Fluoroquinolone Resistance Prevalence Study

Study Overview
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Brief Summary
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This is an exploratory study to determine the prevalence of fluoroquinolone resistance in patients receiving dose-intense melphalan with autologous peripheral blood stem cell (PBSC) transplantation in the treatment of multiple myeloma (MM). These data may be used in subsequent studies exploring the use of prophylaxis in this patient population.

Detailed Description
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The goal of this observational study is to determine the prevalence of fluoroquinolone resistance in patients receiving dose-intense melphalan with autologous peripheral blood stem cell (PBSC) transplantation in the treatment of multiple myeloma (MM). The main question[s] it aims to answer are: What is the prevalence of fluoroquinolone-resistant Enterobacterales (FRE) in patients undergoing autologous PBSC transplantation with dose-intense melphalan? Does the risk of febrile neutropenia differ in FRE carriers compared to non-carriers? Participants will be tested for the presence of FRE before receiving fluoroquinolone prophylaxis at multiple points during the transplant course, including before chemotherapy mobilization (if used) using fluoroquinolone prophylaxis, at initial transplant hospitalization, at time of hospital discharge, and at or after day 84 after transplantation (day 0 is defined as day of HSC (hematopoietic stem cell) infusion). FRE colonization will not be a determining factor in the use of fluoroquinolone prophylaxis during the treatment course. This study will be open at two transplant units: Hackensack University Medical Center (HUMC) and MedStar Georgetown University Hospital (MGUH). Estimated number of subjects to be enrolled; HUMC: 124 MGUH: 20 Anticipated enrollment period: 12-months with monitoring of subjects for 84 days (twelve weeks) after transplantation. Data will be analyzed over a three-month period (total study period of 18 months).

Official Title
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Exploratory Study of Fluoroquinolone Resistance for Patients Undergoing Autologous Hematopoietic Stem Cell (HSC) Transplantation in the Treatment of Multiple Myeloma

Conditions
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Multiple Myeloma

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects >18 yrs of age. Diagnosis of multiple myeloma undergoing (first or subsequent) autologous PBSC transplantation. Transplant conditioning with melphalan 200 mg/m2. PBSC cell dose of >2x10e6 CD34+ cells/kg. Able to receive fluoroquinolone prophylaxis. Subjects must give consent for enrollment into this study. Exclusion Criteria: Unwillingness to provide informed consent. Enrollment into a treatment protocol prescribing antibiotic prophylaxis. A diagnosis other than multiple myeloma. Receiving a conditioning regimen other than melphalan 200 mg/m2. Known light-chain amyloid deposition in any organ.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of FRE | Prevalence of FRE in patients undergoing autologous PBSC transplantation with dose-intense melphalan | Duration between Apheresis Consultation and Day +100 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence/Risk of Febrile Neutropenia (FN) | Occurrence of neutropenic fever during the first 28 days (4 weeks) after autologous PBSC transplantation in the treatment of multiple myeloma. | Within 28 days of the transplantation | 
| Occurrence/Risk of Blood Stream infection (BSI) | The occurrence of Gram-negative BSI among the FRE carriers and FRE non-carriers | Within 28 days of the transplantation | 
| Comparison of severity of GI toxicity between FRE carriers and FRE non-carriers | Comparison of severity of GI toxicity between FRE carriers and FRE non-carriers per the grade of GI toxicity | Duration between Apheresis Consultation and Day +100 | 
| Comparison of Length of Stay (LOS) between FRE carriers and FRE non-carriers | Comparison of Length of Stay (LOS) between FRE carriers and FRE non-carriers by estimating time to discharge | Duration between Day of hospital admission and Day of hospital discharge (estimated duration between 11 - 15 days) | 
| Comparison of Engraftment Kinetics between FRE carriers and FRE non-carriers | Comparison of Engraftment Kinetics (absolute neutrophil count (ANC), absolute lymphocyte count (ALC), platelet) between FRE carriers and FRE non-carriers | Duration between Apheresis Consultation and Day +100 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myeloma, Plasma-Cell, Fluoroquinolone resistance, Autologous Hematopoietic Stem Cell Transplantation, Antibiotic Prophylaxis, Gut Microbiome, Febrile neutropenia