Early infectious complications after autologous hematopoietic cell transplantation for multiple myeloma

Abstract

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. K E Y W O R D S autologous hematopoietic cell transplantation, bacterial infections, central line associated blood stream infection, Clostridium difficile, infections, multiple myeloma

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].…”

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

“…The overall incidence of infections within the first 100 days after the transplant was similar to that reported in earlier studies [ 5 , 6 , 7 ]. Developing complications up to 100 days after transplant did not affect long-term survival.…”

“…The presented analysis is one of the largest single reports about ASCT complications in patients with MM. Some data were already available on ASCT complications during the time shortly after the transplant [ 4 , 5 , 6 ]. However, the short-term and long-term complication rates of ASCT have not been comprehensively assessed in a broad population of patients with MM.…”

Infectious complications in patients with relapsed refractory multiple myeloma after BCMA CAR T-cell therapy

“…However, this is in line with prior studies of infectious complications in CAR-T 8 and stem cell transplant. 20 The absence of finding any risk factors that increased the risk of infections in a statistically significant manner may have been because of our small sample size and our study not being powered enough to identify these risk factors. The absence of finding an association between receiving IVIG for significant or profoundly reduced hypogammaglobulinemia may be secondary to not only small sample size but also missing data, given many patients were given supportive care locally.…”