The Role of Prophylactic Antimicrobials during Autologous Stem Cell Transplantation: A Single Center Experience

Introduction: The prophylactic antimicrobial therapy for autologous stem cell transplantation (ASCT) has not been well defined. The aim of this study was to investigate the efficacy of antibiotic prophylaxis during ASCT in patients with multiple myeloma (MM) and non-Hodgkin’s lymphoma (NHL) in a single center.

Patients and Methods: We searched Asan Medical Center Registry for NHL and MM, and found 278 cases of ASCT between Jan 2001 and Jun 2008. And patient’s record was available in 277 cases. There were168 cases with MM, of whom 41 cases received tandem ASCT, and remaining 109 cases with NHL.

Results: Prophylaxis group (144 patients) had an antimicrobial prophylaxis consisted of ciprofloxacin (500mg twice daily p.o.), fluconazole (100mg twice daily p.o.) and acyclovir (400mg every 8hr p.o.), starting 1 day before high-dose chemotherapy (high-dose mephalan for MM and mostly BEAM or BEAC for NHL), and continued until neutrophil engraftment or switching to intravenous broad spectrum antibiotics at the occurrence of infection. From Sep 2005 to Mar 2008, according to time to time various transplantation protocols, 133 patients did not receive antimicrobial prophylaxis, and included in no-prophylaxis group. In prophylaxis group, 110 of 144 (76.4%) patients had experienced fever as a sign of infection with mean onset of 3.30 ±0.44 day after transplantation. In no-prophylaxis group, 127 of 133 (94.7%) patients had experienced fever with mean onset of 4.31 ±0.26 day after transplantation. The incidence of infection or systemic inflammatory response syndrome (SIRS) between two group had a significant difference (P < 0.001) and the onset time of infection or SIRS had no statistical significance (P = 0.058). As an etiology of infection, microbiologically documented infection occurred in 18 of 110 (16.4%) patients in prophylaxis group, and 21 of 127 (16.5%) patients in no-prophylaxis group (P=0.472). The bacteremia confirmed by blood culture was seen in 10 (9.1%) patients in prophylaxis group, and 10 (8.7%) patients in no-prophylaxis group (P = 0.123). Documented viral infection or reactivation was not observed in prophylaxis group, and was observed in 3 patients including herpes skin infection in no-prophylaxis group. Both group showed no invasive fungal infection or serious adverse event during ASCT. The date of infection resolved was a mean 14.59 ±0.63 day in prophylaxis group and 15.93 ±0.64 day in no-prophylaxis group (P=0.134). The duration of antimicrobial treatment was a mean 13.19 ±0.64 day in prophylaxis group and 12.88 ±0.66 day in no-prophylaxis group (P=0.739).

Conclusions: In our experience, the antimicrobial prophylaxis seems to have an effect on decreasing the incidence of fever during ASCT, however, the antimicrobial prophylaxis of this report did not show beneficial effects on the detection rate of organism as an infective agent, duration of antimicrobial therapy and the mean time from infection to recovery in antimicrobial prophylaxis group.