ANTIBACTERIAL PROPHYLAXIS REDUCES THE RISK OF BACTEREMIA IN PATIENTS WITH MULTIPLE MYELOMA AND LYMPHOMA UNDERGOING HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STEM CELL TRANSPLANTATION
(Abstract release date: 05/19/16)
EHA Library. Vaxman I. 06/09/16; 133087; E1538
Dr. Iuliana Vaxman
Contributions
Contributions
Abstract
Abstract: E1538
Type: Eposter Presentation
Background
Bacterial infections are a major cause of morbidity and mortality in patients undergoing autologous stem cell transplantation (ASCT). However, whether these patients benefit from antibacterial prophylaxis is unclear. The few studies which addressed this issue are limited by small sample size or the use of multiple anti-microbial agents. Current guidelines recommend considering the use of antibacterial prophylaxis in patients with anticipated neutropenia of 7 days or more. At our center, patients undergoing ASCT were given ciprofloxacin for antibacterial prophylaxis until 2012. This change in policy provides a unique opportunity to study the potential benefit of antibacterial prophylaxis in ASCT.
Aims
To explore the efficacy and adverse effects of ciprofloxacin prophylaxis in patients undergoing ASCT.
Methods
This is a single center retrospective study. Data were collected from the medical records of all patients with a diagnosis of non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma (MM) who underwent ASCT at Rabin Medical Center between 03/2007 and 12/2015. Until 10/2012 all patients were given oral ciprofloxacin 500 mg BID starting concomitantly with the conditioning regimen (BEAM for lymphoma and melphalan for multiple myeloma) until the first febrile episode or until engraftment. After 10/2012, our treatment policy has changed and we stopped using antibacterial prophylaxis in the ASCT setting.
Results
Between 03/2007 and 12/2015 303 patients received 327 high dose chemotherapy followed by ASCT. The median age at time of transplant was 55 years (range: 16 to 72) and 186 patients (57%) were males. The diagnosis was MM in 174 patients (46%), NHL in 110 patients (34%) and HD in 43 patients (13%). 154 consecutive patients were given ciprofloxacin prophylaxis and 171 patients were not given ciprofloxacin prophylaxis before and after 10/2012, respectively. Overall, 10% (n=32) of the patients had a bacteremia, 16% (n=27) in the group of patients who did not receive prophylaxis, compared to only 3% (n=5) in the group of patients who received prophylaxis (P<.0001). The rates of febrile neutropenia were 84% (N = 129) in patients who received prophylaxis compared to 91% (155) in patients who did not receive antibacterial prophylaxis (P = 0.06). The number needed to treat (NNT) in order to prevent one episode of bacteremia is 4.9. The frequency of all other infections, the duration of hospitalization, and the rates of all cause and infection-related mortality were not significantly different between groups. Of note, ciprofloxacin prophylaxis was not associated with an increased in bacterial resistance.Patients with lymphoma were younger (median 53 years, range: 19-72) than patients with MM (median 58, range: 33-68) but similar in all other demographic characteristics. The median duration of aplasia was 6 days (range: 4 to 13) in patients with MM after high-dose melphalan and 8 days (range 5 to 14) in patients with lymphoma after BEAM (p<0.0001). However, both groups seemed to equally benefit from antibacterial prophylaxis. In a multivariable analysis ciprofolxacin prophylaxis significantly decreased the odds of bacteremia (Odds Ratio: 0.19 (Confidence interval: 0.07 to 0.52)). Age, diagnosis, and the duration of aplasia were not associated with the risk of bacteremia
Conclusion
Ciprofloxacin prophylaxis markedly reduced the risk of bacteremia and neutropenic fever in lymphoma and MM patients undergoing ASCT without increasing the incidence of resistant bacterial strains in patients receiving ciprofloxacin prophylaxis. The NNT in order to prevent one episode of bacteremia is 4.9, suggesting that antibacterial prophylaxis should be considered in ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Neutropenia, Prophylaxis
Type: Eposter Presentation
Background
Bacterial infections are a major cause of morbidity and mortality in patients undergoing autologous stem cell transplantation (ASCT). However, whether these patients benefit from antibacterial prophylaxis is unclear. The few studies which addressed this issue are limited by small sample size or the use of multiple anti-microbial agents. Current guidelines recommend considering the use of antibacterial prophylaxis in patients with anticipated neutropenia of 7 days or more. At our center, patients undergoing ASCT were given ciprofloxacin for antibacterial prophylaxis until 2012. This change in policy provides a unique opportunity to study the potential benefit of antibacterial prophylaxis in ASCT.
Aims
To explore the efficacy and adverse effects of ciprofloxacin prophylaxis in patients undergoing ASCT.
