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Chopra Y, Hong C, Schechter T, Ali M, Chiang KY, Wall D, Krueger J. Intractable abdominal pain as the sole symptom of Varicella Zoster reactivation after allogeneic stem cell transplantation: brief case report and review of the literature. Pediatr Hematol Oncol 2024; 41:224-228. [PMID: 37898904 DOI: 10.1080/08880018.2023.2271974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
After primary infection, Varicella Zoster (VZV) persists in sensory dorsal root ganglia and may be reactivated in periods of diminished T-cell immunity. Varicella Zoster reactivation post allogenic stem cell transplantation (HSCT) can be challenging to diagnose as it does not always present with characteristic skin lesions. We describe a pediatric patient who presented with isolated severe abdominal pain with no other symptoms. Cutaneous lesions appeared only 10 days later resulting in delayed diagnosis and treatment. He was successfully treated with intravenous acyclovir and recovered after a prolonged hospital stay with post-herpetic neuralgia. Abdominal pain in children post HSCT has a broad differential and VZV reactivation should be considered even in absence of cutaneous lesions. Early diagnosis and treatment are essential to reduce VZV-related morbidity and mortality. In this article we present a case report and review clinical presentation and outcome of similar cases in the literature.
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Affiliation(s)
- Yogi Chopra
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Carly Hong
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Tal Schechter
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Muhammad Ali
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Kuang-Yueh Chiang
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Donna Wall
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
| | - Joerg Krueger
- Blood and Marrow Transplant/Cellular Therapy Program, Division of Hematology/Oncology, The Hospital for Sick Children/University of Toronto, Toronto, Canada
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2
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Gomyo A, Kimura SI, Suzuki J, Ishikawa T, Meno T, Matsuoka A, Nakamura Y, Kawamura M, Kawamura S, Takeshita J, Yoshino N, Misaki Y, Yoshimura K, Okada Y, Akahoshi Y, Tamaki M, Kusuda M, Kameda K, Wada H, Sato M, Tanihara A, Sekine K, Nakasone H, Kako S, Kanda Y. Clinical Impact of Pretransplantation Physical Function on Transplantation after Allogeneic Hematopoietic Cell Transplantation in Older Adults. Transplant Cell Ther 2023; 29:721.e1-721.e8. [PMID: 37643718 DOI: 10.1016/j.jtct.2023.08.023] [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: 06/14/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
Clinical research regarding the impact of pretransplantation physical function on transplantation outcomes in older adults remains limited. We retrospectively reviewed the charts of 150 consecutive patients age >55 years who underwent their first allogeneic hematopoietic cell transplantation (HCT) at our center between 2010 and 2021. We evaluated the clinical impact of pretransplantation physical function, including hand grip strength (HGS), knee extension strength (KES), and distance covered in a 6-minute walk test (6MWT), along with other clinical factors, on transplantation outcomes such as overall survival (OS), nonrelapse mortality (NRM), and cumulative incidence of disease relapse (CIR). There was no difference in OS, NRM, or CIR among the 3 age groups studied (56 to 60 years, 61 to 65 years, and 66 to 70 years). With regard to physical function tests, we divided the study patients into 2 groups based on the median HGS, KES, and 6MWT values: higher physical function and lower physical function groups. Because there were significant differences in HGS and KES between male and female patients, sex-specific threshold values were used. In a univariate analysis, OS tended to be better in the higher physical function group compared with the lower physical function group (4-year OS, 42.0% versus 32.0% in HGS, P = .14; 44.8% versus 37.8% in KES, P = .17; 46.7% versus 30.5% in 6MWT, P = .099). NRM was significantly lower in the higher physical function group (4-year NRM, 25.5% versus 39.9% in HGS, P = .045; 17.7% versus 38.0% in KES, P = .005; 22.5% versus 43.4% in 6MWT, P = .033). There was no significant difference in CIR between the higher and lower physical function groups (4-year CIR, 34.6% versus 28.7% in HGS, P = .38; 38.5% versus 25.8% in KES, P = .20; 33.0% versus 27.0% in 6MWT, P = .42). In multivariate analysis, the higher KES group (hazard ratio [HR], .54; 95% confidence interval [CI], .32 to .90) was significantly associated with better OS, as were female sex (HR, .48; 95% CI, .26 to .89) and low/intermediate Disease Risk Index (HR, 3.59; 95% CI, 2.04 to 6.31). Higher KES (HR, .37; 95% CI, .17 to .83) and female sex (HR .36; 95% CI, .13 to .998) were significantly associated with a reduced risk of NRM. Higher HGS and higher 6MWT tended to be associated with a reduced risk of NRM, but this trend was not statistically significant. Pretransplantation physical function, particularly the strength of the lower extremities, but not chronological age, is associated with NRM and OS after allogeneic HCT in adults age >55 years.
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Affiliation(s)
- Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junko Suzuki
- Department of Physical Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takuto Ishikawa
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tomohiro Meno
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akari Matsuoka
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yuhei Nakamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yosuke Okada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Sekine
- Department of Physical Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
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3
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Tatebe Y, Ushio S, Esumi S, Sada H, Ochi M, Tamefusa K, Ishida H, Fujiwara K, Kanamitsu K, Washio K, Katsube R, Murakawa K, Zamami Y. Low-dose acyclovir for prophylaxis of varicella-zoster virus reactivation after hematopoietic stem cell transplantation in children. Pediatr Blood Cancer 2022; 69:e29979. [PMID: 36151963 DOI: 10.1002/pbc.29979] [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: 05/15/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Varicella-zoster virus (VZV) reactivation is a serious complication of hematopoietic stem cell transplantation (HSCT). Although low-dose acyclovir can prevent VZV reactivation after HSCT in adults, the efficacy of a dose of acyclovir lower than the recommended dose, such as 60-80 mg/kg/day in children, is unclear. In this study, we aimed to evaluate the incidence of VZV reactivation after HSCT during and after low-dose acyclovir administration for preventing VZV reactivation in children. METHODS This single-center retrospective study included children aged ≤15 years who received oral acyclovir (at 15 mg/kg/day) to prevent VZV reactivation after HSCT. We examined the cumulative incidence of VZV reactivation after HSCT, during and after prophylactic acyclovir administration. RESULTS Fifty-three eligible patients were included in this study, of whom 37 underwent allogeneic HSCT. The median duration of prophylactic acyclovir therapy was 264 days (range: 69-1140 days). VZV reactivation occurred in 13 patients (24.5%, 95% confidence interval [CI]: 14.9-37.6). The cumulative incidence of VZV reactivation 1 and 2 years after HSCT was 6.26% (95% CI: 1.60-15.5) and 20.9% (95% CI: 10.3-34.0), respectively. While only one patient developed VZV reactivation during the administration of prophylactic acyclovir, the cumulative incidence of VZV reactivation increased to 24.2% (95% CI: 12.5-38.0) 1 year after the cessation of acyclovir. CONCLUSION Low-dose acyclovir (15 mg/kg/day) could be effective for preventing VZV reactivation after HSCT in children because VZV reactivation seldom occurs during the administration of 15 mg/kg/day acyclovir.
