Evaluation of the bone marrow transplantat recipient patients regarding fever onset, fever permanence, risk factors, and underlying causes, during the pre-engraftment phase

Masoume Mesgarian; Sahar Shadvar; Mehrangiz Zangene; Seyyed Reza Safaee Nodehi

doi:10.18502/bccr.v13i4.14401

Masoume Mesgarian Department of Infection Disease, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
Sahar Shadvar Department of Infection Disease, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
Mehrangiz Zangene Department of Infection Disease, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
Seyyed Reza Safaee Nodehi Department of Internal Medicine, Hematology and Medical Oncology Ward, Cancer Research Center, Cancer institute, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran

DOI: https://doi.org/10.18502/bccr.v13i4.14401

Keywords: Bone marrow diseases, Bone Marrow Transplantation, Fever of unknown origin, Fever, Pre-engraftment

Abstract

Background: Patients undergoing bone marrow transplantation (BMT) are at higher risk of immune system deficiency. The immunosuppression, followed by pre-transplant chemotherapy makes patients vulnerable to a variety of infections, and fever is one of the first symptoms, which could develop as a result of infectious or non-infectious diseases. In the present study, the features of the fever during the pre-engraftment stage in BMT-receiving patients have been investigated.

Materials and Methods: Sixty-four patients receiving BMT were prospectively evaluated during the pre-engraftment phase to evaluate the evidence of the febrile reaction. Data concerning the cause of fever, microbiological tests, the treatments and fever onset pattern, and treatment outcomes were recorded and analyzed.

Results: 73.4% of the patients had autologous transplants, and the others received allogeneic. After transplantation, 75% of patients encountered fever during the pre-engraftment period. Of the 48 patients, 47.9% of the patients suffered from fever of unknown origin (FUO). Age, gender, underlying malignancy, type of transplantation, and acute phase reactants levels before transplantation were not associated with fever development. Among febrile patients, patients with autologous transplantation were significantly more likely to develop FUO (p-value = 0.036) There was also no significant difference in the onset of fever between patients with infectious fever and who suffered FUO

Conclusions: During BMT, half of the patients developed a fever of unknown origin; nevertheless, it seems that patients undergoing autologous transplantation are at higher risk of FUO compared to patients who received an allogeneic transplant.