ABSTRACT
ABSTRACT Introduction: Infection is a serious complication among patients with hematologic malignancies (HMs) and in hematopoietic cell transplant (HCT) recipients. In most centers, the management of these complications is provided by the hematologist in person, thus demanding a knowledge of basic aspects of infection. Methods: To evaluate the knowledge of the hematologist on infections, we invited clinicians to answer two questionnaires with 20 multiple-choice questions covering epidemiology, prophylaxis, diagnosis and treatment of infection in patients with HMs and HCT. Results: We obtained 289 answers: 223 in survey 1 (febrile neutropenia) and 66 in survey 2 (infection in HCT). The median score was 5.0 in both surveys (range 0.5 - 9.0). In survey 1, the questions with the lowest number of correct answers were Q3 (8%), concerning the cefepime dose, and Q1 (9%), which asked about the epidemiologic link between the use of high dose cytarabine and viridans streptococcal bacteremia. In survey 2, two questions about cytomegalovirus (CMV) infection had the lowest percentage of correct answers (Q4, 12% and Q11, 18%). Clinicians attending to HCT recipients had higher scores, compared to clinicians attending to patients with HM only (median score of 5.0 and 4.5, p = 0.03, in survey 1 and 6.0 and 4.5, p = 0.001, in survey 2). In both surveys staff clinicians, residents and professors had similar scores. Conclusion: This is the first study in Brazil assessing the knowledge of hematologists on infectious complications. The low median score overall indicates an urgent need for continuous education. Such initiatives will eventually result in better patient care.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Surveys and Questionnaires , Hematopoietic Stem Cell Transplantation , Education , Febrile NeutropeniaABSTRACT
Abstract Invasive fungal infection (IFI) is frequent in patients with hematologic malignancies or submitted hematopoietic stem cell transplantation (HSCT). Objectives To evaluate the role of the GM (galactomannan) test in prescribing therapeutic antifungals; to determine invasive aspergillosis (IA) frequency, the factors associated with positive GM test, and the in-hospital mortality. Methods We conducted a retrospective observational study including patients aged 18 or over with hematological malignancy or submitted to HSCT. GM test was measured twice weekly. The hypothesis of IFI was considered in patients with neutropenia and persistent fever despite broad-spectrum antibiotics. Results A total of 496 patients were evaluated; the mean of GM tests performed per patient was 4.2 (+3.1), and 86 (17.3 %) had positive results. IFI was diagnosed in 166 (33.5 %) and IA in 22 (24.6 %) patients. Positive GM test was more frequent in patients with IFI (72.2 % and 25.1 %; OR 8.1; 95 % CI 4.8 - 13.8), and was associated with therapeutic antifungals prescription (52, 9 % and 20.5 %; OR 4.3, 95CI% 2.0 - 9.4), as well as lung abnormalities on HRCT (45.3% vs. 21.5 %; OR 3.0, 95 %CI 1.4 - 6.5). Mortality was 31.6 %. In the multivariate analysis, the variables associated with mortality were the hypothesis of IFI (OR 6.35; 95 % CI 3.63-11.12.0), lung abnormalities on HRCT (57.9 % and 26.9 %; OR 2 0.6; 95 % CI 1.5 - 4.4), and positive GM test (57.9 % and 26.9 %; OR 2.7 95 % CI 1.6 - 4.5). Conclusions Positive GM test was associated with lung abnormalities on HRCT and with the introduction of therapeutic antifungals. If adequate anti-mold prophylaxis is available, the GM test should not be used as screening, but to investigate IFI in high-risk patients. The diagnosis of IFI, positive GM test and lung abnormalities on HRCT were predictors of hospital mortality in patients with hematological malignancies or undergoing HSCT.
