Post-Transplant Infections in Multiple Myeloma and Lymphoma: Early Vulnerabilities and Long-Term Risks in ASCT Recipients

Sofro, Muchlis Achsan Udji; Astrilia, Mila; Adhyatma, Galih Prakasa; Hanjani Pramudita, Arcita; Rizky, Daniel; Setiawan, Budi; Pangarsa, Eko Adhi; Santosa, Damai; Tobing, Mika L.; Suyono, Suyono; Suharti, Catharina

doi:10.31557/APJCP.2025.26.11.4103

Post-Transplant Infections in Multiple Myeloma and Lymphoma: Early Vulnerabilities and Long-Term Risks in ASCT Recipients

Document Type : Research Articles

Authors

¹ Infectious Diseases and Tropical Infection Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University, RSUP Dr. Kariadi Semarang, Indonesia.

² Internal Medicine Resident, Department of Internal Medicine, Diponegoro University, RSUP Dr. Kariadi Semarang, Indonesia.

³ Faculty Medicine, Muhammadiyah University of Semarang, Indonesia.

⁴ Research affiliates at Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.

⁵ Hematology and Medical Oncology Division, Department of Internal Medicine, Faculty of Medicine, Diponegoro University, RSUP Dr. Kariadi Semarang, Indonesia.

10.31557/APJCP.2025.26.11.4103

Abstract

Background: Patients with multiple myeloma (MM) and lymphoma undergoing autologous stem cell transplantation (ASCT) are at a higher risk of infection leading to increased morbidity and mortality. This study aims to analyze the infection patterns and outcomes in this population. Methods: A retrospective, descriptive study was conducted at Dr. Kariadi General Hospital, Semarang, Indonesia, involving 28 patients diagnosed with MM and lymphoma who underwent ASCT from January 2013 to May 2023. Data were collected from medical records and phone interviews. Infection patterns, bacterial pathogens, and outcomes were analyzed. Results: Of the 28 patients, 75% experienced post-ASCT infections. Infections occurred predominantly in the first 10 days post-transplant, with 85% of infections occurring during this period. Six patients experienced multiple infection episodes. Blood cultures revealed 52% Gram-positive and 29% Gram-negative bacterial infections. Three patients (14%) died within 28 days post-transplant, though these deaths were attributed to non-infectious causes, including pulmonary edema and hemorrhagic stroke. Two patients developed late-onset infections occuring more than 300 days post-transplant. Conclusions: Infections remain a significant complication following ASCT in MM and lymphoma patients, particularly within the early post-transplant period. Gram-positive bacteria, especially Staphylococcus species, were the predominant pathogens identified.

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