Causes of early death in multiple myeloma patients treated with high‐dose therapy followed by autologous stem cell transplantation: A study based on the nationwide Danish Multiple Myeloma Registry

Andersen, Kristian Thidemann; Klausen, Tobias W.; Abildgaard, Niels; Andersen, Mette Klarskov; Andersen, Niels Frost; Frølund, Ulf Christian; Helleberg, Carsten; Kjeldsen, Eigil; Pedersen, Per Trøllund; Helm-Petersen, Sissel; Svirskaite, Asta; Preiss, Birgitte; Gimsing, Peter; Vangsted, Annette Juul

doi:10.1002/ajh.24857

Cited by 11 publications

(10 citation statements)

References 6 publications

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“…We confirm that this has significantly helped to reduce the TRM over time, from 18·8% in 1994–2000 to 1·1% from 2013 to 2018. This latest TRM compares favourably to a 2·4% TRM quoted by the US for the period 2010–2016 (D'Souza et al , ) and also to the 2·1% quoted in a recent nationwide study from the Danish Multiple Myeloma registry for multiple myeloma treated with ASCT (Thidemann Andersen et al , ). Other factors that may have influenced the reduction in TRM over time include the use of routine broad spectrum gram‐negative prophylactic antibiotics, and that all patients considered for transplant in UK are reviewed at the National Amyloidosis Centre for suitability for transplantation, with a patient‐specific supportive care plan given, to help mitigate the risk associated with a small volume transplant centre.…”

Section: Discussionsupporting

confidence: 78%

“…High dose myeloablative chemotherapy, as part of an autologous stem cell transplant (ASCT), remains the standard of care for younger/fitter patients with MM with the potential for improved survival and a prolonged treatment‐free interval, and has been used for patients with AL for nearly 20 years (Comenzo et al , ). However, ASCT is not without risk, even for uncomplicated MM patients with a 2·5% overall transplant‐related mortality (TRM) (Thidemann Andersen et al , ). The risk of TRM is even higher for AL amyloidosis patients given the involvement of the heart, kidneys, liver and gastrointestinal (GI) tract.…”

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confidence: 99%

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A 24‐year experience of autologous stem cell transplantation for light chain amyloidosis patients in the United Kingdom

et al. 2019

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Summary Autologous stem cell transplantation (ASCT) is considered to be the best method to achieve deep haematological/organ responses and improve survival in selected patients with AL amyloidosis. This field has been led by US centres and is less utilised in Europe. The introduction of effective chemotherapy agents for AL prompted us to re‐evaluate UK outcomes of ASCT in affected patients. A total of 264 AL amyloidosis patients treated with an ASCT between 1994 and 2018 were identified. Patient baseline characteristics, transplant‐related mortality (TRM) and overall survival (OS) were analysed. The median OS post‐ASCT was 87 months [95% confidence interval (CI): 77–106 months]. The median time from ASCT to next treatment was 48 months (95% CI: 29–55 months). A haematological response was achieved in 94·8% of patients and was a strong predictor of time to next treatment [P < 0·0001, hazard ratio (HR) = 1·75, 95% CI = 1·35–2·28] and OS (P = 0·007, HR = 1·91, 95% CI = 1·19–3·07). Organ response was: cardiac (n = 28, 60·9%), renal (n = 101, 76%) and liver (n = 7, 13·5%). Overall TRM was 8·7%, with a significant reduction over time (1994–2000: 18·8%; 2001–2006: 13·6%; 2007–2012: 6·2%; 2013–2018: 1·1%). In conclusion, ASCT is significantly safer and remains a highly effective treatment with excellent long‐term survival; it should be more widely considered as a treatment option for systemic AL amyloidosis.

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Section: Discussionsupporting

confidence: 78%

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confidence: 99%

A 24‐year experience of autologous stem cell transplantation for light chain amyloidosis patients in the United Kingdom

et al. 2019

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“…Newly diagnosed patients with MM have variable survival, ranging from a few days to more than a decade [ 54 , 55 ]. Many studies [ 1 , 2 , 6 , 18 , 31 , 35 ] confirm that infections represent a major threat to patients with MM. Caravita et al [ 45 ] attested that the overall survival (OS) of MM patients with infections was significantly shorter than in those without infections.…”

Section: Discussionmentioning

confidence: 99%

Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics

et al. 2020

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Background Infection is a leading cause of morbidity and death in patients with multiple myeloma (MM). The increased susceptibility to infection is complicated and multifactorial. However, no studies have explored the spectrum and risk factors of infections in newly diagnosed MM patients at the first admission. This cross-sectional study aimed to provide ideas for the assessment, prevention and treatment of infection in newly diagnosed MM patients when admitted for the first time. Methods Retrospectively, the data from electronic medical records for 161 patients newly diagnosed with MM from May 2013 to December 2018 were analysed. All the information was collected at the time of admission, and the patients had received no antineoplastic therapy previously. Independent risk factors of infection in multiple myeloma were determined by univariate and multivariate analysis. Results Newly diagnosed patients with MM were highly susceptible to viruses (43.9%), especially Epstein-Barr virus (EBV) (24.4%) and hepatitis B virus (HBV) (17.1%). Advanced stage (ISS stage III, P = 0.040), more severe anaemia (Hb < 90 g/L, P = 0.044) and elevated CRP (> 10 mg/L, P = 0.006) were independent risk factors for infection. Moreover, infections represented a major survival threat to patients with newly diagnosed MM (P = 0.033), and the existence of risk factors for infection was significantly correlated with poor prognosis (P = 0.011), especially ISS stage III (P = 0.008) and lower haemoglobin level (P = 0.039). Conclusions Newly diagnosed MM patients are highly susceptible to viruses. Advanced ISS stage, more severe anaemia and the elevation of CRP are independent risk factors of infection, which also have a strong impact on prognosis. Our results suggest that viral infection should be taken into account if antibacterial drugs are not effective, and the prevention of infection and improvement of prognosis should be paid more attention in newly diagnosed patents with advanced stage and more severe anaemia.

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“…Patients with multiple myeloma (MM) have an increased risk of infections compared to the general population . Studies have revealed that infections are the leading cause of early deaths in MM patients . The majority of infections in MM patients consists of pneumonia and sepsis/septicemia .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for blood stream infections in multiple myeloma: A population‐based study of 1154 patients in Denmark

Sørrig

Klausen

Salomo

et al. 2018

European J of Haematology

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Causes of early death in multiple myeloma patients treated with high‐dose therapy followed by autologous stem cell transplantation: A study based on the nationwide Danish Multiple Myeloma Registry

Cited by 11 publications

References 6 publications

A 24‐year experience of autologous stem cell transplantation for light chain amyloidosis patients in the United Kingdom

A 24‐year experience of autologous stem cell transplantation for light chain amyloidosis patients in the United Kingdom

Assessment of infection in newly diagnosed multiple myeloma patients: risk factors and main characteristics

Risk factors for blood stream infections in multiple myeloma: A population‐based study of 1154 patients in Denmark

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