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Merino A, Shanley R, Rashid F, Langer J, Dolan M, Tu S, Jurdi NE, Rogosheske J, Hanna K, DeFor T, Janakiram M, Weisdorf D. Impact of melphalan day -1 vs day -2 on outcomes after autologous stem cell transplant for multiple myeloma. Front Immunol 2024; 15:1310752. [PMID: 38504993 PMCID: PMC10948501 DOI: 10.3389/fimmu.2024.1310752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024] Open
Abstract
Background Melphalan is the most common conditioning regimen used prior to autologous stem cell transplant (ASCT); however, there are varying data on optimal melphalan timing prior to transplant for best safety and efficacy. Historically, ASCT conditioning consisted of melphalan 200 mg/m2 on day 2 (D-2) (48 h prior to ASCT), but many institutions have since adopted a melphalan protocol with administration on day 1 (D-1) (24 h prior to SCT) or split dosing over the 2 days. The optimal timing of melphalan has yet to be determined. Methods In this single-center retrospective study, we analyzed transplant outcomes for patients between March 2011 and September 2020 admitted for high-dose, single-agent melphalan 200 mg/m2 on D-1 vs. D-2. The primary outcomes were time to neutrophil and platelet engraftment. Secondary outcomes include incidence of hospital readmission within 30 days, 2-year progression-free survival, and 2-year overall survival. Results A total of 366 patients were studied (D-2 n = 269 and D-1 n = 97). The incidence of high-risk cytogenetics was similar between the two groups (37% vs. 40%). Median days to absolute neutrophil count engraftment was similar at 11 days in the D-2 and D-1 cohort (n = 269, range 0-14, IQR 11-11 vs. n = 97, range 0-14, IQR 11-12). Median days to platelet engraftment >20,000/mcL was 18 days for D-2 melphalan (range: 0-28, IQR 17-20) versus 19 days for D-1 melphalan (range: 0-32, IQR 17-21). Overall survival at 2 years post-transplant was similar in both cohorts (94%; p = 0.76), and PFS was 70% in D-2 compared with 78% in D-1 (p = 0.15). In a multivariable model including age and performance status, hospital readmission within 30 days of transplant was higher in the D-1 cohort (odds ratio 1.9; p = 0.01). Conclusion This study demonstrates similar neutrophil and platelet engraftment in D-1 and D-2 melphalan cohorts with similar 2-year PFS and OS. Either D-2 or D-1 melphalan dosing schedule is safe and effective.
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Affiliation(s)
- Aimee Merino
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Ryan Shanley
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Faridullah Rashid
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jenna Langer
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Michelle Dolan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Tu
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Najla El Jurdi
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - John Rogosheske
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Kirollos Hanna
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Todd DeFor
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | | | - Daniel Weisdorf
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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Watson AN, Shah SA, Shalhoub SD, Piedra KM, Komanduri KV, Kwon D, Pereira DL. Melphalan on day -1 versus day -2 in patients with plasma cell disorders undergoing autologous stem cell transplant. J Oncol Pharm Pract 2023; 29:1398-1403. [PMID: 36245321 DOI: 10.1177/10781552221125871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-dose melphalan-based autologous stem cell transplant (ASCT) remains a standard of care for plasma cell disorders (PCDs). Currently, there is variability in the literature surrounding the timing of melphalan administration to avoid potential cytotoxic effects, although the administration has been safely proposed when given at least 8 hours prior to stem cell infusion. The objectives of this study were to assess differences in safety and efficacy outcomes between day -1 and day -2 single-dose melphalan administration in patients undergoing ASCT for PCDs. A retrospective chart review was performed at our institution comparing patients receiving melphalan on day -1 to an equal number of patients receiving melphalan on day -2. The primary endpoint was time to neutrophil engraftment from stem cell infusion. Univariate analyses were performed. Mean time to neutrophil engraftment from stem cell infusion was identical at 10.7 days for both cohorts (p = 0.88). Mean time to platelet engraftment from stem cell infusion was shorter with day -1 administration (17.4 vs. 18.6 days, p = 0.06). Mean time to neutrophil and platelet engraftment from melphalan infusion were significantly shorter with day -1 administration. Similar outcomes were observed for length of hospitalization, infection- and mucositis-related toxicities, hematologic response, transplant-related mortality, and overall survival. Our findings show no difference in time to neutrophil engraftment from stem cell infusion and a trend toward shorter time to platelet engraftment with day -1 administration. Based on our study, day -1 melphalan administration is an acceptable and safe practice.
