Bacteremias following autologous stem cell transplantation for multiple myeloma: Risk factors and outcomes

Abstract

Background Autologous stem cell transplantation (ASCT) is a commonly used treatment for multiple myeloma (MM). This retrospective cohort study characterizes the risk factors and outcomes associated with bacteremia following ASCT at a single center. Methods We conducted a retrospective analysis in subjects who underwent ASCT for multiple myeloma and other malignancies from May 2014 to March 2015 at a single center. The control cohort included all subjects undergoing ASCT in the same time period who did not develop bacteremia. Results During the study period, 363 ASCTs were completed in 282 discrete patients. Bacteremia was documented in 13% of all transplants. Enterococcus faecium was the most frequent species overall (14/62, 23%). Vancomycin resistance was present in 93% of E faecium isolates. Bacteremia was associated with a significantly decreased survival in patients who received their transplant after the first year of myeloma treatment. Overall survival (OS) was not significantly different in the two cohorts among patients undergoing ASCT within the first year of myeloma treatment. Survival analysis showed a significantly decreased OS in patients who developed Enterococcus bacteremia as compared to the non‐bacteremia cohort. Enterococcal bacteremia was associated with significantly longer duration of neutropenia (mean 14 vs 9.7 days, P = 0.01), hospitalization (mean 61.7 vs 20.4 days, P = 0.0006), and higher mortality (69% vs 25%, P = 0.01) as compared to other bacteremias. Conclusion We found a high incidence of E faecium and a low incidence of MRSA and Pseudomonas bacteremias following ASCT in our patient population. Survival analysis in our cohort suggests that the effect of underlying disease status and cumulative chemotherapy is critically important in determining outcomes related to bacteremia. Enterococcal bacteremias following ASCT were associated with significantly higher morbidity and mortality than non‐enterococcal bacteremias.

Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation: lesson from the nationwide study

“…Due to the same factors, the diagnosis of multiple myeloma was associated with a decreased risk for infection in multivariate analysis. On the other hand, the incidence of infectious complications in this group of patients was similar as presented in recent analyses [35][36][37][38].…”

Risk of infections with B-cell maturation antigen-directed immunotherapy in multiple myeloma

“…An inferior overall survival primarily due to patients succumbing to infections was also seen with venetoclax therapy 11 . Salvage autologous cell transplantation, another acceptable treatment option in this population is also associated with significant infectious complications 12,13 . The only currently FDA-approved BCMA CAR-T, idecabtagene vicleucel was associated with infections in 69% of study patients (relapsed/refractory MM), of which 22% were grade 3 or 4 2 .…”

Autológőssejt-transzplantációt követő korai infekciók epidemiológiája. Egy hazai centrumban kezelt 699 beteg adatainak elemzése

“…Klinikailag igazolt infekció csupán 8 esetben lépett fel. A közelmúltban publikált vizsgálatok szerint aHSCT-ben a bacteriaemia 7,6-38%-os arányban fordul elő [6,[9][10][11]. Kutatásunkban a baktériumok okozta véráram-infekciók előfordulási gyakorisága ugyanakkor 7%nak adódott.…”

“…Az incidencia sorrendjében ezt követték az enterococcusok. Az utóbbiak gyakorisága egyes centrumokban növekszik, ami független kockázatot jelent a kedvezőtlenebb túlélés tekintetében [11]. A két leggyakoribb véráram-infekciót okozó Gram-negatív kórokozó az Escherichia coli és a Pseudomonas aeruginosa volt.…”

“…A leggyakrabban -összesen 49 epizódban -bacteriaemiát észleltünk. Ezek előfordulási mediánja 7 (5)(6)(7)(8)(9)(10)(11) nap volt a transzplantációt követően. A bacteriaemiák döntő többsége (33/49) a megtapadás előtt lépett fel.…”