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Suryadevara N, Otrelo-Cardoso AR, Kose N, Hu YX, Binshtein E, Wolters RM, Greninger AL, Handal LS, Carnahan RH, Moscona A, Jardetzky TS, Crowe JE. Functional and structural basis of human parainfluenza virus type 3 neutralization with human monoclonal antibodies. Nat Microbiol 2024:10.1038/s41564-024-01722-w. [PMID: 38858594 DOI: 10.1038/s41564-024-01722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/02/2024] [Indexed: 06/12/2024]
Abstract
Human parainfluenza virus type 3 (hPIV3) is a respiratory pathogen that can cause severe disease in older people and infants. Currently, vaccines against hPIV3 are in clinical trials but none have been approved yet. The haemagglutinin-neuraminidase (HN) and fusion (F) surface glycoproteins of hPIV3 are major antigenic determinants. Here we describe naturally occurring potently neutralizing human antibodies directed against both surface glycoproteins of hPIV3. We isolated seven neutralizing HN-reactive antibodies and a pre-fusion conformation F-reactive antibody from human memory B cells. One HN-binding monoclonal antibody (mAb), designated PIV3-23, exhibited functional attributes including haemagglutination and neuraminidase inhibition. We also delineated the structural basis of neutralization for two HN and one F mAbs. MAbs that neutralized hPIV3 in vitro protected against infection and disease in vivo in a cotton rat model of hPIV3 infection, suggesting correlates of protection for hPIV3 and the potential clinical utility of these mAbs.
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Affiliation(s)
| | | | - Nurgun Kose
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yao-Xiong Hu
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elad Binshtein
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachael M Wolters
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, USA
| | - Laura S Handal
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert H Carnahan
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Moscona
- Departments of Pediatrics, Microbiology and Immunology, and Physiology and Cellular Biophysics, and Center for Host-Pathogen Interaction, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Theodore S Jardetzky
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, USA.
| | - James E Crowe
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
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2
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Pérez A, Gómez D, Montoro J, Chorão P, Hernani R, Guerreiro M, Villalba M, Albert E, Carbonell-Asins JA, Hernández-Boluda JC, Navarro D, Solano C, Piñana JL. Are any specific respiratory viruses more severe than others in recipients of allogeneic stem cell transplantation? A focus on lower respiratory tract disease. Bone Marrow Transplant 2024:10.1038/s41409-024-02304-4. [PMID: 38730040 DOI: 10.1038/s41409-024-02304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
In the general population, influenza virus, respiratory syncytial virus, and SARS-CoV-2 are considered the most severe community-acquired respiratory viruses (CARVs). However, allogeneic stem cell transplant (allo-SCT) recipients may also face severe courses from other CARVs. This retrospective study compared outcomes of various CARV lower respiratory tract diseases (LRTD) in 235 adult allo-SCT recipients, excluding co-infection episodes. We included 235 adults allo-SCT recipients experiencing 353 CARV LRTD consecutive episodes (130 rhinovirus, 63 respiratory syncytial virus, 43 influenza, 43 human parainfluenza virus, 23 human metapneumovirus, 19 Omicron SARS-CoV-2, 17 common coronavirus, 10 adenovirus and 5 human bocavirus) between December 2013 and June 2023. Day 100 overall survival ranged from 78% to 90% without significant differences among CARV types. Multivariable analysis of day 100 all-cause mortality identified corticosteroid use of >1 to <30 mg/d [Hazard ratio (HR) 2.45, p = 0.02) and ≥30 mg/d (HR 2.20, p = 0.015) along with absolute lymphocyte count <0.2 × 109/L (HR 5.82, p < 0.001) and number of CARV episodes as a continuous variable per one episode increase (HR 0.48, p = 0.001) as independent risk factors for all-cause mortality. Degree of immunosuppression, rather than intrinsic CARV virulence, has the most significant impact on mortality in allo-SCT recipients with CARV-LRTD.
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Affiliation(s)
- Ariadna Pérez
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Eliseo Albert
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | - Juan Carlos Hernández-Boluda
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Department of Hematology. Hospital Clínico Universitario of Valencia, Spain. INCLIVA Biomedical Research Institute, Valencia, Spain.
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3
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Riccò M, Parisi S, Corrado S, Marchesi F, Bottazzoli M, Gori D. Respiratory Syncytial Virus Infections in Recipients of Bone Marrow Transplants: A Systematic Review and Meta-Analysis. Infect Dis Rep 2024; 16:317-355. [PMID: 38667752 PMCID: PMC11050314 DOI: 10.3390/idr16020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Human Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infections. Usually associated with infants and children, an increasing amount of evidence suggests that RSV can cause substantial morbidity and mortality in immunocompromised individuals, including recipients of bone marrow transplantation (BMT). The present systematic review was therefore designed in accordance with the PRISMA guidelines to collect available evidence about RSV infections in BMT recipients. Three medical databases (PubMed, Embase, and MedRxiv) were therefore searched for eligible observational studies published up to 30 September 2023 and collected cases were pooled in a random-effects model. Heterogeneity was assessed using I2 statistics. Reporting bias was assessed by means of funnel plots and regression analysis. Overall, 30 studies were retrieved, including 20,067 BMT cases and 821 RSV infection episodes. Of them, 351 were lower respiratory tract infections, and a total of 78 RSV-related deaths were collected. A pooled attack rate of 5.40% (95% confidence interval [95%CI] 3.81 to 7.60) was identified, with a corresponding incidence rate of 14.77 cases per 1000 person-years (95%CI 9.43 to 20.11), and a case fatality ratio (CFR) of 7.28% (95%CI 4.94 to 10.60). Attack rates were higher in adults (8.49%, 95%CI 5.16 to 13.67) than in children (4.79%, 95%CI 3.05 to 7.45), with similar CFR (5.99%, 95%CI 2.31 to 14.63 vs. 5.85%, 95%CI 3.35 to 10.02). By assuming RSV attack rates as a reference group, influenza (RR 0.518; 95%CI 0.446 to 0.601), adenovirus (RR 0.679, 95%CI 0.553 to 0.830), and human metapneumovirus (RR 0.536, 95%CI 0.438 to 0.655) were associated with a substantially reduced risk for developing corresponding respiratory infection. Despite the heterogeneous settings and the uneven proportion of adult and pediatric cases, our study has identified high attack rates and a substantial CFR of RSV in recipients of BMT, stressing the importance of specifically tailored preventive strategies and the need for effective treatment options.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Milan, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 38122 Trento, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
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4
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Long Y, Zheng Y, Li C, Guo Z, Li P, Zhang F, Liu W, Wang Y. Respiratory pathogenic microbial infections: a narrative review. Int J Med Sci 2024; 21:826-836. [PMID: 38617014 PMCID: PMC11008481 DOI: 10.7150/ijms.93628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
Respiratory infectious diseases have long been recognised as a substantial global healthcare burden and are one of the leading causes of death worldwide, particularly in vulnerable individuals. In the post COVID-19 era, there has been a surge in the prevalence of influenza virus A and other multiple known viruses causing cold compared with during the same period in the previous three years, which coincided with countries easing COVID-19 restrictions worldwide. This article aims to review community-acquired respiratory illnesses covering a broad spectrum of viruses, bacteria, and atypical microorganisms and focuses on the cluster prevalence of multiple known respiratory pathogens in China, thereby providing effective prevention and control measures.
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Affiliation(s)
- Yiyin Long
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yan Zheng
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Changlin Li
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Zhanjun Guo
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Peng Li
- Department of Radiology, Tianjin First Center Hospital, Tianjin 300192, China
| | - Fuqing Zhang
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Wei Liu
- Tianjin Children's Hospital, Children's Hospital, Tianjin University, Tianjin 300134, China
| | - Yuliang Wang
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
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Alzahrani RS, Alzahrani M, Shuraim W, Aldibasi O, Albarrak K, Habib A, Ahmed M, Alsadi H, Alahmari B, Alsaedy A, Bosaeed M. Outcome of Respiratory Viral Infections in Hematopoietic Stem Cell Transplant Recipients. Transplant Proc 2024; 56:186-190. [PMID: 38242760 DOI: 10.1016/j.transproceed.2023.10.008] [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: 06/24/2023] [Revised: 10/01/2023] [Accepted: 10/22/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Respiratory viral infections (RVIs) commonly cause morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. This study aimed at the prevalence of RVIs in adult HSCT recipients and their outcomes. METHODS A retrospective observational cohort study was conducted on all adult patients who underwent HSCT in the period between January 2016 and December 2020. Data were retrospectively abstracted from electronic medical records from a total of 400 patients. All cases with polymerase chain reaction-confirmed RVIs based on real-time reverse transcription polymerase chain reaction were included in the data analysis. RESULT A total of 79 patients had positive results. Sixty-three patients had allogeneic stem cell transplants. Women were 53% of the patients, and the mean age was 32 years (±13.5). The prevalence of documented respiratory virus infections was around 20% during the 4 years of the study. The most common virus was rhinovirus (60.76%), followed by respiratory syncytial virus (15.19%), then parainfluenza (11.39%). Among the 9 patients (11%) who required intensive care unit admission, 67% had lymphopenia (P = .03), 71% had abnormal chest computed tomography scan with pleural effusion (P = .03), 22% required renal support (P = .057), and 2 patients (22%) died (P = .057). CONCLUSIONS The study highlights the associated morbidity and mortality with RVIs among HSCT recipients and the need for more preventive measures and treatment studies.
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Affiliation(s)
- Rahmah S Alzahrani
- Infectious Diseases Division, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Mohsen Alzahrani
- Divisions of Adult Hematology and SCT, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Wadi Shuraim
- Infectious Diseases Division, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Omar Aldibasi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khaled Albarrak
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Habib
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mazen Ahmed
- Divisions of Adult Hematology and SCT, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Husam Alsadi
- Divisions of Adult Hematology and SCT, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bader Alahmari
- Divisions of Adult Hematology and SCT, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Alsaedy
- Infectious Diseases Division, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- Infectious Diseases Division, Internal Medicine Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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6
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Piñana JL, Pérez A, Chorão P, Guerreiro M, García-Cadenas I, Solano C, Martino R, Navarro D. Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances. Transpl Infect Dis 2023; 25 Suppl 1:e14117. [PMID: 37585370 DOI: 10.1111/tid.14117] [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: 05/01/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Before the COVID-19 pandemic, common community-acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well-being of allogeneic hematopoietic cell transplant (allo-HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo-HCT recipients, face when infected with SARS-CoV-2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo-HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo-HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
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Affiliation(s)
- Jose L Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Navarro
- Microbiology department, Hospital Clinico Universitario de Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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Tang L, Huang Z, Mei H, Hu Y. Immunotherapy in hematologic malignancies: achievements, challenges and future prospects. Signal Transduct Target Ther 2023; 8:306. [PMID: 37591844 PMCID: PMC10435569 DOI: 10.1038/s41392-023-01521-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 08/19/2023] Open
Abstract
The immune-cell origin of hematologic malignancies provides a unique avenue for the understanding of both the mechanisms of immune responsiveness and immune escape, which has accelerated the progress of immunotherapy. Several categories of immunotherapies have been developed and are being further evaluated in clinical trials for the treatment of blood cancers, including stem cell transplantation, immune checkpoint inhibitors, antigen-targeted antibodies, antibody-drug conjugates, tumor vaccines, and adoptive cell therapies. These immunotherapies have shown the potential to induce long-term remission in refractory or relapsed patients and have led to a paradigm shift in cancer treatment with great clinical success. Different immunotherapeutic approaches have their advantages but also shortcomings that need to be addressed. To provide clinicians with timely information on these revolutionary therapeutic approaches, the comprehensive review provides historical perspectives on the applications and clinical considerations of the immunotherapy. Here, we first outline the recent advances that have been made in the understanding of the various categories of immunotherapies in the treatment of hematologic malignancies. We further discuss the specific mechanisms of action, summarize the clinical trials and outcomes of immunotherapies in hematologic malignancies, as well as the adverse effects and toxicity management and then provide novel insights into challenges and future directions.
