PREVENTION OF HEUTROPENIC FEVER DURING ADMINISTRATIOH OF HIGH DOSE VP-16 PLUS G-CSF FOR MOBIUZATION OF PBSC-THE EFACIENCY OF PROPHYLACTIC AHTlBIOTIC TREATMENT

Abstract

Neutropenia after high -dose VP-16 plus G-CSF, as mobilization chemotherapy regimen prior autologous setting in patients with hematological malignancies, is common finding, although infectious complications have not been previously described. In the attempt to reduce infective complications and the higher incidence of hospitalization for neutropenic, fever prophylactic antibiotic regimen was administered for patients receiving this regimen. We evaluated 35 patients with lympho-proliferative ma 19nancies (NHL13, HO 6, MM 12, and ALL 4) treated with HOT/ASCT at Department of hematology, Skopje, Macedonia. The patients were mobilized with VP-1 6 (2 grim') and G-CSF 10mcg/kg starting from day 5 of chemotherapy. regimen. The regimen was effective in the progenitor cell mobilization and almost 84% of analyzed patients reached at least2xlO (6)/kg C034+ cells with median 3 (ranges 1-6) apheresis procedures. Only two patients with HD and one AML failed mobilization. The patients were divided in two groups: 1) no specific antibiotic prophylaxis (n=7); (2) vancomycin Lv., cefixime p.o, (n=13); (3) amoxicillin clavulanic acid and ciprofloxacin p.o. (n= 15), The first group of patients revealed higher incidence of need for hospitalization (67%) due to neutropenic fever, versus second (28%) and third group (15%) of patients respectively (p<0,001 between the first and the other two groups). At the end we conclude that VP-16+G-CSF mobilization schedule revealed Significant high incidence of neutropenic fever that can be substantially reduced by a vigorous antimicrobial prophylactic program.