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Neutrophil function and pyogenic infections in bone marrow transplant
recipients
W Zimmerli, A Zarth, A Gratwohl and B Speck
Department of Research University Hospital, Basel, Switzerland.
In a consecutive entry trial, the incidence and time course of decreased
neutrophil function was assessed in 20 patients treated with allogeneic
bone marrow transplantation (BMT). The aim of the study was to assess the
prognostic value of low neutrophil function for late pyogenic infections.
Chemotaxis, superoxide production, and phagocytic- bactericidal activity
were studied before and 2, 6, 9, and 12 months after BMT. Skin window
migration was quantitatively assessed 2 months after BMT. Infectious
complications were recorded prospectively with preset criteria during 1
year. Six of the 20 leukemic patients had defective neutrophil function
before BMT. Two months after BMT all 10 patients with greater than stage II
graft-versus-host disease (GVHD), and 6 of 10 patients with less than or
equal to stage II GVHD had at least one decreased function. At this time,
patients with subsequent pyogenic infections had lower chemotaxis (P less
than .05), phagocytic- bactericidal activity (P less than .005), and
superoxide production (P less than .025) than those without. Defective skin
window migration and combined defects were predictive for late pyogenic
infections. At 9 months all tests were normal in seven patients surviving
without GVHD. In contrast, at 9 months three of three patients, and at 1
year two of three with chronic GVHD had still decreased neutrophil
function. In conclusion, neutrophil function is frequently impaired during
the first months after BMT. Combined neutrophil defects predispose to
pyogenic infections and indicate the patient at risk.
Volume 77,
Issue 2,
pp. 393-399,
01/15/1991
Copyright © 1991 by The American Society of Hematology
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