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1.
Dermatol. argent ; 27(3): 119-122, jul.- sep. 2021. il, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1373038

ABSTRACT

El diagnóstico diferencial entre la enfermedad de injerto contra huésped aguda grave (estadio IV) y la necrólisis epidérmica tóxica pude resultar difícil en el contexto de un paciente trasplantado, ya que ambas tienen presentaciones clínicas similares. Sin embargo, la distinción entre ellas es fundamental porque ocasionan una gran morbimortalidad, y su manejo y pronóstico difieren. Algunas pequeñas diferencias clínicas e histopatológicas son de gran ayuda para el diagnóstico diferencial y el dermatólogo deberá reconocerlas para tomar una conducta correcta y oportuna. Se comunica el caso de un paciente que presentó ampollas y epidermólisis después del trasplante de células hematopoyéticas y en el que se planteó la dificultad diagnóstica para diferenciar entre ambas afecciones.


The differental diagnosis between severe graft-versus-host disease (stage IV) and toxic epidermal necrolysis can be difficult in the context of a transplant patient, since both conditions have similar clinical presentations. However, the distinction between these two entities is critical because they produce great morbidity and mortality and their management and prognosis differ. Some small clinical and histopathological differences are of great help for the differential diagnosis, and the dermatologist must recognize them in order to take a correct and timely conduct. We present the case of a patient who developed blisters and epidermolysis after hematopoietic cell transplantation, and in whom the diagnostic difficulty to differentiate between the two entities was raised.


Subject(s)
Humans , Male , Adult , Hematopoietic Stem Cell Transplantation/adverse effects , Graft vs Host Disease/diagnosis , Methylprednisolone/administration & dosage , Cyclosporine/administration & dosage , Graft vs Host Disease/pathology , Graft vs Host Disease/drug therapy , Antilymphocyte Serum
2.
Rev. cuba. hematol. inmunol. hemoter ; 36(3): e1277, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156444

ABSTRACT

Introducción: La aplasia medular adquirida grave es una enfermedad hematológica infrecuente caracterizada por una disminución o ausencia de precursores hematopoyéticos en la médula ósea, lo cual se expresa con distintos grados de citopenias. Varios factores, infecciosos o no, pueden incidir en su origen. Su manejo es complejo y puede incluir tratamiento inmunosupresor y trasplante de progenitores hematopoyéticos alogénico. Objetivo: Demostrar la utilidad de la realización del trasplante de progenitores hematopoyéticos alogénico haploidéntico en pacientes con aplasia medular grave. Caso clínico: Paciente masculino de 21 años de edad, con antecedentes de salud, que en octubre del 2018 debutó con íctero, pancitopenia, lesiones purpúrico hemorrágicas en piel y mucosas, en el curso de una hepatitis aguda seronegativa. La biopsia de médula ósea mostró aplasia medular severa. Se inició tratamiento inmunosupresor con globulina antitimocίtica, ciclosporina A y metilprednisolona. Al cabo de los 6 meses mantenía trombocitopenia severa con necesidades transfusionales y en octubre de 2019 se decide realizar trasplante de progenitores hematopoyéticos alogénico con donante haploidéntico y empleando como tratamiento acondicionante globulina antitimocίtica, fludarabina, ciclofosfamida y bajas dosis de irradiación corporal total. En evaluación clίnica de julio de 2020 (dίa + 280 del trasplante) el paciente estaba asintomático y con parámetros hematológicos normales. Conclusiones: Se demostró que el trasplante de progenitores hematopoyéticos alogénico haploidéntico es un proceder realizable y útil en pacientes con aplasia medular grave, lo cual corrobora el beneficio clínico que puede aportar su ejecución en pacientes con esta enfermedad(AU)


Introduction: Acquired severe marrow aplasia is a rare hematological disease characterized by decrease or absence of hematopoietic precursors in bone marrow, which is expressed with different degrees of cytopenias. Several factors, infectious or not, can influence its origin. Its management is complex and may include immunosuppressive treatment and allogeneic hematopoietic stem-cell transplantation. Objective: To demonstrate the usefulness of performing haploidentical allogeneic hematopoietic stem-cell transplantation in patients with severe medullary aplasia. Clinical case: A 21-year-old male patient, with medical history, who first presented, in October 2018, with icterus, pancytopenia, as well as purpuric hemorrhagic lesions on the skin and mucosa, in the course of acute seronegative hepatitis. The bone marrow biopsy showed severe marrow aplasia. Immunosuppressive treatment was started with antithymocytic globulin, cyclosporine A, and methylprednisolone. After six months, he maintained severe thrombocytopenia under transfusion requirements and, in October 2019, the decision was to perform allogeneic hematopoietic stem-cell transplantation with a haploidentical donor and using antithymocyte globulin, fludarabine, cyclophosphamide, and low doses of total body irradiation as conditioning treatment. In the clinical assessment carried out in July 2020 (day +280 after transplantation), the patient was asymptomatic and with normal hematological parameters. Conclusions: Transplantation of haploidentic allogeneic hematopoietic progenitors was shown to be a feasible and useful procedure in patients with severe marrow aplasia, which corroborates the clinical benefit that its execution can bring in patients with this disease(AU)


