Higher Rate of Infections After AHCT for Multiple Myeloma Seen in India

In a population of patients in India with multiple myeloma (MM) treated using autologous hematopoietic cell transplantation (AHCT), infections and transplant-related mortality (TRM) appeared to show higher incidence than in countries with established transplant programs. This is according to the results of a new study published in the journal Transplant Infectious Disease.

This was a retrospective analysis of patients with MM who received AHCT at a hospital in Chandigarh, India, from 2010 to 2019. The study investigators evaluated incidence, patterns, and clinical outcomes of infections after AHCT in these patients. They also evaluated various patient-related, disease-related, and transplant-related factors.

The study included 95 patients who underwent AHCT, most of whom (89.5%) had newly diagnosed MM. Patients had a median age of 55 years (range, 33-68), and the majority (84.2%) had reached a very good partial response or better prior to AHCT. Levofloxacin prophylaxis had been given to 33.7% of patients.

The median follow-up occurred at 28 months (range, 3-111). The 5-year overall survival rate in this population was 72.7%, and the 5-year progression-free survival rate was 64.8%.

During hospitalization, 93.7% of patients developed fever. The fever was of unknown focus in 50.5% of patients, while microbiologically confirmed infections were reported in 37.9% of patients, and 5.3% of patients had clinically suspected infections. Diarrhea related to Clostridium difficile infection was found in 8.4% of patients and with a median onset of 6 days (range, 3-12).

The median time to neutrophil engraftment was 11 days (range, 9-14), and the median time to platelet engraftment was 12 days (range, 9-23). Patients had a median duration of hospital stay after AHCT of 16 days (range, 9-29). After hospital discharge, 24.2% of patients developed infections during the first 100 days, with 2 patients (2.1%) being readmitted for infectious complications.

The rate of TRM within the first 100 days after AHCT was 4.2%. The investigators noted that this rate of TRM is comparable to other reports from within India but higher than what has been reported in countries that have established transplant programs.

Compared with the overall population, the median time to neutrophil engraftment was 1 day earlier for patients who received levofloxacin prophylaxis, as was the median time to platelet engraftment.

However, the median time to fever onset, total fever duration, length of hospital stay, TRM rate, and readmission rate by day +100 were not significantly different for patients receiving levofloxacin prophylaxis, compared with rates for patients not receiving levofloxacin prophylaxis. Types of infections also were not significantly different between these 2 patient subgroups.

Overall, the investigators found that febrile neutropenia and documented infections occurred at higher rates after AHCT in this population of patients with MM in India, compared with rates observed in countries that have established transplant programs. “Although the infections were manageable with broad-spectrum antibiotics in majority of patients, there is a need to adopt more stringent infection-control practices to reduce the incidence of post-AHCT infections,” they wrote in their report.

Reference

Jandial A, Lad D, Jain A, et al. Characteristics and outcome of infectious complications after autologous hematopoietic cell transplantation in multiple myeloma patients. Transpl Infect Dis. Published online August 12, 2023. doi:10.1111/tid.14123

This article originally appeared on Hematology Advisor