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Affiliation(s)
- Aleksandra N Watson
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Shreya A Shah
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Sila D Shalhoub
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Katrina M Piedra
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Krishna V Komanduri
- Division of Transplantation and Cellular Therapy, Department of Medicine and Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
| | - Deukwoo Kwon
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Denise L Pereira
- Division of Transplantation and Cellular Therapy, Department of Medicine and Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL, USA
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Nesr G, Shah R, Kyriakou C, Sive J, Popat R, Yong K, Wisniowski B, Xu K, Wechalekar A, Lee L, Ings S, Papanikolaou X, Mahmood S, Mcmillan A, Horder J, Newrick F, Marfil J, Ainley L, Asher S, Cheesman S, Rabin N. Impact of timing of stem cell return following high dose melphalan in multiple myeloma patients with renal impairment: a single center experience. Leuk Lymphoma 2023; 64:1465-1471. [PMID: 37259553 DOI: 10.1080/10428194.2023.2216817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/19/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
High dose melphalan (HDM) followed by autologous stem cell transplantation (ASCT) remains the standard consolidation in transplant eligible multiple myeloma (MM) patients. The timing between HDM administration and hematopoietic stem cell return (HSCR) varies among institutions, with a 'rest period' of 48 hours (h) employed by some for patients with renal impairment (RI). We investigated the differences in hematopoietic recovery and HDM toxicity between MM patients with RI who had HSCR after 24 vs 48 h from HDM. Fifty MM patients with RI (48 h group; n = 31 and 24 h group; n = 19) were included. No statistically significant differences were noted in surrogates for hematopoietic recovery and HDM toxicity between both groups. Only one death occurred in the 24 h group. No patients required renal replacement therapy. Therefore, a 24 h period between HDM and AHSC infusion appears safe for MM patients with RI.
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Affiliation(s)
- George Nesr
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Raakhee Shah
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Charalampia Kyriakou
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jonathan Sive
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rakesh Popat
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kwee Yong
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brendan Wisniowski
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ke Xu
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashu Wechalekar
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lydia Lee
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stuart Ings
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Xenofon Papanikolaou
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Shameem Mahmood
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Annabel Mcmillan
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jackie Horder
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Fiona Newrick
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jotham Marfil
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise Ainley
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Samir Asher
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Simon Cheesman
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Neil Rabin
- Haematology Department, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Banday SZ, Guru F, Ayub M, Ahmed SN, Banday AZ, Mir MH, Nisar R, Hussain S, Bhat GM, Aziz SA. Long-Term Outcomes of Autologous Hematopoietic Stem Cell Transplant (HSCT) for Multiple Myeloma: While New Horizons Emerge, It Is Still Only a Silver Lining for Resource-Constrained Settings. Cureus 2023; 15:e36642. [PMID: 37155458 PMCID: PMC10122934 DOI: 10.7759/cureus.36642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/10/2023] Open
Abstract
Background Significant hurdles impede the optimal implementation of hematopoietic stem cell transplantation (HSCT) in low-middle income countries (LMICs). Herein, we highlight the challenges faced in LMICs while performing HSCT and report the long-term outcomes of patients with newly diagnosed multiple myeloma (MM) who underwent autologous HSCT (AHSCT) at our center. Besides, we provide a comprehensive review of studies reporting long-term outcomes of AHSCT in MM from the Indian subcontinent. Methodology This study was conducted at the State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Case records of all patients with MM who received AHSCT from December 2010 to July 2018 were reviewed retrospectively. A non-systematic literature search was performed using PubMed and Google Scholar databases. Data regarding clinicopathological parameters and long-term follow-up were extracted from relevant studies and for patients included in our study. Results At our center, 47 patients (median age 52.0 years) with MM underwent AHSCT. Majority of patients had stage III disease (ISS) and median time to transplant was 11.5 months. The five-year progression free survival (PFS) and overall survival (OS) were 59.1% and 81.2%, respectively. Studies from the Indian subcontinent have observed a five-year OS of ~50% to ~85%. However, a greater variability in the five-year PFS has been reported, ranging from ~20% to ~75%. The median time to transplant has ranged from seven to 17 months (indicating time delays) with median CD34 cell counts of 2.7-6.3×106 cells/kg (lower than developed countries). Conclusions Despite significant resource limitations in LMICs, AHSCT is increasingly been performed in MM with encouraging long-term outcomes.
