Efficacy of Cefepime Prophylaxis for Autologous Stem Cell Transplantation in Children with High-risk Solid Tumor

Choi, Young Bae; Choi, Hyun Shin; Chueh, Heewon; Lee, Soo Hyun; Yoo, Keon Hee; Kim, Yae Jean; Sung, Ki Woong; Koo, Hong Hoe; Kim, Ju Youn; Cho, Eun Joo

Abstract

PURPOSE
Infection is one of the most important complications associated with hematopoietic stem cell transplantation (HSCT) in children with high-risk solid tumor. The study was designed to determine the efficacy of cefepime prophylaxis to prevent infection in autologous HSCT.
METHODS
From October 2008 to April 2009, 50 children with high-risk solid tumor who received autologous HSCT were enrolled in this study. They were divided to two groups, prophylaxis vs. empirical treatment. In the prophylaxis group, cefepime was given intravenously once the absolute neutrophil count (ANC) fell below 200/microliter, after initiation of HDCT, even in the absence of a high fever. In the empirical group, cefepime was given at onset of fever and neutropenia (ANC <500/microliter).
RESULTS
The two groups had similar clinical characteristics in age at HSCT, conditioning regimens, frequency of HSCT, number of CD34 cells. There were no significant differences in duration of fever, duration of antibacterial agents and cost of total antibacterial agents. However, when the analysis were confined to only patient without grade > or =3 mucositis, duration of fever (P=0.027) and number of patients who needed second-line antibiotic treatment (P=0.009) were lesser in the prophylactic group than in the empirical group. In addition the number of patients without neutropenic fever were more in the prophylactic group than in the empirical group (P=0.010). There was no difference in the development of high grade toxicities (NCI grade > or =3) between two groups.
CONCLUSION
Although there were no significant differences in efficacy and cost effectiveness between prophylactic group and empirical group. Some beneficial effects were observed, when the analysis were confined to only patient without significant mucositis. Further investigation with larger randomized selected patents is needed.