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Michallet M, Sobh M, Morisset S, Deloire A, Raffoux E, de Botton S, Caillot D, Chantepie S, Girault S, Berthon C, Bertoli S, Lepretre S, Leguay T, Castaigne S, Marolleau JP, Pautas C, Malfuson JV, Veyn N, Braun T, Gastaud L, Suarez F, Schmidt A, Gressin R, Bonmati C, Celli-Lebras K, El-Hamri M, Ribaud P, Dombret H, Thomas X, Bergeron A. Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group. Clin Lymphoma Myeloma Leuk 2022; 22:311-318. [PMID: 34895843 DOI: 10.1016/j.clml.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres. MATERIALS AND METHODS This is an ancillary study to a randomized trial on intensive induction chemotherapy in AML patients (ALFA-0702/NCT00932412), where AFP with posaconazole was recommended. IFIs were graded by investigators and by central reviewers according to the revised EORTC definitions. Experts conclusions were compared to the investigators' ones. RESULTS A total of 677 patients were included. Four AFP strategies were reported: Group-1: no AFP (n = 203, 30%), Group-2: posaconazole (n = 241, 36%), Group-3: posaconazole with other AFP (n = 142, 21%), Group-4: other AFP (n = 91, 13%). Experts graded more IFI than investigators: proven/probable IFI, 9.0% (n = 61) versus 6.2% (n = 42). The cumulative incidence at day60 of probable/proven IFI was 13.9% (Group-1); 7.9% (Group-2); 5.6% (Group-3); and 6.6% (Group-4). IFI onset was 26 (19-31) days after induction in Groups 2-3, versus 16 (9-25) days in Group 1 and 20 (12-24) days in Group 4 (P< .001). After a median follow-up of 27.5 months (0.4-73.4), the mortality rate was 38.3%, with 5.4% attributed to IFI. In multivariate analysis, IFI occurrence was an independent risk of death (HR5.63, 95%-CI 2.62-12.08, P< .001). EORTC recommendations were applied in only 57% of patients. In patients without IFI, the rate of AML complete remission was higher. CONCLUSIONS In AML patients, AFP delayed the onset of IFI in addition of decreasing their rate. The frequent misidentification of IFI impacts their appropriate management according to recommendations. hematological remission was more frequent in patients without IFI.
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Affiliation(s)
| | - Mohamad Sobh
- Hematology department, Anticancer Centre Léon Bérard, Lyon, France
| | | | | | | | | | - Denis Caillot
- Hématologie Clinique, Dijon University Hospital, Dijon, France
| | | | | | | | - Sarah Bertoli
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse - Oncopole, CHU de Toulouse, Toulouse, France
| | - Stephane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France
| | | | | | | | | | | | - Norbert Veyn
- Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Felipe Suarez
- Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | | | | | | | | | - Mohamed El-Hamri
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Herve Dombret
- Hematology Department, Saint Louis Hospital, Paris, France
| | - Xavier Thomas
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Anne Bergeron
- Pneumology department, Saint Louis Hospital, AP-HP, Paris, France
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2
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Michallet M, Sobh M, Deray G, Gangneux JP, Pigneux A, Larrey D, Ribaud P, Mira JP, Nivoix Y, Yakoub-Agha I, Timsit JF, Alfandari S, Herbrecht R. Antifungal Stewardship in Hematology: Reflection of a Multidisciplinary Group of Experts. Clin Lymphoma Myeloma Leuk 2020; 21:35-45. [PMID: 32958431 DOI: 10.1016/j.clml.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
We have presented a practical guide developed by a working group of experts in infectious diseases and hematology to summarize the different recommendations issued by the different international groups on antifungal agents used for hematology patients. In addition, a working group of experts in the domains of nephrology, hepatology, and drug interactions have reported their different recommendations when administering antifungal agents, including dose adjustments, monitoring, and management of their side effects. This guide will enable prescribers to have a document available that will allow for better and optimal use of antifungal agents for hematology patients with consideration of the toxicity and interactions adjusted to each indication.
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Affiliation(s)
- Mauricette Michallet
- Hematology Department, Centre de lutte contre le cancer Léon Bérard, Lyon, France.
| | - Mohamad Sobh
- Hematology Department, Centre de lutte contre le cancer Léon Bérard, Lyon, France
| | - Gilbert Deray
- Nephrology Department, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Arnaud Pigneux
- Department of Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Patricia Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Paul Mira
- Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yasmine Nivoix
- Pharmacy Department, Strasbourg University Hospitals, Strasbourg, France
| | | | - Jean-François Timsit
- Medical Intensive Care Unit, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Serge Alfandari
- Intensive Care and Infectious Disease Unit, Tourcoing Hospital, University of Lille, Tourcoing, France
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Strasbourg University Hospitals and Strasbourg University, Strasbourg, France
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3
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Maertens JA, Girmenia C, Brüggemann RJ, Duarte RF, Kibbler CC, Ljungman P, Racil Z, Ribaud P, Slavin MA, Cornely OA, Peter Donnelly J, Cordonnier C. European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother 2019; 73:3221-3230. [PMID: 30085172 DOI: 10.1093/jac/dky286] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The European Conference on Infections in Leukaemia (ECIL) updated its guidelines on antifungal prophylaxis for adults using the grading system of IDSA. The guidelines were extended to provide recommendations for other haematological diseases besides AML and recipients of an allogeneic haematopoietic stem cell transplantation (HSCT). Posaconazole remains the drug of choice when the incidence of invasive mould diseases exceeds 8%. For patients undergoing remission-induction chemotherapy for AML and myelodysplastic syndrome (MDS), fluconazole can still offer an alternative provided it forms part of an integrated care strategy that includes screening with biomarkers and imaging. Similarly, aerosolized liposomal amphotericin B combined with fluconazole can be considered for patients at high risk of invasive mould diseases but other formulations of the polyene are discouraged. Fluconazole is still recommended as primary prophylaxis for patients at low risk of invasive mould diseases during the pre-engraftment phase of allogeneic HSCT whereas only a moderate recommendation could be made for itraconazole, posaconazole and voriconazole for patients at high risk. Posaconazole is strongly recommended for preventing invasive mould disease post-engraftment but only when graft-versus-host disease (GvHD) was accompanied by other risk factors such as its severity, use of an alternative donor or when unresponsive to standard corticosteroid therapy. The need for primary prophylaxis for other patient groups was less clear and should be defined by the estimated risk of invasive fungal disease (IFD).
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Affiliation(s)
- Johan A Maertens
- Department of Haematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Corrado Girmenia
- Department of Haematology, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roger J Brüggemann
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Per Ljungman
- Departments of Haematology and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Zdenek Racil
- Department of Internal Medicine - Haematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Patricia Ribaud
- Quality Unit, Pôle PréBloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.,Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - J Peter Donnelly
- Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Catherine Cordonnier
- Hopital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Department of Haematology, Créteil, France.,Université Paris-Est-Créteil, Créteil, France
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4
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Xhaard A, Roque-Afonso AM, Mallet V, Ribaud P, Nguyen-Quoc S, Rohrlich PS, Tabrizi R, Konopacki J, Lissandre S, Abravanel F, Latour RPD, Huynh A. Hepatitis E and Allogeneic Hematopoietic Stem Cell Transplantation: A French Nationwide SFGM-TC Retrospective Study. Viruses 2019; 11:v11070622. [PMID: 31284515 PMCID: PMC6669459 DOI: 10.3390/v11070622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022] Open
Abstract
Usually self-limited, hepatitis E virus (HEV) infection may evolve to chronicity and cirrhosis in immunosuppressed patients. HEV infection has been described in solid-organ transplantation and hematology patients, but for allogeneic hematopoietic stem cell transplant (alloHSCT) recipients, only small cohorts are available. This retrospective nationwide multi-center series aimed to describe HEV diagnostic practices in alloHSCT French centers, and the course of infection in the context of alloHSCT. Twenty-nine out of 37 centers participated. HEV search in case of liver function tests (LFT) abnormalities was never performed in 24% of centers, occasionally in 55%, and systematically in 21%. Twenty-five cases of active HEV infection were diagnosed in seven centers, all because of LFT abnormalities, by blood nucleic acid testing. HEV infection was diagnosed in three patients before alloHSCT; HEV infection did not influence transplantation planning, and resolved spontaneously before or after alloHSCT. Twenty-two patients were diagnosed a median of 283 days after alloHSCT. Nine patients (41%) had spontaneous viral clearance, mostly after immunosuppressive treatment decrease. Thirteen patients (59%) received ribavirin, with sustained viral clearance in 11/12 evaluable patients. We observed three HEV recurrences but no HEV-related death or liver failure, nor evolution to cirrhosis.