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Affiliation(s)
- Yasuhisa Tatebe
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Soichiro Ushio
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Satoru Esumi
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Hikaru Sada
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Motoharu Ochi
- Department of Pediatrics, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Kosuke Tamefusa
- Department of Pediatrics, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Hisashi Ishida
- Department of Pediatrics, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Kaori Fujiwara
- Department of Pediatrics, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Kiichiro Kanamitsu
- Department of Pediatrics, Okayama University Hospital, Kita-ku, Okayama, Japan.,Department of Pediatrics, National Hospital Organization Okayama Medical Center, Kita-ku, Okayama, Japan
| | - Kana Washio
- Department of Pediatrics, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Risa Katsube
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Kiminaka Murakawa
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
| | - Yoshito Zamami
- Department of Pharmacy, Okayama University Hospital, Kita-ku, Okayama, Japan
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4
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Fukushi K, Konuma T, Monna-Oiwa M, Isobe M, Kato S, Kuroda S, Takahashi S, Nannya Y. Long-term incidence of varicella zoster virus disease in adults receiving single-unit cord blood transplantation. Transplant Cell Ther 2022; 28:339.e1-339.e7. [PMID: 35364334 DOI: 10.1016/j.jtct.2022.03.022] [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: 01/24/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Varicella zoster virus (VZV) disease is a common complication after allogeneic hematopoietic cell transplantation (HCT). However, research into the long-term incidence of VZV disease in adults receiving cord blood transplantation (CBT) has been limited. OBJECTIVE The objective of this study was to evaluate the incidence, risk factors, and clinical impact of VZV disease after CBT with a long-term follow-up in our institute. STUDY DESIGN We retrospectively analyzed the data for 156 adult patients who received single-unit CBT at our institute between 2007 and 2020, who achieved neutrophil engraftment and survived at least 100 days without recurrence of the underlying disease. RESULTS VZV disease occurred in 61 patients at a median of 608 days (range, 36 - 4090 days) after CBT. The cumulative incidence of VZV disease was 14% (95% confidence interval [CI], 9% to 20%) at 1 year and 40% (95% CI, 31% to 48%) at 5 years after CBT. Multivariate analysis showed that the cessation of antiviral prophylaxis was an independent risk factor for a higher risk of VZV disease (hazard ratio: 15.65, 95% CI: 6.59-37.21, P<0.001). The cumulative incidence of VZV disease was significantly lower in the long-term antiviral prophylaxis group given for around 1 year after CBT or the end of immunosuppressive therapy compared to the short-term antiviral prophylaxis group given for 35 days after CBT (P=0.005). Among patients who developed VZV disease, the median onset of VZV disease was significantly delayed in the long-term antiviral prophylaxis group compared to the short-term antiviral prophylaxis group (694 days vs 130 days, P<0.001), but the median onset of VZV disease after the cessation of antiviral prophylaxis was not significantly different between long-term and short-term antiviral prophylaxis (166 days vs 95 days, P=0.087). CONCLUSION These data demonstrated that the long-term incidence of VZV disease was relatively high in adult patients receiving CBT. Given that the incidence of VZV disease after the cessation of antiviral prophylaxis remained high, additional interventions, such as recombinant zoster vaccine administration, could be required to prevent VZV disease in long-term adult survivors after CBT.
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Affiliation(s)
- Kahori Fukushi
- Department of Pharmacy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Maki Monna-Oiwa
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masamichi Isobe
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seiko Kato
- Division of Clinical Precision Research Platform, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Seiichiro Kuroda
- Department of Pharmacy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoshi Takahashi
- Division of Clinical Precision Research Platform, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuhito Nannya
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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5
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Xue E, Xie H, Leisenring WM, Kimball LE, Goyal S, Chung L, Blazevic R, Maltez B, Edwards A, Dahlberg AE, Salit RB, Delaney C, Pergam SA, Boeckh M, Milano F, Hill JA. High Incidence of Herpes Zoster After Cord Blood Hematopoietic Cell Transplant Despite Longer Duration of Antiviral Prophylaxis. Clin Infect Dis 2021; 72:1350-1357. [PMID: 32150265 DOI: 10.1093/cid/ciaa222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cord blood transplant (CBT) recipients have a high incidence of herpes zoster (HZ) in the context of short-term peritransplant antiviral prophylaxis. In 2009, international guidelines recommended HZ prophylaxis for at least 1 year after hematopoietic cell transplant. The impact of longer-term antiviral prophylaxis on HZ incidence after CBT is unknown. METHODS We retrospectively analyzed varicella zoster virus (VZV)-seropositive CBT recipients who were transplanted between 2006 and 2016. We abstracted HZ events and other variables for up to 5 years post-CBT. We calculated the cumulative incidence of HZ and used Cox proportional hazards regression to identify variables associated with HZ. RESULTS The study cohort consisted of 227 patients. Among 1-year survivors, 91% were still receiving prophylaxis, for a median duration of 20.6 months. HZ occurred in 44 patients (19%) at a median of 23.6 months. The cumulative incidence of HZ by 1 year after CBT was 1.8% (95% confidence interval [CI], .1%-4%), but increased to 26% (95% CI, 19%-33%) by 5 years. In a multivariable analysis, acute graft-vs-host disease was associated with increased risk, whereas antiviral prophylaxis was associated with reduced risk for HZ (adjusted hazard ratio, 0.19 [95% CI, .09-.4]). There was no association between CD4+ T-cell counts at 1 year post-CBT and subsequent risk for HZ. CONCLUSIONS We found a high incidence of HZ after CBT despite antiviral prophylaxis for > 1 year. Based on these findings, we suggest longer duration of prophylaxis for HZ after CBT. Compliance with antiviral prophylaxis, VZV-specific immune monitoring, and vaccination to mitigate HZ after CBT also require further study.
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Affiliation(s)
- Elisabetta Xue
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Louise E Kimball
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sonia Goyal
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lisa Chung
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rachel Blazevic
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Byron Maltez
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Anna Edwards
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ann E Dahlberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rachel B Salit
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Colleen Delaney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Nohla Therapeutics, Seattle, Washington, USA
| | - Steven A Pergam
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Michael Boeckh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Joshua A Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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6
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Kawamura K, Wada H, Nakasone H, Akahoshi Y, Kawamura S, Takeshita J, Yoshino N, Misaki Y, Yoshimura K, Gomyo A, Tamaki M, Kusuda M, Kameda K, Sato M, Tanihara A, Kimura SI, Kako S, Kanda Y. Immunity and Vaccination Against Measles, Mumps, and Rubella in Adult Allogeneic Hematopoietic Stem Cell Transplant Recipients. Transplant Cell Ther 2021; 27:436.e1-436.e8. [PMID: 33775586 DOI: 10.1016/j.jtct.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Abstract
Large outbreaks of measles or rubella occasionally occur around the world, and measles infection can be severe and even fatal in transplant patients. However, limited data are available on immunity to measles, mumps, and rubella (MMR) in adult patients after allogeneic stem cell transplantation (allo-HCT). The aim of this study was to evaluate the immune status against MMR and the effects of vaccination against MMR in adult patients after allo-HCT. A total of 135 adult patients who were alive without relapse and new malignancy at 2 years after allo-HCT were included in this study. We measured IgG antibody to MMR before allo-HCT and annually thereafter. The probabilities of being seropositive to measles, mumps or rubella after allo-HCT were estimated according to the Kaplan-Meier method and compared among groups with the log-rank test. The probability of being seropositive at 2 years after allo-HCT in patients who were seropositive before allo-HCT was 60.6% for measles, 39.7% for mumps, and 52.2% for rubella. History of chronic graft-versus-host disease tended to be a risk factor for the loss of immunity against measles (hazard ratio [HR] 1.69, P = .064) and rubella (HR 1.75, P = .056). To predict the loss of immunity against MMR at 2 years after allo-HCT, we defined the following cutoff values for the IgG index before HCT: 18.2 for measles, 5.3 for mumps, and 21.4 for rubella using a receiver-operating characteristics curve. The lower-IgG groups experienced a significant loss of seropositivity at 2 years (39% versus 82% for measles, P < .001; 13% versus 59% for mumps, P < .001; and 33% versus 90% for rubella, P < .001). After this loss of immunity, 25 patients received a single vaccination against MMR. The seroconversion rates were 64%, 36%, and 72% for measles, mumps, and rubella, respectively. Loss of immunity to MMR commonly occurs in the first several years after transplantation. In the patients who lose the immunity, the seroconversion rate after 1 dose of MMR vaccine given at ≥2 years after transplantation is suboptimal.
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Affiliation(s)
- Koji Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
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7
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Malpica L, Moll S. Practical approach to monitoring and prevention of infectious complications associated with systemic corticosteroids, antimetabolites, cyclosporine, and cyclophosphamide in nonmalignant hematologic diseases. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:319-327. [PMID: 33275674 PMCID: PMC7727566 DOI: 10.1182/hematology.2020000116] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Corticosteroids constitute a first-line therapy for adults and children suffering from nonmalignant immune-mediated hematologic diseases. However, high disease relapse rates during the tapering period or upon drug discontinuation result in long-term corticosteroid use that increases the risk of infection. This same concept applies to other immunosuppressive agents, such as antimetabolites, calcineurin inhibitors, and cyclophosphamide. Corticosteroids are associated with a length-of-treatment and dose-dependent risk for infection. Screening and antimicrobial prophylaxis against tuberculosis, hepatitis B, Strongyloides stercoralis, and Pneumocystis jirovecii pneumonia (PJP) might be indicated in patients who are scheduled to be on high-dose corticosteroids for >4 weeks (>30 mg of prednisone-equivalent dose [PEQ]) or in patients chronically treated (≥8 weeks of continuous or intermittent corticosteroid use) with moderate doses (≥15 to <30 mg PEQ). Antimetabolites (azathioprine, mycophenolate) increase the risk of progressive multifocal leukoencephalopathy (PML); however, other opportunistic infections and viral reactivation have also been reported. In case of new onset of neurological symptoms, PML needs to be considered, and an urgent neurology consultation should be obtained. Cyclophosphamide-induced myelosuppression can lead to serious infections related to neutropenia. PJP prophylaxis should be considered with combination therapy of cyclophosphamide and corticosteroids until a PEQ dose ≤ 5 mg/d is reached. Data on infectious risk when cyclosporine is used in patients with nonmalignant hematologic diseases are lacking. Discontinuation of any immunosuppressive agent during an episode of infection is recommended. In all patients, adherence to an age-based immunization schedule is appropriate.
