Preprečevanje bakterijskih in glivičnih okužb pri bolnikih z diseminiranim plazmocitomom, ki prejmejo ciklofosfamid za mobilizacijo krvotvornih matičnih celic
Antimicrobal and antifungal prophylaxis in patients with multiple myeloma, that receive cyclophosphamide for mobilization of hematopoietic stem cells

slovenian

2008

volume 77, issue 1

Bacterial Infections   Ciprofloxacin   Drug Therapy   Fluconazole   Hematopoietic Stem Cell Transplantation   Multiple Myeloma   Mycoses   therapy

Slovensko zdravniško društvo
(Obvezni izvod spletne publikacije)

Background Bacterial and fungal infections are the most common complication inpatients with hematological diseases treated with chemotherapy. Autologous hematopoietic stem cell transplantation is the most effective treatment of patients with multiple myeloma. Mobilization of hematopoietic stem cells (HSC), which allows collection of stem cells from peripheral venous blood, is induced by cyclophosphamide and granulocyte-colony stimulating factor (g-CSF).Cyclophosphamide is a toxic alkylating cytostatic agent that can causesevere neutropenia. Methods The purpose of this randomized retrospective study was to find out the efficacy of antimicrobal and antifungal prophylaxis with ciprofloxacine and fluconazole, respectively, in patients with multiple myeloma, that received cyclophosphamide (4g/m2) for mobilization of HSC. Results Altogether 112 myeloma patients that underwent autologous haematopoietic stem cell transplantation between years 2001-2007 were includedin the study. In the expected interval of neutropenia (from fifth day on after aplication of cyclophosphamide), 69 (62%) patients received ciprofloxacin, 34 (30%) patients also received fluconazole and 43 (55%) patients did not have any antimicrobal or antifungal prophylaxis. Leukopenia was found in 43 (55%) patients on the tenth day after administration of cyclophosphamide. Patients, who did not have any preventive treatment had approximately three times higher incidence of systemic infections. Etiology ofinfections was determined in only seven out of 23 patients. In one patient we suspected a respiratory tract infection with Aspergilus fumigatus. Conclusions Prophylaxis with ciprofloxacin in multiple myeloma patients, who receive cyclophosphamide for mobilization of haematopoetic blood cells, is warranted. On the contrary, prophylaxis with fluconazole does not seem to be necessary.

16.09.2009