1
|
Abdeljelil NB, Ouerghi R, Yaiche IB, Moussa AB, Chebbi Y, Othman TB. Early bacteremia following allogeneic hematopoietic stem cell transplantation without antibiotic prophylaxis: epidemiology and antimicrobial resistance. Hematol Transfus Cell Ther 2024:S2531-1379(24)00301-8. [PMID: 39341750 DOI: 10.1016/j.htct.2024.05.009] [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: 01/23/2024] [Revised: 04/05/2024] [Accepted: 05/06/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVE Bacteremia is a serious complication in patients undergoing allogeneic hematopoietic stem cell transplantation. The aim of this study was to determine the frequency, epidemiological profile, and risk factors of bacteremia early after allogeneic hematopoietic stem cell transplantation. METHODS An observational descriptive retrospective study was conducted in patients who received transplants between January 2016 and December 2021. Early bacteremia was defined as blood stream infection occurring between Day 0 and Day 100 after transplantation. RESULTS Forty episodes of early bacteremia occurred in 36/245 transplanted patients. Fifteen episodes (37.5%) were due to gram-positive bacteria and 25 (62.5%) to gram-negative bacteria. The most frequent species isolated were coagulase negative staphylococci (CoNS) in gram-positive bacteremia (n = 8/15), and Klebsiella species (8/25) and Pseudomonas species (8/25) in gram-negative bacteremia. Twenty-nine episodes of bacteremia (72.5%) occurred during the first 30 days after transplantation with a median time of nine days (range: 0-90 days). Coagulase negative staphylococci were methicillin-resistant in 75% of cases, the only Staphylococcus aureus isolated was methicillin-resistant. All gram-positive bacilli were penicillin-resistant. Gram-negative bacilli were multidrug resistant in 61.5% of cases. In multivariate analysis, bone marrow as source of graft (p-value = 0.02) and cytomegalovirus reactivation (p-value = 0.02) were significantly associated with an increased risk of bacteremia. Mortality attributable to bacteremia was 2.8%. The one-year overall survival was not significantly different between those with and without bacteremia. CONCLUSIONS Bacteremia was more frequent within the first 30 days after transplantation indicating the crucial role of neutropenia. An increase in multidrug resistant gram-negative bacteremia was noted.
Collapse
Affiliation(s)
- Nour Ben Abdeljelil
- Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Rihab Ouerghi
- Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia.
| | - Insaf Ben Yaiche
- Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Amine Ben Moussa
- Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Yosra Chebbi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia; Centre National de Greffe de Moelle Osseuse de Tunis. Service des Laboratoires, Tunis, Tunisia
| | - Tarek Ben Othman
- Centre National de Greffe de Moelle Osseuse de Tunis. Service d'Hématologie et de Greffe, Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, Tunisia
| |
Collapse
|
2
|
Kamel NA, Abdalla MS, Al Ali A, Alshahrani MY, Aboshanab KM, El Borhamy MI. Effectiveness of Pre-Transplant Screening for High-Priority Multidrug-Resistant Pathogens on Pre-Engraftment Infections After Hematopoietic Stem Cell Transplantation. Infect Drug Resist 2024; 17:2249-2260. [PMID: 38854781 PMCID: PMC11162205 DOI: 10.2147/idr.s463868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024] Open
Abstract
Objective Owing to the rising incidence of multidrug-resistant organisms (MDRO) and the high mortality rates associated with such bacterial infections post-hematopoietic stem cell transplantation (HSCT), we investigated the MDRO colonization rate prior to transplantation using an active surveillance approach and determined its impact on subsequent infection during the pre-engraftment period. Methods A single-center observational study was conducted, and surveillance cultures from multiple body sites, including the rectum, nasal cavity, and groin, were performed at admission to determine MDRO colonization. Serological tests were used to detect certain viruses and toxoplasmosis before HSCT. Results In the pre-transplant setting, 59 MDRO were recovered from the 40 HSCT recipients. Of the 59 isolates recovered from one or more body sites, 29 were positive for methicillin-resistant Staphylococcus aureus (MRSA), 7 for carbapenem-resistant Enterobacterales (CRE), and 23 were positive for extended-spectrum β-lactamase (ESBLs). Serological assessment before HSCT revealed active or reactivation of latent infection with cytomegalovirus (7.5%), Epstein-Barr virus (EBV; 5%), and Toxoplasma gondii (2.5%) among HSCT patients. In terms of factors associated with pre-engraftment infections, the type of transplant (p=0.04) was statistically significant, whereas other factors, such as age, sex, and underlying conditions, were not. In post-transplant settings, bloodstream infections (BSIs) were documented in 2 allogeneic HSCT patients (5%), and the isolated microorganisms were ESBL-producing E. coli and non-MDR Acinetobacter baumannii. Conclusion Active screening cultures are a helpful tool for identifying patients colonized by MDRO or relevant viruses before HSCT, and for predicting those at risk of developing subsequent pre-engraftment infections. Additionally, active screening may aid in predicting those who are likely to develop subsequent pre-engraftment infections Our findings highlight the importance of pre-transplant screening for high-priority multidrug-resistant pathogens and the application of infection control interventions after HSCT.
Collapse
Affiliation(s)
- Noha A Kamel
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
| | - Mahmoud S Abdalla
- Hematology and Bone Marrow Transportation (BMT) Unit, International Medical Center (IMC), Cairo, Egypt
| | - Amer Al Ali
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, University of Bisha, Bisha, 67714, Saudi Arabia
| | - Mohammad Y Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 9088, Saudi Arabia
| | - Khaled M Aboshanab
- Microbiology and Immunology Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, University Technology MARA (Uitm), Campus Puncak Alam, Bandar Puncak Alam, Selangor, 42300, Malaysia
| | - Mervat I El Borhamy
- Department of Microbiology, Faculty of Pharmacy, Misr International University (MIU), Cairo, Egypt
- International Medical Center, Clinical Microbiology Laboratory, Cairo, Egypt
| |
Collapse
|
3
|
Lee R, Kim WB, Cho SY, Nho D, Park C, Yoo IY, Park YJ, Lee DG. Clinical Implementation of β-Tubulin Gene-Based Aspergillus Polymerase Chain Reaction for Enhanced Aspergillus Diagnosis in Patients with Hematologic Diseases: A Prospective Observational Study. J Fungi (Basel) 2023; 9:1192. [PMID: 38132792 PMCID: PMC10744750 DOI: 10.3390/jof9121192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
The β-tubulin (benA) gene is a promising target for the identification of Aspergillus species. Assessment of the clinical implementation and performance of benA gene-based Aspergillus polymerase chain reaction (PCR) remains warranted. In this study, we assessed the analytical performance of the BenA probe PCR in comparison with the Aspergenius kit. We prospectively collected bronchoalveolar lavage (BAL) fluid via diagnostic bronchoscopy from adult patients with hematologic diseases. BenA gene-based multiplex real-time PCR and sequential melting temperature analysis were performed to detect the azole resistance of Aspergillus fumigatus. In total, 76 BAL fluids in 75 patients suspicious of invasive pulmonary aspergillosis (IPA) were collected. Before the application of PCR, the prevalence of proven and probable IPA was 32.9%. However, after implementing the benA gene-based PCR, 15.8% (12 out of 76) of potential IPA cases were reclassified as probable IPA. The analytical performance of the BenA probe PCR in BAL samples was comparable to that of the Aspergenius kit. The diagnostic performance was as follows: sensitivity, 52.0%; specificity, 64.7%; positive predictive value, 41.9%; negative predictive value, 73.3%; positive likelihood ratio, 1.473; and negative likelihood ratio, 0.741. Moreover, benA gene-based Aspergillus PCR discriminated all major sections of Aspergillus, including cryptic species such as Aspergillus tubingensis. Sequential melting temperature analysis successfully detected 2 isolates (15.4%) of A. fumigatus carrying resistant mutations. BenA gene-based Aspergillus PCR with melting temperature analysis enhances diagnostic accuracy and detects not only cryptic species but also resistant mutations of A. fumigatus. It shows promise for clinical applications in the diagnosis of IPA.
Collapse
Affiliation(s)
- Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (R.L.); (S.-Y.C.); (D.N.)
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (W.-B.K.); (C.P.)
| | - Won-Bok Kim
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (W.-B.K.); (C.P.)
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (R.L.); (S.-Y.C.); (D.N.)
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (W.-B.K.); (C.P.)
| | - Dukhee Nho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (R.L.); (S.-Y.C.); (D.N.)
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (W.-B.K.); (C.P.)
| | - Chulmin Park
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (W.-B.K.); (C.P.)
| | - In Young Yoo
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (I.Y.Y.); (Y.-J.P.)
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (I.Y.Y.); (Y.-J.P.)
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (R.L.); (S.-Y.C.); (D.N.)