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Affiliation(s)
- Luis Malpica
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Stephan Moll
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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8
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Kimura SI, Nakamura Y, Kawamura M, Takeshita J, Kawamura S, Yoshino N, Misaki Y, Yoshimura K, Matsumi S, Gomyo A, Akahoshi Y, Tamaki M, Kusuda M, Kameda K, Wada H, Sato M, Tanihara A, Nakasone H, Kako S, Kanda Y. Association of the areas over and under the lymphocyte curve with cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2020; 23:e13460. [PMID: 32893940 DOI: 10.1111/tid.13460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND We retrospectively compared the impact of the areas over and under the lymphocyte curve (L_AOC vs L_AUC) on cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Among 394 consecutive patients who underwent their first allogeneic HSCT at our center between 2007 and 2018, 301 patients met the inclusion criteria. L_AOC was calculated as the area over the lymphocyte curve during lymphopenia (absolute lymphocyte count [ALC] <700/μL). We calculated L_AOC and L_AUC from day 0 to day 15 (L_AOC15, L_AUC15) and from day 0 to day 30 (L_AOC30, L_AUC30). RESULTS CMV antigenemia was defined as more than 3 cells/2 slides by the C10/11 method and detected in 204 cases (CMV reactivation) at a median of 39 days after HSCT. Although there were significant differences in L_AOC15, L_AOC30, L_AUC15, and L_AUC30 between patients with and without CMV reactivation, there was no difference in accuracy for predicting CMV reactivation between L_AOC and L_AUC. In a multivariate analysis, L_AOC15 and L_AUC15 were each identified as independent predictive factors for CMV reactivation, along with advanced age and CMV serostatus. However, ALC at day 14 or day 21 was as accurate as area-based indexes such as L_AOC15 and L_AUC15. L_AOC15 and L_AUC15 were significantly associated with longer duration of anti-CMV antiviral therapy while ALC was not. CONCLUSIONS L_AOC15 and L_AUC15 had similar impacts on CMV reactivation. Although these area-based indexes were not superior to ALC for predicting CMV reactivation, they might predict patients who need longer duration of antiviral therapy more accurately.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yuhei Nakamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shimpei Matsumi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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9
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Kimura SI, Nakamura Y, Kawamura M, Takeshita J, Kawamura S, Yoshino N, Misaki Y, Yoshimura K, Matsumi S, Gomyo A, Akahoshi Y, Tamaki M, Kusuda M, Kameda K, Wada H, Sato M, Terasako-Saito K, Tanihara A, Nakasone H, Kako S, Kanda Y. Impact of neutropenia evaluated in terms of the D-index on invasive fungal disease while on empiric or preemptive antifungal treatment strategy in the early phase after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2020; 22:e13409. [PMID: 32654234 DOI: 10.1111/tid.13409] [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: 04/17/2020] [Revised: 06/20/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND We retrospectively evaluated the association between the D-index, which reflects both the depth and duration of neutropenia, and proven/probable invasive fungal disease (IFD) early after allogeneic hematopoietic stem cell transplantation (HSCT) at our center (n = 394). METHODS The D-index was defined as the area over the neutrophil curve during neutropenia. The cumulative D-index from the start of neutropenia until the development of infection (c-D-index) was also evaluated as a real-time assessment of neutropenia. RESULTS There were 19 cases of early proven/probable IFD before and within 1 week after engraftment. Fifteen cases (78.9%) were seen as breakthrough infection while on empiric (n = 7), preemptive (n = 4) or prophylactic (n = 4) antifungal administration with mold-active agents. The c-D-index and lower performance status were identified as independent significant predictive factors for IFD. A receiver operating characteristic (ROC) curve analysis showed that the D-index and c-D-index were more accurate than the simple duration of neutropenia and as accurate as the duration of profound neutropenia for predicting IFD. The sensitivity, specificity, and positive and negative predictive values of the c-D-index using an appropriate cutoff (CO) value (10 644) determined by ROC curve analysis were 73.1%, 63.2%, 9.1%, and 97.9%, respectively. The advantage of the c-D-index to cumulative days of neutropenia in terms of positive and negative predictive values seemed to be small. CONCLUSIONS The appropriate CO value for the c-D-index for predicting IFD was as high as 10 644 in allogeneic HSCT with a more frequent use of empiric antifungal therapy. The c-D-index is useful for assessing the risk of breakthrough IFD.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yuhei Nakamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Shimpei Matsumi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
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10
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Kimura SI, Takeshita J, Kawamura M, Kawamura S, Yoshino N, Misaki Y, Yoshimura K, Matsumi S, Gomyo A, Akahoshi Y, Tamaki M, Kusuda M, Kameda K, Wada H, Kawamura K, Sato M, Terasako-Saito K, Tanihara A, Nakasone H, Kako S, Kanda Y. Association between the kinetics of cytomegalovirus reactivation evaluated in terms of the area under the curve of cytomegalovirus antigenemia and invasive mold infection during the post-engraftment phase after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2020; 22:e13387. [PMID: 32585736 DOI: 10.1111/tid.13387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND We evaluated the clinical impact of cytomegalovirus (CMV) reactivation calculated in terms of the area under the curve of CMV antigenemia (CMV-AUC) on the development of invasive mold infection (IMI) in the post-engraftment phase after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Among 394 consecutive patients who underwent their first allogeneic HSCT at our center between 2007 and 2018, 335 were included after excluding patients with a past history of invasive fungal disease (IFD), the development of IFD before engraftment, engraftment failure, or early death within 30 days. CMV antigenemia (CMV-AG) was monitored weekly after engraftment and 3 or more cells/2 slides were regarded as positive. CMV-AUC was calculated by the trapezoidal method using the number of CMV-AG after logarithmic transformation and the duration in weeks and was added until negative conversion. Patients with CMV reactivation were divided into low and high CMV-AUC groups using the median value of CMV-AUC as a threshold. RESULTS There were 17 proven/probable IMIs including one mucormycosis and 16 probable invasive aspergillosis, and the 2-year cumulative incidence was 1.0% in the negative CMV-AUC group (n = 136), 3.3% in the low CMV-AUC group (n = 98) and 13.8% in the high CMV-AUC group (n = 101) (P = .001). In a multivariate analysis, grade II-IV acute GVHD (HR 3.74) and CMV-AUC (HR low 1.25, high 5.91) were identified as independent significant factors associated with a higher incidence of IMI. CONCLUSIONS Cytomegalovirus kinetics evaluated in terms of CMV-AUC were significantly associated with the development of IMI in the post-engraftment phase after allogeneic HSCT.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Shimpei Matsumi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Koji Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama-city, Japan
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11
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Misaki Y, Kimura SI, Kawamura M, Kawamura S, Takeshita J, Yoshino N, Yoshimura K, Gomyo A, Matsumi S, Akahoshi Y, Tamaki M, Kusuda M, Kameda K, Wada H, Kawamura K, Sato M, Terasako-Saito K, Tanihara A, Nakasone H, Kako S, Kanda Y. Impact of the patient's body weight on the efficacy and adverse events of valganciclovir for cytomegalovirus reactivation after hematopoietic stem cell transplantation. Transpl Infect Dis 2020; 22:e13270. [PMID: 32092224 DOI: 10.1111/tid.13270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 12/01/2022]
Abstract
While the dose of ganciclovir (GCV) is decided base on patients' body weight (BW), that of valganciclovir (VGCV) is fixed as 900 or 1800 mg/d regardless of the patient's BW in preemptive therapy for cytomegalovirus (CMV) reactivation in hematopoietic stem cell transplantation. We analyzed the impact of the patient's BW on the effectiveness and adverse events (AEs) of VGCV. From March 2004 to February 2017, 27 patients received VGCV as a first-line treatment for CMV reactivation. As a historical control group, we extracted 17 patients who started to receive GCV at a similar timing. We used the following definitions of outcomes: speed of reduction of CMV antigenemia (CMV-AG) as a measure of effectiveness, ratios of baseline and minimum value for white blood cell (WBC) and platelet counts, and ratio of baseline and maximum values for serum creatinine (sCr) as measures of AEs. As a result, there was no significant correlation between average daily dose of VGCV with or without adjusting for the patient's BW and speed of reduction of CMV-AG. On the other hand, the decreases in WBC and platelets and the increase in sCr were significantly correlated with the cumulative dose of VGCV. However, the absolute values of the correlation coefficients did not increase when we analyzed the correlations between the BW-adjusted cumulative dose of VGCV and factors associated with adverse events. There were no significant differences in efficacies or AE parameters between the GCV and VGCV groups. In conclusion, the patient's BW did not significantly affect the effectiveness or adverse events of VGCV.
