Evaluation of the pretransplantation phase of the hemopoietic stem cell program in a tertiary hospital.

INTRODUCTION: Therapeutic decisions and clinical events during the pretransplantation phase of stem cell transplantation (SCT) may influence survival, quality of life, and efficiency of health expenses. However, there is a lack of relevant published data. AIMS: The aims of this study were to identify reasons why the procedure was not performed and to know the waiting time for SCT candidates. PATIENTS AND METHODS: We collected pretransplantation data from 166 consecutive patients evaluated by the SCT Committee of a tertiary center between April 2005 and December 2006. RESULTS: One hundred fifty-two of 166 patients were referred for the first time. Additionally, 14 were reconsidered as candidates for a subsequent SCT due to relapse, graft failure, secondary malignancy, or a multiple-graft program. One hundred forty-one were accepted for transplantation, whereas 25 were not. At the time of analysis, 22 patients were still awaiting SCT, 8 were delayed because they required additional courses of treatment, and 32 were excluded because of death (34.4%), poor stem cell mobilization (21.9%), patient refusal (15.6%), relapse/progression (9.4%), comorbidity (6.3%), or absence of a donor (6.3%). The median time between inclusion in the program and transplantation was 3.6 months (range, 0.27-13.43), and 5.7 months (P < .05) for unrelated allogeneic transplantation. No significant differences were observed in the diagnosis or hospital of origin. CONCLUSIONS: SCT was not performed in 22% of transplant candidates, mainly due to death, insufficient stem cell mobilization, patient refusal, or disease progression/relapse. The median time between inclusion in the SCT program and transplantation was 3 months, but longer among the unrelated allogeneic transplantations.

Preemptive therapy for cytomegalovirus disease in allogeneic stem cell transplant recipients.

Cytomegalovirus (CMV) infection causes high morbidity and mortality among allogeneic stem cell transplant recipients. Preemptive therapy with oral valganciclovir or intravenous ganciclovir has replaced universal prophylaxis. We prospectively studied 19 consecutive adult recipients of allogeneic peripheral blood stem cell transplants from May 2005 through February 2007 to analyze the safety and efficacy of preemptive therapy for the treatment of CMV infection. The antigenemia test was persistently negative in 8 patients (42%) and positive at least once in 11 (58%). Eight patients were treated with oral valganciclovir on an outpatient basis and they all became CMV negative after the first week of treatment. The other 3 patients received intravenous ganciclovir and were also CMV negative after the first week of treatment. No patient abandoned treatment, no severe secondary toxicity was noted, and there was no CMV-associated mortality.

[Prospective comparative study of different amino acid and lipid solutions in parenteral nutrition of patients undergoing bone marrow transplantation]. / Estudio prospectivo comparativo de diferentes soluciones de aminoácidos y lípidos, en la nutrición parenteral de pacientes sometidos a trasplante de médula ósea.

UNLABELLED: The patient who will undergo a bone marrow transplant (BMT) has a high protein catabolism in the time period after the infusion of the marrow, and therefore there is a need for an adequate nutritional support. The objective of our study is to analyze the behavior of nutritional assessment parameters, the lipid metabolism, the number of days of mucositis, the number of infections, the number of days to recovery, and the number of hospitalization days when using different parenteral nutrition solutions: 22.5% and 45% branched chain amino acid solutions, and lipid solutions with long chain triglycerides (LCT), vs. medium chain triglycerides (MCT). MATERIAL AND METHODS: We have carried out a prospective, randomized study in patients who underwent a BMT who received parenteral nutrition. The supply of nitrogen was 1.5 +/- 0.3 g of AA/kg/day (either in standard solution or in a 45% branched chain AA solution). The caloric supply was similar in all the groups, with a proportion of 60% coming from carbohydrates and 40% from lipids, either LCT or MCT/LCT. The nutritional assessment parameters were studied, as well as of the lipid metabolism, and also clinical evolutive data: number of days of mucositis, number of days of PN, number of days hospitalized, number of infections, rate of infection density. All the data were measured and/or quantified 4 times: pretransplant, on day--of the transplant, and after 7 and 14 days after the transplant. RESULTS: 62 patients were studied. Group A: 19 patients treated with 22.5% branched chain amino acids + 20% LCT. Group B: 26 patients (45% branched chain amino acids + 20% LCT). Group C: 17 patients, (45% branched chain amino acids + 20% MCT/LCT). There is a quicker recover of the marrow in groups B + C: 14.4 vs. 11.7 and 11.1, with a p < 0.05. The nitrogen balance improves significantly in groups B and C (p < 0.05). The retinol-binding protein increases significantly from day 0 to day 7 (p < 0.01) in the LCT group (Group B). The phospholipids decrease in group B after one day (p < 0.05), and after the 7th day (p < 0.05). The triglycerides increase in group C between 7 and 14 days. The LDL/HDL quotient increases in group B after 14 days (p < 0.05). The triglycerides increase in group C between 7 and 14 days. The LDL/HDL quotient will increase in the B group after 14 days (p < 0.05). There are no differences in the number of days of mucositis, the total number of infections, the number of infections per 100 days of hospitalization, or in the number of hospitalization days. CONCLUSIONS: In patients who are given parenteral nutrition in the period immediately after the BMT, we found an improvement in the catabolic metabolism parameters when using a solution with a high proportion of branched chain amino acids (45%) and a smaller alteration of the metabolism of the plasmatic lipoproteins when we use MCT/LCT enriched solutions.