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (W.-B.K.); (C.P.)
| |
Collapse
|
4
|
Springer F, Kuba K, Ernst J, Friedrich M, Glaesmer H, Platzbecker U, Vucinic V, Heyne S, Mehnert-Theuerkauf A, Esser P. Symptoms of posttraumatic stress disorder and adjustment disorder in hematological cancer patients with different treatment regimes. Acta Oncol 2023; 62:1110-1117. [PMID: 37517064 DOI: 10.1080/0284186x.2023.2239477] [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: 05/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Symptoms of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) are common in hematological cancer patients as they face severe stressors during their serious disease and often intensive treatment, such as stem cell transplantation (SCT). Aims of the present study were to provide frequency and risk factors for PTSD and AjD based on updated diagnostic criteria that are lacking to date. MATERIAL AND METHODS In a cross-sectional study, hematological cancer patients were assessed for stressor-related symptoms via validated self-report questionnaires based on updated criteria for PTSD (PCL-5) and AjD (ADMN-20). Frequency and symptom severity were estimated among the total sample and SCT subgroups (allogeneic, autologous, no SCT). SCT subgroups were compared using Chi-squared-tests and ANOVAs. Linear regression models investigated sociodemographic and medical factors associated with symptomatology. RESULTS In total, 291 patients were included (response rate: 58%). 26 (9.3%), 66 (23.7%) and 40 (14.2%) patients met criteria for cancer-related PTSD, subthreshold PTSD and AjD, respectively. Symptom severity and frequency of criteria-based PTSD and AjD did not differ between SCT subgroups (all p > 0.05). Factors associated with elevated symptomatology were younger age (PTSD: p < 0.001; AjD: p = 0.02), physical comorbidity (PTSD: p < 0.001; AjD: p < 0.001) and active disease (PTSD: p = 0.12; AjD: p = 0.03). CONCLUSION Based on new criteria, a considerable part of hematological cancer patients reports PTSD and AjD symptoms. Younger patients and patients with physical symptom burden might be particularly at risk and need to be monitored closely to enable effective treatment at an early stage.
Collapse
Affiliation(s)
- Franziska Springer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Vladan Vucinic
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Svenja Heyne
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| |
Collapse
|
5
|
Kim DJ, Jeong S, Kong SG, Lee S, Lim SN, Oh SY, Do YR, Lee WS, Lee MH, Bae SH, Kim SH, Kim MK, Lee HS. Incidence and risk factors of opportunistic infections after autologous stem cell transplantation: a nationwide, population-based cohort study in Korea. Sci Rep 2023; 13:2551. [PMID: 36781859 PMCID: PMC9925816 DOI: 10.1038/s41598-023-27465-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/02/2023] [Indexed: 02/15/2023] Open
Abstract
Several guidelines classify autologous stem cell transplantation (ASCT) as a low to intermediate risk group for infection. In a nationwide population-based study, using the Korean Health Insurance Review and Assessment Service database, patients with lymphoma and multiple myeloma (MM) who underwent ASCT from 2002 to 2016 were retrospectively analyzed. Cumulative incidence rates (CIRs) and risk factors of opportunistic infections were investigated. CIRs of fungal, Varicella zoster virus (VZV), cytomegalovirus (CMV), and Pneumocystis jirovecii infections in lymphoma were 7.9%, 16.0%, 7.4%, and 5.1%, respectively, and CIRs in MM were 6.3%, 19.1%, 4.2%, and 5.6%, respectively. Fungal infection was significantly higher in patients with previous infection (Hazard ratio (HR) 2.003, p = 0.005) in lymphoma. Incidence of CMV infection was significantly higher in patients with prior CMV infection: HR 4.920, p < 0.001 (lymphoma); HR 3.022, p = 0.030 (MM). VZV infection was significantly lower in patients receiving prophylaxis: HR 0.082, p < 0.001 (lymphoma); HR 0.096, p < 0.001 (MM). For P. jirovecii infection, busulfex and melphalan conditioning (HR 1.875, p = 0.032) and previous P. jirovecii infection (HR 4.810, p < 0.001) had a higher incidence in MM. Patients who underwent ASCT should receive VZV prophylaxis and prophylaxis for fungal and P. jirovecii may be considered in patients with previous same infection.
Collapse
Affiliation(s)
- Da Jung Kim
- Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam-Dong, Seo-Gu, Busan, 49267, South Korea
| | - Seri Jeong
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, 07441, South Korea
| | - Seom Gim Kong
- Department of Pediatrics, Kosin University College of Medicine, Busan, 49267, Korea
| | - Sangjin Lee
- Graduate School, Department of Statistics, Pusan National University, Busan, 46241, Korea
| | - Sung-Nam Lim
- Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine Inje University, Busan, 48108, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, 49201, Korea
| | - Young Rok Do
- Division of Hematology-Oncology, Department of Medicine, Dongsan Medical Center, Keimyung University, Daegu, 41931, Korea
| | - Won Sik Lee
- Department of Internal Medicine, Busan Paik Hospital, College of Medicine Inje University, Busan, 47392, South Korea
| | - Mark Hong Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, South Korea
| | - Sung Hwa Bae
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, 42472, South Korea
| | - Se Hyung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, 14584, South Korea
| | - Min Kyoung Kim
- Department of Hematology-Oncology, Yeungnam University Medical Center, Yeungnam University School of Medicine, Daegu, 42415, South Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam-Dong, Seo-Gu, Busan, 49267, South Korea.
| | | |
Collapse
|
6
|
Sabancı A, Kuku İ. Oral and post-transplantation infectious status in patients with hematopoietic stem cell transplants: A prospective observational study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:242-248. [PMID: 36344391 DOI: 10.1016/j.oooo.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Infectious status may be life threatening in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to evaluate the effect of oral status on infectious conditions during the neutropenic phase after HSCT. STUDY DESIGN Seventy patients with various hematologic malignancies were involved. Before HSCT, oral and periodontal examination, including the number of teeth and decayed, missing, and filled teeth index (DMFT); visible plaque (%); bleeding on probing (BOP [%]); clinical attachment level; and probing depth (PD) values were collected. Daily blood cultures were collected and analyzed in terms of infection-related parameters, including febrile neutropenia (FN), bacteremia, and C-reactive protein (CRP) during the neutropenic phase of HSCT. RESULTS Forty-two patients (60%) received autologous and 28 (40%) allogeneic HSCT. In both groups, patients without FN after HSCT had significantly lower DMFT index scores and fewer sites with PD ≥4 mm (P < .05). However, bacteremia, FN, and CRP were similar in patients with periodontitis compared with non-periodontitis patients (P > .05). CONCLUSIONS The results suggest that periodontal status may not significantly impact the infection-related parameters in patients treated for HSCT. However, DMFT and the prevalence of sites with PD ≥4 mm may be involved in febrile neutropenia.
Collapse
Affiliation(s)
- Arife Sabancı
- Department of Periodontology, Inonu University, Malatya, Turkey.
| | - İrfan Kuku
- Department of Internal Medicine-Hematology, Inonu University, Malatya, Turkey
| |
Collapse
|
7
|
Jia Y, Liu Y, Liu Y, Yang K, Liu Y. Clinical characteristics, drug resistance and death risk factors of Burkholderia cepacia infection in hematopoietic stem cell transplant patients. BMC Infect Dis 2022; 22:777. [PMID: 36203152 PMCID: PMC9535976 DOI: 10.1186/s12879-022-07754-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Burkholderia cepacia (BC) has been detected more and more in infected patients in recent years. However, as a high-risk population, the clinical characteristics and prognosis of BC infection in hematopoietic stem cell transplantation (HSCT) patients have not been reported. The purpose of this study is to obtain data that will help fill in the gaps in this field, provide evidence for reducing the mortality rate of BC infection in HSCT patients, and guide the use of antibiotics in the future. Methods Electronic medical records of patients with BC infection who underwent HSCT in Xiangya Hospital of Central South University from September 1, 2015 to August 31, 2021 were collected. At the same time, 1:1 case–control matching was conducted according to gender, age and disease type. Comparisons between patients with/without BC infection and respiratory failure were made respectively, and the sensitivity of BC to five clinically commonly used antibiotics was also evaluated. Univariate and multivariate analyses were performed to identify independent risk factors for death. Results The most common site of BC infection in HSCT patients was the lung (75%). Although BC infection rate (3.74%) and antibiotic resistance were not significant, it was closely associated with a higher risk of death (P = 0.022), which even further increased to 90.9% when combined with respiratory failure (P = 0.008). Procalcitonin > 10 µg/L (HR = 40.88, 95% CI 6.51–256.63, P = 0.000) and septic shock (HR = 4.08, 95% CI 1.02–16.33, P = 0.047) were two independent risk factors for death. Conclusion HSCT patients with BC infection are in critical condition, and the management of respiratory infection should be especially strengthened to improve the prognosis of these patients.