ABSTRACT
Objective:To evaluate the safety and efficacy of bortezomib plus highdose melphalan (L-phenylalanine nitrogen mustard) (Bor-HDM) pretreatment regimen for multiple myeloma (MM) with autologous hematopoietic stem cell transplantation (ASCT).Methods:From August 2008 to December 2021, the relevant clinical data were retrospectively reviewed for 58 MM patients undergoing MM transplantation.The conditioning regimens were Bor-HDM (n=36) and HDM (n=22). Non-hematopoietic adverse reactions, hematopoietic reconstruction time, remission rate post-ASCT and minimal negative rate of residual disease (MRD) on flow cytometry within 3 months post-ASCT and survivals were analyzed.Results:In Bor-HDM and HDM groups, median time of neutrophil engraftment was 12(8-30) and 11(8-29) day and median time of platelet reconstitution 16(8-33) and 16(7-32) day respectively.There was no significant inter-group difference ( P=0.890, P=0.638). In Bor-HDM group, the most common non-hematological adverse reactions were nausea (n=21, 58.0%) and diarrhea (n=11, 30.6%). There was no transplant-related death.Complete remission (CR) rate was (25/36, 69.4%) versus (9/22, 40.9%). The inter-group difference was statistically significant ( P=0.032). Median follow-up period was 29.0(2.0-91.0) vs. 20.5(5.0-114.0) month, 3-year progression-free survival(PFS)62.1% vs. 39.7% and 3-year overall survival(OS) 83.8% vs. 62.5%.There were relapse (n=10 vs.10) and death (n=6 vs. 7). Median PFS in Bor-HDM and HDM groups was non-attained and 27 months( P=0.047) and median OS time non-attained and 40 months respectively ( P=0.282). Multivariate analysis revealed that CR was an independent risk factor for PFS ( HR=28.896, 95% CI: 6.130-136.198, P<0.001). Non-CR was an independent risk factor for OS ( HR=3.843, 95% CI: 1.334-11.071, P=0.013; HR=28.595, 95% CI: 6.273-130.355, P<0.001). Conclusions:Bor-HDM pretreatment regimen of ASCT is both safe and efficacious for MM patients.
ABSTRACT
BACKGROUND: The role of allogeneic hematopoietic cell transplantation (allo-HCT) compared with consolidation chemotherapy alone in intermediate-risk acute myeloid leukemia (AML) patients with wild-type nucleophosmin/negative or a low level of Fms related tyrosine kinase 3 internal tandem duplication (NPM1(wt)/FLT3-ITD(neg/low)) has not yet been elucidated. METHODS: In this study, we retrospectively investigated 88 patients newly diagnosed with AML who received intensive induction chemotherapy at Kyungpook National University Hospital from March 2015 to July 2017. The selection criteria included the presence of results on genetic abnormalities including NPM1 and FLT3-ITD. RESULTS: According to the European LeukemiaNet (ELN) risk classification, 25 patients (28%) were categorized as favorable, 44 (50%) as intermediate, and 19 (22%) as adverse risk. Among the intermediate-risk patients, 40 were identified as NPM1 wt/FLT3-ITDneg/low. Among the patients with NPM1(wt)/FLT3-ITD(neg/low), complete remission (CR) was achieved in 26 patients out of 40 (65%). One-year overall survival (OS) rate was 100% in the favorable-risk group and 87.9% in the NPM1(wt)/FLT3-ITD(neg/low) group (P=0.233). Among the intermediate-risk NPM1(wt)/FLT3-ITD(neg/low) patients, there was no survival benefit with allo-HCT (N=19) compared to consolidation chemotherapy (N=21; P=0.372). In the multivariate analysis, the ELN risk group [hazard ratio (HR), 6.36; P=0.019] and the achievement of CR (HR, 2.95; P=0.017) were both identified as factors affecting OS of patients with newly diagnosed AML. CONCLUSION: Among the AML patients, intermediate-risk NPM1(wt)/FLT3-ITD(neg/low) patients and favorable-risk patients showed similar OS rates. Our results suggested that allo-HCT might have limited clinical benefit for the intermediate-risk NPM1(wt)/FLT3-ITD(neg/low) patients. Well controlled studies are needed to confirm the current results.
