Nutritional Assessment As Predictor of Complications Post Hematopoietic Cell Transplantation

Marcela Espinoza, Roberto Olmos, Javiera Perelli, Jessica Liberona, Veronica Jara, Julieta Klaassen, Pablo A. Ramirez
2015 Biology of Blood and Marrow Transplantation  
Patients undergoing hematopoietic cell transplantation (HCT) have an increased risk of Clostridium difficile infection (CD). Literature reports CD infection in nearly 20% of transplanted patients. No information about this infection in HCT patients has been reported in Chile. Patients and Methods: We performed a retrospective analysis of 250 patients undergoing HCT at the Catholic University Hospital in Santiago, Chile, between 2000 and 2013. Statistical analysis of the data was conducted using
more » ... was conducted using SPSS Statistics v21. Results: Of the 250 transplanted patients studied, 59% (n¼147) were allo-HCT and 41% (n¼103) were auto-HCT. The mean age was 39 years old (range, 15-69), with a male predominance (151 patients; 60%). Main indications for HCT were acute leukemia (n¼104; 42%), multiple myeloma (n¼36; 14%) and lymphoma (n¼49; 20%). 93% of patients received myeloablative (MA) regimens, and all of them received proton pump inhibitors and prophylactic antibiotics the previous months of the HCT. Of the 250 patients studied, 192 (77%) had at least one episode of diarrhea that required study, among them 13% (n¼25) were documented as positive for CD (toxin assay or PCR test), the mean age of this group was 36 years old (range, 18-62), with a male predominance (15 patients, 60%). All of the infected patients had mild to moderate diseases and there were no deaths attributed to it. 80% (n¼20) of the infected patients underwent allo-HCT and 20% (n¼5) auto-HCT. In the allo-HCT group, 53% had acute lymphoblastic leukemia, 6% acute myeloid leukemia, 24% chronic myeloid leukemia and 12% other causes. In the auto-HCT group, 40% were transplanted due to multiple myeloma, 20% amyloidosis, 20% germinal cancer and 20% acute myeloid leukemia. No patient required total central parenteral nutrition previous to the infection. During the 3 months before HCT, 84% (n¼21) of the infected patients used antibiotics including cephalosporins, carbapenem, aminoglicosides and vancomycin. The overall incidence of CD infection in the first week, month and year after transplant, was 4%, 6% and 10%, respectively, with a median time frame from transplantation to infection diagnosis of 20 days. In auto-HCT, 7 days, 30 days and 1 year CD incidence was 2, 3 and 5%, respectively. In allo-HCT, 7 days, 30 days and 1 year CD incidence was 5, 9 and 14%, respectively. There was no significant statistical difference in overall survival (OS) between the infected and non-infected patients one year after the transplant (OS 68% for CD negative vs. 72% for CD positive, p¼0.61). Conclusions: In our institution CD infection in patients undergoing HCT had a similar incidence to other reports. Most of cases occur before the first week after HCT (40% of the cases), and the remained stable afterwards. We identified the type of transplant (allo-HCT 3 times higher risk than auto-HCT) and disease (ALL 3 times higher risk than AML) as risk factors for CD infection. Plerixafor (P) is highly effective at mobilizing peripheral blood stem cells. Most centers, including our own, have an algorithm that utilizes P in patients who are predicted to have poor collections using G CSF alone, based on peripheral Abstracts / Biol Blood Marrow Transplant 21 (2015) S240eS265 S257
doi:10.1016/j.bbmt.2014.11.408 fatcat:orhcg4ekcfdqxlsjsjif2icse4