Collapse
Affiliation(s)
- Yan Jia
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Ya Liu
- Department of Gastroenterologyy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, China
| | - Yi Liu
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Kaitai Yang
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Yanfeng Liu
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
| |
Collapse
|
8
|
Wagh H, Arif A, Reddy AJ, Tabaie E, Shekhar A, Min M, Nawathey N, Bachir M, Brahmbhatt H. Assessing the Efficacy of Alkylating Agent Regimens in the Treatment of Infantile Malignant Osteopetrosis: Cyclophosphamide, Busulfan, or Thiotepa. Cureus 2022; 14:e26600. [PMID: 35936184 PMCID: PMC9354912 DOI: 10.7759/cureus.26600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Infantile malignant osteopetrosis is a debilitating disease that requires total bone marrow irradiation and transplant procedures for patients to survive. The major complication of this procedure is graft vs host disease (GVHD), followed by infections and end organ toxicity. Therefore, current research efforts into treatment mainly aim to reduce GVHD while limiting infections and organ toxicity. Different regimens of alkylating agents have been used to try to reduce GVHD. The most common regimen is cyclophosphamide (Cy) with busulfan (Bu), followed by Cy with Bu and thiotepa (Thio). This meta-analysis aimed to evaluate the efficacy of different treatments by comparing mortality and morbidity causes and rates across groups. The mean one-year survival rate for the Cy, Bu, Thio regimen studies in the human leukocyte antigen (HLA) unmatched group (45.01%) was statistically lower than the one-year survival rate for the studies using just a Cy, Bu regimen (70.8%) in the HLA unmatched studies (p<0.00142). The one-year survival in the studies which had HLA-matched donors was 80.56%, which is statistically higher (p<0.001) than the one-year survival in the HLA-unmatched studies (53.96%), indicating a benefit of finding HLA-matched donors. It seems that price and availability could be a factor in the widespread use of Cy.
Collapse
|
9
|
Günay A, Demirpolat E, Ünal A, Aycan MB. A comparison of four drug-drug interaction databases for patients undergoing haematopoietic stem cell transplantation. J Clin Pharm Ther 2022; 47:1711-1719. [PMID: 35777071 DOI: 10.1111/jcpt.13728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Patients who have undergone haematopoietic stem cell transplantation are prone to drug-drug interactions due to polypharmacy. Drug-drug interaction databases are essential tools for identifying interactions in this patient group. However, drug-drug interaction checkers, which help manage interactions, may have disagreements about assessing the existence or severance of the interactions. The study aimed to determine differences among popular drug-drug interaction databases from several angles for patients who underwent haematopoietic stem cell transplantation. METHODS The 21-day treatment sheets of one hundred patients who underwent haematopoietic stem cell transplantation were examined in two subscription-based (Uptodate and Micromedex) and two open-access databases (Drugs.com and Epocrates) in terms of several categories two years in a row. Statistical analysis was utilized to understand the compatibility of databases in terms of severity scores, evidence levels, given references, and word counts in interaction reports. Fleiss' and Cohen's kappa statistics were used to analyse the databases' agreement levels. RESULTS AND DISCUSSION A total of 1393 and 1382 different drug-drug interactions were detected in subsequent versions of the databases, namely the 2021 and 2022 versions. The Fleiss kappa overall agreement among databases was slight. Uptodate and Micromedex showed fair agreement, and other database pairs showed slight agreement in severity ratings. CONCLUSION There was a poor agreement among databases for interactions seen in bone marrow transplantation patients. Therefore, it would be safer to use more than one database in daily practice. Further work needs to be done to understand the agreement level of databases for different types of interactions.
Collapse
Affiliation(s)
- Ayşe Günay
- Faculty of Pharmacy, Clinical Pharmacy Department, Erciyes University, Kayseri, Turkey
| | - Eren Demirpolat
- Faculty of Pharmacy, Clinical Pharmacy Department, Erciyes University, Kayseri, Turkey.,Faculty of Pharmacy, Pharmacology Department, Erciyes University, Kayseri, Turkey
| | - Ali Ünal
- Faculty of Medicine, Hematology Department, Erciyes University, Kayseri, Turkey
| | - Mükerrem Betül Aycan
- Faculty of Pharmacy, Pharmacology Department, Erciyes University, Kayseri, Turkey
| |
Collapse
|
10
|
Ahn H, Lee R, Cho SY, Lee DG. Advances in prophylaxis and treatment of invasive fungal infections: perspectives on hematologic diseases. Blood Res 2022; 57:101-111. [PMID: 35483934 PMCID: PMC9057668 DOI: 10.5045/br.2022.2022036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
Invasive fungal infections (IFIs) are common causes of mortality and morbidity in patients with hematologic diseases. Delayed initiation of antifungal treatment is related to mortality. Aspergillus sp. is the leading cause of IFI followed by Candida sp. Diagnosis is often challenging owing to variable conditions related to underlying diseases. Clinical suspect and prompt management is important. Imaging, biopsy, and non-culture-based tests must be considered together. New diagnostic procedures have been improved, including antigen-based assays and molecular detection of fungal DNA. Among hematologic diseases, patients with acute myeloid leukemia, myelodysplastic syndrome, recipients of hematopoietic stem cell transplantation are at high risk for IFIs. Antifungal prophylaxis is recommended for these high-risk patients. There are continuous attempts to achieve ideal management of IFIs. Scoring system for quality control has been developed with important recommendations of current guidelines. Higher adherence to guidelines is related to decreased mortality in IFIs.
Collapse
Affiliation(s)
- Hyojin Ahn
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
11
|
Moghnieh R, Khalil A, Bizri N, Francis N, Imad S, Mezher M, Mrad Z, Ibrahim J, Zahran K, Farroukh F, Itani M, Assaad A, Sinno L, Abdallah D, Ibrahim A. QTc prolongation during levofloxacin and triazole combination chemoprophylaxis: Prevalence and predisposing risk factors in a cohort of hematopoietic cell transplantation recipients. J Oncol Pharm Pract 2022; 29:534-542. [PMID: 35075933 DOI: 10.1177/10781552221074016] [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: 11/15/2022]
Abstract
BACKGROUND QTc interval prolongation has been reported when combining fluoroquinolones and triazoles for chemoprophylaxis in cancer patients. Herein, we aimed to identify the prevalence and contributing factors to QTc prolongation in hematopoietic cell transplantation (HCT) recipients who received these agents during the neutropenic phase. METHODS This is a retrospective medical chart review conducted at a university hospital in Lebanon from 2017 to 2020. It included all adult HCT inpatients on antimicrobial prophylaxis with fluoroquinolones and triazoles and whose baseline ECG monitoring done prior to chemoprophylaxis administration, then on day-3 and day-6 of therapy, were available. RESULTS Overall, 68 HCT recipients met our inclusion criteria, of which 22% developed QTc prolongation. Based on bivariate analysis, female gender contributed to QTc prolongation (P = 0.001). There was a trend to QTc prolongation in patients with predisposing thyroid disease (P = 0.12), grade 2 vomiting and diarrhea (P = 0.16, P = 0.46, respectively), baseline hypokalemia (P = 0.18) and hypocalcemia (P = 0.3), hypomagnesemia on day-3 (P = 0.21) and day-6 hyponatremia (P = 0.36). Patients receiving two or more drugs with a known or probable risk of QTc prolongation (other than the fluoroquinolone/ triazole combination) were more prone to experience a prolonged QTc interval (P = 0.09). None of the patients that had QTc prolongation died or developed serious arrhythmias. CONCLUSION The prevalence of QTc prolongation was 22% among HCT recipients on fluoroquinolone and triazole prophylaxis, yet we did not identify any independent risk factors for this issue. None of the patients that had QTc interval prolongation died or developed serious arrhythmias.