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Affiliation(s)
- Aliénor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris-Diderot, 75010 Paris, France.
| | - Anne-Marie Roque-Afonso
- Service de virologie, Hôpital Paul-Brousse, 94804 Villejuif, France
- INSERM 1193 et CNR hépatite A et E, Université Paris-Sud, 94804 Villejuif, France
| | - Vincent Mallet
- Service d'hépatologie, Hôpital Cochin, Université Paris Descartes, INSERM U1223, Institut Pasteur, 75014 Paris, France
| | - Patricia Ribaud
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris-Diderot, 75010 Paris, France
| | | | | | - Reza Tabrizi
- Service d'hématologie, CHU Bordeaux, 33600 Pessac, France
| | | | | | | | - Régis Peffault de Latour
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris-Diderot, 75010 Paris, France
| | - Anne Huynh
- Service d'hématologie, CHU, 31000 Toulouse, France
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5
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Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, Lass-Flörl C, Lewis RE, Munoz P, Verweij PE, Warris A, Ader F, Akova M, Arendrup MC, Barnes RA, Beigelman-Aubry C, Blot S, Bouza E, Brüggemann RJM, Buchheidt D, Cadranel J, Castagnola E, Chakrabarti A, Cuenca-Estrella M, Dimopoulos G, Fortun J, Gangneux JP, Garbino J, Heinz WJ, Herbrecht R, Heussel CP, Kibbler CC, Klimko N, Kullberg BJ, Lange C, Lehrnbecher T, Löffler J, Lortholary O, Maertens J, Marchetti O, Meis JF, Pagano L, Ribaud P, Richardson M, Roilides E, Ruhnke M, Sanguinetti M, Sheppard DC, Sinkó J, Skiada A, Vehreschild MJGT, Viscoli C, Cornely OA. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 Suppl 1:e1-e38. [PMID: 29544767 DOI: 10.1016/j.cmi.2018.01.002] [Citation(s) in RCA: 780] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
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Affiliation(s)
- A J Ullmann
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J M Aguado
- Infectious Diseases Unit, University Hospital Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - S Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; European Confederation of Medical Mycology (ECMM)
| | - A H Groll
- Department of Paediatric Haematology/Oncology, Centre for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - K Lagrou
- Department of Microbiology and Immunology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lass-Flörl
- Institute of Hygiene, Microbiology and Social Medicine, ECMM Excellence Centre of Medical Mycology, Medical University Innsbruck, Innsbruck, Austria; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - P Munoz
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - P E Verweij
- Department of Medical Microbiology, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - F Ader
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; Inserm 1111, French International Centre for Infectious Diseases Research (CIRI), Université Claude Bernard Lyon 1, Lyon, France; European Respiratory Society (ERS)
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M C Arendrup
- Department Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R A Barnes
- Department of Medical Microbiology and Infectious Diseases, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; European Confederation of Medical Mycology (ECMM)
| | - C Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; European Respiratory Society (ERS)
| | - S Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; European Respiratory Society (ERS)
| | - E Bouza
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R J M Brüggemann
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG)
| | - D Buchheidt
- Medical Clinic III, University Hospital Mannheim, Mannheim, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Cadranel
- Department of Pneumology, University Hospital of Tenon and Sorbonne, University of Paris, Paris, France; European Respiratory Society (ERS)
| | - E Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India; European Confederation of Medical Mycology (ECMM)
| | - M Cuenca-Estrella
- Instituto de Salud Carlos III, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; European Respiratory Society (ERS)
| | - J Fortun
- Infectious Diseases Service, Ramón y Cajal Hospital, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J-P Gangneux
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de Recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Garbino
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - W J Heinz
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R Herbrecht
- Department of Haematology and Oncology, University Hospital of Strasbourg, Strasbourg, France; ESCMID Fungal Infection Study Group (EFISG)
| | - C P Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany; European Confederation of Medical Mycology (ECMM)
| | - C C Kibbler
- Centre for Medical Microbiology, University College London, London, UK; European Confederation of Medical Mycology (ECMM)
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia; European Confederation of Medical Mycology (ECMM)
| | - B J Kullberg
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lange
- International Health and Infectious Diseases, University of Lübeck, Lübeck, Germany; Clinical Infectious Diseases, Research Centre Borstel, Leibniz Center for Medicine & Biosciences, Borstel, Germany; German Centre for Infection Research (DZIF), Tuberculosis Unit, Hamburg-Lübeck-Borstel-Riems Site, Lübeck, Germany; European Respiratory Society (ERS)
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Confederation of Medical Mycology (ECMM)
| | - J Löffler
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Lortholary
- Department of Infectious and Tropical Diseases, Children's Hospital, University of Paris, Paris, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Maertens
- Department of Haematology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - L Pagano
- Department of Haematology, Universita Cattolica del Sacro Cuore, Roma, Italy; European Confederation of Medical Mycology (ECMM)
| | - P Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Richardson
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Ruhnke
- Department of Haematology and Oncology, Paracelsus Hospital, Osnabrück, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Rome, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Canada; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Sinkó
- Department of Haematology and Stem Cell Transplantation, Szent István and Szent László Hospital, Budapest, Hungary; ESCMID Fungal Infection Study Group (EFISG)
| | - A Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M J G T Vehreschild
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology, Cologne-Bonn, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology (ECMM)
| | - C Viscoli
- Ospedale Policlinico San Martino and University of Genova (DISSAL), Genova, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O A Cornely
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM); ESCMID European Study Group for Infections in Compromised Hosts (ESGICH).
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6
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Zahar JR, Jolivet S, Adam H, Dananché C, Lizon J, Alfandari S, Boulestreau H, Baghdadi N, Bay JO, Bénéteau AM, Bougnoux ME, Brenier-Pinchart MP, Dalle JH, Fournier S, Fuzibet JG, Kauffmann-Lacroix C, Le Guinche I, Lepelletier D, Loukili N, Lory A, Morvan M, Oumedaly R, Ribaud P, Rohrlich P, Vanhems P, Aho S, Vanjak D, Gangneux JP. [French recommendations on control measures to reduce the infectious risk in immunocompromised patients]. J Mycol Med 2017; 27:449-456. [PMID: 29132793 DOI: 10.1016/j.mycmed.2017.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/14/2017] [Accepted: 10/15/2017] [Indexed: 11/27/2022]
Abstract
The increase use of immunosuppressive treatments in patients with solid cancer and/or inflammatory diseases requires revisiting our practices for the prevention of infectious risk in the care setting. A review of the literature by a multidisciplinary working group at the beginning of 2014 wished to answer the following 4 questions to improve healthcare immunocompromised patients: (I) How can we define immunocompromised patients with high, intermediate and low infectious risk, (II) which air treatment should be recommended for this specific population? (III) What additional precautions should be recommended for immunocompromised patients at risk for infection? (IV) Which global environmental control should be recommended? Based on data from the literature and using the GRADE method, we propose 15 recommendations that could help to reduce the risk of infection in these exposed populations.
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Affiliation(s)
- J-R Zahar
- Département de microbiologie clinique, unité de contrôle et de prévention du risque infectieux, IAME, UMR 1137, université Paris 13, Sorbonne Paris Cité, groupe hospitalier Paris-Seine-Saint-Denis, CHU Avicenne, AP-HP, 125, rue de Stalingrad, 93000 Bobigny, France.
| | - S Jolivet
- Unité d'hygiène et de lutte contre les infections nosocomiales, GH Bichat-Claude-Bernard, 75877 Paris, France
| | - H Adam
- Service d'épidémiologie et d'hygiène hospitalière, hôpital d'enfants, CHU, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - C Dananché
- Service hygiène, épidémiologie et prévention, centre international de recherche en infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, laboratoire des pathogènes émergents, fondation mérieux, Hospices Civils de Lyon, Lyon, 69003 France
| | - J Lizon
- Pôle laboratoires, équipe opérationnelle d'hygiène hospitalière, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; Département d'hygiène, des risques environnementaux et associés aux soins, faculté de médecine, université de Lorraine, 9, avenue de la Forêt-de-Haye, CS 50184, 54505 Vandœuvre-Lès-Nancy cedex, France
| | - S Alfandari
- Service de réanimation et maladies infectieuses, centre hospitalier Dron, 59200 Tourcoing, France
| | - H Boulestreau
- Service d'hygiène hospitalière, CHU de Bordeaux, Bordeaux, France
| | - N Baghdadi
- Unité Véronese, CHRU de Lille, UHSA, CS 70001, 59037 Lille cedex, France
| | - J-O Bay
- Service de thérapie cellulaire et d'hématologie clinique adulte, CHU de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 01, France
| | - A-M Bénéteau
- Département en hygiène, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - M-E Bougnoux
- Unité de parasitologie-mycologie, service de microbiologie clinique, hôpital Necker-Enfants-Malades, AP-HP, Paris, France; Unité de biologie et pathogénicité fongiques, Institut Pasteur, université Paris-Descartes, 75019 Paris, France
| | - M-P Brenier-Pinchart
- Inserm U1209, CNRS UMR5309, laboratoire de parasitologie-mycologie, institut de biologie et pathologie, France 2 institute for advanced biosciences (IAB), team host-pathogen interactions and immunity to infection, université Grenoble-Alpes, CHU de Grenoble-Alpes, 38700 Grenoble, France
| | - J-H Dalle
- Service d'hémato-immunologie, université Paris-Diderot, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - S Fournier
- Équipe opérationnelle d'hygiène, direction de l'organisation médicale, AP-HP, 75184 Paris, France
| | - J-G Fuzibet
- Service de médecine interne, hôpital de l'Archet 1, CHU de Nice, 06200 Nice, France
| | - C Kauffmann-Lacroix
- Laboratoire de parasitologie mycologie, CHU de Poitiers, bâtiment UBM, 2, rue de la Milétrie, CS 90577, 86021 Poitiers cedex, France
| | - I Le Guinche
- Équipe opérationnelle d'hygiène, CHU Necker-Enfants-Malades, 75015 Paris, France
| | - D Lepelletier
- Bactériologie-hygiène hospitalière, centre hospitalier universitaire de Nantes, 44093 Nantes cedex 01, France
| | - N Loukili
- Unité de lutte contre les infections nosocomiales, SGRIVI, CHRU de Lille, 59000 Lille, France
| | - A Lory
- ARLIN PACA, hôpital de Ste-Marguerite, AP-HM, 13009 Marseille, France
| | - M Morvan
- Équipe opérationnelle d'hygiène, CHRU de Montpellier, 34295 Montpellier, France
| | - R Oumedaly
- Institut d'hématologie de Basse Normandie (IHBN), CHU de Caen, 14000 Caen, France
| | - P Ribaud
- Département d'hématologie, CHU Saint-Louis, AP-HP, 75010 Paris, France
| | - P Rohrlich
- Inserm U1065, service d'hémato-oncologie pédiatrique, université Côte-d'Azur, centre hospitalier universitaire de Nice, 06204 Nice, France
| | - P Vanhems
- Service hygiène, épidémiologie et prévention, centre international de recherche en infectiologie, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, laboratoire des pathogènes émergents, fondation mérieux, Hospices Civils de Lyon, Lyon, 69003 France
| | - S Aho
- Service d'épidémiologie et d'hygiène hospitalière, hôpital d'enfants, CHU, 14, rue Paul-Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - D Vanjak
- Équipe opérationnelle d'hygiène, institut Curie, 26, rue d'ULM, 75005 Paris, France
| | - J-P Gangneux
- Service de parasitologie-mycologie, centre hospitalier universitaire de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 09, France
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7
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Schnell D, Azoulay E, Benoit D, Clouzeau B, Demaret P, Ducassou S, Frange P, Lafaurie M, Legrand M, Meert AP, Mokart D, Naudin J, Pene F, Rabbat A, Raffoux E, Ribaud P, Richard JC, Vincent F, Zahar JR, Darmon M. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF). Ann Intensive Care 2016; 6:90. [PMID: 27638133 PMCID: PMC5025409 DOI: 10.1186/s13613-016-0189-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/29/2016] [Indexed: 02/07/2023] Open
Abstract
Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
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Affiliation(s)
| | | | | | - Benjamin Clouzeau
- Medical Intensive Care Unit, Pellegrin University Hospital, Bordeaux, France
| | - Pierre Demaret
- Paediatric Intensive Care Unit, Centre Hospitalier Chrétien, Liège, Belgium
| | - Stéphane Ducassou
- Pediatric Hematological Unit, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Frange
- Microbiology Laboratory & Pediatric Immunology - Hematology Unit, Necker University Hospital, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, Saint-Louis University Hospital, Paris, France
| | - Matthieu Legrand
- Surgical ICU and Burn Unit, Saint-Louis University Hospital, Paris, France
| | - Anne-Pascale Meert
- Thoracic Oncology Department and Oncologic Intensive Care Unit, Institut Jules Bordet, Brussels, Belgium
| | - Djamel Mokart
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmette, Marseille, France
| | - Jérôme Naudin
- Pediatric ICU, Robert Debré University Hospital, Paris, France
| | | | - Antoine Rabbat
- Respiratory Intensive Care Unit, Cochin University Hospital Hospital, Paris, France
| | - Emmanuel Raffoux
- Department of Hematology, Saint-Louis University Hospital, Paris, France
| | - Patricia Ribaud
- Department of Stem Cell Transplantation, Saint-Louis University Hospital, Paris, France
| | | | | | - Jean-Ralph Zahar
- Infection Control Unit, Angers University Hospital, Angers, France
| | - Michael Darmon
- University Hospital, Saint-Etienne, France. .,Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raymond, 42270, Saint-Etienne, Saint-Priest-En-Jarez, France.
