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Masamichi Isobe, Takaaki Konuma, Seiko Kato, Susumu Tanoue, Mai Mizusawa, Maki Oiwa-Monna, Satoshi Takahashi, Arinobu Tojo
The different effects of pre-engraftment syndrome (PES) and acute graft-versus-host disease (GVHD) on transplant outcomes after cord blood transplantation (CBT) are unclear. We retrospectively evaluated the impact of PES and acute GVHD on relapse and survival after single CBT for 138 adult patients with hematological malignancies in our institute between 2004 and 2016. Multivariate analysis demonstrated that development of grade III to IV acute GVHD, particularly gut or liver involvement of acute GVHD, significantly contributed to higher non-relapse mortality (P<0...
February 13, 2019: Biology of Blood and Marrow Transplantation
Xingan Wang, Michael Emmet O'Brien, Junyi Yu, Liangfang Fu, Qiang Zhang, Songjian Lu, Xiaojing An, John F McDyer, Rama K Mallampalli
Primary graft dysfunction (PGD), a major cause of morbidity after lung transplantation, is linked to ischemia-reperfusion injury (IRI). Other factors such as preceding brain death (BD), hemorrhagic shock (HS), and pre-engraftment lung management are also important. We hypothesized that a multi-hit isogenic mouse model of lung transplantation is more closely linked to PGD than IRI alone. Left lung transplants were performed between inbred mice. A one-hit model of IRI was established by inducing cold ischemia (CI) to the donor lung at 0°C for 1h, 72h or 96h...
February 11, 2019: American Journal of Respiratory Cell and Molecular Biology
Jinhua Ren, Qiaoxian Lin, Weimin Chen, Congmeng Lin, Yuxin Zhang, Cunrong Chen, Shaozhen Chen, Xiaohong Yuan, Ping Chen, Xiaofeng Luo, Yun Lin, Lvying Shen, Mengxian Guo, Qiuru Chen, Min Xiao, Yongquan Chen, Xueqiong Wu, Yanling Zeng, Zhizhe Chen, Xudong Ma, Jianda Hu, Ting Yang
A multicenter retrospective study in 131 patients (44 females/87 males) with hematological disorders who underwent G-CSF-primed/haplo-identical (Haplo-ID) (n = 76) or HLA-identical (HLA-ID) HSCT (n = 55) from February 2013 to February 2016 was conducted to compare the incidence and risk factors for pre-engraftment bloodstream infection (PE-BSI). In the Haplo-ID group, 71/76 patients with high-risk (n = 28) or relapsed/refractory hematological malignancies (n = 43) received FA5-BUCY conditioning (NCT02328950)...
January 26, 2019: European Journal of Clinical Microbiology & Infectious Diseases
Jacopo Mariotti, Chiara De Philippis, Stefania Bramanti, Barbara Sarina, Federica Tordato, Daria Pocaterra, Erminia Casari, Carmelo Carlo-Stella, Armando Santoro, Luca Castagna
OBJECTIVES: T cell-replete Haploidentical stem transplantation (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) is at high risk of invasive fungal infections (IFI) and anti-mold active drug is required for primary antifungal prophylaxis (PAP) according to international guidelines. No data are available on the efficacy of caspofungin as PAP in this setting. METHODS: Here we report our retrospective experience with 103 consecutive patients treated with caspofungin as PAP after Haplo-SCT...
January 23, 2019: European Journal of Haematology
Hui-Hui Song, Zheng-Ping Yu, Wen-Duo Heg, Jia-Hua Ding, Bao-An Chen
OBJECTIVE: To explore the clinical efficacy and safety of unrelated umbilical cord blood transplantation (UCBT) for the treatment of Wiskott-Aldrich syndrome(WAS). METHODS: Five pediatric patients with WAS received single UCBT were retrospectively analyzed. The median age of these male patients was 268 days (range, 3 days -695 days). Among them, 2 patients were transplanted with a 6/6 matched cord blood graft,the other 3 patients received a 5/6 matched cord blood graft...
December 2018: Zhongguo Shi Yan Xue Ye Xue za Zhi
Chen-Hua Yan, Yu Wang, Xiao-Dong Mo, Yu-Qian Sun, Feng-Rong Wang, Hai-Xia Fu, Yao Chen, Ting-Ting Han, Jun Kong, Yi-Fei Cheng, Xiao-Hui Zhang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Jun Huang
Background: Bloodstream infection (BSI) is a common and serious complication after hematopoietic stem cell transplantation (HSCT). An investigation of the characteristics of pre-engraftment BSI after haploidentical HSCT compared with human leukocyte antigen (HLA)-identical sibling HSCT has not been conducted. Methods: A single-center cohort representing 1847 consecutive patients undergoing haploidentical or HLA-identical sibling HSCT from 2013 to 2016 was selected...
