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Viscovo M, Metafuni E, Giammarco S, Santopaolo F, Frioni F, Pellegrino C, Sica S, Chiusolo P, Pompili M. Late HBV reactivation after hematopoietic stem cell transplantation, despite long-term prophylaxis. Eur J Clin Microbiol Infect Dis 2023; 42:1543-1545. [PMID: 37870712 DOI: 10.1007/s10096-023-04685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Marcello Viscovo
- Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Facoltà Di Medicina E Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Sabrina Giammarco
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
| | - Francesco Santopaolo
- Dipartimento Di Scienze Mediche E Chirurgiche, Facoltà Di Medicina E Chirurgia, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, "Agostino Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Filippo Frioni
- Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Facoltà Di Medicina E Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Pellegrino
- Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Facoltà Di Medicina E Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy
- Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Chiusolo
- Dipartimento Di Diagnostica Per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia Oncologica Ed Ematologia, Rome, Italy.
- Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Maurizio Pompili
- Dipartimento Di Scienze Mediche E Chirurgiche, Facoltà Di Medicina E Chirurgia, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, "Agostino Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
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Nanopore-Targeted Sequencing Improves the Diagnosis and Treatment of Patients with Serious Infections. mBio 2023; 14:e0305522. [PMID: 36651731 PMCID: PMC9979620 DOI: 10.1128/mbio.03055-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Serious infections are characterized by rapid progression, poor prognosis, and difficulty in diagnosis. Recently, a new technique known as nanopore-targeted sequencing (NTS) was developed that facilitates the rapid and accurate detection of pathogenic microorganisms and is extremely suitable for patients with serious infections. The aim of our study was to evaluate the clinical application of NTS in the diagnosis and treatment of patients with serious infections. We developed an NTS technology that could detect microorganisms within a 6-h window based on the amplification of the 16S rRNA gene of bacteria, the internal transcribed spacer region of fungi, and the rpoB gene of Mycobacterium. The NTS detection results were compared with those of blood cultures and anal swabs from 50 patients with blood diseases suffering serious infections. The patient's condition before and after NTS was compared. The response rate and the infection-related mortality after the adjustment of antibiotics based on NTS were calculated. The positivity rate of pathogens was highest in NTS (90%), followed by blood culture (32.6%) and anal swabs (14.6%). After adjusting antibiotics for bacteria and fungi detected by NTS, the patients' condition improved significantly. Moreover, the response rate of anti-infective treatment based on NTS was 93.02% (40/43), and infection-related mortality was reduced to 0. NTS is an effective method to identify pathogens in the blood specimens of patients with serious infections and can guide anti-infection treatment and reduce infection-related mortality. IMPORTANCE We introduce the application of NTS in blood samples of patients with serious infections and expound the efficiency and accuracy of NTS in detecting pathogenic microorganisms. Our work builds on the considerable interest of the scientific community in the management of serious infection. This issue is becoming more pressing, especially since the incidence of blood diseases is increasing year by year and hematopoietic stem cell transplantation (HSCT) has been widely used in benign and malignant blood diseases in recent years. The infection progression of these patients is faster, and the study further demonstrates the effectiveness of NTS in guiding the diagnosis and treatment of patients with severe infections. We firmly believe that this method will guide clinicians to adjust anti-infection strategies and bring significant benefits to patients, and our study will have implications for the future clinical application of NTS in all kinds of patients with serious infections.
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Malagola M, Turra A, Signorini L, Corbellini S, Polverelli N, Masina L, Del Fabro G, Lorenzotti S, Fumarola B, Farina M, Morello E, Radici V, Buttini EA, Colnaghi F, Bernardi S, Re F, Caruso A, Castelli F, Russo D. Results of an Innovative Program for Surveillance, Prophylaxis, and Treatment of Infectious Complications Following Allogeneic Stem Cell Transplantation in Hematological Malignancies (BATMO Protocol). Front Oncol 2022; 12:874117. [PMID: 35785189 PMCID: PMC9247274 DOI: 10.3389/fonc.2022.874117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infectious complications are a significant cause of morbidity and mortality in patients undergoing allogeneic haematopoietic stem cell transplantation (Allo-SCT). The BATMO (Best-Antimicrobial-Therapy-TMO) is an innovative program for infection prevention and management and has been used in our centre since 2019. The specific features of the BATMO protocol regard both prophylaxis during neutropenia (abandonment of fluoroquinolone, posaconazole use in high-risk patients, aerosolized liposomal amphotericin B use until engraftment or a need for antifungal treatment, and letermovir use in CMV-positive recipients from day 0 to day +100) and therapy (empirical antibiotics based on patient clinical history and colonization, new antibiotics used in second-line according to antibiogram with the exception of carbapenemase-producing K pneumoniae for which the use in first-line therapy is chosen). Methods Data on the infectious complications of 116 transplant patients before BATMO protocol (Cohort A; 2016 - 2018) were compared to those of 84 transplant patients following the introduction of the BATMO protocol (Cohort B; 2019 - 2021). The clinical and transplant characteristics of the 2 Cohorts were comparable, even though patients in