melphalan and Cross-Infection

The aim of this study was to analyze and identify documented infections and possible risk factors for Clostridioides difficile infections in children with cancer.. This is a retrospective case-control study, carried out in a pediatric cancer hospital, covering the years 2016-2019. Matching was performed by age and underlying disease, and for each case, the number of controls varied from 1 to 3. Logistic regression models were used to assess risk factors.. We analyzed 63 cases of documented infection by C. difficile and 125 controls. Diarrhea was present in all cases, accompanied by fever higher than 38°C in 52.4% of the patients. Mortality was similar among cases (n=4; 6.3%) and controls (n=6; 4.8%; p=0.7). In all, 71% of patients in the case group and 53% in the control group received broad-spectrum antibiotics prior to the infection. For previous use of vancomycin, the Odds Ratio for C. difficile infection was 5.4 (95% confidence interval [95%CI] 2.3-12.5); for meropenem, 4.41 (95%CI 2.1-9.2); and for cefepime, 2.6 (95%CI 1.3-5.1). For the antineoplastic agents, the Odds Ratio for carboplatin was 2.7 (95%CI 1.2-6.2), melphalan 9.04 (95%CI 1.9-42.3), busulfan 16.7 (95%CI 2.1-134.9), and asparaginase 8.97 (95%CI 1.9-42.9).. C. difficile symptomatic infection in children with cancer was associated with previous hospitalization and the use of common antibiotics in cancer patients, such as vancomycin, meropenem, and cefepime, in the last 3 months. Chemotherapy drugs, such as carboplatin, melphalan, busulfan, and asparaginase, were also risk factors.

Topics: Anti-Bacterial Agents; Asparaginase; Busulfan; Cancer Care Facilities; Carboplatin; Case-Control Studies; Cefepime; Child; Clostridioides difficile; Clostridium Infections; Cross Infection; Humans; Melphalan; Meropenem; Neoplasms; Retrospective Studies; Risk Factors; Vancomycin

Immunoglobulin light chain (AL) amyloidosis can be treated with high-dose melphalan and autologous stem cell transplantation (HDM/SCT). Risk factors for infections may include hyposplenism, hypogammaglobulinemia, treatment-related neutropenia, melphalan-induced mucositis, and nosocomial exposures.. A review of 493 patients with AL amyloidosis undergoing treatment with HDM/SCT from August 1994 to August 2009 was performed. The objectives were to determine the rate and types of infections following HDM/SCT, to identify factors associated with microbiologically documented infections, and to assess the contribution of infections to all-cause treatment-related mortality (TRM; defined as deaths within 100 days of SCT).. Microbiologically documented infections after HDM/SCT occurred in 24% (n = 119) of patients. TRM was 10% (n = 48) overall, and 21% (n = 25) in patients who had a documented infection. Thus, the relative risk of TRM in a patient with a documented infection was 3.42 (95% confidence interval [CI] 2.02-5.79). Infections were caused by gram-positive bacteria in 51%, anaerobic bacteria in 16%, gram-negative bacteria in 13%, and fungi in 9% of cases. Serum creatinine >2 mg/dL was associated with increased risk of post-SCT infection (38% vs. 21%, P = 0.0007) with an odds ratio of 2.27 (95% CI 1.40-3.68). No significant association for infection was found for age, gender, cardiac involvement, prior steroid therapy, dose of melphalan, multiorgan involvement, days to neutrophil engraftment, or dose of CD34 +  cells infused.. Serum creatinine >2 mg/dL is a risk factor for infections in patients with AL amyloidosis undergoing HDM/SCT. The relative risk of TRM in a patient with a documented infection was increased >3-fold. A broad spectrum of infections, similar to that in other SCT patients, is seen in this population in the early post-SCT period.

Topics: Aged; Aged, 80 and over; Amyloidosis; Bacterial Infections; Combined Modality Therapy; Cross Infection; Dose-Response Relationship, Drug; Female; Humans; Immunoglobulin Light Chains; Male; Melphalan; Middle Aged; Mycoses; Myeloablative Agonists; Postoperative Complications; Risk Factors; Stem Cell Transplantation; Transplantation, Autologous

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Biofilms; Bleomycin; Carmustine; Catheter-Related Infections; Central Venous Catheters; Cisplatin; Cross Infection; Cytarabine; Dacarbazine; Deoxycytidine; Doxorubicin; Drug Resistance, Multiple, Bacterial; Equipment Contamination; Etoposide; Female; Gemcitabine; Gram-Negative Bacterial Infections; Hodgkin Disease; Humans; Immunocompromised Host; Melphalan; Methylobacterium; Prednisone; Ribotyping; Spain; Vinblastine

A 27-year-old man with aplastic anemia and renal insufficiency requiring dialysis underwent allogeneic PBSCT. The preparative regimen consisted of melphalan, ATG and TLI. GVHD prophylaxis consisted of cyclosporine and prednisolone. He was dialyzed prior to administration of melphalan and at 24 and 72 h after it. Otherwise, the dialysis schedule was unchanged, at three times a week. Engraftment was rapid. Regimen-related toxicity was minimal. Pharmacokinetic parameters of melphalan were not significantly altered with its plasma half-life 1.5 h. Patients with renal failure can receive allogeneic HSCT, and a combination of melphalan, ATG and TLI may serve as an alternative to CY and ATG.

Topics: Adult; Anemia, Aplastic; Antineoplastic Combined Chemotherapy Protocols; Cross Infection; Graft Survival; Graft vs Host Disease; Humans; Lymphatic Irradiation; Male; Melphalan; Peripheral Blood Stem Cell Transplantation; Renal Dialysis; Renal Insufficiency; Transplantation Conditioning; Transplantation, Homologous