The availability of HEPA-filtered rooms and the incidence of pneumonia in patients after haematopoietic stem cell transplantation (HSCT): results from a prospective, multicentre, eastern European study.

AIMS AND OBJECTIVES: To establish the availability of High Efficiency Particulate Air (HEPA)- and nonHEPA-filtered rooms in eastern European transplant centres and to investigate the impact on incidence of pneumonia and mortality after haematopoietic stem cell transplantation (HSCT). BACKGROUND: Barrier nursing in HEPA-filtered rooms is generally recommended for patients undergoing HSCT. There are only limited data on the availability of HEPA-filtered rooms and the impact on incidence of pneumonia and mortality. DESIGN: A prospective, observational, international study. METHODS: Monitoring cards were distributed within the East Forum EBMT-Nurses Group cooperating centres, and 689 consecutive patients were registered in 1/2010-6/2012. Patients were monitored for 100 days post-transplant. RESULTS: In patients undergoing autologous HSCT, pneumonia developed in 14/400 (3·5%) and was the cause of death in 2/14 (14%) of patients. There was no significant difference in mortality between HEPA-filtered and nonHEPA-filtered groups (4·5% vs. 4·9%, respectively). 239/400 (59%) transplantations were performed in single-bed rooms [190/239 (79%) HEPA-filtered] and 161 (41%) in two-bed rooms [28/161 (17%) HEPA-filtered]. In allogeneic transplantation, pneumonia developed in 24/289 (8·3%) and was the cause of death in 11/24 (45%) of patients. There was no significant difference in mortality between HEPA-filtered and non-HEPA-filtered groups (14% vs. 17%, respectively). 281/289 (97%) of allogeneic transplantations were performed in single-bed rooms [254/281 (90%) HEPA-filtered], and pneumonia was more frequent in patients on corticosteroids and in rooms without HEPA. CONCLUSION: The incidence of pneumonia in the autologous transplantation setting is low. More pneumonia was observed in the allogeneic HSCT group, especially in patients on corticosteroids. There was a trend towards a lower incidence of pneumonia in allogeneic HSCT patients treated in HEPA-filtered rooms. RELEVANCE TO CLINICAL PRACTICE: Autologous HSCT transplantation may safely be performed without HEPA filtration. HEPA filtration might be preferable in patients undergoing allogeneic transplantation.

The effect of polyvinylpyrrolidone-sodium hyaluronate gel (Gelclair) on oral microbial colonization and pain control compared with other rinsing solutions in patients with oral mucositis after allogeneic stem cells transplantation.

BACKGROUND: Gelclair is an oral lubricating gel used in the management of oral mucositis (OM). We evaluated its efficacy, tolerance and impact on oral cavity microbial colonization in patients with OM after allogeneic hematopoietic stem cells transplantation. MATERIAL/METHOD: Gelclair was administered in a group of 22 patients with active OM. A control group of 15 patients used other rinsing solutions (chlorhexidine, benzydamine, salvia). Tests with oral cavity swabs for microbiology analysis were performed once a week. RESULTS: The characteristics of OM in both groups were comparable, and rinsing solutions had satisfactory tolerability. There was no difference in the median improvement of oral intake and OM-related pain relief, which was assessed mostly as "slight effect". In the Gelclair group, the effect duration was longer (median 3 [0-5] vs. 1 [0-3] hours, p = 0.001). There was significant increase of Enterococcus faecalis and Candida sp. colonization of the oral cavity over the course of the hospitalization and significantly reduced incidence of such colonization in patients with OM in the Gelclair group: 1/22 (5%) vs. 6/15 (40%), p = 0.01. In vitro tests showed inhibited growth of Enterococcus faecalis and Candida sp. colonies within the area of the Gelclair application. CONCLUSIONS: Gelclair may be individually helpful in the management of OM and pain in patients after allogeneic stem cells transplantation. Its use did not lead to worsened oral bacterial and yeast colonization and probably even helped to protect mucosa from Enterococcus and Candida sp. Further studies based on larger cohorts are needed.

The risk factors for oral mucositis and the effect of cryotherapy in patients after the BEAM and HD-l-PAM 200 mg/m(2) autologous hematopoietic stem cell transplantation.

PURPOSE: Oral mucositis (OM) still represents a significant complication of hematopoietic stem cell transplantations (HSCT). Observational studies focusing on risk factor definitions are still warranted. METHOD: A total of 126 patients participated in this observational study after autologous HSCT with the BEAM and HD-l-PAM 200mg/m(2) conditioning regimens. Basic clinical and laboratory variables and their impact on OM were assessed. RESULTS: Age, gender, body mass index, and baseline absolute neutrophil counts were not shown to have any negative impact on OM development. The multivariate analysis revealed oral cryotherapy non-provision as being the most significant predictor for OM incidence (p < 0.0001), followed by BEAM conditioning regimen (p = 0.007), OM in a patient's history (p = 0.002) and lower number of days since the last chemotherapy (p = 0.025). The cryotherapy was remarkably effective both in the single high-dose melphalan 200mg/m(2) conditioning regimen (18% OM in cryotherapy vs. 68% without it, p<0.0001) and in the multidrug BEAM (melphalan 140mg/m(2)) regimen (38% vs. 86%, p=0.006). CONCLUSION: Oral cryotherapy should be implemented into supportive care management in patients treated with high-dose melphalan short-infusion chemotherapy. Large and well-designed randomized trials are necessary to obtain more significant and reliable results and understanding regarding OM risk factors.

