The Clinical Research On Early Infectious Complications After Allogeneic Hematopoietic Stem Cell Transplantation

Objective:To investigate the prophylaxis, treatment and the correlative factors of early infectious complications after allogeneic hematopoietic stem cell transplantation (HSCT). Methods: Retrospective analysis was done with the clinical data and the curative effect of de-escalation therapy in 95 cases of patients following allogeneic HSCT performed in the hematology department of the first affiliated hospital of Suzhou University from March 2001 to March 2004. Results:â‘ The incidence of early infectious complications with 95 cases of patients following allogeneic HSCT was 32.63%(31/95) after the comprehensive prophylactic measurements had been taken. â‘¡95 cases of patients were divided into two groups according to the condition regimen. 5 of 21 cases of NST group had early infection while 26 of 74 cases of standard-condition group had early infection(23.81% versus 35.14%, P>0.05 ). Patients were divided into two groups again according to the donate resources. 24 of 80 cases of relative-donor had early infection while 7 of 15 cases of unrelative-donor had early infection(30.00% versus 46.67%, P>0.05 ). Patients were divided to two groups according to whether or not the HLA typing was matched. 25 of 82 cases of fully-matched patients had early infection while 6 of 13 cases of not-fully-matched patients had early infection(30.49% versus 46.15%, P>0.05 ). Patients were divided to two groups according to whether or not the acute graft versus host disease (aGVHD) had happened. 18 of 31 cases with aGVHD had early infection while 18 of 49 cases without aGVHD had early infection(58.06% versus 20.31%, P<0.05 ).â‘¢34 strains of pathogenic microorganisms were isolated from cultures of 31 cases of patients with early infectious complications, with 13 strains(38.24%)were gram negative and 18 strains(52.94%)were gram positive. Among them the most frequent pathogenic microorganisms were Escherichia li, Staphylococcus E, Enterococcus F, Staphylococcus H, etc. 3 strains (8.82%) were fungi. The common infectious positions were lung, pharynx oralis and crissum. â‘£De-Escalation therapy was successfully performed on the patients with early infection after allogeneic HSCT. None of the patients died of early infectious complications in our group. Conclusion: â‘ Comprehensive prophylactic measurements could probably lower the incidence of the early infectious complications following allogeneic HSCT.â‘¡The incidence of early infection after allogeneic HSCT was correlative with acute GvHD.â‘¢Predominant pathogenic bacteria to result in early infection after allogeneic HSCT were Gram-positive. â‘£The therapeutic effect of De-Escalation regimen was obviously manifest for early infectious complications after allogeneic HSCT and the regimen deserved tobe propagated.