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Styczynski J, Tridello G, Knelange N, Wendel L, Ljungman P, Mikulska M, Gil L, Cesaro S, Averbuch D, von dem Borne P, Xhaard A, Mielke S, Neven B, Snowden JA, Dalle JH, Rubio MT, Crawley C, Maertens J, Kuball J, Chevallier P, Michel G, Gabriel M, Burns D, Wynn RF, Renard C, Blijlevens N, Jubert C, Gedde-Dahl T, Collin M, Labussiere-Wallet H, Kalwak K, Broers AEC, Yakoub-Agha I, Itäla-Remes M, de la Camara R. Adenovirus infections after allogeneic hematopoietic cell transplantation in children and adults: a study from the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2024; 59:1402-1412. [PMID: 38987308 DOI: 10.1038/s41409-024-02361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/12/2024]
Abstract
The objective of the study was the analysis of clinical types, outcomes, and risk factors associated with the outcome of adenovirus (ADV) infection, in children and adults after allo-HCT. A total number of 2529 patients (43.9% children; 56.1% adults) transplanted between 2000 and 2022 reported to the EBMT database with diagnosis of ADV infection were analyzed. ADV infection manifested mainly as viremia (62.6%) or gastrointestinal infection (17.9%). The risk of 1-year mortality was higher in adults (p = 0.0001), and in patients with ADV infection developing before day +100 (p < 0.0001). The 100-day overall survival after diagnosis of ADV infections was 79.2% in children and 71.9% in adults (p < 0.0001). Factors contributing to increased risk of death by day +100 in multivariate analysis, in children: CMV seropositivity of donor and/or recipient (p = 0.02), and Lansky/Karnofsky score <90 (p < 0.0001), while in adults: type of ADV infection (viremia or pneumonia vs gastrointestinal infection) (p = 0.0004), second or higher HCT (p = 0.0003), and shorter time from allo-HCT to ADV infection (p = 0.003). In conclusion, we have shown that in patients infected with ADV, short-term survival is better in children than adults. Factors directly related to ADV infection (time, clinical type) contribute to mortality in adults, while pre-transplant factors (CMV serostatus, Lansky/Karnofsky score) contribute to mortality in children.
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Affiliation(s)
- Jan Styczynski
- Department of Pediatric Hematology and Oncology, University Hospital, Collegium Medicum UMK, Bydgoszcz, Poland.
| | - Gloria Tridello
- Department of Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, The Netherlands
| | - Nina Knelange
- Department of Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, The Netherlands
| | - Lotus Wendel
- Department of Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, The Netherlands
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Departments of Medicine Huddinge and Laboratory Medicine, Karolinska University Hospital, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lidia Gil
- Department of Hematology, Poznan University of Medical Sciences, Poznan, Poland
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Diana Averbuch
- Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter von dem Borne
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aliénor Xhaard
- Department of Hematology, BMT, Hopital St. Louis, Paris, France
| | - Stephan Mielke
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Departments of Medicine Huddinge and Laboratory Medicine, Karolinska University Hospital, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Benedicte Neven
- Unité d'Immunologie et d'Hématologie, Hôpital Necker, Paris, France
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jean-Hugues Dalle
- Pediatric Hematology and Immunology Department, Hôpital Robert Debre, Paris, France
| | | | - Charles Crawley
- Department of Hematology, Addenbrookes Hospital, Cambridge, UK
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jurgen Kuball
- Department of Hematology, University Medical Centre, Utrecht, The Netherlands
| | | | - Gérard Michel
- Département Hématologie Oncologie Pédiatrique, Hopital d'Enfants de la Timone, CHU, Marseille, France
| | - Melissa Gabriel
- Oncology Unit, The Children's Hospital at Westmead, Sydney, Australia
| | - David Burns
- University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Robert F Wynn
- Department of Pediatric Hematology, Bone Marrow Unit, Central Manchester NHS Trust, Manchester, UK
| | - Cecile Renard
- Institut d'Hematologie et d'Oncologie Pediatrique, Lyon, France
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Charlotte Jubert
- Onco-Hématologie Pédiatrique, CHU Bordeaux Groupe Hospitalier Pellegrin-Enfants, Bordeaux, France
| | - Tobias Gedde-Dahl
- Department of Hematology, Section for Stem Cell Transplantation, Oslo University Hospital, Rikshospitalet, Clinic for Cancer Medicine, Oslo, Norway
| | - Matthew Collin
- Northern Centre for Bone Marrow Transplantation, Newcastle, UK
| | | | - Krzysztof Kalwak
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, 50-556, Wroclaw, Poland
| | | | | | - Maija Itäla-Remes
- TD7 (Stem Cell Transplant Unit), Turku University Hospital, Turku, Finland
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La Rosa C, Park Y, Yang D, Zhou Q, Kaltcheva T, Karras N, Cheng J, Sun W, Diamond DJ, Pawlowska A. Cytomegalovirus Triplex vaccine in pediatric hematopoietic stem cell transplant patients at high risk for cytomegalovirus complications: evaluation of vaccine safety, immunogenicity and impact on viremia requiring antivirals. Haematologica 2024; 109:2303-2308. [PMID: 38426277 PMCID: PMC11215362 DOI: 10.3324/haematol.2023.284256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Corinna La Rosa
- Department of Hematology and Hematopoietic Cell Transplantation.
