Multiple Myeloma Coverage from Every Angle

Bacteremia After Autologous Stem Cell Transplantation in Multiple Myeloma

By: Andrew Goldstein
Posted: Friday, March 8, 2019

Patients with multiple myeloma who received autologous stem cell transplantation (ASCT) experienced a high incidence of Enterococcus faecium bacteremia. This bacteremia was associated with significantly higher morbidity and mortality, according to a study published by Meera Mohan, MD, FACP, of the Myeloma Institute, Little Rock, Arkansas, and colleagues, in Transplant Infectious Diseases.

During the retrospective study, 363 ASCTs were performed in 282 patients. Of these transplant recipients, 13% developed bacteremia. Patients with bacteremia had a significantly higher duration of neutropenia than those who did not have bacteremia. Bacteremia was also associated with a highly significant increase in C-reactive protein levels.

Among patients who underwent ASCT within the first year ofmyeloma diagnosis, the 6-month overall survival was similar between patients who did and did not have bacteremia. For those who underwent ASCT after the first year of diagnosis, overall survival decreased for those with bacteremia, but the decrease did not reach statistical significance.

Enterococcus spp were responsible for 19 episodes of bacteremia. The enterococcal bacteremia cohort had a longer hospitalization than the nonbacteremia cohort (61.7 days vs. 20.4 days). Enterococcal bacteremia was also associated with a higher mortality than other bacteremias, with mortality rates of 69% and 25%, respectively.Enterococcal bacteremia was associated with an overall survival of 53.3% at 6 months. Of note, just four patients who developed enterococcal bacteremia had ASCT during the first year of myeloma treatment.

Based on these findings, Dr. Mohan and colleagues recommended that antimicrobial prophylaxis practices, vancomycin-resistant enterococcus screenings, and empiric antimicrobial therapy be regularly reassessed as the local antimicrobial resistance data change. The researchers also noted, “While the effect of underlying disease status and cumulative chemotherapy on morbidity and mortality is clinically intuitive, we feel that this is often overlooked while analyzing infection rates in patients with cancer.”

Disclosure: The study authors reported no conflicts of interest.

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