MULTİPL MİYELOMDA OTOLOG KÖK HÜCRE TRANSPLANTASYONUNUN ERKEN DÖNEMİNDE ENFEKSİYON OLAYLARI

Year 2024, , 246 - 252, 19.07.2024

Shirkhan Amikishiyev , Sevgi Kalayoğlu Beşışık , İpek Yonal Hindilerden , Mustafa Nuri Yenerel , Arif Atahan Çagatay , Simge Erdem , Gülkan Özkan , Meliha Nalçacı

https://doi.org/10.26650/IUITFD.1414927

Abstract

Amaç: Multipl miyelom (MM) hastalarında enfeksiyon gelişme riski yüksektir. Bu çalışmada, otolog hematopoetik kök hücre nakli (OHKHN) yapılan MM hastalarında enfeksiyon olayları derlemiştir.
Gereç ve Yöntem: İndüksiyon rejimi ardından OHKHN uygula nan MM hastaları çalışmaya dahil edilmiştir. Rutin antimikrobiyal profilaksi uygulanmamıştır. Enfeksiyon tedavileri febril nötropeni kılavuzlarına paralel yapılmıştır.
Bulgular: Mayıs 2007 ve Kasım 2016 tarihleri arasında toplam 150 MM hastasına OHKHN uygulandı. Ortanca yaş 51,7±7,2 yıl ve erkek/kadın oranı 84/66 idi. Hastaların neredeyse tama mında ateş gelişti. HKHN gününden ilk ateş atağına kadar geçen süre ortanca 7,4±2,8 gündü. Ateşle en sık ilişkili en feksiyonlar pnömoni ve orofarengeal kandidiyazis idi. Kan ve idrar kültürü pozitifliği sırasıyla %18,6 ve %20 olarak bulundu. Nötropeni süresi kültür pozitifliği ile ilişkili değildi, ancak iki tip indüksiyon rejimi alan hastalarda nötropeninin daha uzun sürdüğü görüldü (8,4±3,7 vs, 7,4±2,3 gün, p=0,056). İlk 100 günde mortalite oranı %0,6 olup diğer deneyimli merkezlerin sonuçlarına benzerdi.
Sonuç: Çalışmamız, indüksiyon rejiminin kemoterapi kombinas yonları ile yapıldığı ve yeni ajanların kemoterapi refrakterliğin den sonra veya yanıt kalitesinde iyileşme için kullanıldığı dönemi kapsamaktadır. Bununla bağlantılı olarak, hastaların çoğu ikinci basamak indüksiyon almıştır. Buna rağmen, hastalar çok düşük erken mortalite oranı ile kabul edilebilir bir sonuç göstermiştir.

Keywords

Multipl miyelom, otolog hematopoietik kök hücre nakli, enfeksiyon, febril nötropeni

INFECTION EVENTS IN MULTIPLE MYELOMA DURING THE EARLY PERIOD OF AUTOLOGOUS STEM CELL TRANSPLANTATION

Abstract

Objective: Multiple myeloma (MM) patients have a high risk of developing infections. In this study, we documented the infec tion events in patients with MM who underwent autologous hae matopoietic stem cell transplantation (AHSCT).
Material and Method: Patients who received an induction regi men and underwent AHSCT were enrolled in the study. Routine antimicrobial prophylaxis was not given. Infection treatment was performed in accordance with the febrile neutropenia guidelines.
Result: Between May 2007 and November 2016, 150 patients with MM underwent AHSCT. The median age was 51.7±7.2 years, and the male-to-female ratio was 84/66. Nearly all patients developed fever. The median time from the HSCT day to the first fever episode was 7.4±2.8 days. Pneumonia and oropharyngeal candidiasis were frequently associated with fever. Blood and urine culture positivity was 18.6% and 20%, respectively. The neutropenia duration was not associated with culture positivity but proved to be longer in patients who had received two types of induction regimen (8.4±3.7 vs. 7.4±2.3 days, p=0.056). The mortality rate in the first 100 days was 0.6%, which was similar to the results of other experienced centers.
Conclusion: Our study encompassed the period when the in duction regimen included combinations of chemotherapy, and novel agents were used after chemotherapy refractoriness or for improvement in response quality. In relation to this, most patients received second-line induction therapy. The infection events were manageable, and patients showed acceptable out comes and a very low early mortality rate.

Keywords

Multiple myeloma, autologous haematopoietic stem cell transplantation, infection, febrile neutropenia

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