Subject(s)
Humans , Male , Young Adult , Tissue Donors/ethics , Methylprednisolone/therapeutic use , Whole-Body Irradiation/methods , Microscopy, Electron, Scanning Transmission/methods , Hematologic Diseases , Hematopoietic Stem Cell Transplantation/methods , Cuba , Transplantation, Haploidentical/methods , Anemia, Aplastic/therapy , Antilymphocyte Serum
3.
Blood Research ; : 27-34, 2020.
Article in English | WPRIM | ID: wpr-820806

ABSTRACT

BACKGROUND: Although T-cell-replete hematopoietic cell transplantation (HCT) from haploidentical donors (HIDs) using anti-thymocyte globulin (ATG) has shown promising outcomes, previous studies often adopted heterogenous graft sources and conditioning.METHODS: We retrospectively compared HCT outcomes from 62 HIDs, 36 partially-matched unrelated donors (PUDs), and 55 matched unrelated donors (MUDs) in patients with acute leukemia or myelodysplastic syndrome using the same graft source of peripheral blood and a reduced intensity conditioning of busulfan, fludarabine, and ATG.RESULTS: The estimates of 3-yr disease-free survival (DFS) and overall survival (OS) rates were not significantly different among the MUD, HID, and PUD groups, at 46%, “41%, and 36%” for the DFS rate (P=0.844), and 55%, 45%, and 45% for the OS rate (P=0.802), respectively. Cumulative incidence of relapse and non-relapse mortality at 3 yr was similar among different donor types. Subsequent multivariable analyses showed that the sex of the patient (male) and a high/very high disease risk index were independently associated with poorer DFS and OS, while the donor type was not.CONCLUSION: T-cell replete HCT from HIDs using an ATG-containing reduced intensity conditioning regimen may be a reasonable option in the absence of matched related donors in patients with acute leukemia or myelodysplastic syndrome.


Subject(s)
Antilymphocyte Serum , Busulfan , Cell Transplantation , Disease-Free Survival , Humans , Incidence , Leukemia , Mortality , Myelodysplastic Syndromes , Recurrence , Retrospective Studies , T-Lymphocytes , Tissue Donors , Transplants , Unrelated Donors
5.
Rev. méd. Chile ; 146(2): 175-182, feb. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961375

ABSTRACT

Background: The first line treatment for patients < 40 years old with aplastic anemia (AA) is allogeneic HLA-identical sibling donor transplantation (SCT). Immunosuppressive therapy (IST) with a combination of Thymoglobuline (ATG) and cyclosporine is used for older patients or those without a donor. Five year overall survival (OS) for both therapies is > 70%. Aim: To report the experience with SCT and ATG for AA in a public hospital. Patients and Methods: AA was diagnosed in 42 patients between 1998 and 2016, according to Camitta criteria. Thirty eight (90%) received treatment, 7 (18%) under 40 years old received SCT, and 31 (82%) IST. The rest were not treated. OS was calculated from date of diagnosis until last control, death or loss from follow up. Results: Complete or partial hematologic response, was obtained in 71% and 58% of cases with SCT and IS, respectively. Five year OS was 71% and 55% with SCT and IST, respectively. No difference in response was observed between horse and rabbit ATG. Conclusions: SCT from an HLA-identical sibling donor had a high response rate and survival. IST instead, had a lower response and survival, due to an initial high mortality rate.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cyclosporine/administration & dosage , Stem Cell Transplantation , Immunosuppressive Agents/administration & dosage , Anemia, Aplastic/surgery , Anemia, Aplastic/mortality , Antilymphocyte Serum/administration & dosage , Time Factors , Severity of Illness Index , Combined Modality Therapy , Kaplan-Meier Estimate , Hospitals, Public
6.
Yonsei Medical Journal ; : 643-651, 2018.
Article in English | WPRIM | ID: wpr-715898

ABSTRACT

PURPOSE: To investigate the efficacy and safety of umbilical cord blood (UCB) infusion (UCBI) plus immunosuppressive therapy (IST) treatment in comparison to IST treatment, as well as predictive factors for clinical responses, in severe aplastic anemia (SAA) patients. MATERIALS AND METHODS: Totally, 93 patients with SAA were enrolled in this cohort study. In the IST group, rabbit antithymocyte globulin (r-ATG) combined with cyclosporine A (CsA) was administered, while in the IST+UBCI group, r-ATG, CsA, and UCB were used. RESULTS: After 6 months of treatment, UCBI+IST achieved a higher complete response (CR) rate (p=0.002) and an elevated overall response rate (ORR) (p=0.004), compared to IST. Regarding hematopoietic recovery at month 6, platelet responses in the UCBI+IST group were better than those in the IST group (p=0.002), and UCBI+IST treatment facilitated increasing trends in absolute neutrophil count (ANC) response (p=0.056). Kaplan-Meier curves illuminated UCBI+IST achieved faster ANC response (p < 0.001) and platelet response (p < 0.001), compared with IST therapy. There was no difference in overall survival (OS) between the two groups (p=0.620). Furthermore, logistic regression analysis demonstrated that UCBI+IST was an independent predicting factor for both CR (p=0.001) and ORR (p < 0.001), compared to IST; meanwhile, very severe aplastic anemia (VSAA) and ANC could predict clinical responses as well. However, Cox proportional hazard regression indicated that VSAA (p=0.003), but not UCBI+IST, affected OS. Safety profiles showed that UCBI+IST therapy did not elevate adverse events, compared with IST treatment. CONCLUSION: UCBI+IST achieved better clinical responses and hematopoietic recovery than IST, and was well tolerated in SAA patients.