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Affiliation(s)
- Yukiko Misaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Masakatsu Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Shunto Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Junko Takeshita
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Nozomu Yoshino
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Ayumi Gomyo
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Shimpei Matsumi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Masaharu Tamaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Machiko Kusuda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Aki Tanihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama-City, Japan
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12
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Kimura SI, Sato M, Misaki Y, Yoshimura K, Gomyo A, Hayakawa J, Akahoshi Y, Harada N, Tamaki M, Kusuda M, Kameda K, Wada H, Kawamura K, Terasako-Saito K, Kikuchi M, Tanihara A, Nakasone H, Kako S, Kanda Y. Prospective validation of the L-index reflecting both the intensity and duration of lymphopenia and its detailed evaluation using a lymphocyte subset analysis after allogeneic hematopoietic stem cell transplantation. Transpl Immunol 2019; 58:101262. [PMID: 31899256 DOI: 10.1016/j.trim.2019.101262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 12/17/2022]
Abstract
We prospectively validated the previously reported L-index, which reflects both the intensity and duration of lymphopenia, and further evaluated it using a lymphocyte subset analysis after allogeneic hematopoietic stem cell transplantation (HSCT) (n = 30). The L-index was defined as the area over the lymphocyte curve during lymphopenia (<700/μl), and calculated from the start of conditioning to day30 (L-index(30)) and day100 (L-index(100)). The lymphocyte subset including CD3, CD4, CD8, CD19 and CD56 was analyzed before and at 14, 21, 28, 42, 56, 70, and 84 days after HSCT. Cytomegalovirus (CMV) antigenemia was detected as >3 cells/2 slides by the C10/11 method in 21 cases (CMV-AG ≥3 group) at a median of 34 days. L-index(30) was significantly higher in the CMV-AG ≥3 group than in the CMV-AG <3 group (median 20,358 vs 17,235, P = .028). Recovery of the CD4+ and CD56+ cell counts between days 14 and 28 after HSCT was impaired in the CMV-AG ≥3 group. Regarding graft-versus-host disease (GVHD), grade II-IV acute GVHD was identified in 14 patients (GVHD group) at a median of 31 days. L-index(30) was significantly lower in the GVHD group (median 19,048 vs 22,256, P = .043). Recovery of CD3+ cells including both CD4+ and CD8+ cells between days 14 and 28 tended to be better in the GVHD group. In conclusion, L-index(30) was significantly associated with CMV reactivation and grade II-IV acute GVHD, but its clinical significance seemed to differ according to the results of a lymphocyte subset analysis.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Jin Hayakawa
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Naonori Harada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Koji Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | | | - Misato Kikuchi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan.
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13
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Ashizawa M, Akahoshi Y, Nakano H, Kawamura S, Takeshita J, Yoshino N, Misaki Y, Yoshimura K, Gomyo A, Tamaki M, Kusuda M, Kameda K, Wada H, Kawamura K, Sato M, Terasako-Saito K, Tanihara A, Kimura SI, Nakasone H, Kako S, Akahane K, Wakatsuki M, Shirai K, Kanda Y. Updated Clinical Outcomes of Hematopoietic Stem Cell Transplantation Using Myeloablative Total Body Irradiation with Ovarian Shielding to Preserve Fertility. Biol Blood Marrow Transplant 2019; 25:2461-2467. [PMID: 31394267 DOI: 10.1016/j.bbmt.2019.07.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
Myeloablative conditioning regimens are associated with severe gonadal toxicity. To preserve ovarian function, we have been investigating ovarian shielding during total body irradiation (TBI) with a myeloablative dose. In this report, we update the clinical outcomes. Female patients with standard-risk hematologic diseases, aged 40 years or younger, who desired to have children, were included (n = 19). The conditioning regimen consisted of TBI at 12 Gy with ovarian shielding and cyclophosphamide (120 mg/kg) or cytarabine (24 g/m2). Ovarian shielding reduced the actual irradiation dose applied to the ovaries from 12 Gy to 2 to 3 Gy. The median age at hematopoietic stem cell transplantation (HSCT) was 24 years (range, 19 to 33 years). With a median follow-up period of 1449 days (range, 64 to 3694) after HSCT, 5-year overall survival and 1- and 5-year relapse rates were 67%, 17%, and 31%, respectively. Only 2 of 14 patients with acute myeloid or lymphoid leukemia in remission have relapsed thus far. The 6-month and 1-year cumulative rates of menstrual recovery were 42% and 78%, respectively. In all patients with menstrual recovery, menstruation recovered within 1 year. The serum anti-Müllerian hormone (AMH) level tended to gradually increase after menstrual recovery. Three patients with extensive chronic graft-versus-host disease experienced delayed recovery of menstruation and serum AMH. Five pregnancies in 3 patients resulted in normal delivery in 1, selective cesarean operation in 1, current pregnancy in 1, and natural abortion in 2. These results suggest that a myeloablative TBI regimen with ovarian shielding could preserve fertility after HSCT without an apparent increase in relapse in standard-risk patients. Because serum AMH recovered gradually over time, the AMH level during the early phase after HSCT may have little value as a marker of ovarian reserve.
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Affiliation(s)
- Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yu Akahoshi
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shunto Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Junko Takeshita
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nozomu Yoshino
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yukiko Misaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuki Yoshimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ayumi Gomyo
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaharu Tamaki
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Machiko Kusuda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Koji Kawamura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Keiko Akahane
- Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaru Wakatsuki
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Katsuyuki Shirai
- Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan; Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
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14
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Fei N, Shah N, Cumpston A, Wen S, Ross KG, Craig M, Kanate AS. Low-Dose Acyclovir Prophylaxis for Varicella zoster Reactivation in Autologous Hematopoietic Cell Transplantation Recipients. Clin Hematol Int 2019; 1:101-104. [PMID: 34595417 PMCID: PMC8432389 DOI: 10.2991/chi.d.190329.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/28/2019] [Indexed: 11/17/2022] Open
Abstract
Varicella zoster virus (VZV) reactivation after autologous hematopoietic cell transplantation (auto-HCT) may be observed in a quarter of patients. Currently, prophylactic use of acyclovir 800 mg twice daily or valacyclovir 500 mg twice daily is recommended for prophylaxis against VZV reactivation for at least one-year post-HCT, with continued use recommended in immunosuppressed recipients. Acyclovir dosing regimens vary between institutions despite the noted recommendations. In this single-center, retrospective study, recipients of auto-HCT who received at least one year of low-dose antiviral prophylaxis defined as the equivalent of acyclovir 400 mg orally twice daily or valacyclovir 500 mg daily were included. The primary objective of this study was to assess the incidence of VZV reactivation with low-dose acyclovir/valacyclovir prophylaxis in autograft recipients. One hundred and eighty patients undergoing auto-HCT between April 2008 and March 2015 were included. Patients received low-dose acyclovir, for a median duration of 55.5 months (range 12–100). There were no occurrences of VZV reactivation while patients were on these drugs. However, 2 patients (1.1%) had VZV reactivation after discontinuation of therapy, occurring 18.8 and 14 months from transplant and 6.7 and 2 months after stopping prophylaxis, respectively. Our retrospective analysis found low-dose antiviral prophylaxis with oral acyclovir 400 mg twice daily or valacyclovir 500 mg daily to be effective in preventing VZV reactivation in auto-HCT recipients.