| | - Yoonsuh Park
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Dongyun Yang
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Qiao Zhou
- Department of Hematology and Hematopoietic Cell Transplantation
| | | | - Nicole Karras
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA
| | - Jerry Cheng
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA
| | - Weili Sun
- The Janssen Pharmaceutical Companies of Johnson and Johnson, Los Angeles, CA
| | - Don J Diamond
- Department of Hematology and Hematopoietic Cell Transplantation
| | - Anna Pawlowska
- Department of Pediatrics, City of Hope National Medical Center, Duarte, CA
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Pickett LR, Daukshus NP, Camacho-Bydume C, Mathew S, Mauguen A, Cohen N, Cancio M. Retrospective Evaluation of Cystatin C as a Measure of Renal Function in Pediatric Hematopoietic Stem Cell Transplant Patients Receiving Foscarnet for Cytomegalovirus Reactivation. Pediatr Infect Dis J 2024; 43:457-462. [PMID: 38190640 DOI: 10.1097/inf.0000000000004238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection following allogeneic hematopoietic cell transplantation has considerable morbidity and mortality, and foscarnet is a treatment option that requires renal dose adjustment. Serum creatinine (SCr)-based estimated glomerular filtration rate (eGFR) equations are used to estimate renal function for patients receiving foscarnet, but cystatin C (cysC) has been shown as a possible alternative. Data examining cysC-based eGFR in this population is sparse. Our primary objective was to evaluate outcomes of patients treated with foscarnet dosed utilizing cysC-based eGFR versus SCr-based eGFR. METHODS We analyzed patients on the transplantation and cellular therapies service at Memorial Sloan Kettering Kids from January 2011 to September 2021 who received allogeneic hematopoietic cell transplantation and ≥14 days of foscarnet for CMV infection. Patients with cysC-based eGFR were compared to a historical cohort of patients who only had SCr-based eGFR. Outcomes included time to CMV clearance, death or change in anti-CMV therapy. Cumulative incidence curves and cause-specific hazards model were used for analysis. RESULTS In 61 analyzed patients, no differences were found between the cohorts in cumulative incidence of change in anti-CMV therapy ( P = 0.17) or death ( P = 0.69). After adjustment for multiple confounders, patients in the SCr cohort seemed to have a higher chance of CMV clearance compared with the cysC cohort, but the difference was not statistically significant (hazard ratio = 2.42, P = 0.089). Patients who received corticosteroids appeared to have lower incidence of CMV clearance ( P = 0.056). CONCLUSIONS We did not find differences in outcomes when dosing foscarnet using cysC versus SCr for treatment of CMV infection.
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Affiliation(s)
- Logan R Pickett
- From the Department of Pharmacy, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Nicole P Daukshus
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Christine Camacho-Bydume
- Department of Pediatric Blood and Marrow Transplant and Cellular Therapy, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | - Sherry Mathew
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York City, New York
| | | | - Nina Cohen
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Maria Cancio
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York City, New York
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4
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Balletto E, Ponzano M, Raiola AM, Gambella M, Grazia CD, Dominietto A, Giannoni L, Ghiso A, Nicolini LA, Sepulcri C, Ullah N, Bruzzone B, Signori A, Angelucci E, Bassetti M, Mikulska M. Adenovirus infection in adult patients undergoing allogeneic hematopoietic stem cell transplant: Incidence, clinical management, and outcome. Transpl Infect Dis 2024; 26:e14215. [PMID: 38192010 DOI: 10.1111/tid.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Adenovirus infection (ADVi) is an emergent complication in adult patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with poor outcome. Available data on risk factors and optimal management of ADVi in adult allo-HSCT recipients are limited, and recommendations on monitoring and pre-emptive therapy are mainly based on pediatric data. METHODS In this single-center, retrospective study, we reported all cases of positive ADV-DNA from adult patients undergoing allo-HSCT in the period 2014-2019. The study aimed to describe the incidence of ADVi at day +180 post-transplant. Secondly to describe timing, clinical presentation, risk factors, and outcome of ADVi and to analyze the application of a screening strategy in our cohort. RESULTS In 445 allo-HSCT recipients, the day +180 incidence was: 9% (39/445) for ADVi, 5% (24/445) for ADV viremia (ADVv), and 3% (15/445) for localized ADVi. The median time to ADVi was 65 (IQR 19; 94) days after HSCT. ADVv-related mortality was 13% (3/24), all cases occurring with blood max-ADV-DNA > 10^3 cp/mL. Independent risk factors for ADVi were diagnosis of lymphoproliferative disease (p = .011) and acute graft-versus-host-disease (p = .021). CONCLUSIONS In our cohort, ADVi and ADVv were more frequent than previously reported. ADVv with max-ADV-DNA > 10^3 cp/mL was associated with ADV-related mortality, thus careful monitoring and early initiation of treatment are advisable.
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Affiliation(s)
- Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Anna Maria Raiola
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Massimiliano Gambella
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Carmen Di Grazia
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Alida Dominietto
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Livia Giannoni
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Anna Ghiso
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Nadir Ullah
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy
| | - Emanuele Angelucci
- Division of Trapianto di cellule staminali e terapie cellulari, San Martino Hospital, Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Adamska M, Kowal-Wiśniewska E, Barańska M, Przybyłowicz-Chalecka A, Łojko-Dankowska A, Joks M, Jarmuż-Szymczak M, Gil L. Acute Myeloid Leukemia Post Cytotoxic Therapy in Breast Cancer Survivors-Over 23 Years of Single Center Analysis. J Clin Med 2024; 13:989. [PMID: 38398301 PMCID: PMC10888691 DOI: 10.3390/jcm13040989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Acute myeloid leukemia post cytotoxic therapy (AML-pCT) among breast cancer (BC) survivors represents a life-threatening complication. This study aims to assess the clinical outcomes of AML-pCT post BC. Methods: An analysis of all AML patients treated at a single hematology center (2000-2023) was performed to select patients with AML-pCT post BC. We applied the 2022 ELN criteria to define the genetic risk. Results: Among 847 AML patients, 28 were diagnosed with AML-pCT following BC. Complex karyotype (CK) occurred in 23.8% of patients. The median overall survival (OS) was 40 months. The survival outcomes were better after allogenic hematopoietic stem cell transplantation (alloHCT) treatment compared to chemotherapy alone (median OS: 47 versus 7 months, p = 0.008). Patients demonstrating CK showed lower survival compared to those without CK (2-year OS: 25.0% versus 66.2%, p = 0.0048). The multivariable Cox proportional hazards regression model indicated that treatment with alloHCT emerged as a significant factor associated with improved OS. The treatment was associated with superior OS (HR = 0.07, 95% CI = 0.01-0.86, p = 0.04). Conclusions: Patients with AML-pCT following BC were characterized with the highest frequency of adverse genetic risk profiles and demonstrated worse survival rates. AlloHCT should be performed as early as possible in such patients. The growing need for studies on inherited cancer susceptibility underscores the importance of close AML-pCT development monitoring in BC survivors.
