Evaluation of the bone marrow transplantation recipient patients regarding fever onset, fever permanence, risk factors, and underlying causes, during pre-engraftment phase

Patients undergoing bone marrow transplantation (BMT) are at higher risk of immune system deficiency. The immunosuppression, followed by pre-transplant chemotherapy makes patients vulnerable to a variety of infections, and fever is one of the first symptoms, which could develop as a result of infectious or non-infectious diseases. In the present study, the features of the fever during the pre-engraftment stage in BMT receiving patients have been investigated.

Sixty-four patients receiving BMT were prospectively evaluated during the pre-engraftment phase to evaluate the evidence of the febrile reaction.  Data concerning the cause of fever, microbiological test, the treatments and fever onset pattern, and treatment outcomes were recorded and analyzed.

73.4% of the patients had an autologous transplant, and the others received allogeneic. After transplantation, 75% of patients encountered fever during the pre-engraftment period. Of the 48 patients, 47.9% of the patients suffered fever of unknown origin (FUO). Age, gender, underlying malignancy, type of transplantation, and acute phase reactants levels before transplantation were not associated with fever development. Among febrile patients, patients with autologous transplantation were significantly more likely to develop FUO (p-value = 0.036) There was also no significant difference in the onset of fever between patients with infectious fever and who suffered FUO.

During BMT, half of the patients developed a fever of unknown origin; nevertheless, it seems that patients undergoing allogeneic transplantation are at higher risk of FUO compared to patients who received an autologous transplant.