Early infection in post-autologous hematopoietic stem cell transplant patients: Princess Noorah Oncology Center experience

Roaa S. Gassas; Ahmed N. Absi; Abdulrahman A. Alghamdi; Ahmed S. Alsaeed; Sameer M. Alamoudi; Ihab Y. Hemaidi; Majed D. Alahmadi; Walaa A. Rajkhan; Mannar M. Khalil; Saleem K. Dadah; Ahmed S. Higazi; Amani S. Ahmed

doi:10.15537/smj.2021.42.8.20210236

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Table 1

- Baseline characteristics of participants and their disease status.

Variables	n	(%)
Age
Up to 20 years	15	(10.0)
21-40 years	76	(50.7)
Above 40 years	59	(39.3)
Mean	37.5
SD	±13.5
Range	54
Gender
Male	95	(63.3)
Female	55	(36.7)
Diabetes mellitus
Yes	21	(14.0)
No	129	(86.0)
Diagnosis
HL	66	(44.0)
NHL	37	(24.7)
MM	40	(26.7)
Pomes syndrome	3	(2.0)
APL	3	(2.0)
Germ cell tumor	1	(0.7)
Disease status pre-salvage for HL and NHL
Relapsed	44	(29.3)
Refractory	56	(37.3)
NA	50	(33.3)
Number of lines (salvage chemotherapy)
One line	71	(47.3)
Two lines	22	(14.7)
Three lines	9	(6.0)
Four lines	1	(0.7)
NA	47	(31.3)

SD: standard deviation, HL: Hodgkin lymphoma, NHL: non-Hodgkin lymphoma, MM: multiple myeloma, APL: acute promyelocytic leukemia, NA: not applicable (multiple myeloma group)

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Table 2

- Prevalence of bacterial infections with 95% confidence interval (CI).

Infection	Prevalence (95% CI)
Neutropenic fever	98.7 (96.7-100)
Neutropenic colitis/ileitis	7.3 (3.3-12)
Pneumonia	3.3 (0.7-6.7)
Gram positive infection	12.7 (7.4-18)
Gram negative infection	30 (22.7-37.3)
Clostridium difficile	9.3 (5.3-14.7)

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Table 3

- Univariate analysis for baseline and disease characteristics and infectious complications in patients who underwent autologous hematopoietic stem cell transplant modified.

Characteristic	Neutropenic fever		P-value	Neutropenic colitis/ileitis		P-value
	Yes	No		Yes	No
	n (%)	n (%)		n (%)	n (%)
Gender
Male	93 (97.9)	2 (2.1)	0.532*	5 (5.3)	90 (94.7)	0.212*
Female	55 (100.0)	0 (0)	0.532*	6 (10.9)	49 (89.1)	0.212*
Age category
Up to 20 years	15 (100.0)	0 (0)	0.344*	1 (6.7)	14 (93.3)	0.900*
21-40 years	76 (100.0)	0 (0)		5 (6.6)	71 (93.4)
41 years and above	57 (96.6)	2 (3.4)		5 (8.5)	54 (91.5)
Diabetes mellitus
Yes	21 (100.0)	0 (0)	0.999*	0 (0)	21 (100.0)	0.364*
No	127 (98.4)	2 (1.6)	0.999*	11 (8.5)	118 (91.5)	0.364*
Patient diagnosis
HL	66 (100.0)	0 (0)	0.221*	5 (7.6)	61 (92.4)	0.548*
NHL	37 (100.0)	0 (0)		4 (10.8)	33 (89.2)
MM	38 (95.0)	2 (5.0)		2 (5)	38 (95.0)
Pomes syndrome	3 (100).0	0 (0)		0 (0)	3 (100)
APL	3 (100.0)	0 (0)		0 (0)	3 (100)
Germ cell tumor	1 (100.0)	0 (0)		0 (0)	1 (100)
Disease status pre-salvage for HL and NHL
Relapsed	44 (100)	0 (0)	0.194*	1 (2.3)	43 (97.7)	0.066*
Refractory	56 (100.0)	0 (0)		8 (14.3)	48 (85.7)
NA	48 (96.0)	2 (4.0)		2 (4.0)	48 (96.0)
Number of lines (salvage chemotherapy)
One line	71 (100.0)	0 (0)	0.339*	5 (7)	66 (93.0)	0.458*
Two lines	22 (100.0)	0 (0)		3 (13.6)	19 (86.4)
Three lines	9 (100.0)	0 (0)		1 (11.1)	8 (88.9)
Four lines	1 (100.0)	0 (0)		0 (0)	1 (100)
NA	45 (95.7)	2 (4.3)		2 (4.3)	45 (95.7)
ICU admission
Yes	3 (100.0)	0 (0)	0.999*	0 (0)	3 (100.0)	0.999*
No	145 (98.6)	2 (1.4)	0.999*	11 (7.5)	136 (92.5)	0.999*
Line-related infection
Yes	12 (100)	0 (0)	0.999*	0 (0)	12 (100.0)	0.601*
NO	136 (98.6)	2 (1.4)	0.999*	11 (8.0)	127 (92)	0.601*
CD34
Median (range)	4.54 (30.61)	8.94 (6.76)	0.159	3.92 (8.5)	90 (94.7)	0.091
Engraftment
Median (range)	10 (19.0)	10.50 (1.0)	0.650	9 (2.0)	49 (89.1)	0.157
Discharge
Median (range)	14 (46.0)	12.50 (1.0)	0.206	13 (16.0)	14 (93.3)	0.988

