The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever.

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  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science
    • Subject Terms:
      Stem Cell Transplantation*/adverse effects; Adrenal Cortex Hormones/*therapeutic use ; Fever/*prevention & control ; Granulocyte Colony-Stimulating Factor/*therapeutic use ; Multiple Myeloma/*therapy ; Patient Readmission/*statistics & numerical data; Adult ; Age Factors ; Aged ; Antineoplastic Agents, Alkylating/therapeutic use ; Female ; Fever/epidemiology ; Humans ; Incidence ; Male ; Melphalan/therapeutic use ; Middle Aged ; Multiple Myeloma/drug therapy ; Multiple Myeloma/mortality ; Odds Ratio ; Progression-Free Survival ; Risk Factors ; Transplantation, Autologous
    • Abstract:
      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.
      Competing Interests: The authors have declared that no competing interests exist.
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    • Accession Number:
      0 (Adrenal Cortex Hormones)
      0 (Antineoplastic Agents, Alkylating)
      143011-72-7 (Granulocyte Colony-Stimulating Factor)
      Q41OR9510P (Melphalan)
    • Publication Date:
      Date Created: 20201104 Date Completed: 20201224 Latest Revision: 20240330
    • Publication Date:
      20250114
    • Accession Number:
      PMC7641449
    • Accession Number:
      10.1371/journal.pone.0241778
    • Accession Number:
      33147257