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Jahan D, Peile E, Sheikh MA, Islam S, Parasnath S, Sharma P, Iskandar K, Dhingra S, Charan J, Hardcastle TC, Samad N, Chowdhury TS, Dutta S, Haque M. Is it time to reconsider prophylactic antimicrobial use for hematopoietic stem cell transplantation? a narrative review of antimicrobials in stem cell transplantation. Expert Rev Anti Infect Ther 2021; 19:1259-1280. [PMID: 33711240 DOI: 10.1080/14787210.2021.1902304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hematopoietic Stem Cell Transplantation (HSCT) is a life-saving procedure for multiple types of hematological cancer, autoimmune diseases, and genetic-linked metabolic diseases in humans. Recipients of HSCT transplant are at high risk of microbial infections that significantly correlate with the presence of graft-versus-host disease (GVHD) and the degree of immunosuppression. Infection in HSCT patients is a leading cause of life-threatening complications and mortality. AREAS COVERED This review covers issues pertinent to infection in the HSCT patient, including bacterial and viral infection; strategies to reduce GVHD; infection patterns; resistance and treatment options; adverse drug reactions to antimicrobials, problems of antimicrobial resistance; perturbation of the microbiome; the role of prebiotics, probiotics, and antimicrobial peptides. We highlight potential strategies to minimize the use of antimicrobials. EXPERT OPINION Measures to control infection and its transmission remain significant HSCT management policy and planning issues. Transplant centers need to consider carefully prophylactic use of antimicrobials for neutropenic patients. The judicious use of appropriate antimicrobials remains a crucial part of the treatment protocol. However, antimicrobials' adverse effects cause microbiome diversity and dysbiosis and have been shown to increase morbidity and mortality.
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Affiliation(s)
- Dilshad Jahan
- Department of Hematology, Asgar Ali Hospital, 111/1/A Distillery Road, Gandaria Beside Dhupkhola, Dhaka 1204, Bangladesh
| | - Ed Peile
- Department of Medical Education, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | - Sharlene Parasnath
- Department of Clinical Hematology, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Road, Cato Manor, Durban, South Africa
| | - Paras Sharma
- Department of Pharmacognosy, BVM College of Pharmacy, Gwalior, India
| | - Katia Iskandar
- Lebanese University, School of Pharmacy, Beirut, Lebanon.,INSPECT-LB: Institute National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Universite Paul Sabatier UT3, INSERM, UMR1027, Toulouse, France
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Timothy Craig Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa.,Department of Surgery, Nelson R Mandela School of Clinical Medicine, UKZN, South Africa
| | - Nandeeta Samad
- Department of Public Health, North South University, Bangladesh
| | | | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur, Malaysia
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Abstract
BACKGROUND Patients who receive autologous hematopoietic cell transplantation (HCT) for the treatment of hematologic malignancies are at risk of serious adverse outcomes including infections and death. Hyperglycemia following the HCT is associated with increased risk of these adverse outcomes. However, limited information is available on demographic and clinical characteristics that contribute to changes in blood glucose levels following HCT. OBJECTIVE The objective of this study was to determine the trajectories of fasting blood glucose (FBG) levels as well as the demographic and clinical characteristics that predicted interindividual differences in these FBG trajectories. METHODS A sample of adult patients with hematologic malignancies who were scheduled to receive autologous HCT (n = 53) was enrolled in the study. Patients with preexisting diabetes were excluded. Demographic and clinical characteristics were abstracted from electronic medical records. Morning fasting laboratory tests (ie, FBG and absolute neutrophil counts) were obtained. Data were analyzed using hierarchical linear modeling from the day of HCT (day 0) through 14 days post-HCT. RESULTS Among 8 characteristics evaluated, pre-HCT FBG was associated with variability in both the initial levels and the trajectories of FBG. Body mass index was only associated with initial levels of FBG. CONCLUSIONS The large amount of interindividual variability in the trajectories of FBG levels following autologous HCT suggests that glucose control in these patients warrants ongoing assessments and preemptive tailoring. IMPLICATIONS FOR PRACTICE Fasting blood glucose monitoring is warranted. Additional research with larger samples is warranted to identify additional modifiable and nonmodifiable characteristics associated with interindividual variability in FBG levels.
