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Hou LQ, Liu JR, Gu JL, Chen ML, Kuang LF, Huang BH, Zou WY, Li J. Efficacy of prophylactic antibiotics for the prevention of neutropenic fever in patients with multiple myeloma receiving high-dose cyclophosphamide for stem cell mobilization. Ann Hematol 2024; 103:1601-1611. [PMID: 38267561 PMCID: PMC11009761 DOI: 10.1007/s00277-023-05537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 01/26/2024]
Abstract
High-dose cyclophosphamide (HD-Cy) (3 g/m2) plus granulocyte colony-stimulating factor (G-CSF) is a very effective regimen for peripheral blood stem cell (PBSC) mobilization. Unfortunately, it is associated with an increased risk of neutropenic fever (NF). We analyzed the effect of NF on PBSC apheresis results and the efficacy of prophylactic antibiotics for the prevention of NF associated with HD-Cy plus G-CSF for PBSC mobilization in patients with newly diagnosed multiple myeloma (MM). First, patients were divided into NF ( +) and NF ( -) groups according to whether they suffered from NF during mobilization. Second, we divided patients into an antibiotic prophylaxis group and a nonantibiotic prophylaxis group according to whether antibiotic prophylaxis was used during the mobilization period. Our study showed that NF( +) patients (n = 44) had lower CD34 + cell dose collection (median 2.60 versus 5.34 × 106/kg, P < 0.001) and slower neutrophil engraftment and platelet engraftment (median 11 versus 10 days, P = 0.002, and median 13 versus 11 days, P = 0.043, respectively) than NF( -) patients (n = 234). Of note, the nonantibiotic prophylaxis group patients (n = 30) had a 26.7% incidence of NF. In the patients receiving antibiotic prophylaxis (n = 227), the incidence was reduced to 9.3% (P = 0.01). The antibiotic prophylaxis patients had higher CD34 + cell collection (median 5.41 versus 2.27 × 106/kg, P < 0.001) and lower hospitalization cost of mobilization ($ median 3108.02 versus 3702.39, p = 0.012). Thus, our results demonstrate that NF is associated with lower CD34 + cell collection and that antibiotic prophylaxis can reduce the incidence of NF and improve stem cell mobilization and collection outcomes, which reduces the hospitalization cost of mobilization.
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Affiliation(s)
- Li-Qiong Hou
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Jun-Ru Liu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Jing-Li Gu
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Mei-Lan Chen
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Li-Fen Kuang
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Bei-Hui Huang
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Wai-Yi Zou
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Second Zhongshan Road, Guangzhou, 510080, China.
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Yazal Erdem A, Özyörük D, Ok Bozkaya İ, Çakmakcı S, Emir S, Demir HA, Özgüner HM, Ergürhan İlhan İ, Özbek NY. Autologous peripheral blood stem cell mobilization and apheresis in pediatric patients with cancer: A single-center report of 64 procedures. Pediatr Transplant 2024; 28:e14751. [PMID: 38659194 DOI: 10.1111/petr.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The published experience concerning autologous peripheral blood stem cell collection in children is very limited. METHODS The data of pediatric patients who underwent autologous stem cell mobilization and apheresis between January 2011 and April 2020 were analyzed retrospectively. RESULTS We studied retrospectively 64 mobilization and apheresis procedures in 48 pediatric patients (34 males, 14 females), mean age of 7.31 ± 5.38 (range, 1.5-19.7) years, the underlying disease was mostly neuroblastoma (NBL). The body weight of 21 patients (43.75%) was 15 kg or less. The targeted autologous peripheral stem cell apheresis (APSCA) was successfully achieved in 98% of patients. Neuroblastoma patients were younger than the rest of the patients and underwent apheresis after receiving fewer chemotherapy cycles than others and all of them mobilized within the first session successfully. Plerixafor was added to mobilization in nine heavily pretreated patients (18.7%), median two doses (range, 1-4 doses). 11 patients (22.9%) underwent radiotherapy (RT) before mobilization with doses of median 24 Gy (range, 10.8-54.0 Gy). Patients with RT were older at the time of apheresis and had received more chemotherapy courses than patients without RT. As a result, patients with a history of RT had significantly lower peripheral CD34+ cells and CD34+ yields than those without RT. In 17 patients (35.4%), 22 different complications were noted. The most common complications were catheter-related infections (n:10, 20.8%), followed by catheter-related thrombosis in eight patients (16.7%). CONCLUSIONS Patients who had far less therapy before apheresis were more likely to mobilize successfully. Our study provides a detailed practice approach including complications during APSCA aiming to increase the success rates of apheresis in transplantation centers.