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Affiliation(s)
- Saquib Z Banday
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Faisal Guru
- Department of Medical Oncology, Pediatrics Unit, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Maniza Ayub
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Syed N Ahmed
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Aaqib Z Banday
- Department of Pediatrics, Government Medical College, Srinagar, IND
| | - Mohmad H Mir
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Rahila Nisar
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Saleem Hussain
- Department of Laboratory Hematology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Gull M Bhat
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
| | - Sheikh A Aziz
- Department of Medical Oncology, State Cancer Institute, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, IND
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Shuman K, Palmer S, Anders B, Moore D, Ptachcinski J, Grgic T, Alexander M, Hill L, Sung AD, Armistead PM, Kennedy L, Shaw JR. Correlation of Engraftment and Time from Melphalan Administration to Stem Cell Infusion. Transplant Cell Ther 2023; 29:36.e1-36.e5. [PMID: 36404519 DOI: 10.1016/j.jtct.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Single-agent, high-dose melphalan continues to be the most commonly used conditioning regimen for transplantation-eligible patients with multiple myeloma undergoing autologous stem cell transplantation. The timing of melphalan administration with respect to stem cell infusion has not been clearly defined. Many institutions require a minimum of 24 hours between melphalan administration and stem cell infusion; however, some institutions have adopted shorter intervals based on melphalan's short half-life. Some studies have suggested that shortening the interval between melphalan administration and stem cell infusion may contribute to delays in engraftment, but this correlation has not been clearly evaluated or defined. This multicenter retrospective cohort study evaluated the times to neutrophil and platelet engraftment in patients who received stem cells at least 24 hours after melphalan (≥24 hours cohort) compared with those who received stem cells within 24 hours of melphalan (<24 hours cohort. The study included a total of 723 adult patients, 502 patients in the ≥24 hours cohort and 221 in the <24 hours cohort, treated at 3 transplantation centers between January 1, 2016, and September 30, 2019. Patient characteristics were summarized using descriptive statistics. The Fisher exact test was used to compare nominal categorical variables between the 2 cohorts, and the nonparametric van der Waerden test or Mood median test was used to compare ordinal or continuous variables. The median time to neutrophil engraftment was 12 days for both the ≥24 hours cohort (interquartile range [IQR], 11 to 12 days) and the <24 hours cohort (IQR, 11 to 13 days) (P = .07). The median time to platelet engraftment was 19 days for both the ≥24 hours cohort (IQR, 17 to 22 days) and <24 hours cohort (IQR, 17 to 20 days) (P = .25). The median time between melphalan administration and stem cell infusion in the <24 hours cohort was 18 hours, with a minimum time of 12 hours. The existing literature has not clearly defined the impact of the timing between melphalan administration and stem cell infusion on engraftment in autologous transplantation. The ability to safely shorten the interval between chemotherapy and transplantation could increase logistical flexibility and/or decrease the length of hospital stay. This large multicenter retrospective study did not identify a statistical or clinical impact on engraftment when melphalan was infused <24 hours or ≥24 hours before autologous stem cell infusion.
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Affiliation(s)
- Kaci Shuman
- Huntsville Hospital, Department of Pharmacy, Huntsville, Alabama
| | - Shannon Palmer
- Oregon Health & Science University, Department of Pharmacy, Portland, Oregon
| | - Brandi Anders
- Atrium Health Wake Forest Baptist, Department of Pharmacy, Winston-Salem, North Carolina
| | - Dominic Moore
- University of North Carolina Health, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Jonathan Ptachcinski
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina
| | - Tatjana Grgic
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina
| | - Maurice Alexander
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina
| | - Lauren Hill
- Duke University Health System, Division of Hematologic Malignancies and Cellular Therapy, Durham, North Carolina
| | - Anthony D Sung
- Duke University Health System, Division of Hematologic Malignancies and Cellular Therapy, Durham, North Carolina
| | - Paul M Armistead
- University of North Carolina Health, Division of Hematology; Program in Bone Marrow Transplant and Cellular Therapy, Chapel Hill, North Carolina
| | - LeAnne Kennedy
- Atrium Health Wake Forest Baptist, Department of Pharmacy, Winston-Salem, North Carolina
| | - J Ryan Shaw
- University of North Carolina Health, Department of Pharmacy, Chapel Hill, North Carolina.
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Pahwa R, Chhabra J, Kumar R, Narang R. Melphalan: Recent insights on synthetic, analytical and medicinal aspects. Eur J Med Chem 2022; 238:114494. [DOI: 10.1016/j.ejmech.2022.114494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022]
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Differences in engraftment with day-1 compared with day-2 melphalan prior to stem cell infusion in myeloma patients receiving autologous stem cell transplant. Bone Marrow Transplant 2020; 55:2132-2137. [PMID: 32358546 DOI: 10.1038/s41409-020-0916-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022]
Abstract
We conducted a retrospective study comparing posttransplant outcomes between myeloma patients receiving conditioning melphalan on day-2 vs day-1 for autologous stem cell transplant. Between January 2017 and December 2018, 201 patients received melphalan on day-2 and 166 on day-1 prior to stem cell infusion. Baseline disease and clinical characteristics between the two groups were similar. Although rates of hospitalization were similar between the cohorts, duration of hospital admission was longer for day-1 (median 7 days for day-1 vs 5 days for day-2, p = 0.003). Rates of fever were higher in the day-1 cohort (69% vs 49%, p = 0.0002). Time to platelet and neutrophil engraftment was significantly longer in the day-1 cohort (platelet engraftment median days 17 for day-1 vs 15 for day-2, p < 0.0001, neutrophil engraftment median days 16 for day-1 vs 16 for day-2, p = 0.025). Overall response rate was similar between the cohorts (99% for day-1, vs 100% for day-2). Day-2 melphalan infusions should be considered in preference for day-1 protocols, given the clinically significant delay in platelet and neutrophil engraftment and longer duration of hospitalization with day-1 infusions.