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Qi J, Wang J, Chen J, Su J, Tang Y, Wu X, Ma X, Chen F, Ruan C, Zheng XL, Wu D, Han Y. Plasma levels of complement activation fragments C3b and sC5b-9 significantly increased in patients with thrombotic microangiopathy after allogeneic stem cell transplantation. Ann Hematol 2017; 96:1849-1855. [PMID: 28801815 PMCID: PMC6225065 DOI: 10.1007/s00277-017-3092-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 08/04/2017] [Indexed: 12/30/2022]
Abstract
Transplantation-associated thrombotic microangiopathy (TA-TMA) is an uncommon but severe complication in patients undergoing allogeneic stem cell transplantation (allo-SCT). However, the mechanism is unclear. From 2011 to 2014, 20 patients with TA-TMA, 20 patients without, and 54 patients with various other complications, including veno occlusive disease (VOD), graft-versus-host disease (GVHD), and infection, were recruited in the study. Plasma vWF antigen (vWFAg), vWF activity (vWFAc), and ADAMTS13 activity were determined in these patients by ELISAs and FRETS-vWF73 assay, respectively. Plasma C3b, sC5b-9, and CH50 were also determined by ELISAs. Plasma levels of C3b were significantly increased in patients with either TA-TMA (p < 0.0001) or GVHD (p < 0.01). Plasma sC5b-9 and CH50 levels in patients with TA-TMA were also significantly increased (p < 0.001). Plasma ADAMTS13 activity was lower in patients with VOD, but normal with other complications. Both plasma vWFAg and vWFAc levels were not elevated in patients with TA-TMA or VOD compared with those of other groups. Complement activation likely via an alternative pathway (increased C3b, sC5b-9, and CH50) may play a role in the pathogenesis of TA-TMA. ADAMTS13 activity is reduced in VOD, but the ADAMTS13/vWF axis appears to be unaffected in patients with TA-TMA.
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Affiliation(s)
- Jiaqian Qi
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Jie Wang
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Jia Chen
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Jian Su
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Yaqiong Tang
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Xiaojin Wu
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Xiao Ma
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Feng Chen
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - Changgeng Ruan
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China
| | - X Long Zheng
- Divsion of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, 35243, USA
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China.
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China.
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China.
| | - Yue Han
- The First Affiliated Hospital of Soochow University, Jiangsu Institute of Haematology, Suzhou, China.
- Soochow University, Collaborative Innovation Centre of Haematology, Suzhou, China.
- Key Laboratory of Thrombosis and Haemostasis of Ministry of Health, Suzhou, China.
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Hammer MJ, D'Eramo Melkus G, Knobf MT, Casper C, Fletcher J, Cleland CM. Glycemic Status and Infection Risk in Nondiabetic Autologous Hematopoietic Cell Transplantation Recipients. Biol Res Nurs 2016; 18:344-50. [PMID: 26792914 DOI: 10.1177/1099800415619227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients undergoing hematopoietic cell transplantation (HCT) for hematological malignancies experience a number of challenges during treatment. There is growing evidence that malglycemia (hyperglycemia, hypoglycemia, and/or increased glycemic variability) contributes to HCT-related complications, even in patients without preexisting diabetes. The purpose of this pilot study was to investigate factors influencing glycemic status and associated infection occurrences in nondiabetic autologous HCT recipients. METHODS Oncology patients without preexisting diabetes treated with autologous HCT at a National Cancer Institute-designated cancer center were followed from admission through discharge or 28 days post-HCT. Patients had morning fasting laboratory tests. Descriptive statistics and Cox proportional hazards models were used to examine associations between BG levels and risk for infection while adjusting for baseline covariates including age, body mass index (BMI), cumulative glucocorticoid dose, and diagnosis. RESULTS The sample included 28 female and 25 male predominately non-Hispanic White patients (mean age 55.7 years, SD = 11.32). Blood glucose (BG) range was 35-325 mg/dl. Twenty-three patients incurred at least one infection. BMI ≥ 25 kg/m(2) was associated with high BG and infections. In the multivariate Cox model, an increase of 1 interquartile range in BG 2 days before infection was associated with a moderately increased risk of infection (hazard ratio = 1.44, p = .008). CONCLUSIONS Understanding the contributors to and consequences of malglycemic events can lead to better protocols for identifying patients at greater risk for infection. Further investigation is warranted for interventions to mitigate BG events for improved outcomes.