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Affiliation(s)
- Lu Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China
| | - Zhongpei Huang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China.
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China.
- Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, 430022, Wuhan, China.
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, 430022, Wuhan, China.
- Hubei Key Laboratory of Biological Targeted Therapy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China.
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[Chinese expert consensus on the application of metagenomic next-generation sequencing technology in the diagnosis of pathogens in hematological patients (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:617-623. [PMID: 37803833 PMCID: PMC10520238 DOI: 10.3760/cma.j.issn.0253-2727.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 10/08/2023]
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9
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Ammad Ud Din M, Jaan A, Shahzad M, Liaqat H, McGuirk J, Mushtaq MU. Poor hospitalization outcomes in patients undergoing allogeneic hematopoietic stem cell transplant with hospital acquired influenza infection. Transpl Infect Dis 2023; 25:e14066. [PMID: 37129229 DOI: 10.1111/tid.14066] [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: 01/06/2023] [Revised: 04/02/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Although hospital-acquired influenza infection (HAII) is a known complication among immunocompromised patients, the data in the setting of hospitalization for allogeneic hematopoietic stem cell transplant (allo-HSCT) are scarce. METHODS A retrospective study using the National Inpatient sample database was done to determine the impact of HAII on hospitalization outcomes among patients admitted for allo-HSCT. RESULTS The data for 77 103 allo-HSCT weighted hospitalizations were collected between 2002 and 2019. Among these, only 314 (0.4%) allo-HSCT cases were billed for HAII. Patients with influenza were more likely to have comorbid conditions like chronic obstructive lung disease, diabetes mellitus, hypertension, and myocardial infarction. Multivariate logistic regression revealed that patients with influenza had a higher risk of all-cause mortality: (odds ratio = 4.87, 95% confidence interval: 3.63-6.54; p < .01). Patients with influenza also had statistically higher odds of developing acute kidney injury, septic shock, and respiratory failure requiring mechanical ventilation. They also had a significantly longer length of stay (34 days versus 26 days) and adjusted cost for hospitalization ($195 345 versus $121 967). CONCLUSION Our large analysis of real-world data reveals that patients undergoing allo-HSCT that develop HAII are at substantially higher risk of inpatient complications and death.
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Affiliation(s)
- Mohammad Ammad Ud Din
- Department of Hematology/Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA
- Department of Hematology/Oncology, University of South Florida, Tampa, Florida, USA
| | - Ali Jaan
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Moazzam Shahzad
- Department of Hematology/Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida, USA
- Department of Hematology/Oncology, University of South Florida, Tampa, Florida, USA
| | - Hania Liaqat
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, Medical Center, Kansas University, Kansas City, Kansas, USA
| | - Muhammad Umair Mushtaq
- Division of Hematologic Malignancies and Cellular Therapeutics, Medical Center, Kansas University, Kansas City, Kansas, USA
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10
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Temporal Changes in SARS-CoV-2 Infection Pattern in Patients Admitted with Hematological Diseases—A Single Center Experience from North India. HEMATO 2023. [DOI: 10.3390/hemato4010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Previous studies have shown the vulnerability of hematological patients with the Coronavirus disease of 2019 (COVID-19). We aimed to compare the outcomes and risk factors for poor survival in patients with hematological conditions hospitalized with COVID-19 infection. Single centre, retrospective, cohort study included all patients with a hematological condition admitted to Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India between 1 April 2020 and 31 May 2021. Of a total of 154 patients, 81 were in the pre-delta group and 73 were in the delta group out of which 21 (25.97%) in the pre-delta group and 24 (33.88%) patients in the delta group died. Haematological characteristics—age > 60 years, progressive hematological cancer, more than two lines of anti-cancer therapy, and active chemo-immunotherapy or targeted therapy were associated with higher mortality in the delta group. COVID-19 characteristics associated with higher mortality during the delta wave were severity of COVID infection, higher oxygen requirements, and COVID plasma therapy There were no deaths in individuals (n = 15) within the delta group who received COVID-19 vaccination. This study adds to the evidence that patients with hematological diseases are a particularly vulnerable group and the delta variant of the virus is associated with higher mortality. We could identify patient characteristics and features related to COVID-19 infection and underlying hematological conditions that were associated with poor outcomes in the delta sub-group. Vaccination was found to be an effective strategy for overcoming mortality and morbidity in these patients.
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11
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Yim KC, Mousa JJ, Blanco JCG, Kim S, Boukhvalova MS. Human Metapneumovirus (hMPV) Infection and MPV467 Treatment in Immunocompromised Cotton Rats Sigmodon hispidus. Viruses 2023; 15:476. [PMID: 36851691 PMCID: PMC9966515 DOI: 10.3390/v15020476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Human metapneumovirus (hMPV) is an important cause of respiratory disease in immunocompromised individuals, yet hMPV infection has not been modeled before in immunocompromised animals. In this work, cotton rats S. hispidus immunosuppressed by cyclophosphamide were infected with hMPV, and viral replication and pulmonary inflammation in these animals were compared to those in normal hMPV-infected S. hispidus. The efficacy of prophylactic and therapeutic administration of the anti-hMPV antibody MPV467 was also evaluated. Immunosuppressed animals had higher pulmonary and nasal titers of hMPV on day 5 post-infection compared to normal animals, and large amounts of hMPV were still present in the respiratory tract of immunosuppressed animals on days 7 and 9 post-infection, indicating prolonged viral replication. Immunosuppression was accompanied by reduced pulmonary histopathology in hMPV-infected cotton rats compared to normal animals; however, a delayed increase in pathology and pulmonary chemokine expression was seen in immunosuppressed cotton rats. Prophylactic and therapeutic MPV467 treatments protected both upper and lower respiratory tracts against hMPV infection. The lung pathology and pulmonary expression of IP-10 and MIP-1α mRNA were reduced by therapeutic MPV467 administration. These results indicate that immunosuppressed cotton rats represent a useful model for studying hMPV pathogenesis and for evaluating therapeutics that could alleviate hMPV-induced disease in immunocompromised subjects.
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Affiliation(s)
- Kevin C. Yim
- Sigmovir Biosystems, Inc., 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - Jarrod J. Mousa
- Center for Vaccines and Immunology, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
- Department of Biochemistry and Molecular Biology, Franklin College of Arts and Sciences, University of Georgia, Athens, GA 30602, USA
| | - Jorge C. G. Blanco
- Sigmovir Biosystems, Inc., 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
| | - Sonnie Kim
- NIH/NIAID, Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, Rockville, MD 20852, USA
| | - Marina S. Boukhvalova
- Sigmovir Biosystems, Inc., 9610 Medical Center Drive, Suite 100, Rockville, MD 20850, USA
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12
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Lazarus HM, Pitts K, Wang T, Lee E, Buchbinder E, Dougan M, Armstrong DG, Paine R, Ragsdale CE, Boyd T, Rock EP, Gale RP. Recombinant GM-CSF for diseases of GM-CSF insufficiency: Correcting dysfunctional mononuclear phagocyte disorders. Front Immunol 2023; 13:1069444. [PMID: 36685591 PMCID: PMC9850113 DOI: 10.3389/fimmu.2022.1069444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Endogenous granulocyte-macrophage colony-stimulating factor (GM-CSF), identified by its ability to support differentiation of hematopoietic cells into several types of myeloid cells, is now known to support maturation and maintain the metabolic capacity of mononuclear phagocytes including monocytes, macrophages, and dendritic cells. These cells sense and attack potential pathogens, present antigens to adaptive immune cells, and recruit other immune cells. Recombinant human (rhu) GM-CSF (e.g., sargramostim [glycosylated, yeast-derived rhu GM-CSF]) has immune modulating properties and can restore the normal function of mononuclear phagocytes rendered dysfunctional by deficient or insufficient endogenous GM-CSF. Methods We reviewed the emerging biologic and cellular effects of GM-CSF. Experts in clinical disease areas caused by deficient or insufficient endogenous GM-CSF examined the role of GM-CSF in mononuclear phagocyte disorders including autoimmune pulmonary alveolar proteinosis (aPAP), diverse infections (including COVID-19), wound healing, and anti-cancer immune checkpoint inhibitor therapy. Results We discuss emerging data for GM-CSF biology including the positive effects on mitochondrial function and cell metabolism, augmentation of phagocytosis and efferocytosis, and immune cell modulation. We further address how giving exogenous rhu GM-CSF may control or treat mononuclear phagocyte dysfunction disorders caused or exacerbated by GM-CSF deficiency or insufficiency. We discuss how rhu GM-CSF may augment the anti-cancer effects of immune checkpoint inhibitor immunotherapy as well as ameliorate immune-related adverse events. Discussion We identify research gaps, opportunities, and the concept that rhu GM-CSF, by supporting and restoring the metabolic capacity and function of mononuclear phagocytes, can have significant therapeutic effects. rhu GM-CSF (e.g., sargramostim) might ameliorate multiple diseases of GM-CSF deficiency or insufficiency and address a high unmet medical need.
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Affiliation(s)
- Hillard M. Lazarus
- Department of Medicine, Division of Hematology and Oncology, Case Western Reserve University, Cleveland, OH, United States
| | - Katherine Pitts
- Medical Affairs, Partner Therapeutics, Inc., Lexington, MA, United States
| | - Tisha Wang
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Elinor Lee
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Elizabeth Buchbinder
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Michael Dougan
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - David G. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Robert Paine
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Timothy Boyd
- Clinical Development, Partner Therapeutics, Inc., Lexington, MA, United States
| | - Edwin P. Rock
- Clinical Development, Partner Therapeutics, Inc., Lexington, MA, United States
| | - Robert Peter Gale
- Hematology Centre, Department of Immunology and Inflammation, Imperial College, London, United Kingdom
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Respiratory Viral Infections in the Pediatric Hematopoietic Stem Cell Transplant Population: Progression to Lower Respiratory Tract Disease. J Pediatr Hematol Oncol 2023; 45:e75-e81. [PMID: 36031189 DOI: 10.1097/mph.0000000000002525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Respiratory viral infections (RVIs) are important complications in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT); however, risk factors for lower respiratory tract infections (LRTIs) are not well characterized. The aim of this study was to determine risk factors for the progression to LRTIs in pediatric patients with respiratory symptoms who underwent HSCT. PATIENTS AND METHODS This retrospective study included 87 pediatric patients with respiratory symptoms who underwent HSCT. Respiratory viral polymerase chain reaction samples were obtained from all patients. The evaluated data included risk factors to progression to LRTIs, long-term pulmonary complications, transplantation-related mortality, and overall survival. RESULTS Viral pathogens were detected in 31 (48.4%) patients with upper respiratory tract infections and 13 (56.5%) patients with LRTIs. There was a statistically significant difference between the groups in engraftment delay and lymphocytopenia. Also it was determined that engraftment delay (odds ratio: 7.46 [95% CI, 1.99 to 27.86]; P = 0.003) and COVID-19 infection had statistically significant effects on overall survival in general (odds ratio: 8.06 [95% CI, 2.63 to 24.64]; P <0.001]). CONCLUSION Not only host and transplant-related factors but also viral agent type were found to be effective in progression to LRTIs. As the available therapy for respiratory viral infections remains limited, the focus should be on the prevention of infection.
