Examining infection rates after stem cell transplantation

This study examined infection rates after autologous stem cell transplantation in multiple myeloma patients. 1.2% in-hospital deaths were recorded in this study. All were caused by an infection following the stem cell transplant. 

Autologous stem cell transplantation after high-dose chemotherapy has resulted in improved response rates and survival in multiple myeloma patients. This is when blood-forming cells destroyed by the cancer treatment are replaced with stem cells (immature cells) from the blood or bone marrow of the patient. Infection is one of the main causes of early-treatment mortality in multiple myeloma patients following a stem cell transplant. 

The aim of this study was to examine the risk factors associated with infection after stem cell transplantation.

The records of 285 multiple myeloma patients were analyzed. All patients underwent an autologous stem cell transplant. Antibiotics were administered before the transplant to help prevent infection. Infection rates and patient characteristics were recorded.

68 infections occurred. 31 of these were caused by bacterial infections. 37 infections were caused by a virus. Viruses included cytomegalovirus, herpes simplex virus, varicella zoster virus, aspergillus, and pneumocystis jiroveci. There were no significant differences in infection rates between patients treated between 2006 and 2010 and those treated between 2011 and 2015.

The average hospital stay was 19.9 days. 4 patients (1.2%) died during the hospital stay after undergoing a stem cell transplant. Of these, 3 were caused by a bacterial infection. 1 patient died due to a lung infection caused by the pneumocystis jiroveci virus.

Patients with higher beta2-microglobulin levels (a measure of tumor size and kidney function) at diagnosis were 3.5 times more likely to have a bacterial infection. Previous treatment with bortezomib (Velcade) increased the risk of a bacterial infection 4.3-fold. 

This study concluded that infection was the main cause of in-hospital mortality in patients who underwent a stem cell transplant. Higher beta-2 microglobulin levels and previous bortezomib treatment significantly increased the risk of infection.