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Affiliation(s)
- Naomi Fei
- Section of Hematology and Oncology, West Virginia University, Morgantown, WV, USA
| | - Nilay Shah
- Alexander B. Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, WV, USA
| | - Aaron Cumpston
- Alexander B. Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, WV, USA.,Department of Pharmacy, West Virginia University Hospitals, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Kelly G Ross
- Alexander B. Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, WV, USA
| | - Michael Craig
- Alexander B. Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, WV, USA
| | - Abraham S Kanate
- Alexander B. Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, WV, USA
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15
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Wada-Shimosato Y, Tanoshima R, Hiratoko K, Takeuchi M, Tsujimoto SI, Shiba N, Ito S, Yamanaka T, Ito S. Effectiveness of acyclovir prophylaxis against varicella zoster virus disease after allogeneic hematopoietic cell transplantation: A systematic review and meta-analysis. Transpl Infect Dis 2019; 21:e13061. [PMID: 30756465 DOI: 10.1111/tid.13061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Varicella zoster virus (VZV) disease is a common complication after hematopoietic cell transplantation (HCT). The mortality rate for disseminated VZV infection is 34%. Acyclovir has been used for the prophylaxis of VZV disease after HCT, but the effectiveness of prophylaxis is controversial. We conducted a meta-analysis of the incidence of VZV disease within the first 1 year after acyclovir prophylaxis had been discontinued and assessed the risk of VZV disease during acyclovir prophylaxis. METHODS Medline, EMBASE plus EMBASE classics, and the Cochrane Central Register of Controlled Trials were used for a systematic search. The inclusion criteria were both randomized controlled trials and cohort studies that described the effectiveness of acyclovir as prophylaxis against VZV disease after allogeneic HCT. RESULTS We included seven studies involving a total of 2265 patients. No mortality by VZV was identified. Acyclovir prophylaxis significantly reduced the rate of VZV infection within the first 1 year after discontinuation (risk ratio: 0.38, 95% confidence interval (CI): 0.29-0.51). The risk of VZV disease during acyclovir prophylaxis was also reduced (risk ratio: 0.17, 95% CI: 0.12-0.24). Both short-term and long-term prophylaxis reduced the incidence of VZV infection (RR: 0.51, 95% CI: 0.30-0.86 vs RR: 0.34, 95% CI: 0.22-0.54). Low-dose acyclovir (<400 mg/d) is sufficient to reduce the risk of VZV disease. CONCLUSION This study showed that acyclovir prophylaxis reduced VZV infection after HCT with no fatal cases and acyclovir prophylaxis is beneficial. No significant adverse effects occurred and no delayed VZV disease was identified.
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Affiliation(s)
- Yuko Wada-Shimosato
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Reo Tanoshima
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kanako Hiratoko
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masanobu Takeuchi
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shin-Ichi Tsujimoto
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Norio Shiba
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shuichi Ito
- Department of Pediatrics, Yokohama City University School of Medicine, Yokohama, Japan
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16
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Kako S, Gomyo A, Akahoshi Y, Harada N, Kameda K, Ugai T, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako-Saito K, Kimura SI, Kikuchi M, Nakasone H, Kanda J, Kanda Y. Haploidentical transplantation using low-dose alemtuzumab: Comparison with haploidentical transplantation using low-dose thymoglobulin. Eur J Haematol 2019; 102:256-264. [PMID: 30578673 DOI: 10.1111/ejh.13204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To establish the optimal strategy for haploidentical hematopoietic stem cell transplantation (HSCT). METHODS We performed a prospective study on haploidentical HSCT using low-dose alemtuzumab. Alemtuzumab was added at 0.25 mg/kg for 2 days. The primary outcome measure was the survival rate with the engraftment of donor cells and without grade III-IV acute graft-vs-host disease (GVHD) at 60 days after transplantation. RESULTS Fourteen adult patients with advanced hematological disease were enrolled. The primary outcome measure was achieved in 86% of the patients. Six patients experienced relapse/progression. Non-relapse death was observed in three patients, and all of them had a history of previous allogeneic HSCT. Overall survival and progression-free survival rates at 1 year were 51% and 43%, respectively. Four patients were suspected to have herpes simplex virus infection and three had aseptic meningitis under the use of acyclovir at 200 mg. There were no deaths due to viral infection. Compared to those who underwent haploidentical HSCT using thymoglobulin, patients with alemtuzumab showed a slower recovery of CD8+ T-cells and lower incidences of GVHD and EB virus reactivation. CONCLUSIONS Haploidentical HSCT using low-dose alemtuzumab can be performed safely. We need to overcome the high relapse/progression rate in non-remission patients.
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Affiliation(s)
- Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ayumi Gomyo
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naonori Harada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomotaka Ugai
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junya Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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17
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Lo Presti C, Curti C, Montana M, Bornet C, Vanelle P. Chickenpox: An update. Med Mal Infect 2018; 49:1-8. [PMID: 29789159 DOI: 10.1016/j.medmal.2018.04.395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/25/2017] [Accepted: 04/23/2018] [Indexed: 11/17/2022]
Abstract
Despite its benign characteristics, chickenpox is a childhood disease responsible for complications and deaths, particularly in the high-risk population. VariZIG®, not commercialized in France, is a good alternative for seronegative individuals exposed to the virus and not eligible for vaccination. The efficacy of routine vaccination has been demonstrated with a decrease in chickenpox incidence and with the development of herd immunity. Over time, the protective antibody titer of vaccinated people decreases and can be maintained by two doses of the vaccine. A tetravalent measles-mumps-rubella-chickenpox vaccine, used in the United States, has a good tolerability in spite of the occurrence of fever and febrile seizures. Routine vaccination would contribute to make savings in France, by reducing direct and indirect costs of chickenpox.
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Affiliation(s)
- Coralie Lo Presti
- Assistance publique-Hôpitaux de Marseille (AP-HM), pharmacie usage intérieur, hôpital Nord, Chemin-des-Bourrely, 13915 Marseille cedex 20, France; Laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, Aix-Marseille Université, CNRS, ICR, UMR 7273, 27, boulevard Jean-Moulin-CS30064, 13385 Marseille cedex 05, France.
| | - Christophe Curti
- Assistance publique-Hôpitaux de Marseille (AP-HM), service central de la qualité et de l'information pharmaceutiques (SCQIP), hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; Laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, Aix-Marseille Université, CNRS, ICR, UMR 7273, 27, boulevard Jean-Moulin-CS30064, 13385 Marseille cedex 05, France.
| | - Marc Montana
- Assistance publique-Hôpitaux de Marseille (AP-HM), pharmacie usage intérieur, hôpital Nord, Chemin-des-Bourrely, 13915 Marseille cedex 20, France; Laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, Aix-Marseille Université, CNRS, ICR, UMR 7273, 27, boulevard Jean-Moulin-CS30064, 13385 Marseille cedex 05, France.
| | - Charléric Bornet
- Assistance publique-Hôpitaux de Marseille (AP-HM), pharmacie usage intérieur, hôpital de la conception, 147, boulevard Baille, 13005 Marseille, France; Laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, Aix-Marseille Université, CNRS, ICR, UMR 7273, 27, boulevard Jean-Moulin-CS30064, 13385 Marseille cedex 05, France.
| | - Patrice Vanelle
- Assistance publique-Hôpitaux de Marseille (AP-HM), pharmacie usage intérieur, hôpital de la conception, 147, boulevard Baille, 13005 Marseille, France; Laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, Aix-Marseille Université, CNRS, ICR, UMR 7273, 27, boulevard Jean-Moulin-CS30064, 13385 Marseille cedex 05, France.
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18
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Akahoshi Y, Kimura SI, Gomyo A, Hayakawa J, Tamaki M, Harada N, Kusuda M, Kameda K, Ugai T, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako-Saito K, Kikuchi M, Nakasone H, Kako S, Kanda Y. Antifungal prophylaxis with fluconazole in allogeneic stem cell transplantation recipients who had prior invasive aspergillosis with subsequent complete resolution by computed tomography. Infect Dis (Lond) 2017; 50:280-288. [PMID: 29087731 DOI: 10.1080/23744235.2017.1396621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Consensus has yet to be reached regarding secondary prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT) with a complete resolution of invasive aspergillosis (IA) confirmed by chest computed tomography (CT). METHODS We retrospectively evaluated the feasibility of antifungal prophylaxis with fluconazole in allogeneic HSCT recipients who had previously developed IA which showed complete resolution as confirmed by chest CT before HSCT. Consecutive adult patients who underwent allogeneic HSCT at our institution and who had received fluconazole as systemic antifungal prophylaxis from June 2007 to January 2015 were included. We compared the clinical outcomes between patients with a past history of IA who showed a complete resolution of chest CT abnormalities (n = 13) and those without a previous history of IA (n = 137). RESULTS The cumulative incidence of proven or probable IA was 8.8% in the group without a past history of IA and 0.0% in the group with a past history of IA (p = .268). The cumulative incidence of proven or probable invasive fungal disease (IFD) within 100 days after allogeneic HSCT was 10.9% in the group without a past history of IA and 15.4% in the group with a past history of IA (p = .647). Fluconazole was switched to anti-mould agents in two-thirds of the patients in each group by day 100 after HSCT. CONCLUSIONS Fluconazole was confirmed to be an acceptable prophylactic agent early after allogeneic HSCT in appropriately selected patients.