Subject(s)
Anemia, Aplastic , Antilymphocyte Serum , Blood Platelets , Cohort Studies , Cyclosporine , Fetal Blood , Humans , Logistic Models , Neutrophils , Umbilical Cord
7.
Blood Research ; : 145-151, 2018.
Article in English | WPRIM | ID: wpr-714929

ABSTRACT

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapy for β-thalassemia major (TM) and sickle cell disease (SCD) in children. Graft-versus-host disease (GVHD) and treatment-related mortality (TRM) remain significant challenges to improving survival after HSCT. Here, we analyzed the outcome of TM and SCD patients, who received allogeneic HSCT with myeloablative conditioning at our institution. METHODS: Twenty-two patients (15 TM, 7 SCD), with a median age of 9 years (range, 1.6–16.9), underwent allogeneic HSCT using busulfan, cyclophosphamide and rabbit anti-thymocyte globulin-based conditioning. Cells were derived from either the bone marrow (8 patients), or peripheral blood stem cells (14 patients). The majority of patients received HSCT from a matched sibling donor (N=18). GVHD prophylaxis included cyclosporine and short course methotrexate. RESULTS: All patients achieved donor engraftment. Two SCD patients died from TRM-related grade IV gut GVHD (N=1) or severe bronchiolitis obliterans (BO) (N=1). Cumulative incidence of acute and chronic GVHD was 36.4% and 32.7%, respectively. Veno-occlusive disease (VOD) occurred in 8 patients (36.4%), but resolved in all instances. Epstein-Barr virus (EBV)-related post-transplantation lymphoproliferative disease (PTLD) occurred in 1 patient. The overall survival (OS) was 90.9% (TM 100%, SCD 71.4%), with all patients achieving transfusion independence, while 8 achieved complete donor chimerism. CONCLUSION: Busulfan, cyclophosphamide, and ATG-based conditioning for HSCT of TM and SCD patients did not result in graft failure, although modifications may be required to reduce VOD incidence. Further changes to donor type and cell source prioritization are necessary to minimize TRM and morbidity caused by GVHD.


Subject(s)
Anemia, Sickle Cell , Antilymphocyte Serum , beta-Thalassemia , Bone Marrow , Bronchiolitis Obliterans , Busulfan , Child , Chimerism , Cyclophosphamide , Cyclosporine , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells , Hemoglobinopathies , Herpesvirus 4, Human , Humans , Incidence , Methotrexate , Mortality , Siblings , Stem Cells , Tissue Donors , Transplants
8.
Article in English | WPRIM | ID: wpr-718768

ABSTRACT

BACKGROUND: Currently, trimethoprim-sulfamethoxazole is used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis, but it is associated with frequent adverse effects. This study evaluated the efficacy and safety of the current protocol and proposes an individualized risk-based prophylaxis protocol. METHODS: The PJP incidence and risk factors during the first 6 months (early PJP) and afterwards (late PJP) was assessed in renal transplant recipients with (prophylaxis group) and without (no-prophylaxis group) 6-month PJP prophylaxis. RESULTS: In 578 patients, there were 39 cases of PJP during a median follow-up of 51 months. Renal adverse events were encountered frequently during trimethoprim-sulfamethoxazole prophylaxis, leading to premature discontinuation. Patients without the prophylaxis had a significantly higher incidence of early PJP (n=27, 6.6%) compared to patients with the prophylaxis (n=0). The incidence of late PJP was 2.2%, without between-group differences. The factors associated with early PJP were preoperative desensitization and acute rejection within 1 month, whereas late PJP was associated with age, deceased donor transplant, and acute rejection requiring antithymocyte globulin treatment. CONCLUSIONS: Based on the simulation results of several risk-based scenarios, the authors recommend universal prophylaxis up to 6 months post-transplant and extended selective prophylaxis in patients aged ≥57 years and those with a transplant from deceased donors.


Subject(s)
Antilymphocyte Serum , Follow-Up Studies , Humans , Incidence , Kidney Transplantation , Pneumocystis carinii , Pneumocystis , Pneumonia , Risk Factors , Tissue Donors , Transplant Recipients , Trimethoprim, Sulfamethoxazole Drug Combination
9.
Rev. bras. ter. intensiva ; 29(4): 436-443, out.-dez. 2017. tab
Article in Portuguese | LILACS | ID: biblio-899534

