Park Hyunkyung, Youk Jeonghwan, Kim Hak Ro, Koh Youngil, Kwon Ji Hyun, Yoon Sung-Soo, Park Seonyang, Choe Pyoeng Gyun, Kim Nam Joong, Oh Myoung-Don, Park Wan Beom, Kim Inho
Division of Hematology/Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehag-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Int J Hematol. 2017 Dec;106(6):801-810. doi: 10.1007/s12185-017-2313-2. Epub 2017 Aug 20.
Infection is one of the main causes of early-treatment mortality in multiple myeloma (MM) patients during autologous stem cell transplantation (autoSCT). In the present study, we sought to determine the incidence of, and risk factors for, infection during hospital stays after autoSCT. We retrospectively evaluated 324 autoSCT events that occurred in 285 MM patients between 2006 and 2015, and reviewed the clinical characteristics of patients and history of infections. Sixty-eight infection events occurred, including bacteremia (24), other bacterial infections (7), as well as infections caused by Cytomegalovirus (17), Herpes simplex virus (12), Varicella zoster virus (3), Aspergillus (3) and Pneumocystis jiroveci (2). There was no significant difference in number of infections in the 2006-2010 and 2011-2015 periods (P = 0.194). Risk factors for bacteremia included higher beta-2 microglobulin levels at diagnosis [≥3.5 mg/L; adjusted odds ratio (aOR) 3.544 (95% CI 1.070-11.736), P = 0.038] and previous bortezomib treatment [aOR 4.270 (95% CI 1.389-13.125), P = 0.011]. In-hospital mortality occurred in 1.2% of all cases and all were infection-related. In conclusion, infection was the main cause of in-hospital mortality in patients who underwent autoSCT. Bacteremia was the most common type of microbiologically confirmed infection, and was associated with higher beta-2 microglobulin levels and previous bortezomib treatment.
感染是多发性骨髓瘤（MM）患者在自体干细胞移植（autoSCT）期间早期治疗死亡的主要原因之一。在本研究中，我们试图确定autoSCT后住院期间感染的发生率及危险因素。我们回顾性评估了2006年至2015年间285例MM患者发生的324次autoSCT事件，并审查了患者的临床特征和感染史。发生了68次感染事件，包括菌血症（24例）、其他细菌感染（7例），以及由巨细胞病毒（17例）、单纯疱疹病毒（12例）、水痘带状疱疹病毒（3例）、曲霉菌（3例）和耶氏肺孢子菌（2例）引起的感染。2006 - 2010年和2011 - 2015年期间的感染次数无显著差异（P = 0.194）。菌血症的危险因素包括诊断时较高的β2微球蛋白水平[≥3.5 mg/L；调整后的优势比（aOR）3.544（95%置信区间1.070 - 11.736），P = 0.038]和既往硼替佐米治疗[aOR 4.270（95%置信区间1.389 - 13.125），P = 0.011]。所有病例中有1.2%发生院内死亡，且均与感染相关。总之，感染是接受autoSCT患者院内死亡的主要原因。菌血症是微生物学确诊感染中最常见的类型，且与较高的β2微球蛋白水平和既往硼替佐米治疗相关。
