| ironjustice@aol.com 2006-03-22, 3:41 pm |
| Iron overload is a major risk factor for severe infection after
autologous stem cell transplantation: a study of 367 myeloma patients.
Miceli MH, Dong L, Grazziutti ML, Fassas A, Thertulien R, Van Rhee F,
Barlogie B, Anaissie EJ
Bone Marrow Transplant. 2006 Mar 13;
We evaluated the risk factors for infection of 367 consecutive myeloma
patients who underwent high-dose melphalan and autologous stem cell
transplantation (ASCT). Examination of bone marrow iron stores (BMIS)
prior to ASCT was used to evaluate body iron stores. Other variables
included age, sex, active smoking, myeloma remission status, severity
of mucositis and duration of severe neutropenia post-ASCT (<100
absolute neutrophils counts (ANC)/mul). Median age was 56 years; 61% of
patients were males. 140 episodes of severe infections occurred in 116
patients, including bacteremia (73), pneumonia (40), severe colitis
(25) and bacteremia with septic shock (two). The infection incidence
per 1000 days at risk was 45.2. Pre-ASCT risk factors for severe
infection by univariate analysis were increased BMIS (OR=2.686; 95% CI
1.707-4.226; P<0.0001), smoking (OR=1.565; 95% CI 1.005-2.437;
P=0.0474) and male gender (OR=1.624; 95% CI 1.019-2.589; P=0.0414).
Increased BMIS (OR=2.716; 95% CI 1.720-4.287; P<0.0001) and smoking
(OR=1.714; 95% CI 1.081-2.718; P=0.022) remained significant by
multivariate analysis. Duration of ANC <100 mu/l (OR=1.129; 95% CI
1.039-1.226; P=0.0069 and OR=1.127; 95% CI 1.038-1.224; P=0.0045 by
both univariate and multivariate analysis, respectively) was the only
post-ASCT risk factor for infection. Increased pre-transplant BMIS and
smoking are significant predictors of severe infection after
myeloablative chemotherapy followed by ASCT in myeloma patients.Bone
Marrow Transplantation advance online publication, 13 March 2006;
doi:10.1038/sj.bmt.1705340.
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