Complications of Autologous Stem Cell Transplantation in Multiple Myeloma: Results from the CALM Study

Abstract

Background: The main goal of this post hoc analysis of the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study was to evaluate the rate of short- and long-term infectious and non-infectious complications occurring after ASCT in patients with multiple myeloma (MM). Methods: The analysis included all patients with MM from the CALM study who underwent ≥1 ASCT. The primary endpoint of the analysis was to determine the rate of infectious and non-infectious complications after ASCT and to compare them in three time periods: 0–100 days, 101 days–1 year, and >1 year after the first transplant. Results: The analysis included a total of 3552 patients followed up for a median of 56.7 months (range 0.4–108.1). Complication rates decreased with the time from ASCT with 24.85 cases per 100 patient-years from day 0 to 100 days after the transplant, and <2.31 cases per 100 patient-years from the 101st day. At 100 days after ASC T, 45.7% of patients had complications, with infectious events being twice as frequent as non-infectious complications. Bacterial infections (6.5 cases per 100 patient-years, 95% CI: 6.1–7.0) and gastrointestinal complications (4.7 cases per 100 patient-years, 95% CI: 4.3–5.1) were the most common early events. The pattern of complications changed with time from ASCT. The presence of complications after ASCT was not associated with overall survival. Conclusions: Our data provide a solid basis for comparing ASCT-related complications to those caused by emerging treatments in multiple myeloma, such as CAR T-cell therapy and other immunotherapies.

The shifting roles and toxicities of cellular therapies in B‐cell malignancies

“…Following neutrophil engraftment, viral infections are most common, while bacterial infections are markedly decreased; however, patients remain at risk for infection due to Streptococcus pneumoniae . Fungal infections remain rare 42 . Immune reconstitution involves the numerical and functional restoration of the myeloid, B cell, T cell, innate lymphoid (including natural killer [NK] cell), and antigen‐presenting cell populations.…”

Validation of the GATMO score in predicting non‐relapse mortality following hematopoietic cell transplant in multiple myeloma patients

“…1,2 AHCT can be associated with significant morbidity and non-relapse mortality (NRM) especially in patients with multiple comorbidities; hence, patients are carefully screened for eligibility determination. [3][4][5] In 2019, the Grupo Argentino De Transplante De Medula Osea (GATMO) developed a scoring system to predict overall survival (OS) and NRM post-AHCT. 6 However, the score is still not routinely incorporated into MM clinical practice.…”

Effects on the Physical Functioning of Two Exercise Interventions in Patients with Multiple Myeloma: A Pilot Feasibility Study

“…However, out of fear of further bone damage, MM patients are oftentimes advised not to participate in any such activities, even though many of them report a strong desire to do so [10]. Certain MM therapies, especially ASCT [11] and CAR-T [12], are associated with some level of toxicity, and patient frailty is considered a risk factor for complications, independent of the effect of age [13], sometimes leading to the exclusion of patients from these therapies or lower doses/shorter durations of treatment and worse outcomes [14][15][16][17]. Although a common characteristic of MM patients, particularly in the relapsed/refractory setting [16], frailty is a somewhat influenceable factor and can be improved through interventions like PT and physical exercise [18], potentially paving the way to better treatment outcomes.…”