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Affiliation(s)
| | | | - M Tish Knobf
- Division of Acute Care/Health Systems, Yale University School of Nursing, New Haven, CT, USA
| | - Corey Casper
- Fred Hutchinson Cancer Research Center/University of Washington, Seattle, WA, USA
| | - Jason Fletcher
- New York University College of Nursing, New York, NY, USA
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Abstract
PURPOSE/OBJECTIVES To introduce a conceptual model detailing the physiologic contributions of malglycemia to cancer formation and increased morbidity and mortality. DATA SOURCES A literature search was conducted using the PubMed, CINAHL®, and Cochrane databases, as well as Surveillance, Epidemiology and End Results (SEER) cancer statistics. DATA SYNTHESIS Multiple complex factors are associated with malignancy formation, proliferation, and outcomes for each individual. The authors present a model, termed the Malglycemia Orbit Model, that is analogous to an atom, centered on a core of individual factors, and surrounded by "orbits" containing cancer and related factors. Highlighted in this model is the role of malglycemia. CONCLUSIONS Cancer formation and sequelae involve numerous multifaceted factors. One factor not well described or understood within the context of malignancies is glycemic status, most notably how malglycemia impacts cancer formation and risks for adverse outcomes. The atomic-structured malglycemia model describes this process. IMPLICATIONS FOR NURSING Among the many uncontrollable factors that contribute to cancer formation and adverse outcomes, malglycemia is one that is modifiable. Nurses are in a prime position to conduct research to enhance understanding and ultimately improve protocols for better glycemic control and, in effect, better outcomes for individuals with cancer.
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Gurion R, Belnik‐Plitman Y, Gafter‐Gvili A, Paul M, Vidal L, Ben‐Bassat I, Shpilberg O, Raanani P. Colony-stimulating factors for prevention and treatment of infectious complications in patients with acute myelogenous leukemia. Cochrane Database Syst Rev 2012; 2012:CD008238. [PMID: 22696376 PMCID: PMC7390444 DOI: 10.1002/14651858.cd008238.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute myelogenous leukemia (AML) is a fatal bone marrow cancer. Colony-stimulating factors (CSFs) are frequently administered during and after chemotherapy to reduce complications. However, their safety with regard to disease-related outcomes and survival in AML is unclear. Therefore, we performed a systematic review and meta-analysis to evaluate the impact of CSFs on patient outcomes, including survival. OBJECTIVES To assess the safety/efficacy of CSFs with regard to disease-related outcomes and survival in patients with AML. SEARCH METHODS We conducted a comprehensive search strategy. We identified relevant randomized clinical trials by searching the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 7), MEDLINE (January 1966 to July 2010), LILACS (up to December 2009), databases of ongoing trials and relevant conference proceedings. SELECTION CRITERIA Randomized controlled trials that compared the addition of CSFs during and following chemotherapy to chemotherapy alone in patients with AML. We excluded trials evaluating the role of CSFs administered for the purpose of stem cell collection and/or priming (e.g. before and/or only for the duration of chemotherapy). DATA COLLECTION AND ANALYSIS Two review authors appraised the quality of trials and extracted data. For each trial, we expressed results as relative risk (RR) with 95% confidence intervals (CI) for dichotomous data. We analyzed time-to-event outcomes as hazard ratios (HRs). MAIN RESULTS The search yielded 19 trials including 5256 patients. The addition of CSFs to chemotherapy yielded no difference in all-cause mortality at 30 days and at the end of follow up (RR 0.97; 95% CI 0.80 to 1.18 and RR 1.01; 95% CI 0.98 to 1.05, respectively) or in overall survival (HR 1.00; 95% 0.93 to 1.08). There was no difference in complete remission rates (RR 1.03; 95% CI 0.99 to 1.07), relapse rates (RR 0.97; 95% CI 0.89 to 1.05) and disease-free survival (HR 1.00; 95% CI 0.90 to 1.13). CSFs did not decrease the occurrence of bacteremias (RR 0.96; 95% CI 0.82 to 1.12), nor the occurrence of invasive fungal infections (RR 1.40; 95% CI 0.90 to 2.19). CSFs marginally increased adverse events requiring discontinuation of CSFs as compared to the control arm (RR 1.33; 95% CI 1.00 to 1.56). AUTHORS' CONCLUSIONS In summary, colony-stimulating factors should not be given routinely to acute myelogenous leukemia patients post-chemotherapy since they do not affect overall survival or infectious parameters including the rate of bacteremias and invasive fungal infections.
