Sjögren-like syndrome after bone marrow transplantation.

OBJECTIVE: To study the incidence of dry eye in Sjögren-like syndrome, graft-versus-host disease (GVHD) in hematological patients undergoing bone marrow transplantation (BMT). MATERIAL AND METHOD: Prospective, cross-sectional study in twenty-six patients that were planned for BMT (group I). Twenty-nine patients undergoing BMT before study were classified as group II no GVHD (9), and group III with GVHD (20). Thirty-two normal subjects were controls. All subjects were examined by slit lamp biomicroscopy and had their tear samples analyzed about tear osmolarity. They were also evaluated for aqueous tear production by phenol red thread test, Schirmer test without anesthesia, tear film stability by tear break-up time (TBUT), and rose bengal staining 2 weeks before BMT (for group I) as well as 6 weeks, 3 months, and 6 months after BMT. The patients with GVHD were followed up 1 month later. Main outcome measures were amount of tear production, tear film stability, and dry eye symptoms. RESULTS: Average aqueous tear production in group III was less than control and group II (p < 0.001). Mean TBUT in group III was faster than control (p < 0.001) and group I before BMT (p = 0.001). Mean score of rose bengal staining in group III was more than control and group I before BMT (p < 0.001). Keratoconjunctivitis sicca and red eye developed in 27.5%, and 20% of group III, with incidence of dry eye by Schirmer test without anesthesia (67.5%). This compares with group II having incidence of dry eye of 16.7%. However, 42.3% of group I before BMT had dry eye compared with 9.4% in the controls (p < 0.001). CONCLUSION: Trend of dry eye in patients with BMT and GVHD were higher than no-GVHD group. Doctors should be aware of ocular symptoms and signs of dry eye in patients with BMT and follow-up for proper management.

Prevalence of antibiotic-resistant bacteria colonized in neutropenic patients at Siriraj Hospital.

Objective: To determine prevalence of antibiotic-resistant bacteria colonized in throat and gastrointestinal tract of neutropenic patients at Siriraj Hospital. Methods: Adult patients who had recent neutropenia (absolute neutrophils <500) without any evidence of infections were recruited from January 2006 to March 2007 at Hematology Clinic and Department of Medicine, Siriraj Hospital. The throat swabs and stool samples or peri-anal swabs collected from the patients were sent for bacterial culture and antibiotic susceptibility testing. Results: There were 140 patients. 75 (53.6%) were females. The mean age was 49.3 years. The major underlying diseases were leukemia (53.6%) and lymphoma (33.3%). The main causes of neutropenia were chemotherapy-induced (84.3%) and the underlying diseases (15.7%). The bacteria commonly recovered from the stools or throat swabs of the patients were E.coli (77.9%), Klebsiella pneumoniae (46.4%), Enterobacter sp (20%) and Enterococcus sp. (45.7%). ESBL-producing gram negatives, Pseudomonas aeruginosa, Acinetobacter sp. and MRSA were found in 13.6%, 8.6%, 5% and 1.4% respectively. The susceptibility rate of E.coli, Klebsiella pneumoniae and Enterobacter sp. to co-trimoxazole, co-amoxiclav and ciprofloxacin was 51.5%, 73.2% and 74.8% respectively. Less than 50% of ESBL-producing gram negatives, Pseudomonas aeruginosa and Acinetobacter sp. were susceptible to the aforementioned oral antibiotics. Conclusion: Ciprofloxacin or co-amoxiclav seems to be a suitable oral antibiotic for preventing gram negative bacterial infection in ambulatory neutropenic patients in Thailand. However, the patients receiving such antibiotics still have more than 25% risk of carrying gram negatives resistant to both antibiotics.

Collection and processing of umbilical cord blood for cryopreservation.

Umbilical cord blood (UCB) is being increasingly used as an alternative source of hematopoietic stem cells for allogeneic bone marrow transplantation. UCB transplantation has been successfully used to treat a variety of genetic, hematological, and oncological disorders in children and adults. The objectives of this study was to establish a closed-system technique for UCB collection and buffy coat separation by Optipress I device. Thirty-four UCB were collected by triple-bag system from pregnant mothers whose fetuses were not affected by thalassemic diseases after prenatal diagnosis. The mean volumn of UCB collection were 120 +/- 5 ml (range 65-180 ml). Total WBC, CD34+ cells, the progenitor cell erythroid burst-forming unit (BFU-E) and granulocyte-macrophage colony-forming unit (CFU-GM) in the UCB units were (9.36 +/- 0.84) x 10(8), (3.61 +/- 0.52) x 10(6), (9.12 +/- 1.60) x 10(5), and (5.32 +/- 1.23) x 10(5), respectively. Good correlation between the nucleated cell and net cord blood volume could be demonstrated (p < 0.0001). The correlation between CD34+ cells and the following parameters: nucleated cell, BFU-E or CFU-GM were also demonstrated (p = 0.001, 0.0105 or 0.0001, respectively). Buffy coat was subsequently separated from 18 UCB units by Optipress I device. 70 +/- 3 ml of buffy coat were collected and cryoprocessing was done by automatic controlled-rate freezer. Good recovery of total WBC, CD34+ cells, progenitor cells BFU-E and CFU-GM after buffy coat separation were observed 89 per cent, 95 per cent, 109 per cent, and 102 per cent respectively. There was no aerobic bacterial or fungal contamination in the separated blood products. By using this technique, the UCB units were easily collected, rapidly separated within one hour, and high recovery of the hematopoietic progenitor cells could be obtained.

Reversal of marrow fibrosis in agnogenic myeloid metaplasia by allogeneic peripheral blood stem cell transplantation.

Agnogenic myeloid metaplasia (AMM) is a clonal hematopoietic stem cell disorder characterized by bone marrow fibrosis, extramedullary hemopoiesis, splenomegaly and a leukoerythroblastic blood picture. Current standard therapies using hydroxyurea, interferon, androgens or corticosteroids have not shown to prolong survival of patients with AMM. In this study, we performed a curative approach using an HLA-matched sibling as a donor for allogeneic peripheral blood stem cell transplantation (PBSCT) for a 45-year-old woman with AMM. Busulfan and cyclophosphamide were given as a conditioning regimen from day -7 to day -2 with cyclosporinA and methotrexate as post-transplant immunosuppressive therapy. Donor PBSCs were mobilized by G-CSF at 16 microg/kg/day for five days and transplantation was performed on March 2-3, 2000. The patient rapidly engrafted within 2 weeks after PBSC infusion without evidence of graft versus host disease. Her blood counts and bone marrow 2 years after transplantation were normal with full donor pattern by molecular analysis. In conclusion, marrow fibrosis can be reverted to normal by allogeneic PBSCT. Allogeneic PBSCT should thus be offered to AMM patients if an HLA-matched sibling is available. This report represents the first SCT for AMM in Thailand.

Nutritional support for children underwent bone marrow transplantation.

Nutritional support for children underwent bone marrow transplantation was studied by comparing parenteral nutritional support and oral intakes. During 1988-1991 a total of 15 recipients, 10 boys and 5 girls, ages ranging 1-12 years from the Department of Pediatrics, Faculty of Medicine, Siriraj Hospital were studied. The patients were classified according to underlying diseases into 3 groups; Group I (thalassemia), Group II (aplastic anemia) and Group III (malignancy). The results indicate that Group I required less parenteral support than the other groups. Group III required the most parenteral support. Complications from bone marrow transplantation support among the 3 groups were similar. Therefore the requirement for nutritional support depend on the type of hematologic disease from which the patient is suffering.