Early infectious complications after peripheral blood stem cell autografts in children
1Department of Pediatrics, University of Tokushima, Japan.
Insights
High-dose chemotherapy with stem cell autografts is safe for children. Simple patient management effectively prevented fatal infectious complications post-transplant.
Area of Science:
- Pediatric Oncology
- Hematology
- Infectious Diseases
Background:
- Marrow-ablative chemotherapy followed by autologous stem cell transplantation is a critical treatment for pediatric cancers.
- Infectious complications pose a significant risk to pediatric patients undergoing these intensive therapies.
Purpose of the Study:
- To retrospectively analyze the incidence, types, and outcomes of infectious complications in pediatric patients post-peripheral blood stem cell autograft.
- To evaluate the safety and efficacy of a simplified patient management protocol without decontamination procedures.
Main Methods:
- Retrospective study of 17 pediatric patients undergoing high-dose chemotherapy and peripheral blood stem cell autografts.
- Patients were housed in isolated rooms with laminar airflow, receiving maternal care, but no gut sterilization or special diets.
- Infectious complications were monitored for 3 months post-transplant.
Main Results:
- Fifteen patients (88%) experienced 16 febrile episodes within the first 4 weeks.
- Common infections included mucositis (12), enterocolitis (9), and septicemia (4).
- All infectious episodes were successfully treated with parenteral antibiotics; no deaths from infection occurred.
Conclusions:
- High-dose chemotherapy with peripheral blood stem cell autografts can be safely performed in pediatric patients using a simplified management protocol.
- Intensive decontamination is not essential for managing infectious complications in this patient population.
- This approach supports the feasibility of effective treatment with reduced patient and caregiver burden.
Abstract:
Seventeen children underwent marrow-ablative high-dose chemotherapy with peripheral blood stem cell autografts and were studied retrospectively to determine the type, frequency, and outcomes associated with infectious complications 3 months postgraft. The patients were kept in isolated rooms with a laminar air flow facility, but no decontamination procedures, such as gut sterilization with nonabsorbable antibiotics, nonmicrobial diet, and skin cleansing, were used. They were under their mothers' daily care to maintain good psychological conditions. After the completion of marrow-ablative chemotherapy and the infusion of stem cells, the absolute granulocyte count exceeded 0.5 x 10(9)/liter with a mean of 17.9 days (range 6-65 days). Fifteen patients developed a total of 16 febrile episodes during the first 4 week period, and the confirmed diagnoses were mucositis (12), enterocolitis (nine), septicemia (four), central venous catheter-associated infection (three), pneumonia (one), perianal abscess (one), and possible invasive fungal infection (one). All episodes were successfully treated with parenteral antibiotic therapy, and no patient died of infectious complications. The observations suggest that high-dose chemotherapy can be performed safely with simple and efficient patient management protocol followed by peripheral blood stem cell autografts.
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