Investigating racial disparities in quality-of-life years after pediatric hematopoietic stem cell transplant

BACKGROUND

While racial disparities in the clinical outcomes of hematopoietic stem cell transplant (HSCT) patients have been explored, racial disparities in quality of life (QoL) during the re-adjustment phase after transplant are yet to be investigated in pediatric patients. The objective of this study was to examine the role of patient race in QoL at least 2 years after pediatric HSCT.

PROCEDURE

We conducted a retrospective chart review of patients under 21 years of age at diagnosis who received an allogeneic transplant at our institution between January 2007 and December 2017. Patient QoL was assessed using the Pediatric Quality-of-Life Inventory Generic Score Scales (PedsQL TM 4.0) at least 2 years post transplant. Patient demographic, treatment, and transplant outcome data were obtained for subsequent analysis, where patient race was categorized as either Black, White, Hispanic, or Native American.

RESULTS

Data were collected on 86 pediatric patients who underwent HSCT. Forty patients (46.5%) were non-Hispanic White, 29 (33.7%) Hispanic, 10 (11.6%) Black, and seven (8.1%) Native American. Where preliminary analyses indicated a difference in QoL by patient race, there were no significant differences in physical, emotional, social, and school functioning by patient race after adjusting for transplant characteristics (age at transplant, sex, diagnosis, donor type, and conditioning regimen) and determinants of socioeconomic status (insurance type, estimated household income).

CONCLUSIONS

Pediatric patients had comparable QoL, regardless of race, at a median of 3 years after HSCT in our study cohort.

Adolescent male fertility following reduced-intensity conditioning regimen for hematopoietic stem cell transplantation in non-malignant disorders

INTRODUCTION

The effects of RIC for HSCT on male fertility remain unknown. We investigated spermatogenesis and gonadal hormonal status among adolescent male patients who received RIC HSCT for non-malignant diseases.

PATIENTS AND METHODS

Patients with non-malignant disease who had undergone a RIC HSCT were recruited and evaluated for spermatogenesis via semen analysis and gonadal hormonal function via serum hormone levels. Those who had received prior chemotherapy or radiation were excluded from the study. We reviewed the charts to record demographic factors, conditioning regimen and complications during and after transplant.

RESULTS

Five patients were enrolled. The median age at the time of transplant was 15 years (range, 11-19 years), and the median time between bone marrow transplant and semen analysis was 5 years (range, 3-11 years). Median age of patients was 20 years (range, 18-25 years) at the time of the study. Serum FSH and LH levels were elevated in four patients, and inhibin B levels were low for age in three patients. Semen analysis showed two patients had azoospermia, and the remaining three patients showed severe oligozoospermia. Normal morphology and motility were seen in only one patient.

CONCLUSION

This case series suggests that RIC transplants may be associated with impaired spermatogenesis and sequential follow-up is necessary given the potential for either permanent impairment or delayed recovery. Further larger studies are needed to confirm these findings.

Diversity in species composition and fungicide resistance profiles in Colletotrichum isolates from apples

Outbreaks of bitter rot were observed in three commercial apple orchards in Illinois despite best management efforts during the 2018 production season. Three isolates from symptomatic fruit from these orchards and two isolates from an orchard in South Carolina were identified to the species level using morphological tools and calmodulin, glyceraldehyde-3-phosphate dehydrogenase, and beta-tubulin gene sequences. The isolates from Illinois were identified as Colletotrichum siamense of the Colletotrichum gloeosporioides species complex and the ones from South Carolina as Colletotrichum fioriniae and Colletotrichum fructicola of the Colletotrichum acutatum and the C. gloeosporioides species complex, respectively. Two of the three C. siamense isolates from Illinois were resistant to azoxystrobin and thiophanate-methyl as determined in mycelial growth tests in vitro. EC₅₀ values were >100 μg/ml for both fungicides. One isolate was only resistant to azoxystrobin. None of the isolates from South Carolina was resistant to either of the two compounds. All five isolates were sensitive to fludioxonil (EC₅₀ values <0.1 μg/ml), propiconazole (EC₅₀ values ranged from 0.15 to 0.36 μg/ml), and benzovindiflupyr (EC₅₀ values ranged from <0.1 to 0.33 μg/ml). Resistance in C. siamense to azoxystrobin and thiophanate-methyl was confirmed in detached fruit studies using apples treated with label rates of registered product. Resistance to thiophanate-methyl in C. siamense was based on E198A mutation in b-tubulin gene, whereas resistance to azoxystrobin was based on G143A in cytochrome b (CYTB). One isolate resistant to azoxystrobin possessed no amino acid variation in CYTB. This study shows that quinone outside inhibitor fungicide resistance in Colletotrichum from apple has emerged and is being selected for in Illinois apple orchards by current spray strategies. Resistance monitoring may alert growers to potential threats, but the employment of molecular tools based on current knowledge of resistance mechanisms will provide incomplete results.