Collapse
Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Division of Infectious Diseases, Middle East Institute of Health University Hospital, Bsalim, Lebanon.,Department of Internal Medicine, Division of Infectious Diseases, 36696Makassed General Hospital, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Ahmad Khalil
- Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Nazih Bizri
- Faculty of Medicine and Medical Sciences, 54686Universityof Balamand, Koura, Lebanon
| | - Nadine Francis
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Sabine Imad
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Maria Mezher
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Zahraa Mrad
- Department of Internal Medicine, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Jad Ibrahim
- Faculty of Sciences, 11238American University of Beirut, Beirut, Lebanon
| | - Kamal Zahran
- Hematology, Oncology and Bone Marrow Transplantation Unit, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Farah Farroukh
- Hematology, Oncology and Bone Marrow Transplantation Unit, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Malak Itani
- Hematology, Oncology and Bone Marrow Transplantation Unit, Middle East Institute of Health University Hospital, Bsalim, Lebanon
| | - Amani Assaad
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Loubna Sinno
- Department of Medical Research, 36696Makassed General Hospital, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, 36696Makassed General Hospital, Beirut, Lebanon
| | - Ahmad Ibrahim
- Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, Middle East Institute of Health University Hospital, Bsalim, Lebanon.,Department of Internal Medicine, Division of Hematology, Oncology and Bone Marrow Transplantation, 36696Makassed General Hospital, Beirut, Lebanon
| |
Collapse
|
12
|
Wattanakamolkul K, Nakayama Y. Incidence, economic burden, and treatment of acute respiratory tract infection in hematopoietic stem cell transplantation recipients using real world data in Japan: a retrospective claims data analysis. J Med Econ 2022; 25:870-879. [PMID: 35703058 DOI: 10.1080/13696998.2022.2088184] [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] [Indexed: 10/18/2022]
Abstract
AIMS Acute respiratory tract infections (ARTIs) are common in hematopoietic stem cell transplantation (HSCT) recipients, however, data is limited regarding epidemiology and economic burden of ARTI in HSCT recipients in Japan. We evaluated the incidence of ARTI in HSCT recipients, associated economic burden, and ARTI-related treatments post-HSCT. MATERIALS AND METHODS Patients receiving HSCT between July 2017 and December 2018, and those enrolled in the JMDC Claims Database for ≥6 months before index month (month when latest medical procedure code of HSCT recorded) were included. The outcomes included demographics, ARTI incidence, healthcare resource utilization (HCRU), direct costs, and ARTI-related treatments. RESULTS In 330 analyzed patients, the ARTI incidence rate was 85.5% during total follow-up, consisting of post-HSCT hospitalization of mean 2.1 months and post-discharge periods of mean 17.6 months (post-HSCT hospitalization: 44.8%; post-discharge: 77.6%). For ARTI vs non-ARTI patients during post-HSCT hospitalization, length of hospitalization was significantly longer (mean [SD] months; 2.40 [1.73] vs 1.84 [1.09]; p = 0.0004), and median cost was significantly higher (JPY; 6,250,120.00 vs 4,774,570.00; p = 0.0096). The cost of outpatient visits during post-discharge periods, drug-related and non-drug-related costs of outpatient visits were generally higher for ARTI vs non-ARTI patients. In ARTI vs non-ARTI patients, utilization of any symptom relievers (decongestants, antitussives, and antipyretics), bronchodilators, immunoglobulin G, antibiotics, antivirals, and oxygen supply were numerically higher during post-HSCT hospitalization and post-discharge periods. The proportion of patients and mean prescription days for immunosuppressants during post-HSCT hospitalization were higher in ARTI vs non-ARTI patients. LIMITATIONS This administrative claims study lacks clinical data and contains only direct medical costs. Patients were retained if they had at least 1 month of enrollment post-HSCT. CONCLUSIONS In HSCT recipients, ARTI leads to substantial incremental HCRU and direct costs for management in real-world settings in Japan.
Collapse
|
13
|
Lee J, Kim SC, Rhee CK, Lee J, Lee JW, Lee DG. Prevalence and clinical course of upper airway respiratory virus infection in critically ill patients with hematologic malignancies. PLoS One 2021; 16:e0260741. [PMID: 34905565 PMCID: PMC8670702 DOI: 10.1371/journal.pone.0260741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background The clinical significance of upper airway respiratory virus (RV) detection in patients with hematologic malignancies remains unclear. We aimed to investigate the association between upper airway RV detection and prognosis in critically ill patients with hematologic malignancies. Methods This retrospective observational study included 331 critically ill patients with hematologic malignancies who presented respiratory symptoms and their nasopharyngeal swab was tested using a multiplex PCR assay between January 2017 and December 2018. A logistic regression model was used to adjust for potential confounding factors in the association between assay positivity and in-hospital mortality. Results Among the 331 analyzed patients, RVs were detected in 29.0%. The overall mortality rates in the intensive care unit and hospital were 56.8% and 65.9%, respectively. Positive upper airway RV detection was associated with relapsed hematologic malignancies, higher level of C-reactive protein, and prior use of high dose steroids and anti-cancer chemotherapeutic drugs. Furthermore, it was independently associated with in-hospital mortality (adjusted odds ratio, 2.36; 95% confidence interval, 1.23 to 4.54). Among different RVs, parainfluenza virus was more prevalent among patients who died in the hospital than among those who survived (11.5% vs. 3.5%, P = 0.027). Conclusions RV detection in the upper respiratory tract was relatively common in our cohort and was significantly associated with a poor prognosis. Thus, it can be used as a predictor of prognosis. Moreover, RV presence in the upper respiratory tract should be examined in patients who have previously been prescribed with high dose corticosteroids and anti-cancer drugs.
Collapse
Affiliation(s)
- Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Chan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaewoong Lee
- Department of Laboratory Medicine, Catholic Genetic Laboratory Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Wook Lee
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Divison of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
14
|
The Impact of NLRP3 Activation on Hematopoietic Stem Cell Transplantation. Int J Mol Sci 2021; 22:ijms222111845. [PMID: 34769275 PMCID: PMC8584591 DOI: 10.3390/ijms222111845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/12/2023] Open
Abstract
NLR family pyrin domain-containing 3 (NLRP3) is an intracellular protein that after recognizing a broad spectrum of stressors, such as microbial motifs and endogenous danger signals, promotes the activation and release of the pro-inflammatory cytokines IL-1β and IL-18, thus playing an essential role in the innate immune response. Several blood cell types, including macrophages, dendritic cells, and hematopoietic stem and progenitor cells (HSPCs), express NLRP3, where it has been implicated in various physiological and pathological processes. For example, NLRP3 participates in the development and expansion of HSPCs, and their release from bone marrow into the peripheral blood has been implicated in certain hematological disorders including various types of leukemia. In addition, accumulating evidence indicates that activation of NLRP3 plays a pivotal role in the development of transplant complications in patients receiving hematopoietic stem cell transplantation (HSCT) including graft versus host disease, severe infections, and transplant-related mortality. The majority of these complications are triggered by the severe tissue damage derived from the conditioning regimens utilized in HSCT which, in turn, activates NLRP3 and, ultimately, promotes the release of proinflammatory cytokines such as IL-1β and IL-18. Here, we summarize the implications of NLRP3 in HSCT with an emphasis on the involvement of this inflammasome component in transplant complications.
Collapse
|
15
|
Iravani Saadi M, Ramzi M, Hesami Z, kheradmand N, Owjfard M, Nabi Abdolyousefi E, Karimi Z. MiR-181a and -b expression in acute lymphoblastic leukemia and its correlation with acute graft-versus-host disease after hematopoietic stem cell transplantation, COVID-19 and torque teno viruses. Virusdisease 2021; 32:727-736. [PMID: 34722832 PMCID: PMC8543773 DOI: 10.1007/s13337-021-00743-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL), a malignant transformation and proliferation of the lymphoid line of blood cells, is characterized by chromosomal abnormalities and genetic changes. The purpose of this research was the evaluation of expression level of miR-181a and -b in patients with ALL compared to the control group. Furthermore, we examined their expression level in hematopoietic stem-cell transplantation (HSCT) patients who developed acute graft-versus-host disease (aGVHD) in comparison with those without aGVHD and explore the relationship between their expression level and cytogenetic abnormalities. In this cross-sectional study, 76 newly diagnosed adult De novo ALL patients were enrolled who were admitted to our referral hospital. All patients received standard chemotherapy, consisting of daunorubicin. A total of 37 patients underwent HSCT from the related human leukocyte antigen-matched donors. ALL patients have been diagnosed with the coronavirus disease 2019 (COVID-19) and Torque teno viruses (TTVs). We assessed the expression levels of miR-181a and -b in the peripheral blood sample of ALL patients at the time of diagnosis prior to chemotherapy, and healthy matched individuals by RT–PCR. TTVs and COVID-19 load were also determined via RT–PCR. In conclusion, the expression level of miR-181a and -b were significantly higher in ALL patients than healthy controls and also increased in patients who developed aGVHD in comparison with those without aGVHD. MiR-181a and -b can be a useful biomarker in ALL and a useful indicator of aGVHD. The expression level of miR-181a in ALL patients with COVID-19 is significantly up-regulated, while it is reduced in these patients with TTV.
