Recipients and donors of bone marrow transplants suffering from Chagas' disease: management and preemptive therapy of parasitemia.

We report the clinical course of five adult patients with chronic Chagas' disease (Cd) who underwent BMT. Two patients with non-Hodgkin's lymphoma and one with ALL received an ABMT. Allogeneic BMT was performed in two patients with AML and CML respectively. One donor had chronic Cd. Samples of peripheral blood for parasite investigation by the Strout method, blood culture, and immunological studies by indirect immunofluorescent assay, ELISA and indirect hemagglutination tests were performed weekly from the start of chemotherapy until day +60 for ABMT and during the period of immunosuppression for allogeneic BMT. No prophylaxis was given to any of these patients. In only one ABMT patient were trypomastigotes detected early by blood culture without symptoms of reactivation. Benznidazole as preemptive treatment was administered at 5-8 mg/kg/daily for 30 days. Parasitemia was rapidly cleared and at the end of therapy xenodiagnosis was negative. The other Cd patients showed no evidence of relapse of parasitemia or signs and symptoms of reactivation. In brief, evidence of Cd should be sought in all BMT patients coming from endemic areas because parasitemia and reactivation are potential complications during the period of neutropenia and immunosuppression. The strategy used for early detection and treatment of parasitemia and reactivation was safe and effective.

Double-blind prospective randomized comparison of interferon gamma-1b versus placebo after autologous stem cell transplantation.

Thirty-eight patients, including 14 with Hodgkin's disease, 9 with non-Hodgkin's lymphomas, 4 with multiple myeloma and 11 with solid tumors, were enrolled in our study. Between March 1995 and March 1997, 24 of these patients had been autografted with peripheral blood, and 14 had received peripheral blood autografts plus bone marrow. The study was a double-blind, prospectively randomized comparison of interferon gamma-1b (IFN-gamma), given subcutaneously at a dose of 50 microg/m(2) daily for 30 days to 18 of the 38 patients, vs. placebo (20 of 38). Administration started after 2 consecutive days of >0.5 x 10(9) neutrophils/l following autologous stem cell transplantation. At a mean follow-up time of 536 +/- 269 days, disease-free survival (DFS) for the IFN-gamma and placebo groups was 728 vs. 510 days, respectively (p < 0.0750 by the Generalized Wilcoxon/Peto-Prentice test). Overall survival (OS) time for the IFN-gamma and placebo groups was 830 vs. 755 days, respectively. Despite the limited number of patients included in this comparison, a trend for superior DFS was observed in the IFN-gamma-treated group, a finding which merits further study.

Multivariate analyses of prognostic factors associated with hematopoietic recovery in autograft patients with different sources of progenitor cells. A GATMO experience. Argintine Group of Bone Marrow Transplant.

OBJECTIVE: To evaluate in a multivariate analysis the prognostic factors associated with hematopoietic recovery and the supportive care requirements after autotransplant of progenitor cells (PC) from various sources: bone marrow (BMPC), BMPC & peripheral blood (PBPC), and PBPC alone. PATIENTS AND METHODS: A total of 570 patients with hematological malignancies and solid tumors underwent high-dose therapy followed by autotransplant. PBPC were obtained after mobilization with chemotherapy and/or cytokines. One-hundred five patients received BMPC, 217 received BMPC & PBPC and 248 PBPC alone; all of the patients received G-CSF or GM-CSF after infusion. RESULTS: In a multivariate analysis the recovery of neutrophils was adversely associated with low numbers of nucleated cells infused (P < 0.13), bone marrow progenitor cell source, and diagnosis of multiple myeloma and acute leukemia (P < 0.001). The factors that adversely affected platelet recovery were low number of nucleated cells and diagnosis of multiple myeloma and acute leukemia (P < 0.001). CONCLUSIONS: We conclude that BMPC adversely affect neutrophil recovery while low numbers of nucleated cells and diagnosis of multiple myeloma and acute leukemia adversely affect both neutrophil and platelet recovery.