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Affiliation(s)
- Monika Adamska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Ewelina Kowal-Wiśniewska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
| | - Marta Barańska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Anna Przybyłowicz-Chalecka
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Anna Łojko-Dankowska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Monika Joks
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
| | - Małgorzata Jarmuż-Szymczak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznan, Poland
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Styczynski T, Sadlok J, Richert-Przygonska M, Debski R, Zalas-Wiecek P, Czyzewski K, Styczynski J. Infection With Saprochaete Clavata in Children After Hematopoietic Cell Transplantation. J Pediatr Hematol Oncol 2023; 45:e976-e979. [PMID: 37278583 DOI: 10.1097/mph.0000000000002686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023]
Abstract
Septic shock is a very rare manifestation of invasive fungal disease (IFD) in children after allogeneic hematopoietic cell transplantation (allo-HCT). The objective of this paper is analysis of two cases of pediatric patients with IFD caused by Saprochaete clavata after allo-HCT. Literature data on this infection in children and its outcome were also summarized. Infection with Saprochaete clavate presenting with symptoms of septic shock was being reported in 4 children, and 2 of them survived the infection. In conclusion, with quick diagnosis and quick treatment, the outcome of therapy of infection with Saprochaete clavata was successful.
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Affiliation(s)
- Tomasz Styczynski
- Departments of Pediatric Hematology and Oncology
- Student Scientific Society, Collegium Medicum, Nicolaus Copernicus University, Poland
| | - Jagoda Sadlok
- Departments of Pediatric Hematology and Oncology
- Student Scientific Society, Collegium Medicum, Nicolaus Copernicus University, Poland
| | | | | | - Patrycja Zalas-Wiecek
- Microbiology, Collegium Medicum, Nicolaus Copernicus University, Jurasz University Hospital 1, Bydgoszcz
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7
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Jiménez-Hernández E, Núñez-Enriquez JC, Arellano-Galindo J, de los Angeles Del Campo-Martínez M, Reynoso-Arenas PV, Reyes-López A, Delgado-Gaytan AV, Del Socorro Méndez-Tovar M, Marín-Palomares T, Dueñas-Gonzalez MT, Ortíz-Fernández A, Montero-Ponce I, Espinosa-Hernández LE, Núñez-Villegas NN, Pérez-Casillas R, Sánchez-Jara B, García-Soto A, Herver-Olivares AN, Jaimes-Reyes EZ, Tiznado-García HM, Martínez-Villegas O, Valdez-Garibay B, Del Rocío Loza-Santiaguillo P, García-Jiménez X, Ortíz-Torres G, Fernández-Castillo GJ, Aguilar-Olivares DM, Díaz-Padilla LA, Noya-Rodríguez MA, García-Jiménez M, Mejía-Aranguré JM. Infections and risk factors for infection-related mortality after pediatric allogeneic hematopoietic stem cell transplantation in Mexico: A single center retrospective study. PLoS One 2023; 18:e0284628. [PMID: 37773955 PMCID: PMC10540957 DOI: 10.1371/journal.pone.0284628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/04/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE To identify the type of infections and risk factors for infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Retrospective cohort study of patients <16 years of age treated in 2010-2019 was conducted. Unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) with 95% confidence intervals (95% CIs) were estimated using Cox regression. Cumulative incidence was calculated. RESULTS Data for 99 pediatric patients were analyzed. The myeloablative conditioning was the most used regimen (78.8%) and the hematopoietic stem cell source was predominantly peripheral blood (80.8%). Primary graft failure occurred in 19.2% of patients. Frequency of acute graft-versus-host disease was 46.5%. Total of 136 infectious events was recorded, the most common of which were bacterial (76.4%) followed by viral infection (15.5%) and then fungal infection (8.1%). The best predictors for infection subtypes where the following: a) for bacterial infection (the age groups of 10.1-15 years: aHR = 3.33; 95% CI: 1.62-6.85 and. >15 years: aHR = 3.34; 95% CI: 1.18-9.45); b) for viral infection (graft versus host disease: aHR = 5.36; 95% CI: 1.62-17.68), however, for fungal infection statistically significant predictors were not identified. Related mortality was 30% (n = 12). Increased risk for infection-related mortality was observed in patients with unrelated donor and umbilical cord stem cells recipients (HR = 3.12; 95% CI: 1.00-9.85). CONCLUSIONS Frequencies of infections and infection-related mortality appear to be similar to those reported. Unrelated donors and stem cells from umbilical cord recipients were associated with a high risk of mortality.