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8
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Cornetto MA, Chevret S, Abbes S, de Margerie-Mellon C, Hussenet C, Sicre de Fontbrune F, Tazi A, Ribaud P, Bergeron A. Early Lung Computed Tomography Scan after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1511-1516. [PMID: 27189110 DOI: 10.1016/j.bbmt.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/09/2016] [Indexed: 11/24/2022]
Abstract
A lung computed tomography (CT) scan is essential for diagnosing lung diseases in hematopoietic stem cell transplantation (HSCT) recipients. As a result, lung CT scans are increasingly prescribed in the early phase after allogeneic HSCT, with no assessment of the added value for global patient management. Among 250 patients who underwent allogeneic HSCT in our center over a 2-year period, we evaluated 68 patients who had at least 1 lung CT scan within the first 30 days post-transplantation. The median interval between allogeneic HSCT and lung CT scan was 8.5 days. Patients who underwent an early lung CT scan were more immunocompromised and had a more severe course. Fever was the main indication for the CT scan (78%). The lung CT scan was abnormal in 52 patients, including 17 patients who had an abnormal pre-HSCT CT scan. A therapeutic change was noted in 37 patients (54%) within 24 hours after the lung CT scan. The main changes included the introduction of corticosteroids (n = 23; 62%), especially in patients with a normal CT scan (89%). In univariate models, we found that a normal pretransplantation CT scan (P = .002), the absence of either dyspnea (P = .029) or hypoxemia (P = .015), and a serum C-reactive protein level <10 mg/L (P = .004) were associated with a normal post-HSCT lung CT scan. We found that the association of these variables could predict the normality of early post-HSCT lung CT scans. Pretransplantation lung CT scans are useful for the interpretation of subsequent lung CT scans following allogeneic HSCT, which are frequently abnormal. Early post-HSCT lung CT scans are helpful in patient management, but prescriptions could be more targeted.
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Affiliation(s)
| | - Sylvie Chevret
- Univ Paris Diderot, Sorbonne Paris Cité, UMR1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Paris, France; Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-Louis, Paris, France
| | - Sarah Abbes
- Univ Paris Diderot, Sorbonne Paris Cité; AP-HP, Hématologie-Greffe, Hôpital Saint-Louis, Paris, France; Service de Pneumologie, CHU Nantes, Nantes, France
| | | | - Claire Hussenet
- Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Flore Sicre de Fontbrune
- Univ Paris Diderot, Sorbonne Paris Cité; AP-HP, Hématologie-Greffe, Hôpital Saint-Louis, Paris, France
| | - Abdellatif Tazi
- Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMR1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Paris, France
| | - Patricia Ribaud
- Univ Paris Diderot, Sorbonne Paris Cité; AP-HP, Hématologie-Greffe, Hôpital Saint-Louis, Paris, France
| | - Anne Bergeron
- Service de Pneumologie, AP-HP, Hôpital Saint-Louis, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMR1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Paris, France.
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9
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Cornetto M, Chevret S, Abbes S, De Margerie Mellon C, Hussenet C, Sicre De Fontbrune F, Tazi A, Ribaud P, Bergeron A. Scanner thoracique précoce après allogreffe de cellules souches hématopoïétiques. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Granier C, Biard L, Masson E, Porcher R, Peffault de Latour R, Robin M, Boissel N, Xhaard A, Ribaud P, Lengline E, Larghero J, Charron D, Loiseau P, Socié G, Dhédin N. Impact of the source of hematopoietic stem cell in unrelated transplants: comparison between 10/10, 9/10-HLA matched donors and cord blood. Am J Hematol 2015; 90:897-903. [PMID: 26149659 DOI: 10.1002/ajh.24112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
In absence of available matched-related or unrelated donor (MUD), mismatched unrelated donors (MMUD) and unrelated cord blood (UCB) are both considered to be suitable donors, with similar post-transplant overall survival. In most of these retrospective comparisons, HLA typing of adult donors was performed at eight loci. The aim of this study was to compare the outcome of patients transplanted from UCB (N = 64) with those transplanted from 9/10-HLA MMUD (N = 84) or 10/10-HLA MUD (N = 196). In multivariate analysis, UCB was associated with less Grade II-IV acute GVHD in comparison with MUD (aHR 1.97, 95% CI 1.19-3.27, P = 0.009) and MMUD transplants (aHR 1.79, 95% CI 1.02-3.15, P = 0.042), while the cumulative incidence of chronic GVHD was not significantly different between the three groups. Overall survival (OS), non-relapse mortality, and relapse were not different between MMUD and UCB transplantation, whereas OS was impaired after UCB in comparison with MUD (aHR 0.65, 95% CI 0.43-0.99, P = 0.043). Factors also impacting OS were the donor/recipient CMV serostatus (Donor-/Recipient+ aHR 1.76, 95% CI 1.23-2.52, P = 0.002 compared with D-/R-), the donor/recipient gender combination (Female/Male versus other combinations aHR 1.57, 95% CI 1.11-2.22, P = 0.012) and disease risk (aHR 1.58, 95% CI 1.05-2.38, P = 0.027 for high vs. low risk disease). Our data confirm that UCB and 9/10-HLA MMUD are both relevant alternative options when no 10/10-HLA donor is available. Donor/recipient gender combination and CMV serostatus had a significant impact on survival and may be taken into account, along with donor type, in the setting of MMUD and UCB transplants.
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Affiliation(s)
- Clémence Granier
- Laboratoire D'immunologie Et Histocompatibilité; Hôpital Saint-Louis, AP-HP; Paris France
| | - Lucie Biard
- Service De Biostatistique Et D'information Médicale; Hôpital Saint-Louis, AP-HP; Paris France
| | - Emeline Masson
- Laboratoire D'immunologie Et Histocompatibilité; Hôpital Saint-Louis, AP-HP; Paris France
| | - Raphaël Porcher
- Service De Biostatistique Et D'information Médicale; Hôpital Saint-Louis, AP-HP; Paris France
| | | | - Marie Robin
- Service D'hématologie Greffe; Hôpital Saint-Louis, AP-HP; Paris France
| | - Nicolas Boissel
- Unité Hématologie Adolescents Jeunes Adultes; Hôpital Saint-Louis, AP-HP; Paris France
| | - Alienor Xhaard
- Service D'hématologie Greffe; Hôpital Saint-Louis, AP-HP; Paris France
| | - Patricia Ribaud
- Service D'hématologie Greffe; Hôpital Saint-Louis, AP-HP; Paris France
| | - Etienne Lengline
- Unité Hématologie Adolescents Jeunes Adultes; Hôpital Saint-Louis, AP-HP; Paris France
| | - Jérôme Larghero
- Unité Thérapie Cellulaire; Hôpital Saint-Louis, AP-HP; Paris France
| | - Dominique Charron
- Laboratoire D'immunologie Et Histocompatibilité; Hôpital Saint-Louis, AP-HP; Paris France
| | - Pascale Loiseau
- Laboratoire D'immunologie Et Histocompatibilité; Hôpital Saint-Louis, AP-HP; Paris France
| | - Gérard Socié
- Service D'hématologie Greffe; Hôpital Saint-Louis, AP-HP; Paris France
- Université Paris Diderot Sorbonne Paris Cité; Paris F-75475 France
- Inserm UMR1160 Et Centre D'investigation Clinique En Biotherapies (CICBT501); Institut Universitaire D'hématologie; Paris France
| | - Nathalie Dhédin
- Unité Hématologie Adolescents Jeunes Adultes; Hôpital Saint-Louis, AP-HP; Paris France
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11
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Lanternier F, Poiree S, Elie C, Garcia-Hermoso D, Bakouboula P, Sitbon K, Herbrecht R, Wolff M, Ribaud P, Lortholary O. Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB) for the initial treatment of mucormycosis. J Antimicrob Chemother 2015; 70:3116-23. [PMID: 26316385 DOI: 10.1093/jac/dkv236] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mucormycosis incidence is increasing and is associated with a high rate of mortality. Although lipid-based formulations of amphotericin B are the recommended first-line treatment, only one prospective trial in a limited number of patients has been performed to evaluate this regimen. METHODS Patients with proven or probable mucormycosis were included between June 2007 and March 2011. Patients were scheduled to receive 10 mg/kg/day liposomal amphotericin B (L-AMB) monotherapy for 1 month and surgery was performed when appropriate. The primary outcome was response rate at week 4 or at the end of treatment (EOT) if before week 4, evaluated by an independent committee. ClinicalTrials.gov Identifier: NCT00467883. RESULTS Forty patients were enrolled. Response was analysed in 33 patients at week 4. Most patients had a haematological malignancy as their primary underlying disease (53%). Seventy-one percent of patients underwent therapeutic surgery. The response rate at week 4 or at EOT was 36%, with 18% partial responses and 18% complete responses. The response rate at week 12 was 45%, with 13% partial responses and 32% complete responses. Overall mortality was 38% at week 12 and 53% at week 24. Serum creatinine doubled in 16 (40%) patients and returned to normal levels within 12 weeks in 10/16 (63%). CONCLUSIONS High-dose L-AMB for mucormycosis, in combination with surgery in 71% of cases, was associated with an overall response rate of 36% at week 4 and 45% at week 12 and creatinine level doubling in 40% of patients (transient in 63%). These results may serve as the basis for future clinical trials.
