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Microbiologically documented infections in patients undergoing high‐dose melphalan and autologous stem cell transplantation for the treatment of light chain amyloidosis
Author(s) -
Taimur S.,
Nader C.,
LloydTravaglini C.,
Seldin D.C.,
Sanchorawala V.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12037
Subject(s) - medicine , melphalan , autologous stem cell transplantation , mucositis , al amyloidosis , transplantation , gastroenterology , odds ratio , hypogammaglobulinemia , creatinine , neutropenia , amyloidosis , surgery , immunology , chemotherapy , antibody , immunoglobulin light chain
Abstract Background Immunoglobulin light chain ( AL ) amyloidosis can be treated with high‐dose melphalan and autologous stem cell transplantation ( HDM / SCT ). Risk factors for infections may include hyposplenism, hypogammaglobulinemia, treatment‐related neutropenia, melphalan‐induced mucositis, and nosocomial exposures. Methods and design A review of 493 patients with AL amyloidosis undergoing treatment with HDM / SCT from A ugust 1994 to A ugust 2009 was performed. The objectives were to determine the rate and types of infections following HDM / SCT , to identify factors associated with microbiologically documented infections, and to assess the contribution of infections to all‐cause treatment‐related mortality ( TRM ; defined as deaths within 100 days of SCT ). Results Microbiologically documented infections after HDM / SCT occurred in 24% ( n = 119) of patients. TRM was 10% ( n = 48) overall, and 21% ( n = 25) in patients who had a documented infection. Thus, the relative risk of TRM in a patient with a documented infection was 3.42 (95% confidence interval [CI] 2.02–5.79). Infections were caused by gram‐positive bacteria in 51%, anaerobic bacteria in 16%, gram‐negative bacteria in 13%, and fungi in 9% of cases. Serum creatinine >2 mg/dL was associated with increased risk of post‐ SCT infection (38% vs. 21%, P = 0.0007) with an odds ratio of 2.27 (95% CI 1.40–3.68). No significant association for infection was found for age, gender, cardiac involvement, prior steroid therapy, dose of melphalan, multiorgan involvement, days to neutrophil engraftment, or dose of CD 34 + cells infused. Conclusion Serum creatinine >2 mg/dL is a risk factor for infections in patients with AL amyloidosis undergoing HDM / SCT . The relative risk of TRM in a patient with a documented infection was increased >3‐fold. A broad spectrum of infections, similar to that in other SCT patients, is seen in this population in the early post‐ SCT period.