Methods
This is a single center retrospective study. Data were collected from the medical records of all patients with a diagnosis of non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma (MM) who underwent ASCT at Rabin Medical Center between 03/2007 and 12/2015. Until 10/2012 all patients were given oral ciprofloxacin 500 mg BID starting concomitantly with the conditioning regimen (BEAM for lymphoma and melphalan for multiple myeloma) until the first febrile episode or until engraftment. After 10/2012, our treatment policy has changed and we stopped using antibacterial prophylaxis in the ASCT setting.
Results
Between 03/2007 and 12/2015 303 patients received 327 high dose chemotherapy followed by ASCT. The median age at time of transplant was 55 years (range: 16 to 72) and 186 patients (57%) were males. The diagnosis was MM in 174 patients (46%), NHL in 110 patients (34%) and HD in 43 patients (13%). 154 consecutive patients were given ciprofloxacin prophylaxis and 171 patients were not given ciprofloxacin prophylaxis before and after 10/2012, respectively. Overall, 10% (n=32) of the patients had a bacteremia, 16% (n=27) in the group of patients who did not receive prophylaxis, compared to only 3% (n=5) in the group of patients who received prophylaxis (P<.0001). The rates of febrile neutropenia were 84% (N = 129) in patients who received prophylaxis compared to 91% (155) in patients who did not receive antibacterial prophylaxis (P = 0.06). The number needed to treat (NNT) in order to prevent one episode of bacteremia is 4.9. The frequency of all other infections, the duration of hospitalization, and the rates of all cause and infection-related mortality were not significantly different between groups. Of note, ciprofloxacin prophylaxis was not associated with an increased in bacterial resistance.Patients with lymphoma were younger (median 53 years, range: 19-72) than patients with MM (median 58, range: 33-68) but similar in all other demographic characteristics. The median duration of aplasia was 6 days (range: 4 to 13) in patients with MM after high-dose melphalan and 8 days (range 5 to 14) in patients with lymphoma after BEAM (p<0.0001). However, both groups seemed to equally benefit from antibacterial prophylaxis. In a multivariable analysis ciprofolxacin prophylaxis significantly decreased the odds of bacteremia (Odds Ratio: 0.19 (Confidence interval: 0.07 to 0.52)). Age, diagnosis, and the duration of aplasia were not associated with the risk of bacteremia
Conclusion
Ciprofloxacin prophylaxis markedly reduced the risk of bacteremia and neutropenic fever in lymphoma and MM patients undergoing ASCT without increasing the incidence of resistant bacterial strains in patients receiving ciprofloxacin prophylaxis. The NNT in order to prevent one episode of bacteremia is 4.9, suggesting that antibacterial prophylaxis should be considered in ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Neutropenia, Prophylaxis
Abstract: E1538
Type: Eposter Presentation
Background
Bacterial infections are a major cause of morbidity and mortality in patients undergoing autologous stem cell transplantation (ASCT). However, whether these patients benefit from antibacterial prophylaxis is unclear. The few studies which addressed this issue are limited by small sample size or the use of multiple anti-microbial agents. Current guidelines recommend considering the use of antibacterial prophylaxis in patients with anticipated neutropenia of 7 days or more. At our center, patients undergoing ASCT were given ciprofloxacin for antibacterial prophylaxis until 2012. This change in policy provides a unique opportunity to study the potential benefit of antibacterial prophylaxis in ASCT.
Aims
To explore the efficacy and adverse effects of ciprofloxacin prophylaxis in patients undergoing ASCT.
Methods
This is a single center retrospective study. Data were collected from the medical records of all patients with a diagnosis of non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma (MM) who underwent ASCT at Rabin Medical Center between 03/2007 and 12/2015. Until 10/2012 all patients were given oral ciprofloxacin 500 mg BID starting concomitantly with the conditioning regimen (BEAM for lymphoma and melphalan for multiple myeloma) until the first febrile episode or until engraftment. After 10/2012, our treatment policy has changed and we stopped using antibacterial prophylaxis in the ASCT setting.