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Affiliation(s)
- Elva Jiménez-Hernández
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Juan Carlos Núñez-Enriquez
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE, Hospital de Pediatría, CMN “Siglo XXI”, IMSS, Mexico City, Mexico
| | - José Arellano-Galindo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - María de los Angeles Del Campo-Martínez
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Alfonso Reyes-López
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, de la Secretaría de Salud, México City, Mexico
| | | | | | - Teresa Marín-Palomares
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - María Teresa Dueñas-Gonzalez
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Antonio Ortíz-Fernández
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Inés Montero-Ponce
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Laura Eugenia Espinosa-Hernández
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Nora Nancy Núñez-Villegas
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Ruy Pérez-Casillas
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Berenice Sánchez-Jara
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Angel García-Soto
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Annecy Nelly Herver-Olivares
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Ethel Zulie Jaimes-Reyes
- Centro Estatal de Cancerología, “Dr. Miguel Dorantes-Mesa”, Secretaría de Salud, Xalapa Veracruz, México
| | - Hector Manuel Tiznado-García
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Octavio Martínez-Villegas
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Betzayda Valdez-Garibay
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Paloma Del Rocío Loza-Santiaguillo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Xochiketzalli García-Jiménez
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
- Hospital Pediátrico Coyoacán, Secretaría de Salud Gobierno de la Ciudad de México, Mexico City, México
| | - Guadalupe Ortíz-Torres
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Gabriela Jazmin Fernández-Castillo
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Dulce María Aguilar-Olivares
- Servicio de Hematología Pediátrica y Unidad de Trasplante de Médula Osea, Unidad Médica de Alta Especialidad (UMAE), Centro Médico Nacional (CMN)” La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Luis Alejandro Díaz-Padilla
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Mario Alberto Noya-Rodríguez
- Laboratorio de Virología Clínica y Experimental, Unidad de Investigación Unidad de Investigación en Enfermedades Infecciosas, Hospital Infantil de México “Federico Gómez” Ciudad de México, México, Mexico
| | - Mariana García-Jiménez
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Manuel Mejía-Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE, Hospital de Pediatría, CMN “Siglo XXI”, IMSS, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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8
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Popova MO, Rogacheva YA. Invasive mycoses in patients with hematological malignancies and recipients of hematopoietic stem cell transplantation: results of a systematic review, literature review and meta-analysis. ONCOHEMATOLOGY 2023. [DOI: 10.17650/1818-8346-2023-18-1-101-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- M. O. Popova
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - Yu. A. Rogacheva
- Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
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9
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Chan CYW, Gani SMA, Chung WH, Chiu CK, Hasan MS, Kwan MK. A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients. Global Spine J 2023; 13:81-88. [PMID: 33648369 PMCID: PMC9837521 DOI: 10.1177/2192568221991510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
STUDY DESIGN Retrospective propensity score matching (PSM) study. OBJECTIVE To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). METHODS 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. RESULTS Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients (P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) (P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable (P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. CONCLUSION Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.
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Affiliation(s)
- Chris Yin Wei Chan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anaesthesiology, Faculty
of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery
(NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,Mun Keong Kwan, Department of Orthopedic
Surgery, National Orthopedic Centre of Excellence for Research and Learning
(NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur,
Malaysia.
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10
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Secondary antibody deficiency in chronic lymphocytic leukemia and non-Hodgkin lymphoma: Recommendations from an international expert panel. Blood Rev 2022. [DOI: 10.1016/j.blre.2022.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Hill JA, Moon SH, Chandak A, Zhang Z, Boeckh M, Maziarz RT. Clinical and Economic Burden of Multiple Double-Stranded DNA Viral Infections after Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2022; 28:619.e1-619.e8. [DOI: 10.1016/j.jtct.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/27/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
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12
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Waszczuk-Gajda A, Penack O, Sbianchi G, Koster L, Blaise D, Reményi P, Russell N, Ljungman P, Trneny M, Mayer J, Iacobelli S, Kobbe G, Scheid C, Apperley J, Touzeau C, Lenhoff S, Jantunen E, Anagnostopoulos A, Paris L, Browne P, Thieblemont C, Schaap N, Sierra J, Yakoub-Agha I, Garderet L, Styczynski J, Schoemans H, Moiseev I, Duarte RF, Peric Z, Montoto S, van Biezen A, Mikulska M, Aljurf M, Ruutu T, Kröger N, Morris C, Koenecke C, Schoenland S, Basak GW. Complications of Autologous Stem Cell Transplantation in Multiple Myeloma: Results from the CALM Study. J Clin Med 2022; 11:jcm11123541. [PMID: 35743620 PMCID: PMC9225651 DOI: 10.3390/jcm11123541] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: The main goal of this post hoc analysis of the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study was to evaluate the rate of short- and long-term infectious and non-infectious complications occurring after ASCT in patients with multiple myeloma (MM). Methods: The analysis included all patients with MM from the CALM study who underwent ≥1 ASCT. The primary endpoint of the analysis was to determine the rate of infectious and non-infectious complications after ASCT and to compare them in three time periods: 0−100 days, 101 days−1 year, and >1 year after the first transplant. Results: The analysis included a total of 3552 patients followed up for a median of 56.7 months (range 0.4−108.1). Complication rates decreased with the time from ASCT with 24.85 cases per 100 patient-years from day 0 to 100 days after the transplant, and <2.31 cases per 100 patient-years from the 101st day. At 100 days after ASC T, 45.7% of patients had complications, with infectious events being twice as frequent as non-infectious complications. Bacterial infections (6.5 cases per 100 patient-years, 95% CI: 6.1−7.0) and gastrointestinal complications (4.7 cases per 100 patient-years, 95% CI: 4.3−5.1) were the most common early events. The pattern of complications changed with time from ASCT. The presence of complications after ASCT was not associated with overall survival. Conclusions: Our data provide a solid basis for comparing ASCT-related complications to those caused by emerging treatments in multiple myeloma, such as CAR T-cell therapy and other immunotherapies.
