Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 94
Filter
1.
Sci Rep ; 14(1): 21481, 2024 09 14.
Article in English | MEDLINE | ID: mdl-39277641

ABSTRACT

Patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) are highly susceptible to infections. The consequent use of masks on wards for allo-HSCT has been controversial in the past decades and was not common before the COVID-19 pandemic. We retrospectively compared incidence and outcomes of viral respiratory infections during allo-HSCT on our specialized ward between 01/2018 and 09/2020 to the era of FFP2 masking between 10/2020 and 10/2022 covering similar seasons of the year. Each group consisted of 150 matched patients. The usage of FFP2 masks reduced the incidence of viral respiratory infections from 22.1 to 2.1% (p < 0.005). This reduced the time on ward from a median of 26 days to 23.5 days (p = 0.002). It also resulted in less use of CT-scans (p = 0.003) and bronchoalveolar lavage procedures (p = 0.057). Median time to proof of infection was 21 days after admission in both groups. No difference was detected in progression free survival, hospital survival or non-relapse mortality (p = 0.78). Our retrospective results indicate that FFP2 masks worn by patients and hospital staff may help to significantly reduce the incidence of viral respiratory infections, including COVID-19, shorten the in-hospital time, and reduce costs without affecting survival.


Subject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , Masks , Respiratory Tract Infections , Humans , Hematopoietic Stem Cell Transplantation/adverse effects , Male , Female , Middle Aged , COVID-19/prevention & control , COVID-19/epidemiology , Respiratory Tract Infections/prevention & control , Respiratory Tract Infections/virology , Respiratory Tract Infections/epidemiology , Retrospective Studies , Adult , Transplantation, Homologous/adverse effects , Aged , SARS-CoV-2/isolation & purification , Incidence
3.
Bone Marrow Transplant ; 59(2): 224-231, 2024 02.
Article in English | MEDLINE | ID: mdl-37993503

ABSTRACT

The optimal conditioning for patients with higher risk MDS receiving potentially curative allogeneic haematopoietic stem cell transplant(allo-HCT) remains to be defined. This is particularly the case for patients with excess of blasts at time of allo-HCT. Sequential (Seq) conditioning, whereby chemotherapy is followed rapidly by transplant conditioning, offers an opportunity to decrease disease burden, potentially improving outcomes allo-HCT outcomes. Herein we present the only analysis comparing Seq to myeloablative (MAC) and reduced intensity conditioning (RIC) specifically focussed on MDS patients with excess of blasts at allo-HCT. 303 patients were identified in the EBMT registry, receiving RIC (n = 158), Seq (n = 105), and MAC (n = 40). Median follow-up was 67.2 months and median age at allo-HCT was 59.5 years (IQR 53.5-65.6). For the entire cohort, 3 y overall survival (OS) was 50% (95% CI 45-56%) and relapse free survival (RFS) 45% (95% CI 40-51%). No significant differences in OS (log-rank p = 0.13) and RFS (log-rank p = 0.18) were observed between conditioning protocols. On multivariable analysis, lower performance status, worse IPSS-R cytogenetics, sibling donor (compared to 8/8 MUD) and ≥20% blasts at allo-HCT were associated with worse outcomes. In conclusion, the Seq protocol did little to influence the outcome in this high-risk group of patients, with outcomes mostly determined by baseline disease risk and patient characteristics such as performance status.


Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Myelodysplastic Syndromes , Humans , Middle Aged , Aged , Retrospective Studies , Transplantation, Homologous/methods , Neoplasm Recurrence, Local , Myelodysplastic Syndromes/therapy , Chronic Disease , Hematopoietic Stem Cell Transplantation/methods , Transplantation Conditioning/methods , Graft vs Host Disease/etiology
5.
Science ; 366(6469): 1143-1149, 2019 11 29.
Article in English | MEDLINE | ID: mdl-31780560

ABSTRACT

Disruption of intestinal microbial communities appears to underlie many human illnesses, but the mechanisms that promote this dysbiosis and its adverse consequences are poorly understood. In patients who received allogeneic hematopoietic cell transplantation (allo-HCT), we describe a high incidence of enterococcal expansion, which was associated with graft-versus-host disease (GVHD) and mortality. We found that Enterococcus also expands in the mouse gastrointestinal tract after allo-HCT and exacerbates disease severity in gnotobiotic models. Enterococcus growth is dependent on the disaccharide lactose, and dietary lactose depletion attenuates Enterococcus outgrowth and reduces the severity of GVHD in mice. Allo-HCT patients carrying lactose-nonabsorber genotypes showed compromised clearance of postantibiotic Enterococcus domination. We report lactose as a common nutrient that drives expansion of a commensal bacterium that exacerbates an intestinal and systemic inflammatory disease.


