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• W2024807652 abstract "Single and tandem high-dose cytoreductive therapy with autologous stem cell transplantation is increasingly used for treating multiple myeloma. Although no cure has been documented, high-dose therapy combined with transplantation improves the response rate, event-free survival, and overall survival in these patients (1Attal M. Harousseau J.L. Stoppa A.M. et al.A prospective, randomised trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome.N Engl J Med. 1996; 335: 91-97Crossref PubMed Scopus (2569) Google Scholar, 2Johnsen H. Björkstrand B. Carlson K. et al.Outcome for patients with leukemia, multiple myeloma and lymphoma who relapse after high dose therapy and autologous stem cell support.Leuk Lymphoma. 1996; 24: 81-91Crossref PubMed Scopus (15) Google Scholar). In their article on infections after high-dose therapy and autologous stem cell transplantation in patients with lymphoproliferative malignancies, Ketterer et al (3Ketterer N. Espinousse D. Chomarat M. et al.Infections following peripheral blood progenitor cell transplantation for lymphoprolipherative malignancies etiology and potential risk factors.Am J Med. 1999; 106: 191-197Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar) reported that total body irradiation, fludarabine, and a diagnosis of multiple myeloma were associated with an increased risk of late infections after autologous stem cell transplantation. We retrospectively analyzed infectious complications (including those that occurred a year or more after autologous stem cell transplantation) and risk factors in a cohort of patients with multiple myeloma who underwent autologous stem cell transplantation at our institution. Our findings that varicella zoster viral (VZV) infection and pneumonia were the most frequently observed infections corroborate those of Ketterer et al. Sixteen patients with multiple myeloma were included (9 women; median age 52 years, range 30 to 60). Twelve patients received tandem au-tografts and high-dose therapy consisting of melphalan at the first autol-ogous stem cell transplantation, and melphalan followed by total body irradiation at the second transplantation. Patients who underwent a single autologous stem cell transplantation were given cyclophosphamide, etoposide, and total body irradiation (n = 3) or melphalan alone (n = l). All patients undergoing tandem transplantation received a CD34+ selected graft on the second occasion. The average dose of reinfused CD34+ cells was 3.7 × 106/kg body weight, and all but 3 patients received >2.5 × 106/kg body weight CD34+ cells. Patients received prophylaxis for Pneumocystis carinii pneumonia for 3 months after autologous stem cell transplantation, but no antiviral prophylaxis. Infectious complications from day 30 after transplantation until relapse or progression of the underlying disease or death were registered. The median follow-up time was 660 days (range 330 to 1,305). Thirteen patients (75%) developed a total of 46 infectious episodes. Six patients had 8 episodes of VZV infection (6 herpes zoster and 2 varicella). Three patients had septicemia and 7 had pneumonia; Streptococcus pneumoniae was the causative agent in 6 of these 10 infections. Three patients died during a nonprogressive phase of the underlying disease. One patient developed angioimmunoblastic lymphadenopathy after autologous stem cell transplantation and died of S. pneumoniae pneumonia. Another died of encephalitis caused by an unknown pathogen, and the third patient died of pneumonitis related to total body irradiation. Ketterer et al (3Ketterer N. Espinousse D. Chomarat M. et al.Infections following peripheral blood progenitor cell transplantation for lymphoprolipherative malignancies etiology and potential risk factors.Am J Med. 1999; 106: 191-197Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar) reported a lower incidence of late infectious complications than we did. This is consistent with their findings that a diagnosis of multiple myeloma and total body irradiation are associated with an increased risk of late infections. Pneumonia and bacteremia occurred more than 2 years after transplant, whereas all VZV infections developed within 12 months after transplant (Table 1). Table 1Late Infectious Complications in Relation to Time IntervalslegendTime intervals: 1 = 30–100 days posttransplant; 2 = 100–365 days posttransplant; 3 = ≥1 year posttransplant; x = patients affected; S.p = infections caused by Streptococcus pneumoniae.Patient NumberVaricella zosterPneumoniaBacteremia1231231231xxx S.p2x3x S.p4xx5x6x S.pxxx S.p78x9xx S.px1011xxxxxx S.p1213xx S.p1415x16legend Time intervals: 1 = 30–100 days posttransplant; 2 = 100–365 days posttransplant; 3 = ≥1 year posttransplant; x = patients affected; S.p = infections caused by Streptococcus pneumoniae. Open table in a new tab In our patients, age, type of high-dose treatment, or time to T and B cell reconstitution were not associated with a risk of developing infectious complications after autologous stem cell transplantation. The addition of total body irradiation to melphalan in patients who receive tandem autografts does not lead to increased complete remission rates. Instead, the survival of patients receiving total body irradiation as part of the conditioning therapy is inferior to that of patients treated with melphalan alone (4Desikan K.R. Tricot G. Dhodapkar M. et al.Melphalan plus total body irradiation (MEL-total body irradiation) or cyclophosphamide (MEL-CY) as a conditioning regimen with second autotransplant in responding patients with myeloma is inferior compared to historical controls receiving tandem transplants with melphalan alone.Bone Marrow Transplant. 2000; 25: 483-487Crossref PubMed Scopus (53) Google Scholar). At our hospital, responding patients under the age of 60 with multiple myeloma receive melphalan 200 mg/m2 as the preparative regimen for first and second autologous stem cell transplantation. Treatment with single and tandem autologous stem cell transplantation predisposes patients to viral and bacterial infections for a long time. We believe that a nontotal body irradiation preparative regimen is to be preferred, and patients should receive long-term anti-viral prophylaxis as well as pneumococcal vaccination. Gammaglobulin administration should be considered for certain patients." @default.
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• W2024807652 title "Late infections after blood progenitor cell transplantation in patients with multiple myeloma" @default.
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