Collapse
Affiliation(s)
- Mahdiyar Iravani Saadi
- Hematology Research Center and Department of Bone Marrow Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Hematology Research Center and Department of Bone Marrow Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Hematology, Medical Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Hesami
- Hematology Research Center and Department of Bone Marrow Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nadiya kheradmand
- Hematology Research Center and Department of Bone Marrow Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Owjfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Nabi Abdolyousefi
- Hematology Research Center and Department of Bone Marrow Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahed Karimi
- Hematology Research Center and Department of Bone Marrow Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Hematology, Medical Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Sun Y, Hu J, Huang H, Chen J, Li J, Ma J, Li J, Liang Y, Wang J, Li Y, Yu K, Hu J, Jin J, Wang C, Wu D, Xiao Y, Huang X. Clinical risk score for predicting invasive fungal disease after allogeneic hematopoietic stem cell transplantation: Analysis of the China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study. Transpl Infect Dis 2021; 23:e13611. [PMID: 33825274 DOI: 10.1111/tid.13611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/03/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Invasive fungal disease (IFD) is associated with a high mortality for patients with hematological malignancies undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). This study aimed not only to develop a proven/probable IFD risk-scoring model but to identify high-risk populations that would benefit from anti-fungal prophylaxis. METHODS Data from the China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study were retrieved, and all patients (n = 1053) undergoing allo-HSCT were randomly divided into the training set (n = 685) for model development and the validation set (n = 368) for model verification. A weighted risk score for proven or probable IFD was established through multivariate logistic regression analysis. RESULTS The study population had a mean age of 28.95 years and the majority underwent myeloablative transplantation in complete remission 1 (53.4%). Five risk factors of IFD were identified, namely neutropenia lasting longer than 14 days, corticosteroid use, diabetes, haploidentical donor, and unrelated donor. Based on the risk score for IFD, the patients were categorized into three groups: low risk (score 0-4, 1.5%-4.0%), intermediate risk (score 5-8, 9.8%), and high risk (score>8, 24.7%-14.0%). Anti-fungal prophylaxis may provide benefits for patients with intermediate (8.5% vs. 18.5%, P = .0085) or high risk (19.4% vs. 30.8%, P = .4651) but not low risk (2.1% vs. 3.8%, P = .6136) of IFD. CONCLUSION A practical weighted risk score for IFD in patients receiving allo-HSCT was established, which can aid decision-making regarding the administration of anti-fungal prophylaxis.
Collapse
Affiliation(s)
- Yuqian Sun
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University, People's Hospital, Beijing, People's Republic of China
| | - Jiong Hu
- Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - He Huang
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Jing Chen
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai, People's Republic of China
| | - Jianyong Li
- Jiangsu Province Hospital, Nanjing, People's Republic of China
| | - Jun Ma
- Harbin Hematologic Tumor Institution, Harbin, People's Republic of China
| | - Juan Li
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yingmin Liang
- Tangdu Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jianmin Wang
- Changhai Hospital of the Second Military Medical University, Shanghai, People's Republic of China
| | - Yan Li
- The First Affiliated Hospital of China Medical University, Shengyang, People's Republic of China
| | - Kang Yu
- The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People's Republic of China
| | - Jianda Hu
- Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
| | - Jie Jin
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China
| | - Chun Wang
- The First People's Hospital of Shanghai, Shanghai, People's Republic of China
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yang Xiao
- The General Hospital of Guangzhou Military Command of PLA, Guangzhou, People's Republic of China
| | - Xiaojun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University, People's Hospital, Beijing, People's Republic of China
| |
Collapse
|
18
|
El Cheikh J, Cheaito R, Abdul-Nabi SS, Cheaito MA, Mufarrij AJ, Tamim H, Makki M, El Majzoub I. Predictors of a short hospitalization in bone marrow transplantation patients presenting to the emergency department. Am J Emerg Med 2021; 45:117-123. [PMID: 33684868 DOI: 10.1016/j.ajem.2021.02.036] [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: 01/18/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite the advantages of bone marrow transplantation (BMT), patients receiving this intervention visit the emergency department (ED) frequently and for various reasons. Many of those ED visits result in hospitalization, and the length of stay varies. OBJECTIVES The objective of our study was to identify the patients who were only briefly hospitalized and were thus eligible for safe discharge from the ED. METHODS This was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and had an ED visit that resulted in hospitalization. RESULTS Our study included 115 unique BMT with a total number of 357 ED visits. Around half of those visits resulted in a short hospitalization. We found higher odds of a short hospitalization among those who have undergone autologous BMT (95%CI [1.14-2.65]). Analysis of the discharge diagnoses showed that patients with gastroenteritis were more likely to have a shorter hospitalization in comparison to those diagnosed with others (95%CI [1.10-3.81]). Furthermore, we showed that patients who presented after a month from their procedure were more likely to have a short hospitalization (95%CI [1.04-4.87]). Another significant predictor of a short of hospitalization was the absence of Graft versus Host Disease (GvHD) (95%CI [2.53-12.28]). Additionally, patients with normal and high systolic blood pressure (95%CI [2.22-6.73] and 95%CI [2.81-13.05]; respectively), normal respiratory rate (95%CI [2.79-10.17]) and temperature (95%CI [2.91-7.44]) were more likely to have a shorter hospitalization, compared to those presenting with abnormal vitals. Likewise, we proved higher odds of a short hospitalization in patients with a quick Sepsis Related Organ Failure Assessment score of 1-2 (95%CI [1.29-5.20]). Moreover, we demonstrated higher odds of a short hospitalization in patients with a normal platelet count (95%CI [1.39-3.36]) and creatinine level (95%CI [1.30-6.18]). CONCLUSION In our study, we have shown that BMT patients visit the ED frequently and many of those visits result in a short hospitalization. Our study showed that patients presenting with fever/chills are less likely to have a short hospitalization. We also showed a significant association between a short hospitalization and BMT patients without GvHD, with normal RR, normal T °C and a normal platelet count.
Collapse
Affiliation(s)
- Jean El Cheikh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Rola Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Sarah S Abdul-Nabi
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Mohamad Ali Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Afif Jean Mufarrij
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Maha Makki
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
19
|
Ochoa-Grullón J, Benavente Cuesta C, González Fernández A, Cordero Torres G, Pérez López C, Peña Cortijo A, Conejero Hall L, Mateo Morales M, Rodríguez de la Peña A, Díez-Rivero CM, Rodríguez de Frías E, Guevara-Hoyer K, Fernández-Arquero M, Sánchez-Ramón S. Trained Immunity-Based Vaccine in B Cell Hematological Malignancies With Recurrent Infections: A New Therapeutic Approach. Front Immunol 2021; 11:611566. [PMID: 33679698 PMCID: PMC7928395 DOI: 10.3389/fimmu.2020.611566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
Infectious complications are a major cause of morbidity and mortality in B-cell hematological malignancies (HM). Prophylaxis for recurrent infections in HM patients with antibody deficiency consists of first-line antibiotics and when unsuccessful, gammaglobulin replacement therapy (IgRT). Recent knowledge of trained immunity-based vaccines (TIbV), such as the sublingual polybacterial formulation MV130, has shown a promising strategy in the management of patients with recurrent infections. We sought to determine the clinical benefit of MV130 in a cohort of HM patients with recurrent respiratory tract infections (RRTIs) who underwent immunization with MV130 for 3 months. Clinical information included the frequency of infections, antibiotic use, number of visits to the GP and hospitalizations previous and after MV130 immunotherapy. Improvement on infection rate was classified as: clear (>60% reduction of infection), partial (26%-60%) and low (≤25%) improvement. Fifteen HM patients (aged 42 to 80 years; nine females) were included in the study. All patients reduced their infection rate. Analysis of paired data revealed that the median (range, min - max) of respiratory infectious rate significantly decreased from 4.0 (8.0-3.0) to 2.0 (4.0-0.0) (p<0.001) at 12 months of MV130. A clear clinical improvement was observed in 53% (n = 8) of patients, partial improvement in 40% (n = 6) and low improvement in 7% (n = 1). These data correlated with a decrease on antibiotic consumption from 3.0 (8.0-1.0) to 1.0 (2.0-0.0) (p = 0.002) during 12 months after initiation of treatment with MV130. The number of infectious-related GP or emergency room visits declined from 4.0 (8.0-2.0) to 2.0 (3.0-0.0) (p<0.001), in parallel with a reduction in hospital admissions due to infections (p = 0.032). Regarding safety, no adverse events were observed. On the other hand, immunological assessment of serum IgA and IgG levels demonstrated an increase in specific antibodies to MV130-contained bacteria following MV130 immunotherapy. In conclusion, MV130 may add clinical benefit reducing the rate of infections and enhancing humoral immune responses in these vulnerable patients.