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Affiliation(s)
- Yu Akahoshi
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Shun-Ichi Kimura
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Ayumi Gomyo
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Jin Hayakawa
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Masaharu Tamaki
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Naonori Harada
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Machiko Kusuda
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Kazuaki Kameda
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Tomotaka Ugai
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Hidenori Wada
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Yuko Ishihara
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Koji Kawamura
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Kana Sakamoto
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Miki Sato
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Kiriko Terasako-Saito
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Misato Kikuchi
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Hideki Nakasone
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Shinichi Kako
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Yoshinobu Kanda
- a Division of Haematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
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19
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Akahoshi Y, Kimura SI, Gomyo A, Hayakawa J, Tamaki M, Harada N, Kusuda M, Kameda K, Ugai T, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako-Saito K, Kikuchi M, Nakasone H, Kako S, Kanda Y. Delayed platelet recovery after allogeneic hematopoietic stem cell transplantation: Association with chronic graft-versus-host disease and survival outcome. Hematol Oncol 2017; 36:276-284. [DOI: 10.1002/hon.2427] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Yu Akahoshi
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Shun-ichi Kimura
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Ayumi Gomyo
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Jin Hayakawa
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Masaharu Tamaki
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Naonori Harada
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Machiko Kusuda
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Tomotaka Ugai
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center; Jichi Medical University; Saitama Japan
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20
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Chen LK, Arai H, Chen LY, Chou MY, Djauzi S, Dong B, Kojima T, Kwon KT, Leong HN, Leung EMF, Liang CK, Liu X, Mathai D, Pan JY, Peng LN, Poblete ERS, Poi PJH, Reid S, Tantawichien T, Won CW. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infect Dis 2017; 17:213. [PMID: 28298208 PMCID: PMC5353949 DOI: 10.1186/s12879-017-2198-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023] Open
Abstract
Background Herpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region. Methods We searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines. Results From 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand. HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation. Conclusions Several countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan. .,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-340 Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Liang-Yu Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan
| | - Samsuridjal Djauzi
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Salemba Raya No. 6, Jakarta, 10430, Indonesia
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Medical School/West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Renmin Nan Lu, Chengdu, Sichuan, 610041, China
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Jongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ki Tae Kwon
- Division of Infectious Diseases, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu, 710-600, Korea
| | - Hoe Nam Leong
- Rophi Clinic, 38 Irrawaddy Rd. #07-54/55, Mount Elizabeth Novena Specialist Centre, Singapore, 329563, Singapore
| | - Edward M F Leung
- Geriatric Medicine Centre (Healthy Ageing), Hong Kong Sanatorium and Hospital, 2 Village Rd. Happy Valley, Hong Kong S.A.R., China
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386 Ta-Chun 1st Rd., Kaohsiung, 81362, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Xiaohong Liu
- Division of Geriatrics, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Jubilee Hills, Hyderabad, 500096, India
| | - Jiun Yit Pan
- National Skin Centre, 1 Mandalay Rd., Singapore, 308205, Singapore
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Eduardo Rommel S Poblete
- Geriatric Center, St. Luke's Medical Center, 279 E. Rodriguez Sr. Ave., Quezon City, 1102, Philippines
| | - Philip J H Poi
- Division of Geriatrics, Department of Medicine, University Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia
| | - Stewart Reid
- Ropata Medical Centre, Lower Hutt, 5010, New Zealand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, 1 Hoigi-dong, Dongdaemun-gu, Seoul, 130-720, Korea
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21
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Yamasaki R, Kanda J, Akahoshi Y, Nakano H, Ugai T, Wada H, Kawamura K, Ishihara Y, Sakamoto K, Sato M, Ashizawa M, Machishima T, Terasako-Saito K, Kimura SI, Kikuchi M, Nakasone H, Yamazaki R, Kako S, Nishida J, Kanda Y. Comparison of levofloxacin and garenoxacin for antibacterial prophylaxis during neutropenia. Int J Hematol 2017; 105:835-840. [PMID: 28168415 DOI: 10.1007/s12185-017-2188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
Levofloxacin (LVFX) is widely used for antibacterial prophylaxis during neutropenia. Garenoxacin (GRNX), which has been investigated in Japan, has stronger antibacterial activity than LVFX against gram-positive bacteria; however, no studies have compared the effectiveness of LVFX and GRNX. We retrospectively analyzed 42 patients with acute leukemia and 32 patients who underwent hematopoietic cell transplantation. Thirty-one patients before September 2009 received GRNX, and subsequent 43 patients received LVFX. We compared the cumulative incidences of positive blood and stool cultures. There was no significant difference in the incidence of bacteremia between the GRNX and LVFX groups. However, while gram-negative bacteria were detected in 80% of the patients with bacteremia in the GRNX group, they were detected in only 33% of the patients with bacteremia in the LVFX group. Patients in the GRNX group more frequently experienced positive stool cultures than those in the LVFX group, and this was confirmed by a multivariate analysis. Gram-negative bacteria accounted for 100 and 67% of the stool culture results in the GRNX and LVFX groups, respectively. While both fluoroquinolones may be appropriate antibacterial prophylactic agents for neutropenia patients with hematological malignancies, vigilance for gram-negative bacterial infections should be exercised when GRNX is used as prophylaxis.
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Affiliation(s)
- Ryoko Yamasaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Junya Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hirofumi Nakano
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Tomotaka Ugai
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Tomohito Machishima
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Rie Yamazaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Junji Nishida
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
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22
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Shimizu R, Ohwada C, Nagao Y, Togasaki E, Kawajiri C, Muto T, Tsukamoto S, Sakai S, Takeda Y, Mimura N, Takeuchi M, Sakaida E, Iseki T, Nakaseko C. The Successful Treatment of a Cord Blood Transplant Recipient with Varicella Zoster Virus Meningitis, Radiculitis and Myelitis with Foscarnet. Intern Med 2017; 56:353-356. [PMID: 28154282 PMCID: PMC5348462 DOI: 10.2169/internalmedicine.56.6930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infections of the central nervous system (CNS) with varicella zoster virus (VZV) is a rare occurrence after allogeneic hematopoietic stem cell transplantation. We herein report a case of VZV meningitis, radiculitis and myelitis that developed 8 months after cord blood transplantation, shortly after the cessation of cyclosporine and low-dose acyclovir. Although treatment with acyclovir did not achieve a satisfactory response, the patient was successfully treated with foscarnet. Our report indicates that VZV infection should be considered in allo-hematopoietic stem cell transplantation (HSCT) patients with CNS symptoms and that foscarnet may be effective for the treatment of acyclovir-resistant VZV infections of the CNS. The development of optimal prophylactic strategies and vaccination schedules may eradicate post-transplant VZV disease.
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Affiliation(s)
- Ryo Shimizu
- Department of Hematology, Chiba University Hospital, Japan
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23
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Sahoo F, Hill JA, Xie H, Leisenring W, Yi J, Goyal S, Kimball LE, Lee I, Seo S, Davis C, Pergam SA, Flowers ME, Liaw KL, Holmberg L, Boeckh M. Herpes Zoster in Autologous Hematopoietic Cell Transplant Recipients in the Era of Acyclovir or Valacyclovir Prophylaxis and Novel Treatment and Maintenance Therapies. Biol Blood Marrow Transplant 2016; 23:505-511. [PMID: 28039754 DOI: 10.1016/j.bbmt.2016.12.620] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 01/10/2023]
Abstract
The epidemiology of herpes zoster (HZ) in contemporary autologous hematopoietic cell transplant (HCT) recipients, and the impact of acyclovir (ACV)/valacyclovir (VACV) prophylaxis, is not well described. In this observational study from 2002 to 2010, we retrospectively identified 1000 varicella zoster virus (VZV)-seropositive autologous HCT recipients with up to 5 years of follow-up. The incidence of HZ and use of ACV/VACV prophylaxis were determined through review of medical records and mailed questionnaires. Risk factors for HZ were determined by multivariable Cox regression. Over a period of 5 years after autologous HCT, 194 patients developed at least 1 HZ episode, with a cumulative incidence of 21%; 159 of 194 (82%) were not on prophylaxis at the time of HZ. A second episode of HZ occurred in 31 of 194 (16%) patients. Patients taking ACV/VACV had reduced risk for HZ (adjusted hazard ratio [aHR], .59; 95% confidence interval [CI], .37 to .91), whereas those older than the median age (≥55.5 years) had increased risk (aHR, 1.42; 95% CI, 1.05 to 1.9). Disseminated VZV was reported in 8% and postherpetic neuralgia in 13% of patients. We demonstrate a high burden of HZ late after autologous HCT, despite long-term antiviral prophylaxis. Improved prevention strategies are needed to provide sustained protection against HZ after autologous HCT.
