Long-term results of adjuvant donor lymphocyte transfusion in AML after allogeneic stem cell transplantation.

Adjuvant transfusion of donor lymphocytes (aDLT) may reduce the risk of relapse after allogeneic stem cell transplantation in high-risk AML. We performed a retrospective analysis on the safety and efficacy of aDLT in a cohort of 46 patients. To be eligible for aDLT, patients had to be in CR for at least 120 days from transplantation, off immunosuppression for ⩾30 days and free of GvHD. Thirty-four patients with similar disease characteristics and fulfilling the same selection criteria served as controls. Median follow-up among aDLT recipients was 7.2 years. Ten patients (22%) relapsed inspite of aDLT, as compared with 53% in the control group. Induction of GvHD was the main complication. However, non-relapse mortality was low with patients dying from infection (n=2), severe chronic GvHD (n=1) and secondary malignancy (n=2). At the time of analysis, 31/46 aDLT recipients were alive in CR at a median of 5.7 years after first aDLT. Overall survival at 7 years after transplant was 67% as compared with 31% in the control group (P<0.001). In conclusion, aDLT is safe, when given in escalating doses to a well predefined group of patients. Long-term survival can be achieved.

Epidemiological role of arthropods detectable in health facilities.

A total of 161 arthropod specimens were collected from 55 sites in a health care facility during July and September 1990. Of the 116 bacterial isolates obtained from their body surfaces 6% were from parasites (mosquitoes), 59% from eusynanthropic arthropods (Tenebrionid beetles, flies, German cockroaches, wasps), 16% from hemisynanthropic arthropods (ants, spiders) and 19% from occasionally encountered insects (non-biting midges, moths, beetles). Most (88%) of the isolated bacteria were Gram-negative rods of the species E. coli, Enterobacter, Klebsiella, Citrobacter, Proteus, Serratia, Pseudomonas and Acinetobacter. Gram-positive cocci accounted for 13% of isolates and were primarily represented by coagulase-negative staphylococci. The highest isolation rates were from body surfaces of flies, German cockroaches, non-biting midges (Chironomids) and Tenebrionid beetles. About one third of all isolates were resistant to more than three antimicrobials using a standard disc diffusion assay. The presence of multiple resistance to antibiotics was observed in two thirds of Enterobacter isolates, namely those of Enterobacter cloacae from the body surface of Germany cockroaches, in 13% of Citrobacter spp and in 8% of Klebsiella spp as well as Acinetobacter calcoaceticus strains. Strains of Morganella and Hafnia species were very infrequent but all of them shared resistance to the antibiotics tested. In contrast, strains of Serratia spp were relatively antibiotic-sensitive. The group of isolated Gram-positive organisms was represented by two strains of Staphylococcus hominis and one strain of Enterococcus sp, all of them were multiply-resistant to antimicrobials.

Calcineurin inhibitor-free GVHD prophylaxis with sirolimus, mycophenolate mofetil and ATG in Allo-SCT for leukemia patients with high relapse risk: an observational cohort study.

Certain leukemias have a high relapse risk even after allo-SCT, and GVHD prophylaxis with calcineurin inhibitors (CNIs) may interfere with a possible GVL effect. Therefore, we replaced CYA by sirolimus in patients with high relapse risk. In contrast to CNIs, sirolimus promotes the generation of regulatory T-cells and has potent antineoplastic activity. Sirolimus has been used in combination with CNI for GVHD prophylaxis in hematopoietic SCT. However, no CNI-free prophylactic regimen with sirolimus has been evaluated so far. Within the FLAMSA-RIC protocol, 15 patients received GVHD prophylaxis with sirolimus and mycophenolate mofetil (MMF). The underlying diagnoses were relapsed or refractory T-ALL (n=3), AML with FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) or mixed-lineage leukemia-partial tandem duplication (MLL-PTD; n=10; 5 with refractory disease) and CML in refractory myeloid blast crisis (n=2). All evaluable patients (n=14) were engrafted. Grades II-IV acute GVHD occurred in 21% and chronic GVHD in 30% of patients. Non-relapse mortality rate was 14%. No thrombotic microangiopathy or sinusoidal obstruction syndrome was observed. Three patients with FLT3-ITD+ AML relapsed after a median of 112 days. At a median follow-up of 10 months after transplantation, 10 patients are alive and in complete remission. In conclusion, sirolimus-based GVHD prophylactic regimens deserve further investigation.

