (65%): orofaríngeo en 33 (46%) y digestivo en 29 (41%), que fueron los más frecuentes. Se aislaron 48 microorganismos gramnegativos (GN) y 29 grampositivos (GP) (71% GN resistentes a ofloxacino). Entre 1997-1999 la relación GN/GP fue de 2,3. No hubo muertes relacionadas con la infección

Conclusiones

La excelente evolución de nuestras pacientes permite considerar su neutropenia como deriesgo medio o bajo, lejos de las tasas de mortalidad por infección publicadas en otros tipos de trasplante hematopoyético. El predominio de GN en los últimos años y su escasa sensibilidad a quinolonas debe hacer reconsiderar su uso profiláctico en estas pacientes. Palabras clave: neutropenia febril, cáncer de mama, trasplante de progenitores hematopoyéticos

Palabras clave:
neutropenia febril
cáncer de mama
trasplante de progenitores hematopoyéticos
Background

The extent and duration of neutropenia and the characteristics of the underlying disease are determinant factors for the prognosis of febrile syndromes. Despite the fact that traditionally the peripheral blood stem cell transplantation (PBSCT) were considered to cause high risk neutropenia, in all probability the neutropenia observed in the PBSCT in some solid tumours could be considered moderate risk. Febrile episodes in patients with these characteristics were evaluated

Methods

We prospectively analysed 132 autologus PBSCT in patients with breast cancer (1994-1999). Conditioning regime: STAMP V. Antibacterial prophylaxis: ofloxacin (400 mg/12 hrs PO). Classification of the febrile syndrome: bacteremia, microbiologically documented infection withut bacteremia, clinical infection and a fever of unknown origin

Results

122 patients had a fever (92%), mean age: 45 years (range: 27-61). There were 32 (26%) bacteremias, 13 (11%) microbiologically documented infections without bacteremia and 54 (44%) clinical infections. The mean number of days with a neutrophil count of <1x109/1 was 14 (range: 11-20). In the 74 patients (61%) that had a granulocyte colony stimulating factor (G-CSF), the mean number of days to reach a 0,5x109/I neutrophil count (7,6) and the average number of days in hospital (26) were significantly less. There was a main infectious point in 80 patients (65%): the most frequent being oropharinx in 33 cases (46%) and digestive in 29 cases (41%). 48 gramnegative (GN) 29 grampositive (GP) bacteria were isolated (71% of the GN’s were resistant to ofloxacin). Between 1997-1999 the GN/GP ratio was 2,3. There were no deaths related to the infection

Conclusions

Given the excellent evolution of our patients we can consider their neutropenia to be moderate or low risk, and they are a long way from the death rates caused by infections published by other types of hemopoietic transplants. The predominance of GN over the last few years and their limited sensitivity to quinolones means that their prophylactic use in these patients should be reconsidered. Key words: Febrile neutropenia, breast cancer, peripheral blood stem cell transplants