ABSTRACT

RESUMO Objetivos: Definir frequência de doença por citomegalovírus dentre pacientes transplantados renais na unidade de terapia intensiva nos quais houve a suspeita desta complicação; identificar fatores predisponentes e possível impacto na evolução clínica. Métodos: Estudo retrospectivo observacional, no qual foram incluídos pacientes transplantados renais acima de 18 anos, internados por quaisquer motivos em uma unidade de terapia intensiva, com pelo menos uma coleta de antigenemia ou reação em cadeia da polimerase para citomegalovírus durante internação. Doença por citomegalovírus foi definida por antigenemia positiva ou reação em cadeia da polimerase acima de 500 cópias/mL, na presença de sintomas, no contexto clínico apropriado, conforme julgamento do médico assistente. Resultados: Foram incluídos 99 pacientes (idade: 53,4 ± 12,8 anos, 71,6% homens). A doença por citomegalovírus foi diagnosticada em 39 pacientes (39,4%). Sintomas respiratórios (51%), piora clínica inespecífica (20%) ou sintomas gastrintestinais (14%) foram os principais motivos para coleta de exames. O tempo de transplante foi menor naqueles com doença por citomegalovírus em relação àqueles sem este diagnóstico (6,5 meses e 31,2 meses; p = 0,001), bem como uso de pulsoterapia nos últimos 6 meses (41% e 16,9%; p = 0,008) e uso prévio de timoglobulina no último ano (35,9% e 6,8%; p < 0,001). No modelo de regressão logística, somente o tempo de transplante e o uso de timoglobulina associaram-se à maior frequência de citomegalovírus. Não houve diferença na evolução clínica entre pacientes com ou sem doença por citomegalovírus. Conclusão: Em pacientes transplantados renais com suspeita de doença por citomegalovírus, a prevalência foi alta. O tempo de transplante menor que 6 meses e o uso de timoglobulina no último ano devem aumentar a suspeita do intensivista para esta complicação.


ABSTRACT Objectives: To define the frequency of cytomegalovirus disease among kidney transplant patients in an intensive care unit in which this complication was suspected and to identify predisposing factors and their possible impact on clinical outcome. Methods: Retrospective observational study in which kidney transplant patients over the age of 18 years were hospitalized for any reason in an intensive care unit with at least one collection of samples to test for the presence of antigenemia or cytomegalovirus via polymerase chain reaction during hospitalization. Cytomegalovirus disease was defined as positive antigenemia or polymerase chain reaction above 500 copies/mL in the presence of symptoms and in the appropriate clinical setting, as judged by the attending physician. Results: A total of 99 patients were included (age: 53.4 ± 12.8 years, 71.6% male). Cytomegalovirus disease was diagnosed in 39 patients (39.4%). Respiratory symptoms (51%), non-specific clinical worsening (20%) or gastrointestinal symptoms (14%) were the main reasons for exam collection. Transplant time was lower in those with cytomegalovirus disease than in those without this diagnosis (6.5 months and 31.2 months, p = 0.001), along with pulse therapy in the last 6 months (41% and 16.9%, p = 0.008) and previous use of thymoglobulin in the last year (35.9% and 6.8%, p < 0.001). In the logistic regression model, only the transplant time and the use of thymoglobulin were associated with a higher frequency of cytomegalovirus. There was no difference in clinical evolution between patients with and without cytomegalovirus disease. Conclusion: In kidney transplant patients suspected of cytomegalovirus disease, the prevalence was high. Transplant time less than 6 months, and the use of thymoglobulin in the last year should increase the intensivist's suspicion for this complication.


Subject(s)
Humans , Male , Female , Adult , Aged , Kidney Transplantation/methods , Cytomegalovirus Infections/epidemiology , Intensive Care Units , Antilymphocyte Serum/administration & dosage , Time Factors , Logistic Models , Polymerase Chain Reaction , Prevalence , Retrospective Studies , Cytomegalovirus/isolation & purification , Immunosuppressive Agents/administration & dosage , Middle Aged
10.
Rev. fac. cienc. méd. (Impr.) ; 14(1): 9-17, ene.-jun. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-849246

ABSTRACT

Según la Organización Mundial de la Salud, se estima que anualmente suceden unos 5 millones de accidentes por mordedura de serpiente con 100 000 fallecimientos y cerca del triple de casos de amputación y discapacidad permanente. En el departamento de Atlántida, Honduras, la mordedura de serpiente se ha relacionado con la actividad agrícola, específicamente, con el cultivo de palma africana. Objetivo: Describir las características epidemiológicas y demográficas de pacientes que sufrieron mordedura de serpiente atendidos en el Hospital Tela, Atlántida. Material y Métodos: Estudio descriptivo, retrospectivo y transversal realizado durante el periodo comprendido del año 2013 al 2015 en el Hospital Tela. Universo, 92 casos con diagnóstico de mordedura de serpiente, de los cuales se excluyeron 8 casos por no cumplir criterios de inclusión, se obtuvo una muestra de 84 casos. La recolección de datos se obtuvo de los expedientes clínicos. Resultados: Del total de casos estudiados, la incidencia fue de 32(38.1%) casos en el 2015, 20(23.8%) en el 2014 y 32(38.1%) en el 2013. El rango de edad de los pacientes oscilaba entre los 2 a 75 años, con edad media de 28 años. De los 84 casos estudiados, 25(29.8%) eran menores de 18, 53(63.1%) se encontraban entre los 18-60 y 6(7.1%) eran mayores de 60 años. Se encontró 40(47.6%) casos del sexo femenino y 44(52.4%) masculino. 82(97.6%) eran del departamento de Atlántida y 2 eran procedentes del departamento de Yoro. 52(61.9%) pacientes afirmaron haber sido mordido por serpiente de la especie Bothrops asper (Barba Amarilla), los pies fueron los sitios anatómicos de mayor frecuencia afectados 55(65.5%), con predominio del pie izquierdo. Conclusión: La frecuencia de mordeduras de serpiente fue de 84 casos entre los años 2013-2015, siendo la población del municipio de Tela la más afectada, con 68% de los casos...(AU)