Vitamin D deficiency and outcomes in pediatric hematopoietic stem cell transplantation

BACKGROUND

Pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) are frequently diagnosed with vitamin D deficiency, which may impact outcomes.

OBJECTIVES

To estimate the prevalence of vitamin D deficiency and examine its association with short-term survival in pediatric HSCT patients.

METHODS

Patients undergoing HSCT at Phoenix Children's Hospital were retrospectively identified. Routine serum 25-hydroxyvitamin D measurements were described prior to transplant and at 100 days and 1-year post-HSCT. Associations of pre-HSCT vitamin D groups (i.e., normal ≥30 ng/ml, insufficient 20-29 ng/ml, and deficient <30 ng/ml) with demographics, clinical factors, and outcomes were examined using nonparametric tests and Cox proportional hazards analyses.

RESULTS

Among 72 study subjects, the median vitamin D pre-HSCT was 26 ng/ml (range: 19-34 ng/ml). Levels were insufficient and deficient in 25 (35%) and 20 (28%) patients, respectively, with only two (3%) patients on supplemental therapy pre-HSCT. Despite supplemental therapy provided to 46 (74%) subjects, insufficient/deficient rates did not significantly change between pre-HSCT and 100 days post-HSCT, but mean vitamin D levels significantly increased by 1-year post-HSCT (P = 0.01).Vitamin D pre-HSCT was not associated with the development of acute or chronic graft-versus-host disease (GVHD) or delayed engraftment. Overall 1-year survival was significantly lower for patients with deficient (65%) compared to normal (93%) pre-HSCT vitamin D (P = 0.001).

CONCLUSION

Suboptimal vitamin D levels are common in pediatric patients scheduled to receive HSCT and are associated with lower overall 1-year survival. Further study is warranted to delineate the mechanisms underlying the role of vitamin D in successful HSCT.

Disseminated granuloma annulare--treatment with fumaric acid esters

BACKGROUND

The therapy of disseminated granuloma annulare has often limited success. Treatment of granuloma annulare with fumaric acid esters (FAE) has recently been reported to be effective in 2 patients.

OBJECTIVES

To assess the efficacy of a systemic therapy with FAE in consecutive patients with disseminated granuloma annulare.

METHODS

Eight patients with disseminated granuloma annulare were treated with FAE in tablet form according to the standard therapy regimen used in psoriasis. The colour and the elevation of the skin lesions were assessed by a visual analogue scale before and after therapy.

RESULTS

Systemic therapy with FAE induced a significant clinical improvement in elevation and colour of skin lesions, with remission in 3 and partial remission in 4 patients. One patient remained unchanged. Side-effects associated with the therapy were seen in 6 patients.

CONCLUSIONS

Systemic therapy with FAE can be effective in patients suffering from disseminated forms of granuloma annulare, but side-effects of FAE have to be taken into consideration.

MIA as a reliable tumor marker in the serum of patients with malignant melanoma

BACKGROUND

Reports published in 1996 concerning the protein MIA proposed it as a useful tumor marker for patients suffering from malignant melanoma. Therefore we systematically started to measure MIA levels in patients with malignant melanoma. It was and still is questionable whether MIA in the serum of melanoma patients is a reliable tumor marker in terms of course of disease, therapy-monitoring and prognostic value. Previous studies have already confirmed the specifity of MIA as a tumor marker for malignant melanoma.

MATERIALS AND METHODS

Using an ELISA- System, we examined over 830 blood samples of 326 melanoma patients. The cut-off was determined at 9.8 ng/ml.

RESULTS

5.6% (n = 17) of melanoma patients at stage I/II (n = 302) showed increased MIA levels, whereas at stage III/IV (n = 5/n = 19) high levels were found in 60.0% and 89.5% respectively. Patients at stage III/IV with MIA levels below the cut-off turned out to be the ones after metastatic surgery, irradiation or chemotherapy. None of these patients developed further metastases during follow-up, just as patients at stage I/II without increased MIA levels. After a distinct rise of MIA levels, metastases could be detected at the same time or shortly after. On the other hand we saw decreasing levels after or during therapy.

CONCLUSION

Our data showed that MIA is a suitable serum marker to detect metastases and to monitor course and therapy of disease. The prognostic value (increased MIA levels at stage I/II), however, requires further investigation.