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Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Centre—The Medical University of Warsaw, 02-097 Warsaw, Poland;
- Correspondence:
| | - Olaf Penack
- Charité Universitätsmedizin Berlin, 10771 Berlin, Germany;
| | | | - Linda Koster
- EBMT Data Office Leiden, 2333 AA Leiden, The Netherlands; (L.K.); (A.v.B.)
| | | | | | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, 17177 Stockholm, Sweden;
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Marek Trneny
- University Hospital, 12808 Prague, Czech Republic;
| | - Jiri Mayer
- University Hospital Brno, 62500 Brno, Czech Republic;
| | | | - Guido Kobbe
- Heinrich Heine Universitaet, 40225 Duesseldorf, Germany;
| | | | | | | | | | - Esa Jantunen
- Department of Medicine, University of Eastern Finland and Hospital District of North Carelia, Kuopio University Hospital, 70211 Kuopio, Finland;
| | | | - Laura Paris
- Division of Hematology, SST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | | | | | - Nicolaas Schaap
- Radboud University Medical Centre, Department of Hematology, 6525 GA Nijmegen, The Netherlands;
| | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, 08001 Barcelona, Spain;
| | | | - Laurent Garderet
- Centre de Recherche Saint-Antoine, Sorbonne Université-INSERM, UMR_S 938, 75013 Paris, France;
- Département d’Hématologie et de Thérapie Cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpetrière, 75012 Paris, France
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum UMK, 85-067 Bydgoszcz, Poland;
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Public Health and Primary Care, ACCENT VV, KU Leuven—University of Leuven, 3000 Leuven, Belgium
| | - Ivan Moiseev
- R.M. Gorbacheva Memorial Institute of Hematology, Oncology and Transplantation, Pavlov University, 197022 Saint-Petersburg, Russia;
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda—Universidad Autónoma de Madrid, 28222 Madrid, Spain;
| | - Zinaida Peric
- Department of Internal Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew’s Hospital, Barts Health NHS Trust, London EC1A 7BE, UK;
| | - Anja van Biezen
- EBMT Data Office Leiden, 2333 AA Leiden, The Netherlands; (L.K.); (A.v.B.)
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, 16121 Genoa, Italy;
- Division of Infectious Diseases, IRC CS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mahmoud Aljurf
- Section of Adult Haematolgy/BMT, King Faisal Specialist Hospital & Research Centre Oncology, Riyadh 11564, Saudi Arabia;
| | - Tapani Ruutu
- Comprehensive Cancer Center, Department of Hematology, Helsinki University Hospital and University of Helsinki, 00290 Helsinki, Finland;
- Clinical Research Institute, Helsinki University Hospital and University of Helsinki, 00280 Helsinki, Finland
| | | | | | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, 30625 Hannover, Germany;
| | - Stefan Schoenland
- Department of Internal Medicine V, Division of Hematology/Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany;
| | - Grzegorz W. Basak
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Centre—The Medical University of Warsaw, 02-097 Warsaw, Poland;
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Camacho-Bydume C, Mauguen A, Rodriguez-Sanchez MI, Klein E, Kernan NA, Prockop S, Boelens JJ, Papanicolaou GA, Cancio M. Time to initiation of pre-emptive therapy for cytomegalovirus impacts overall survival in pediatric hematopoietic stem cell transplant recipients. Cytotherapy 2022; 24:428-436. [PMID: 35042670 PMCID: PMC10019069 DOI: 10.1016/j.jcyt.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AIMS Cytomegalovirus (CMV) reactivation is a significant complication following allogeneic hematopoietic stem cell transplant (HSCT) and affects upwards of 40% of pediatric HSCT patients. Pre-emptive therapy remains the only effective treatment strategy available for pediatric patients following CMV reactivation. Little is known about how the timing of induction treatment following CMV reactivation impacts outcomes in pediatric patients, especially following ex vivo T-cell-depleted (TCD) HSCT. METHODS The authors evaluated how the timing of induction treatment after CMV reactivation impacts overall survival (OS) and CMV disease in pediatric patients undergoing TCD HSCT at a single institution. The authors retrospectively analyzed patients treated on the pediatric service who received an initial ex vivo TCD HSCT at Memorial Sloan Kettering Cancer Center (MSKCC) from January 2010 to June 2018. CMV reactivation was defined as ≥1 CMV polymerase chain reaction >500 copies/mL in whole blood or >137 IU/mL in plasma within the first 180 days after allogeneic HSCT. To analyze the impact of the timing of induction treatment, the authors' primary study outcome was OS and secondary outcome was CMV disease. RESULTS A total of 169 patients who underwent an initial allogeneic TCD HSCT on the pediatric service at MSKCC from January 2010 to June 2018 were included in the analysis. Thirty-seven (22%) patients reactivated CMV during the first 180 days following HSCT. Of those patients who reactivated CMV, CMV donor/recipient (D/R) serostatus was as follows: D+/R+ n = 28 (76%) and D-/R+ n = 9 (24%). There was no CMV reactivation observed among recipients who were CMV-seronegative irrespective of donor serostatus. In those patients who reactivated CMV, the median time from HSCT to CMV reactivation was 24 days (interquartile range, 20-31). Eleven patients ultimately developed CMV disease in addition to CMV viremia, whereas the remaining patients had only CMV viremia. The cumulative incidence of CMV reactivation at 60 days was 45.2% (95% confidence interval [CI], 32.8-57.5) in the D+/R+ subgroup and 31% (95% CI, 14.2-47.9) in the D-/R+ subgroup. For those patients who reactivated CMV, 30 (81%) received induction treatment with ganciclovir or foscarnet. To analyze the impact of the timing of induction treatment on clinical outcomes, the authors restricted the analysis to those patients who reactivated CMV and received induction treatment (n = 30). The timing of induction treatment was significantly associated with OS, with optimal timing of initiation within a week of CMV reactivation (P = 0.02). There was no significant impact on the timing of induction treatment and risk of CMV disease (P = 0.30). CONCLUSIONS In ex vivo TCD HSCT in pediatric patients, early initiation of induction treatment after CMV reactivation is associated with improved OS.
