A retrospective review of infections and outcomes within 100 days of hematopoietic stem cell transplantation: insights from a new transplant program in the Philippines

Background: Few hematopoietic stem cell transplantations (HSCT) are performed in lower-middle income countries. Only four institutions in the Philippines are able to perform transplants. This study describes the experience of a newly established program. Methods: The charts of all adult patients who underwent HSCT at The Medical City from May 1, 2016 to December 31, 2019 were reviewed retrospectively. Results: A total of 33 patients were included in the cohort, of whom 31 (93.9%) underwent autologous HSCT and only two (6.1%) underwent allogeneic HSCT. Most were female (21/33, 63%), and median age was 51 years (range 21-67 years). The primary indication for transplantation was multiple myeloma ( n = 21), followed by diffuse B-cell lymphoma ( n = 6). Fifteen of the 33 patients had a history of treated tuberculosis (TB) disease ( n = 4) or latent TB infection ( n = 11). The median time for neutrophil recovery was 7.4 days (range 4-13 days). Transplant complications included neutropenic fever ( n = 33, 100%) and mucositis ( n = 14, 42.4%). Bacterial infection was documented in 12 (36.4%) patients, with nine (24.2%) developing a bacterial blood stream infection of which seven were related to a central line. The overall mortality rate was at 6.1% (2/33) in the first 30 days post-transplant, with no additional mortality in the succeeding days until day 100. Conclusions: This cohort with mostly autologous HSCT had favorable outcomes in the first 100 days. Rates of bacterial infection were high in the early post -transplant period. Latent TB infection was common, but no reactivation was observed. Longer-term follow-up of patients is needed to determine late post-transplant complications and outcomes.