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Fauer AJ, Choi SW, Friese CR. The Roles of Nurses in Hematopoietic Cell Transplantation for the Treatment of Leukemia in Older Adults. Semin Oncol Nurs 2019; 35:150960. [PMID: 31753706 PMCID: PMC7150366 DOI: 10.1016/j.soncn.2019.150960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To review and summarize nurses' roles in the care of the older adult undergoing an allogeneic hematopoietic cell transplant (HCT) for the treatment of leukemia. DATA SOURCES Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION Nurses are a vital component of the highly specialized care delivered before, during, and after an allogeneic HCT. IMPLICATIONS FOR NURSING PRACTICE Nurses who are prepared for the complex HCT care trajectory will be able to optimally meet the complex needs of the older adult patient and their caregiver(s).
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Affiliation(s)
- Alex J Fauer
- University of Michigan, School of Nursing, Ann Arbor, MI; University of Michigan, Rogel Cancer Center, Ann Arbor, MI.
| | - Sung Won Choi
- University of Michigan, Department of Pediatrics, Ann Arbor, MI; University of Michigan, Rogel Cancer Center, Ann Arbor, MI
| | - Christopher R Friese
- University of Michigan, School of Nursing, Ann Arbor, MI; University of Michigan, Rogel Cancer Center, Ann Arbor, MI; University of Michigan, School of Public Health, Ann Arbor, MI
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Sivik JM, Davidson J, Hale CM, Drabick JJ, Talamo G. Addition of doxycycline to ciprofloxacin for infection prophylaxis during autologous stem cell transplants for multiple myeloma. Support Care Cancer 2018; 26:3055-3061. [PMID: 29564621 DOI: 10.1007/s00520-018-4165-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The most commonly used antibacterial prophylaxis during autologous stem cell transplants (ASCT) for multiple myeloma (MM) involves a fluoroquinolone, such as ciprofloxacin or levofloxacin. We assessed the impact of adding doxycycline to ciprofloxacin as routine antibacterial prophylaxis in these patients. METHODS We retrospectively reviewed electronic medical records and our ASCT database to analyze rates and types of bacterial infections in MM patients who underwent ASCT in our institution. RESULTS Among 419 patients, 118 received ciprofloxacin alone (cipro group), and 301 ciprofloxacin and doxycycline (cipro-doxy group). Neutropenic fever (NF) developed in 63 (53%) and 108 (36%) patients of the cipro and cipro-doxy groups, respectively (p = 0.010). The number of documented bacteremic episodes was 13 (11%) and 14 (4.7%) in the two groups, respectively (p = 0.017). Antimicrobial resistance and Clostridium difficile infections were uncommon. Transplant-related mortality was 1% in both groups. CONCLUSIONS The addition of doxycycline to standard prophylaxis with ciprofloxacin seems to reduce the number of NF episodes and documented bacterial infections in patients with MM undergoing ASCT, without increasing rate of serious complications.
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Affiliation(s)
- J M Sivik
- Department of Pharmacy, Penn State Health-M.S. Hershey Medical Center, Hershey, PA, USA.
| | - J Davidson
- Department of Medicine, Hematology/Oncology Division, Penn State College of Medicine, Hershey, PA, USA
| | - C M Hale
- Department of Pharmacy, Penn State Health-M.S. Hershey Medical Center, Hershey, PA, USA
| | - J J Drabick
- Department of Medicine, Hematology/Oncology Division, Penn State College of Medicine, Hershey, PA, USA
| | - G Talamo
- Department of Medicine, Hematology/Oncology Division, Penn State College of Medicine, Hershey, PA, USA
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Faiman B, Miceli T, Noonan K, Lilleby K. Clinical Updates in Blood and Marrow Transplantation in Multiple Myeloma. Clin J Oncol Nurs 2013; 17 Suppl:33-41. [DOI: 10.1188/13.cjon.s2.33-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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