key: cord-0009705-5iwrmlj1
authors: Knoll, Bettina M.; Ahmed, Jibran; Karass, Michael; Aujla, Amandeep; McHale, Patricia; Kretschmer, Patricia; Mazumder, Amitabha; Seiter, Karen; Ahmed, Tauseef; Lim, Seah H.
title: Procalcitonin as a biomarker to differentiate bacterial infections from engraftment syndrome following autologous hematopoietic stem cell transplantation for multiple myeloma
date: 2018-12-31
journal: Am J Hematol
DOI: 10.1002/ajh.25378
sha: a74ef5efce969f6838904c795f25c5b3785990ae
doc_id: 9705
cord_uid: 5iwrmlj1

nan

Procalcitonin as a biomarker to differentiate bacterial infections from engraftment syndrome following autologous hematopoietic stem cell transplantation for multiple myeloma To the Editor:

Procalcitonin (PCT) is a hormokine. It is approved by the Food and Drug Agency as a biomarker for sepsis and has been found to be a useful prognostic biomarker in febrile neutropenic patients with documented infections. 1, 2 Infectious complications are the major cause of morbidity and mortality in febrile neutropenic patients after ASCT.

Fever is, therefore, frequently treated with antibiotics. However, unnecessary use of broad-spectrum antibiotic treatment harbors the risk of evolution of drug resistant bacteria and Clostridium difficile infection.

We previously reported the high resource utilization associated with late-onset fever and engraftment syndrome (ES) following autologous stem cell transplantation (ASCT). 3 The median hospital length-of-stay in patients who developed ES was 3 days longer than those without ES. These patients also incurred an average additional cost of $9825/patient/day. Patients with multiple myeloma (MM) are most at risk for the development of ES following ASCT. Up to 30% of these patients developed the complication and the high incidence has been attributed to the prior use of bortezomib and lenalidomide. 4 Sixty-six percent were men. Autologous peripheral blood stem cells were mobilized using G-CSF (10 μg/kg/day) AE plerixafor PCT with a cutoff of <2 ng/mL might be an adjunctive biomarker in identifying patients suffering from non-infectious fever associated with ES following ASCT. A PCT guided algorithm may limit the duration of antibiotics, reduce adverse events and prevent the emergence of antimicrobial resistance. Large randomized controlled trials comparing PCT guided antimicrobial therapy vs. standard of care to limit unnecessary exposure to antimicrobials in immunocompromised ASCT recipients are warranted.

Nothing to report. Definite clinical evidence for a causal association was described for 18 drugs and the food supplement; 10 drugs and the food supplement had not been previously described with definite evidence.

Nine articles reported evaluable group data; only one report of quinine treatment described definite evidence for a causal association and quinine has been previously reported with definite evidence. 1 Supporting Information Table S2 summarizes the data for the 61 evaluable reported patients and the 9 articles reporting evaluable group data. These new data from our systematic literature review together with the new data from the BloodCenter of Wisconsin are merged with the previously reported data on our updated web site. 

Procalcitonin guiding antimicrobial therapy duration in febrile cancer patients with documented infection or neutropenia

Diagnostic performance of procalcitonin, presepsin, and C-reactive protein in patients with hematological malignancies

Late-onset fever and engraftment syndrome following autologous stem cell transplant: impact on resource utilization

Engraftment syndrome following autologous hematopoietic stem cell transplantation: definition of diagnostic criteria

Engraftment syndrome following hematopoietic stem cell transplantation