November 13, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Hao-Yu Cheng, Lei Yuan, Jing-Bo Wang
RATIONALE: Surgical intervention may be not a contraindication for acute invasive fungal rhinosinusitis (AIFR) during the pre-engraftment period of allogeneic hematopoietic stem cell transplantation (allo-HSCT). PATIENT CONCERNS: We present 2 cases involving patients with AIFR in the pre-engraftment phase of allo-HSCT. DIAGNOSES: Both patients received surgical debridement combined with systemic antifungal treatment. The biopsies identified the diagnosis of AIFR in these 2 cases...
October 2018: Medicine (Baltimore)
Naoyuki Uchida
Cure rates achieved with allogeneic hematopoietic cell transplantation (allo-HCT) for nonremission leukemia have been largely unsatisfactory (10-20%). Cord blood (CB) transplantation has long been thought to have a low propensity for graft-versus-leukemia (GVL) effect because of the low incidence of graft-versus-host disease (GVHD). However, several retrospective studies have revealed that GVL effect of CB transplantation is comparable to or even greater than that of peripheral blood (PB) or bone marrow (BM) transplantation...
2018: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Johan A Maertens, Corrado Girmenia, Roger J Brüggemann, Rafael F Duarte, Christopher C Kibbler, Per Ljungman, Zdenek Racil, Patricia Ribaud, Monica A Slavin, Oliver A Cornely, J Peter Donnelly, Catherine Cordonnier
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...
December 1, 2018: Journal of Antimicrobial Chemotherapy
Mara Bonardi, Elena Turpini, Giuseppina Sanfilippo, Tommaso Mina, Alessandra Tolva, Federico Zappoli Thyrion
Hematopoietic stem cell transplantation (HSCT) is the only therapy for a subset of patients with malignant and nonmalignant diseases. Central nervous system (CNS) complications continue to be an important cause of morbidity and significantly contribute to mortality after HSCT. These complications include infections, cerebrovascular lesions, therapy-induced diseases, metabolic disturbances, and post-HSCT carcinogenesis. Following HSCT, three phases can be identified on the basis of the patient's immune status: the pre-engraftment period (<30 days after HSCT), the early postengraftment period (30-100 days after HSCT), and the late postengraftment period (>100 days after HSCT)...
July 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Carlos Solano, Estela Giménez, Eliseo Albert, Eva María Mateo, Montserrat Gómez, Rosa Goterris, Ariadna Pérez, Paula Amat, Juan Carlos Hernández-Boluda, Marc Poch, José Luis Piñana, David Navarro
To gauge the risk of delaying initiation of prophylaxis with letermovir from the time of donor infusion to prevent CMV infection in allo-HSCT recipients we investigated the clinical outcomes of CMV DNAemia episodes occurring before engraftment, and compared to that of episodes developing after engraftment (up to day +365). A total of 197 consecutive adult patients were included. Plasma CMV DNA load was monitored by real-time PCR assays [limit of detection: 31 IU/ml]. A total of 150 out of 197 patients had CMV DNAemia (cumulative incidence of 77%; 95% CI, 73-81%), and 38 out of the 197 patients developed it before engraftment (cumulative incidence, 19%; 95% CI, 10-30...
June 13, 2018: Bone Marrow Transplantation
Barbara Sarina, Jacopo Mariotti, Stefania Bramanti, Lucio Morabito, Roberto Crocchiolo, Andrea Rimondo, Federica Tordato, Daria Pocaterra, Erminia Casari, Chiara De Philippis, Carmelo Carlo-Stella, Armando Santoro, Luca Castagna
BACKGROUND: Invasive fungal infections (IFI) represent a common side effect of allogeneic hematopoietic stem cell transplant (allo-SCT), resulting in increased non relapse mortality (NRM) and reduced overall survival (OS) rates. Seventy-five days of Fluconazole 400 mg/d represents the standard primary antifungal prophylaxis (PAP) after allo-SCT, especially for low-risk transplants. However, the ideal dosage of fluconazole has never been tested. METHODS: Here, we report the experience of our institution on 113 consecutive patients receiving an allo-SCT from a HLA identical sibling between 1999 and 2015, where PAP consisted of fluconazole 100 mg/d only during the pre-engraftment phase...
August 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Giulia Gustinetti, Anna Maria Raiola, Riccardo Varaldo, Federica Galaverna, Francesca Gualandi, Valerio Del Bono, Andrea Bacigalupo, Emanuele Angelucci, Claudio Viscoli, Malgorzata Mikulska
To investigate rates and outcomes of antibiotic de-escalation during pre-engraftment neutropenia in allogeneic hematopoietic stem cell transplantation (HSCT) recipients. 110 consecutive HSCTs performed between January 2013 and March 2014 were analyzed. De-escalation was defined as narrowing the spectrum of antibiotic treatment either within (early) or after 96 hours (late) from starting antibiotics. Discontinuation, considered a form of de-escalation, was defined as stopping antibiotics before engraftment. De-escalation failure was defined as restarting/escalating antibiotics within 96 hours after de-escalation...