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Affiliation(s)
- Arzu Yazal Erdem
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Derya Özyörük
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Selma Çakmakcı
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Suna Emir
- Department of Pediatrics, Atılım University Faculty of Medicine, Ankara, Turkey
| | - Hacı Ahmet Demir
- Department of Pediatric Hematology and Oncology, Memorial Private Hospital, Ankara, Turkey
| | - Habibe Meltem Özgüner
- Department of Histology and Embriology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - İnci Ergürhan İlhan
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology and Oncology, Ankara Bilkent City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Kobayashi T, Otake S, Mori T, Hasegawa D, Kosaka Y, Ohkusu K, Kasai M. A pediatric case of Gordonia otitidis bacteremia detected by long-term blood culture. J Infect Chemother 2022; 28:1427-1429. [PMID: 35724915 DOI: 10.1016/j.jiac.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
For immunocompromised patients receiving chemotherapy or bone mallow transplantation, slow-growing bacteria should also be considered one of the pathogenic microorganisms. However, there is no evidence pertaining to the microbiological tests associated with a patient with febrile neutropenia before peripheral blood stem cell harvest (PBSCH). We report a case of a 4-year-old cancer-bearing female presenting with a catheter-related bloodstream infection due to Gordonia otitidis. We detected G. otitidis from long-term blood cultures for approximately 6 days and prevented iatrogenic bacteremia by identifying the same organism from the culture of the PBSC sample and postponing the scheduled PBSCH. If febrile neutropenia occurs before PBSCH, we should collect multiple sets of blood cultures and culture them for a longer period.
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Affiliation(s)
- Takao Kobayashi
- Division of Infectious Diseases, Department of Pediatrics, Kobe Children's Hospital, Hyogo, Japan
| | - Shogo Otake
- Division of Infectious Diseases, Department of Pediatrics, Kobe Children's Hospital, Hyogo, Japan.
| | - Takeshi Mori
- Department of Hematology and Oncology, Children's Cancer Center, Kobe Children's Hospital, Hyogo, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Children's Cancer Center, Kobe Children's Hospital, Hyogo, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Children's Cancer Center, Kobe Children's Hospital, Hyogo, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Hyogo, Japan
| | - Masashi Kasai
- Division of Infectious Diseases, Department of Pediatrics, Kobe Children's Hospital, Hyogo, Japan
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Yang C, Dehghani M, Hopman W, Bhella S. Are we choosing mobilization regimens for autologous stem cell transplantation in multiple myeloma wisely: A single center comparison of GCSF+/-plerixafor vs cyclophosphamide/GCSF+/-plerixafor. J Clin Apher 2022; 37:348-353. [PMID: 35218068 DOI: 10.1002/jca.21976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) is a standard consolidation treatment for eligible patients with multiple myeloma (MM). There is no standardized mobilization regimen for collection of CD34+ stem cells, which is crucial to the success of ASCT. Cyclophosphamide/GCSF is an effective regimen, although reported associated toxicities include risk of febrile neutropenia (FN). Since plerixafor was introduced in Canada, this mobilization agent has been increasingly used as needed with GCSF at Kingston Health Science Centre (KHSC), with elimination of cyclophosphamide. This single center, retrospective, quality improvement study evaluates mobilization and ASCT outcomes of MM patients who had undergone stem cell mobilization at KHSC with cyclophosphamide/GCSF+/-plerixafor without antibiotics, cyclophosphamide/GCSF+/-plerixafor with antibiotics, and GCSF+/-plerixafor without antibiotics. METHODS A retrospective chart review was conducted evaluating 137 patients. The primary outcome measure was FN rates with mobilization. Balancing measures include CD34+ cell collected, plerixafor usage, days of apheresis and transplant outcomes. Chi-square, ANOVA, or Kruskal-Wallis methods were used to test statistical significance where appropriate. RESULTS Our study noted a higher total and day one CD34+ count in the two groups utilizing cyclophosphamide in mobilization. All nine cases of FN occurred in these two groups (P < .05). Addition of antibiotics decreased, but did not eliminate risk of FN. There were no significant differences in the rate of plerixafor usage and number of apheresis days. Difference in transplant outcomes, including engraftment and transfusion support, were statistically but not clinically significant. A larger sample size may be needed to explore this fully. There was no significant difference in length of transplant hospital stay. CONCLUSION The elimination of cyclophosphamide from mobilization regimens for MM appears to significantly reduce FN rates, without increasing balancing measures such as total number of apheresis days, plerixafor usage, duration of transplant hospitalization or mortality outcomes.
