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].