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A Prospective Study of Infectious Diseases Following Bone Marrow Transplantation: Emergence of Aspergillus and Cytomegalovirus as the Major Causes of Mortality

Published online by Cambridge University Press:  02 January 2015

Phillip K. Peterson ,
Philip McGlave ,
Norma K.C. Ramsay ,
Frank Rhame ,
Eve Cohen ,
Guy S. Perry III ,
Anne I. Goldman  and
John Kersey
Phillip K. Peterson*
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Philip McGlave
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Norma K.C. Ramsay
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Frank Rhame
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Eve Cohen
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Guy S. Perry III
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Anne I. Goldman
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
John Kersey
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
*
Department of Medicine, University of Minnesota Hospitals, Minneapolis, MN 55455
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Abstract

We performed a prospective study of infections following bone marrow transplantation in 50 patients treated for aplastic anemia or hematologic malignancy. Early, continuous prophylaxis with trimethoprim/sulfamethoxazole and oral nystatin, and empiric intravenous antimicrobial therapy during febrile granulocytopenic episodes were standard treatment for all patients. The use of trimethoprim/sulfamethoxazole did not appear to adversely affect donor marrow engraftment. Serious gram-negative bacillary and systemic Candida infections were uncommon. Although gram-positive bacterial infections were frequent, they were rarely associated with mortality. Aspergillosis emerged as the single most important infection, contributing to the death of nine patients. Cytomegalovirus diseases developed in 13 patients, seven of whom died. Patient age and chronic myelogenous leukemia were risk factors for the development of fatal infections. This study demonstrates that although certain serious infections can be controlled, there is a critical need for effective measures to prevent and treat aspergillosis and cytomegalovirus disease in these seriously compromised hosts.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 4 , Issue 2 , April 1983 , pp. 81 - 89
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