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Karhana S, Hussain K, Bint-E-Attar G, Bhurani D, Khan MA. Risk of Mortality in Bone Marrow Transplant Patients During SARS-CoV-2 Infection: A Systematic Review. EXP CLIN TRANSPLANT 2023; 21:1-11. [PMID: 36757164 DOI: 10.6002/ect.2022.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Recipients of bone marrow transplant with COVID-19 are at high risk of mortality and morbidity from their underlying immunocompromised state. Graft-versus-host disease and other comorbidities lead to poor COVID-19 outcomes in these patients. Understanding the outcomes and clinical characteristics of bone marrow transplant recipients with COVID-19 is needed to devise potential life-saving therapies for patients with hematologic malignancies. Reviewing large data sets from different ethnic groups and regions can lead to better understanding. We conducted a systematic review ofreal-world data from prospective and retrospective observational cohort studies that reported the clinical outcomes of COVID- 19 in bone marrow transplant patients. MATERIALS AND METHODS We used electronic databases (PubMed, ScienceDirect, Google Scholar), with a cut off date of May 31, 2022, to conduct our search. After screening 349 articles, we selected 33 original reports for screening. After screening these articles for eligibility criteria, we selected 12 studies for final data extraction. We extracted data per the preferred reporting items followed for systematic reviews. Quality evaluation was done with a Cochrane risk-of bias tool for nonrandomized studies (ROBINS-1). RESULTS Bone marrow transplant recipients with COVID-19 experienced poor disease outcomes and high mortality rates. Patient age, immunosuppressant intensity, and presence of graft-versus-host disease or other underlying comorbidities directly affected mortality rates of bone marrow transplant recipients with COVID-19. Other factors, like type of malignancy, type of transplant, and time between transplant and COVID-19 diagnosis, did not affect mortality or poor outcomes of COVID-19. CONCLUSIONS Bone marrow transplant recipients have a higher risk of mortality and poor disease outcomes from COVID-19. Because curative therapies for COVID- 19 are not available, the only option available is its prevention. Transplant centers worldwide, as pertheir capacities, should develop and adhere to strict standard operating procedures based on international or national guidelines related to transplant recipients with COVID-19.
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Affiliation(s)
- Sonali Karhana
- From the Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi 110062, India
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15
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Al-Mansour M. Treatment Landscape of Relapsed/Refractory Mantle Cell Lymphoma: An Updated Review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e1019-e1031. [PMID: 36068158 DOI: 10.1016/j.clml.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
Mantle cell lymphoma (MCL) accounts for nearly 2-6% of all non-Hodgkin lymphoma (NHL) cases, with a steady incidence increase over the past few decades. Although many patients achieve an adequate response to the upfront treatment, the short duration of remission with rapid relapse is challenging during MCL management. In this regard, there is no consensus on the best treatment options for relapsed/refractory (R/R) disease, and the international guidelines demonstrate wide variations in the recommended approaches. The last decade has witnessed the introduction of new agents in the treatment landscape of R/R MCL. Since the introduction of Bruton's tyrosine kinase (BTK) inhibitors, the treatment algorithm and response of R/R MCL patients have dramatically changed. Nevertheless, BTK resistance is common, necessitating further investigations to develop novel agents with a more durable response. Novel agents targeting the B-cell receptor (BCR) signaling have exhibited clinical activity and a well-tolerable safety profile. However, as the responses to these novel agents are still modest in most clinical trials, combination strategies were investigated in pre-clinical and early clinical settings to determine whether the combination of novel agents would exhibit a better durable response than single agents. In this report, we provide an updated literature review that covers recent clinical data about the safety and efficacy of novel therapies for the management of R/R MCL.
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Affiliation(s)
- Mubarak Al-Mansour
- Adult Medical Oncology, Princess Noorah Oncology Center, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
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16
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曹 乐, 周 婧, 陈 育, 陈 欢, 韩 伟, 陈 瑶, 张 圆, 闫 晨, 程 翼, 莫 晓, 付 海, 韩 婷, 吕 萌, 孔 军, 孙 于, 王 昱, 许 兰, 张 晓, 黄 晓. [Relationship between treatment and prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:1013-1020. [PMID: 36241246 PMCID: PMC9568376 DOI: 10.19723/j.issn.1671-167x.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore the relationship between drug treatment and outcomes in patients with late-onset severe pneumonia (LOSP) after allogeneic stem cell transplantation (allo-SCT). METHODS We retrospectively analyzed the effects of the initiation time of treatment drugs, especially antiviral drugs and glucocorticoids on the clinical outcomes in 82 patients between January 2016 and August 2021 who developed LOSP after allo-SCT in Peking University People's Hospital. Univariate analysis was performed by Mann-Whitney U test and χ2 test, and multivariate analysis was performed by Logistic regression. When multiple groups (n>2) were involved in the χ2 test, Bonferroni correction was used for the level of significance test. RESULTS Of all 82 patients in this study, the median onset time of LOSP was 220 d (93-813 d) after transplantation, and the 60-day survival rate was 58.5% (48/82). The median improvement time of the survival patients was 18 d (7-44 d), while the median death time of the died patients was 22 d (2-53 d). Multivariate analysis showed that the initiation time of antiviral drugs from the onset of LOSP (< 10 d vs. ≥10 d, P=0.012), and the initiation time of glucocorticoids from antiviral drugs (< 10 d vs. ≥10 d, P=0.027) were the factors affecting the final outcome of the patients with LOSP at the end of 60 d. According to the above results, LOSP patients were divided into four subgroups: group A (antiviral drugs < 10 d, glucocorticoids ≥10 d), group B (antiviral drugs < 10 d, glucocorticoids < 10 d), group C (antiviral drugs ≥10 d, glucocorticoids ≥10 d) and group D (antiviral drugs ≥10 d, glucocorticoids < 10 d), the 60-day survival rates were 91.7%, 56.8%, 50.0% and 21.4%, respectively. CONCLUSION Our study demonstrated that in patients who developed LOSP after allo-SCT, the initiation time of antiviral drugs and glucocorticoids were associated with the prognosis of LOSP, and the survival rate was highest in patients who received antiviral drugs early and glucocorticoids later. It suggested that for patients with LOSP of unknown etiology should be highly suspicious of the possibility of a secondary hyperimmune response to viral infection.
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Affiliation(s)
- 乐清 曹
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 婧睿 周
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 育红 陈
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 欢 陈
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 伟 韩
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 瑶 陈
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 圆圆 张
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 晨华 闫
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 翼飞 程
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 晓冬 莫
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 海霞 付
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 婷婷 韩
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 萌 吕
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 军 孔
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 于谦 孙
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 昱 王
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 兰平 许
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 晓辉 张
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - 晓军 黄
- />北京大学人民医院血液科, 北京大学血液病研究所, 国家血液系统疾病临床医学研究中心, 造血干细胞移植治疗血液病北京市重点实验室, 北京 100044Department of Hematology, Peking University People's Hospital; Peking University Institute of Hematology; National Clinical Research Center for Hematologic Disease; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Chen J, Li Z, Zhao Q, Chen L. Roles of apelin/APJ system in cancer: Biomarker, predictor, and emerging therapeutic target. J Cell Physiol 2022; 237:3734-3751. [DOI: 10.1002/jcp.30845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jiawei Chen
- Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, Hengyang Medical School, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Institute of Pharmacy and Pharmacology University of South China Hengyang Hunan China
| | - Zhiyue Li
- Health Management Center, The Third Xiangya Hospital Central South University Changsha Hunan Province China
| | - Qun Zhao
- Department of Orthopedics Third Xiangya Hospital of Central South University Changsha Hunan China
| | - Linxi Chen
- Hunan Provincial Key Laboratory of Tumor Microenvironment Responsive Drug Research, Hengyang Medical School, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, Institute of Pharmacy and Pharmacology University of South China Hengyang Hunan China
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18
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Ison MG, Marty FM, Chao N, Moon SH, Zhang Z, Chandak A. Economic and clinical burden associated with respiratory viral infections after allogeneic hematopoietic cell transplant in the United States. Transpl Infect Dis 2022; 24:e13866. [PMID: 35598293 PMCID: PMC9542538 DOI: 10.1111/tid.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Michael G. Ison
- Northwestern University Feinberg School of Medicine Chicago IL
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19
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Marchesi F, Salmanton-García J, Emarah Z, Piukovics K, Nucci M, López-García A, Rácil Z, Farina F, Popova M, Zompi S, Audisio E, Ledoux MP, Verga L, Weinbergerová B, Szotkovski T, Da Silva MG, Fracchiolla N, De Jonge N, Collins G, Marchetti M, Magliano G, García-Vidal C, Biernat MM, Van Doesum J, Machado M, Demirkan F, Al-Khabori M, Žák P, Víšek B, Stoma I, Méndez GA, Maertens J, Khanna N, Espigado I, Dragonetti G, Fianchi L, Del Principe MI, Cabirta A, Ormazabal-Vélez I, Jaksic O, Buquicchio C, Bonuomo V, Batinié J, Omrani AS, Lamure S, Finizio O, Fernández N, Falces-Romero I, Blennow O, Bergantim R, Ali N, Win S, Van Praet J, Tisi MC, Shirinova A, Schönlein M, Prattes J, Piedimonte M, Petzer V, Navrátil M, Kulasekararaj A, Jindra P, Sramek J, Glenthøj A, Fazzi R, De Ramón-Sánchez C, Cattaneo C, Calbacho M, Bahr NC, El-Ashwah S, Cordoba R, Hanakova M, Zambrotta GPM, Zambrotta G, Sciumè M, Booth S, Rodrigues RN, Sacchi MV, García-Poutón N, Martín-González JA, Khostelidi S, Gräfe S, Rahimli L, Ammatuna E, Busca A, Corradini P, Hoenigl M, Klimko N, Koehler P, Pagliuca A, Passamonti F, Cornely OA, Pagano L. COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA). Haematologica 2022; 108:22-33. [PMID: 35545919 PMCID: PMC9827164 DOI: 10.3324/haematol.2022.280847] [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: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with acute myeloid leukemia (AML) are at high risk of dying from coronavirus disease 2019 (COVID-19). The optimal management of AML patients with COVID-19 has not been established. Our multicenter study included 388 adult AML patients diagnosed with COVID-19 between February 2020 and October 2021. The vast majority were receiving or had received AML treatment in the preceding 3 months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients (44.8%), delayed in 68 and permanently discontinued in 106. After a median follow-up of 325 days, 180 patients (46.4%) had died; death was attributed to COVID-19 (43.3%), AML (26.1%) or to a combination of both (26.7%), whereas in 3.9% of cases the reason was unknown. Active disease, older age, and treatment discontinuation were associated with death, whereas AML treatment delay was protective. Seventy-nine patients had a simultaneous AML and COVID-19 diagnosis, with better survival when AML treatment could be delayed (80%; P<0.001). Overall survival in patients with a diagnosis of COVID-19 between January 2020 and August 2020 was significantly lower than that in patients diagnosed between September 2020 and February 2021 and between March 2021 and September 2021 (39.8% vs. 60% vs. 61.9%, respectively; P=0.006). COVID-19 in AML patients was associated with a high mortality rate and modifications of therapeutic algorithms. The best approach to improve survival was to delay AML treatment, whenever possible.