Collapse
Affiliation(s)
- Juliana Ochoa-Grullón
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | | | | | - Gustavo Cordero Torres
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | | | | | | | | | | | | | - Edgard Rodríguez de Frías
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Kissy Guevara-Hoyer
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Miguel Fernández-Arquero
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| |
Collapse
|
20
|
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| |
Collapse
|
21
|
Costa ALF, Santos BA, Torregrossa VR, Miranda ECM, Vigorito AC, Palmieri M, Ricardo ALF, Sarmento DJS, Mamana AC, Tozetto-Mendoza TR, Correa MEP, Braz-Silva PH. Oral shedding of CMV and HSV-1 in hematopoietic stem cell transplantation patients. Oral Dis 2020; 27:1572-1579. [PMID: 33085827 DOI: 10.1111/odi.13690] [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: 05/29/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the oral shedding of herpesviruses in patients undergoing hematopoietic stem cell transplantation (HSCT) and correlate it with oral mucositis (OM). METHODS Saliva samples were collected before the HSCT and on day D + 8. Multiplex Polymerse Chain Reaction (PCR) was performed to detect herpes simplex virus (HSV)-1 and HSV-2, Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Variella-zoster virus (VZV), and human herpesvirus (HHV)-6, HHV-7, and HHV-8. OM was assessed according to WHO criteria. RESULTS Thirty one patients were enrolled, in which 20 of 31 (64.5%) were males; median age was 50 (21-70) years; 16 of 31 (51.6%) underwent allo-HSCT; and 15 of 31 (48.4%) underwent auto-HSCT. On D + 8, OM grades III and IV were observed in 8 of 31 (25.8%) patients. In the first salivary collection, EBV was found in 24 of 31 (77.4%), followed by HHV-6 (7/31, 22.6%) and HHV-7 (8/31 25.8%). In the second collection, EBV was found in 24 of 27(89%), followed by HSV-1 (8/27, 30%) and CMV, HHV-6, and HHV-7 (5/27, 18.5%, each one). On D + 8, OM grades II and IV were associated with the presence of HSV-1. HSV-1 was also associated with worsening degrees of OM on D + 15. CONCLUSION The presence of HSV-1 and CMV in oral samples was more frequent on day D + 8 after HSCT. HSV-1 detection was associated with severity and worsening of OM. HSV-1 and CMV seem to be associated with oral dysbiosis due to HSCT.
Collapse
Affiliation(s)
- Andre L F Costa
- Postgraduate Program in Dentistry, Cruzeiro Do Sul University (UNICSUL), São Paulo, Brazil
| | - Bruna A Santos
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Eliana C M Miranda
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Afonso C Vigorito
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Michelle Palmieri
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil
| | - Ana L F Ricardo
- Postgraduate Program in Dentistry, Cruzeiro Do Sul University (UNICSUL), São Paulo, Brazil
| | - Dmitry J S Sarmento
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.,Department of Stomatology, School of Dentistry, State University of Paraíba, Araruna, Brazil
| | - Ana C Mamana
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Tania R Tozetto-Mendoza
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - M Elvira P Correa
- Hematology and Hemotherapy Center, University of Campinas (UNICAMP), Campinas, Brazil
| | - Paulo H Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo (USP), São Paulo, Brazil.,Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo (USP), São Paulo, Brazil
| |
Collapse
|
22
|
Zidan M, Nafea DA, Okasha HAS, Abouelnour AF, Eshmawey HA. Evaluation of pulmonary complications in patients undergoing allogenic stem cell transplantation. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [PMCID: PMC7527666 DOI: 10.1186/s43168-020-00032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Mature blood cells can be differentiated from hematopoietic stem cells; thus, the latter can play a crucial role in maintaining defense against different microorganisms. Thus, hematopoietic stem cell transplantation is one of the most important lines of immunotherapy. Major systemic complications may occur post transplantation and could be fatal. Pulmonary complications include infectious and non-infectious complications. The aim of this study was to detect the pulmonary complications in allogeneic stem cell transplantation patients. Results We studied 20 patients after transplantation of allogeneic stem cells with regular follow-up in outpatient clinic of hematology department of Alexandria Main University Hospital. All the studied patients were subjected to history taking, plain x-ray chest PA view, CT chest, complete blood count, serum creatinine, liver enzymes, and serum cytomegalovirus (CMV) detection by antibodies IgG and IgM. Regarding sputum sampling, 7 patients’ samples (35%) were obtained either spontaneously or by induction via hypertonic saline 3%. One patient (5%) had miniBAL done, while bronchoalveolar lavage using fiber optic bronchoscopy was done for 2 patients (10%). Samples could not be obtained from the remaining patients. Samples were analyzed for culture for bacteria, Pneumocystis jiroveci using immunofluorescence test, CMV PCR, fungal culture, and smear for acid fast bacilli (AFB). Among the examined patients, 2 patients (20%) had pulmonary bacterial infection including streptococcus and multidrug-resistant strain of Klebsiella, 3 patients (30%) had pulmonary candida infection, and one patient (10%) had positive result of pulmonary CMV of low count which was considered insignificant. None of our patients had positive results for pulmonary tuberculosis nor Pneumocystis jiroveci. Six patients (30%) had CMV in serum; 3 patients (15.8%) had manifested CMV reactivation. One patient (5%) of our patients had pulmonary graft versus host disease GVHD. One patient (5%) had died during our study course within 12 days post-transplantation due to ARDS followed by multiple organ failure. Conclusion The prevalence of pulmonary infectious complications after allogenic stem cell transplantation was 50% of all studied patients, while 5% of the studied patients presented with non-infectious pulmonary complications.
Collapse
|
23
|
Gabutti G, De Motoli F, Sandri F, Toffoletto MV, Stefanati A. Viral Respiratory Infections in Hematological Patients. Infect Dis Ther 2020; 9:495-510. [PMID: 32638228 PMCID: PMC7339094 DOI: 10.1007/s40121-020-00313-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Viral infections of the respiratory system represent one of the most important complications in hematological patients in terms of both the severity of the clinical picture and its related impact on the duration of hospitalization, and of mortality. The most implicated viruses are those that commonly cause community-based respiratory diseases: respiratory syncytial virus, Influenza virus and rhinovirus. However, in some cases the clinical picture may be triggered by first infection with or reactivation of pathogens normally not responsible for clinically relevant diseases in immunocompetent subjects. This issue is currently being taken into greater consideration within the scientific community. However, the strong heterogeneity in the epidemiology and clinical expression of these infections and the lack of adequate therapeutic options imply that there is currently no uniform consensus on the best management of these patients. The main purpose of this review is to highlight which viruses are currently most implicated in the onset of these infections, what is their incidence in so heterogeneous and fragile patients and the factors that lead to disease's onset and evolution. Possible or available clinical management options, diagnostic and therapeutic tools, and preventive and prophylaxis measures are also discussed.
Collapse
Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Francesco De Motoli
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Post-Graduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | | | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| |
Collapse
|
24
|
Bhaskar S, Sinha A, Banach M, Mittoo S, Weissert R, Kass JS, Rajagopal S, Pai AR, Kutty S. Cytokine Storm in COVID-19-Immunopathological Mechanisms, Clinical Considerations, and Therapeutic Approaches: The REPROGRAM Consortium Position Paper. Front Immunol 2020; 11:1648. [PMID: 32754159 PMCID: PMC7365905 DOI: 10.3389/fimmu.2020.01648] [Citation(s) in RCA: 311] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022] Open
Abstract
Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint.
Collapse
Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Department of Neurology & Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia
- Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Akansha Sinha
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Góra, Zielona Gora, Poland
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Shikha Mittoo
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Department of Rheumatology, University Health Network and The University of Toronto, Toronto, ON, Canada
| | - Robert Weissert
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Joseph S. Kass
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Department of Neurology, Ben Taub General Hospital and Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, Houston, TX, United States
| | - Santhosh Rajagopal
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- World Health Organisation, Country Office for India, NPSP, Madurai, India
| | - Anupama R. Pai
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shelby Kutty
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Immunity Sub-committee
- Department of Pediatric and Congenital Cardiology, Blalock-Taussig-Thomas Heart Center, John Hopkins Hospital, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, School of Medicine, John Hopkins University, Baltimore, MD, United States
| |
Collapse
|
25
|
Cho SY, Park SS, Lee JY, Kim HJ, Kim YJ, Min CK, Cho B, Lee DG, Kim DW. Successful prevention and screening strategies for COVID-19: focus on patients with haematologic diseases. Br J Haematol 2020; 190:e33-e37. [PMID: 32420621 PMCID: PMC7276883 DOI: 10.1111/bjh.16818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sung-Yeon Cho
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Infection Control Office, Seoul St. Mary's Hospital, Seoul, South Korea.,Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Soo Park
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Young Lee
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Hee-Je Kim
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoo-Jin Kim
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang-Ki Min
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Bin Cho
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Gun Lee
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Infection Control Office, Seoul St. Mary's Hospital, Seoul, South Korea.,Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Wook Kim
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, South Korea.,Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
26
|
Lee Y, Hong J, Kim I, Choi Y, Park H. Prospective evaluation of clinical symptoms of chemotherapy-induced oral mucositis in adult patients with acute leukemia: A preliminary study. Clin Exp Dent Res 2020; 6:90-99. [PMID: 32067405 PMCID: PMC7025998 DOI: 10.1002/cre2.253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/04/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to prospectively evaluate the clinical features of chemotherapy-induced oral mucositis (CIOM) in adult patients with acute leukemia and the aggravating factors for such symptoms. SUBJECTS Thirty-seven prospective patients aged ≥19 years with acute leukemia undergoing chemotherapy were enrolled. Oral and clinical investigations were performed at baseline and on Day 14 after starting chemotherapy. The presence and severity of cancer-induced oral mucositis were demonstrated using the World Health Organization (WHO) scoring system. RESULTS On Day 14, we found that oral mucositis had developed in eight patients (21.6%). Hematopoietic stem cell transplantation (HSCT) in patients was a predictor of increased WHO scores (β = 1.937, p < .001). Regarding oral sites, ventral tongue (β = 1.670), soft palate (β = 1.242), and buccal mucosa (β = 0.593) were predictors for increased scores. In addition, the increase in WHO scores was positively correlated with the number of oral lesions (r = .521), the difficulty in eating (r = .250), and the overall oral health (r = .534; all p < .05). CONCLUSION The main factors affecting the severity of CIOM symptoms were the treatment with HSCT and the location of oral lesions. The incidence of CIOM and WHO scores were not significantly different between the subgroups of disease. Our findings will help clinicians investigate the oral findings after chemotherapy in adult patients with acute leukemia.