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Affiliation(s)
- Chloe Yang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mina Dehghani
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sita Bhella
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Basci S, Bozan E, Yaman S, Ulu B, Bakırtaş M, Yiğenoğlu T, Kılınç A, Özcan N, Dal M, Çakar M, Altuntaş F. Is neutropenic fever an obstacle to effective stem cell harvesting? Asian J Transfus Sci 2022. [DOI: 10.4103/ajts.ajts_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ebisawa K, Honda A, Chiba A, Masamoto Y, Okazaki H, Kurokawa M. High D-index during mobilization predicts poor mobilization of CD34+ cells after anti-lymphoma salvage chemotherapy. J Clin Apher 2021; 37:4-12. [PMID: 34687244 DOI: 10.1002/jca.21943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/10/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Performing stem cell collection after mobilization chemotherapy was a well-balanced strategy between anti-tumor effect and efficient collection of CD34+ cells, but deep and prolonged nadir exposed patients to risk of febrile neutropenia. Febrile neutropenia was known to be associated with lower yields of CD34+ cells, but quantitative data referring to association between yields of CD34+ cells and severity of neutropenia was lacking. We hypothesized that D-index, which was developed for quantitative evaluation of severity of neutropenia especially in the field of hematologic malignancies, could predict yields of CD34+ cells. METHODS We performed a single center, retrospective analysis of patients with relapsed or refractory aggressive lymphoma who were mobilized with ESHAP or modified ESHAP. We evaluated the association between yields of CD34+ cells at first apheresis and D-index. RESULTS Thirty-six patients were included, and we demonstrated that yields of CD34+ cells from patients with higher D-index were significantly lower than those from patients with lower D-index. Multivariate linear regression analysis and logistic regression analysis also demonstrated the significant predictive power of D-index. Further, D-index was significantly correlated to platelet count before starting mobilization chemotherapy. Platelet count was known to predict yields of CD34+ cells, and combination of platelet count and D-index could identify patients with lowest CD34+ yields. CONCLUSION D-index could predict yields of CD34+ cells and it seemed that its predictive power was not less than that of platelet count. Prospective studies including more heterogeneous patients were needed to validate our study.
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Affiliation(s)
- Kazutoshi Ebisawa
- Department of Hematology & Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Blood Transfusion, The University of Tokyo Hospital, Tokyo, Japan
| | - Akira Honda
- Department of Hematology & Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Chiba
- Department of Hematology & Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Blood Transfusion, The University of Tokyo Hospital, Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology & Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Okazaki
- Department of Blood Transfusion, The University of Tokyo Hospital, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology & Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan
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7
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Topcuoglu P, Ozcan M. Neutropenic fever and stem cell mobilization. J Clin Apher 2019; 34:517-518. [PMID: 30779434 DOI: 10.1002/jca.21688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/18/2018] [Accepted: 01/28/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Pervin Topcuoglu
- Faculty of Medicine, Department of Hematology, Stem Cell Transplantation Unit, Ankara University, Ankara, Turkey
| | - Muhit Ozcan
- Faculty of Medicine, Department of Hematology, Stem Cell Transplantation Unit, Ankara University, Ankara, Turkey
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