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Affiliation(s)
- Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy,FM and JSG contributed equally as co-first authors
| | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany,FM and JSG contributed equally as co-first authors
| | - Ziad Emarah
- Oncology Center, Mansoura University, Mansoura, Egypt
| | - Klára Piukovics
- Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary
| | - Marcio Nucci
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alberto López-García
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Zdenék Rácil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Marina Popova
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Sofia Zompi
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Ernesta Audisio
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | | | - Luisa Verga
- Azienda Ospedaliera San Gerardo - Monza, Monza, Italy,Università Milano-Bicocca, Milan, Italy
| | - Barbora Weinbergerová
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | | | | | - Nicola Fracchiolla
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nick De Jonge
- Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | | | - Monia Marchetti
- Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | | | - Carolina García-Vidal
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Monika M. Biernat
- Department of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jaap Van Doesum
- University Medical Center Groningen, Groningen, the Netherlands
| | - Marina Machado
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fatih Demirkan
- Division of Hematology, Dokuz Eylul University, Izmir, Turkey
| | | | - Pavel Žák
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Benjamín Víšek
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Igor Stoma
- Gomel State Medical University, Gomel, Belarus
| | | | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven and Department of Hematology, UZ Leuven, Leuven, Belgium
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, and Department of Clinical Research, University and University Hospital of Basel, Basel, Switzerland
| | - Ildefonso Espigado
- Department of Hematology, University Hospital Virgen Macarena - University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Universidad de Sevilla, Seville, Spain
| | - Giulia Dragonetti
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Luana Fianchi
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | | | - Alba Cabirta
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain,Department of Hematology, Vall d’Hebron Hospital Universitari, Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | | | | | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Josip Batinié
- Croatian Cooperative Group for Hematological Diseases (CROHEM), Zagreb, Croatia,Faculty of Medicine University of Zagreb, Zagreb, Croatia,University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ali S. Omrani
- Hamad Medical Corporation, Division of Infectious Diseases, Doha, Qatar
| | - Sylvain Lamure
- Département d’Hématologie Clinique, CHU de Montpellier, UMR-CNRS 5535, Universite de Montpellier, Montpellier, France
| | | | - Noemí Fernández
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Rui Bergantim
- Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Natasha Ali
- Aga Khan University Hospital, Karachi, Pakistan
| | - Sein Win
- Department of Clinical Hematology, Yangon General Hospital, University of Medicine, Yangon, Myanmar
| | - Jens Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | | | - Ayten Shirinova
- Azerbaijan Scientific Research Hematology and Transfusiology Institute, Baku, Azerbaijan
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juergen Prattes
- Medical University of Graz, Department for Infectious Diseases, Graz, Austria
| | | | - Verena Petzer
- Department of Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Milan Navrátil
- Head of the ICU and Transplant Unit, Department of Hematooncology, University Hospital of Ostrava, Ostrava-Poruba, Czech Republic
| | | | - Pavel Jindra
- University Hospital Pilsen, Pilsen, Czech Republic
| | - Jirí Sramek
- Department of Hematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic,Department of Histology and Embryology, Faculty of Medicine, Pilsen, Czech Republic
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rita Fazzi
- AOUP - Azienda Ospedaliera Università Pisana - Cisanello, Pisa, Italy
| | - Cristina De Ramón-Sánchez
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain,IBSAL, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | | | | | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Michaela Hanakova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Maria Vittoria Sacchi
- Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Nicole García-Poutón
- Department of Infectious Diseases, Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Sofya Khostelidi
- North-Western State Medical University named after Iliá Ilich Méchnikov, Saint-Petersburg, Russia
| | - Stefanie Gräfe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany,Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Laman Rahimli
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | | | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Paolo Corradini
- University of Milan and Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, USA,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA,Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nikolai Klimko
- North-Western State Medical University named after Iliá Ilich Méchnikov, Saint-Petersburg, Russia
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Antonio Pagliuca
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Oliver A. Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany,University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany,OAC and LP contributed equally as co-senior authors
| | - Livio Pagano
- Hematology Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy,Hematology Unit, Università Cattolica del Sacro Cuore, Rome, Italy,OAC and LP contributed equally as co-senior authors
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20
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Busca A, Marchesi F, Cattaneo C, Trecarichi EM, Delia M, Del Principe MI, Candoni A, Pagano L. When Viruses Meet Fungi: Tackling the Enemies in Hematology. J Fungi (Basel) 2022; 8:jof8020184. [PMID: 35205938 PMCID: PMC8875273 DOI: 10.3390/jof8020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
The association of invasive fungal infections (IFI) and viral infections has been described in patients with hematologic malignancies (HM), in particular in hematopoietic stem cell transplant recipients. Regrettably, the diagnosis is often challenging, making the treatment inappropriate in some circumstances. The present review takes into consideration the viral infections commonly associated with IFI. Clinical presentation of IFI and viral infections, risk factors, and impact on the outcome of HM patients are discussed throughout the paper.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Unit, AOU Citta’ della Salute e della Scienza, 10126 Torino, Italy
- Correspondence:
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, University “Magna Graecia”—“Mater Domini” Teaching Hospital, 88100 Catanzaro, Italy;
| | - Mario Delia
- Hematology and Stem Cell Transplantation Unit, AOUC Policlinico, 70124 Bari, Italy;
| | | | - Anna Candoni
- Division of Hematology and Stem Cell Transplantation, University of Udine-ASUFC, 33100 Udine, Italy;
| | - Livio Pagano
- Unità di Ematologia Geriatrica ed Emopatie Rare, Fondazione Policlinico Universitario A. Gemelli—IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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21
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Tığlıoğlu P, Albayrak M, Tığlıoğlu M, Öztürk HBA, Aras MR, Sağlam B, Maral S. The outcome of COVID-19 in patients with hematological malignancy. MEMO 2022; 15:83-89. [PMID: 34904019 PMCID: PMC8655323 DOI: 10.1007/s12254-021-00775-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of coronavirus disease 2019 (COVID-19) on the malignancy-related clinical course and overall survival, and to determine the factors affecting mortality. METHODS This retrospective study included 77 patients with hematological cancer and COVID-19. Patients were sub-grouped for analysis as survivors and non-survivors. RESULTS COVID-19 was seen more frequently in myeloproliferative neoplasms (MPN), non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) patients. Mortality rate due to COVID-19 was 20.8%. No statistically significant difference was determined between the survivor and non-survivor groups with respect to age and gender, presence of any comorbidity, leukocyte, neutrophil, lymphocyte, and monocyte values. Platelet count and hemoglobin count were significantly lower in the group with mortality than in the group with recovery. CONCLUSION It should be kept in mind that low hemoglobin and platelet levels contribute to mortality. In addition, it is important to protect patients with hematological cancer from COVID-19 and undertake effective vaccination due to its mortal course.
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Affiliation(s)
- Pınar Tığlıoğlu
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | - Murat Albayrak
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | - Mesut Tığlıoğlu
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | - Hacer Berna Afacan Öztürk
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | - Merih Reis Aras
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | - Buğra Sağlam
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
| | - Senem Maral
- Diskapi Yildirim Beyazit Training and Research Hospital, Department of Hematology, University of Health Sciences, Ankara, Turkey
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22
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Lynch JP, Kajon AE. Adenovirus: Epidemiology, Global Spread of Novel Types, and Approach to Treatment. Semin Respir Crit Care Med 2021; 42:800-821. [PMID: 34918322 DOI: 10.1055/s-0041-1733802] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. Epidemics of AdV infection may occur in healthy children or adults in closed or crowded settings (particularly military recruits). The vast majority of cases are self-limited. However, the clinical spectrum is broad and fatalities may occur. Dissemination is more likely in patients with impaired immunity (e.g., organ transplant recipients, human immunodeficiency virus infection). Fatality rates for untreated severe AdV pneumonia or disseminated disease may exceed 50%. More than 100 genotypes and 52 serotypes of AdV have been identified and classified into seven species designated HAdV-A through -G. Different types display different tissue tropisms that correlate with clinical manifestations of infection. The predominant types circulating at a given time differ among countries or regions, and change over time. Transmission of novel strains between countries or across continents and replacement of dominant viruses by new strains may occur. Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been done. Cidofovir has been the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States but currently are not available to civilians.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Adriana E Kajon
- Infectious Disease Program, Lovelace Biomedical Research Institute, Albuquerque, New Mexico
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23
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Severe acute respiratory syndrome coronavirus 2 infection in the stem cell transplant recipient - clinical spectrum and outcome. Curr Opin Infect Dis 2021; 34:654-662. [PMID: 34751184 PMCID: PMC8577303 DOI: 10.1097/qco.0000000000000790] [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] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Focusing on large multicenter cohorts reported over the last months, this review aims at summarizing the available evidence by July 2021 on the impact of coronavirus disease 2019 (COVID-19) on hematopoietic stem cell transplant (HSCT) recipients in terms of epidemiology, clinical features, and outcome. RECENT FINDINGS The incidence of COVID-19 in institutional cohorts varied according to different regions and study periods from 0.4% to 8.3%. Clinical presentation was overall comparable to other immunocompromised hosts and the general population. Microbiologically confirmed superinfection occurred in 13-25% of recipients, with most episodes due to hospital-acquired bacteria and few reported cases of COVID-19-associated aspergillosis. Prolonged nasopharyngeal severe acute respiratory syndrome coronavirus 2 shedding has been demonstrated for as long as 210 days. Mortality rates were similar across studies (14.8-28.4%) and did not markedly differ from those observed in nontransplant hematological patients during the first wave. Older age and shorter time from transplantation were associated with mortality, as well as underlying disease status and amount of immunosuppression. No outcome differences were found in most studies between allogeneic and autologous procedures. SUMMARY Considerable advances have been achieved in the characterization of COVID-19 in the HSCT population, although uncertainties remain in the optimal therapeutic management.
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24
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Wang XA, Binder AF, Gergis U, Wilde L. COVID-19 in Patients With Hematologic Malignancies: A Single Center Retrospective Study. Front Oncol 2021; 11:740320. [PMID: 34778057 PMCID: PMC8581235 DOI: 10.3389/fonc.2021.740320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/14/2021] [Indexed: 12/14/2022] Open
Abstract
Initial studies that described the novel coronavirus (COVID-19) reported increased morbidity and mortality in patients with cancer. Of this group, patients with hematologic malignancies (HM) had the highest disease severity and death rates. Subsequent studies have attempted to better describe how COVID-19 affects patients with HM. However, these studies have yielded variable and often contradictory results. We present our single-institution experience with patients with HM who were diagnosed with COVID-19 from March 2020 to March 2021. We report 62 total cases with 10 patients who died during this time. The overall mortality was 16.1%. Mortality during the first two waves of COVID was 27.8% and 25%. Mortality during the third wave of COVID was 10%. The median age of patients was 67 years (range 20-89 years). 55% of patients had lymphoid malignancies and the majority had active disease at the time of diagnosis with COVID-19. 87% of patients had more than one co-morbidity. Important co-morbidities included cardiovascular disease and smoking history. 38.7% of patients had asymptomatic or mild disease, 54.8% required hospitalization, and 17.5% required ICU level care. In patients who required ICU level care, the mortality was 60%.