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Affiliation(s)
- Christine Camacho-Bydume
- General Oncology Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M Irene Rodriguez-Sanchez
- Pediatric Translational Medicine Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Klein
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy A Kernan
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Prockop
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Maria Cancio
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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14
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Perez P, Patiño J, Franco AA, Rosso F, Beltran E, Manzi E, Castro A, Estacio M, Valencia DM. Prophylaxis for invasive fungal infection in pediatric patients with allogeneic hematopoietic stem cell transplantation. Blood Res 2022; 57:34-40. [PMID: 35256547 PMCID: PMC8958374 DOI: 10.5045/br.2021.2021127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Antifungal prophylaxis is recommended for hematopoietic stem cell transplantation (HSCT) to decrease the incidence of invasive fungal infections (IFI). This study aimed to compare the two groups of antifungal prophylaxis in pediatric patients undergoing allogeneic HSCT. Methods This observational, analytic, retrospective cohort study compared the incidence of IFI with antifungal prophylaxis with voriconazole vs. other antifungals in the first 100 days after allogeneic HSCT in patients aged <18 years between 2012 and 2018. The statistical analysis included univariate and multivariate analyses and determination of the cumulative incidence of invasive fungal infection by the Kaplan‒Meier method using STATA 14 statistical software. Results A total of 139 allogeneic HSCT were performed. The principal diagnosis was acute leukemia (63%). The 75% had haploidentical donors, and 50% used an antifungal in the month before transplantation. Voriconazole (69%) was the most frequently administered antifungal prophylaxis. The cumulative incidence of IFI was 5% (7 cases). Of the patients with IFIs, four began prophylaxis with voriconazole, one with caspofungin, and one with fluconazole. Additionally, six were possible cases, one was proven (Candida parapsilosis), and 1/7 died. Conclusion There were no differences in the incidence of IFI between patients who received prophylaxis with voriconazole and other antifungal agents.
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Affiliation(s)
- Paola Perez
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Servicio de Infectología Pediátrica, Departamento Materno-infantil, Cali, Colombia
| | - Jaime Patiño
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Servicio de Infectología Pediátrica, Departamento Materno-infantil, Cali, Colombia
| | - Alexis A. Franco
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Unidad de trasplante de médula ósea, Departamento Materno-infantil, Cali, Colombia
| | - Fernando Rosso
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Estefania Beltran
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Eliana Manzi
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Andrés Castro
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Mayra Estacio
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Diego Medina Valencia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Unidad de trasplante de médula ósea, Departamento Materno-infantil, Cali, Colombia
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15
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Wysocka-Słowik A, Gil L, Ślebioda Z, Kręgielczak A, Dorocka-Bobkowska B. Oral mucositis in patients with acute myeloid leukemia treated with allogeneic hematopoietic stem cell transplantation in relation to the conditioning used prior to transplantation. Ann Hematol 2021; 100:2079-2086. [PMID: 34117519 PMCID: PMC8285359 DOI: 10.1007/s00277-021-04568-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/04/2021] [Indexed: 11/02/2022]
Abstract
This study was designed to investigate the frequency and severity of oral mucositis in patients with acute myeloid leukemia after allogeneic hematopoietic cell transplantation, in relation to the type of conditioning used. Eighty patients diagnosed with acute myeloid leukemia were assigned to two groups based on the conditioning regimen used before transplantation. The intensity of oral inflammatory lesions induced by chemotherapy (oral mucositis) was evaluated according to a 5-point scale recommended by World Health Organization. Oral mucosa was investigated in all patients before the transplantation and during two subsequent stages of the post-transplantation procedure in relation to the conditioning regimen used. Mucositis in the oral cavity was observed in the majority of patients (66%) in the first week after transplantation, whereas the largest percentage of patients suffering oral lesions (74%) occurred in the second week after transplantation. A significantly higher percentage of patients with mucositis was observed in the group which underwent myeloablation therapy (74% of MAC and 50% of RIC patients in the first week; 83% of MAC and 53% of RIC patients in the second examination).The severity of mucositis after transplantation was higher in the MAC patients compared to the RIC patients. The highest mean value of the mucositis index was recorded in the second week in the MAC group (1.59). In AML sufferers receiving allo-HSCT, oral mucositis is a significant complication of the transplantation. This condition is more frequent and more severe in patients after treatment with myeloablation therapy.
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Affiliation(s)
- Aleksandra Wysocka-Słowik
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznań, Poland
| | - Zuzanna Ślebioda
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland.
| | - Agnieszka Kręgielczak
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland
| | - Barbara Dorocka-Bobkowska
- Department of Gerodontology and Oral Pathology, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland
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16
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Yu U, Wang X, Zhang X, Wang C, Yang C, Zhou X, Li Y, Huang X, Wen J, Wen F, Liu S. Cytomegalovirus Infection and the Implications of Drug-Resistant Mutations in Pediatric Allogeneic Hematopoietic Stem Cell Transplant Recipients: A Retrospective Study from a Tertiary Hospital in China. Infect Dis Ther 2021; 10:1309-1322. [PMID: 33966176 PMCID: PMC8322184 DOI: 10.1007/s40121-021-00452-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Drug-resistant cytomegalovirus (CMV) infection remains a challenge in the management of pediatric recipients of hematopoietic stem cell transplantation (HSCT). In this study, we retrospectively reviewed the clinical data on pediatric recipients of HSCT and identified known and unknown drug-resistant CMV variants. METHODS A total of 221 children underwent allogeneic HSCT between October 2017 and November 2019 at Shenzhen Children's Hospital; of these, 35 patients were suspected of having drug-resistant CMV infections and were tested for drug-resistant mutations in the UL97 and UL54 genes by Sanger sequencing. RESULTS Mutations in UL97 or UL54, or in both, were detected in 11 patients. Most of these mutations have not been previously reported. The UL97 mutation (A582V) was detected in only one patient who also harbored two UL54 mutations (T760X and R876W). One patient with both the G604S and T691A mutations in the UL54 gene died of CMV pneumonia. We investigated the risk factors associated with the development of drug-resistant CMV infection. Patients in whom both the donor and recipient had positive CMV serostatuses were less likely to have drug-resistant mutations (Fisher's exact test, p < 0.05). CONCLUSION Newly and previously detected CMV mutations in UL97 and UL54 may be associated with the development of drug-resistant CMV infection. The detection of these mutations may provide guidance for the management of post-transplant CMV infections.