Once- versus twice-weekly changing of central venous catheter occlusive dressing in intensive chemotherapy patients: results of a randomized multicenter study.

BACKGROUND: Changing a central venous catheter occlusive dressing on a twice-weekly basis is usually recommended in hemato-oncological patients. A longer interval is believed to give rise to infections. However, frequent dressing changes might cause local cutaneous damage. MATERIAL/METHODS: Local cutaneous damage and infections were compared in patients with once-weekly versus twice-weekly changes of central venous catheters occlusive dressings. This was a prospective, randomized, multicenter trial. RESULTS: Eighty-one patients with acute myeloid leukemia being treated with intensive chemotherapy were enrolled (twice-weekly group: n=42, once-weekly group: n=39). They had a non-tunneled polyurethane central venous catheter inserted into the vena subclavia and the insertion site was covered by a polyurethane semi-permeable occlusive dressing. No differences were observed between the groups with respect to local cutaneous damage, fevers, or positive catheter blood cultures. There were more insertion-site inflammations in the twice-weekly group (55% vs. 25%, p=0.008). In the once-weekly group it was necessary to change the occlusive dressing sooner in 42% of the cases, mostly due to a soiled dressing and local bleeding, and the real mean interval of changes was 5.4 days. CONCLUSIONS: Prolonging the frequency of occlusive dressing change to a once-weekly interval was limited by an increasing number of unplanned dressing changes. The prolonged interval of dressing changes, with a real mean interval of 5.4 days, did not lead to an increased number of local cutaneous complications or central venous catheter blood culture positivity and even contributed to reduced insertion-site inflammation occurrence.

Antimicrobial chlorhexidine/silver sulfadiazine-coated central venous catheters versus those uncoated in patients undergoing allogeneic stem cell transplantation.

INTRODUCTION: Only a minimum is known about clinical effect of antimicrobial-coated central venous catheters (CVC) in stem cell transplantation settings, where CVC-related infections impose major threat to severely immunocompromised patients. MATERIALS AND METHODS: In this prospective, non-sponsored and nonrandomized study, there were 49 uncoated multi-lumen and non-tunneled CVCs and 58 antimicrobial chlorhexidine/silver sulfadiazine-coated CVCs inserted in allogeneic stem cell transplanted patients to facilitate treatment during conditioning and pre-engraftment phase (<30days after transplantation). RESULTS AND DISCUSSION: No significant differences were found between the two groups with respect to gender, age, intensity of pretransplant chemotherapy conditioning, duration of leucopenia, number of days with inserted CVC, number of CVC occlusive dressing changes performed per patient, and number of non-CVC-related infections. In the antimicrobial coated CVC group, there were observed less median days with fever [2 (0-18) vs. 4 (0-16), p = 0,17], fever incidence (67% vs. 77.5%, p = 0.28), and less days with fever per 1,000 catheter-days (108 vs. 147, p = 0.001), less patients with positive CVC blood cultures (36% vs. 45%, p = 0.05), repeatedly positive CVC blood cultures (8.6% vs. 26%, p = 0,018), less positive CVC blood cultures per 1,000 catheter-days (14 vs. 29, p = 0.005), and less positive CVC tip cultures (17.3% vs. 34.6%, p = 0.065) observed. CONCLUSION: Lower number of patients with fever, days with fever, and lower number of patients with positive and repeatedly positive CVC blood cultures indicates less intensive antibiotic and antipyretic treatment probably needed in neutropenic allo-transplanted patients with indwelling antimicrobial-coated CVCs. Real impact on antibiotic consumption should be verified in large randomized study.

Higher incidence of chemotherapy induced oral mucositis in females: a supplement of multivariate analysis to a randomized multicentre study.

Study on the normal saline vs povidone-iodine mouthwashes for oral mucositis (OM) prophylaxis in patients after high-dose chemotherapy comprising bischloroethyl nitrosourea etoposide ara-C melphalan (BEAM) or high-dose melphalan (HD-L-PAM) followed by autologous peripheral stem cell transplantation indicated that females have higher a incidence of OM compared to men, as reported by [Vokurka et al. 13:554-558, (2005)]. The multivariable analysis of larger cohort of 148 patients compliant with the original study protocol confirmed female gender to be an independent risk factor and predictor for OM. The HD-L-PAM (200 mg/m2) conditioning regimen revealed to be more toxic compared to BEAM as for incidence of OM grades 3-4 World Health Organization score. Body mass index, age, mouthwash solution used, and CD34+ cell number in the autologous graft were verified not to have an impact on OM incidence in this group of patients.

The comparative effects of povidone-iodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT--results of a randomized multicentre study.

Antimicrobial solutions are widely used in the nursing care of chemotherapy induced oral mucositis (OM). There is little evidence, however, supporting their use for reducing mucosal damage. In our study, 132 patients were randomized to use normal saline (n=65) or povidone-iodine diluted 1:100 (n=67) mouthwashes for OM prophylaxis and treatment after high-dose chemotherapy comprising BEAM or HD-L-PAM followed by autologous peripheral stem cell transplantation. The study groups were well balanced in respect of age, sex, chemotherapy and the number of CD34+ cells in the graft. No significant difference was found between the groups in respect of OM characteristics, fever of unknown origin (FUO) and other infections. The antimicrobial solution was less tolerable for patients. OM occurred significantly more often in females than in males (86% vs 60%, P=0.0016) and was worse and of longer duration. The mechanical effect of mouthwashes might have a certain importance in FUO prevention. When indicating oral rinses, the patient's individual preference and tolerance of solutions offered should be considered.