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Affiliation(s)
- Xuejun Alice Wang
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Adam F Binder
- Department of Medical Oncology, Division of Hematologic Malignancies, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Usama Gergis
- Department of Medical Oncology, Division of Hematologic Malignancies, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Lindsay Wilde
- Department of Medical Oncology, Division of Hematologic Malignancies, Thomas Jefferson University Hospital, Philadelphia, PA, United States
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25
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Abstract
Parainfluenza viruses, members of the enveloped, negative-sense, single stranded RNA Paramyxoviridae family, impact global child health as the cause of significant lower respiratory tract infections. Parainfluenza viruses enter cells by fusing directly at the cell surface membrane. How this fusion occurs via the coordinated efforts of the two molecules that comprise the viral surface fusion complex, and how these efforts may be blocked, are the subjects of this chapter. The receptor binding protein of parainfluenza forms a complex with the fusion protein of the virus, remaining stably associated until a receptor is reached. At that point, the receptor binding protein actively triggers the fusion protein to undergo a series of transitions that ultimately lead to membrane fusion and viral entry. In recent years it has become possible to examine this remarkable process on the surface of viral particles and to begin to understand the steps in the transition of this molecular machine, using a structural biology approach. Understanding the steps in entry leads to several possible strategies to prevent fusion and inhibit infection.
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Affiliation(s)
- Tara C Marcink
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Center for Host-Pathogen Interaction, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Matteo Porotto
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Center for Host-Pathogen Interaction, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Microbiology & Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Anne Moscona
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Center for Host-Pathogen Interaction, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Caserta, Italy; Department of Physiology & Cellular Biophysics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.
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26
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Partridge DG, Sori A, Green DJ, Simpson R, Poller B, Raza M, Kaur H, Jessop H, Colton B, Nield A, Evans CM, Lee A. Universal use of surgical masks is tolerated and prevents respiratory viral infection in stem cell transplant recipients. J Hosp Infect 2021; 119:182-186. [PMID: 34543704 PMCID: PMC8447542 DOI: 10.1016/j.jhin.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022]
Abstract
Prevention of respiratory viral infection in stem cell transplant patients is important due to its high risk of adverse outcome. This single-centre, mixed methods study, conducted before the severe acute respiratory syndrome coronavirus-2 pandemic, explored the barriers and facilitators to a policy of universal mask use by visitors and healthcare workers, and examined the impact of the first year of introduction of the policy on respiratory viral infection rates compared with preceding years, adjusted for overall incidence. Education around universal mask use was highlighted as being particularly important in policy implementation. A significant decrease in respiratory viral infection was observed following introduction.
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Affiliation(s)
- D G Partridge
- Department of Microbiology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK; Florey Institute for Host-Pathogen Interaction, University of Sheffield, Sheffield, UK.
| | - A Sori
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - D J Green
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Simpson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - B Poller
- Department of Laboratory Medicine, NHS Lothian, Edinburgh, UK
| | - M Raza
- Department of Virology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - H Kaur
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - H Jessop
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - B Colton
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - A Nield
- Department of Haematology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - C M Evans
- Florey Institute for Host-Pathogen Interaction, University of Sheffield, Sheffield, UK; Department of Virology, Sheffield Teaching Hospitals Foundation NHS Trust, Sheffield, UK
| | - A Lee
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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27
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Civriz Bozdağ S, Cengiz Seval G, Yönal Hindilerden İ, Hindilerden F, Andıç N, Baydar M, Aydın Kaynar L, Koçak Toprak S, Göksoy HS, Balık Aydın B, Demirci U, Can F, Özkocaman V, Gündüz E, Güven ZT, Özkurt ZN, Demircioğlu S, Beksaç M, İnce İ, Yılmaz U, Eroğlu Küçükdiler H, Abishov E, Yavuz B, Ataş Ü, Mutlu YG, Baş V, Özkalemkaş F, Üsküdar Teke H, Gürsoy V, Çelik S, Çiftçiler R, Yağcı M, Topçuoğlu P, Çeneli Ö, Abbasov H, Selim C, Ar MC, Yücel OK, Sadri S, Albayrak C, Demir AM, Güler N, Keklik M, Terzi H, Doğan A, Yegin ZA, Kurt Yüksel M, Sadri S, Yavaşoğlu İ, Beköz HS, Aksu T, Maral S, Erol V, Kaynar L, İlhan O, Bolaman AZ, Sevindik ÖG, Akyay A, Özcan M, Gürman G, Ünal Ş, Yavuz Y, Diz Küçükkaya R, Özsan GH. Clinical Characteristics and Outcome of COVID-19 in Turkish Hematological Malignancy Patients. Turk J Haematol 2021; 39:43-54. [PMID: 34521187 PMCID: PMC8886271 DOI: 10.4274/tjh.galenos.2021.2021.0287] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey. Materials and Methods: In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection. Results: Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use. Conclusion: Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.
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Affiliation(s)
- Sinem Civriz Bozdağ
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | | | - İpek Yönal Hindilerden
- İstanbul University, İstanbul Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Fehmi Hindilerden
- İstanbul Bakırköy Sadi Konuk Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Neslihan Andıç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskisehir, Turkey
| | - Mustafa Baydar
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Lale Aydın Kaynar
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Selami Koçak Toprak
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hasan Sami Göksoy
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Berrin Balık Aydın
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Ufuk Demirci
- Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
| | - Ferda Can
- Ankara City Hospital, Clinic of Internal Medicine, Ankara, Turkey
| | - Vildan Özkocaman
- Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Eren Gündüz
- Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskisehir, Turkey
| | - Zeynep Tuğba Güven
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Zübeyde Nur Özkurt
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Sinan Demircioğlu
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
| | - Meral Beksaç
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - İdris İnce
- Dr. Ersin Arslan Training and Research Hospital, Clinic of Hematology, Gaziantep, Turkey
| | - Umut Yılmaz
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | | | - Elgün Abishov
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Boran Yavuz
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
| | - Ünal Ataş
- Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
| | - Yaşa Gül Mutlu
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Volkan Baş
- Trakya University Faculty of Medicine, Department of Hematology, Edirne, Turkey
| | - Fahir Özkalemkaş
- Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
| | - Hava Üsküdar Teke
- Eskişehir Osmangazi University Faculty of Medicine, Department of Hematology, Eskisehir, Turkey
| | - Vildan Gürsoy
- Bursa City Hospital, Clinic of Hematology, Bursa, Turkey
| | - Serhat Çelik
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Rafiye Çiftçiler
- Aksaray Training and Research Hospital, Clinic of Hematology, Aksaray, Turkey
| | - Münci Yağcı
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Pervin Topçuoğlu
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Özcan Çeneli
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Hematology, Konya, Turkey
| | - Hamza Abbasov
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Cem Selim
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Muhlis Cem Ar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Orhan Kemal Yücel
- Akdeniz University Faculty of Medicine, Department of Hematology, Antalya, Turkey
| | - Sevil Sadri
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Canan Albayrak
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology, Samsun, Turkey
| | | | - Nil Güler
- Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
| | - Muzaffer Keklik
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Hatice Terzi
- Cumhuriyet University Faculty of Medicine, Department of Hematology, Sivas, Turkey
| | - Ali Doğan
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Hematology, Van, Turkey
| | - Zeynep Arzu Yegin
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Meltem Kurt Yüksel
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Soğol Sadri
- Yeni yüzyıl University, Özel Gaziosmanpaşa Hospital, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - İrfan Yavaşoğlu
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Hüseyin Saffet Beköz
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Tekin Aksu
- University of Health Sciences Turkey, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Department of Pediatric Hematology and Oncology, Ankara, Turkey
| | - Senem Maral
- University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Veysel Erol
- Pamukkale University Faculty of Medicine, Department of Internal Medicine, Denizli, Turkey
| | - Leylagül Kaynar
- Erciyes University Faculty of Medicine, Department of Internal Medicine, Kayseri, Turkey
| | - Osman İlhan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Ali Zahit Bolaman
- Adnan Menderes University Faculty of Medicine, Department of Hematology, Aydın, Turkey
| | - Ömür Gökmen Sevindik
- Medipol University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Arzu Akyay
- İnönü University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Malatya, Turkey
| | - Muhit Özcan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Günhan Gürman
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Şule Ünal
- Hacettepe University Faculty of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Yasemin Yavuz
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Reyhan Diz Küçükkaya
- İstanbul University Faculty of Science, Department of Molecular Biology and Genetic, İstanbul, Turkey
| | - Güner Hayri Özsan
- Dokuz Eylül University Faculty of Medicine, Department of Hematology, İzmir, Turkey
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28
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Puius YA, Bartash RM, Zingman BS. Maintaining mask momentum in transplant recipients. Transpl Infect Dis 2021; 23:e13697. [PMID: 34324251 PMCID: PMC8420158 DOI: 10.1111/tid.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
The widespread use of facemasks has been a crucial element in the control of the SARS‐CoV‐2 pandemic. With mounting evidence for mask efficacy against respiratory infectious diseases and greater acceptability of this intervention, it is proposed that masking should continue after the pandemic has abated to protect some of our most vulnerable patients, recipients of stem cell and solid organ transplants. This may involve not only masking these high‐risk patients, but possibly their close contacts and the healthcare workers involved in their care. We review the evidence for mask efficacy in prevention of respiratory viruses other than SARS‐CoV‐2 and address the burden of disease in transplant recipients. Although we acknowledge that there are limited data on masking to prevent infection in transplant recipients, we propose a framework for the study and implementation of routine masking as a part of infection prevention interventions after transplantation.
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Affiliation(s)
- Yoram A Puius
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.,Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel M Bartash
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Barry S Zingman
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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29
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Hospitalizations for vaccine-preventable infections among pediatric hematopoietic cell transplantation recipients in the first 5 years after transplantation. Bone Marrow Transplant 2021; 56:2656-2663. [PMID: 34155358 DOI: 10.1038/s41409-021-01373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
Despite recommendations for vaccination after hematopoietic cell transplantation (HCT), immunization rates remain low leaving children at high risk for vaccine preventable infections (VPIs). However, the burden from VPIs in pediatric HCT recipients is not well known. We describe the prevalence, risk factors, and outcomes of VPI-associated hospitalizations at centers participating in the Pediatric Health Information System database. Children <18 years who underwent allogeneic or autologous-HCT between 1/1/2010-31/12/2018, were identified and prevalence of overall VPI and of each infection were determined at five time-points within 5 years post-HCT. In total, 684 of 9591 pediatric HCT recipients had a VPI-associated hospitalization, most frequently in the first 6-12 months, for an overall prevalence of 7.1% (95% CI: 6.6-7.7%). Influenza, varicella, and invasive pneumococcal infections were the most frequent. Multivariable analyses identified younger age (OR = 0.96 [95% CI: 0.93-0.99]; p = 0.013), primary immune deficiency (PID) (OR = 1.78 [95% CI: 1.11-2.84]; p = 0.016), and GVHD (OR = 1.62 [95% CI: 1.05-2.48]; p = 0.028) as independent risk factors during the initial HCT-hospitalization. Children with VPI had longer duration of hospitalization (55[51] vs 36[24] days, p < 0.001), higher rates of ICU admission (42 vs 26%, p < 0.001), and mortality (11% [n = 17) vs 6% [n = 519]; p = 0.003). Continued efforts to improve vaccination early post-HCT are warranted.