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Affiliation(s)
- F Lanternier
- Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker Enfants Malades, AP-HP, IHU Imagine, 149 rue de Sèvres, 75015 Paris, France Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - S Poiree
- Service de Radiologie, Hôpital Universitaire Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - C Elie
- Unité de Recherche Clinique/Centre d'Investigation Clinique, Hôpital Universitaire Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - D Garcia-Hermoso
- Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Paris, France
| | - P Bakouboula
- Unité de Recherche Clinique/Centre d'Investigation Clinique, Hôpital Universitaire Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75015 Paris, France
| | - K Sitbon
- Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Paris, France
| | - R Herbrecht
- Service d'Onco-Hématologie, Hôpital d'Hautepierre, Strasbourg, France
| | - M Wolff
- Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Paris, France
| | - P Ribaud
- Université Paris Diderot, Sorbonne Paris-Cité, Service d'Hématologie-Greffe de Moelle, AP-HP, Hôpital Saint-Louis, Paris, France
| | - O Lortholary
- Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker Enfants Malades, AP-HP, IHU Imagine, 149 rue de Sèvres, 75015 Paris, France Université Paris Descartes, Sorbonne Paris-Cité, Paris, France Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France Institut Pasteur, Unité de Mycologie Moléculaire, CNRS URA3012, Paris, France
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12
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Kheav VD, Busson M, Scieux C, Peffault de Latour R, Maki G, Haas P, Mazeron MC, Carmagnat M, Masson E, Xhaard A, Robin M, Ribaud P, Dulphy N, Loiseau P, Charron D, Socié G, Toubert A, Moins-Teisserenc H. Favorable impact of natural killer cell reconstitution on chronic graft-versus-host disease and cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation. Haematologica 2014; 99:1860-7. [PMID: 25085354 DOI: 10.3324/haematol.2014.108407] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Natural killer cells are the first lymphocyte subset to reconstitute, and play a major role in early immunity after allogeneic hematopoietic stem cell transplantation. Cells expressing the activating receptor NKG2C seem crucial in the resolution of cytomegalovirus episodes, even in the absence of T cells. We prospectively investigated natural killer-cell reconstitution in a cohort of 439 adult recipients who underwent non-T-cell-depleted allogeneic hematopoietic stem cell transplantation between 2005 and 2012. Freshly collected blood samples were analyzed 3, 6, 12 and 24 months after transplantation. Data were studied with respect to conditioning regimen, source of stem cells, underlying disease, occurrence of graft-versus-host disease, and profiles of cytomegalovirus reactivation. In multivariate analysis we found that the absolute numbers of CD56(bright) natural killer cells at month 3 were significantly higher after myeloablative conditioning than after reduced intensity conditioning. Acute graft-versus-host disease impaired reconstitution of total and CD56(dim) natural killer cells at month 3. In contrast, high natural killer cell count at month 3 was associated with a lower incidence of chronic graft-versus-host disease, independently of a previous episode of acute graft-versus-host disease and stem cell source. NKG2C(+)CD56(dim) and total natural killer cell counts at month 3 were lower in patients with reactivation of cytomegalovirus between month 0 and month 3, but expanded greatly afterwards. These cells were also less numerous in patients who experienced later cytomegalovirus reactivation between month 3 and month 6. Our results advocate a direct role of NKG2C-expressing natural killer cells in the early control of cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation.
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Affiliation(s)
- Vissal David Kheav
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris
| | - Marc Busson
- Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris
| | - Catherine Scieux
- Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; AP-HP, Hôpital Saint-Louis, Laboratoire de Microbiologie, Paris, France
| | - Régis Peffault de Latour
- Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe de Moelle, Paris
| | - Guitta Maki
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris
| | - Philippe Haas
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris
| | - Marie-Christine Mazeron
- Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; AP-HP, Hôpital Saint-Louis, Laboratoire de Microbiologie, Paris, France
| | - Maryvonnick Carmagnat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris
| | - Emeline Masson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris
| | - Aliénor Xhaard
- AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe de Moelle, Paris
| | - Marie Robin
- AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe de Moelle, Paris
| | - Patricia Ribaud
- AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe de Moelle, Paris
| | - Nicolas Dulphy
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris
| | - Pascale Loiseau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris INSERM UMRS-1160, Paris
| | - Dominique Charron
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris
| | - Gérard Socié
- Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris; AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe de Moelle, Paris
| | - Antoine Toubert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris;
| | - Hélène Moins-Teisserenc
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris Université Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie Paris; INSERM UMRS-1160, Paris;
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Wolfromm A, Porcher R, Legoff J, Peffault de Latour R, Xhaard A, de Fontbrune FS, Ribaud P, Bergeron A, Socié G, Robin M. Viral respiratory infections diagnosed by multiplex PCR after allogeneic hematopoietic stem cell transplantation: long-term incidence and outcome. Biol Blood Marrow Transplant 2014; 20:1238-41. [PMID: 24732781 PMCID: PMC7110602 DOI: 10.1016/j.bbmt.2014.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Abstract
Viral respiratory infections (VRIs) are frequent after hematopoietic stem cell transplantation and constitute a potential cause of mortality. We analyzed the incidence, risk factors, and prognosis of VRIs in a cohort of transplanted patients. More frequent viruses were human coronavirus and human rhinovirus followed by flu-like viruses and adenovirus. Risk factors for death were lymphocytopenia and high steroid dosage.
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Affiliation(s)
- Alice Wolfromm
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France
| | - Raphael Porcher
- Teams Methods, Epidemiology and Statistics Sorbonne Paris Cité Research Centre UMR 1153, INSERM, Paris Descartes University. APHP, Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France
| | - Jérome Legoff
- Laboratoire de Virologie, Hôpital Saint Louis, APHP, Paris, France
| | - Régis Peffault de Latour
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France
| | - Aliénor Xhaard
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France
| | - Flore Sicre de Fontbrune
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France
| | - Patricia Ribaud
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France
| | - Anne Bergeron
- Service de Pneumologie, Hôpital Saint Louis, APHP, Paris, France
| | - Gérard Socié
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France
| | - Marie Robin
- Service d'Hématologie Greffe, Hôpital Saint Louis, APHP, Paris, France. INSERM U 11 60, Université Paris VII Denis Diderot, France.
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Ferry C, Saussine A, Bouaziz JD, Xhaard A, Peffault de Latour R, Ribaud P, Robin M, Cambau E, Socié G. Disseminated cutaneous infection due to Mycobacterium chelonae following hematopoietic stem cell transplantation. IDCases 2014; 1:68-9. [PMID: 26839776 PMCID: PMC4735022 DOI: 10.1016/j.idcr.2014.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/02/2014] [Indexed: 11/16/2022] Open
Abstract
This report describes two cases of disseminated cutaneous Mycobacterium chelonae after hematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- C Ferry
- Service hematologie greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - A Saussine
- Service de dermatologie, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - J D Bouaziz
- Service de dermatologie, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - A Xhaard
- Service hematologie greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - R Peffault de Latour
- Service hematologie greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - P Ribaud
- Service hematologie greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - M Robin
- Service hematologie greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
| | - E Cambau
- Department de bactériologie-virologie groupe hospitalier Lariboisière-Fernand Widal, Paris, France
| | - G Socié
- Service hematologie greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
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15
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Dhédin N, Krivine A, Le Corre N, Mallet A, Lioure B, Bay JO, Rubio MT, Agape P, Thiébaut A, Le Goff J, Autran B, Ribaud P. Comparable humoral response after two doses of adjuvanted influenza A/H1N1pdm2009 vaccine or natural infection in allogeneic stem cell transplant recipients. Vaccine 2013; 32:585-91. [PMID: 24333120 PMCID: PMC7115606 DOI: 10.1016/j.vaccine.2013.11.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 11/14/2013] [Accepted: 11/21/2013] [Indexed: 11/05/2022]
Abstract
2 doses of vaccine induces a humoral response comparable to that triggered by natural infection after allogeneic transplant. Seroprotection rate significantly increases after the second dose of adjuvanted vaccine. Adjuvanted vaccine was safe with low rate of graft-versus-host disease.
