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1.
PLoS One ; 15(11): e0241778, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33147257

RESUMEN

BACKGROUND: Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. METHODS: Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. RESULTS: The incidence of NF among the groups was reduced (64%, 44%, and 24%; P<0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI >2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age ≥60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05). CONCLUSIONS: G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial.


Asunto(s)
Corticoesteroides/uso terapéutico , Fiebre/prevención & control , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Mieloma Múltiple/terapia , Readmisión del Paciente/estadística & datos numéricos , Trasplante de Células Madre , Adulto , Factores de Edad , Anciano , Antineoplásicos Alquilantes/uso terapéutico , Femenino , Fiebre/epidemiología , Humanos , Incidencia , Masculino , Melfalán/uso terapéutico , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/mortalidad , Oportunidad Relativa , Supervivencia sin Progresión , Factores de Riesgo , Trasplante de Células Madre/efectos adversos , Trasplante Autólogo
2.
Leuk Lymphoma ; 61(7): 1565-1574, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32208787

RESUMEN

Despite the use of fluoroquinolone (FQ) prophylaxis, neutropenic fever (NF) is the most frequent cause of hospital readmission in ambulatory care programs for patients treated with autologous stem cell transplantation (ASCT). We analyzed the impact of intensifying primary prophylaxis with the addition of piperacillin/tazobactam (PT) to FQ. Between January 2002 and August 2018, 154 lymphoma patients conditioned with BEAM were included (40% received ceftriaxone (Ct) plus FQ and 60% PT plus FQ). NF and hospital readmission were required in 84 vs. 41% (p < .0001) and 12 vs. 1% (p = .007) of patients within the Ct and PT groups, respectively. The multivariate analysis showed that PT plus FQ retained its independent protective factor for NF (odds ratio (OR): 0.13; p < .001) and for hospital readmission (OR: 0.07; p = .01). The use of PT and FQ prophylaxis may effectively prevent episodes of NF and hospitalizations in lymphoma patients managed in our at-home ASCT care model.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Linfoma , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Linfoma/tratamiento farmacológico , Trasplante Autólogo
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