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Affiliation(s)
- Farah Sahoo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Public Health, University of Washington, Seattle, Washington
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Hu Xie
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jessica Yi
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sonia Goyal
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Louise E Kimball
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ingi Lee
- Merck and Co. Inc, Kenilworth, New Jersey
| | - Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chris Davis
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephen A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Mary E Flowers
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Leona Holmberg
- Department of Medicine, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Michael Boeckh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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24
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Kanbayashi Y, Matsumoto Y, Kuroda J, Kobayashi T, Horiike S, Hosokawa T, Taniwaki M. Predicting risk factors for varicella zoster virus infection and postherpetic neuralgia after hematopoietic cell transplantation using ordered logistic regression analysis. Ann Hematol 2016; 96:311-315. [PMID: 27896415 DOI: 10.1007/s00277-016-2883-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/14/2016] [Indexed: 11/24/2022]
Abstract
To identify risk factors for varicella zoster virus (VZV) infection and postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT), we conducted a retrospective chart review of 163 consecutive patients who underwent HCT between November 2004 and July 2014. Overall, the male/female (M/F) ratio was 80/83, median age at HCT was 54 (range 15-69) years, and autologous/allogeneic HCT (auto/allo-HCT) ratio was 71/92. Forty-four patients [M/F, 25/19; median age, 57 (range: 16-68) years; auto/allo-HCT, 26/18] developed VZV infection after HCT. All cases were successfully treated with acyclovir (ACV) or valacyclovir, and there was no VZV-related death. Nine (20%) of the 44 patients [M/F, 5/4; median age, 58 (range: 21-63) years; auto/allo-HCT, 7/2] developed PHN after resolution of zoster. Multivariate ordered logistic analysis identified receiving immunosuppressive therapy at the cessation of ACV [odds ratio (OR) = 74.53; 95% confidence interval (CI) = 6.99-794.32; P = 0.0004] as a risk factor for VZV infection and PHN in allo-HCT recipients. However, in auto-HCT recipients, only advanced age was identified as a risk factor (OR = 1.06, 95% CI = 1.002-1.127, P = 0.0429). Our findings indicate receiving immunosuppressive therapy at the cessation of ACV is a significant risk factor for allo-HCT recipients, while advanced age is a significant risk factor for auto-HCT recipients.
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Affiliation(s)
- Yuko Kanbayashi
- Departments of Hospital Pharmacy, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. .,Pain Treatment & Palliative Care Unit, University Hospital, Kyoto, Japan.
| | - Yosuke Matsumoto
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan.,Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Tsutomu Kobayashi
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Shigeo Horiike
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Toyoshi Hosokawa
- Pain Treatment & Palliative Care Unit, University Hospital, Kyoto, Japan.,Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masafumi Taniwaki
- Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan.,Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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25
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Akahoshi Y, Kanda J, Gomyo A, Hayakawa J, Komiya Y, Harada N, Kameda K, Ugai T, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako-Saito K, Kimura SI, Kikuchi M, Nakasone H, Kako S, Kanda Y. Risk Factors and Impact of Secondary Failure of Platelet Recovery After Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1678-1683. [DOI: 10.1016/j.bbmt.2016.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
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26
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Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Krüger W, Mousset S, Neuburger S, Neumann S, Penack O, Silling G, Vehreschild JJ, Einsele H, Maschmeyer G. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol 2016; 95:1435-55. [PMID: 27339055 PMCID: PMC4972852 DOI: 10.1007/s00277-016-2711-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/28/2016] [Indexed: 12/13/2022]
Abstract
Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial agents but includes recommendations on the use of vaccinations. This is the updated version of the AGHIO guideline in the field of allogeneic haematopoietic stem cell transplantation utilizing methods according to evidence-based medicine criteria.
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Affiliation(s)
- Andrew J Ullmann
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Martin Schmidt-Hieber
- Clinic for Hematology, Oncology und Tumor Immunology, Helios Clinic Berlin-Buch, Berlin, Germany
| | - Hartmut Bertz
- Department of Hematology/Oncology, University of Freiburg Medical Center, 79106, Freiburg, Germany
| | - Werner J Heinz
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Kiehl
- Medical Clinic I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - William Krüger
- Haematology and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Greifswald, Germany
| | - Sabine Mousset
- Medizinische Klinik III, Palliativmedizin und interdisziplinäre Onkologie, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Stefan Neuburger
- Sindelfingen-Böblingen Clinical Centre, Medical Department I, Division of Hematology and Oncology, Klinikverbund Südwest, Sindelfingen, Germany
| | | | - Olaf Penack
- Hematology, Oncology and Tumorimmunology, Charité University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Gerda Silling
- Department of Internal Medicine IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, German Centre for Infection Research, Partner-site: Bonn-Cologne, University Hospital of Cologne, Cologne, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
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27
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Okuma HS, Kobayashi Y, Makita S, Kitahara H, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Tobinai K. Disseminated herpes zoster infection initially presenting with abdominal pain in patients with lymphoma undergoing conventional chemotherapy: A report of three cases. Oncol Lett 2016; 12:809-814. [PMID: 27446355 PMCID: PMC4950796 DOI: 10.3892/ol.2016.4683] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/15/2016] [Indexed: 12/31/2022] Open
Abstract
Visceral disseminated varicella zoster virus (VZV) disease has a high mortality rate, and occurs in immunocompromised hosts, mostly subsequent to allogeneic stem cell transplantation. Only a few cases of this disease that onset during conventional chemotherapy in patients with lymphoma have been reported. The present study reports the cases of 3 patients with disseminated and visceral VZV infection undergoing treatment for follicular lymphoma, diffuse large B-cell lymphoma and peripheral T-cell lymphoma, not otherwise specified. All 3 patients presented with initial symptoms of abdominal pain, and 2 patients demonstrated syndrome of inappropriate antidiuretic hormone and hepatitis. All patients developed widespread cutaneous dissemination, and all had a low cluster of differentiation 4 cell count or lymphocyte count at the time of VZV diagnosis and at least 4 month prior. With intravenous systemic acyclovir therapy (Cases 1 and 3, 1500 mg/day; Case 2, 750 mg/day), the patients achieved complete recovery by day 14 of therapy. Visceral disseminated VZV infection is not limited to patients undergoing stem cell transplantation, and may present with abdominal pain with or without skin eruption. Visceral infection may take a poor clinical course, therefore, in patients with prolonged duration of low lymphocyte count and/or long-term use of steroids, the prophylactic use of acyclovir may be considered.
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Affiliation(s)
- Hitomi Sumiyoshi Okuma
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan; Department of Medical Oncology, Graduate School of Medicine, Chiba University Hospital, Chiba, Chiba 260-8670, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hideaki Kitahara
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
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28
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Akahoshi Y, Kimura SI, Nakano H, Harada N, Kameda K, Ugai T, Wada H, Yamasaki R, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Sato M, Terasako-Saito K, Nakasone H, Kikuchi M, Yamazaki R, Kanda J, Kako S, Nishida J, Kanda Y. Significance of a positive Clostridium difficile toxin test after hematopoietic stem cell transplantation. Clin Transplant 2016; 30:703-8. [PMID: 27019071 DOI: 10.1111/ctr.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 01/31/2023]
Abstract
Patients with hematological malignancies show a high prevalence of asymptomatic colonization with Clostridium difficile (CD colonization). Therefore, it is difficult to distinguish CD colonization with diarrhea induced by a conditioning regimen from true Clostridium difficile infection (CDI) in hematopoietic stem cell transplantation (HSCT) recipients. We retrospectively analyzed 308 consecutive patients who underwent a CD toxin A/B enzyme immunoassay test for diarrhea within 100 d after HSCT from November 2007 to May 2014. Thirty patients (9.7%) had positive CD toxin results, and 11 of these had positive results in subsequent tests after an initial negative result. Allogeneic HSCT, total body irradiation, stem cell source, acute leukemia, and the duration of neutropenia were significantly correlated with positive CD toxin results. In a logistic regression model, allogeneic HSCT was identified as a significant risk factor (odds ratio 18.6, p < 0.01). In an analysis limited to within 30 d after the conditioning regimen, the duration of neutropenia was the sole risk factor (odds ratio 10.4, p < 0.01). There were no distinctive clinical features for CDI, including the onset or duration of diarrhea. In conclusion, although CDI may be overdiagnosed in HSCT recipients, it is difficult to clinically distinguish between CDI and CD colonization.
