Infectious Complications in Patients With Multiple Myeloma After High-Dose Chemotherapy Followed by Autologous Stem Cell Transplant: Nationwide Study of the Infectious Complications Study Group of the Polish Adult Leukemia Group

Waszczuk‐Gajda, Anna; Drozd‐Sokołowska, Joanna; Basak, Grzegorz W.; Piekarska, Agnieszka; Mensah-Glanowska, Patrycja; Sadowska‐Klasa, Alicja; Wierzbowska, Agnieszka; Rzepecki, Piotr; Tomaszewska, Agnieszka; Mańko, Joanna; Hus, Marek; Adamska, Monika; Romejko‐Jarosińska, Joanna; Dybko, Jarosław; Biernat, Monika; Kyrcz‐Krzemień, Sławomira; Sędzimirska, Mariola; Winciorek, Natalia; Jędrzejczak, Wiesław Wiktor; Styczyński, Jan; Giebel, Sebastian; Gil, Lidia

doi:10.1016/j.transproceed.2020.02.068

Cited by 16 publications

(17 citation statements)

References 19 publications

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“…Moreover, if the toxoplasmosis mortality rate after auto‐HSCT is also 33% in Japan (as calculated from the data presented in Table 2), we would expect approximately 13 deaths per year, corresponding to 0.65% of all auto‐HSCT cases. Infectious disease mortality in auto‐HSCT, most of which are bacterial and fungal infections, has been reported to be 1.0%–1.2%; however, no toxoplasmosis has been reported 29,30 . In our literature review, among the eight patients (cases 1–4, 11, 15–17) who died of toxoplasmosis after auto‐HSCT, four patients were diagnosed by autopsy (cases 1, 4, 16, and 17), indicating that the diagnosis of cerebral and particularly pulmonary or disseminated toxoplasmosis in patients with HSCT is difficult because of the lack of specificity of the clinical features and specific CT or MRI pattern 14 .…”

Section: Review and Discussionmentioning

confidence: 79%

Clinical characteristics and incidence of toxoplasmosis after autologous hematopoietic stem cell transplantation: A retrospective study and literature review

Kitahara

Hiroshima

Norose

et al. 2021

Transplant Infectious Dis

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Background Toxoplasmosis is a rare but life‐threatening infection occurring in immunocompromised hosts, including allogeneic hematopoietic stem cell transplantation (allo‐HSCT) recipients. However, thus far, the clinical features and incidence of toxoplasmosis in autologous HSCT (auto‐HSCT) recipients remain unknown. This retrospective survey aimed to analyze 152 patients who received auto‐HSCT between 1998 and 2017. Methods Serological tests for Toxoplasma gondii‐specific IgG were performed on 109 (71.7%) recipients, and 12 pre‐HSCT recipients (11%) were Toxoplasma seropositive. Among the 12 recipients, three who did not receive trimethoprim‐sulfamethoxazole (TMP/SMX) prophylaxis developed cerebral, pulmonary or disseminated toxoplasmosis due to reactivation after auto‐HSCT and died despite treatment. Results The incidences of toxoplasmosis were 2% and 25% among 152 auto‐HSCT recipients (five recipients received auto‐HSCT two times) and 12 pre‐HSCT Toxoplasma seropositive recipients, respectively. Further, we conducted a literature review and identified 21 cases of toxoplasmosis following auto‐HSCT. In these previous cases, the mortality rate was high, especially for pulmonary and disseminated toxoplasmosis. Our findings suggest that, similar to toxoplasmosis after allo‐HSCT, toxoplasmosis after auto‐HSCT is a fatal complication. Conclusions Serial screening of T. gondii‐specific IgG before HSCT could contribute to the detection of Toxoplasma reactivation and allow for prompt diagnosis and treatment. The present study is the first to reveal the incidence of toxoplasmosis after auto‐HSCT among seropositive patients in Japan.

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Section: Review and Discussionmentioning

confidence: 79%

Clinical characteristics and incidence of toxoplasmosis after autologous hematopoietic stem cell transplantation: A retrospective study and literature review

Kitahara

Hiroshima

Norose

et al. 2021

Transplant Infectious Dis

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Waszczuk‐Gajda

Penack

Sbianchi

et al. 2022

JCM

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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.

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“…No cases of Cryptococcus neoformans were detected in observational studies of infections including IFD in MM in the era of novel therapies 3,4,14,15 . However, there are increasing case reports of cryptococcal infection in heavily treated MM patients receiving mAb and second‐generation IMiDs 16 .…”

Section: Discussionmentioning

confidence: 99%

Low rates of invasive fungal disease in patients with multiple myeloma managed with new generation therapies: Results from a multi‐centre cohort study

Lim

Sinha

Harrison

et al. 2020

Mycoses

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Introduction: A multi-centre study to determine the outcomes and risks for invasive fungal disease (IFD) in myeloma (MM) patients treated with second-generation immunomodulatory drugs, proteasome inhibitors and monoclonal antibodies was conducted. Methods: Clinical and microbiology records were reviewed to capture patient demographics, disease characteristics, treatment, IFD episodes and outcomes. Categorical and continuous variables between patients with IFD and without IFD were compared using chi-square test, Fisher's exact test and Mann-Whitney rank sum test, respectively, with P-value < .05 considered statistically significant. Results: Five out of 148 (3.4%) MM patients were diagnosed with five episodes of IFI: 3 were proven, 1 probable and 1 possible. Median time from commencement of new generation therapy to IFD diagnosis was 4.0 months (Interquartile range [IQR]: 3.4-5.7). In patients with IFD, median cumulative steroid dose over 60 days was 1119 mg (IQR: 1066-1333 mg). None of the patients with IFD had prolonged neutropenia (neutrophil count < 0.5 × 10 9 /L for more than 10 days). Common sites of infection were the respiratory tract (40.0%) and bloodstream (40.0%). Cryptococcus neoformans (n = 2) and Candida krusei (n = 1) were the fungal pathogens isolated in the three proven cases. 30-day mortality rate was 40.0%. Patients with IFD were younger (median 58 versus 68 years, P = .52) and treated with more lines of therapy (median 5 vs 3, P = .04). Conclusion: IFD rate is low in heavily treated MM patients treated with secondgeneration therapy including monoclonal antibodies. Patients do not appear to have traditional risk factors such as prolonged neutropenia.

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Infectious Complications in Patients With Multiple Myeloma After High-Dose Chemotherapy Followed by Autologous Stem Cell Transplant: Nationwide Study of the Infectious Complications Study Group of the Polish Adult Leukemia Group

Cited by 16 publications

References 19 publications

Clinical characteristics and incidence of toxoplasmosis after autologous hematopoietic stem cell transplantation: A retrospective study and literature review

Clinical characteristics and incidence of toxoplasmosis after autologous hematopoietic stem cell transplantation: A retrospective study and literature review

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

Low rates of invasive fungal disease in patients with multiple myeloma managed with new generation therapies: Results from a multi‐centre cohort study

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