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Affiliation(s)
- Ronit Gurion
- Beilinson Hospital, Rabin Medical CenterInstitute of Hematology, Davidoff Center39 Jabotinski StreetPetah TikvaIsrael49100
| | - Yulia Belnik‐Plitman
- Beilinson Hospital, Rabin Medical CenterInstitute of Hematology, Davidoff Center39 Jabotinski StreetPetah TikvaIsrael49100
| | - Anat Gafter‐Gvili
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E39 Jabotinski StreetPetah TikvaIsrael49100
| | - Mical Paul
- Sackler Faculty of MedicineInfectious Diseases UnitTel Aviv UniversityTel AvivIsrael49100
| | - Liat Vidal
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E39 Jabotinski StreetPetah TikvaIsrael49100
| | | | - Ofer Shpilberg
- Beilinson Hospital, Rabin Medical CenterInstitute of Hematology, Davidoff Center39 Jabotinski StreetPetah TikvaIsrael49100
| | - Pia Raanani
- Beilinson Hospital, Rabin Medical CenterInstitute of Hematology, Davidoff Center39 Jabotinski StreetPetah TikvaIsrael49100
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Gurion R, Belnik-Plitman Y, Gafter-Gvili A, Paul M, Vidal L, Ben-Bassat I, Shpilberg O, Raanani P. Colony-stimulating factors for prevention and treatment of infectious complications in patients with acute myelogenous leukemia. Cochrane Database Syst Rev 2011:CD008238. [PMID: 21901718 DOI: 10.1002/14651858.cd008238.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute myelogenous leukemia (AML) is a fatal bone marrow cancer. Colony-stimulating factors (CSFs) are frequently administered during and after chemotherapy to reduce complications. However, their safety with regard to disease-related outcomes and survival in AML is unclear. Therefore, we performed a systematic review and meta-analysis to evaluate the impact of CSFs on patient outcomes, including survival. OBJECTIVES To assess the safety/efficacy of CSFs with regard to disease-related outcomes and survival in patients with AML. SEARCH STRATEGY We conducted a comprehensive search strategy. We identified relevant randomized clinical trials by searching the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 7), MEDLINE (January 1966 to July 2010), LILACS (up to December 2009), databases of ongoing trials and relevant conference proceedings. SELECTION CRITERIA Randomized controlled trials that compared the addition of CSFs during and following chemotherapy to chemotherapy alone in patients with AML. We excluded trials evaluating the role of CSFs administered for the purpose of stem cell collection and/or priming (e.g. before and/or only for the duration of chemotherapy). DATA COLLECTION AND ANALYSIS Two review authors appraised the quality of trials and extracted data. For each trial, we expressed results as relative risk (RR) with 95% confidence intervals (CI) for dichotomous data. We analyzed time-to-event outcomes as hazard ratios (HRs). MAIN RESULTS The search yielded 19 trials including 5256 patients. The addition of CSFs to chemotherapy yielded no difference in all-cause mortality at 30 days and at the end of follow up (RR 0.97; 95% CI 0.80 to 1.18 and RR 1.01; 95% CI 0.98 to 1.05, respectively) or in overall survival(HR 1.00; 95% 0.93 to 1.08). There was no difference in complete remission rates(RR 1.03; 95% CI 0.99 to 1.07), relapse rates(RR 0.97; 95% CI 0.89 to 1.05) and disease-free survival(HR 1.00; 95% CI 0.90 to 1.13). CSFs did not decrease the occurrence of bacteremias(RR 0.96; 95% CI 0.82 to 1.12), nor the occurrence of invasive fungal infections(RR 1.40; 95% CI 0.90 to 2.19). CSFs marginally increased adverse events requiring discontinuation of CSFs as compared to the control arm(RR 1.33; 95% CI 1.00 to 1.56). AUTHORS' CONCLUSIONS The addition of CSFs to chemotherapy does not adversely influence all-cause mortality, complete remission or relapse rates in patients with AML. Although the benefit of CSFs is limited to reduction of neutropenic and febrile days, they can be administered safely when necessary.