Subject(s)
Humans , Antilymphocyte Serum/adverse effects , Neglected Diseases , Snake Bites/complications
11.
J. bras. nefrol ; 39(2): 181-185, Apr.-June 2017. graf
Article in English | LILACS | ID: biblio-893754

ABSTRACT

Abstract Introduction: Immunosuppression of T lymphocytes is required for preventing acute rejection after transplantation and for the treatment of chronic autoimmune and inflammatory diseases. The laboratory monitoring for this therapy is the measurement of T cells by immunophenotyping, aiming the target value of less than 20 cells per µL. Objective: To establish a cut-off point for the total number of lymphocytes in the automated blood cell count that reflects less than twenty T cells µL by immunophenotyping. Methods: We studied and evaluated 242 kidney transplant patients that had results of automated blood cell count and quantification of T cells by immunophenotyping technique. The patients were divided into two groups, depending on the T lymphocyte immunophenotyping rates established by lower and higher than 20 cells per µL. After, we evaluated the cut-off point for lymphocytes in the blood cell count with a specificity of 100% to exclude patients with high levels of T lymphocytes. Results: We found that the cut-off point of 70 lymphocytes per µL obtained by automated blood cell count showed 100% of specificity to exclude patients with T-cell counts higher than 20 cells per µL by immunophenotyping. Conclusion: The results found in this study may be helpful to monitor the immunosuppressive therapy in kidney transplant patients in places where a flow cytometer is not available, or when this equipment is not present in the full routine.


Resumo Introdução: A imunossupressão de linfócitos T é necessária para a prevenção da rejeição aguda em transplantes e no tratamento de doenças autoimunes e inflamatórias crônicas. O seu monitoramento laboratorial consiste na quantificação dos linfócitos T realizada pela técnica de imunofenotipagem, na qual o valor preconizado é manter inferior a 20 células/µL. Objetivo: Estabelecer um ponto de corte para o número de linfócitos totais no hemograma automatizado que reflita uma contagem de linfócitos T inferior a 20 células/µL por imunofenotipagem. Métodos: Foram avaliados 242 pacientes transplantados renais que continham resultados do hemograma automatizado e quantificação de linfócitos T por imunofenotipagem. Os pacientes foram divididos em dois grupos, conforme os valores de linfócitos T estabelecidos pela imunofenotipagem: inferiores e superiores a 20 células/µL. A partir disto, foi avaliado o ponto de corte de linfócitos no hemograma com especificidade de 100% para excluir os pacientes com valores elevados de linfócitos T. Resultados: Este estudo evidenciou que o ponto de corte de 70 linfócitos/µL obtidos pelo hemograma automatizado apresentou especificidade de 100% para excluir os pacientes com contagens de linfócitos T superiores a 20 células/µL na imunofenotipagem. Conclusão: Esta pesquisa poderá auxiliar no monitoramento da terapia imunossupressora em pacientes transplantados renais em locais que não possuem um citômetro de fluxo disponível, ou ainda quando este equipamento não se faz presente na rotina integral.


Subject(s)
Humans , Male , Female , Middle Aged , T-Lymphocytes/immunology , Immunosuppression Therapy , Kidney Transplantation , CD3 Complex , Immunosuppressive Agents/therapeutic use , Antilymphocyte Serum/therapeutic use , Retrospective Studies , Immunophenotyping/methods , Drug Monitoring , Lymphocyte Count
12.
J. Health NPEPS ; 2(1): 1-4, Janeiro-Março. 2017.
Article in Portuguese | LILACS, BDENF, ColecionaSUS | ID: biblio-1052495
13.
Article in English | WPRIM | ID: wpr-162098

ABSTRACT

A high degree of sensitization to human leukocyte antigen requires more intensive induction therapy; however, this increases vulnerability to opportunistic infections following kidney transplantation. Although recent studies have suggested that combined induction therapy with antithymocyte globulin and rituximab would be more effective in highly sensitized kidney recipients, we experienced a case of near-fatal invasive pulmonary aspergillosis 2 months after combined induction and early rejection therapy for graft dysfunction. Fortunately, the patient recovered with intensive antifungal treatment and lung lobectomy for a necrotic cavity. Antifungal prophylaxis should be considered in cases undergoing intensive induction therapy.