Subject(s)
Humans , Cell Transplantation , Classification , Consolidation Chemotherapy , Induction Chemotherapy , Leukemia, Myeloid, Acute , Multivariate Analysis , Patient Selection , Protein-Tyrosine Kinases , Retrospective Studies , TransplantsABSTRACT
BACKGROUND: Although allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment option for myelodysplastic syndrome (MDS), a substantial number of patients experience relapse. We reviewed the clinical outcomes of patients with MDS who relapsed after allogeneic HCT. METHODS: Thirty patients who experienced relapse or progression after allogeneic HCT for MDS between July 2000 and May 2016 were included in this retrospective analysis. RESULTS: The median time from HCT to relapse was 6.6 (range, 0.9–136.3) months. Donor lymphocyte infusions (DLIs) were administered to four patients: one achieved complete remission (CR) and survived disease free, while three did not respond to DLI and died. Hypomethylating agents were administered to seven patients: one who had stable disease continuously received decitabine, while six died without response to treatment. Six patients received AML-like intensive chemotherapy, and three achieved CR: two underwent second HCT and one DLI. One patient receiving second HCT survived without disease, but the other two relapsed and died. Three, four, and eight patients who did not respond to intensive chemotherapy, low-dose cytarabine, and best supportive care, respectively, died. One patient who underwent second HCT following cytogenetic relapse survived disease free. Median overall survival after relapse was 4.4 months, and relapse within 6 months after HCT was associated with shorter survival. CONCLUSION: Outcomes of MDS patients relapsing after allogeneic HCT were disappointing. Some patients could be saved using DLI or second HCT.
Subject(s)
Humans , Cell Transplantation , Cytarabine , Cytogenetics , Drug Therapy , Lymphocytes , Myelodysplastic Syndromes , Recurrence , Retrospective Studies , Tissue Donors , TransplantsABSTRACT
La infección diseminada por Fusarium se ha convertido en un problema creciente en las personas con neoplasias hematológicas malignas, principalmente en pacientes con leucemias agudas; se describen cada vez más casos en aquellos sometidos a un trasplante de médula ósea. No existe un tratamiento óptimo establecido para la fusariosis diseminada. La mortalidad global comunicada de esta infección oscila entre el 50 y el 80%. Se presenta a continuación el caso de un paciente de sexo masculino de 29 años, con diagnóstico de leucemia mieloide aguda, que presenta como complicación una fusariosis diseminada, y logra sobrellevar un trasplante alogénico de médula ósea en el Hospital Italiano de San Justo (Argentina) de forma exitosa. (AU)
Disseminated fusariosis has become an increasing problem in people with hematopoietic neoplasms, mainly in patients affected by acute leukemias, and even more in those who undergo hematopoietic cell transplantation. There is not an optimal treatment for disseminated fusariosis. The global mortality described in the literature is between 50% and 80%. We introduce a case of a 29 year old patient with diagnosis of acute myeloid leukemia complicated with disseminated fusariosis, who copes with an allogeneic hematopoietic cell transplantation with a successful outcome in the "Hospital Italiano de San Justo" (Argentina). (AU)
Subject(s)
Humans , Male , Adult , Leukemia, Myeloid, Acute/surgery , Bone Marrow Transplantation/trends , Fusariosis/therapy , Azacitidine/adverse effects , Tobacco Use Disorder , Transplantation, Homologous , Leukemia, Myeloid, Acute/complications , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Mitoxantrone/administration & dosage , Mitoxantrone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Cytarabine/administration & dosage , Cytarabine/therapeutic use , Positron-Emission Tomography , Drug Therapy , Fever , Fusariosis/microbiology , Fusariosis/mortality , Fusariosis/epidemiology , Fusariosis/diagnostic imaging , Myalgia , Voriconazole/administration & dosage , Voriconazole/therapeutic use , Filgrastim/therapeutic use , Marijuana Use , Cocaine Smoking , Terbinafine/therapeutic use , Melphalan/administration & dosage , Melphalan/therapeutic use , Anti-Bacterial Agents/therapeutic useABSTRACT
El trasplante de médula ósea, es actualmente una alternativa de tratamiento en hemopatías malignas como las leucemias agudas, los linfomas y en enfermedades no malignas como la aplasia medular, la drepanocitosis y las inmunodeficiencias. Su objetivo es restaurar la función de la médula ósea y lograr una hematopoyesis con normalidad. El régimen de acondicionamiento favorece la inmunosupresión del paciente y previene el rechazo del injerto; sin embargo, puede provocar serias complicaciones, entre las que se encuentran las infecciones. Los cuidados de enfermería en todas las etapas del trasplante están encaminados a proporcionar atención oportuna y eficaz, con la finalidad de prevenir, tratar y superar las complicaciones propias del proceder, mediante la elaboración y establecimiento de un plan de cuidados específicos para estos pacientes, que servirá como guía al personal de enfermería de nuevo ingreso en el servicio y como parte del adiestramiento en el centro a otros interesados en este proceder(AU)
