The Predictive Value for Pulmonary Infection by Area Over the Neutrophil Curve (D-index) in Patients Who Underwent Reduced Intensity Hematopoietic Stem Cell Transplantation
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We evaluated the predictive value of the D-index for pulmonary infection in the early phase of reduced intensity stem cell transplantation (RIST). Out of 68 patients, ten patients developed a pulmonary infection within 100 days after RIST. Both the D-index and the cD-index were higher in the patients with pulmonary infection than in the control group (P = 0.009, P = 0.042, respectively). The best sensitivity and specificity, calculated with receiver operating characteristic curves, showed that the D-index was superior to the duration of neutropenia in predicting pulmonary infection. We also evaluated the utility of a cumulative D-index until 21 days after RIST (D21-index). The D21-index was higher in the patients with pulmonary infection (P = 0.047). The cutoff value of the D21-index was lower than that of the D-index (8650 vs. 11000) with comparable sensitivity and specificity. Our results demonstrate that the D21-index, as well as the D-index, are useful tools for the prediction of pulmonary infection in RIST.
KeywordsD-index cD-index D21-index Pulmonary infection Reduced intensity conditioning regimen
We are very grateful to the patients who participated in this study. We would also like to thank the staff of the Hematology division at Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital for their excellent patient care.
Conflict of Interest
The authors declare that there are no competing financial interests.
- 2.Kruger W, Russmann B, Kroger N, Salomon C, Ekopf N, Elsner HA, Kaulfers PM, Mack D, Fuchs N, Durken M, Kabisch H, Erttmann R, Zander AR (1999) Early infections in patients undergoing bone marrow or blood stem cell transplantation–a 7 year single centre investigation of 409 cases. Bone Marrow Transplant 23(6):589–597. doi: 10.1038/sj.bmt.1701614 PubMedCrossRefGoogle Scholar
- 4.Sparrelid E, Hagglund H, Remberger M, Ringden O, Lonnqvist B, Ljungman P, Andersson J (1998) Bacteraemia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection. Bone Marrow Transplant 22(8):795–800. doi: 10.1038/sj.bmt.1701404 PubMedCrossRefGoogle Scholar
- 6.Kimura S, Oshima K, Sato K, Sato M, Terasako K, Nakasone H, Kikuchi M, Okuda S, Kako S, Yamazaki R, Tanaka Y, Tanihara A, Nishida J, Kanda Y (2010) Retrospective evaluation of the area over the neutrophil curve index to predict early infection in hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant 16(10):1355–1361. doi: 10.1016/j.bbmt.2010.04.012 PubMedCrossRefGoogle Scholar