Neutropenic Fever During Stem Cell Mobilization Is Associated with Decreased CD34+ Cell Collection and Poor Survival Following Autologous Stem Cell Transplantation,

Abstract 4053

High-dose chemotherapy followed by autologous stem cell transplant can improve long-term outcome of patients with relapsed non-Hodgkin and Hodgkin lymphoma. Stem cell mobilization with chemotherapy in addition to G-CSF improves stem cell collection, however it is also associated with increased risk of neutropenic fever. We analyze whether hospitalization for neutropenic fever (NF) affects outcomes after transplantation.

From 1/1998 to 12/2008, 599 patients underwent chemotherapy priming with etoposide + G-CSF (27 patients also received rituximab). Forty five (8%) did not proceed to transplant. Of the 554 (92%) patients who were transplanted, the median age was 51 years, and 348 (63%) were male. The diagnoses were 422 non-Hodgkin lymphoma (63%) and 132 Hodgkin lymphoma (24%). A majority of these patients (92%) had received 3 or less prior chemotherapy regimens. Only 6% had been exposed to fludarabine therapy. Most patients had chemosensitive disease (88% were in CR or PR) at time of transplant. For preparative regimen: 517 (93%) received busulfan/etoposide/cyclophosphamide, 32 (5.8%) received melphalan, 5 (0.9%) received other chemotherapy.

Of the transplanted patients, 121 (21.8%) were admitted for NF during stem cell mobilization. The median duration of admission for NF was 5 days (range 1–20). Six (5%) patients had bacteremia, 1 (<1%) had parainfluenza virus pneumonia, and the remainder 114 (94%) did not have any infection source or organism identified. The patients hospitalized for NF had significantly lower CD34+ cell collection (7.49 × 10^6 CD34 cells vs. 9.36 × 10^6, P=0.029) and lower CD34+ cell dose (7.34 × 10^6 CD34 cells/kg vs. 8.60 × 10^6 CD34+ cells/kg, P=0.047) despite more apheresis days required for collection (4 days vs. 3 days, P=0.01). Following transplant hospitalization, the 30-day readmission rate was higher in NF patients (16.8% compared to 8.8%, P=0.012). Hospitalization for NF was also associated with worse survival as shown below:

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In conclusion, admission for neutropenic fever during stem cell mobilization is associated with significantly increased number of apheresis days required for adequate stem cell collection, lower CD34+ cell collection, higher 30-day re-admission rates, and poorer survival.