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Transplant Cell Ther ; 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34537419


In the coronavirus disease 19 (COVID-19) pandemic era, the number of haploidentical hematopoietic cell transplantations (HCTs) with peripheral blood (PB) grafts increased significantly compared with HCTs with bone marrow (BM) grafts, which may be associated with adverse outcomes. We compared outcomes of HCT in BM graft and PB graft recipients age ≥18 years with hematologic malignancies who underwent T cell- replete haploidentical HCT and received graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide, tacrolimus, and mycophenolate mofetil. Among the 264 patients, 180 (68%) received a BM graft and 84 (32%) received a PB graft. The median patient age was 50 years in both groups. The majority (n = 199; 75%) received reduced-intensity conditioning. The rate of acute leukemia or myelodysplastic syndrome was higher in the BM graft recipients compared with the PB graft recipients (85% [n = 152] versus 55% [n = 46]; P < .01). The median times to neutrophil and platelet engraftment and the incidence of grade II-IV and grade III-IV acute GVHD (aGVHD) were comparable in the 2 groups. Among the patients with grade II-IV aGVHD, the rate of steroid-refractory aGVHD was 9% (95% confidence interval [CI], 5% to 18%) in the BM group versus 32% (95% CI, 19% to 54%) in the PB group (hazard ratio [HR], 3.7, 95% CI, 1.5 to 9.3; P = .006). At 1 year post-HCT, the rate of chronic GVHD (cGVHD) was 8% (95% CI, 4% to 13%) in the BM group versus 22% (95% CI, 14% to 36%) in the PB group (HR, 3.0; 95% CI, 1.4-6.6; P = .005), and the rate of systemic therapy-requiring cGVHD was 2.5% (95% CI, 1% to 7%) versus 14% (95% CI, 7% to 27%), respectively (HR, 5.6; 95% CI, 1.7 to 18; P = .004). The PB group had a significantly higher risk of bacterial and viral infections, with no appreciable advantage in the duration of hospitalization, immune reconstitution, relapse, nonrelapse mortality, or survival. Our data suggest a benefit of the use of BM grafts over PB grafts for haplo-HCT.

Am J Med Sci ; 358(3): 175-181, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31326094


BACKGROUND: Blood cultures are drawn regularly on hematology/oncology patients due to the concern for infectious complications. However, this practice is costly in many ways, and there are limited data to support this practice. We aimed to investigate the frequency with which blood cultures are drawn in these patients, and moreover, how frequently they provide meaningful data. MATERIALS AND METHODS: We performed a single-center retrospective review study in hematology/oncology patients admitted to our hospital. We reviewed 1,437 blood cultures from 220 unique patients between July 1, 2013 and June 30, 2014. We reviewed the proportion and characteristics of the positive blood cultures, as well as organisms isolated. RESULTS: Of all 1,437 blood cultures drawn during the study period, 111 (8%) of the blood cultures grew a clinically meaningful organism. Gram-positive organisms were more likely than gram-negative organisms, with coagulase-negative Staphylococcus and vancomycin-resistant Enterococcus being most common. In patients who were receiving broad-spectrum antimicrobials, only 13 (4%) of 358 blood cultures collected grew a clinically meaningful organism, all of which were performed for clearance. None of these 13 positive blood cultures represented a new infectious organism. No patient receiving broad-spectrum antibiotics with blood cultures drawn in response to a fever had a positive culture. CONCLUSIONS: In hospitalized cancer patients receiving broad-spectrum antimicrobials, the likelihood of growing a new clinically significant organism from a blood culture was extremely low. We speculate that the practice of repeating blood cultures in hospitalized cancer patients on broad-spectrum antimicrobials, particularly in response to fever alone, should be eliminated.

Anti-Infecciosos/administração & dosagem , Hemocultura , Pacientes Internados , Neoplasias/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Neoplasias/microbiologia , Estudos Retrospectivos , Adulto Jovem