Abstract
Infectious complications were retrospectively analyzed in 129 transplants, performed in 90 patients, to identify characteristics that qualify breast cancer patients for outpatient-based PBSCT. Thirty-one cases (24%) did not develop fever. Of the remaining 98 cases, 84.7% developed fever during severe neutropenia. On univariate analysis, disease stages II-III, first PBSCT, mucositis grades II-IV and the use of two alkylators were associated with a higher risk of fever development. The latter two factors also affected fever occurrence on multivariate analysis. A longer median time to fever onset was observed in patients conditioned with single as compared to double alkylating agent-containing regimens (respectively 8th vs 6th day, P < 0.00001). As compared with metastatic breast cancer (MBC), high risk breast cancer showed a 2.3-fold increased risk of developing early fever during neutropenia (CI 2.3-3.8), remaining the only variable still significant on multivariate analysis (P = 0.0039). Combination antibiotic therapy was equivalent to single agent therapy. Patients suffering from microbiologically documented fever were at higher risk of undergoing second-line antibiotic therapy. In conclusion, MBC patients treated with a conditioning regimen containing only one alkylating agent and adequate prophylaxis for mucositis may qualify for outpatient-based PBSCT on the basis of a lower risk of infection.
MeSH terms
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Adult
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Aged
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Ambulatory Care*
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Anti-Bacterial Agents
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Antineoplastic Agents, Alkylating / administration & dosage
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Antineoplastic Agents, Alkylating / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Breast Neoplasms / complications
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Breast Neoplasms / drug therapy
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Breast Neoplasms / therapy*
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Carboplatin / administration & dosage
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Carboplatin / adverse effects
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Combined Modality Therapy
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Docetaxel
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Drug Therapy, Combination / therapeutic use
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Female
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Fever / epidemiology
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Fever / etiology
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Hematopoietic Stem Cell Transplantation*
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Humans
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Immunocompromised Host
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Infection Control
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Infections / epidemiology
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Infections / etiology*
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Inflammation
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Melphalan / administration & dosage
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Melphalan / adverse effects
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Middle Aged
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Mitoxantrone / administration & dosage
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Mitoxantrone / adverse effects
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Mucous Membrane / pathology
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Multivariate Analysis
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Neutropenia / complications
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Paclitaxel / administration & dosage
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Paclitaxel / adverse effects
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Paclitaxel / analogs & derivatives*
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Patient Selection*
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Retrospective Studies
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Risk
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Taxoids*
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Thiotepa / administration & dosage
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Thiotepa / adverse effects
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Transplantation Conditioning / adverse effects
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Transplantation Conditioning / methods*
Substances
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Anti-Bacterial Agents
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Antineoplastic Agents, Alkylating
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Taxoids
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Docetaxel
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Cyclophosphamide
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Thiotepa
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Carboplatin
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Mitoxantrone
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Paclitaxel
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Melphalan