Nursing in LAF units and routine high dose IVIG were considered essential elements and standard of care in allogeneic HSCT during the 1980s. They were abandoned by many teams in view of high costs, lack of formal proof of evidence and improved diagnostic and therapeutic interventions against viral and fungal infections. A recent prospective study showed no benefit of routine IVIG but few data have analysed the consequences of the combined change in practice. We made these changes at our institution in two stages during a 10-year period: change from care in LAF rooms to single rooms (SR) and change from routine high dose IVIG to targeted IVIG replacement according to CDC guidelines. Basic strategies in supportive care and data collection remained unchanged. This resulted in a retrospective analysis of 357 allogeneic HSCT in three cohorts, i.e. LAF + IVIG, SR + IVIG and SR − IVIG (Table). Endpoints analysed were survival, transplant related mortality (TRM), relapse rate, incidence and severity of GvHD and infectious complication rates defined as: sepsis, septic thrombosis, urinary tract infections, pneumonias, and CMV reactivation. Results were adjusted by multivariate analyses for all the changes over time (see Table *significant difference between groups). There were more patients in advanced stage of disease and with higher age in more recent years. There were significantly fewer septicemias per hospital day but not per day in neutropenia in the LAF + IVIG group without impact on survival. There were no significant differences in any of the other outcomes analysed. Abandoning LAF and routine high dose IVIG use did not impact negatively on HSCT outcome. These data support current practice.

GroupLAF + IVIGSR + IVIGSR, no IVIGTotal
N 116 134 107 357 
Male 55% 51% 62% 59% 
Age, years* 34 34 40 35 
Median, range 4–58 2–62 1–62 35 
Diagnosis*     
Leukemias 85% 83% 82% 84% 
Lymphoproliferative 7% 13% 15% 11% 
Others 8% 4% 3% 5% 
Early disease* 46% 38% 29% – 
Late disease 54% 72% 71% 66% 
% RIC* 0% 10% 32% – 
Days in hospital* 53 32 28 38 
Days in neutropenia* 16 15 11 14 
Day 100 TRM 18% 20% 22% 20% 
GroupLAF + IVIGSR + IVIGSR, no IVIGTotal
N 116 134 107 357 
Male 55% 51% 62% 59% 
Age, years* 34 34 40 35 
Median, range 4–58 2–62 1–62 35 
Diagnosis*     
Leukemias 85% 83% 82% 84% 
Lymphoproliferative 7% 13% 15% 11% 
Others 8% 4% 3% 5% 
Early disease* 46% 38% 29% – 
Late disease 54% 72% 71% 66% 
% RIC* 0% 10% 32% – 
Days in hospital* 53 32 28 38 
Days in neutropenia* 16 15 11 14 
Day 100 TRM 18% 20% 22% 20% 
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Topics:
allogeneic hematopoietic stem cell transplant, hematopoietic stem cell transplantation, immunoglobulins, intravenous, infections, laminar airflow, neutropenia, cmv reactivation, graft-versus-host disease, infection as complication of medical care, leukemia

Author notes

Corresponding author

2005, The American Society of Hematology
2004
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