Bone marrow transplantation is currently an alternative treatment for malignant hematological diseases such as acute leukemias and lymphomas and for non-malignant diseases such as aplastic anemia, sickle cell disease and immunodeficiencies. Its purpose is to restore the function of bone marrow and achieve a normal hematopoiesis. The conditioning regime favors the immunosuppression of the patient and prevents rejection of the graft. However, it can lead to serious complications, including infections. Nursing care during the transplantation is aimed at providing timely and effective care in order to prevent, treat and overcome the complications of the procedure by developing and establishing a specific care plan for this type of patient, which will serve as a guide for newly enrolled nurses and as training in our hospital to others interested in this procedure(AU)
Subject(s)
Humans , Male , Female , Nursing Diagnosis/methods , Hematopoietic Stem Cell Transplantation/nursing , Nursing Care/methods , Infusion Pumps/standardsABSTRACT
BACKGROUND: Autoimmune cytopenia (AIC) is a rare complication of allogeneic hematopoietic cell transplantation (HCT). In this study, we reviewed the diagnosis, treatment and response to therapy for pediatric patients with post-HCT AIC at our institution. METHODS: Of the 292 allogeneic HCTs performed from January, 2011 to December, 2015 at the Department of Pediatrics, The Catholic University of Korea, seven were complicated by post-HCT AIC, resulting in an incidence of 2.4%. RESULTS: All seven patients with post-HCT AIC had received unrelated donor transplant. Six of seven patients had a major donor-recipient blood type mismatch. The subtypes of AIC were as follows: immune thrombocytopenia (ITP) 2, autoimmune hemolytic anemia (AIHA) 2, Evans syndrome 3. Median time from HCT to AIC diagnosis was 3.6 months. All but one patient responded to first line therapy of steroid±intravenous immunoglobulin (IVIG), but none achieved complete response (CR) with this treatment. After a median duration of treatment of 15.3 months, two patients with ITP achieved CR and five had partial response (PR) of AIC. Five patients were treated with rituximab, resulting in the following response: 2 CR, 2 PR, 1 no response (NR). Median time to response to rituximab was 26 days from first infusion. All patients are alive without event. CONCLUSION: Post-HCT AIC is a rare complication that may not resolve despite prolonged therapy. Rapid initiation of second line agents including but not limited to B cell depleting treatment should be considered for those that fail to achieve CR with first line therapy.
Subject(s)
Child , Humans , Anemia, Hemolytic, Autoimmune , Cell Transplantation , Diagnosis , Immunoglobulins , Incidence , Korea , Pediatrics , Purpura, Thrombocytopenic, Idiopathic , Rituximab , Transplants , Unrelated DonorsABSTRACT
ABSTRACT Introduction: Nutritional support is pivotal in patients submitted to hematopoietic stem cell transplantation. Nutritional status has been associated with time of engraftment and infection rates. In order to evaluate the association between nutritional parameters and clinical outcomes after transplantation a cohort of transplant patients was retrospectively evaluated. Methods: All 50 patients transplanted between 2011 and 2014 were included. The nutritional status before transplantation, ten days after transplantation and before discharge was assessed including anthropometry, body mass index, albumin, prealbumin and total urinary nitrogen. Results: The median follow-up time was 41 months and the median age of patients was 41 years. Thirty-two underwent allogeneic and 18 autologous transplants. Diagnoses included acute leukemias (n = 27), lymphoma (n = 7), multiple myeloma (n = 13), and aplastic anemia (n = 3). Thirty-seven patients developed mucositis (three Grade 1, 15 Grade 2, 18 Grade 3 and one Grade 4), and twenty-two allogeneic, and five autologous transplant patients required total parenteral nutrition. Albumin and total urinary nitrogen were associated with length of hospital stay and platelet and neutrophil engraftment. None of the nutritional parameters evaluated were associated with overall survival. Non-relapse mortality was 14% and overall survival was 79% at 41 months of follow-up. Conclusions: After hematopoietic stem cell transplantation, high catabolism was associated with longer length of hospital stay, the need of total parenteral nutrition and platelet and neutrophil engraftment times. Nutritional parameters were not associated with overall survival.
