ANTIMICROBAL AND ANTIFUNGAL PROPHYLAXIS IN PATIENTS WITHMULTIPLE MYELOMA, THAT RECEIVE CYCLOPHOSPHAMIDE FORMOBILIZATION OF HEMATOPOIETIC STEM CELLS

Abstract

BACKGROUND Bacterial and fungal infections are the most common complication in patients withhematological diseases treated with chemotherapy. Autologous hematopoietic stem cell transplantation is the most effective treatment of patients with multiple myeloma. Mobilizationof 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 cause severe 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, inpatients with multiple myeloma, that received cyclophosphamide (4g/m2) for mobilizationof HSC. RESULTS Altogether 112 myeloma patients that underwent autologous haematopoietic stem cell transplantation between years 2001–2007 were included in the study. In the expected intervalof 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 wasfound in 43 (55 %) patients on the tenth day after administration of cyclophosphamide.Patients, who did not have any preventive treatment had approximately three timeshigher incidence of systemic infections. Etiology of infections was determined in onlyseven out of 23 patients. In one patient we suspected a respiratory tract infection withAspergilus 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