HL: Hodgkin lymphoma, NHL: non-Hodgkin lymphoma, MM: multiple myeloma, ICU: intensive care unit, APL: acute promyelocytic leukemia, NA: not applicable (multiple myeloma group),
↵* Chi-square and Fisher’s exact tests

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Table 4

- Univariate analysis for baseline and disease characteristics and infectious complications in patients who underwent autologous hematopoietic stem cell transplant modified.

Characteristics	Pneumonia		P-value	Bacterial		P-value
	Yes	No		Yes	No
	n (%)	n (%)		n (%)	n (%)
Gender
Male	3 (3.2)	92 (96.8)	0.999*	42 (44.2)	53 (55.8)	0.732
Female	2 (3.6)	53 (96.4)	0.999*	22 (40.0)	33 (60.0)	0.732
Age category (years)
Up to 20	1 (6.7)	14 (93.3)	0.162*	6 (40.0)	9 (60.0)	0.971
21-40	4 (5.3)	72 (94.7)		32 (42.1)	44 (57.9)
>41	0 (0)	59 (100)		26 (44.1)	33 (55.9)
Diabetes mellitus
Yes	0 (0)	21 (100)	0.999*	11 (52.4)	10 (47.6)	0.351
No	5 (3.9)	124 (96.1)	0.999*	53 (41.1)	76 (58.9)	0.351
Patient diagnosis
HL	2 (3)	64 (97.0)	0.309*	27 (40.9)	39 (59.1)	0.223*
NHL	3 (8.1)	34 (91.9)		21 (56.8)	16 (43.2)
MM	0 (0)	40 (100.0)		13 (32.5)	27 (67.5)
Pomes syndrome	0 (0)	3 (100.0)		1 (33.3)	2 (66.7)
APL	0 (0)	3 (100.0)		1 (33.3)	2 (66.7)
Germ cell tumor	0 (0)	1 (100.0)		1 (100.0)	0 (0)
Disease status pre-salvage for HL and NHL
Relapsed	1 (2.3)	43 (97.7)	0.627*	25 (56.8)	19 (43.2)	0.034
Refractory	3 (5.4)	53 (94.6)		24 (42.9)	32 (57.1)
NA	1 (2.0)	49 (98.0)		15 (30.0)	35 (70)
Number of lines (salvage chemotherapy)
One line	3 (4.2)	68 (95.8)	0.896*	33 (46.5)	38 (53.5)	0.291
Two lines	1 (4.5)	21 (95.5)		10 (45.5)	12 (54.5)
Three lines	0 (0)	9 (100.0)		5 (55.6)	4 (44.4)
Four lines	0 (0)	1 (100.0)		1 (100.0)	0 (0)
NA	1 (2.1)	46 (97.9)		15 (31.9)	32 (68.1)
ICU admission
Yes	0 (0)	3 (100.0)	0.999*	2 (66.7)	1 (33.3)	0.576*
No	5 (3.4)	142 (96.6)	0.999*	62 (42.2)	85 (57.8)	0.576*
Line-related infection
Yes	0 (0)	12 (100)	0.999*	12 (100)	0 (0)	<0.001
NO	5(3.6)	133 (96.4)	0.999*	52 (37.7)	86 (62.3)	<0.001
CD 34
Median (range)	3.83 (3.76)	14 (46.0)	0.429	4.72 (12.1)	4.47 (30.61)	0.917
Engraftment
Median (range)	10 (4.0)	4.61 (30.6)	0.515	10 (15.0)	10.50 (11.0)	0.001
Discharge
Median (range)	16 (6.0)	10 (19.0)	0.033	15 (46.0)	13 (13.0)	0.013

HL: Hodgkin lymphoma, NHL: non-Hodgkin lymphoma, MM: multiple myeloma, ICU: intensive care unit, APL: acute promyelocytic leukemia, NA: not applicable (multiple myeloma group),
↵* Chi-square and Fisher’s exact tests