Subject(s)
Hematopoietic Stem Cell Transplantation , Body Mass Index , Nutrition Assessment , Nutritional Status , Parenteral Nutrition, Total , Nutritional Support , Transplants , Reference Standards , Infections , Length of Stay , Lymphoma , Multiple MyelomaABSTRACT
Acute myeloid leukemia (AML) is a heterogeneous malignancy that comprises 25-30% of pediatric leukemias in Korea. Several inherited diseases, such as Down syndrome and Fanconi anemia, predispose towards AML leukemogenesis. Subgrouping of AML is a key diagnostic step, previously done with the French-American-British (FAB) classification and recently complemented by that of the World Health Organization (WHO). An important feature of AML is the possibility of chloroma at diagnosis, which, if detected, requires follow-up evaluation to determine treatment response. Numerous genetic abnormalities with prognostic relevance have recently been found, the most important of which include those of the core-binding factor (CBF) leukemias, and FLT3-ITD mutation. These genetic abnormalities, combined with patient response to initial treatment, allow for a scheme of risk stratification, and the current consensus is to treat low risk patients with chemotherapy only, whereas high risk patients may receive allogeneic transplant in first remission, although the benefits of transplant remain inconclusive. Overall, the outcome of children and adolescents with AML has improved significantly so that many clinical trials now report event-free survival of around 60%. However, much of this improvement stems from better supportive care and transplant methods, and the genetics-based diagnostic advances in AML have yet to result in enhanced treatment. New therapeutics, including possibly targeted therapy, are necessary to further improve the outcome of pediatric AML.
Subject(s)
Adolescent , Child , Humans , Classification , Complement System Proteins , Consensus , Core Binding Factors , Diagnosis , Disease-Free Survival , Down Syndrome , Drug Therapy , Fanconi Anemia , Korea , Leukemia , Leukemia, Myeloid, Acute , Sarcoma, Myeloid , World Health OrganizationABSTRACT
Acute myeloid leukemia (AML) is a heterogeneous malignancy that comprises 25-30% of pediatric leukemias in Korea. Several inherited diseases, such as Down syndrome and Fanconi anemia, predispose towards AML leukemogenesis. Subgrouping of AML is a key diagnostic step, previously done with the French-American-British (FAB) classification and recently complemented by that of the World Health Organization (WHO). An important feature of AML is the possibility of chloroma at diagnosis, which, if detected, requires follow-up evaluation to determine treatment response. Numerous genetic abnormalities with prognostic relevance have recently been found, the most important of which include those of the core-binding factor (CBF) leukemias, and FLT3-ITD mutation. These genetic abnormalities, combined with patient response to initial treatment, allow for a scheme of risk stratification, and the current consensus is to treat low risk patients with chemotherapy only, whereas high risk patients may receive allogeneic transplant in first remission, although the benefits of transplant remain inconclusive. Overall, the outcome of children and adolescents with AML has improved significantly so that many clinical trials now report event-free survival of around 60%. However, much of this improvement stems from better supportive care and transplant methods, and the genetics-based diagnostic advances in AML have yet to result in enhanced treatment. New therapeutics, including possibly targeted therapy, are necessary to further improve the outcome of pediatric AML.
