自体造血干细胞移植（AHCT）后感染是多发性骨髓瘤（MM）患者发生的重要疾病导致死亡的原因之一。在过去的十年里，MM治疗领域经历了快速进展和演变。关于来自发展中国家的MM患者进行AHCT后感染并发症的信息有限。我们进行了一项回顾性研究，以探索2010年至2019年期间我中心MM患者AHCT后感染的发生率、模式和临床结果。研究从病历中检索了与患者特异性、疾病特异性和移植特异性有关的详细信息。分析了感染并发症（部位、程度、病原体、治疗和结果）的特征。在2010年至2016年期间进行移植的所有患者都接受了左氧氟沙星抗生素预防。临床试验不良事件共同术语标准（CTCAE）（v5.0）用于感染和与方案相关的毒性分级。移植前和术后100天使用国际骨髓瘤工作组更新标准评估疾病反应。在研究期间，接受了新诊断的多发性骨髓瘤（NDMM）（n=85）、复发性多发性骨髓瘤（RRMM）（n=7）、浆细胞白血病（n=2）和多发性神经病、器官肥大、内分泌功能异常、单克隆球蛋白异常、皮肤异常（POEMS）综合征（n=1）的连续95例患者接受了AHCT。他们的中位年龄为55岁（范围：33-68岁），其中55.8%为男性。免疫球蛋白IgG kappa是最常见的单克隆蛋白（32.6%），国际分期系统III期疾病占45.3%，84.2%的患者在AHCT前达到超过非常好的部分缓解。从诊断到AHCT的中位时间为10个月（范围：4-144个月）。89例患者（93.7%）在AHCT后发热。无法确定病灶的发热、经微生物学证实的感染和临床怀疑的感染分别占患者人数的50.5%、37.9%和5.3%。发生8例（8.4%）克雷氏副梭菌相关腹泻。粒细胞和血小板移植均在中位数11天（范围：9-14天）和12天（范围：9-23天）后完成。住院时间中位数为16天（范围：9-29天）。仅有2例患者（2.1%）在AHCT后100天内因感染需要再入院。研究人群中移植相关死亡率（TRM）为4.2%（n=4）。左氧氟沙星预防组（n=32，33.7%）的粒细胞移植（第10天与第11天）和血小板移植（第11天与第12天）时间较早，但发热开始时间、发热持续时间、住院时间、TRM和术后100天再入院率与无左氧氟沙星预防组患者的差异无显著性。接受和不接受左氧氟沙星预防的患者感染谱之间没有显著差异。研究人群在5年内的总生存率和无进展生存率分别为72.7%和64.8%。本研究显示，来自中低收入国家的MM患者在AHCT后感染和TRM的发生率高于发达国家的患者。这类患者中的大多数缺乏感染的临床定位和微生物学证据。接受和不接受左氧氟沙星预防的患者的感染谱及其结局没有显著差异。 © 2023 Wiley Periodicals LLC.

Infections are a significant cause of morbidity and mortality after autologous hematopoietic cell transplantation (AHCT) in multiple myeloma (MM) patients. There has been a rapid advancement and evolution in MM treatment landscape in the last decade. There is limited information on post-AHCT infectious complications among MM patients with or without levofloxacin prophylaxis from developing countries.We performed a retrospective study to explore the incidence, pattern, and clinical outcome of infections following AHCT in MM patients from 2010 to 2019 at our center. Patient-specific, disease-specific, and transplant-specific details were retrieved from the case files. The characteristics of infectious complications (site, intensity, organism, treatment, and outcomes) were analyzed. All patients who underwent transplantation from 2010 to 2016 received levofloxacin antibiotic prophylaxis. Common terminology criteria for adverse events (CTCAE) criteria (v5.0) were used for the grading of infections and regimen-related toxicity. International Myeloma Working Group updated criteria were used for the assessment of disease response before transplant and at day +100.Ninety-five consecutive patients with newly diagnosed multiple myeloma (NDMM) (n = 85), RRMM (n = 7), plasma cell leukemia (n = 2), and Polyneuropathy, Orgaomegaly, Endocrinopathy, Monoclonal gammopathy, skin abnormalities (POEMS) syndrome (n = 1) underwent AHCT during the study period. Their median age was 55 years (range 33-68); 55.8% were males. Immunoglobulin IgG kappa was the most common monoclonal protein (32.6%), International Staging System stage III disease was present in 45.3%, and 84.2% of patients achieved more than very good partial response before AHCT. The median time from diagnosis to AHCT was 10 months (range 4-144). Eighty-nine patients (93.7%) developed fever after AHCT. Fever of unknown focus, microbiologically confirmed infections, and clinically suspected infections were found in 50.5%, 37.9%, and 5.3% of patients, respectively. Clostridiodes difficile-associated diarrhea was observed in eight patients (8.4%). Neutrophil and platelet engraftment occurred after a median of 11 days (range 9-14) and 12 days (range 9-23), respectively. The median duration of hospital stay was 16 days (range 9-29). Only two patients (2.1%) required readmission for infections within 100 days of AHCT. Transplant-related mortality (TRM) in the study population was 4.2% (n = 4). The levofloxacin prophylaxis group (n = 32, 33.7%) had earlier neutrophil engraftment (day +10 vs. day +11) and platelet engraftment (day +11 vs. day +12), but time to fever onset, duration of fever, hospital stay, TRM, and day +100 readmission rates were not significantly different from those of patients without levofloxacin prophylaxis. There was no significant difference in the spectrum of infections between patients with and without levofloxacin prophylaxis. The overall survival and progression-free survival of the study population at 5 years were 72.7% and 64.8%, respectively.This study shows that the incidence of infections and TRM are higher in MM patients from lower-middle income countries after AHCT than in those from developed countries. The majority of such patients lack clinical localization and microbiological proof of infection. There was no significant difference in the spectrum of infections and their outcomes in patients with and without levofloxacin prophylaxis.© 2023 Wiley Periodicals LLC.