Subject(s)
Antilymphocyte Serum , Humans , Immunoglobulins , Invasive Pulmonary Aspergillosis , Kidney Transplantation , Kidney , Leukocytes , Lung , Opportunistic Infections , Plasmapheresis , Rituximab , Transplants
14.
J. bras. nefrol ; 38(1): 82-89, jan.-mar. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-777492

ABSTRACT

Resumo Introdução: A sensibilização está associada a piores desfechos clínicos após o transplante renal (TxR), incluindo maior incidência de função tardia, rejeição aguda e perda do enxerto. Objetivos: Avaliar os desfechos de eficácia e segurança de 1 ano de receptores de TxR com doador falecido sensibilizados induzidos com globulina antitimócito (ATG) e compará-las aos de pacientes não sensibilizados. Métodos: Receptores de TxR com doador falecido entre janeiro de 1998 e dezembro de 2009 foram divididos em 5 grupos: grupo controle 1 - n = 89, PRA negativo, sem indução; grupo controle 2 - n = 94, PRA negativo, indução com basiliximabe; grupo controle 3 - n = 81, PRA negativo, indução com ATG; grupo teste 4 - n = 64, PRA 1-49%, indução com ATG; grupo teste 5 - n = 118, PRA ≥ 50%, indução com ATG. Resultados: Não houve diferença na incidência de rejeição entre pacientes sensibilizados e não sensibilizados, exceto pelo grupo 1, que apresentou a maior incidência de rejeição aguda comprovada por biópsia (20,2%, p = 0,006 vs. grupo 4 ep = 0,001 vs. grupo 5). Os pacientes sensibilizados induzidos com ATG apresentaram maior incidência de infecção por citomegalovírus quando comparados aos pacientes do grupo 2 (26,6% e 14,4% vs. 2,1%). Não houve diferença nas sobrevidas do enxerto e do paciente. Na análise multivariada, PRA > 50% e uso de ATG não foram associados à perda, perda com óbito censorado ou óbito. Conclusão: Os pacientes sensibilizados induzidos com ATG apresentaram incidência de rejeição semelhante ou inferior à de pacientes não sensibilizados não induzidos. Estes pacientes apresentaram sobrevidas do enxerto e do paciente semelhantes em 1 ano e comparável perfil de segurança.


Abstract Introduction: Sensitization is associated with worse clinical outcomes after kidney transplantation (KT), including increased incidence of delayed graft function, acute rejection (AR) and graft loss. Objectives: To evaluate 1-year efficacy and safety outcomes in sensitized KT recipients receiving antithymocyte globulin (ATG) induction and compare them to non-sensitized patients. Methods: Deceased donors KT recipients transplanted between January 1998 and December 2009 were divided into 5 groups: control group 1 -n = 89, PRA negative, without induction therapy; control group 2 - n = 94, PRA negative, basiliximab induction; control group 3 - n = 81, PRA negative, ATG induction; test group 4 - n = 64, PRA 1-49%, ATG induction; test group 5 -n = 118, PRA ≥ 50%, ATG induction. Results: There was no difference in the incidence of AR among patients sensitized and non-sensitized, except for group 1, with highest incidence of AR (20.2%,p = 0.006 vs. Group 4 andp = 0.001 vs. group 5). Sensitized patients induced with ATG had higher incidence of citomegalovirus infection when compared with group 2 (26.6% and 14.4% vs. 2.1%). There were no differences in graft and patient survivals. In multivariable analysis, PRA > 50% and ATG induction were not associated with graft loss, death or death-censored graft loss. Conclusion: Sensitized patients induced with ATG presented similar or lower incidence of AR when compared with non-sensitized patients not induced. Besides, these patients had similar safety profile and graft and patient survivals at 1 year.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Kidney Transplantation , Graft Rejection/epidemiology , Graft Survival , Immunosuppressive Agents/therapeutic use , Antilymphocyte Serum/therapeutic use , Retrospective Studies , Risk Assessment
15.
Article in Chinese | WPRIM | ID: wpr-264050

ABSTRACT

<p><b>OBJECTIVE</b>To compare the efficacy of porcine and rabbit antithymocyte globulins (ATG) in the treatment of severe aplastic anemia (SAA).</p><p><b>METHODS</b>We reviewed the clinical data of 43 SAA patients receiving porcine ALG treatment and 32 patients receiving rabbit ATG treatment between 2004 and 2013 in our hospital. The overall response rates of the patients at 6 month were compared, and the patients' survival in the two groups was analyzed using Kaplan-Meier survival curves.</p><p><b>RESULTS</b>The overall response rates at 6 months was significantly higher in porcine ALG group than in rabbit ATG group (79.07% vs 56.25%, P=0.034). The 5-year overall survival was also higher in porcine ALG group than in rabbit ATG group, but this difference was not statistically significant (86.047% vs 72.878%, P=0.190).</p><p><b>CONCLUSIONS</b>Porcine ALG is superior over rabbit ATG in terms of hematological response but is comparable with rabbit ATG in view of the patients' survival and safety.</p>


Subject(s)
Anemia, Aplastic , Therapeutics , Animals , Antilymphocyte Serum , Therapeutic Uses , Humans , Kaplan-Meier Estimate , Rabbits , Retrospective Studies , Swine
16.
Article in Chinese | WPRIM | ID: wpr-360048