Results
Between 03/2007 and 12/2015 303 patients received 327 high dose chemotherapy followed by ASCT. The median age at time of transplant was 55 years (range: 16 to 72) and 186 patients (57%) were males. The diagnosis was MM in 174 patients (46%), NHL in 110 patients (34%) and HD in 43 patients (13%). 154 consecutive patients were given ciprofloxacin prophylaxis and 171 patients were not given ciprofloxacin prophylaxis before and after 10/2012, respectively. Overall, 10% (n=32) of the patients had a bacteremia, 16% (n=27) in the group of patients who did not receive prophylaxis, compared to only 3% (n=5) in the group of patients who received prophylaxis (P<.0001). The rates of febrile neutropenia were 84% (N = 129) in patients who received prophylaxis compared to 91% (155) in patients who did not receive antibacterial prophylaxis (P = 0.06). The number needed to treat (NNT) in order to prevent one episode of bacteremia is 4.9. The frequency of all other infections, the duration of hospitalization, and the rates of all cause and infection-related mortality were not significantly different between groups. Of note, ciprofloxacin prophylaxis was not associated with an increased in bacterial resistance.Patients with lymphoma were younger (median 53 years, range: 19-72) than patients with MM (median 58, range: 33-68) but similar in all other demographic characteristics. The median duration of aplasia was 6 days (range: 4 to 13) in patients with MM after high-dose melphalan and 8 days (range 5 to 14) in patients with lymphoma after BEAM (p<0.0001). However, both groups seemed to equally benefit from antibacterial prophylaxis. In a multivariable analysis ciprofolxacin prophylaxis significantly decreased the odds of bacteremia (Odds Ratio: 0.19 (Confidence interval: 0.07 to 0.52)). Age, diagnosis, and the duration of aplasia were not associated with the risk of bacteremia
Conclusion
Ciprofloxacin prophylaxis markedly reduced the risk of bacteremia and neutropenic fever in lymphoma and MM patients undergoing ASCT without increasing the incidence of resistant bacterial strains in patients receiving ciprofloxacin prophylaxis. The NNT in order to prevent one episode of bacteremia is 4.9, suggesting that antibacterial prophylaxis should be considered in ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Neutropenia, Prophylaxis
Type: Eposter Presentation
Background
Bacterial infections are a major cause of morbidity and mortality in patients undergoing autologous stem cell transplantation (ASCT). However, whether these patients benefit from antibacterial prophylaxis is unclear. The few studies which addressed this issue are limited by small sample size or the use of multiple anti-microbial agents. Current guidelines recommend considering the use of antibacterial prophylaxis in patients with anticipated neutropenia of 7 days or more. At our center, patients undergoing ASCT were given ciprofloxacin for antibacterial prophylaxis until 2012. This change in policy provides a unique opportunity to study the potential benefit of antibacterial prophylaxis in ASCT.
Aims
To explore the efficacy and adverse effects of ciprofloxacin prophylaxis in patients undergoing ASCT.
Methods
This is a single center retrospective study. Data were collected from the medical records of all patients with a diagnosis of non-Hodgkin's lymphoma, Hodgkin's disease or multiple myeloma (MM) who underwent ASCT at Rabin Medical Center between 03/2007 and 12/2015. Until 10/2012 all patients were given oral ciprofloxacin 500 mg BID starting concomitantly with the conditioning regimen (BEAM for lymphoma and melphalan for multiple myeloma) until the first febrile episode or until engraftment. After 10/2012, our treatment policy has changed and we stopped using antibacterial prophylaxis in the ASCT setting.
Results
Between 03/2007 and 12/2015 303 patients received 327 high dose chemotherapy followed by ASCT. The median age at time of transplant was 55 years (range: 16 to 72) and 186 patients (57%) were males. The diagnosis was MM in 174 patients (46%), NHL in 110 patients (34%) and HD in 43 patients (13%). 154 consecutive patients were given ciprofloxacin prophylaxis and 171 patients were not given ciprofloxacin prophylaxis before and after 10/2012, respectively. Overall, 10% (n=32) of the patients had a bacteremia, 16% (n=27) in the group of patients who did not receive prophylaxis, compared to only 3% (n=5) in the group of patients who received prophylaxis (P<.0001). The rates of febrile neutropenia were 84% (N = 129) in patients who received prophylaxis compared to 91% (155) in patients who did not receive antibacterial prophylaxis (P = 0.06). The number needed to treat (NNT) in order to prevent one episode of bacteremia is 4.9. The frequency of all other infections, the duration of hospitalization, and the rates of all cause and infection-related mortality were not significantly different between groups. Of note, ciprofloxacin prophylaxis was not associated with an increased in bacterial resistance.Patients with lymphoma were younger (median 53 years, range: 19-72) than patients with MM (median 58, range: 33-68) but similar in all other demographic characteristics. The median duration of aplasia was 6 days (range: 4 to 13) in patients with MM after high-dose melphalan and 8 days (range 5 to 14) in patients with lymphoma after BEAM (p<0.0001). However, both groups seemed to equally benefit from antibacterial prophylaxis. In a multivariable analysis ciprofolxacin prophylaxis significantly decreased the odds of bacteremia (Odds Ratio: 0.19 (Confidence interval: 0.07 to 0.52)). Age, diagnosis, and the duration of aplasia were not associated with the risk of bacteremia
Conclusion
Ciprofloxacin prophylaxis markedly reduced the risk of bacteremia and neutropenic fever in lymphoma and MM patients undergoing ASCT without increasing the incidence of resistant bacterial strains in patients receiving ciprofloxacin prophylaxis. The NNT in order to prevent one episode of bacteremia is 4.9, suggesting that antibacterial prophylaxis should be considered in ASCT.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Neutropenia, Prophylaxis
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