Background The present study evaluated immunogenicity and tolerance of two-dose influenza A/H1N1pdm09 vaccination in allogeneic hematopoietic stem cell transplantation (HSCT) recipients, and compared the vaccine-induced humoral response to that triggered by natural infection in another group of HSCT patients. Methods Adult allogeneic HSCT recipients vaccinated with two doses of influenza A/H1N1pdm09 vaccine, separated by 3 weeks, and patients with proven influenza A/H1N1pdm09 infection were included. Antibody responses were measured by hemagglutination-inhibition assay 1) on days 0, 21, 42 and 6 months after the first vaccine injection in vaccinated patients and 2) before pandemic and after influenza A/H1N1pdm09 infection, in patients presented natural infection. Results At baseline, 3% of 59 recipients of adjuvanted vaccine and 0% of 20 infected patients were seroprotected (antibody titer ≥ 1/40). Seroprotection rate observed 42 days after vaccination was not different from that observed after natural infection (66% and 60% respectively, p = 0.78). In vaccinated patients, seroprotection rate increased significantly from 54% to 66% between day 21 and 42 (p = 0.015). Moreover, after 6 months, seroprotection rate in 21 vaccinated patients was similar to that observed in 10 infected patients evaluated at least 76 days after infection (D76–217) (60% and 81% respectively, p = 0.2). In multivariate analysis, no immunosuppressive treatment or chronic graft-versus-host disease (GVHD) and longer time between transplantation and vaccination/infection were associated with a stronger humoral response. The adjuvanted vaccine was safe with low rate of GVHD worsening. Conclusion In HSCT recipients, two doses of influenza A/H1N1pdm09 adjuvanted vaccine were safe and induced a humoral response comparable to that triggered by natural infection in these patients.
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Affiliation(s)
- Nathalie Dhédin
- Service d'Hématologie-Adolescents Jeunes Adultes, Hôpital Saint-Louis, AP-HP, Paris, France; Service d'Hématologie, Groupe Hospitalier Pitié Salpêtrière, AP-HP, Paris, France.
| | - Anne Krivine
- Service de Virologie, Hôpital Saint-Vincent-de-Paul Cochin, AP-HP, Paris, France
| | - Nicole Le Corre
- UPMC Université Paris 06, UMR S 945, Laboratory Immunity and Infection, F-75013 Paris, France; INSERM, UMR S 945, Laboratory Immunity and Infection, F-75013 Paris, France
| | - Alain Mallet
- Unité de Recherche Clinique, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Bruno Lioure
- Département d'Hématologie, Hôpitaux Universitaires Strasbourg, France
| | - Jacques-Olivier Bay
- Service d'Hématologie, Centre Hospitalier-Universitaire Estaing, Clermont-Ferrand, France
| | | | - Philippe Agape
- Service d'Hématologie et d'Oncologie médicale. Centre Hospitalier Universitaire de la Réunion. Hôpital Felix Guyon, Saint Denis, Réunion, France
| | - Anne Thiébaut
- Service d'Hématologie, Hôpital Michallon, Grenoble, France
| | - Jérôme Le Goff
- Service de virologie, Hôpital Saint-Louis, AP-HP, Paris, France; Université Paris-Diderot, Sorbonne Paris, Cité, Paris, France
| | - Brigitte Autran
- UPMC Université Paris 06, UMR S 945, Laboratory Immunity and Infection, F-75013 Paris, France; INSERM, UMR S 945, Laboratory Immunity and Infection, F-75013 Paris, France
| | - Patricia Ribaud
- Université Paris-Diderot, Sorbonne Paris, Cité, Paris, France; Service d'Hématologie-Greffe de Moelle, Hôpital Saint-Louis, AP-HP, Paris, France
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Schnepf N, Dhédin N, Mercier-Delarue S, Andreoli A, Mamez AC, Ferry C, Deback C, Ribaud P, Robin M, Socié G, Simon F, Mazeron MC. Dynamics of cytomegalovirus populations harbouring mutations in genes UL54 and UL97 in a haematopoietic stem cell transplant recipient. J Clin Virol 2013; 58:733-6. [DOI: 10.1016/j.jcv.2013.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/14/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
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Servais S, Porcher R, Xhaard A, Robin M, Masson E, Larghero J, Ribaud P, Dhedin N, Abbes S, Sicre F, Socié G, Peffault de Latour R. Pre-transplant prognostic factors of long-term survival after allogeneic peripheral blood stem cell transplantation with matched related/unrelated donors. Haematologica 2013; 99:519-26. [PMID: 24241489 DOI: 10.3324/haematol.2013.089979] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Mobilized peripheral blood has become the predominant stem cell source for allogeneic hematopoietic cell transplantation. In this retrospective single center study of 442 patients with hematologic malignancies, we analyzed prognostic factors for long-term survival after peripheral blood stem cell transplantation from HLA-matched related or unrelated donors. To account for disease/status heterogeneity, patients were risk-stratified according to the Disease Risk Index. Five-year overall survival was similar after transplants with matched related and unrelated donors (45% and 46%, respectively; P=0.49). Because donor age ≥60 years impacted outcome during model building, we further considered 3 groups of donors: matched unrelated (aged <60 years by definition), matched related aged <60 years and matched related aged ≥60 years. In multivariate analysis, the donor type/age group and the graft CD34(+) and CD3(+) cell doses impacted long-term survival. Compared with matched unrelated donor transplant, transplant from matched related donor <60 years resulted in similar long-term survival (P=0.67) while transplant from matched related donor ≥60 years was associated with higher risks for late mortality (hazard ratio (HR) 4.41; P=0.006) and treatment failure (HR: 6.33; P=0.009). Lower mortality risks were observed after transplant with CD34(+) cell dose more than 4.5×10(6)/kg (HR: 0.56; P=0.002) and CD3(+) cell dose more than 3×10(8)/kg (HR: 0.61; P=0.01). The Disease Risk Index failed to predict survival. We built an "adapted Disease Risk Index" by modifying risks for myeloproliferative neoplasms and multiple myeloma that improved stratification ability for progression-free survival (P=0.04) but not for overall survival (P=0.82).
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Marcade G, Micol JB, Jacquier H, Raskine L, Donay JL, Nicolas-Viaud S, Rouveau M, Ribaud P, Dombret H, Leclercq R, Cambau E. Outbreak in a haematology unit involving an unusual strain of glycopeptide-resistant Enterococcus faecium carrying both vanA and vanB genes. J Antimicrob Chemother 2013; 69:500-5. [DOI: 10.1093/jac/dkt376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bergeron A, Godet C, Chevret S, Lorillon G, Peffault de Latour R, de Revel T, Robin M, Ribaud P, Socié G, Tazi A. Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis. Bone Marrow Transplant 2012. [PMID: 23208317 PMCID: PMC7091913 DOI: 10.1038/bmt.2012.241] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic SCT (HSCT) is recognized as a new-onset obstructive lung defect (OLD) in pulmonary function testing and is related to pulmonary chronic GVHD. Little is known about the different phenotypes of patients with BOS and their outcomes. We reviewed the data of all allogeneic HSCT recipients referred to our pulmonary department for a non-infectious bronchial disease between 1999 and 2010. We identified 103 patients (BOS (n=77), asthma (n=11) and chronic bronchitis (n=15)). In patients with BOS, we identified two functional phenotypes: a typical OLD, that is, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7 (n=53), and an atypical OLD with a concomitant decrease in the FEV1 <80% and FVC <80% predicted with a normal total lung capacity (n=24). The typical OLD was characterized by more severe FEV1 and fewer centrilobular nodules on the computed tomography scan. The FEV1 was not significantly affected during the follow-up, regardless of the phenotype. In addition to acute and extensive chronic GVHD, only the occurrence of BOS soon after transplantation and the intentional treatment of BOS with steroids were associated with a poor survival. The determination of patient subgroups should be explored to improve the management of this condition.
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Affiliation(s)
- A Bergeron
- Université Paris Diderot, Sorbonne Cité, Service de Pneumologie, AP-HP, Hôpital Saint Louis, Paris, France.
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Resche-Rigon M, Pirracchio R, Robin M, De Latour RP, Sibon D, Ades L, Ribaud P, Fermand JP, Thieblemont C, Socié G, Chevret S. Estimating the treatment effect from non-randomized studies: The example of reduced intensity conditioning allogeneic stem cell transplantation in hematological diseases. BMC Blood Disord 2012; 12:10. [PMID: 22898556 PMCID: PMC3532369 DOI: 10.1186/1471-2326-12-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 08/09/2012] [Indexed: 01/27/2023]
Abstract
Background In some clinical situations, for which RCT are rare or impossible, the majority of the evidence comes from observational studies, but standard estimations could be biased because they ignore covariates that confound treatment decisions and outcomes. Methods Three observational studies were conducted to assess the benefit of Allo-SCT in hematological malignancies of multiple myeloma, follicular lymphoma and Hodgkin’s disease. Two statistical analyses were performed: the propensity score (PS) matching approach and the inverse probability weighting (IPW) approach. Results Based on PS-matched samples, a survival benefit in MM patients treated by Allo-SCT, as compared to similar non-allo treated patients, was observed with an HR of death at 0.35 (95%CI: 0.14-0.88). Similar results were observed in HD, 0.23 (0.07-0.80) but not in FL, 1.28 (0.43-3.77). Estimated benefits of Allo-SCT for the original population using IPW were erased in HR for death at 0.72 (0.37-1.39) for MM patients, 0.60 (0.19-1.89) for HD patients, and 2.02 (0.88-4.66) for FL patients. Conclusion Differences in estimated benefits rely on whether the underlying population to which they apply is an ideal randomized experimental population (PS) or the original population (IPW). These useful methods should be employed when assessing the effects of innovative treatment in non-randomized experiments.
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Affiliation(s)
- Matthieu Resche-Rigon
- Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, AP-HP, Paris 75010, France.
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Bergeron A, Porcher R, Raffoux E, Sulahian A, Ribaud P. Response Assessment in Invasive Aspergillosis. Clin Infect Dis 2012; 55:475-6; author reply 476-7. [DOI: 10.1093/cid/cis415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Xhaard A, Lanternier F, Porcher R, Dannaoui E, Bergeron A, Clement L, Lacroix C, Herbrecht R, Legrand F, Mohty M, Michallet M, Cordonnier C, Malak S, Guyotat D, Couderc LJ, Socié G, Milpied N, Lortholary O, Ribaud P. Mucormycosis after allogeneic haematopoietic stem cell transplantation: a French Multicentre Cohort Study (2003-2008). Clin Microbiol Infect 2012; 18:E396-400. [PMID: 22672535 DOI: 10.1111/j.1469-0691.2012.03908.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We conducted a nationwide retrospective study to evaluate clinical characteristics and outcome of mucormycosis among allogeneic haematopoietic stem cell transplant recipients. Twenty-nine patients were diagnosed between 2003 and 2008. Mucormycosis occurred at a median of 225 days after allogeneic haematopoietic stem cell transplant, and as a breakthrough infection in 23 cases. Twenty-six patients were receiving steroids, mainly for graft-versus-host disease treatment, while ten had experienced a prior post-transplant invasive fungal infection. Twenty-six patients received an antifungal treatment; surgery was performed in 12. Overall survival was 34% at 3 months and 17% at 1 year.