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the treatment outcome of a consecutive series of 100 leukemia patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>The clinical data of leukemia patients received allo-HSCT were analyzed retrospectively, the therapeutic efficacy was summarized. 100 evaluable cases of leukemia included 47 cases of AML, 33 cases of ALL, 2 cases of AL (biphenotypic), 16 CML and 2 CMML. Before transplantation, 76 cases were in first complete remission, 9 cases in second or greater complete remission and 15 cases in non-remission or relapse. All the patients received peripheral blood hematopoietic stem cell transplantation (PBHSCT). The conditioning regimen of human leukocyte antigen (HLA)-matched allo-HSCT group was modified BuCy, but in HLA-mismatched group Fludarabine and anti-human thymocyte globulin (ATG) was added. CsA+MTX regimen was used for prophylaxis of graft-versus-host disease (GVHD) in HLA-identical allo-HSCT, while additional MMF was added in HLA-mismatched group. The average time of follow-up was 13 months.</p><p><b>RESULTS</b>At the last follow-up, 66.0% (66/100) patients survived, 53.0% (53/100) patients survived without leukemia, 28.0% (28/100) patients relapsed and 34.0% (34/100) patients died, 44.1% patients of them died from infectious pulmonary complications. During transplantation, 65.0% of the patients were suffered from lung infection. The overall survival (OS) and disease-free survival (DFS) of all cases was 60.9% and 48.8%, respectively. The recurrence rate was significantly higher in non-remission (66.7%) than in CR (21.2%) patients (P < 0.05). The cumulative incidence of GVHD in HLA-mismatched transplantation was 60.8%, which was significantly higher than that of HLA-matched transplantation (38.8%) (P < 0.05).</p><p><b>CONCLUSION</b>Allo-HSCT can cure a significant proportion of leukemia patients, especially for those in CR status. Since the incidence of infectious pulmonary complications after allo-HSCT is still high, much more attention should be paid to it. The comprehensive prognosis of HLA-matched transplantation is better than the HLA-mis-matched transplantation.</p>


Subject(s)
Antilymphocyte Serum , Therapeutic Uses , Disease-Free Survival , Graft vs Host Disease , HLA Antigens , Genetics , Humans , Incidence , Leukemia , Therapeutics , Peripheral Blood Stem Cell Transplantation , Recurrence , Retrospective Studies , Transplantation Conditioning , Treatment Outcome , Vidarabine , Therapeutic Uses
17.
Article in Chinese | WPRIM | ID: wpr-360047

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the safety and effectiveness of HLA-mismatched allogeneic hematopoietic stem cell transplantation (allo-HSCT) combined with related haploidentical bone marrow infusion for treatment of hematologic malignancies and to explore the mathod for reduction of aGVHD incidence and clinical significance.</p><p><b>METHODS</b>A total of 30 patients with hematologic malignancies (8 cases of AML, 17 AML, 2 MDS and 3 Mix-AL) received related haploidentical and unrelated HLA-mismatched allo-HSCT combined with related haploidentical bone marrow infusion. Among them 20 cases received related haploidentical transplantation of the first donor, 10 cases received unrelated HLA-mismatched treaplantation. The new conditioning regimen for the patients underwent allo-HSCT consisted of fludarabine, busulfan, Me-CCNU and cyclophosphamide. The drugs for GVHD prophylaxis included cyclosporine A and methotrexate, while mycophenolate mofetil and rabbit anti-T-lymphocyte globulin (ATG) were used.</p><p><b>RESULTS</b>All the patients achieved full engraftment. The median time for neutrophils to reach over 0.5 × 10(9)/L was 14 days (8-26 days), while the median time for platelets to reach over 20 × 10(9)/L was 11.5days (10-24 days). The incidence of I-II grade of aGVHD at 100 d was 22.28% (95% CI 9.9%-34.7%), the incidences of II-IV and III-IV grade of aGVHD were 22.7% (95% CI, 10%-35.4%) and 12.7% (95% CI 6.9%-15.5%) respectively. The incidences of I-II and III-IV cGVHD were 13.3% (95% CI, 1.4%- 26.8%) and 3.3 % (95% CI, 0%-12.2%), one case (3.3%) was in extensive cGVHD. DFS and OS of 2 years were 81.1% (95% CI, 66.0%-96.2%) and 68.2% (95% CI 51.0%-85.4%).</p><p><b>CONCLUSION</b>These data suggest that the incidence of grade II-IV grade of aGVHD in recipients of 2 partially HLA-matched units was lower, co-infusion of haplo-BM and partially matched units in allogeneic transplantation is safe and effective for reducing the incidence of aGVHD and improving the survival in DFS.</p>


Subject(s)
Antilymphocyte Serum , Therapeutic Uses , Busulfan , Therapeutic Uses , Cyclosporine , Therapeutic Uses , Graft vs Host Disease , HLA Antigens , Genetics , Hematologic Neoplasms , Therapeutics , Hematopoietic Stem Cell Transplantation , Humans , Incidence , Leukemia , Therapeutics , Mycophenolic Acid , Therapeutic Uses , Stem Cell Transplantation , Tissue Donors , Transplantation Conditioning , Transplantation, Homologous , Vidarabine , Therapeutic Uses
18.
Chinese Journal of Hematology ; (12): 138-143, 2016.
Article in Chinese | WPRIM | ID: wpr-234016