Collapse
Affiliation(s)
- Yeon‐Hee Lee
- Department of Orofacial Pain and Oral MedicineKyung Hee University Dental HospitalSeoulKorea
| | - Junshik Hong
- Department of Internal MedicineSeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
- Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Inho Kim
- Department of Internal MedicineSeoul National University Hospital, Seoul National University College of MedicineSeoulKorea
- Cancer Research InstituteSeoul National UniversitySeoulKorea
| | - Youngnim Choi
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research InstituteSeoul National UniversitySeoulKorea
| | - Hee‐Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research InstituteSeoul National University Dental Hospital, Seoul National University School of DentistrySeoulKorea
| |
Collapse
|
27
|
Marinelli T, Wee LYA, Rowe E, Chhetri R, Friel O, Higgins G, Bardy P, Singhal D, Pradhan A, Crawford L, Hiwase DK. Respiratory Viruses Cause Late Morbidity in Recipients of Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 26:782-788. [PMID: 31866345 DOI: 10.1016/j.bbmt.2019.12.724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
Common respiratory viral infections (CRVIs) frequently complicate hematopoietic stem cell transplantation (HSCT). We conducted a retrospective, single-center, observational cohort study to determine the incidence of CRVI in patients who received an allogeneic (allo) or autologous (auto) HSCT at the Royal Adelaide Hospital between 2009 and 2017. The median follow-up was 8.9 and 4.5 years for auto- and allo-HSCT recipients, respectively. There were 149 CRVI episodes in 74 patients, with rhinovirus being the most commonly isolated virus (n = 81, 47%). The majority of CRVIs (113/149, 75.8%) occurred more than 100 days post-HSCT and 67% were diagnosed in the outpatient setting. There was evidence of lower respiratory tract infection (LRTI) in 45.6% (68/149) of CRVIs. On multivariate logistic regression analysis, coviral infections and cytomegalovirus viremia were independent risk factors for progression of CRVI to LRTI. Ten (6.7%) CRVI episodes resulted in admission to intensive care for ventilatory support and 8 (5.4%) patients died within 30 days of CRVI diagnosis. In our study, 10.4% of HSCT recipients experienced a CRVI post-transplant, primarily causing late morbidity and potentially mortality. Prevention with strict infection control practices, vaccination, and patient education is essential.
Collapse
Affiliation(s)
- Tina Marinelli
- Department of Infectious Diseases, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Li Yan A Wee
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Emily Rowe
- Department of Infectious Diseases, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Rakchha Chhetri
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Oisin Friel
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Geoffrey Higgins
- Department of Infectious Diseases, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; SA Pathology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Peter Bardy
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Deepak Singhal
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Alyssa Pradhan
- Department of Infectious Diseases, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Lucy Crawford
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia; SA Pathology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Devendra K Hiwase
- Department of Haematology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia; Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia; Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| |
Collapse
|
28
|
Lee HJ, Cho SY, Lee DG, Park C, Chun HS, Park YJ. Characteristics and risk factors for mortality of invasive non-Aspergillus mould infections in patients with haematologic diseases: A single-centre 7-year cohort study. Mycoses 2019; 63:257-264. [PMID: 31762083 PMCID: PMC7065074 DOI: 10.1111/myc.13038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
Since mould-active azole prophylaxis has become a standard approach for patients with high-risk haematologic diseases, the epidemiology of invasive fungal infections (IFIs) has shifted towards non-Aspergillus moulds. It was aimed to identify the epidemiology and characteristics of non-Aspergillus invasive mould infections (NAIMIs). Proven/probable NAIMIs developed in patients with haematologic diseases were reviewed from January 2011 to August 2018 at Catholic Hematology hospital, Seoul, Korea. There were 689 patients with proven/probable invasive mould infections; of them, 46 (47 isolates) were diagnosed with NAIMIs. Fungi of the Mucorales order (n = 27, 57.4%) were the most common causative fungi, followed by Fusarium (n = 9, 19.1%). Thirty-four patients (73.9%) had neutropenia upon diagnosis of NAIMIs, and 13 (28.3%) were allogeneic stem cell transplantation recipients. The most common site of NAIMIs was the lung (n = 27, 58.7%), followed by disseminated infections (n = 8, 17.4%). There were 23.9% (n = 11) breakthrough IFIs, and 73.9% (n = 34) had co-existing bacterial or viral infections. The overall mortality at 6 and 12 weeks was 30.4% and 39.1%, respectively. Breakthrough IFIs (adjusted hazards ratio [aHR] = 1.99, 95% CI: 1.3-4.41, P = .031) and surgical treatment (aHR = 0.09, 95% CI: 0.02-0.45, P = .003) were independently associated with 6-week overall mortality. NAIMIs were not rare and occur as a complex form of infection often accompanied by breakthrough/mixed/concurrent IFIs and bacterial or viral infections. More active diagnostic efforts for NAIMIs are needed.
Collapse
Affiliation(s)
- Hyeon-Jeong Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,College of Medicine, Catholic Hematology Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,College of Medicine, Catholic Hematology Hospital, The Catholic University of Korea, Seoul, Korea.,College of Medicine, Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,College of Medicine, Catholic Hematology Hospital, The Catholic University of Korea, Seoul, Korea.,College of Medicine, Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Chulmin Park
- College of Medicine, Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Hye-Sun Chun
- College of Medicine, Vaccine Bio Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
29
|
Riau AK, Ong HS, Yam GHF, Mehta JS. Sustained Delivery System for Stem Cell-Derived Exosomes. Front Pharmacol 2019; 10:1368. [PMID: 31798457 PMCID: PMC6868085 DOI: 10.3389/fphar.2019.01368] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022] Open
Abstract
Recent literature has ascribed that the paracrine action of stem cells is mediated by exosomes. Exosomes are nano-sized extracellular vesicles (30 to 100 nm) of endocytic origin that play important roles in intercellular communication. They have the ability to deliver various therapeutic effects, e.g., skin regeneration or cardiac function recovery, when applied topically or injected systemically. However, injection of exosomes has been shown to result in rapid clearance from blood circulation and accumulation of the exosomes in the liver, spleen, lung, and gastrointestinal tract can be found as early as 2 h after injection. Topical administration of exosomes on the skin or ocular surface would suffer the same fate due to rapid fluid turnover (sweat or tears). Biodegradable or highly porous hydrogels have been utilized to load exosomes and to deliver a sustained therapeutic effect. They can also prevent the exosomes from being cleared prematurely and allow the delivery of a more localized and concentrated exosome dosage by placing the hydrogel directly at or in the proximity of the target site. In this mini-review, we elaborate on the challenges of conventional exosome administration and highlight the solution to the shortcomings in the form of exosome-incorporated hydrogels. Different techniques to encapsulate exosomes and examples of hydrogels that have been used to create sustained delivery systems of exosomes are also discussed.