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Affiliation(s)
- A Xhaard
- Service d'Hématologie- Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.
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De Castro N, Mazoyer E, Porcher R, Raffoux E, Suarez F, Ribaud P, Lortholary O, Molina JM. Hepatosplenic candidiasis in the era of new antifungal drugs: a study in Paris 2000-2007. Clin Microbiol Infect 2012; 18:E185-7. [DOI: 10.1111/j.1469-0691.2012.03819.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Lanternier F, Sun HY, Ribaud P, Singh N, Kontoyiannis DP, Lortholary O. Mucormycosis in Organ and Stem Cell Transplant Recipients. Clin Infect Dis 2012. [DOI: 10.1093/cid/cis195] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Willems L, Porcher R, Lafaurie M, Casin I, Robin M, Xhaard A, Andreoli AL, Rodriguez-Otero P, Dhedin N, Socié G, Ribaud P, Peffault de Latour R. Clostridium difficile infection after allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and outcome. Biol Blood Marrow Transplant 2012; 18:1295-301. [PMID: 22387347 DOI: 10.1016/j.bbmt.2012.02.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 02/22/2012] [Indexed: 12/21/2022]
Abstract
Clostridium difficile (C. difficile) infection was observed in 13% of recipients after hematopoietic stem cell transplantation (HSCT), mainly in the first month posttransplantation. Risk factors were cord blood as the source of stem cells, acute graft-versus-host disease (GVHD), and total body irradiation (TBI). No association was found with an increased risk of mortality. The purpose of this study was to evaluate the incidence, risk factors, and outcome of C. difficile infection (CDI) after HSCT. We conducted a single-center, retrospective, cohort study on all patients who received an allogeneic HSCT from January 2004 to December 2007. All patients with diarrhea in the first year after HSCT were tested for the presence of C. difficile in stools. Among the 407 assessable patients, 53 presented at least 1 CDI in the first year post-HSCT. The total incidence rate was 5.6 cases of CDI per 10,000 patient-days. Fifty percent of cases were diagnosed in the first month after HSCT, and 95% occurred during the first 6 months. Fewer than 5% of patients with CDI had severe diarrhea and severe complications were never observed. TBI in the conditioning regimen, cord blood as the source of stem cells, and acute graft-versus-host disease (aGVHD) were independently associated with CDI. Six patients (11%) had a recurrence of CDI. Four patients required second-line treatment with vancomycin. With a median follow-up of 22 months, the 2-year overall survival rates were similar between patients who presented a CDI and those who did not. CDI was observed in approximately 13% of recipients after HSCT, mainly in the first month posttransplantation and was associated with CB, aGVHD, and TBI. CDI was not associated either with severe complications or with an increased risk of mortality in this large cohort of patients.
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Affiliation(s)
- Lise Willems
- Service Hématologie Greffe, AP-HP, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, Paris, France.
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Salmeron G, Porcher R, Bergeron A, Robin M, Peffault de Latour R, Ferry C, Rocha V, Petropoulou A, Xhaard A, Lacroix C, Sulahian A, Socié G, Ribaud P. Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis. Haematologica 2012; 97:1357-63. [PMID: 22371177 DOI: 10.3324/haematol.2011.058255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Voriconazole treatment increases early survival of allogeneic hematopoietic stem cell transplant recipients with invasive aspergillosis. We investigated whether this survival advantage translates into an increased long-term survival. DESIGN AND METHODS This retrospective study involved all patients with an invasive aspergillosis diagnosis transplanted between September 1997 and December 2008, at the Saint-Louis Hospital, Paris, France. The primary end point was survival up to 36 months. Survival analysis before and after 12 weeks, as well as cumulative incidence analysis in a competing risk framework, were used to assess the effect of voriconazole treatment and other factors on mortality. RESULTS Among 87 patients, 42 received first-line voriconazole and 45 received another antifungal agent. Median survival time was 2.6 months and survival rate at 36 months was 18%. Overall, there was a significant difference in the survival rates of the two groups. Specifically, there was a dramatic difference in survival rates up to ten months post-aspergillosis diagnosis but no significant difference after this time. Over the first 36 months as a whole, no significant difference in survival rate was observed between the two groups. First-line voriconazole significantly reduced aspergillosis-attributable mortality. However, first-line voriconazole patients experienced a significantly higher probability of death from a non-aspergillosis-attributable cause. CONCLUSIONS Although the prognosis for invasive aspergillosis after stem cell transplantation has dramatically improved with the use of voriconazole, this major advance in care does not translate into increased long-term survival for these severely immunocompromised patients.
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Affiliation(s)
- Géraldine Salmeron
- Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris, France
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Konopacki J, Porcher R, Robin M, Bieri S, Cayuela JM, Larghero J, Xhaard A, Andreoli AL, Dhedin N, Petropoulou A, Rodriguez-Otero P, Ribaud P, Moins-Teisserenc H, Carmagnat M, Toubert A, Chalandon Y, Socie G, Peffault de Latour R. Long-term follow up after allogeneic stem cell transplantation in patients with severe aplastic anemia after cyclophosphamide plus antithymocyte globulin conditioning. Haematologica 2011; 97:710-6. [PMID: 22180425 DOI: 10.3324/haematol.2011.050096] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Due to increased rates of secondary solid organ cancer in patients with severe aplastic anemia who received an irradiation-based conditioning regimen, we decided some years ago to use the combination of cyclophosphamide and antithymocyte globulin. We report the long-term follow up of patients who underwent hematopoietic stem cell transplantation from an HLA-matched sibling donor after this conditioning regimen. DESIGN AND METHODS We analyzed 61 consecutive patients transplanted from June 1991 to February 2010, following conditioning with cyclophosphamide (200 mg/kg) and antithymocyte globulin (2.5 mg/kg/day × 5 days). RESULTS Median age was 21 years (range 4-43); 41 of the 61 patients were adults. Median duration of the disease before hematopoietic stem cell transplantation was 93 days. All but 2 patients received bone marrow as the source of stem cells and all but 2 engrafted. Cumulative incidence of acute grade II-IV graft-versus-host disease was 23% (95%CI 13-34) and 18 developed chronic graft-versus-host disease (cumulative incidence 32% at 72 months, 95% CI 20-46). In multivariate analysis, a higher number of infused CD3 cells was associated with an increased risk of developing chronic graft-versus-host disease (P = 0.017). With a median follow up of 73 months (range 8-233), the estimated 6-year overall survival was 87% (95% CI 78-97). At 72 months, the cumulative incidence of avascular necrosis was 21% and 12 patients presented with endocrine dysfunction (cumulative incidence of 19%). Only one patient developed a secondary malignancy (Hodgkin's lymphoma) during follow up. CONCLUSIONS Cyclophosphamide and antithymocyte globulin is an effective conditioning regimen for patients with severe aplastic anemia and is associated with low treatment-related mortality. Long-term complications include avascular necrosis and endocrine dysfunction.
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Marks DI, Pagliuca A, Kibbler CC, Glasmacher A, Heussel CP, Kantecki M, Miller PJS, Ribaud P, Schlamm HT, Solano C, Cook G. Voriconazole versus itraconazole for antifungal prophylaxis following allogeneic haematopoietic stem-cell transplantation. Br J Haematol 2011; 155:318-27. [PMID: 21880032 PMCID: PMC3253339 DOI: 10.1111/j.1365-2141.2011.08838.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Antifungal prophylaxis for allogeneic haematopoietic stem-cell transplant (alloHCT) recipients should prevent invasive mould and yeast infections (IFIs) and be well tolerated. This prospective, randomized, open-label, multicentre study compared the efficacy and safety of voriconazole (234 patients) versus itraconazole (255 patients) in alloHCT recipients. The primary composite endpoint, success of prophylaxis, incorporated ability to tolerate study drug for ≥100 d (with ≤14 d interruption) with survival to day 180 without proven/probable IFI. Success of prophylaxis was significantly higher with voriconazole than itraconazole (48·7% vs. 33·2%, P <0·01); more voriconazole patients tolerated prophylaxis for 100 d (53·6% vs. 39·0%, P<0·01; median total duration 96 vs. 68 d). The most common (>10%) treatment-related adverse events were vomiting (16·6%), nausea (15·8%) and diarrhoea (10·4%) for itraconazole, and hepatotoxicity/liver function abnormality (12·9%) for voriconazole. More itraconazole patients received other systemic antifungals (41·9% vs. 29·9%, P<0·01). There was no difference in incidence of proven/probable IFI (1·3% vs. 2·1%) or survival to day 180 (81·9% vs. 80·9%) for voriconazole and itraconazole respectively. Voriconazole was superior to itraconazole as antifungal prophylaxis after alloHCT, based on differences in the primary composite endpoint. Voriconazole could be given for significantly longer durations, with less need for other systemic antifungals.