Subject(s)
Adolescent , Child , Humans , Classification , Complement System Proteins , Consensus , Core Binding Factors , Diagnosis , Disease-Free Survival , Down Syndrome , Drug Therapy , Fanconi Anemia , Korea , Leukemia , Leukemia, Myeloid, Acute , Sarcoma, Myeloid , World Health OrganizationABSTRACT
BACKGROUND/AIMS: Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto-HSCT. METHODS: We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score > or = 2. From 2006 to 2011, among the 150 DLBCL patients aged or = 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone. CONCLUSIONS: We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Age Factors , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/blood , Chemotherapy, Adjuvant , Cyclophosphamide/therapeutic use , Disease Progression , Disease-Free Survival , Doxorubicin/therapeutic use , Kaplan-Meier Estimate , L-Lactate Dehydrogenase/blood , Lymphoma, Large B-Cell, Diffuse/blood , Neoadjuvant Therapy , Neoplasm Staging , Predictive Value of Tests , Prednisone/therapeutic use , Proportional Hazards Models , Reproducibility of Results , Risk Assessment , Risk Factors , Stem Cell Transplantation , Time Factors , Transplantation, Autologous , Treatment Outcome , Up-Regulation , Vincristine/therapeutic useABSTRACT
Patients with hematopoietic stem cell transplantation can develop some degree of renal failure. The aim of this descriptive study is to evaluate markers of kidney injury in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation between 1991 and 2011. Patients and Method: A descriptive study of pediatric patients with allogeneic transplant of hematopoietic precursors between 1991 and 2011. The patients were between 1 month and 18 years of age at the time of the study and had at least 6 months of follow up. Clinical and nutritional history, continuous blood pressure monitoring (ABPM), urine tests, proteinuria, creatinine and renal and bladder ultrasonography imaging were evaluated. Results: During this period 65 patients were transplanted, of which 13 patients were included. 46% (n = 6) showed diverse degrees of renal compromise defined by altered renal parenchymal echogenicity, clinic or masked hypertension and/or microalbuminuria. Conclusion: In this clinical group, almost half of the patients patients had some degree of renal injury in their evolution. We consider essential to assess the renal function in the follow-up of these patients.
Introducción: Los pacientes con trasplante de progenitores hematopoyéticos pueden evolucionar con algún grado de compromiso renal. El objetivo de este estudio descriptivo fue evaluar marcadores de injuria renal en pacientes pediátricos sometidos a trasplante alogénico de progenitores hematopoyéticos entre 1991 y 2011. Pacientes y Método: Estudio descriptivo en pacientes pediátricos con Trasplante alogénico de Precursores Hematopoyéticos entre los años 1991 y 2011 con edad entre 1 mes y 18 años al momento de realizar el estudio y que tuviesen al menos 6 meses de seguimiento. Se evaluaron antecedentes clínicos, nutricionales, presión arterial por monitoreo continuo (MAPA), exámenes de orina, proteinuria, creatininuria y estudio de imágenes por ecotomografía renal y vesical. Resultados: Durante este período se trasplantaron 65 pacientes, de los cuales se incluyeron 13 pacientes. Un 46% (n = 6) presentó compromiso renal de grado variable definido por alteración en la ecogenicidad del parénquima renal, hipertensión arterial clínica o enmascarada y/o microalbuminuria. Conclusión: En la serie clínica estudiada con el 50% de los pacientes presentó algún grado de injuria renal en su evolución. Consideramos importante evaluar función renal en el seguimiento de este grupo de pacientes.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Hematopoietic Stem Cell Transplantation/adverse effects , Proteinuria/epidemiology , Renal Insufficiency/epidemiology , Albuminuria/epidemiology , Albuminuria/etiology , Blood Pressure Determination , Creatinine/metabolism , Follow-Up Studies , Kidney Function Tests , Proteinuria/etiology , Renal Insufficiency/etiology , Transplantation, HomologousABSTRACT
Aim: We conducted a retrospective review of all brain imaging studies in the first year after allogeneic haematopoietic cell transplantation (HCT) to determine (a) the percentage of patients with CNS neurological complications based solely on undergoing brain imaging, (b) transplant-related risk factors of undergoing brain imaging, and (c) overall survival in the patients with neurological complications compared to those transplant patients who did not have brain imaging. Methods: Subjects were 543 consecutive recipients (August 2004-August 2007) of allogeneic HCT followed for overall survival for up to 6 years after HCT. Comparisons between patient groups with brain imaging and without brain imaging were tested using the Pearson chi-square test. Survival analyses with outcome time-to-brain-scan started at date of transplant and used Kaplan-Meier methods. Results: Of 543 HCT recipients, 128 patients (24%) underwent brain imaging during the first year after transplantation. There was a greater risk of brain imaging in unrelated donor transplants and in lymphoid as opposed to myeloid malignancies (respective hazard ratios 1.45 and 1.43, P=0.04). Overall survival was significantly worse in unrelated donor transplants (hazard ratio 1.42, P=0.003) and in cord blood transplants (hazard ratio 1.68, P=0.02). Landmark survival analysis of patients alive 1 year after HCT showed worse survival over the next 5 years in those who had brain imaging in the first post transplant year (P<0.0001). Conclusion: These results suggest that development of neurological symptoms or a sign sufficient to prompt clinicians to order brain imaging early after HCT identifies a poor prognosis in transplant population.
