Prospective Evaluation of Procalcitonin in Adults after Prolonged Neutropenia.

Infectious disease are persisting problem in patients with prolonged aplasia and a main cause to death. Determination of localization and germ remains difficult. The clinical presentation is poor and C Reactive Protein (CRP) is not specific. Treatment is empirical and uses broad spectrum antibiotic and antifungal therapy with sometimes moderate efficacy. Monotherapy or bitherapy in intial fewer are frequently discussed and no consensus exists. However, in sepsis, it is recommanded to use bitherapy in initial phase. Procalcitonin (PCT) is a pro-peptide of calcitonin produced mainly but not only in the C-cells of the thyroid glands. Several studies show PCT levels in plasma increase during infectious diseases in immunocompetent patients. In febrile neutropenia, data of PCT is scare and controversal. To determine the diagnostic and prognostic values of PCT, we assessed daily PCT level before and during the first febrile episode in 58 consecutive adults. Between November 2004 - April 2006, 32 patients received induction, or consolidation treatment for acute leukemia and 26 patients allogeneic or autologous hematopoietic stem cells transplantation. The mean duration of neutropenia was 17 days (range 5–43). Patients were treated with imipen only in first line except when clinical criteria of severity were presents (14 patients). Twenty-six percent had a clinically localized infectious (LI) which was documented in 14/15 patients, 45% had non documented fever and 29% bacteriemia. Twenty-one percent had a gram - bacillus and 29% gram+. No death was noted in this period. Mean duration of fever is 3.3 days (1–11). The means of CRP and PCT at day 0 and day 1 are presented in table 1. No difference exists in PCT before the first day of fewer (day -1). Not correlation was noted between different etiologies of fever and PCT or CRP. However, a trend of PCT values in bacteriemia was noted at day 1 (p=.07). The predictive value of PCT level at day 1 was calculated for bacteriemia. With a cut-off at 0.03, the negative predictive value was 78% (positive predictive value: 55%). In conclusions, neither PCT nor CRP levels can anticipate infections. Nevertheless, at day +1, PCT level < 0.03 could exclude the possibility of bacteriemia and therefore avoid the use of bitherapy before bacteriologic results. More patients are necesseray to confirm these preliminary results.