UČESTALOST INFEKCIJA TOKOM PRIMENE VISOKODOZNE HEMIOTERAPIJE SA AUTOLOGNOM TRANSPLANTACIJOM MATIČNIH ĆELIJA
Sažetak
Uvod: Autologna transplantacija matičnih ćelija hematopoeze (ATMĆH) je standardni oblik lečenja hematoloških maligniteta. Promene u strategiji ATMĆH-a i unapređenje potporne nege značajno su smanjili incidenciju i obrazac ispoljavanja infekcija kod pacijenata.
Cilj rada: Ispitati učestalost infekcija u prvih 30 dana nakon ATMĆH-a, kao i eventualni uticaj broja CD34+ matičnih ćelija u transplantatu i parametara engraftmenta: ALC500_20 (engl. absolute lymphocyte count 0,5x109/L na dan +20), ANC500_11 (engl. absolute neutrophil count 0,5x109/L na dan +11), i PLT20_13
(engl. platelets 20x109/L na dan +13), na pojavu infekcija.
Materijali i metode: U retrospektivnoj kohortnoj studiji ispitivano je 80 bolesnika starosti iznad 20 godina sa dijagnozom multiplog mijeloma (MM), nehočkinskih limfoma (NHL) i Hočkinovog limfoma (HL), lečenih na Klinici za hematologiju Kliničkog centra Srbije, u periodu od jula 2006. do decembra 2017. godine. Zabeležene su sve epizode povišene telesne temperature i/ili dokumentovane infekcije u toku neutropenije.
Rezultati: Prosečno preživljavanje nakon ATMĆH-a iznosilo je 34,5 meseci, a kod 54 pacijenta (67,5%) je dokumentovan uzročnik infekcije. Gram pozitivne bakterijske infekcije su bile pet puta češće u odnosu na gram negativne. Kod gram pozitivnih izolata najčešći je bio koagulaza negativni staphylococcus – CoNS (engl.
coagulase-negative staphylococcus), 37,0%, i Streptococcus α haemoliticus, 12,4%. Među gram negativnim izolatima najčešća je bila Escherichia coli, 62,5%, a Klebsiella spp. i Ralstonia pickettii su bile zastupljene sa podjednakom učestalošću od 12,5% . Gljivične infekcije su bile retke (10,0% Candida spp). Virusne infekcije su
verifikovane kod 5 (6,3%) pacijenata (Herpes zoster virus, 3,8% i H1N1, 2,5%).
Zaključak: Broj CD34+ matičnih ćelija u transplantatu, kao i brzina rekonstitucije hematopoeze, odnosno postizanje ALC500_20, ANC500_11 i PLT20_13, nisu bili statistički značajni za nastanak infekcija u ranoj fazi nakon ATMĆH-a.
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