Autologous Bone Marrow Transplantation - Blog Science Connections

660 Amphotericin B for Neutropenic Feuer
MATERIALS AND METHODS
Patients
The hospital records of 107 patients representing 138 consecutive admissions
to the Ireland Cancer Center inpatient unit were reviewed. Median patient
age was 42 years, with a range of 17-68 years. Disease categories are listed in
Table 1. Sixty-eight treatment courses involved intensive chemotherapy without
bone marrow support, and 70 treatment courses were associated with
intensive chemoradiotherapy and bone marrow transplantation.
Supportive Care
Supportive care measures included oral therapy with trimethoprimsulfamethoxazole,
one double-strength tablet twice daily at the start of antineoplastic
therapy, and either oral Mycostatin suspension or clotrimazole
troche therapy at the development of neutropenia (polymorphonuclear leukocytes
< 500//il). Neutropenic fevers, defined as single oral temperature
elevations of greater than or equal to 38.2° C in patients with neutrophil
counts of less than or equal to 500//ul, were treated with broad-spectrum
antibacterial agents after blood, urine, sputum, stool, and other appropriate
cultures were obtained. The most commonly employed antibacterial agent
regimen included intravenous nafcillin (2 g every 4 hours), tobramycin (5
mg/kg/day), and ticarcillin (300 mg/kg every 4 hours). Vancomycin (500 mg
intravenously every 6 hours) was substituted for nafcillin when central venous
catheter-related infections occurred, or when semisynthetic penicillinresistant
staphylococci were identified on culture. Tobramycin dosages were
measured and adjusted routinely to keep serum concentrations in therapeutic
Table 1. Disease Status
No. of Patients
Disease (n = 107)
Acute nonlymphocytic leukemia 24
Acute lymphoblastic leukemia 11
Hodgkin's disease 8
Non-Hodgkin's lymphoma 8
Malignant melanoma 22
Small cell carcinoma—lung 6
Non-small cell carcinoma—lung 6
Colorectal carcinoma 6
Carcinoma—breast 2
Other 14