Cutaneous aspergillosis as a first manifestation of systemic infection in allogeneic haematopoietic stem cell transplantation.

Infections are one of the major causes of morbidity and mortality after stem cell transplantation (SCT). Opportunistic infections of varying severity with bacterial fungal and viral organisms occur in > 90% of patients after allogeneic SCT. Fatal opportunistic infections have been reported in 4-15% of related transplant recipients and 12-28% of unrelated transplant recipients. More than half of the transplant patients affected by invasive aspergillosis die despite treatment. Cutaneous aspergillosis has been rarely reported in transplant patients. During last five years 154 patients underwent allo SCT at our centre for various haematological disorders. Aspergillus infection was observed in six patients. Three patients had systemic aspergillosis whereas other three patients had primary cutaneous aspergillus infection. Patients with primary cutaneous aspergillosis are presented here as case report.

FLAG-IDA in the treatment of refractory/relapsed acute leukaemias: single centre study.

OBJECTIVE: To evaluate the efficacy and toxicity profile of the combination of fludarabine, high dose cytarabine, idarubicin, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, a study is being conducted at Armed Forces Bone Marrow Transplant Centre (AFBMTC) Rawalpindi since January 2003. Data up to June 2004 (early report) is being presented. METHODS: Twelve Patients with refractory/relapsed (Ref/Rel) acute leukaemia (AL) were treated with fludarabine 30 mg/m2 and cytosine arabinoside (AraC) Arac 2 g/m2 for 5 days, idarubicin 10 mg/m2 for 3 days, and granulocyte colony stimulating factor G-CSF 5 micro g/kg from day 0 till neutrophil recovery (ANC > 1.0 x 10(9)/1). Response was evaluated by bone marrow examination on day 20-post chemotherapy. RESULTS: Patients included were refractory acute lymphoblastic leukaemia (ALL) (n=2), relapsed ALL (n = 3), refractory acute myeloid leukaemia (AML) (n = 3), secondary AML (n=2) relapsed AML (n = 1) and acute undifferentiated leukaemia (AUL) (n = 1). Complete remission (CR) was achieved in 8 (66.6%) patients. Three (25%) patients died of post chemotherapy complications and one patient failed to achieve remission. Out of 8 patients who achieved CR, 4 underwent allogeneic bone marrow transfusion (BMT), 1 is being evaluated for the same, 1 received idorubicin, AraC and etopuside (ICE) and high dose AraC, 1 did not receive further chemotherapy and 1 relapsed two months after remission. Seven patients are still in CR after a median follow up of 8 months (range 3-18). Major complications encountered were diarrhoea, mucositis, toxic ileus, transient hepatic toxicity, fungal and bacterial infections. CONCLUSION: In our experience, FLAG-IDA is well tolerated and effective regimen in relapsed/refractory acute leukaemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures.

Posttransplant Guillain Barre Syndrome.

This case report describes a patient with severe aplastic anaemia, who developed Guillain Barre Syndrome (GBS) 10 weeks after allogeneic haematopoietic stem cell transplantation (HSCT) from HLA-matched sibling-younger sister. GBS was preceded by pneumonia, herpes labialis and oral candidiasis a week earlier. Treatment with ventilatory management, intravenous human immunoglobulin (IVIg) and antimicrobials resulted in smooth recovery in thirty-one days.