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Affiliation(s)
- David I Marks
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
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Lorillon G, Robin M, Meignin V, Ribaud P, Lescoeur B, Gossot D, Socie G, Tazi A, Bergeron A. Rituximab in bronchiolitis obliterans after haematopoietic stem cell transplantation. Eur Respir J 2011; 38:470-2. [DOI: 10.1183/09031936.00003711] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Xhaard A, Rocha V, Bueno B, de Latour RP, Lenglet J, Petropoulou A, Rodriguez-Otero P, Ribaud P, Porcher R, Socié G, Robin M. Steroid-refractory acute GVHD: lack of long-term improved survival using new generation anticytokine treatment. Biol Blood Marrow Transplant 2011; 18:406-13. [PMID: 21736868 DOI: 10.1016/j.bbmt.2011.06.012] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 06/24/2011] [Indexed: 11/18/2022]
Abstract
There is no consensus on the optimal treatment of steroid-refractory acute graft-versus-host disease (SR-aGVHD) after allogeneic hematopoietic stem cell transplantation. In our center, the treatment policy has changed over time with mycophenolate mofetil (MMF) being used from 1999 to 2003, and etanercept or inolimomab after 2004. An observational study compared survival and infection rates in all consecutive patients receiving 1 of these 3 treatments. Ninety-three patients were included. The main end point was overall survival (OS). Median age was 37 years. Acute GVHD developed at a median of 15 days after transplantation. Second-line treatment was initiated a median of 12 days after aGVHD diagnosis. Therapies were MMF in 56%, inolimomab in 22%, and etanercept in 23% of the patients. Overall, second-line treatment response rate was 45% (complete response: 28%), MMF: 55%, inolimomab: 35%, and etanercept: 28%. With 74 months median follow-up, the 2-year survival was 30% (95% confidence interval: 22-41). Risk factors significantly associated with OS in multivariate analysis were disease status at transplantation; grade III-IV aGVHD at second-line treatment institution; and liver involvement. None of the second-line therapy influenced this poor outcome. Viral and fungal infections were not statistically different among the 3 treatment options; however, bacterial infections were more frequent in patients treated with anticytokines. Over an 11-year period, 3 treatment strategies, including 2 anticytokines, give similar results in patients with SR-aGVHD.
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Affiliation(s)
- Aliénor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, université Paris 7, Paris, France
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Menotti J, Porcher R, Ribaud P, Lacroix C, Jolivet V, Hamane S, Derouin F. Monitoring of nosocomial invasive aspergillosis and early evidence of an outbreak using cumulative sum tests (CUSUM). Clin Microbiol Infect 2011; 16:1368-74. [PMID: 20041891 DOI: 10.1111/j.1469-0691.2009.03150.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In order to provide a statistically based evaluation of the incidence of invasive aspergillosis (IA) over time, we applied the cumulative sums (CUSUM) methodology, which was developed for quality control and has already been applied for the surveillance of hospital-acquired infections. Cases of IA were recorded during a 5-year period. Incidence rates of cases assumed to be hospital-acquired, i.e. nosocomial IA (NIA), were analysed using CUSUM tests. Relationships between NIA, fungal contamination and construction or renovation work were tested using time-series methods. Between January 2002 and December 2006, 81 cases of NIA were recorded. CUSUM analysis of NIA incidence showed no significant deviation from the expected monthly number of cases until August 2005, and then the CUSUM crossed the decision limit, i.e. identified a significant increase in NIA as compared with the reference period (January 2002 to December 2004). Up to April 2006, the learning-curve CUSUM stayed over its limit, supporting an ongoing outbreak involving 24 patients, and then it significantly decreased in May 2006. Follow-up after May 2006 indicated no out-of-control situation, supporting a return to the baseline situation. In haematology wards, significant links were found between NIA incidence and fungal contamination of several sites at each ward (mainly unprotected common sites). An environmental source of contamination could be suspected, but no significant relationship was found between NIA incidence and ongoing construction or renovation. In conclusion, the CUSUM test proved to be well suited for real-time monitoring of NIA and for early identification and follow-up of an outbreak.
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Affiliation(s)
- J Menotti
- Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and Université Paris-Diderot, Paris, France
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Mariotte E, Schnell D, Scieux C, Agbalika F, Legoff J, Ribaud P, Boissel N, Schlemmer B, Azoulay E. Significance of herpesvirus 6 in BAL fluid of hematology patients with acute respiratory failure. Infection 2011; 39:225-30. [PMID: 21538037 DOI: 10.1007/s15010-011-0114-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Human herpesvirus 6 (HHV6) is an emerging cause of interstitial pneumonia in immunocompromised hosts. However, the clinical significance of a positive PCR test for HHV6 in respiratory samples from patients with hematological malignancies remains unclear. METHODS We retrospectively studied the features and outcomes of 29 critically ill hematology patients with acute respiratory failure and lung pulmonary infiltrates visible on a chest radiograph, who tested positive for a qualitative PCR for HHV6 in bronchoalveolar lavage fluid. RESULTS Of the 29 patients, 18 (62%) were stem cell transplant recipients and 11 (38%) had received chemotherapy. All patients had a fever. Clinical manifestations consistent with extra-pulmonary HHV6 disease were noted in 17 (59%) patients. One or more co-pathogens were found in 25 (86%) patients. The four remaining patients diagnosed with HHV6 pneumonia and subsequently recovered with foscarnet therapy. Antiviral therapy was also given to seven patients with co-infections, of whom two ultimately died. CONCLUSIONS In most cases, HHV6 recovered from BAL fluid is a co-pathogen whose clinical relevance remains undetermined. However, in some cases, HHV6 is the only pathogen, along with disseminated systemic viral disease, and the patient is likely to benefit from foscarnet therapy.
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Affiliation(s)
- E Mariotte
- Medical ICU, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, 1 avenue Claude Vellefaux, Paris, France
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Ruggeri A, Peffault de Latour R, Carmagnat M, Clave E, Douay C, Larghero J, Cayuela JM, Traineau R, Robin M, Madureira A, Ribaud P, Ferry C, Devergie A, Purtill D, Rabian C, Gluckman E, Toubert A, Socié G, Rocha V. Outcomes, infections, and immune reconstitution after double cord blood transplantation in patients with high-risk hematological diseases. Transpl Infect Dis 2011; 13:456-65. [PMID: 21466640 DOI: 10.1111/j.1399-3062.2011.00632.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Double unrelated cord blood transplant (dUCBT) has been used to circumvent cell dose limitation of single UCBT; however, few data are available describing outcomes, infectious disease, and immune recovery. We analyzed 35 consecutive dUCBT recipients with high-risk malignant disorders (n=21) and bone marrow failure syndromes (n=14). Median follow-up was 32 months. Conditioning regimen was myeloablative in 14 and reduced intensity in 21 patients. Median infused nucleated cell dose was 4 × 10(7) /kg. Median time to absolute neutrophil count >0.5 × 10(9) /L was 25 days. Cumulative incidence (CI) of acute grade II-IV graft-versus-host disease was 47%. Estimated overall survival at 2 years was 48%. CI of first viral infections at 1 year was 92%. We observed 49 viral infections in 30 patients, 34 bacterial infections in 19 patients, and 16 fungal or parasitic infections in 12 patients. Lymphocyte subset analyses were performed at 3, 6, 9, and >12 months after dUCBT. Decreased T-cell and B-cell counts with expansion of natural killer cells were observed until 9 months post transplantation. Recovery of thymopoiesis measured by T-cell receptor excision circles was impaired until 9 months after dUCBT, when the appearance of new thymic precursors was observed. Delayed immune recovery and high incidence of infectious complications were observed after dUCBT in patients with high-risk hematological diseases.
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Affiliation(s)
- A Ruggeri
- Service d'Hématologie-Greffe, Hôpital Saint Louis, APHP, Paris University 7, Paris, France
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Michallet M, Gangneux JP, Lafuma A, Herbrecht R, Ribaud P, Caillot D, Dupont B, Moreau P, Berger P, O'Sullivan AK. Cost effectiveness of posaconazole in the prophylaxis of invasive fungal infections in acute leukaemia patients for the French healthcare system. J Med Econ 2011; 14:28-35. [PMID: 21175376 DOI: 10.3111/13696998.2010.542393] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute myeloblastic leukaemia (AML) patients are at high risk of suffering from invasive fungal infections (IFI). Posaconazole demonstrated higher efficacy than standard azole agents (SAA) in the prophylaxis of IFI in this population. The authors estimated the cost effectiveness of posaconazole versus SAA in France. METHODS A decision-tree model was developed to compare posaconazole with SAA with the results of a published clinical trial. Clinical events were modelled with chance nodes reflecting probabilities of IFI, IFI-related death, and death from other causes. Medical resource consumption and costs were obtained from results of the clinical trial and from a dedicated survey on the costs of treating IFI using a retrospective chart review design. RESULTS IFI treatment costs were estimated using medical files from 50 AML patients from six French centres, with a proven and probable IFI, who had been followed-up for 298 days on average. Direct costs directly related to IFI were estimated at €51,033, including extra costs of index hospitalisation, costs of antifungal therapy and additional hospitalisations related to IFI treatment. The model indicated that the healthcare costs for the posaconazole strategy were €5,223 (€2,697 for prophylaxis and €2,526 for IFI management), which was €859 less than the €6,083 in costs with SAA (€469 for prophylaxis and €5614 for IFI management). A sensitivity analysis indicated that there was an 80% probability that prophylaxis using the posaconazole strategy would be superior. CONCLUSION The findings from this analysis suggest that posaconazole use is a clinically and economically dominant strategy in the prophylaxis of IFI in AML patients, given the usual limits of economic models and the uncertainty of costs estimates.
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Thepot S, Zhou J, Perrot A, Robin M, Xhaard A, de Latour RP, Ades L, Ribaud P, Petropoulou AD, Porcher R, Socié G. The graft-versus-leukemia effect is mainly restricted to NIH-defined chronic graft-versus-host disease after reduced intensity conditioning before allogeneic stem cell transplantation. Leukemia 2010; 24:1852-8. [PMID: 20827288 DOI: 10.1038/leu.2010.187] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Incidence on relapse and nonrelapse mortality (NRM) of chronic graft-versus-host disease (GVHD), per National Institutes of Health (NIH) criteria, is not well defined after reduced-intensity conditioning (RIC) regimens. We analyzed the association of chronic GVHD with the risk of relapse and NRM using Cox models in 177 consecutive patients who underwent transplantation for hematological malignancies after RIC. The cumulative incidence of chronic GVHD at 36 months was 74% when using Seattle's criteria compared with 54% with NIH consensus. In Cox model, NRM was significantly higher in patients with late-onset, persistent and recurrent acute GVHD (hazard ratio (HR): 6, 25 and 11; P = 0.014, P<0.0001, P<0.0001, respectively). The cumulative incidence of relapse was significantly decreased in patients with chronic GVHD compared with no GVHD group using either Seattle's or NIH criteria (HR 0.43 and 0.38; P = 0.022 and 0.016, respectively), whereas the presence of late-onset, persistent and recurrent acute GVHD was not associated with a decreased rate of relapse (HR: not significant, 0.70 and 0.71; P = not significant, P = 0.73 and P = 0.54, respectively). Chronic GVHD per NIH consensus definition is associated with the graft-versus-tumor effect, whereas all forms associated with acute features beyond day 100 are associated with NRM.