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References

1.Storb, R, Thomas, ED, Buckner, CD, et al: Marrow transplantation in thirty “untransfused” patients with severe aplastic anemia. Ann Intern Med 1980;92:30–36.CrossRefGoogle ScholarPubMed
2.Ramsay, NKC, Kim, T, Nesbit, ME, et al: Total lymphoid irradiation and cyclosphosphamide as preparation for bone marrow transplantation in severe aplastic anemia. Blood 1980;55:344–446.CrossRefGoogle Scholar
3.Bortin, MM, Gale, RP, Rimm, AA, Allogeneic bone marrow transplantation for 144 patients with severe aplastic anemia JAMA 1981;245:1132–1139.CrossRefGoogle ScholarPubMed
4.Blume, KG, Beutler, EO, Bross, KJ, et al: Bone marrow ablation and allogeneic marrow transplantation in acute leukemia. N Engl J Med 1980;302:1041–1046.CrossRefGoogle ScholarPubMed
5.Thomas, ED, Sanders, JE, Flournoy, N, et al: Marrow transplantation for patients with acute lymphoblastic leukemia in remission. Blood 1979;54:468–476.CrossRefGoogle ScholarPubMed
6.Meyers, JD, Thomas, ED, Infection complicating bone marrow transplantation, in Rubin, RH, Young, LD (eds): The Clinical Approach to Infections in the Immunocompromised Host. New York, Plenum Publishing Corp, 1981, pp 507–551.Google Scholar
7.Winston, DJ, Gale, RP, Meyer, DV, et al: Infectious complications of human bone marrow transplantation. Medicine 1979;58:1–31.CrossRefGoogle ScholarPubMed
8.Winston, DJ, Schiffman, G, Wang, DC, et al: Pneumococcal infections after human bone marrow transplantation. Ann Intern Med 1979;91:835–841.CrossRefGoogle ScholarPubMed
9.Peterson, PK, Balfour, HH Jr, Marker, SC, et al: Cytomegalovirus disease in renal allograft recipients: A prospective study of the clinical features, risk factors and impact on renal transplantation. Medicine 1980;59:283–300.CrossRefGoogle ScholarPubMed
10.Benedetti, J, Yuen K, Life tables and survival functions, in Dixon, WJ, Brown, MB (eds): BMDP-79-Biomedual Computer Programs P-Series. Berkeley, Univ of California Press, 1979.Google Scholar
11.Breslow, N, A generalized Kruskal-Wallis test for comparing k samples subject to unequal patterns of censorship. Biometrika 1970;47:579–594.CrossRefGoogle Scholar
12.Bloomfield, CD, Gajl-Peczalska, KJ, Frizzera, G, et al: Clinical utility of lymphocyte surface markers combined with the Lukes-Collins histologic classification in adult lymphoma. N Engl J Med 1979;301:512–518.CrossRefGoogle ScholarPubMed
13.Gurwith, MJ, Brunton, JL, Lank, BA, et al: A prospective controlled investigation of prophylactic trimethoprim/sulfamethoxazole in hospitalized granulocytopenic patients. Am J Med 1979;66:248–256.CrossRefGoogle ScholarPubMed
14.Wade, JC, Schimpff, SC, Hargadon, MT, et al: A comparison of trimethoprim-sulfamethoxazole plus nystatin with gentamicin plus nystatin in the prevention of infections in acute leukemia. N Engl J Med 1981;304:1057–1062.CrossRefGoogle ScholarPubMed
15.Weiser, B, Lange, M, Fialk, MA, et al: Prophylactic trimethoprim-sulfamethoxazole during consolidation chemotherapy for acute leukemia: A controlled trial. Ann Intern Med 1981;95:436–438.CrossRefGoogle ScholarPubMed
16.Young, LS, Trimethoprim-sulfamethoxazole and bacterial infections during leukemia therapy. Ann Intern Med 1981;95:508–509.CrossRefGoogle ScholarPubMed
17.Wilson, JM, Guiney, DG, Failure of oral trimethoprim-sulfamethoxazole prophylaxis in acute leukemia: Isolation of resistant plasmids from strains of Enterobacteriaceae causing bacteremia. N Engl J Med 1982;306:16–20.CrossRefGoogle ScholarPubMed
18.Jacoby, GA, Perils of prophylaxis. N Engl J Med 1982;306:43–44.CrossRefGoogle ScholarPubMed
19.Aisner, J, Murillo, J, Schimpff, SC, et al: Invasive aspergillosis in acute leukemia: Correlation with nose cultures and antibiotic use. Ann Intern Med 1979;90:4–9.CrossRefGoogle ScholarPubMed
20.Rand, KH, Pollard, RB, Merrigan, TC, Increased pulmonary superinfections in cardiac-transplant patients undergoing primary cytomegalovirus infection. N Engl J Med 1978;298:951–953.CrossRefGoogle ScholarPubMed
21.Fisher, BD, Armstrong, D, Yu, B, et al: Invasive aspergillosis: Progress in early diagnosis and treatment. Am J Med 1981;71:571–577.CrossRefGoogle ScholarPubMed
22.Meyers, JC, Flournoy, N, Thomas, ED, Cytomegalovirus infection and specific cell-mediated immunity after marrow transplant. J Infect Dis 1980;142:816–824.CrossRefGoogle ScholarPubMed
23.Ho, M, Suwansirikul, S, Dowling, JN, et al: The transplanted kidney as a source of cytomegalovirus infection. N Engl J Med 1975;293:1109–1112.CrossRefGoogle ScholarPubMed
24.Fryd, DS, Peterson, PK, Ferguson, RM, et al: Cytomegalovirus (CMV) as a risk factor in renal transplantation. Transplantation 1980;30:436–439.CrossRefGoogle ScholarPubMed
25.Winston, DJ, Ho, WG, Young, LS, et al: Prophylactic granulocyte transfusions during human bone marrow transplantation. Am J Med 1980;68:893–897.CrossRefGoogle ScholarPubMed