ABSTRACT
Primary amyloidosis has unfavorable prognosis, particularly with organ involvement. Here, we report a case of clinical remission of renal amyloidosis after autologous hematopoietic cell transplantation. A 51-year-old female patient visited our hospital due to generalized edema. Initial evaluation showed hyperlipidemia, hypoalbuminemia, and heavy proteinuria, which were consistent with nephrotic syndrome. However, IgM lamda type monoclonal gammopathy was detected in serum and urine electrophoresis studies. Renal biopsy showed Congo red-positive amyloid deposition in mesangial area, glomerular capillary walls, and arterioles and amyloid fibers were confirmed by electron microscopy. Immunohistochemial study of the biopsy tissue demonstrated systemic light-chain amyloidosis (AL amyloidosis). Multiple myeloma was not evident on bone marrow examination. She received autologous hematopoietic cell transplantation after high dose melphalan treatment. Complete remissions were achieved after the treatment, respectively. Our findings suggest the potential role of autologous peripheral blood stem cell transplantation in treatment of AL amyloidosis.
Subject(s)
Female , Humans , Middle Aged , Amyloid , Amyloidosis , Arterioles , Biopsy , Bone Marrow Examination , Capillaries , Cell Transplantation , Congo , Edema , Electrophoresis , Hyperlipidemias , Hypoalbuminemia , Immunoglobulin M , Melphalan , Microscopy, Electron , Multiple Myeloma , Nephrotic Syndrome , Paraproteinemias , Peripheral Blood Stem Cell Transplantation , Plaque, Amyloid , Prognosis , Proteinuria , TransplantsABSTRACT
Primary amyloidosis has unfavorable prognosis, particularly with organ involvement. Here, we report a case of clinical remission of renal amyloidosis after autologous hematopoietic cell transplantation. A 51-year-old female patient visited our hospital due to generalized edema. Initial evaluation showed hyperlipidemia, hypoalbuminemia, and heavy proteinuria, which were consistent with nephrotic syndrome. However, IgM lamda type monoclonal gammopathy was detected in serum and urine electrophoresis studies. Renal biopsy showed Congo red-positive amyloid deposition in mesangial area, glomerular capillary walls, and arterioles and amyloid fibers were confirmed by electron microscopy. Immunohistochemial study of the biopsy tissue demonstrated systemic light-chain amyloidosis (AL amyloidosis). Multiple myeloma was not evident on bone marrow examination. She received autologous hematopoietic cell transplantation after high dose melphalan treatment. Complete remissions were achieved after the treatment, respectively. Our findings suggest the potential role of autologous peripheral blood stem cell transplantation in treatment of AL amyloidosis.
Subject(s)
Female , Humans , Middle Aged , Amyloid , Amyloidosis , Arterioles , Biopsy , Bone Marrow Examination , Capillaries , Cell Transplantation , Congo , Edema , Electrophoresis , Hyperlipidemias , Hypoalbuminemia , Immunoglobulin M , Melphalan , Microscopy, Electron , Multiple Myeloma , Nephrotic Syndrome , Paraproteinemias , Peripheral Blood Stem Cell Transplantation , Plaque, Amyloid , Prognosis , Proteinuria , TransplantsABSTRACT
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (e.g. umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, periand post-transplant exposures and risk-factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
Os avanços na tecnologia do transplante de células hematopoéticas (TCH) e do tratamento de suporte levaram a melhoria na sobrevida a longo prazo após os TCH. Indicações emergentes de transplante, introdução de novas fontes de células (p.ex. sangue de cordão umbilical) e transplante de pacientes mais velhos utilizando regimes de condicionamento menos intensos também contribuíram para o aumento no número de sobreviventes após TCH. Estes sobreviventes estão sob risco de desenvolver complicações tardias devido a exposições e fatores de risco pré, peri e pós-transplante. Práticas recomendadas para a triagem e a prevenção de complicações em sobreviventes de TCH foram publicadas em 2006. Um grupo internacional de especialistas foi formado em 2011 para rever a literatura contemporânea e atualizar as recomendações, considerando as mudanças nas práticas de transplante e a aplicabilidade internacional destas recomendações. Esta revisão fornece as recomendações atualizadas para o diagnóstico precoce e práticas para prevenção de complicações aos sobreviventes de TCH autólogo e alogênico, adultos e crianças.
