RESUMEN
A case of localized Trichosporon beigelii infection is reported in a 40-year-old woman with Ph+ chronic granulocyte leukemia who underwent autologous blood stem cell transplantation. On day +14 after autograft, while severely neutropenic, she developed a local infection involving the soft tissues surrounding the central venous catheter (CVC) point of entry into the subclavian vein. Trichosporon beigelii was isolated from culture of the CVC tip; resolution occurred after removal of the CVC, neutrophil recovery and antifungal treatment with amphotericin B and 5-fluorocytosine. To our knowledge this is the first case of CVC localized infection from Trichosporon beigelii after transplantation.
Asunto(s)
Transfusión de Sangre Autóloga , Cateterismo Venoso Central/efectos adversos , Trasplante de Células Madre Hematopoyéticas , Micosis/etiología , Trichosporon/aislamiento & purificación , Adulto , Antifúngicos/uso terapéutico , Terapia Combinada , Femenino , Humanos , Huésped Inmunocomprometido , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Leucemia Mieloide de Fase Acelerada/complicaciones , Leucemia Mieloide de Fase Acelerada/terapia , Micosis/tratamiento farmacológico , Micosis/microbiologíaRESUMEN
A 53-yr.-old woman with amyloidosis AL was treated with high-dose chemotherapy and autologous stem cell infusion in an attempt to suppress the amyloid secretion. A diagnosis of MGUS had been made six years earlier. During the last year her disease had progressively shifted to a full-blown picture of amyloidosis AL, with renal failure, proteinuria, renal amyloid deposition and plasma cell sheets in the marrow. After an unsuccessful attempt with standard-dose chemotherapy, she received a high-dose regimen of busulphan (14 mg/Kg) and melphalan (40 mg/m2), followed by the infusion of both autologous bone marrow and peripheral blood stem cells. She had full and prompt engraftment, but eight weeks post-graft developed interstitial pneumonitis: CMV was isolated. The patient died while in the intensive care unit. In the literature, this is the first case of amyloidosis AL treated with high-dose therapy and autologous transplantation.
Asunto(s)
Amiloidosis/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Transfusión de Sangre Autóloga , Trasplante de Células Madre Hematopoyéticas , Paraproteinemias/terapia , Amiloidosis/tratamiento farmacológico , Amiloidosis/etiología , Busulfano/administración & dosificación , Terapia Combinada , Dexametasona , Doxorrubicina/administración & dosificación , Femenino , Humanos , Melfalán/administración & dosificación , Persona de Mediana Edad , Paraproteinemias/complicaciones , Paraproteinemias/tratamiento farmacológico , Fibrosis Pulmonar/complicaciones , Vincristina/administración & dosificaciónRESUMEN
Autologous peripheral blood stem cells (PBSC) collected after an intensive course of chemotherapy were employed for hematological reconstitution in 3 patients (age 24-44 years), 2 with Hodgkin's and 1 with high-grade non-Hodgkin's lymphoma, in 2nd complete or partial remission. PBSC collections were performed with a Fenwal CS-3000 cell separator (programs "3" and "1-modified"). After collection and partial RBC removal, cells were cryopreserved and stocked in liquid nitrogen. In all patients the CVB combination was employed as myeloablative transplant regimen. Patients received respectively 28.0, 33.1 and 12.3 x 10(4)/Kg peripheral blood CFU.GM. Hematologic recovery was prompt and complete in 2 patients, while a patient with Hodgkin's lymphoma who had previously been treated with combined modality, is still moderately thrombocytopenic and granulocytopenic 148 days post graft. Patients are currently alive and disease-free 148-301 days post graft.