Article

Iron overload is a major risk factor for severe infection after autologous stem cell transplantation: A study of 367 myeloma patients

Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Bone Marrow Transplantation (Impact Factor: 3.47). 06/2006; 37(9):857-64. DOI: 10.1038/sj.bmt.1705340
Source: PubMed

ABSTRACT 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)/microl). 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 1,000 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 micro/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.

0 Followers
 · 
102 Views
 · 
0 Downloads
  • Source
    • "j.transci.2012.08.003 associated with iron overload (IO) in patients with hematological malignancies [7] [8] [9]. In recent reports, a similar association was found between invasive fungal infections and iron overload in allogeneic bone marrow recipients [10] [11]. Thus, given that post-transplant pulmonary complications are associated with high rates of morbidity and mortality, predicting the predisposing factors is explored as the potential basis for preventive treatment strategies. "
  • Source
    • "c o m / l o c a t e / t r a n s c i associated with iron overload (IO) in patients with hematological malignancies [7] [8] [9]. In recent reports, a similar association was found between invasive fungal infections and iron overload in allogeneic bone marrow recipients [10] [11]. Thus, given that post-transplant pulmonary complications are associated with high rates of morbidity and mortality, predicting the predisposing factors is explored as the potential basis for preventive treatment strategies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Invasive fungal pneumonia (IFP) has become increasingly common in patients that previously underwent alloHSCT. The aim of this study was to determine the role of hyperferritinemia, via iron overload in invasive fungal pneumonia in patients that underwent alloHSCT. Medical records of 73 patients with pneumonia that underwent alloHSCT were studied retrospectively, whereby a pre-transplantation serum ferritin level measured up to 100days prior to transplantation of patients with invasive fungal pneumonia (IFP) and non-fungal pneumonia (non-IFP) was compared. Patient records revealed 35 and 38 cases of IFP and non-IFP, respectively. In risk evaluation for IFP, age, gender, HLA status, conditioning regimen, smoking history, and underlying disease were not significantly different among groups (p>0.05). However, performance status (Karnofsky) was significantly lower in patients with IFP (p<0.05). The median ferritin levels were 1705ng/ml (41-7198) in the IFP group and 845ng/ml (18-7099) in non-IFP group and the difference was found statistically significant (p=0.001). Elevated pretransplant serum ferritin level is associated with IFP in patients that underwent alloHSCT, in particular when values exceed 1550ng/ml.
    Transfusion and Apheresis Science 09/2012; 48(1). DOI:10.1016/j.transci.2012.08.003 · 1.07 Impact Factor
  • Source
    • "Moreover, AIDS patients (Hage et al. 2002) or individuals with other acquired immunodeficiency conditions (Pappas 2010), intensive care patients (Smith and Kaufmann 2010), preterm neonates (Kaufman 2007), and patients undergoing long-term corticosteroid therapy (Lionakis and Kontoyiannis 2003) also carry a high risk of IFD. In addition to the state of immunosuppression, long-term exposure to broad spectrum antibiotic therapy, high-dose anticancer chemotherapy, long presence of indwelling catheters, and biological factors such as iron overload and patient age (Erjavec et al. 2009; Miceli et al. 2006) have also been shown to increase the risk of developing IFD. Furthermore, the recently recognized genetic factors predisposing to IFD, such as impaired NADPH oxidase activity (Segal and Romani 2009), disturbed production of tumor necrosis factor-α or interleukin-10 (Sainz et al. 2007a, b), and genetic polymorphisms in Toll-like receptors that result in deficient production of some inflammatory cytokines (Bochud et al. 2008), represent conditions constituting a group of vulnerable patients at high risk for IFD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although invasive fungal diseases (IFDs) are relatively rare, they have become an increasingly common life-threatening complication in a variety of critically ill patients. Due to changes in treatment strategies, patterns of IFDs have changed substantially as well. Yeast infections have shifted toward a higher proportion of non-albicans Candida species, but their overall incidence has remained stable. In contrast, IFDs caused by molds, including particularly various species of Aspergillus, Fusarium, and Mucorales, have increased in number. In view of the growing incidence and the high mortality rates of IFDs, accurate diagnostic techniques permitting timely onset of adequate antifungal treatment are of paramount importance. Although conventional approaches such as microscopy, cultivation, histopathological examination, and imaging methods still represent the gold standard, the diagnosis remains difficult because of limited sensitivity and specificity. Noninvasive and culture-independent diagnostic techniques, including fungal antigen detection, and different molecular-based techniques are becoming increasingly important. Of the fungal surrogate markers such as cell wall components, galactomannan and (1,3)-β-D-glucan by commercially available diagnostic kits have become widely used, but the results are still controversial. A plethora of PCR-based diagnostic methods targeting different gene regions and exploiting a variety of amplicon detection tools have been published. Molecular assays have the capacity to overcome the limitations of other diagnostic approaches, but the current lack of methodological standardization and validation, together with not always clear interpretation of the results, has prevented broad application in the clinical setting.
    Folia Microbiologica 05/2012; 57(5):421-30. DOI:10.1007/s12223-012-0152-3 · 1.15 Impact Factor
Show more

Preview

Download
0 Downloads
Available from