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Title: The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever
Author: Rodríguez Lobato, Luis Gerardo
Martínez Roca, Alexandra
Castaño Díez, Sandra
Palomino Mosquera, Alicia
Gutiérrez García, Gonzalo
Pedraza, Alexandra
Suárez-Lledó, María
Rovira, Montserrat
Martínez, Carmen
Fernández de Larrea Rodríguez, Carlos José
Cibeira, María Teresa
Rosiñol Dachs, Laura
Lozano Garcia, Ester
Marín, Pedro
Cid, Joan
Lozano, Miquel
Moreno-Castaño, Ana Belén
Palomo, Marta
Diaz Ricart, M. Isabel
Gallego, Cristina
Hernando, Adelina
Segura, Susana
Carreras, Enric
Urbano Ispizua, Álvaro
Bladé, J. (Joan)
Fernández Avilés, Francesc
Keywords: Febre
Mieloma múltiple
Multiple myeloma
Issue Date: 4-Nov-2020
Publisher: Public Library of Science (PLoS)
Abstract: Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. The incidence of NF among the groups was reduced (64%, 44%, and 24%; P<0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI >2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age �60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05. G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial.
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It is part of: PLoS One, 2020, vol. 15, num. 11, p. e0241778
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ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (Biologia Cel·lular, Fisiologia i Immunologia)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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