BACKGROUND: The spectrum of infectious complications in autologous hematopoietic cell transplant recipients (AHCT) with multiple myeloma has not been well described in the recent era of novel agent induction and improved supportive care. METHODS: We conducted a retrospective cohort study of 413 adult myeloma AHCT recipients at our institution from 2007-2016 to describe the cumulative incidence and risk factors for various infections and FN occurring within the first 100 days after AHCT. Additionally, landmark analysis was done among 404 patients who survived at least 100 days after transplant admission to estimate the association of infections with subsequent non-relapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS). RESULTS: Cumulative incidences (95% CI) of infection events by day 100 were: FN 43% (38-48), any infection 21% (17-25), bacterial 17% (14-21), viral 4% (3-7) and fungal 1% (0.5-3), central line-associated blood stream infection 3% (2-6), and Clostridium difficile colitis 6% (4-8). Patients with infection had a longer initial transplant hospitalization (median 17 vs 16 days, P < 0.01), more readmissions (31% vs 8%, P < 0.01), and spent more days in hospital in first 100 days (median 18 vs 16 days, P < 0.01). A 100-day mortality was low and similar between groups (2% vs 1%, P = 0.28). In landmark analysis of 404 100-day survivors, OS was worse among patients with early infections (hazard ratio 1.54 [1.03-2.30], P = 0.03), although there was no difference in NRM and RFS. CONCLUSIONS: Notwithstanding advances in supportive care, early infectious complications remain a relevant source of morbidity and require attention in myeloma AHCT recipients.
BACKGROUND: The spectrum of infectious complications in autologous hematopoietic cell transplant recipients (AHCT) with multiple myeloma has not been well described in the recent era of novel agent induction and improved supportive care. METHODS: We conducted a retrospective cohort study of 413 adult myeloma AHCT recipients at our institution from 2007-2016 to describe the cumulative incidence and risk factors for various infections and FN occurring within the first 100 days after AHCT. Additionally, landmark analysis was done among 404 patients who survived at least 100 days after transplant admission to estimate the association of infections with subsequent non-relapse mortality (NRM), overall survival (OS), and relapse-free survival (RFS). RESULTS: Cumulative incidences (95% CI) of infection events by day 100 were: FN 43% (38-48), any infection 21% (17-25), bacterial 17% (14-21), viral 4% (3-7) and fungal 1% (0.5-3), central line-associated blood stream infection 3% (2-6), and Clostridium difficilecolitis 6% (4-8). Patients with infection had a longer initial transplant hospitalization (median 17 vs 16 days, P < 0.01), more readmissions (31% vs 8%, P < 0.01), and spent more days in hospital in first 100 days (median 18 vs 16 days, P < 0.01). A 100-day mortality was low and similar between groups (2% vs 1%, P = 0.28). In landmark analysis of 404 100-day survivors, OS was worse among patients with early infections (hazard ratio 1.54 [1.03-2.30], P = 0.03), although there was no difference in NRM and RFS. CONCLUSIONS: Notwithstanding advances in supportive care, early infectious complications remain a relevant source of morbidity and require attention in myeloma AHCT recipients.
Authors: Anna Waszczuk-Gajda; Olaf Penack; Giulia Sbianchi; Linda Koster; Didier Blaise; Péter Reményi; Nigel Russell; Per Ljungman; Marek Trneny; Jiri Mayer; Simona Iacobelli; Guido Kobbe; Christof Scheid; Jane Apperley; Cyrille Touzeau; Stig Lenhoff; Esa Jantunen; Achilles Anagnostopoulos; Laura Paris; Paul Browne; Catherine Thieblemont; Nicolaas Schaap; Jorge Sierra; Ibrahim Yakoub-Agha; Laurent Garderet; Jan Styczynski; Helene Schoemans; Ivan Moiseev; Rafael F Duarte; Zinaida Peric; Silvia Montoto; Anja van Biezen; Malgorzata Mikulska; Mahmoud Aljurf; Tapani Ruutu; Nicolaus Kröger; Curly Morris; Christian Koenecke; Stefan Schoenland; Grzegorz W Basak Journal: J Clin Med Date: 2022-06-20 Impact factor: 4.964
Authors: Srirama Josyula; Margot J Pont; Sayan Dasgupta; Xiaoling Song; Sushma Thomas; Gregory Pepper; Jacob Keane-Candib; Terry L Stevens-Ayers; Hans D Ochs; Michael J Boeckh; Stanley R Riddell; Andrew J Cowan; Elizabeth M Krantz; Damian J Green; Joshua A Hill Journal: Transplant Cell Ther Date: 2022-03-11
Authors: Roaa S Gassas; Ahmed N Absi; Abdulrahman A Alghamdi; Ahmed S Alsaeed; Sameer M Alamoudi; Ihab Y Hemaidi; Majed D Alahmadi; Walaa A Rajkhan; Mannar M Khalil; Saleem K Dadah; Ahmed S Higazi; Amani S Ahmed Journal: Saudi Med J Date: 2021-08 Impact factor: 1.422