Key words:
Febrile neutropenia
breast cancer
peripheral blood stem cell transplants
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Bibliografía
[1.]
P.A. Pizzo.
Management of fever in patients with cancer and treatment-induced neutropenia.
N Engl J Med, 328 (1993), pp. 1.323-1.332
[2.]
K. Larsson, B. Bjorkstrand, P. Ljungman.
Faster engraftment but no reduction in infectious complications after peripheral blood stem cell transplantation compared to autologous bone marrow transplantation.
Support Care Cancer, 6 (1998), pp. 378-383
[3.]
R.W. Finberg, J.A. Talcott.
Fever and neutropenia. How to use a new treatment strategy.
N Engl J Med, 341 (1999), pp. 362-363
[4]
National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing: eighth Informational supplement. Wayne, Pa: National Committee for Clinical Laboratory Standards, 1998; Document M100-S8, vol. 18, no 1
[5.]
G.P. Bodey, M. Buckley, Y.S. Sathe, E.J. Freireich.
Quantitative relationships between circulant leukocytes and infection in patients with acute leukemia.
Ann Intern Med, 64 (1966), pp. 328-340
[6.]
C.A. Mullen, G.R. Buchanan.
Early hospital discharge of children with cancer treated for fever and neutropenia: identification and management of the low-risk patients.
J Clin Oncol, 8 (1990), pp. 1.988-2.004
[7.]
J.A. Talcott, R.D. Siegel, R. Finberg, L. Goldman.
Risk assessment in cancer patients with fever and neutropenia. A prospective, two-center validation of a prediction rule.
J Clin Oncol, 10 (1992), pp. 316-322
[8.]
K.V.I. Rolston.
New trends in patient management: risk-based therapy for febrile patients with neutropenia.
Clin Infect Dis, 29 (1999), pp. 515-521
[9.]
J.E. Groopman, J-M. Molina, D.T. Scadden.
Hematopoietic growth factors. Biology and clinical applications.
N Engl J Med, 321 (1989), pp. 1.449-1.459
[10.]
G.J. Lieschke, A.W. Burguess.
Granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor.
N Engl J Med, 327 (1992), pp. 28-35
[11.]
K. Geissler, E. Koller, E. Hubmann, D. Neiderwiser, W. Hinterberger, D. Geisler, et al.
Granulocyte colony-stimulating factor as an adjunct to induction chemotherapy for adult acute lymphoblastic leukemia: a randomized phase III study.
Blood, 90 (1997), pp. 590-596
[12.]
A. Cometta, S. Zinner, R. de Bock, T. Calandra, H. Gaya, J. Klastersky, et al.
Piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer.
Antimicrob Agents Chemother, 39 (1995), pp. 445-452
[13.]
A. Cometta, T. Calandra, H. Gaya, S.H. Zinner, R. de Bock, A. del Favero, et al.
Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer.
Antimicrob Agents Chemother, 40 (1996), pp. 1.108-1.115
[14.]
A. Cometta, T. Calandra, J. Bille, M.P. Glauser.
Escherichia coli resistant to fluoroquinolones in patients with cancer and neutropenia (letter).
N Engl J Med, 330 (1994), pp. 1.240-1.241
[15.]
W.V. Kern, E. Andriof, M. Oethinger, P. Kern, J.J. Hacker, R. Marre.
Emergence of fluoroquinole-resistant Escherichia coli at a cancer center.
Antimicrob Agents Chemother, 38 (1994), pp. 681-687
[16.]
J. Carratalá, A. Fernández-Sevilla, F. Tubau, M.A. Domínguez, F. Gudiol.
Emergence of fluoroquinole-resistant Escherichia coli bacteremia in neutropenic patients with cancer who have received prophylactic norfloxacin.
Clin Infect Dis, 20 (1995), pp. 557-560
[17.]
R. Ramphal, M. Bolguer, D.J. Oblon, R.J. Sherertz, J.D. Malone, K.H. Rand, et al.
Vancomycin is not an essential component of the initial empiric treatment regimen for febrile neutropenic patients receiving ceftazidime; a randomized prospective study.
Antimicrob Agents Chemother, 36 (1992), pp. 1.062-1.067
[18.]
S.R. Smith, J. Cheesebrough, R. Spearing, J.M. Davies.