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30
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Mulroney CM, Bilal Abid M, Bashey A, Chemaly RF, Ciurea SO, Chen M, Dandoy CE, Diaz Perez MA, Friend BD, Fuchs E, Ganguly S, Goldsmith SR, Kanakry CG, Kim S, Komanduri KV, Krem MM, Lazarus HM, Ljungman P, Maziarz R, Nishihori T, Patel SS, Perales MA, Romee R, Singh AK, Reid Wingard J, Yared J, Riches M, Taplitz R. Incidence and impact of community respiratory viral infections in post-transplant cyclophosphamide-based graft-versus-host disease prophylaxis and haploidentical stem cell transplantation. Br J Haematol 2021; 194:145-157. [PMID: 34124796 DOI: 10.1111/bjh.17563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Community respiratory viral infections (CRVIs) are associated with pulmonary function impairment, alloimmune lung syndromes and inferior survival in human leucocyte antigen (HLA)-matched allogeneic haematopoietic stem cell transplant (HCT) recipients. Although the incidence of viral infections in HLA-haploidentical HCT recipients who receive post-transplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis is reportedly increased, there are insufficient data describing the incidence of CRVIs and the impact of donor source and PTCy on transplant outcomes. Analysing patients receiving their first HCT between 2012 and 2017 for acute myeloid leukaemia, acute lymphoblastic leukaemia and myelodysplastic syndromes, we describe comparative outcomes between matched sibling transplants receiving either calcineurin-based GVHD prophylaxis (SibCNI, N = 1605) or PTCy (SibCy, N = 403), and related haploidentical transplants receiving PTCy (HaploCy, N = 757). The incidence of CRVIs was higher for patients receiving PTCy, regardless of donor type. Patients in the HaploCy cohort who developed a CRVI by day +180 had both a higher risk of treatment-related mortality [hazard ratio (HR) 2⋅14, 99% confidence interval (CI) 1⋅13-4⋅07; P = 0⋅002] and inferior 2-year overall survival (HR 1⋅65, 99% CI 1⋅11-2⋅43; P = 0⋅001) compared to SibCNI with no CRVI. This finding justifies further research into long-term antiviral immune recovery, as well as development of preventive and treatment strategies to improve long-term outcomes in such patients.
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Affiliation(s)
- Carolyn M Mulroney
- Department of Medicine, Division of Blood and Marrow Transplant, University of California San Diego, La Jolla, CA, USA
| | | | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan O Ciurea
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Min Chen
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher E Dandoy
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Miguel A Diaz Perez
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Brian D Friend
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Houston, TX, USA
| | - Ephraim Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | | | - Scott R Goldsmith
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Soyoung Kim
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Maxwell M Krem
- Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL, USA
| | - Sagar S Patel
- Utah Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rizwan Romee
- Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, MA, USA
| | - Anurag K Singh
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Fairway, KS, USA
| | - John Reid Wingard
- Division of Hematology/Oncology, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jean Yared
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Marcie Riches
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randy Taplitz
- Department of Medicine, City of Hope, Duarte, CA, USA
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31
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Obrová K, Grumaz S, Remely M, Czurda S, Krickl I, Herndlhofer S, Gleixner KV, Sperr WR, Größlinger L, Frank T, Andrade N, Egger‐Matiqi T, Peters C, Engstler G, Dworzak M, Attarbaschi A, Grotel M, Heuvel‐Eibrink MM, Moiseev IS, Rogacheva Y, Zubarovskaya L, Zubarovskaya N, Pichler H, Lawitschka A, Koller E, Keil F, Valent P, Sohn K, Lion T. Presence of viremia during febrile neutropenic episodes in patients undergoing chemotherapy for malignant neoplasms. Am J Hematol 2021; 96:719-726. [PMID: 33784434 DOI: 10.1002/ajh.26177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
The importance of viral infections as a leading cause of morbidity and mortality is well documented in severely immunosuppressed patients undergoing allogeneic stem cell transplantation. By contrast, viral infections generally receive less attention in patients with malignant disorders undergoing chemotherapy, where the onset of neutropenic fever is mostly associated with bacterial or fungal infections, and screening for viral infections is not routinely performed. To address the occurrence of invasive viral infections in a clinical setting commonly associated with less pronounced immunosuppression, we have prospectively screened 237 febrile neutropenic episodes in pediatric (n = 77) and adult (n = 69) patients undergoing intensive chemotherapy, primarily for treatment of acute leukemia. Serial peripheral blood specimens were tested by RQ-PCR assays for the presence and quantity of the clinically relevant viruses CMV, EBV, HHV6 and HAdV, commonly reactivated in highly immunocompromised patients. Viremia was documented in 36 (15%) episodes investigated, including the detection of HHV6 (n = 14), EBV (n = 15), CMV (n = 6), or HAdV (n = 1). While low or intermediate levels of viremia (<104 virus copies/mL) were commonly associated with bacterial or fungal co-infection, viremia at higher levels (>104 copies/mL) was documented in patients without evidence for other infections, raising the possibility that at least in some instances the onset of fever may have been attributable to the virus detected. The observations suggest that viral infections, potentially resulting from reactivation, might also play a clinically relevant role in patients receiving chemotherapy for treatment of malignant neoplasms, and routine screening for viremia in this clinical setting might be warranted.
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Affiliation(s)
- Klára Obrová
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | | | - Marlene Remely
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Stefan Czurda
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Isabella Krickl
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Susanne Herndlhofer
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
| | - Karoline V. Gleixner
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
| | - Wolfgang R. Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
| | | | - Tijana Frank
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Nuno Andrade
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
| | - Teresa Egger‐Matiqi
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Christina Peters
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Gernot Engstler
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Michael Dworzak
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Andishe Attarbaschi
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Martine Grotel
- Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
| | | | - Ivan S. Moiseev
- I. P. Pavlov First Saint Petersburg State Medical University Saint Petersburg Russia
| | - Yuliya Rogacheva
- I. P. Pavlov First Saint Petersburg State Medical University Saint Petersburg Russia
| | - Ludmilla Zubarovskaya
- I. P. Pavlov First Saint Petersburg State Medical University Saint Petersburg Russia
| | - Natalia Zubarovskaya
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Herbert Pichler
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | - Anita Lawitschka
- St. Anna Children's Hospital, Department of Pediatrics Medical University of Vienna Vienna Austria
| | | | - Felix Keil
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
- 3rd Medical Department Hanuschhospital Vienna Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
| | - Kai Sohn
- Fraunhofer IGB Stuttgart Germany
| | - Thomas Lion
- St.Anna Children's Cancer Research Institute (CCRI) Vienna Austria
- Ludwig Boltzmann Institute for Hematology & Oncology Medical University of Vienna Vienna Austria
- Labdia Labordiagnostik GmbH Vienna Austria
- Department of Pediatrics Medical University of Vienna Vienna Austria
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32
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Mo L, Urbauer DL, Bruera E, Hui D. Recommendations for supportive care and best supportive care in NCCN clinical practice guidelines for treatment of cancer: Differences between solid tumor and hematologic malignancy guidelines. Support Care Cancer 2021; 29:7385-7392. [PMID: 34052931 DOI: 10.1007/s00520-021-06245-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/20/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE It is unclear how NCCN guidelines recommend "supportive care" and "best supportive care" in oncology practice. We examined the usage of "supportive care" and "best supportive care" in NCCN guidelines and compared between solid tumor and hematologic malignancy guidelines. METHODS We reviewed all updated NCCN Guidelines for Treatment of Cancer in October 2019. We documented the frequency of occurrence, definition, and timing of introduction of each term. We compared between solid tumor and hematologic malignancy guidelines. RESULTS We identified a total of 37 solid tumor and 16 hematologic guidelines. Thirty-seven (70%) guidelines mentioned "supportive care" and 36 (68%) mentioned "best supportive care." Hematologic guidelines were significantly more likely than solid tumor guidelines to use the term "supportive care" (median occurrence 19 vs. 2; P = 0.001) and to describe "supportive care" as management of cancer-related complications (N = 11/15, 73% vs. N = 2/22, 9%; P < 0.001). Domains of specialist palliative care were infrequently mentioned (N = 10/37, 27%). In contrast, solid tumor guidelines were significantly more likely than hematologic guidelines to mention "best supportive care" (median occurrence 6 vs. 0; P = 0.016). This term was rarely defined and mostly used in the advanced disease setting. CONCLUSION "Supportive care" and "best supportive care" were frequently used in NCCN guidelines, with significant variations in usage between solid tumor and hematologic oncologists. "Supportive care" was mostly limited to management of cancer-related complications and treatment adverse effects in NCCN guidelines, highlighting the need to go beyond the traditional biomedical model to more a patient-centered care model with greater integration of palliative care.
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Affiliation(s)
- Li Mo
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, FCT5.6046, 1515 Holcombe, Houston, TX, 77030, USA
- The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Diana L Urbauer
- Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, FCT5.6046, 1515 Holcombe, Houston, TX, 77030, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, FCT5.6046, 1515 Holcombe, Houston, TX, 77030, USA.
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Ghazizadeh Esslami G, Mamishi S, Mahmoudi S, Navaeian A, Behfar M, Hamidieh AA, Alimadadi H, Mahmoudieh Y. COVID-19 in transplant recipient children: An Iranian referral hospital-based study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021095. [PMID: 33988141 PMCID: PMC8182621 DOI: 10.23750/abm.v92i2.11189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
To our knowledge, there is still very limited information on the severity, mortality, laboratory, and radiologic findings of COVID-19 infection in transplant patients, particularly children. In this study, we reported 7 transplant recipients with laboratory-confirmed COVID-19 infection. The median age was 7.5 years (IQR: 31month-10 years), and 71% of the patients were male. All cases presented with a fever. The median duration of fever before admission was 2 days (IQR:1-8 days). Five patients (71%) experienced cough and dyspnea. Lymphocytopenia (Median of 0.6 (IQR: 0.14-2.0 × 109 cells per L) and thrombocytopenia (Median of 65 (IQR: 49-201 × 109 cells per L) were the most common CBC findings (both seen in 5 out of the 7 patients. Among 4 of the patients who underwent CT scans, 2 had ground glass opacity and consolidations. The mean number of lobe involvement in our patients was 3 (0-5), and 75% of the cases showed bilateral lung involvement in the imaging. In 4 patients (51%) the disease course manifested severely, and 2 patients are now deceased (28.6%). In conclusion, immunocompromised pediatric subgroups may experience higher rates of disease severity and mortality in comparison with the immunocompetent pediatric population. (www.actabiomedica.it)
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Affiliation(s)
| | - Setareh Mamishi
- a:1:{s:5:"en_US";s:37:"Tehran University of Medical sciences";}.
| | | | | | | | | | | | - Yasmine Mahmoudieh
- 7- Department of Molecular and Cell Biology, University of California, Berkeley .
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Wang LQ, Tan Su Yin E, Wei GQ, Hu YX, Nagler A, Huang H. Weathering the storm: COVID-19 infection in patients with hematological malignancies. J Zhejiang Univ Sci B 2021; 21:921-939. [PMID: 33843158 PMCID: PMC7759451 DOI: 10.1631/jzus.b2000423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Within a matter of months, this highly contagious novel virus has led to a global outbreak and is still spreading rapidly across continents. In patients with COVID-19, underlying chronic diseases and comorbidities are associated with dismal treatment outcomes. Owing to their immunosuppressive status, patients with hematological malignancies (HMs) are at an increased risk of infection and have a worse prognosis than patients without HMs. Accordingly, intensive attention should be paid to this cohort. In this review, we summarize and analyze specific clinical manifestations for patients with coexisting COVID-19 and HMs. Furthermore, we briefly describe customized management strategies and interventions for this susceptible cohort. This review is intended to guide clinical practice.