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Affiliation(s)
- Ronit Gurion
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, Israel, 49100
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Han Y, Zhu L, Sun A, Lu X, Hu L, Zhou L, Ren Y, Hu X, Wu X, Wang Z, Ruan C, Wu D. Alterations of hemostatic parameters in the early development of allogeneic hematopoietic stem cell transplantation-related complications. Ann Hematol 2011; 90:1201-8. [PMID: 21674145 PMCID: PMC3168446 DOI: 10.1007/s00277-011-1273-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 06/05/2011] [Indexed: 11/18/2022]
Abstract
Thrombotic events are common and potentially fatal complications in patients receiving hematopoietic stem cell transplantation (HSCT). Early diagnosis is crucial but remains controversial. In this study, we investigated the early alterations of hemostatic parameters in allogeneic HSCT recipients and determined their potential diagnostic values in transplantation-related thrombotic complications and other post-HSCT events. Results from 107 patients with allogeneic HSCT showed higher levels of plasma plasminogen activator inhibitor-1 (PAI-1), fibrinogen, and tissue-plasminogen activator (t-PA) and a lower level of plasma protein C after transplantation. No change was found for prothrombin time, antithrombin III, d-dimer, and activated partial thromboplastin time following HSCT. Transplantation-related complications (TRCs) in HSCT patients were defined as thrombotic (n = 8), acute graft-versus-host disease (aGVHD, n = 45), and infectious (n = 38). All patients with TRCs, especially the patients with thrombotic complications, presented significant increases in the mean and maximum levels of PAI-1 during the observation period. Similarly, a high maximum t-PA level was found in the thrombotic group. In contrast, apparent lower levels of mean and minimum protein C were observed in the TRC patients, especially in the aGVHD group. Therefore, the hemostatic imbalance in the early phase of HSCT, reflecting prothrombotic state and endothelial injury due to the conditioning therapy or TRCs, might be useful in the differential diagnosis of the thrombotic complication from other TRCs.
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Affiliation(s)
- Yue Han
- Department of Hematology, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, No.188 Shi Zi Street, Suzhou, People's Republic of China.
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Anabtawi I, Abdel-Rahman F, Al Masri M. Surgical complications related to hematopoietic stem cell transplantation. Eur J Surg Oncol 2011; 37:576-82. [PMID: 21420823 DOI: 10.1016/j.ejso.2011.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 12/19/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Surgical complications in recipients of hematopoietic stem cell transplantation (HSCT) are common. However, this issue is infrequently reported in the literature. METHODS The records of 165 patients who underwent hematopoietic stem cell transplantation at King Hussein Cancer Center between January 2007 and December 2008 were retrospectively reviewed. All surgical complications were included and were classified into gastrointestinal (GI), catheter-related, ear, nose and throat (ENT), peri anal, musculoskeletal, neurological and urological complications. RESULTS There were 279 surgical complications in the studied patients. Gastrointestinal (n = 122) and catheter-related (n = 78) complications were the most frequent. The frequency and the percentage of patients needing surgical intervention for the 5 most common complications were as follows: Gastrointestinal (n = 122, 4.5% needed surgical intervention), catheter-related (n = 78, 46.2%), ear, nose and throat (n = 31, 9.7%), perianal disease (n = 21, 19%) and urinary complications (n = 17, 5.9%). Surgical consultation was sought for 116 surgical complications. Surgical interventions were necessary for 55 patients. All the patients who underwent surgery did not have an intervention-related mortality except for one patient who died from surgical intervention post-gastrointestinal complication. CONCLUSION The majority of surgical complications after HSCT do not require surgical intervention. However, these conditions may overlap with the more common reasons for surgical consultation and must be identifiable by the surgeon. Extra vigilance is necessary when dealing with both GI and catheter-related complications as they are the most frequent. The early involvement of surgeons and proper timing of surgical management may circumvent detrimental outcomes.
