Prophylactic intravenous immunoglobulin during autologous haemopoietic stem cell transplantation for multiple myeloma is not associated with reduced infectious complications
ABSTRACT Patients with multiple myeloma undergoing autologous haemopoietic stem cell transplantation (ASCT) are at high risk for infectious complications. Peri-transplant intravenous immunoglobulin (IVIG) has been used with the aim of reducing these risks. Our retrospective, non-randomised study of peri-transplant IVIG use and effect on infectious complications in 266 ASCTs for myeloma from 2000 to 2009 at a major metropolitan referral centre for haematological malignancies found no difference between those receiving peri-transplant IVIG (0.4 g/kg) (n=130) and those who were not (n=110) with regard to bloodstream infections, pneumonia, urinary tract or gastrointestinal infections. When analysed according to pre-transplant therapy (conventional chemotherapy versus novel agents), there was no significant difference in infectious complications between those who did or did not receive peri-transplant IVIG. In conclusion, our study did not show a benefit for the use of peri-transplant IVIG (0.4 g/kg) to reduce infectious complications in a large cohort of patients with myeloma undergoing ASCT. In the absence of data supporting efficacy in this context, there appears to be no benefit in the routine use of IVIG for this purpose.
- Disease-a-month: DM 04/2012; 58(4):239-49. DOI:10.1016/j.disamonth.2012.01.001 · 0.54 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The process of hematopoietic stem cell transplantation (HSCT) is well defined, yet debate remains surrounding the role and timing of HSCT in patients with multiple myeloma (MM). Since the 1980s, survival advances have been made with the use of newer agents by recognizing the role of transplantation, identifying the anticipated side effects at each phase, and improving supportive care strategies. Data support transplantation as part of the treatment strategy, but the optimal induction regimen and timing of transplantation have yet to be defined. The general consensus is that eligible patients should undergo autologous HSCT at some point in the treatment spectrum, preferably earlier rather than later in the disease. Allogeneic transplantation is only recommended in the context of a clinical trial and in patients with high-risk disease. The transplantation process can be overwhelming for patients and caregivers. Nurses play a key role in improving outcomes by caring for patients and families throughout the transplantation experience and, therefore, need to be knowledgeable about the process. This article is intended to expand discussion on the role of nurses in assisting patients and families undergoing transplantation to include an overview of the acute care phase of the transplantation process.Clinical Journal of Oncology Nursing 12/2013; 17:33-41. DOI:10.1188/13.CJON.S2.33-41
- [Show abstract] [Hide abstract]
ABSTRACT: Plasma cell myeloma (PCM) is increasing in prevalence in older age groups and infective complications are a leading cause of mortality. Patients with PCM are at increased risk of severe infections, having deficits in many arms of the immune system due to disease and treatment-related factors. Treatment of PCM has evolved over time with significant impacts on immune function resulting in changing rates and pattern of infection. Recently, there has been a paradigm shift in the treatment of PCM with the use of immunomodulatory drugs and proteasome inhibitors becoming the standard of care. These drugs have wide-ranging effects on the immune system but their impact on infection risk and aetiology remain unclear. The aims of this review are to discuss the impact of patient, disease and treatment factors on immune function over time for patients with PCM and to correlate immune deficits with the incidence and aetiology of infections seen clinically in patients with PCM. Preventative measures and the need for clinically relevant tools to enable infective profiling of patients with PCM are discussed.Blood reviews 03/2014; 28. DOI:10.1016/j.blre.2014.01.004 · 5.45 Impact Factor