ABSTRACT

<p><b>OBJECTIVE</b>To analyze the prevalence of Epstein Barr Virus (EBV) infection in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p><p><b>METHODS</b>The occurrence of EBV viremia, EBV disease and post-transplant lymphoproliferative disease (PTLD) were retrospectively analyzed in 736 patients received allo-HSCT in single-center from 1st January 2012 through July 31th, 2014.</p><p><b>RESULTS</b>Of 736 patients (302 male and 434 females) with a median age of 31 (2 to 62) years old, EBV infection occurred in 181 patients, the total incidence of EBV infection was 27.6%, with a median time of 57 (16 to 829) days. The cumulative incidences of probable EBV disease and PTLD were 7.2% (13/181) and 2.8% (5/181). Viral load higher than 1.0×10(4) copies/ml occurs in 130 patients, of which 67 patients received rituximab as pre-empty prophylaxis and significantly reduced the incidences of probable EBV disease and PTLD (6.0% vs 22.2%, P=0.009). The mortality was 27.6% in all patients with EBV infection: 24.5% in EBV viremia, 53.8% in probable EBV disease, and 60.6% in PTLD. By univariate and multivariate analysis, the use of anti-thymocyte globulin (ATG), HLA-mismatch HSCT, cGVHD and CMV reactivation were independent risk factors for EBV infection. The time of first EBV reactivation was closely related with cGVHD(OR=0.620, 95%CI 0.453-0.849, P=0.003) and bone marrow or cord blood (OR=1.156, 95%CI 1.022-2.250, P=0.039) as source of stem cells for transplantation.</p><p><b>CONCLUSION</b>EBV reactivation is a common complication in patients with allo-HSCT, especially high mortality in PTLD and probable EBV disease. The use of ATG, HLA-mismatch HSCT, cGVHD and CMV reactivation were independent risk factors for EBV infection. The usage of rituximab as pre-empty prophylaxis may reduce the incidences of probable EBV disease and PTLD.</p>


Subject(s)
Adolescent , Adult , Antilymphocyte Serum , Therapeutic Uses , Child , Child, Preschool , Epstein-Barr Virus Infections , Female , Hematopoietic Stem Cell Transplantation , Herpesvirus 4, Human , Humans , Incidence , Lymphoproliferative Disorders , Virology , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , Rituximab , Therapeutic Uses , Transplantation, Homologous , Viral Load , Virus Activation , Young Adult
19.
Article in English | WPRIM | ID: wpr-201861

ABSTRACT

Chronic granulomatous disease (CGD) is a primary immunodeficiency disease caused by impaired phagocytic function. Hematopoietic stem cell transplantation (HSCT) is a definitive cure for CGD; however, the use of HSCT is limited because of associated problems, including transplantation-related mortality and engraftment failure. We report a case of a patient with CGD who underwent successful HSCT following a targeted busulfan and fludarabine reduced-toxicity myeloablative conditioning. Intravenous busulfan was administered once daily for 4 consecutive days (days –8 to –5), and the target area under the curve was 75,000 µg·hr/L. Fludarabine (40 mg/m2) was administered once daily for 6 consecutive days from days –8 to –3. Antithymocyte globulin (2.5 mg/kg/day) was administered from days –4 to –2. The patient underwent successful engraftment and did not have any severe toxicity related to the transplantation. Conditioning with a targeted busulfan and fludarabine regimen could provide a better outcome for HSCT in CGD, with close regulation of the busulfan dose.


Subject(s)
Antilymphocyte Serum , Bone Marrow Transplantation , Bone Marrow , Busulfan , Granulomatous Disease, Chronic , Hematopoietic Stem Cell Transplantation , Humans , Mortality , Transplantation Conditioning
20.
Article in English | WPRIM | ID: wpr-788565

ABSTRACT

Allogeneic hematopoietic stem cell transplantation (HSCT) may not be considered feasible in a patient with active fungal infection due to transplant-related mortality. We report a case of HSCT performed on a 6-month-old girl, who was diagnosed with very severe aplastic anemia (vSAA) at the age of 2 months, during active invasive pulmonary aspergillosis (IPA). Despite receiving continuous antifungal treatment and multiple granulocyte infusions, her IPA was aggravated. She underwent allogeneic HSCT from a matched sibling donor using conditioning regimen of fludarabine, reduced dose of cyclophosphamide, and anti-thymocyte globulin (ATG) during IPA. After neutrophil engraftment, fever subsided and IPA improved. She was continued on voriconazole for 7 months after HSCT. She is alive with normal hematopoiesis 4 years post-transplant. Our report suggests that allogeneic HSCT using conditioning regimen of fludarabine, reduced dose of cyclophosphamide, and ATG can be a feasible option for the patients with vSAA even during active fungal infection.


Subject(s)
Anemia, Aplastic , Antilymphocyte Serum , Cyclophosphamide , Female , Fever , Granulocytes , Hematopoiesis , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells , Humans , Infant , Invasive Pulmonary Aspergillosis , Mortality , Neutrophils , Siblings , Tissue Donors
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