MM-597 Diarrhea in Multiple Myeloma Autologous Stem Cell Transplant Recipients: Think Beyond Mucositis

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 24; p. S575
• Main Authors: Kumar, Nikhil M.M., Rastogi, Neha, Bhargava, Rahul, Yadav, Chitresh, Swaminathan, Anusha, Garg, Paritosh, Kothari, Akriti
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2024
• Subjects: autologous stem cell transplant; mucositis; multiple myeloma; persistent diarrhea; MM; persistent diarrhea; autologous stem cell transplant; mucositis; multiple myeloma
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01713-0

Persistent diarrhea in patients with multiple myeloma (MM) undergoing autologous transplant is related to conditioning regimen toxicity unless proven otherwise. However, we are observing a rise in infectious complications in this setting, and hence it is necessary to evaluate these events to ensure better clinical outcomes. This is an ambispective study over 2 years (2021-2023) conducted at the Department of Hematology and Bone Marrow Transplant at a tertiary care hospital in Northern India. A total of 106 patients with MM underwent autologous transplant during the study period, of which 84 patients (79.24%) had newly diagnosed MM with partial response (PR) or better response after first-line treatment, while 22 patients (20.37%) had relapsed/refractory MM after multiple lines of therapy. Patients were stratified based on age, comorbidities, disease status, prior treatment, and dose of melphalan used during conditioning. All patients who had diarrhea (by standard definition) for more than 2 weeks post-transplant were evaluated for alternative etiology (other than mucositis) using both conventional and molecular techniques along with colonoscopy (wherever needed). Over the study period, out of the 106 patients included (median age 62 years), 32 patients (30.19%) had persistent diarrhea. Twenty-nine (90.62%) had febrile neutropenia for which empiric/definitive antibiotics were given. Eight patients had Clostridium difficile toxins, 3 patients had giardiasis, and 1 patient had Cryptosporidium oocysts detected on routine stool analysis. Colonoscopy with biopsy and immunohistochemistry was performed in 18 of the remaining 20 patients. CMV colitis was diagnosed in 6 patients, and 2 patients had biopsy-proven GVHD. Diarrhea in 12 patients was still attributable to mucositis after ruling out other etiologies. All patients were treated with standard treatment protocols, including trial of steroids for patients with GVHD. Successful resolution of diarrhea was achieved in 31 of 32 patients. In the current treatment era, melphalan-related mucositis is still the most common cause of debilitating diarrhea. However, with newer diagnostic modalities and a collaborative team approach, other infectious and noninfectious etiologies are being increasingly recognized in this subgroup of patients. A careful analysis of causation could lead to earlier intervention and prevention of serious complications.