Introduction
Bone marrow transplant, known as hematopoietic stem cells transplant
(HSCT), entails infusion of healthy hematopoietic stem cells into
patients with diminished or dysfunctional bone marrow. This aims to
boost bone marrow function and allows to either destroy tumor cells with
malignancy or to generate functional cells that can replace the
dysfunctional cells[1]. It can be used
in various types of diseases including leukemia, lymphoproliferative
disorders, solid tumor, non-malignant disorders, and
others[2]. Life enhancing HSCT is
mainly divided into two main types, the autologous form (stem cells are
harvested from the recipient) and the allogeneic form (stem cells are
harvested from a different donor individual or from cord blood
units)[3].
Our bone marrow transplant center is at the medical city, Baghdad we
commonly use autologous stem cell transplant as a mainstay treatment
line for patients with relapsed Hodgkin lymphoma, moderate-high degree
non-Hodgkin lymphoma, and multiple myeloma after the failure of therapy
with chemotherapy alone or in combination with radiotherapy. Patients
who undergo bone marrow transplantation procedures are at high risk of
severe illness, infectious complications, and myelosuppression including
neutropenia[4].
Patients with Low neutrophil count (less than 500/μL) and febrile, 38°C
that consist for one hour or 38.3°C for one reading, few days after
transplantation have febrile neutropenia which considered as a medical
emergency. It may represent the only clinical sign of severe infection
leading to increased length of hospital admission and prompts the
physician to initiate empirical broad spectrum antimicrobial therapy
prior to isolation of bacterial organism. Early administration of
antimicrobial will improve overall morbidity and mortality
rates[5,
6]. Choosing appropriate empirical
therapy is a raising challenge especially in an era of elevated
antimicrobial resistance rates[7].
Unresponsiveness with persistent or recurrent fever despite of
antibiotic therapy could indicate an invasive fungal infection that
requires the administration of empirical antifungal therapy because
Invasive fungal infection risk increases with neutropenia duration and
severity[8,
9]. Amphotericin B deoxycholate
(conventional) for many decades is believed to be a cornerstone
treatment of fungal infection [10].
Unfortunately, empirical treatment with conventional amphotericin B is
limited by breakthrough fungal infections, acute toxic effects related
to the infusion, and dose-limiting nephrotoxic
reactions[11]. An alternative
strategy that improves outcomes like evaluating lipid formulations of
amphotericin to enhance tolerability profile conventionally has
demonstrated significant benefits in treating fungal infections like
liposomal amphotericin B[12]. In our
BMT center, we started to administer liposomal amphotericin which is a
unique lipid formulation of amphotericin B. used for a wide range of
medically fungal pathogens. It has significantly improved safety and
toxicity profile compared with conventional amphotericin B
deoxycholate[13,
14].