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Affiliation(s)
- S Thepot
- APHP, Hôpital Saint Louis, Service d'Hématologie Greffe, Paris, France
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Robin M, Espérou H, De Latour RP, Petropoulou AD, Xhaard A, Ribaud P, Socié G. correspondence: Splenectomy after allogeneic haematopoietic stem cell transplantation in patients with primary myelofibrosis. Br J Haematol 2010; 150:721-4. [DOI: 10.1111/j.1365-2141.2010.08276.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blin N, Traineau R, Houssin S, Peffault de Latour R, Petropoulou A, Robin M, Larghero J, Ribaud P, Socié G. Impact of Donor-Recipient Major ABO Mismatch on Allogeneic Transplantation Outcome According to Stem Cell Source. Biol Blood Marrow Transplant 2010; 16:1315-23. [DOI: 10.1016/j.bbmt.2010.03.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 03/22/2010] [Indexed: 11/16/2022]
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Menotti J, Porcher R, Ribaud P, Lacroix C, Jolivet V, Hamane S, Derouin F. Monitoring of nosocomial invasive aspergillosis and early evidence of an outbreak using cumulative sum tests (CUSUM). Clin Microbiol Infect 2010. [DOI: 10.1111/j.1469-0691.2010.03150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lafaurie M, Lapalu J, Raffoux E, Breton B, Lacroix C, Socié G, Porcher R, Ribaud P, Touratier S, Molina JM. High rate of breakthrough invasive aspergillosis among patients receiving caspofungin for persistent fever and neutropenia. Clin Microbiol Infect 2010; 16:1191-6. [DOI: 10.1111/j.1469-0691.2009.03050.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fan Y, Willems L, Leboeuf C, Li W, Lacroix C, Robin M, Socié G, Ribaud P, Verneuil L, Janin A. Skin Microvascular Thrombosis in Fusarium Infection in Two Early Biopsied Cases. Case Rep Dermatol 2010; 2:76-81. [PMID: 21113281 PMCID: PMC2988840 DOI: 10.1159/000313934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Fusarium species cause rare and severe infections. Their incidence is increasing in immunocompromised patients but they are also observed in healthy hosts. Because of the rapid dissemination of infection and the frequent resistance of Fusarium species to antifungal drugs, histopathologic evidence of hyphae is very helpful to obtain the diagnosis rapidly. We report the clinical and pathological features of two patients with initial cutaneous lesions. Cutaneous early biopsies showed microvessel involvement with hyphae and thrombosis. Fusarium infection was confirmed by skin culture. Hyphae within a microvessel thrombus in the skin were highly suggestive of disseminated fungal infection. These pathological features enabled to establish an early diagnosis and to start efficient antifungal treatment. In early cutaneous biopsies of immunocompromised patients, the presence of cutaneous vessel thrombosis can suggest a fungal infection and may help to start specific therapy without delay for these life-threatening infections.
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Affiliation(s)
- Yang Fan
- Inserm, U728, Service de Pathologie, Paris, France
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Menotti J, Garin YJF, Thulliez P, Sérugue MC, Stanislawiak J, Ribaud P, de Castro N, Houzé S, Derouin F. Evaluation of a new 5'-nuclease real-time PCR assay targeting the Toxoplasma gondii AF146527 genomic repeat. Clin Microbiol Infect 2010; 16:363-8. [DOI: 10.1111/j.1469-0691.2009.02809.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cordonnier C, Labopin M, Chesnel V, Ribaud P, Camara RDL, Martino R, Ullmann AJ, Parkkali T, Locasciulli A, Yakouben K, Pauksens K, Bonnet E, Einsele H, Niederwieser D, Apperley J, Ljungman P. Immune response to the 23-valent polysaccharide pneumococcal vaccine after the 7-valent conjugate vaccine in allogeneic stem cell transplant recipients: Results from the EBMT IDWP01 trial. Vaccine 2010; 28:2730-4. [DOI: 10.1016/j.vaccine.2010.01.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/07/2010] [Accepted: 01/13/2010] [Indexed: 01/23/2023]
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Corre E, Carmagnat M, Busson M, de Latour RP, Robin M, Ribaud P, Toubert A, Rabian C, Socié G. Long-term immune deficiency after allogeneic stem cell transplantation: B-cell deficiency is associated with late infections. Haematologica 2010; 95:1025-9. [PMID: 20133894 DOI: 10.3324/haematol.2009.018853] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Immune reconstitution was analyzed in 140 consecutive patients who were 2-year disease-free and who underwent myeloablative allogeneic transplantation. A CD4 and CD8 defect was observed involving naive, terminally differentiated, memory and competent cells and above limits values for activated subsets. Natural killer cells normalize at six months while we observed expansion of CD19(+)/CD5(+) B cells after three months and a persisting defect of memory B cells. Chronic graft-versus-host disease did not influence significantly those parameters for CD8 subsets while the naïve and competent CD4 subsets were strongly affected. But the most profound impact of chronic graft-versus-host disease was on B-cell subsets, especially on the memory B population. The cumulative incidence of late severe infections was low (14% at four years). Using Cox's models, only low B-cell counts at 12 (P=0.02) and 24 (P=0.001) months were associated with the hazard of developing late infection, in particular if patients did not develop chronic graft-versus-host disease.
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Affiliation(s)
- Elise Corre
- Service d'Hématologie Greffe, & Inserm U728, Hôpital Saint-Louis, 1 Av Vellefaux, 75010 Paris, France
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Marks D, Kibbler C, Cook G, Glasmacher A, Heussel C, Ribaud P, Solano C, Schlamm H, Miller P, Kantecki M, Pagliuca A. Voriconazole Compared To Itraconazole For Primary Prophylaxis Of Invasive Fungal Infections (IFI) In Allogeneic Hematopoietic Cell Transplant (HCT) Recipients – Results Of The Improvit Study With One Year Follow Up. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bergeron A, Belle A, Sulahian A, Lacroix C, Chevret S, Raffoux E, Arnulf B, Socié G, Ribaud P, Tazi A. Contribution of Galactomannan Antigen Detection in BAL to the Diagnosis of Invasive Pulmonary Aspergillosis in Patients With Hematologic Malignancies. Chest 2010; 137:410-5. [DOI: 10.1378/chest.09-0701] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Marr KA, Bow E, Chiller T, Maschmeyer G, Ribaud P, Segal B, Steinbach W, Wingard JR, Nucci M. Fungal infection prevention after hematopoietic cell transplantation. Bone Marrow Transplant 2009; 44:483-7. [DOI: 10.1038/bmt.2009.259] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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48
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Gupta V, Tomblyn M, Pedersen TL, Atkins HL, Battiwalla M, Gress RE, Pollack MS, Storek J, Thompson JC, Tiberghien P, Young JAH, Ribaud P, Horowitz MM, Keating A. Allogeneic hematopoietic cell transplantation in human immunodeficiency virus-positive patients with hematologic disorders: a report from the center for international blood and marrow transplant research. Biol Blood Marrow Transplant 2009; 15:864-71. [PMID: 19539219 DOI: 10.1016/j.bbmt.2009.03.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 03/28/2009] [Indexed: 11/27/2022]
Abstract
The role of allogeneic hematopoietic cell transplantation (alloHCT) in human immunodeficiency virus (HIV)-positive patients is not known. Using the Center for International Blood and Marrow Transplant Research database, we retrospectively evaluated 23 HIV-positive patients undergoing matched sibling donor (n = 19) or unrelated donor (n = 4) alloHCT between 1987 and 2003. The median age at alloHCT was 32 years. Indications for alloHCT were diverse and included malignant (n = 21) and nonmalignant (n = 2) hematologic disorders. Nine patients (39%) underwent transplantation after 1996, the approximate year that highly active antiretroviral therapy became standard treatment. The median time to neutrophil engraftment was 16 days (range, 7 to 30 days), and the cumulative incidences of grade II-IV acute graft-versus-host disease (aGVHD) at 100 days, chronic GVHD (cGVHD), and survival at 2 years were 30% (95% confidence interval [CI] = 14% to 50%), 28% (95% CI = 12% to 48%), and 30% (95% CI = 14% to 50%), respectively. At a median follow-up of 59 months, 6 patients were alive. Survival appears to be better in the patients undergoing alloHCT after 1996; 4 of these 9 patients survived, compared with only 2 of 14 those undergoing transplantation before 1996. These data suggest that alloHCT is feasible for selected HIV-positive patients with malignant and nonmalignant disorders. Prospective studies are needed to evaluate the safety and efficacy of this modality in specific diseases in these patients.
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Affiliation(s)
- Vikas Gupta
- Division of Haematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
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Debbache K, Varon E, Hicheri Y, Legrand P, Donay JL, Ribaud P, Cordonnier C. The epidemiology of invasive Streptococcus pneumoniae infections in onco-haematology and haematopoietic stem cell transplant patients in France. Are the serotypes covered by the available anti-pneumococcal vaccines? Clin Microbiol Infect 2009; 15:865-8. [DOI: 10.1111/j.1469-0691.2009.02810.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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50
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Cordonnier C, Labopin M, Chesnel V, Ribaud P, De La Camara R, Martino R, Ullmann A, Parkkali T, Locasciulli A, Yakouben K, Pauksens K, Einsele H, Niederwieser D, Apperley J, Ljungman P. Randomized Study of Early versus Late Immunization with Pneumococcal Conjugate Vaccine after Allogeneic Stem Cell Transplantation. Clin Infect Dis 2009; 48:1392-401. [DOI: 10.1086/598324] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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