Sensitivity of strains of Candida albicans to jaritin, haloprogin, clotrimazole and miconazole.

The antifungal activity of jaritin and haloprogin against Candida albicans is similar. In vitro they had less activity than clotrimazole and miconazole, but the activity was independent of inoculum size.

In vitro bacteriological study of a new antibiotic substance: sisomicin.

Effects of a new antimicrobial agent sisomicin on microorganisms isolated from pathologic material (Pseudomonas aeruginosa, Staphylococcus aureus, Serratia marcescens, Klebsiella pneumoniae, Salmonella spp., Streptococcus pyogenes-B, Citrobacter Freundii) were studied. The results obtained were compared with another two aminoglycoside antibiotics - gentamicin and tobramycin. All three antibiotics were found to be very effective in vitro; their effect was enhanced by addition of an antibiotic of the penicillin group (carbenicillin, suncillin) or an antibiotic of the tetracyklin series (oxytetracyklin, doxycyklin). All three preparations were tested on 26 Mycobacterium tuberculosis strains. Tobramycin inhibited growth of 22 strains and thus presented the highest level of efficiency among these deoxystreptamin preparations.

The effects of chemotherapeutics on the species streptococcus in vitro.

The authors studied the sensitivity of some rather recent products--flucloxacillin, doxycyclin, clindamycin and cotrimoxazol--in correlation with classical penicillin. If therapy by means of classical penicillins is unsuitable, clindamycin and the semi-synthetic penicillin flucloxacillin appear to be a further alternative and the most suitable chemotherapeutic in streptococcal infections.

Yersinia enterocolitica, indole-negative and indole-positive biotypes. Isolation, identification and sensitivity to chemotherapeutics.

A population of 200 Y. enterocolitica strains of the serotype 03 and 100 strains belonging to other serotypes mostly, however, to the biotype 1 were examined for their sensitivity to chemotherapeutics. The serotype 03 strains were obtained from human material of diarrhoeal cases, the origin of other serotypes was various. They originated from human extraintestinal material, animals, water and foods. To summarize their results, the authors elaborated an antibiogram presented in graphs.

Combination effect with some aminoglycoside antibiotics.

Strains of resistant species -- Staphylococcus aureus and Streptococcus faecalis -- isolated from material of nosocomial infections in the surgical department of a Prague hospital were tested for combined effect with further chemotherapeutics. The same concerned Ps, aeruginosa noted, at present, by a high degree of resistance. In Ps. aeruginosa it was the combination sisomicin-carfecillin that proved a success in 50 p. c. of cases as well as that of sisomicin-doxycyclin. At the same time the authors draw attention to the possibility of antagonistic action of the combination sisomicin-chloramphenicol in a third part of the strains tested. Potentiation of the effect in Staphylococcus aureus strains was observed also in the combination sisomicin-carfecillin in more than one half of the strains tested and in case of sisomicin-doxycyclin in one third of the strains. In Streptococcus faecalis strains sisomicin was combined with amoxycillin, carbenicillin, carfecillin and doxycyclin; synergistic action being observed with all those combinations in more than one half of strains tested. No antagonism was registered in those cases. (Ta.).

Lytic manifestations in the bacterial strains of Pseudomonas aeruginosa (bacteriophages bacteriocines, autoplaques).

Ps. aeruginosa strains--a frequement resuet of an irresponsible antibiotic therapy--represent a common agent of nosocomial infektions. At the same time, gravity of Pseudomonas diseases is also increasing. Lysogeny, bacteriocinogeny and frequent occurrence of autoplaques are the lytic manifestations of Pseudomonas aeruginosa strains which play a great role in the complexity of solving diagnostic, epidemiological end therapeutical problems connected with infections induced by these microbes. A survey is presented of the importance and utilization of the lytic properties of bacterial strains of Pseudomonas aeruginosa during the differentiation, epidemiological typing and further expansion of therapeutical possibilities in infections caused by Pseudomonas aeruginosa bacteria.

Concerning the sensitivity of Acinetobacter calcoaceticus.

The strains of Acinetobacter calcoaceticus, var. anitratus (A. c. a.) were isolated in the nosocomial environment as an opportune pathogen. The therapy of choice may be determined after in vitro tests. Our results show following therapeutical possibilities: beta-lactam antibiotics--cephalosporins of IIIrd generation (cefotaxime), also combinations of antimicrobials have shown good results: amoxycillin or ticarcillin with clavulanic acid. Best synergistic effect was found in combination ticarcillin-amikacin.