Practice of inflammatory biomarkers for prediction of infectious complications after autologous hematopoietic stem cell transplantation

Background . High-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is a treatment option for hematological diseases, and can lead to severe neutropenia and an increased risk of infectious complications. The term “febrile neutropenia” combines all infectious complications, and fever may be the only sign of infection in this group of patients. Due to this, there is a need for additional diagnostic methods in clinical practice that can predict and diagnose infectious complications in patients after HDCT / auto-HSCT. Aim . To evaluate the prognostic significance of inflammatory biomarkers (C-reactive protein, procalcitonin and presepsin) in the early detection of infectious complications, as well as the capabilities of these biomarkers in the diagnosis of bacteremia in patients with lymphomas and plasma cell neoplasms after HDCT / auto-HSCT. Materials and methods . This prospective study included 139 patients with lymphomas and plasma cell neoplasms after HDCT / auto-HSCT. Infectious complications developed in the early post-transplant period in 99 (71.2 %) patients; 40 patients had no infectious complications, they formed the control group. The dynamics of C-reactive protein, procalcitonin and presepsin on day 1, 3 and 7 after stem cell infusion were assessed. Results . The median time of fever onset was 5 (1–10) days after transplantation. On day 3, significant differences were observed between the group of infectious complications and the control group in all biomarkers: C-reactive protein, procalcitonin and presepsin were significantly higher in the group of patients with infectious complications. On day 3, procalcitonin demonstrated the highest specificity for infection: with values >0.11 ng / mL, the probability of infectious complications increased by 9 times, and the specificity of the test reached 88.9 %. In 77 patients with febrile neutropenia, microbiological cultures were negative; in 21 patients – bacteremia was detected. None of the biomarkers demonstrated their effectiveness in diagnosing bacteremia: the differences in biomarkers concentration in patients with bacteremia and with sterile cultures were insignificant. Conclusion . Monitoring of C-reactive protein, procalcitonin and presepsin can facilitate early detection of infectious complications in patients after HDCT / auto-HSCT. The most significant day for assessing the biomarkers is day 3 after stem cell infusion. Procalcitonin monitoring is recommended for timely detection of patients with a high risk of severe infection and possible preventive antibacterial therapy.