Subject(s)
Enterococcus/growth & development , Gastrointestinal Microbiome , Graft vs Host Disease/microbiology , Hematopoietic Stem Cell Transplantation , Lactose/metabolism , Aged , Animals , Dysbiosis , Enterococcus/genetics , Enterococcus/metabolism , Feces/microbiology , Female , Gastrointestinal Microbiome/genetics , Humans , Intestines/microbiology , Male , Mice , Microbiota , Middle Aged , RNA, Ribosomal, 16S , Sequence Analysis, RNA , Transplantation, Homologous
6.
Leukemia ; 32(2): 383-390, 2018 02.
Article in English | MEDLINE | ID: mdl-28761118

ABSTRACT

The Dutch-Belgian Cooperative Trial Group for Hematology Oncology Group-65/German-speaking Myeloma Multicenter Group-HD4 (HOVON-65/GMMG-HD4) phase III trial compared bortezomib (BTZ) before and after high-dose melphalan and autologous stem cell transplantation (HDM, PAD arm) compared with classical cytotoxic agents prior and thalidomide after HDM (VAD arm) in multiple myeloma (MM) patients aged 18-65 years. Here, the long-term follow-up and data on second primary malignancies (SPM) are presented. After a median follow-up of 96 months, progression-free survival (censored at allogeneic transplantation, PFS) remained significantly prolonged in the PAD versus VAD arm (hazard ratio (HR)=0.76, 95% confidence interval (95% CI) of 0.65-0.89, P=0.001). Overall survival (OS) was similar in the PAD versus VAD arm (HR=0.89, 95% CI: 0.74-1.08, P=0.24). The incidence of SPM were similar between the two arms (7% each, P=0.73). The negative prognostic effects of the cytogenetic aberration deletion 17p13 (clone size ⩾10%) and renal impairment at baseline (serum creatinine >2 mg dl-1) on PFS and OS remained abrogated in the PAD but not VAD arm. OS from first relapse/progression was similar between the study arms (HR=1.02, P=0.85). In conclusion, the survival benefit with BTZ induction/maintenance compared with classical cytotoxic agents and thalidomide maintenance is maintained without an increased risk of SPM.


Subject(s)
Bortezomib/administration & dosage , Multiple Myeloma/drug therapy , Adolescent , Adult , Aged , Chromosome Aberrations/drug effects , Female , Follow-Up Studies , Hematopoietic Stem Cell Transplantation/methods , Humans , Male , Melphalan/therapeutic use , Middle Aged , Multiple Myeloma/mortality , Multiple Myeloma/pathology , Prognosis , Progression-Free Survival , Thalidomide/therapeutic use , Transplantation, Autologous/methods , Young Adult
7.
Bone Marrow Transplant ; 53(1): 52-57, 2018 01.
Article in English | MEDLINE | ID: mdl-29131156

ABSTRACT

Recent data link the incidence of intestinal GvHD (iGvHD) after allogeneic haematopoietic stem cell transplantation (aSCT) to exposure with piperacillin-tazobactam or imipenem-cilastatin. To assess relevance of timing, duration, sequence and combination of antibiotic treatment in this setting, we applied a time-dependent model to our aSCT cohort. Patients from the prospective Cologne Cohort of Neutropenic Patients (CoCoNut) undergoing aSCT from January 2007 to April 2013 were included into a time-dependent multivariate Cox proportional hazards regression model with backward-stepwise selection. In 399 eligible patients, cumulative antibiotic exposure (hazard ratio (HR) 2.46; 95% confidence interval (95% CI) 1.59-3.81; P<0.001) and exposure to sequential treatment with penicillin derivatives and carbapenems (HR 6.22, 95% CI 1.27-30.31), but not to the individual classes, were associated with iGvHD at day 100. Glycopeptides were assessed as a risk factor (HR 3.73, 95% CI 1.51-9.19), but not considered independent, since their use was dependent on previous exposure to penicillin derivatives and carbapenems. Patients with iGvHD presented with increased non-relapse mortality at day 365 (HR 3.51; 95% CI 2.10-5.89; P<0.001). We identified sequential exposure to penicillin derivatives and carbapenems as well as overall exposure to antibiotics as independent risk factors for iGVHD. Confirmation of these findings in larger, prospective cohorts is necessary.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Hematopoietic Stem Cell Transplantation/methods , Transplantation Conditioning/methods , Transplantation, Homologous/methods , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Treatment Outcome , Young Adult
8.
Bone Marrow Transplant ; 52(11): 1519-1525, 2017 Nov.
Article in English | MEDLINE | ID: mdl-28892084