August 2018: Biology of Blood and Marrow Transplantation
A M Ferreira, F Moreira, T Guimaraes, F Spadão, J F Ramos, M V Batista, J S Filho, S F Costa, V Rocha
BACKGROUND: Bloodstream infections (BSI) are a major complication in the early phase of a haematopoietic stem cell transplant (HSCT). AIM: To describe the incidence and risk factors for BSI occurring in the pre-engraftment phase of HSCT, and its impact on mortality. METHODS: Clinical variables of 232 HSCT patients were analysed retrospectively between 2014 and 2015. Univariate Cox regression analyses were performed to test the association between each covariate and the outcome...
September 2018: Journal of Hospital Infection
Sung-Yeon Cho, Hyeon-Jeong Lee, Dong-Gun Lee
Hematopoietic stem cell transplantation (HSCT) is a treatment for hematologic malignancies, immune deficiencies, or genetic diseases, ect. Recently, the number of HSCTs performed in Korea has increased and the outcomes have improved. However, infectious complications account for most of the morbidity and mortality after HSCT. Post-HSCT infectious complications are usually classified according to the time after HSCT: pre-engraftment, immediate post-engraftment, and late post-engraftment period. In addition, the types and risk factors of infectious complications differ according to the stem cell source, donor type, conditioning intensity, region, prophylaxis strategy, and comorbidities, such as graft-versushost disease and invasive fungal infection...
March 2018: Korean Journal of Internal Medicine
Ella J Ariza-Heredia, Roy F Chemaly, Lokesh R Shahani, Ying Jang, Richard E Champlin, Victor E Mulanovich
Acyclovir is commonly used to prevent and treat herpes simplex virus (HSV) reactivation after hematopoietic cell transplant (HCT), and only few reports have been published on acyclovir-resistant HSV in HCT recipients. We reviewed the medical records of patients with a microbiologic diagnosis of acyclovir-resistant HSV by plaque reduction test who received an HCT from 2002 through 2014. A total of 4 028 HCTs were performed during the study period, and 18 of the recipients met the diagnostic criteria for acyclovir-resistant HSV...
June 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Xiao-Dong Mo, Xia Yan, Wei Hu, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Xiao-Dong Xu, Lin-Nan Wang, Xin-Xin He, Chen-Hua Yan, Huan Chen, Yu-Hong Chen, Kai-Yan Liu, Xiao-Jun Huang
In this study, we aimed to investigate the incidence, risk factors, and clinical outcomes of perianal infections during the pre-engraftment phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Consecutive patients who underwent non-T-cell-depleted allo-HSCT at the Peking University Institute of Hematology from January 1 to December 31, 2016 were enrolled (n = 646). Ninety-nine patients were found to have perianal infections during the pre-engraftment phase, and 80 were found to have neutropenia on perianal infection diagnosis...
2018: Acta Haematologica
S M Rubinstein, K A Culos, B Savani, G Satyanarayana
Hematopoietic cell transplantation (HCT) offers definitive management for a wide variety of malignant and nonmalignant diseases. Conditioning regimens and therapies used to prevent and treat GvHD are immune suppressive, often increasing the risk of developing fungal disease due to yeasts or molds. Antifungal prophylaxis may be useful in preventing morbidity and mortality during and after HCT. In this article, we review the epidemiology and current literature regarding strategies for prevention of invasive fungal disease (IFD) in the pre-engraftment and post-engraftment settings, and propose future direction for scientific discovery...
February 2018: Bone Marrow Transplantation
Corrado Girmenia, Alice Bertaina, Alfonso Piciocchi, Katia Perruccio, Alessandra Algarotti, Alessandro Busca, Chiara Cattaneo, Anna Maria Raiola, Stefano Guidi, Anna Paola Iori, Anna Candoni, Giuseppe Irrera, Giuseppe Milone, Giampaolo Marcacci, Rosanna Scimè, Maurizio Musso, Laura Cudillo, Simona Sica, Luca Castagna, Paolo Corradini, Francesco Marchesi, Domenico Pastore, Emilio Paolo Alessandrino, Claudio Annaloro, Fabio Ciceri, Stella Santarone, Luca Nassi, Claudio Farina, Claudio Viscoli, Gian Maria Rossolini, Francesca Bonifazi, Alessandro Rambaldi
Background: Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable. Methods: We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant...
November 13, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Malgorzata Mikulska, Anna Maria Raiola, Federica Galaverna, Elisa Balletto, Maria Lucia Borghesi, Riccardo Varaldo, Francesca Gualandi, Livia Giannoni, Giordana Pastori, Daniele Roberto Giacobbe, Alessio Signori, Valerio Del Bono, Claudio Viscoli, Andrea Bacigalupo, Emanuele Angelucci
Bloodstream infections (BSIs) are frequent and important infectious complications after hematopoietic cell transplantation (HCT). The aim of this study was to analyze the incidence, risk factors, and outcome of pre-engraftment BSIs after allogeneic HCT. We retrospectively analyzed data from 553 consecutive patients who underwent HCT between 2010 and 2016. Sixty percent of the patients received T cell-replete unmanipulated haploidentical bone marrow with high-dose post-transplantation cyclophosphamide. The BSI rate was 30%; among isolated 213 pathogens, 54% were Gram-positive, 43% were Gram-negative, and 3% were fungi...
January 2018: Biology of Blood and Marrow Transplantation
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