Collapse
Affiliation(s)
- Andri K Riau
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Hon Shing Ong
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Corneal and External Eye Disease Department, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Gary H F Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,Corneal and External Eye Disease Department, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
30
|
Park SS, Cho SY, Han E, Min GJ, Park S, Yoon JH, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Kim HJ, Min CK, Cho SG, Lee JW. Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia. Eur J Haematol 2019; 103:433-441. [PMID: 31381187 DOI: 10.1111/ejh.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to identify the natural course of cytomegalovirus (CMV)/Epstein-Barr virus (EBV) after rabbit antithymocyte globulin and cyclosporine (rATG-CsA) for aplastic anemia (AA). METHODS In 113 prospectively observed AA patients treated with rATG-CsA, the CMV/EBV cohort was classified into two groups by baseline viremic status: no viremia (CMV-G1, n = 112; EBV-G1, n = 98) and the presence of viremia (CMV-G2, n = 1; EBV-G2, n = 13). RESULTS In CMV-G1, the mean CMV load increased up to 3 months but was completely resolved from 6 months. The mean EBV load of EBV-G1 showed a peak at 1 month and then gradually decreased over time but remained detectable throughout the observation period. EBV-G2 showed fluctuating EBV dynamics. With reactivation rates of 38.4% in CMV-G1 and 62.2% in EBV-G1, a longer time to rATG-CsA from diagnosis and a lower absolute lymphocyte count at 1 month from rATG-CsA were significantly associated with CMV and EBV reactivation, respectively. The mean peak CMV and EBV loads of patients with CMV-related (3.5%) and EBV-related (0.9%) diseases were evidently higher than those of the remaining patients without CMV and EBV diseases in the respective cohort. CONCLUSION Considering frequent reactivation and distinct courses of CMV/EBV, virologic surveillance is recommended after rATG-CsA for AA.
Collapse
Affiliation(s)
- Sung-Soo Park
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Yeon Cho
- Division of Infectious Disease, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eunhee Han
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gi June Min
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Silvia Park
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Ho Yoon
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Eun Lee
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Sik Cho
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Seong Eom
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo-Jin Kim
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Lee
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee-Je Kim
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok-Goo Cho
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Wook Lee
- Division of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
31
|
Cho SY, Lee DG, Kim HJ. Cytomegalovirus Infections after Hematopoietic Stem Cell Transplantation: Current Status and Future Immunotherapy. Int J Mol Sci 2019; 20:ijms20112666. [PMID: 31151230 PMCID: PMC6600658 DOI: 10.3390/ijms20112666] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/19/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
Cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) is one of the critical infectious complications related to host immune recovery. The spectrum of CMV infection is quite extensive, from asymptomatic CMV reactivation presenting mainly as CMV DNAemia to fatal CMV diseases involving gut, liver, lungs, or brain. In addition to organ involvement, CMV reactivation can exert indirect effects such as immunosuppression or graft failure that may result in the development of concurrent infectious complications. Currently, preemptive therapy, which is based on PCR-based monitoring of CMV from blood, is a mainstay enabling improvement in CMV-related outcomes. During the past decades, new antiviral drugs, clinical trials for prophylaxis in high-risk groups, and vaccines for preventing CMV infection have been introduced. In addition, data for immunologic monitoring and adoptive immunotherapy have also been accumulated. Here, we review the current status and recent updates in this field, with future perspectives including immunotherapy in HSCT recipients.
Collapse
Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| | - Hee-Je Kim
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
| |
Collapse
|
32
|
Wu P, Liang W, Chen X, Chen L, Yang X, Yan Z, Wang W. Pretransplant C-reactive protein as a prognostic marker in allogeneic stem cell transplantation: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e14474. [PMID: 30813150 PMCID: PMC6408063 DOI: 10.1097/md.0000000000014474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Numerous reports have explored the prognostic value of pretransplant serum C-reactive protein (CRP) in patients receiving allogeneic stem cell transplant (ASCT), but the results remain conflicting. Therefore, we performed a meta-analysis to comprehensively assess the prognostic value of pretransplant serum CRP in patients receiving ASCT. METHODS We systematically searched eligible studies in PubMed, Embase, and Web of Science from 1999 to September 2018. The pooled hazard ratios (HRs) and their corresponding 95% CIs were used to synthetically assess the prognostic value of pre-ASCT CRP in terms of overall survival (OS), non-relapse mortality (NRM), and acute graft versus host disease (aGVHD). RESULTS A total of 14 articles with 15 studies containing 3458 patients were included in this meta-analysis. The pooled results showed that high pre-ASCT CRP level was significantly related to worse OS (HR = 1.63; 95% CI: 1.34-1.98; P < .05), to an increased risk of NRM (HR = 2.06; 95% CI: 1.62-2.62; P < .05), and aGVHD (HR = 1.35; 95% CI: 1.07-1.71; P < .05). Additionally, sensitivity and subgroup analyses demonstrated that our pooled results were stable and reliable. CONCLUSIONS High pre-ASCT serum CRP was significantly associated with worse OS, as well as higher risk of NRM and aGVHD. CRP may be a candidate factor of updating the existing risk scoring systems or establishing a novel risk scoring systems, which has the potential of guiding patient selection for ASCT and proceeding with risk-adapted therapeutic strategies. However, more high-quality clinical studies and basic research are required to further validate our findings in view of several limitations in our meta-analysis.
Collapse
Affiliation(s)
| | - Wei Liang
- Emergency Department, Southeast Hospital Affiliated to Xiamen University (the 175th Hospital of PLA), Zhangzhou, Fujian, China
| | | | | | | | | | | |
Collapse
|
33
|
Espinoza JL, Wadasaki Y, Takami A. Infection Complications in Hematopoietic Stem Cells Transplant Recipients: Do Genetics Really Matter? Front Microbiol 2018; 9:2317. [PMID: 30356925 PMCID: PMC6190889 DOI: 10.3389/fmicb.2018.02317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a highly advanced technique that offers a potential cure for an increasing number of life-threatening diseases. Enormous progress achieved in the last decade, including the refinement of donor selection and advancements in patient supportive care, had significantly improved transplant outcomes; however, invasive infections, graft-vs.-host disease (GVHD) and other serious complications still represent a major source of morbidity and mortality in HSCT recipients. The damage of anatomical barriers due to pre-transplant conditioning, a severely damaged immune function and a profound disruption in the composition of gut microbial commensals (gut microbiota) are alterations inherent to the transplant procedure that are directly implicated in the development of invasive infections and other HSCT complications. Although HLA-matching represents the most important genetic predictor of transplant outcomes, genetic variants in non-HLA genes, especially single nucleotide polymorphisms (SNPs) of genes encoding proteins associated with the immune response to tissue injury and pathogen infection have also been proposed as additional risk factors implicated in the occurrence of HSCT complications. Furthermore, although the microbiota composition is affected by several factors, recent evidence suggests that certain host genetic variants are associated with an altered composition of the gut microbiome and may, therefore, predispose some individuals to invasive infectious complications. This article summarizes the current understanding of the influence that genetic variants in non-HLA genes have on the development of infectious complications in HSCT recipients.
Collapse
Affiliation(s)
- J. Luis Espinoza
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yohei Wadasaki
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Akiyoshi Takami
- Division of Hematology, Department of Internal Medicine, School of Medicine, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
34
|
Afreen S, Weiss JM, Strahm B, Erlacher M. Concise Review: Cheating Death for a Better Transplant. Stem Cells 2018; 36:1646-1654. [DOI: 10.1002/stem.2901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/05/2018] [Accepted: 07/15/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Sehar Afreen
- Faculty of Medicine, Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg; University of Freiburg; Freiburg Germany
- Faculty of Biology; University of Freiburg; Freiburg Germany
| | - Julia Miriam Weiss
- Faculty of Medicine, Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg; University of Freiburg; Freiburg Germany
| | - Brigitte Strahm
- Faculty of Medicine, Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg; University of Freiburg; Freiburg Germany
| | - Miriam Erlacher
- Faculty of Medicine, Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg; University of Freiburg; Freiburg Germany
- German Cancer Consortium (DKTK); Freiburg Germany
- German Cancer Research Center (DKFZ); Heidelberg Germany
| |
Collapse
|
35
|
Kim SH, Park SH, Choi SM, Lee DG. Implementation of Hospital Policy for Healthcare Workers and Patients Exposed to Varicella-Zoster Virus. J Korean Med Sci 2018; 33:e252. [PMID: 30181734 PMCID: PMC6115693 DOI: 10.3346/jkms.2018.33.e252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/12/2018] [Indexed: 01/04/2023] Open
Abstract
Varicella-zoster virus (VZV) causes a highly contagious and generally benign, self-limited disease. However, in high-risk populations including immunocompromised patients, pregnant women, and neonates, VZV infection can be associated with significant morbidity and mortality. Healthcare-associated transmission of VZV occurs among healthcare workers (HCWs) and patients by airborne transmission or by direct contact with the index case. To minimize the risk of transmission in healthcare settings, all VZV-susceptible HCWs should be encouraged strongly to be immunized with the varicella vaccine. For post-exposure management, active immunization (varicella vaccine), passive immunization (varicella-zoster immune globulin) and/or antiviral agents, and isolation could be used in specific situations. To prevent the transmission of VZV infection in the hospital settings, the development and implementation of hospital policies for appropriate infection control is also warranted. This article reviews the general information and healthcare-associated transmission of VZV and summarizes the recommendations for the pre- and post-exposure management of HCWs and patients, in hospital settings.
Collapse
Affiliation(s)
- Si-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|