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Affiliation(s)
- Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirofumi Nakano
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naonori Harada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomotaka Ugai
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rie Yamazaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junya Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junji Nishida
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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29
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A retrospective analysis of computed tomography findings in patients with pulmonary complications after allogeneic hematopoietic stem cell transplantation. Eur J Radiol 2015; 84:2663-70. [DOI: 10.1016/j.ejrad.2015.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/28/2015] [Accepted: 08/30/2015] [Indexed: 01/15/2023]
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30
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A randomized controlled trial of cyclosporine and tacrolimus with strict control of blood concentrations after unrelated bone marrow transplantation. Bone Marrow Transplant 2015; 51:103-9. [DOI: 10.1038/bmt.2015.222] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/30/2015] [Accepted: 08/16/2015] [Indexed: 11/12/2022]
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31
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Nakamae H, Koh H, Katayama T, Nishimoto M, Hayashi Y, Nakashima Y, Nakane T, Nakamae M, Hirose A, Hino M. HLA haploidentical peripheral blood stem cell transplantation using reduced dose of posttransplantation cyclophosphamide for poor-prognosis or refractory leukemia and myelodysplastic syndrome. Exp Hematol 2015; 43:921-929.e1. [PMID: 26284307 DOI: 10.1016/j.exphem.2015.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/06/2015] [Accepted: 07/31/2015] [Indexed: 12/31/2022]
Abstract
Nonmyeloablative, human leukocyte antigen (HLA) haploidentical, T-cell-replete bone marrow transplantation followed by high-dose posttransplantation cyclophosphamide (PT/Cy) has recently been developed. This transplantation milieu has resulted in favorable outcomes with low transplantation-related mortality, owing to a low incidence of graft-versus-host disease (GVHD), without increased infectious complications. However, the high relapse rate remains a major concern. We therefore performed a prospective pilot study of HLA haploidentical peripheral blood stem cell transplantation (PBSCT) with intensified conditioning, followed by two lower doses of PT/Cy. A total of 20 patients with refractory or poor-prognosis myelodysplastic syndrome (MDS) and leukemia were enrolled in the study. A trend toward a lower incidence of grade III-IV acute GVHD at day 100 in the group receiving 25 mg/kg × 2 doses of PT/Cy, compared with the group receiving 25 mg/kg of PT/Cy (9.1% vs. 33%, p = 0.20), was noted. However, the cumulative incidence of chronic GVHD was low, at 10% irrespective of PT/Cy dose. The number of infused CD34(+) cells significantly correlated with the grade of acute GVHD (p = 0.004). In addition, the occurrence of BK virus hemorrhagic cystitis was significantly more common in the double-dose PT/Cy group (25% vs. 0%, p = 0.043), especially when combined with busulfan. The probability of overall survival at 1 year in the double-dose group tended to be better compared with that in the single-dose group (64% vs. 44%, respectively; p = 0.20). In conclusion, HLA haploidentical, T-cell-replete PBSCT with 25 mg/kg × 2 doses of PT/Cy might be a feasible option for treating high-risk leukemia and MDS.
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Affiliation(s)
- Hirohisa Nakamae
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Hideo Koh
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takako Katayama
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Mitsutaka Nishimoto
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshiki Hayashi
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahiko Nakane
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Mika Nakamae
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Asao Hirose
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Kawamura K, Hayakawa J, Akahoshi Y, Harada N, Nakano H, Kameda K, Ugai T, Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Ashizawa M, Sato M, Terasako-Saito K, Kimura SI, Kikuchi M, Nakasone H, Yamazaki R, Kanda J, Kako S, Tanihara A, Nishida J, Kanda Y. Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus and varicella zoster virus diseases after autologous hematopoietic stem cell transplantation. Int J Hematol 2015; 102:230-7. [DOI: 10.1007/s12185-015-1810-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 05/06/2015] [Accepted: 05/13/2015] [Indexed: 12/13/2022]
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False-positive Aspergillus galactomannan and its kinetics in allogeneic hematopoietic stem cell transplantation. J Infect 2015; 70:520-40. [DOI: 10.1016/j.jinf.2015.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/23/2022]
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34
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Ichikawa S, Kim M, Hasegawa S, Ohashi K, Kondo A, Kato H, Kamata M, Okitsu Y, Fukuhara N, Onishi Y, Ishizawa K, Harigae H. Fatal visceral varicella-zoster developing early after autologous hematopoietic stem cell transplantation for refractory diffuse large B-cell lymphoma. J Clin Exp Hematop 2014; 54:237-41. [PMID: 25501115 DOI: 10.3960/jslrt.54.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A middle-aged woman who had undergone autologous hematopoietic stem cell transplantation (HSCT) 1 month previously suffered severe epigastralgia and relapse of lymphoma. The epigastralgia was not relieved by chemotherapy. Thereafter, her pancreatic and hepatic enzyme levels were markedly elevated and disseminated varicella emerged. Despite acyclovir administration, her general condition deteriorated rapidly and she died. Serum varicella zoster virus (VZV) DNA level was shown to be elevated and a diagnosis of disseminated VZV infection was established postmortem. In patients with severe abdominal pain following HSCT, early suspicion and therapeutic intervention for VZV are important, even in the absence of skin lesions.
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Affiliation(s)
- Satoshi Ichikawa
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
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35
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Yamazaki R, Tanaka Y, Nakasone H, Sato M, Terasako-Saito K, Sakamoto K, Akahoshi Y, Nakano H, Ugai T, Yamasaki R, Wada H, Ishihara Y, Kawamura K, Ashizawa M, Kimura SI, Kikuchi M, Kako S, Kanda J, Tanihara A, Nishida J, Kanda Y. Allotype analysis to determine the origin of cytomegalovirus immunoglobulin-G after allogeneic stem cell transplantation. Transpl Infect Dis 2014; 16:904-13. [DOI: 10.1111/tid.12304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/17/2014] [Accepted: 08/07/2014] [Indexed: 11/26/2022]
Affiliation(s)
- R. Yamazaki
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Tanaka
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - H. Nakasone
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - M. Sato
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - K. Terasako-Saito
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - K. Sakamoto
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Akahoshi
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - H. Nakano
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - T. Ugai
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - R. Yamasaki
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - H. Wada
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Ishihara
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - K. Kawamura
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - M. Ashizawa
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - S.-I. Kimura
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - M. Kikuchi
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - S. Kako
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - J. Kanda
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - A. Tanihara
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - J. Nishida
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Y. Kanda
- Division of Hematology; Department of Internal Medicine; Saitama Medical Center; Jichi Medical University; Saitama Japan
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36
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Norvell JP. Liver disease after hematopoietic cell transplantation in adults. Transplant Rev (Orlando) 2014; 29:8-15. [PMID: 25315987 DOI: 10.1016/j.trre.2014.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/10/2014] [Accepted: 08/22/2014] [Indexed: 01/22/2023]
Abstract
Liver-related complications constitute a large component of the overall morbidity and mortality associated with hematopoietic cell transplantation. Affecting up to 80% of allogeneic HCT recipients, prompt recognition and treatment are essential. The differential diagnosis is broad and is best categorized by time of onset after transplantation. Early complications include drug-induced liver injury, sinusoidal obstruction syndrome, and graft-versus-host disease. Late complications include infectious sequelae, cirrhosis, and hepatic malignancies. Patients being considered for hematopoietic cell transplantation should be screened and evaluated for liver-related complications to help improve outcomes.
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Affiliation(s)
- J P Norvell
- Department of Medicine, Division of Digestive Diseases, Emory Transplant Center, Emory University, Atlanta, GA, USA.
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