Antibacterial Prophylaxis Reduces the Incidence of Neutropenic Fever and the Rate of Infections in Patients with Multiple Myeloma Who Undergo An Autologous Stem Cell Transplantation.

Evangelos Eleutherakis-Papaiakovou*,1, Evangelos Kostis*,1, Dimitrios Christoulas*,1, Magdalini Migkou*,1, Maria Gavriatopoulou*,1, Maria Roussou*,1, Despina Mparmparoussi*,1, Charis Matsouka*,1, Efstathios Manios*,1, Eleni Efstathiou*,1, Efstathios

Author address: 

1 Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece, 2 Department of Clinical Therapeutics, Alexandra Hospital, University of Athens School of Medicine, Athens, 11528, Greece

Abstract: 

Poster Board III-222 High dose melphalan (HDM) with autologous stem cell transplantation (ASCT) is the standard of care for eligible patients with multiple myeloma (MM) aged up to 65 years. This procedure is accompanied by a high incidence of neutropenic fever and infections that represent a leading cause of morbidity in these patients. The aim of this study was to evaluate the impact of prophylactic antibiotic administration after ASCT on the rate of infections and neutropenic fever. As of June 2009, 126 MM patients who underwent ASCT in our institution were randomized to receive or not prophylactic antibiotics post-ASCT. The prophylactic antibiotic regimen included IV vancomycin at a dose of 1000 mg once daily and ciprofloxacin at a dose of 500 mg, PO, twice daily. The administration of prophylactic antibiotics was started on day 0 of ASCT and continued until resolution of neutropenia or until the occurrence of a febrile event. In addition, all patients, irrespective of randomization, received fluconazole 200 mg, PO, once daily, and valacyclovir 500 mg, PO, once daily. G-CSF was given to all patients until resolution of neutropenia. When temperature exceeded 38°C for more than 1 hour, peripheral blood and urine samples were collected for microbiologic cultures, a chest X-ray was performed and empirical antibiotic treatment with IV wide spectrum antibiotics including amikacin, ceftazidime and therapeutic dose of vancomycin was started. This empirical therapy was later modified individually, according to cultures and sensitivity data. If patient remained febrile for 3-5 days after this initial treatment, a second-line regimen consisting of a carbapenem with a glycopeptide in the majority of cases was administered, until fever resolution. In the case of a proven or suspected fungal or viral infection, appropriate antifungal or antiviral therapy was administered. Sixty-nine (54%) patients were randomized to receive antibiotic prophylaxis. These patients had a significantly lower incidence of neutropenic fever post-ASCT compared to those who received only supportive care (58% versus 92%; p0.5x109/L: 9.6 versus 10.7, p25x109/L: 9.7 versus 11.8, p
2009

abstract No: 

3334

Full conference title: 

51st American Society of Haematologists Annual Meeting
    • ASH 51st (2009)