Randomized prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with Hickman catheters.
Antimicrob Agents Chemother, 33 (1989), pp. 1.193-1.197
[19.]
I.I. Raad, G.P. Bodey.
Infectious complications of indwelling vascular catheters.
Antimicrob Agents Chemother, 15 (1992), pp. 197-210
[20.]
M. Cruciani, R. Rampazzo, M. Malena, L. Lazzarini, G. Todeschini, A. Mesori, et al.
Prophylaxis with fluoroquinolones for bacterial infections in neutropenic patients: a meta-analysis.
Clin Infect Dis, 23 (1996), pp. 795-805
[21.]
J.W. Sanders, N.R. Powe, R.D. Moore.
Ceftazidime monotherapy for empiric treatment of febrile neutropenic patients: a meta-analysis.
J Infect Dis, 164 (1991), pp. 907-916
[22.]
D. Yamamura, R. Gucalp, P. Carlisle, M. Cimino, J. Roberst, C. Rotstein.
Open randomized study of cefepime versus piperacillin-gentamixin for treatment of febrile neutropenic cancer patients.
Antimicrob Agents Chemother, 41 (1997), pp. 1.704-1.708
[23.]
M. Karthaus, G. Egerer, K.H. Kullmann, J. Ritter, H. Jurgens.
Ceftriaxone in the outpatient treatment of cancer patients with fever and neutropenia.
Eur J Clin Microbiol Infect Dis, 17 (1988), pp. 501-504
[24.]
P. Biron, C. Fuhrmann, H. Cure, P. Viens, D. Lefebvre, A. Thyss.
Cefepime versus imipenem-cilastatin as empirical monotherapy in 400 febrile patients with short duration neutropenia.
J Antimicrob Chemother, 42 (1998), pp. 511-518
[25.]
I.A. Malik, Z. Abbas, M. Karim.
Randomised comparison of oral ofloxacin alone with combination of parenteral antibiotics in neutropenic febrile patients.
Lancet, 339 (1992), pp. 1.092-1.096
[26.]
W.V. Kern, A. Cometta, R. de Bock, J. Langenaeken, M. Paesmans, H. Gaya.
Oral versus intravenous empirical antimicrobial therapy for fever in patients with granulocytopenia who are receiving cancer chemotherapy.
N Engl J Med, 341 (1999), pp. 312-318
[27.]
A. Freifeld, D. Marchigiani, T. Walsh, S. Chanock, L. Lewis, J. Hiemenz, et al.
A double blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer chemotherapy.
N Engl J Med, 341 (1999), pp. 305-311
[28.]
M. Hidalgo, J. Hornedo, C. Lumbreras, J.M. Trigo, R. Colomer, S. Perea, et al.
Outpatient therapy with oral ofloxacin for patients with low risk neutropenia and fever: a prospective, randomized clinical trial.
Cancer, 85 (1999), pp. 213-219
[29.]
H.R. Paganini, C.M. Sarjis, M.G. De Martino, P.A. Zubizarreta, L. Casimir, C. Fernández, et al.
Oral administration of cefixime to lower risk febrile neutropenic children with cancer.
Cancer, 88 (2000), pp. 2.848-2.852
[30.]
M. Karthaus, J. Carratala, H. Jurgens, A. Ganser.
New strategies in the treatment of infectious complications in haematology and oncology: is there a role for out-patient antibiotic treatment of febrile neutropenia?.
Chemotherapy, 44 (1998), pp. 427-435
[31.]
B.R. Meisemberg, W.E. Miller, R. McMillan, M. Callaghan, C. Sloan, T. Brehm, et al.
Outpatient high-dose chemotherapy with autologous stem-cell rescue for hematologic and nonhematologic malignancies.
J Clin Oncol, 15 (1997), pp. 11-17
[32.]
S. Glück, C. des Rochers, C. Cano, M. Dorren, C. Germond, K. Gill, et al.
High-dose chemotherapy followed by autologous blood cell transplantation: a safe and effective outpatient approach.
Bone Marrow Transplant, 20 (1997), pp. 431-434
[33.]
S. Rives, E. Carreras, M. Rovira, S. Montoto, A. Urbano-Aspizua, C. Martínez, et al.
Trasplante autogénico de progenitores hematopoyéticos en régimen ambulatorio: análisis de viabilidad en el Hospital Clínic de Barcelona.
Med Clin (Barc), 113 (1999), pp. 201-204
Copyright © 2001. Elsevier España, S.L.. Todos los derechos reservados
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