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Affiliation(s)
- I Anabtawi
- Department of Surgery, King Hussein Cancer Center, Queen Rania Street, PO Box 1269, Al-Jubeiha, Amman 11941, Jordan
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Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG, McGeer AJ, Neuzil KM, Pavia AT, Tapper ML, Uyeki TM, Zimmerman RK. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1003-32. [PMID: 19281331 PMCID: PMC7107965 DOI: 10.1086/598513] [Citation(s) in RCA: 495] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Guidelines for the treatment of persons with influenza virus infection were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic issues, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal (interpandemic) influenza. They are intended for use by physicians in all medical specialties with direct patient care, because influenza virus infection is common in communities during influenza season and may be encountered by practitioners caring for a wide variety of patients.
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Affiliation(s)
- Scott A Harper
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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11
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Pawson H, Jayaweera A, Wigmore T. Intensive care management of patients following haematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.cacc.2008.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Moreno L, Andres MM, Verdeguer A, Alvarez O, Fernández-Navarro JM, Fernández-Sanmartin M. Can etoposide infusion during stem cell transplantation produce a febrile reaction mimicking bacterial sepsis? Bone Marrow Transplant 2008; 42:59-60. [PMID: 18362905 DOI: 10.1038/bmt.2008.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Al-Anazi KA, Abu Jafar S, Al-Jasser AM, Al-Shangeeti A, Chaudri NA, Al Jurf MD, Al-Mohareb FI. Septic shock caused by Sphingomonas paucimobilis bacteremia in a patient with hematopoietic stem cell transplantation. Transpl Infect Dis 2007; 10:142-4. [PMID: 17605729 DOI: 10.1111/j.1399-3062.2007.00262.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sphingomonas paucimobilis is an aerobic gram-negative bacillus that causes a variety of infections in healthy as well as in immunocompromised individuals. The organism is usually susceptible to tetracycline, chloramphenicol, aminoglycosides, trimethoprim-sulfamethoxazole, and carbapenems. However, resistance to penicillins and the first-generation cephalosporins is commonly encountered. Reported here is a patient with acute myeloid leukemia who developed S. paucimobilis bacteremia complicated by septic shock just before receiving an autologous hematopoietic stem cell transplant (SCT) at King Faisal Specialist Hospital and Research Centre in Riyadh. The septic episode was successfully treated in the intensive care unit. To our knowledge, this is the first case report of septic shock caused by S. paucimobilis bacteremia in a hematopoietic SCT recipient.
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Affiliation(s)
- K A Al-Anazi
- Section of Adult Hematology and Stem Cell Transplant, King Faisal Cancer Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Wrede CE, Holler E. [Intensive care support of patients after stem cell transplantation]. INTENSIVMEDIZIN + NOTFALLMEDIZIN : ORGAN DER DEUTSCHEN UND DER OSTERREICHISCHEN GESELLSCHAFT FUR INTERNISTISCHE INTENSIVMEDIZIN, DER SEKTION NEUROLOGIE DER DGIM UND DER SEKTION INTENSIVMEDIZIN IM BERUFSVERBAND DEUTSCHER INTERNISTEN E.V 2007; 44:129-141. [PMID: 32287638 PMCID: PMC7102276 DOI: 10.1007/s00390-007-0774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 12/11/2006] [Indexed: 10/31/2022]
Abstract
Within the hematologic therapy procedures, stem cell transplantation (SCT) represents the most extensive and invasive intervention. Those patients have certain risks for several bacterial, viral, as well as fungal infections during the different stages of transplantation. Especially in allogenic transplantation, discrimination of non-infectious, mostly immunologic complications like graft-versus-host reactions or VOD (veno-occlusive disease) is crucial, and often represents a therapeutic challenge. An adequate intensive care therapy of these patients can only be achieved with the knowledge of the specific complications of SCT. This review starts with an overview of the SCT stages with their corresponding infectious and noninfectious complications, followed by the discussion of organ specific pulmonary, renal, cardiac, gastrointestinal, hepatic and neurological complications of stem cell transplantation.