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Affiliation(s)
- Lin-Qin Wang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Elaine Tan Su Yin
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Guo-Qing Wei
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Yong-Xian Hu
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
| | - He Huang
- Bone Marrow Transplantation Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou 310058, China.,Institute of Hematology, Zhejiang University, Hangzhou 310058, China.,Zhejiang Laboratory for Systems & Precision Medicine, Zhejiang University Medical Center, Hangzhou 310058, China
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Abstract
Human parainfluenza virus type 3 (HPIV-3) is a significant cause of lower respiratory tract infections, with the most severe disease in young infants, immunocompromised individuals, and the elderly. HPIV-3 infections are currently untreatable with licensed therapeutics, and prophylactic and therapeutic options are needed for patients at risk. To complement existing human airway models of HPIV-3 infection and develop an animal model to assess novel intervention strategies, we evaluated infection and transmission of HPIV-3 in ferrets. A well-characterized human clinical isolate (CI) of HPIV-3 engineered to express enhanced green fluorescent protein (rHPIV-3 CI-1-EGFP) was passaged on primary human airway epithelial cells (HAE) or airway organoids (AO) to avoid tissue culture adaptations. rHPIV3 CI-1-EGFP infection was assessed in vitro in ferret AO and in ferrets in vivo. Undifferentiated and differentiated ferret AO cultures supported rHPIV-3 CI-1-EGFP replication, but the ferret primary airway cells from AO were less susceptible and permissive than HAE. In vivo rHPIV-3 CI-1-EGFP replicated in the upper and lower airways of ferrets and targeted respiratory epithelial cells, olfactory epithelial cells, type I pneumocytes, and type II pneumocytes. The infection efficiently induced specific antibody responses. Taken together, ferrets are naturally susceptible to HPIV-3 infection; however, limited replication was observed that led to neither overt clinical signs nor ferret-to-ferret transmission. However, in combination with ferret AO, the ferret model of HPIV-3 infection, tissue tropism, and neutralizing antibodies complements human ex vivo lung models and can be used as a platform for prevention and treatment studies for this important respiratory pathogen. IMPORTANCE HPIV-3 is an important cause of pediatric disease and significantly impacts the elderly. Increasing numbers of immunocompromised patients suffer from HPIV-3 infections, often related to problems with viral clearance. There is a need to model HPIV-3 infections in vitro and in vivo to evaluate novel prophylaxis and treatment options. Currently existing animal models lack the potential for studying animal-to-animal transmission or the effect of immunosuppressive therapy. Here, we describe the use of the ferret model in combination with authentic clinical viruses to further complement human ex vivo models, providing a platform to study approaches to prevent and treat HPIV-3 infection. Although we did not detect ferret-to-ferret transmission in our studies, these studies lay the groundwork for further refinement of the ferret model to immunocompromised ferrets, allowing for studies of severe HPIV-3-associated disease. Such models for preclinical evaluation of prophylaxis and antivirals can contribute to reducing the global health burden of HPIV-3.
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Outcomes of patients with hematologic malignancies and COVID-19: a report from the ASH Research Collaborative Data Hub. Blood Adv 2020; 4:5966-5975. [PMID: 33278301 PMCID: PMC7724912 DOI: 10.1182/bloodadvances.2020003170] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
The ASH Research Collaborative COVID-19 Registry for Hematology collects data on patients with hematologic diseases and COVID-19. Among the first 250 patients, mortality was 28%, and in several patients, a decision was made to forgo intensive care unit admission.
Coronavirus disease 2019 (COVID-19) is an illness resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in late 2019. Patients with cancer, and especially those with hematologic malignancies, may be at especially high risk of adverse outcomes, including mortality resulting from COVID-19 infection. The ASH Research Collaborative COVID-19 Registry for Hematology was developed to study features and outcomes of COVID-19 infection in patients with underlying blood disorders, such as hematologic malignancies. At the time of this report, data from 250 patients with blood cancers from 74 sites around the world had been entered into the registry. The most commonly represented malignancies were acute leukemia (33%), non-Hodgkin lymphoma (27%), and myeloma or amyloidosis (16%). Patients presented with a myriad of symptoms, most frequently fever (73%), cough (67%), dyspnea (50%), and fatigue (40%). Use of COVID-19–directed therapies, such as hydroxychloroquine (n = 76) or azithromycin (n = 59), was common. Overall mortality was 28%. Patients with a physician-estimated prognosis from the underlying hematologic malignancy of <12 months at the time of COVID-19 diagnosis and those with relapsed/refractory disease experienced a higher proportion of moderate/severe COVID-19 disease and death. In some instances, death occurred after a decision was made to forgo intensive care unit admission in favor of a palliative approach. Taken together, these data support the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection. Batch submissions from sites with high incidence of COVID-19 infection are planned to support future analyses.
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García-Suárez J, de la Cruz J, Cedillo Á, Llamas P, Duarte R, Jiménez-Yuste V, Hernández-Rivas JÁ, Gil-Manso R, Kwon M, Sánchez-Godoy P, Martínez-Barranco P, Colás-Lahuerta B, Herrera P, Benito-Parra L, Alegre A, Velasco A, Matilla A, Aláez-Usón MC, Martos-Martínez R, Martínez-Chamorro C, Susana-Quiroz K, Del Campo JF, de la Fuente A, Herráez R, Pascual A, Gómez E, Pérez-Oteyza J, Ruiz E, Alonso A, González-Medina J, Martín-Buitrago LN, Canales M, González-Gascón I, Vicente-Ayuso MC, Valenciano S, Roa MG, Monteliu PE, López-Jiménez J, Escobar CE, Ortiz-Martín J, Diez-Martin JL, Martinez-Lopez J. Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study. J Hematol Oncol 2020; 13:133. [PMID: 33032660 PMCID: PMC7542567 DOI: 10.1186/s13045-020-00970-7] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. METHODS In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. RESULTS Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60-79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17-10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). CONCLUSIONS In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.
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Affiliation(s)
- Julio García-Suárez
- Hematology Department, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Javier de la Cruz
- Research Institute imas12, University Hospital, SAMID-ISCIII, 12 de Octubre, Madrid, Spain
| | - Ángel Cedillo
- Asociación Madrileña de Hematología Y Hemoterapia (AMHH), Madrid, Spain
| | - Pilar Llamas
- Hematology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Rafael Duarte
- Hematology Department, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | | | | | - Rodrigo Gil-Manso
- Hematology Department, CNIO-ISCIII, CIBERONC, Complutense University, Hospital 12 de Octubre, imas12, Madrid, Spain
| | - Mi Kwon
- Hematology Department, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | | | | | | | - Pilar Herrera
- Hematology Department, University Hospital Ramón Y Cajal, Madrid, Spain
| | | | - Adrián Alegre
- Hematology Department, University Hospital La Princesa, Madrid, Spain
| | - Alberto Velasco
- Hematology Department, University Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Arturo Matilla
- Hematology Department, University Hospital Central de La Defensa Gómez Ulla, Madrid, Spain
| | | | | | | | | | | | | | - Regina Herráez
- Hematology Department, University Hospital Infanta Sofía, San Sebastián de Los Reyes, Madrid, Spain
| | - Adriana Pascual
- Hematology Department, University Hospital Infanta Elena, Valdemoro, Madrid, Spain
| | - Elvira Gómez
- Hematology Department, University Hospital Sureste, Arganda del Rey, Madrid, Spain
| | - Jaime Pérez-Oteyza
- Hematology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - Elena Ruiz
- Hematology Department, University Hospital Tajo, Aranjuez, Madrid, Spain
| | | | - José González-Medina
- Hematology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - Miguel Canales
- Hematology Department, University Hospital La Paz, Madrid, Spain
| | | | | | - Susana Valenciano
- Hematology Department, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - María García Roa
- Hematology Department, University Hospital Fundación Alcorcón, Madrid, Spain
| | | | | | | | | | - José Luis Diez-Martin
- Hematology Department, University General Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Joaquín Martinez-Lopez
- Hematology Department, CNIO-ISCIII, CIBERONC, Complutense University, Hospital 12 de Octubre, imas12, Madrid, Spain.
- i+12, CNIO-ISCIII, Hospital 12 de Octubre, Servicio de Hematología, Centro de Actividades Ambulatorias, Planta Tercera Bloque D, Univ. Complutense, Avd de Cordoba s/n, 28041, Madrid, Spain.
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Zamperlini-Netto G, Fernandes JF, Garcia JL, Ribeiro AAF, Camargo LFA, de Moraes Terra C, Hamerschlak N. COVID-19 after hematopoietic stem cell transplantation: report of two children. Bone Marrow Transplant 2020; 56:713-715. [PMID: 32934304 DOI: 10.1038/s41409-020-01041-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Gabriele Zamperlini-Netto
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Julia Lopes Garcia
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | | | - Luis Fernando Aranha Camargo
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Celso de Moraes Terra
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Nelson Hamerschlak
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil.
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Gabutti G, De Motoli F, Sandri F, Toffoletto MV, Stefanati A. Viral Respiratory Infections in Hematological Patients. Infect Dis Ther 2020; 9:495-510. [PMID: 32638228 PMCID: PMC7339094 DOI: 10.1007/s40121-020-00313-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Viral infections of the respiratory system represent one of the most important complications in hematological patients in terms of both the severity of the clinical picture and its related impact on the duration of hospitalization, and of mortality. The most implicated viruses are those that commonly cause community-based respiratory diseases: respiratory syncytial virus, Influenza virus and rhinovirus. However, in some cases the clinical picture may be triggered by first infection with or reactivation of pathogens normally not responsible for clinically relevant diseases in immunocompetent subjects. This issue is currently being taken into greater consideration within the scientific community. However, the strong heterogeneity in the epidemiology and clinical expression of these infections and the lack of adequate therapeutic options imply that there is currently no uniform consensus on the best management of these patients. The main purpose of this review is to highlight which viruses are currently most implicated in the onset of these infections, what is their incidence in so heterogeneous and fragile patients and the factors that lead to disease's onset and evolution. Possible or available clinical management options, diagnostic and therapeutic tools, and preventive and prophylaxis measures are also discussed.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Francesco De Motoli
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | | | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Ferrara F, Zappasodi P, Roncoroni E, Borlenghi E, Rossi G. Impact of Covid-19 on the treatment of acute myeloid leukemia. Leukemia 2020; 34:2254-2256. [PMID: 32561842 PMCID: PMC7304503 DOI: 10.1038/s41375-020-0925-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
| | - Patrizia Zappasodi
- Division of Hematology, Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisa Roncoroni
- Division of Hematology, Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Erika Borlenghi
- Division of Hematology, Spedali Civili Brescia, Brescia, Italy
| | - Giuseppe Rossi
- Division of Hematology, Spedali Civili Brescia, Brescia, Italy
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Legoff J, Michonneau D, Socie G. The virome in hematology-Stem cell transplantation and beyond. Semin Hematol 2020; 57:19-25. [PMID: 32690140 DOI: 10.1053/j.seminhematol.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 05/06/2020] [Indexed: 12/23/2022]
Abstract
The virome has been recently studied in hematology and mostly in the setting of allogeneic hematopoietic stem cell transplantation. However, in hematology (as in the setting of nonhematological disorders) the study of the microbiome (that indeed includes the virome) is a growing field. The overall field is moving beyond species catalogue to the understanding of the complex ecological relationship that microbes have with each other and with their host. Here we review the existing literature on the virome in transplant recipients and in other settings, and discuss potential applications of the virome study in hematology.
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Affiliation(s)
- Jérôme Legoff
- Université de Paris, INSERM U976, Paris, France; Microbiology department, Virology laboratory, Saint Louis Hospital, Paris, France
| | - David Michonneau
- Université de Paris, INSERM U976, Paris, France; Hematology-Transplantation, Saint Louis Hospital, Paris, France
| | - Gérard Socie
- Université de Paris, INSERM U976, Paris, France; Hematology-Transplantation, Saint Louis Hospital, Paris, France.
