Comparison of two different anti-infectious approaches after high-dose chemotherapy and autologous stem cell transplantation for hematologic malignancies in a 12-year period in British Hospital, Uruguay

Ann Hematol. 2020 Apr;99(4):877-884. doi: 10.1007/s00277-020-03947-1. Epub 2020 Feb 15.


Autologous stem cell transplant (ASCT) is a widely used and safe procedure to treat mostly hematologic diseases. These patients are at risk of infectious complications, which represents a major cause of morbidity and it is the second cause of mortality. This retrospective 12-year analysis of the incidence, type, and severity of infections in 266 consecutive unselected ASCT patients at our institution provides novel information addressing this issue. We included 266 ASCT procedures. Patients included in the 2006-2013 period are referred to as group 1 (ciprofloxacin prophylaxis and ceftazidime-amikacin as empirical antibiotics), and those in the 2013-2017 period are group 2 (levofloxacin prophylaxis and meropenem as empirical antibiotics). The incidence of febrile neutropenia was 72% in group 1 and 86.2% in group 2 (p = 0.004). The majority of infectious episodes were associated with fever of unknown origin: 55% in group 1 and 59% in group 2. Febrile of unknown origin episodes were 82.6% in group 1 and 80% in group 2. Significant differences between both groups were found in age, hypogammaglobulinemia, and advanced disease at ASCT. No differences were found between groups regarding the most common agent documented in positive blood cultures (Gram+ were 66.6% in group 1 and 69% in group 2 (p = 0.68)). Mortality within 100 days of transplant was low, 1.87%. Regardless of the prophylactic regimen used, most patients experience febrile episodes in the ASCT setting, fever of unknown origin is the most common infection complication, and Gram+ agents are prevalent in both groups. Mortality rates were low. According to our results, ASCT is a safe procedure and there is no clear benefit in favor of levofloxacin versus ciprofloxacin prophylaxis. Both anti-infectious approaches are acceptable, yielding similar outcomes.

Keywords: Autologous; High-dose chemotherapy; Infection; Risk factors; Stem cell transplantation.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amikacin / therapeutic use
  • Antibiotic Prophylaxis*
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bacteremia / etiology
  • Bacteremia / prevention & control*
  • Ceftazidime / therapeutic use
  • Ciprofloxacin / therapeutic use
  • Febrile Neutropenia / chemically induced
  • Febrile Neutropenia / prevention & control*
  • Female
  • Fever of Unknown Origin / prevention & control
  • Hematologic Neoplasms / drug therapy
  • Hematologic Neoplasms / therapy
  • Humans
  • Incidence
  • Levofloxacin / therapeutic use
  • Male
  • Meropenem / therapeutic use
  • Middle Aged
  • Peripheral Blood Stem Cell Transplantation / methods
  • Retrospective Studies
  • Transplantation, Autologous
  • Uruguay
  • Young Adult


  • Ciprofloxacin
  • Levofloxacin
  • Amikacin
  • Ceftazidime
  • Meropenem