Conventional Hospital Room Is as Safe as Sterile Unit for High-Dose Chemotherapy and Peripheral Blood Stem Cells (PBSC) Transplantation.

Infectious complications in transplanted patients (pts) motivate recommendations that autologous stem cell transplantation (ASCT) should be carried out in special rooms endowed with positive pressure and high-efficiency particulate air filtration (HEPA) filters. However growing indications for ASCT and cost restrictions prompt to lighten the procedure without compromising the safety. We report here 59 consecutive and non-selected ASCTs performed from 2/00 to 4/04 in conventional single rooms (without positive pressure air filtration) to analyze early toxicity, infectious complications and 100-days (d.) transplant related death (TRD). High-dose chemotherapy (HDC) and ASCT were administered for non-Hodgkin’s lymphoma (n=39), multiple myeloma (n=13) and Hodgkin’s lymphoma (n=2). Five pts with multiple myeloma received double ASCT. Median (med.) age was 54 years (range 22–71). Med. number (nb.) of previous lines of treatment was 1 (range 1–6). Thirty-nine pts were intensified in 1^st remission (26 CR, 11 PR, 2 MR), 12 in 2^nd remission (10 CR, 2 PR), 1 in 3^rd CR and 2 in either SD or refractory relapse. Except for amphotericin-B mouthwashes and oral valacyclovir in case of HSV seropositivity, no systemic prophylactic antibiotic (abt) was used. The med. nb. of reinfused stem cells was 3.7x10⁶ CD34+/kg (1.86–33.3). One pt received 0.94x10⁶ CD34+ cells/kg combined with bone marrow. G-CSF was started at day 7 (2–15) after transplant. Med. time to achieve an absolute neutrophil count >0.5x10⁹/L and >1.0x10⁹/L was respectively (resp.) 10 d. (8–13) and 11 d. (8–13). Med. time to spontaneous platelet count >20x10⁹/L and >50x10⁹/L was resp. 11 d. (0–28) and 13 d. (9–81). The med. nb. of red cells and platelets transfusions was resp. 2 (0–12) and 2 (0–25). Except five pts, all developed fever (>38.3°C) and 56 out of the 59 pts received abt for a med. duration of 12 d. (1–46). Twenty-six pts (44%) had fever without any documented infection. Grade3/4 infections were diagnosed in 27 pts (46%). One patient presented candidemia. No case of aspergillosis was observed. Two pts (3%) needed transient transfer to the intensive care unit because of septicemia with reversible cardio-respiratory failure. The med duration of hospitalization was 20 d. (2–75), and was <28 d. for 54/59 pts (92%). With a med. follow up of 22.6 months (3–52), 44 patients are still alive: 33 (61%) in CR and 11 (20%) with relapse. 11 patients died: 8 from progressive disease, one following allotransplant 12 months after ASCT and one at d. 104 due to thrombotic thrombocytopenic purpura. The later was the unique TRD. The profile of toxicity and the low TRD rate observed in our non selected pts are comparable to whose reported usually in the literature for pts treated in sterile units with HEPA, confirming that HDC and ASCT can be safely realized in conventional single rooms.