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Affiliation(s)
- Uet Yu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Xiaodong Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Xiaoling Zhang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Chunjing Wang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Chunlan Yang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Xiaohui Zhou
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Yue Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Xiaochan Huang
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Jing Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Yitian Road No. 7019, Futian, Shenzhen, 518038, China.
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17
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Potential Risk Factors Associated With Graft Failure of Haploidentical Hematopoietic Stem Cell Transplantation in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2021; 43:e583-e586. [PMID: 32604335 DOI: 10.1097/mph.0000000000001873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
Nonmyeloablative (NMA) haploidentical hematopoietic stem cell transplantation for sickle cell disease has significantly increased donor availability for transplant and is increasingly used as curative treatment. The authors describe 3 pediatric patients who rejected grafts after an NMA regimen, previously reported to result in good engraftment rates in the mainly adult population. In this manuscript, potential factors contributing to rejection are described and discussed. The authors emphasize the need to further optimize the NMA regimens in pediatric patients and perform haploidentical transplants for sickle cell disease on clinical trials.
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18
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Enok Bonong PR, Zahreddine M, Buteau C, Duval M, Laporte L, Lacroix J, Alfieri C, Trottier H. Factors Associated with Post-Transplant Active Epstein-Barr Virus Infection and Lymphoproliferative Disease in Hematopoietic Stem Cell Transplant Recipients: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2021; 9:288. [PMID: 33808928 PMCID: PMC8003684 DOI: 10.3390/vaccines9030288] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
This systematic review was undertaken to identify risk factors associated with post-transplant Epstein-Barr virus (EBV) active infection and post-transplant lymphoproliferative disease (PTLD) in pediatric and adult recipients of hematopoietic stem cell transplants (HSCT). A literature search was conducted in PubMed and EMBASE to identify studies published until 30 June 2020. Descriptive information was extracted for each individual study, and data were compiled for individual risk factors, including, when possible, relative risks with 95% confidence intervals and/or p-values. Meta-analyses were planned when possible. The methodological quality and potential for bias of included studies were also evaluated. Of the 3362 titles retrieved, 77 were included (62 for EBV infection and 22 for PTLD). The overall quality of the studies was strong. Several risk factors were explored in these studies, but few statistically significant associations were identified. The use of anti-thymocyte globulin (ATG) was identified as the most important risk factor positively associated with post-transplant active EBV infection and with PTLD. The pooled relative risks obtained using the random-effect model were 5.26 (95% CI: 2.92-9.45) and 4.17 (95% CI: 2.61-6.68) for the association between ATG and post-transplant EBV infection and PTLD, respectively. Other risk factors for EBV and PTLD were found in the included studies, such as graft-versus-host disease, type of conditioning regimen or type of donor, but results are conflicting. In conclusion, the results of this systematic review indicate that ATG increases the risk of EBV infection and PTLD, but the link with all other factors is either nonexistent or much less convincing.
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Affiliation(s)
- Pascal Roland Enok Bonong
- Department of Social and Preventive Medicine, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (P.R.E.B.); (M.Z.)
| | - Monica Zahreddine
- Department of Social and Preventive Medicine, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (P.R.E.B.); (M.Z.)
| | - Chantal Buteau
- Department of Pediatrics, Division of Infectious Diseases, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1C5, Canada;
| | - Michel Duval
- Department of Pediatrics, Division of Hematology-Oncology, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1C5, Canada;
| | - Louise Laporte
- Research Center of CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada;
| | - Jacques Lacroix
- Department of Pediatrics, Division of Pediatric Intensive Care Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1C5, Canada;
| | - Caroline Alfieri
- Departement of Microbiology, Infectiology and Immunology, Université de Montréal, CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada;
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (P.R.E.B.); (M.Z.)
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19
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Jerry Teng CL, Wang PN, Chen YC, Ko BS. Cytomegalovirus management after allogeneic hematopoietic stem cell transplantation: A mini-review. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 54:341-348. [PMID: 33514495 DOI: 10.1016/j.jmii.2021.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/05/2023]
Abstract
Because of the high incidence of cytomegalovirus (CMV) seropositivity in the population, CMV infection is a common and severe complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Taiwan. Here we propose a CMV management strategy for patients undergoing allo-HSCT from the Taiwanese perspective, which focuses on the epidemiology, diagnosis, monitoring, prophylaxis, and treatment of CMV infection after allo-HSCT. In terms of CMV monitoring, weekly CMV monitoring with the COBAS® AmpliPrep system is the standard approach because the pp65 CMV antigenemia assay has a lower sensitivity than CMV monitoring with the COBAS® AmpliPrep system. However, pp65 CMV antigenemia assay has a better correlation with clinical symptoms in immunocompromised patients. A 14-week prophylactic course of letermovir is recommended for allo-HSCT recipients in Taiwan, especially for recipients of hematopoietic stem cells from mismatched unrelated and haploidentical donors. Preemptive ganciclovir therapy should be initiated when the CMV viral load exceeds 1000 copies/mL, and should not be discontinued until CMV DNA is no longer detected in the blood. For allo-HSCT recipients who have CMV-related diseases, ganciclovir with or without CMV-specific intravenous immunoglobulin is the standard of care. The limited availability of foscarnet, an alternative for patients who are not responsive to or cannot tolerate ganciclovir, is a crucial issue in Taiwan. For pediatric allo-HSCT recipients, more data are needed to propose a CMV management recommendation.