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Freeman CL, Mikhael J. COVID-19 and myeloma: what are the implications for now and in the future? Br J Haematol 2020; 190:173-178. [PMID: 32428242 PMCID: PMC7276733 DOI: 10.1111/bjh.16815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
The pandemic has affected every aspect of myeloma care. Immediate focus is minimising risk of contracting coronavirus disease 2019 (COVID-19) and the sequelae of infection. However, what does the future hold for our patients? What lessons will be taken forward to tackle myeloma in the fiscally constrained future? If we embrace the challenges that will emerge in the post-pandemic environment, the treatment delivered to patients could be more cost-effective and better tailored than before. Healthcare delivery post-COVID-19 will not return to how it was, and now is the time to invest in novel strategies to deliver the best possible outcomes for patients.
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Affiliation(s)
- Ciara L Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer and the University of British Columbia, Vancouver, BC, Canada
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute, City of Hope Cancer Center, Duarte, CA, USA
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Alcaraz R, Saiz-Rodríguez M, Cuevas B, González-López TJ, Labrador J. Risk of COVID-19 in oncohematological patients. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:52-53. [PMID: 32685259 PMCID: PMC7364271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
As of April 23, 2020, the COVID-19 (SARS-CoV-2) pandemic has affected 2,544,792 people, causing 175,694 deaths worldwide. The global scientific community has turned its attention to the impact of the new virus, which has become a major challenge for healthcare systems in many countries. Oncology patients have been considered of high risk within the ongoing COVID-19 pandemic. Oncology patients are especially vulnerable to infection due to the underlying disease and the type of therapy received. In general, the epidemiologic behavior of community-acquired respiratory viruses among oncology patients resembles that of the general population. Although, at present, there is limited data regarding COVID-19 and solid tumors, oncology patients seem to carry a higher risk of developing severe events. Yet, among patients harboring hematological diseases we have not observed an increase in COVID 19 infections.
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Affiliation(s)
- Raquel Alcaraz
- Research Unit, Hospital Universitario de BurgosBurgos, Spain
| | | | - Beatriz Cuevas
- Hematology Department, Hospital Universitario de BurgosBurgos, Spain
| | | | - Jorge Labrador
- Research Unit, Hospital Universitario de BurgosBurgos, Spain
- Hematology Department, Hospital Universitario de BurgosBurgos, Spain
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Patel R, Park J, Shah A, Wasif Saif M. COVID-19 and Cancer Patients. CANCER MEDICINE JOURNAL 2020; 3:40-48. [PMID: 32405629 PMCID: PMC7219960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
COVID-19 has now been declared a global pandemic with evolving incidence rates and fatalities. It is important to identify vulnerable populations who will be impacted most by this pandemic leading to higher mortality rates compared to the general healthy population. Although older patients and patients with co-morbidities fall into this vulnerable group, patients with hematologic and oncologic malignancies on active cytotoxic treatments are at even greater risk as they are both myelosuppressed and immunosuppressed. In addition to following the universal guidelines recommended by the Centers for Disease Control (CDC), it is important to also institute guidelines for cancer centers to help protect this vulnerable population. We review the current data, risks, and recommendations for COVID-19 in cancer patients.
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Affiliation(s)
- Rajvi Patel
- Department of Medical Oncology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra and Feinstein Institute for Medical Research, USA
| | - Jennifer Park
- Department of Medical Oncology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra and Feinstein Institute for Medical Research, USA
| | - Ankit Shah
- Department of Medical Oncology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra and Feinstein Institute for Medical Research, USA
| | - Muhammad Wasif Saif
- Department of Medical Oncology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra and Feinstein Institute for Medical Research, USA
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Santos CAQ, Rhee Y, Czapka MT, Kazi AS, Proia LA. Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients. J Clin Med 2020; 9:jcm9030865. [PMID: 32245201 PMCID: PMC7141503 DOI: 10.3390/jcm9030865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Hematopoietic stem cell transplant recipients are at increased risk of infection and immune dysregulation due to reception of cytotoxic chemotherapy; development of graft versus host disease, which necessitates treatment with immunosuppressive medications; and placement of invasive catheters. The prevention and management of infections in these vulnerable hosts is of utmost importance and a key “safety net” in stem cell transplantation. In this review, we provide updates on the prevention and management of CMV infection; invasive fungal infections; bacterial infections; Clostridium difficile infection; and EBV, HHV-6, adenovirus and BK infections. We discuss novel drugs, such as letermovir, isavuconazole, meropenem-vaborbactam and bezlotoxumab; weigh the pros and cons of using fluoroquinolone prophylaxis during neutropenia after stem cell transplantation; and provide updates on important viral infections after hematopoietic stem cell transplant (HSCT). Optimizing the prevention and management of infectious diseases by using the best available evidence will contribute to better outcomes for stem cell transplant recipients, and provide the best possible “safety net” for these immunocompromised hosts.
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Piñana J, Montoro J, Aznar C, Lorenzo I, Gómez MD, Guerreiro M, Carretero C, González-Barberá EM, Balaguer-Roselló A, Sanz R, Salavert M, Navarro D, Sanz MA, Sanz G, Sanz J. The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. J Infect 2020; 80:333-341. [PMID: 31972212 PMCID: PMC7112613 DOI: 10.1016/j.jinf.2019.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/11/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023]
Abstract
Rapid detection methods used as first diagnostic test for CARVs may delayed the start of antiviral therapy in a significant number of influenza and RSV cases. Syndromic multiplex RT-PCR-based prospective clinical CARV survey in allo-HCT recipients translates into a lower mortality rate as compared to standard clinical practice based on RSV and influenza virus rapid detection test. We found that donor/recipient HLA mismatch, CARV LRTD and high-risk ISI were also associated with higher mortality.
Background There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections. Methods We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center. Results CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs. 57%, hospital admission 69% vs. 28% and lower respiratory tract 58% vs. 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs. 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs. 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n = 23, 37% vs. n = 10, 7%, p < 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12–0.7, p = 0.01]. Conclusion This study report on outcome differences when reporting retrospective vs. prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality.
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Affiliation(s)
- JoséLuis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carla Aznar
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Dolores Gómez
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Rosa Sanz
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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Cheng MP, Orejas JL, Arbona-Haddad E, Bold TD, Solomon IH, Chen K, Pandit A, Kusztos AE, Cummins KC, Liakos A, Marty FM, Koo S, Hammond SP. Use of triazoles for the treatment of invasive aspergillosis: A three-year cohort analysis. Mycoses 2019; 63:58-64. [PMID: 31587405 DOI: 10.1111/myc.13013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
In a 3-year cohort study of adult patients with proven or probable IA, fewer patients initially treated with isavuconazole experienced adverse events compared with voriconazole, but more patients required a change in therapy due to lack of clinical efficacy.
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Affiliation(s)
- Matthew P Cheng
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - José L Orejas
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Esther Arbona-Haddad
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Tyler D Bold
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Isaac H Solomon
- Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kaiwen Chen
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alisha Pandit
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amanda E Kusztos
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kaelyn C Cummins
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alexis Liakos
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sophia Koo
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarah P Hammond
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Cornely OA, Hoenigl M, Lass-Flörl C, Chen SCA, Kontoyiannis DP, Morrissey CO, Thompson GR. Defining breakthrough invasive fungal infection-Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology. Mycoses 2019; 62:716-729. [PMID: 31254420 DOI: 10.1111/myc.12960] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/14/2022]
Abstract
Breakthrough invasive fungal infections (IFIs) have emerged as a significant problem in patients receiving systemic antifungals; however, consensus criteria for defining breakthrough IFI are missing. This position paper establishes broadly applicable definitions of breakthrough IFI for clinical research. Representatives of the Mycoses Study Group Education and Research Consortium (MSG-ERC) and the European Confederation of Medical Mycology (ECMM) reviewed the relevant English literature for definitions applied and published through 2018. A draft proposal for definitions was developed and circulated to all members of the two organisations for comment and suggestions. The authors addressed comments received and circulated the updated document for approval. Breakthrough IFI was defined as any IFI occurring during exposure to an antifungal drug, including fungi outside the spectrum of activity of an antifungal. The time of breakthrough IFI was defined as the first attributable clinical sign or symptom, mycological finding or radiological feature. The period defining breakthrough IFI depends on pharmacokinetic properties and extends at least until one dosing interval after drug discontinuation. Persistent IFI describes IFI that is unchanged/stable since treatment initiation with ongoing need for antifungal therapy. It is distinct from refractory IFI, defined as progression of disease and therefore similar to non-response to treatment. Relapsed IFI occurs after treatment and is caused by the same pathogen at the same site, although dissemination can occur. These proposed definitions are intended to support the design of future clinical trials and epidemiological research in clinical mycology, with the ultimate goal of increasing the comparability of clinical trial results.
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Affiliation(s)
- Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Department I of Internal Medicine, ECMM Center of Excellence for Medical Mycology, German Centre for Infection Research, Partner Site Bonn-Cologne (DZIF), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.,Division of Pulmonology and Section of Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Cornelia Lass-Flörl
- Division of Hygiene and Microbiology, ECMM Excellence Center for Medical Mycology, Medical University Innsbruck, Innsbruck, Austria
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology, Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Centre for Infectious Diseases and Microbiology, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - C Orla Morrissey
- Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - George R Thompson
- Departments of Medical Microbiology and Immunology and Internal Medicine Division of Infectious Diseases, UC-Davis Medical Center, Sacramento, CA, USA
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Bowen CD, Tallman GB, Hakki M, Lewis Ⅱ JS. Isavuconazole to prevent invasive fungal infection in immunocompromised adults: Initial experience at an academic medical centre. Mycoses 2019; 62:665-672. [PMID: 31050373 DOI: 10.1111/myc.12924] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate clinical and economic outcomes associated with the use of isavuconazole as antifungal prophylaxis in high-risk immunocompromised patients. PATIENTS/METHODS Retrospective, single-centre cohort study of patients who received isavuconazole prophylaxis. Outcomes assessed included breakthrough IFI, early discontinuation of isavuconazole for any reason and antifungal prophylaxis prescribed at discharge. The impact on inpatient drug expenditure was evaluated using current isavuconazole and posaconazole drug costs per observed isavuconazole days of therapy (DOT) during the study period. RESULTS One hundred thirty-eight courses of isavuconazole prophylaxis were administered to 98 inpatients (2193 DOT). Relapsed/refractory acute myelogenous leukaemia was the indication for prophylaxis in over half (59.4%) of patients. Breakthrough IFI occurred in 8 (5.8%) courses. Suspected drug-related toxicities led to early discontinuation in 6 (4.3%) courses (five hepatotoxicity, one drug rash). At discharge, 24 (17.4%) courses lacked insurance coverage for isavuconazole. The formulary switch to isavuconazole prophylaxis resulted in an estimated mean drug cost savings of $128.25 per DOT relative to estimated posaconazole costs (P < 0.001). CONCLUSION Isavuconazole may be an option for antifungal prophylaxis in high-risk immunocompromised adults and has the potential to produce significant inpatient drug cost savings. Further studies are needed to confirm the clinical efficacy and cost-effectiveness of isavuconazole in this role.
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Affiliation(s)
- Christina D Bowen
- Department of Pharmacy Services, Oregon Health & Science University Hospital and Clinics, Portland, Oregon
| | - Gregory B Tallman
- College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, Oregon
| | - Morgan Hakki
- Division of Infectious Diseases, Oregon Health & Science University Hospital and Clinics, Portland, Oregon
| | - James S Lewis Ⅱ
- Department of Pharmacy Services, Oregon Health & Science University Hospital and Clinics, Portland, Oregon
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