Cohort B were at a higher risk of developing bacterial, fungal, and CMV infections, due to a significantly higher proportion of myeloablative regimens and haploidentical donors. Results No change in the incidence of infections with organ localization was observed between the two Cohorts. A significant reduction in Clostridioides difficile infections by day +100 was observed in Cohort B (47% vs. 15%; p=0.04). At day +30, a higher incidence of Gram-negative bloodstream infections (BSIs) was observed in Cohort B (12% vs. 23%; p=0.05). By day +100 and between days +100 and +180, the incidence of BSIs and of the various etiological agents, the mortality from Gram-negative bacteria, and the incidence of invasive fungal infections were not different in the two Cohorts. The incidence of CMV reactivations by day +100 dropped drastically in patients of Cohort B, following letermovir registration (51% vs. 15%; p=0.00001). Discussion The results of this study suggest that the BATMO program is safe. In particular, the choice to avoid prophylaxis with fluoroquinolone was associated with an increase in Gram-negative BSIs by day +30, but this did not translate into higher levels of mortality. Moreover, this strategy was associated with a significant reduction of Clostridiodes difficile infections. The efficacy of anti-CMV prophylaxis with letermovir was confirmed by a significant reduction in CMV reactivations. Even though patients in Cohort B were at higher risk of developing fungal infections (more haploidentical transplants with more myeloablative regimens), the extensive use of posaconazole for prophylaxis balanced this risk, and no increase in the incidence of fungal-associated complications was observed.
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Affiliation(s)
- Michele Malagola
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
- *Correspondence: Michele Malagola,
| | - Alessandro Turra
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Liana Signorini
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Nicola Polverelli
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Lorenzo Masina
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Giovanni Del Fabro
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Silvia Lorenzotti
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Benedetta Fumarola
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Mirko Farina
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Enrico Morello
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Vera Radici
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Eugenia Accorsi Buttini
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Federica Colnaghi
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
| | - Simona Bernardi
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
- Centro di Ricerca Ematologico – Associazione Italiana per la Lotta alle Leucemie, Linfomi e Mieloma (AIL), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brecia, Brescia, Italy
| | - Federica Re
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
- Centro di Ricerca Ematologico – Associazione Italiana per la Lotta alle Leucemie, Linfomi e Mieloma (AIL), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brecia, Brescia, Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Section of Microbiology and Virology, University of Brescia Medical School, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Domenico Russo
- Chair of Hematology, Bone Marrow Transplant Unit, ASST-Spedali Civili Brescia, Depatment of Clinical and Experimental Sciences University of Brescia, Brescia, Italy
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Veldkamp SR, Jansen MHA, Swart JF, Lindemans CA. Case Report: Lessons Learned From Subsequent Autologous and Allogeneic Hematopoietic Stem Cell Transplantations in a Pediatric Patient With Relapsing Polychondritis. Front Immunol 2022; 13:812927. [PMID: 35359992 PMCID: PMC8960202 DOI: 10.3389/fimmu.2022.812927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Autologous hematopoietic stem cell transplantation (autoHSCT) is increasingly being recognized as a treatment option for severe refractory autoimmune diseases (AD). However, efficacy is hampered by high relapse rates. In contrast, allogeneic HSCT (alloHSCT) has high potential to cure AD, but is associated with significant morbidity and mortality, and data in AD are limited. Experience with autoHSCT in relapsing polychondritis, a rare episodic inflammatory disorder characterized by destruction of cartilage, is scarce and alloHSCT has not been described before. Case Presentation Here, we present a case of a 9-year-old girl who was diagnosed with relapsing polychondritis, with severe airway involvement requiring a tracheostomy. The disease proved to be steroid-dependent and refractory to a wide array of disease-modifying anti-rheumatic drugs and biologicals. After an autoHSCT procedure, the disease became inactive for a short period of time, until the patient experienced a relapse after 31 days, accompanied by repopulation of effector/memory CD8+ T cells. Because of persistent inflammation and serious steroid toxicity, including severe osteoporosis, growth restriction, and excessive weight gain, the patient was offered an alloHSCT. She experienced transient antibody-mediated immune events post-alloHSCT, which subsided after rituximab. She ultimately developed a balanced immune reconstitution and is currently still in long-term disease remission, 8 years after alloHSCT. Conclusion This case adds to the few existing reports on autoHSCT in relapsing polychondritis and gives new insights in its pathogenesis, with a possible role for CD8+ T cells. Moreover, it is the first report of successful alloHSCT as a treatment for children with this severe autoimmune disease.
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Affiliation(s)
- Saskia R Veldkamp
- Center for Translational Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc H A Jansen
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joost F Swart
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Caroline A Lindemans
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Blood and Bone Marrow Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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