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Affiliation(s)
- Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Po-Nan Wang
- Division of Hematology, Department of Internal Medicine, Chang Gung Medical Foundation Linkou Branch, Taoyuan, Taiwan
| | - Yee-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, National Taiwan University, College of Medicine, Taiwan
| | - Bor-Sheng Ko
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.
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20
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Abstract
Following primary infection, herpesviruses establish latency in infected individuals in the host cells and may reactivate upon external stimuli and during periods of immunosuppression. The objective of this paper was to the present current strategies on preventive and therapeutic management of infections with herpesviruses in recipients of hematopoietic cell transplantation. Strategies of antiviral management include prophylaxis, pre-emptive treatment and targeted treatment. Empirical therapy is not used in antiviral strategies. Prophylaxis can be done at universal (preventive strategy) and specific level. Universal prophylaxis includes non-pharmacologic methods of prevention of infection or reactivation. Risk-adapted specific prophylaxis includes use of specific antivirals or cellular therapy or other specific methods in order to prevent specific infection, in high-risk groups. Pre-emptive therapy means use of therapeutic approaches in asymptomatic infection, detected by a screening assay. Targeted therapy is used in established specific viral end-organ infections. The following sections of the paper refer to prophylaxis and treatment strategies, respectively, against CMV, EBV, HSV, VZV, HHV-6, HHV-7, and HHV-8 after allogeneic hematopoietic cell transplantation.
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21
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McMasters M, Blair BM, Lazarus HM, Alonso CD. Casting a wider protective net: Anti-infective vaccine strategies for patients with hematologic malignancy and blood and marrow transplantation. Blood Rev 2020; 47:100779. [PMID: 33223246 DOI: 10.1016/j.blre.2020.100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023]
Abstract
Patients who have hematologic malignancies are at high risk for infections but vaccinations may be effective prophylaxis. The increased infection risk derives from immune defects secondary to malignancy, the classic example being CLL, and chemotherapies and immunotherapy used to treat the malignancies. Therapy of hematologic malignancies is being revolutionized by introduction of novel targeted agents and immunomodulatory medications, improving the survival of patients. At the same time those agents uniquely change the infection risk and response to immunizations. This review will summarize current vaccine recommendations for patients with hematologic malignancies including patients who undergo hematopoietic cell transplant.
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Affiliation(s)
- Malgorzata McMasters
- Division of Hematologic Malignancy and Bone Marrow Transplant, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA
| | - Barbra M Blair
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Carolyn D Alonso
- Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, Boston, MA 02215, USA.
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22
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Akinboyo IC, Young RR, Spees LP, Heston SM, Smith MJ, Chang YC, McGill LE, Martin PL, Jenkins K, Lugo DJ, Hazen KC, Seed PC, Kelly MS. Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients. Open Forum Infect Dis 2020; 7:ofaa093. [PMID: 32284949 PMCID: PMC7141603 DOI: 10.1093/ofid/ofaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/12/2020] [Indexed: 12/02/2022] Open
Abstract
Background Children undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for hospital-associated bloodstream infections (HA-BSIs). This study aimed to describe the incidence, microbiology, and risk factors for HA-BSI in pediatric HSCT recipients. Methods We performed a single-center retrospective cohort study of children and adolescents (<18 years of age) who underwent HSCT over a 20-year period (1997–2016). We determined the incidence and case fatality rate of HA-BSI by causative organism. We used multivariable Poisson regression to identify risk factors for HA-BSI. Results Of 1294 patients, the majority (86%) received an allogeneic HSCT, most commonly with umbilical cord blood (63%). During the initial HSCT hospitalization, 334 HA-BSIs occurred among 261 (20%) patients. These were classified as gram-positive bacterial (46%), gram-negative bacterial (24%), fungal (12%), mycobacterial (<1%), or polymicrobial (19%). During the study period, there was a decline in the cumulative incidence of HA-BSI (P = .021) and, specifically, fungal HA-BSIs (P = .002). In multivariable analyses, older age (incidence rate ratio [IRR], 1.03; 95% confidence interval [CI], 1.01–1.06), umbilical cord blood donor source (vs bone marrow; IRR, 1.69; 95% CI, 1.19–2.40), and nonmyeloablative conditioning (vs myeloablative; IRR, 1.85; 95% CI, 1.21–2.82) were associated with a higher risk of HA-BSIs. The case fatality rate was higher for fungal HA-BSI than other HA-BSI categories (21% vs 6%; P = .002). Conclusions Over the past 2 decades, the incidence of HA-BSIs has declined among pediatric HSCT recipients at our institution. Older age, umbilical cord blood donor source, and nonmyeloablative conditioning regimens are independent risk factors for HA-BSI among children undergoing HSCT.
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Affiliation(s)
- Ibukunoluwa C Akinboyo
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebecca R Young
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah M Heston
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Smith
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Yeh-Chung Chang
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren E McGill
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.,Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina, USA
| | - Paul L Martin
- Division of Pediatric Blood and Marrow Transplantation, Duke University Medical Center, Durham, North Carolina, USA
| | - Kirsten Jenkins
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Debra J Lugo
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Kevin C Hazen
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick C Seed
- Division of Pediatric Infectious Diseases, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
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