Subject(s)
Humans , Male , Female , Child , Adult , Hematopoietic Stem Cell Transplantation , Postoperative Complications , Secondary Prevention , Transplantation, Autologous , Transplantation, HomologousABSTRACT
BACKGROUND: We evaluated characteristics of infectious complications in pediatric patients who received monoclonal antibody (mAb) therapy after allogeneic hematopoietic cell transplantation (HCT). METHODS: Between February 2004 and May 2009, 17 pediatric patients (<19 years at diagnosis) who received mAbs were identified as a study group (mAb group). One hundred twenty-two pediatric allogeneic HCT patients (<19 years at diagnosis) who did not receive mAb during the same period were identified as a control group (non-mAb group). A retrospective chart review of medical records was performed for the incidence of infectious complications and mortality. RESULTS: In the mAb group, 12 of the 17 patients (70.6%) had 29 infectious complications (1.71 episodes per person), whereas 89 of the 122 patients (73.8%) had 162 infectious complications (1.32 episodes per person) in the non-mAb group (P=0.838). Although, there were no significant differences in characteristics or incidence of infectious complications between the two groups, the infection-associated mortality rate was significantly higher in the mAb group compared to non-mAb group (29.4% vs. 8.2% P=0.021; RR 3.44, 95% CI, 1.407 to 8.433). CONCLUSION: The mAb therapy was associated with significantly high mortality in pediatric allogeneic HCT recipients.
Subject(s)
Child , Humans , Cell Transplantation , Incidence , Medical Records , Retrospective Studies , TransplantsABSTRACT
BACKGROUND: We evaluated characteristics of infectious complications in pediatric patients who received monoclonal antibody (mAb) therapy after allogeneic hematopoietic cell transplantation (HCT).METHODS: Between February 2004 and May 2009, 17 pediatric patients (<19 years at diagnosis) who received mAbs were identified as a study group (mAb group). One hundred twenty-two pediatric allogeneic HCT patients (<19 years at diagnosis) who did not receive mAb during the same period were identified as a control group (non-mAb group). A retrospective chart review of medical records was performed for the incidence of infectious complications and mortality.RESULTS: In the mAb group, 12 of the 17 patients (70.6%) had 29 infectious complications (1.71 episodes per person), whereas 89 of the 122 patients (73.8%) had 162 infectious complications (1.32 episodes per person) in the non-mAb group (P=0.838). Although, there were no significant differences in characteristics or incidence of infectious complications between the two groups, the infection-associated mortality rate was significantly higher in the mAb group compared to non-mAb group (29.4% vs. 8.2% P=0.021; RR 3.44, 95% CI, 1.407 to 8.433).CONCLUSION: The mAb therapy was associated with significantly high mortality in pediatric allogeneic HCT recipients.
Subject(s)
Child , Humans , Cell Transplantation , Incidence , Medical Records , Retrospective Studies , TransplantsABSTRACT
Traditionally, human leukocyte antigen (HLA)-mismatched hematopoietic cell transplantation (HCT) has been considered ill-advised in a routine clinical practice due to excessive serious post-transplant complications, such as graft failure, graft-versus-host disease, and prolonged immunosuppression resulting in increased fatal infections. Recent introduction of new HCT techniques, especially in the area of conditioning therapy, has improved outcomes of HLAmismatched HCT considerably. Using several regimens of reduced-intensity conditioning (RIC), it is now possible to perform allogeneic HCT in patients without HLA-matched donors in the family or in the registry from HLA-mismatched family donors. Furthermore, due to less rigorous nature of RIC therapy, elderly patients (up to 70 years of age) and patients who have been treated heavily especially with a previous HCT can also be treated. In this review, we gave a brief historical background for the development of allogeneic HCT, discussed rationale for the use RIC for HLA-mismatched HCT, and summarized trial results of HLA-mismatched HCT after RIC. Lastly, future areas of research regarding HLA-mismatched HCT were discussed.