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Affiliation(s)
- C E Wrede
- 1Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg, 93042 Regensburg, Germany
| | - E Holler
- 2Abteilung für Hämatologie und internistische Onkologie, Klinikum der Universität Regensburg, 93042 Regensburg, Germany
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Abstract
OBJECTIVE To review the available clinical data on the critical care complications of hematopoietic stem cell transplantation (HSCT). DATA SOURCE The MEDLINE database and references from the identified articles related to the critical care in HSCT. CONCLUSION HSCT is an important treatment for a variety of malignant and nonmalignant conditions. The procedure is, however, limited by significant complications that may involve every organ of the body. Up to 40% of HSCT recipients are admitted to the intensive care unit as a result of severe complications related to the transplantation. The outcome of those critically ill patients has been traditionally poor. However, recent advances in the transplantation procedure, diagnostic studies, antimicrobial prophylaxis and therapy, and intensive care unit care have improved the outcome of these patients. The increasing number of HSCTs performed annually, the unique complications that develop in these patients, and the improvement in the intensive care unit outcome make knowledge about the critical care aspect of HSCT an essential part of the current practice of critical care medicine.
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Affiliation(s)
- Ayman O Soubani
- Division of Pulmonary, Critical Care, and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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Koldehoff M, Elmaagacli AH, Steckel NK, Trenschel R, Hlinka M, Ditschkowski M, Beelen DW. Successful treatment of patients with respiratory failure due to fungal infection after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2006; 7:137-45. [PMID: 16390403 DOI: 10.1111/j.1399-3062.2005.00115.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The mortality rate associated with respiratory failure due to invasive fungal infections after allogeneic hematopoietic stem cell transplantation (HSCT) is exceedingly high. We present a retrospective analysis of 4 HSCT recipients who survived long-term artificial respiration subsequent to pulmonary mycosis, and compare our current findings with historic data. Several clinical parameters indicate a remarkable improvement in the clinical courses of those patients in recent years: weaning time, extubation rate, and improvement of additional organ failures were all significantly better in patients treated after the emergence of new antimycotic agents, resulting in prolonged overall survival. We propose that our observations reflect an improved management of these patients, mainly because of the use of new antimycotics with alternative mechanisms of action and decreased toxicity, allowing for earlier, more aggressive, and more effective antifungal treatment approaches. In addition, the optimized use of new technologies designed to augment spontaneous breathing efforts by patients, mechanical ventilation, as well as the advantages of early tracheotomy will contribute to better outcomes in the treatment of respiratory failure due to pulmonary mycoses following allogeneic HSCT.
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Affiliation(s)
- M Koldehoff
- Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany.
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Koldehoff M, Zakrzewski JL. Modern management of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem-cell transplantation. Am J Hematol 2005; 79:158-63. [PMID: 15929105 DOI: 10.1002/ajh.20361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Pulmonary mycoses count among the most dangerous complications in allogeneic hematopoietic stem cell transplantation. Despite the establishment of antifungal chemoprophylaxis and empirical antifungal treatment, they frequently lead to respiratory failure and are still associated with an extraordinarily poor prognosis. However, the emergence of new antimycotics with alternative mechanisms of actions and decreased toxicity in combination with the development of new non culture-based diagnostic techniques may allow earlier, more aggressive and more effective antifungal treatment approaches. In addition, the optimized use of new technologies designed to augment spontaneous breathing efforts by patients, mechanical ventilation, as well as the advantages of early tracheostomy lead us to expect better outcomes in the treatment of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Michael Koldehoff
- Department of Bone Marrow Transplantation, University Hospital Essen, 45122 Essen, Germany.
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