Miceli M H, Dong L, Grazziutti M L, Fassas A, Thertulien R, Van Rhee F, Barlogie B, Anaissie E J
Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Bone Marrow Transplant. 2006 May;37(9):857-64. doi: 10.1038/sj.bmt.1705340.
We evaluated the risk factors for infection of 367 consecutive myeloma patients who underwent high-dose melphalan and autologous stem cell transplantation (ASCT). Examination of bone marrow iron stores (BMIS) prior to ASCT was used to evaluate body iron stores. Other variables included age, sex, active smoking, myeloma remission status, severity of mucositis and duration of severe neutropenia post-ASCT (<100 absolute neutrophils counts (ANC)/microl). Median age was 56 years; 61% of patients were males. 140 episodes of severe infections occurred in 116 patients, including bacteremia (73), pneumonia (40), severe colitis (25) and bacteremia with septic shock (two). The infection incidence per 1,000 days at risk was 45.2. Pre-ASCT risk factors for severe infection by univariate analysis were increased BMIS (OR=2.686; 95% CI 1.707-4.226; P<0.0001), smoking (OR=1.565; 95% CI 1.005-2.437; P=0.0474) and male gender (OR=1.624; 95% CI 1.019-2.589; P=0.0414). Increased BMIS (OR=2.716; 95% CI 1.720-4.287; P<0.0001) and smoking (OR=1.714; 95% CI 1.081-2.718; P=0.022) remained significant by multivariate analysis. Duration of ANC <100 micro/l (OR=1.129; 95% CI 1.039-1.226; P=0.0069 and OR=1.127; 95% CI 1.038-1.224; P=0.0045 by both univariate and multivariate analysis, respectively) was the only post-ASCT risk factor for infection. Increased pre-transplant BMIS and smoking are significant predictors of severe infection after myeloablative chemotherapy followed by ASCT in myeloma patients.
我们评估了367例连续接受大剂量美法仑和自体干细胞移植（ASCT）的骨髓瘤患者的感染风险因素。在ASCT前检测骨髓铁储备（BMIS）以评估机体铁储备。其他变量包括年龄、性别、当前吸烟状况、骨髓瘤缓解状态、黏膜炎严重程度以及ASCT后严重中性粒细胞减少的持续时间（绝对中性粒细胞计数（ANC）<100/微升）。中位年龄为56岁；61%的患者为男性。116例患者发生了140次严重感染，包括菌血症（73例）、肺炎（40例）、严重结肠炎（25例）和伴有感染性休克的菌血症（2例）。每1000天的感染风险发生率为45.2。单因素分析显示，ASCT前严重感染的风险因素包括BMIS增加（OR = 2.686；95%CI 1.707 - 4.226；P < 0.0001）、吸烟（OR = 1.565；95%CI 1.005 - 2.437；P = 0.0474）和男性（OR = 1.624；95%CI 1.019 - 2.589；P = 0.0414）。多因素分析显示，BMIS增加（OR = 2.716；95%CI 1.720 - 4.287；P < 0.0001）和吸烟（OR = 1.714；95%CI 1.081 - 2.718；P = 0.022）仍然具有显著性。ANC<100微升的持续时间（单因素分析OR = 1.129；95%CI 1.039 - 1.226；P = 0.0069，多因素分析OR = 1.127；95%CI 1.038 - 1.224；P = 0.0045）是ASCT后唯一的感染风险因素。移植前BMIS增加和吸烟是骨髓瘤患者接受清髓性化疗后进行ASCT后严重感染的重要预测因素。