ABSTRACT

The International Prognostic Scoring System has been revised (IPSS-R) to predict prognosis of patients with myelodysplastic syndromes at diagnosis. To validate the use of the IPSS-R assessed before transplant rather than at diagnosis we performed a retrospective analysis of the EBMT database. A total of 579 patients had sufficient information available to calculate IPSS-R at transplant. Median overall survival (OS) from transplant was significantly different according to IPSS-R: very low 23.6 months, low 55.0 months, intermediate 19.7 months, high 13.5 months, very high 7.8 months (P<0.001). In a multivariate Cox model the following parameters were significant risk factors for OS: IPSS-R, graft source, age and prior treatment. Median relapse free survival also showed significant differences according to IPSS-R: very low: 23.6 months, low: 24.8 months, intermediate 10.6 months, high 7.9 months, very high 5.5 months (P<0.001). Multivariate risk factors for relapse-free survival (RFS) were: IPSS-R, reduced intensity conditioning, graft source and prior treatment. A trend for an increased relapse incidence was noted for very high risk IPSS-R. We conclude that the IPSS-R at transplant is a useful prognostic score for predicting OS and RFS after transplantation, capturing both disease evolution and response to prior treatment before transplant.


Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Leukemia, Myeloid, Acute/diagnosis , Myelodysplastic Syndromes/diagnosis , Prognosis , Adolescent , Adult , Aged , Aged, 80 and over , Databases, Factual , Disease-Free Survival , Female , Hematopoietic Stem Cell Transplantation/mortality , Humans , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Male , Middle Aged , Myelodysplastic Syndromes/mortality , Myelodysplastic Syndromes/therapy , Retrospective Studies , Risk Factors , Survival Rate , Transplantation, Homologous , Young Adult
9.
Orthopade ; 46(1): 25-33, 2017 Jan.
Article in German | MEDLINE | ID: mdl-27981344

ABSTRACT

Due to demographic changes the number of elderly patients undergoing hip replacement surgery is increasing. In order to ensure safe treatment of elderly patients, age-specific medical factors must be taken into consideration. This article presents an overview of these factors. Furthermore, we evaluated our own patients treated between 2010 and 2015 regarding age-related treatment strategies and complication rates. Out of 3166 patients a total of 439 were over 80 years old (average age 84 years). It can be concluded from the scientific literature and from own data that elective hip replacement surgery in elderly patients is a technically safe procedure; however, the risk profile of each patient must be thoroughly analyzed so that in the event of even minor signs of potential complications countermeasures can be taken in good time.


Subject(s)
Arthroplasty, Replacement, Hip/mortality , Elective Surgical Procedures/mortality , Hip Fractures/mortality , Hip Fractures/surgery , Osteoarthritis, Hip/mortality , Osteoarthritis, Hip/surgery , Postoperative Complications/mortality , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Female , Humans , Male , Postoperative Complications/prevention & control , Prevalence , Risk Factors , Survival Rate , Treatment Outcome
10.
Orthopade ; 45(12): 1072-1079, 2016 Dec.
Article in German | MEDLINE | ID: mdl-27535405

ABSTRACT

Necrotizing fasciitis is a life-threatening clinical pattern, which may lead to multi-organ failure and death with delayed diagnosis or inadequate treatment. We report on a 68-year old patient who developed necrotizing fasciitis of the right elbow with multiorgan failure and long-term ventilation after an accidental and minor injury. The patient survived as a result of an early diagnosis and surgical intervention. In this case report we want to clarify the diagnosis and treatment of necrotizing fasciitis and give an overview of the recent literature on the topic.


Subject(s)
Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/surgery , Multiple Organ Failure/diagnosis , Multiple Organ Failure/therapy , Aged , Diagnosis, Differential , Fasciitis, Necrotizing/complications , Humans , Male , Multiple Organ Failure/etiology , Treatment Outcome
SELECTION OF CITATIONS
SEARCH DETAIL