Subject(s)
Anemia, Aplastic/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , Hemoglobinuria, Paroxysmal/drug therapy , Immunosuppression Therapy/methods , Adult , Aged , Anemia, Aplastic/pathology , Antibodies, Monoclonal, Humanized/pharmacology , Hemoglobinuria, Paroxysmal/pathology , Humans , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Bloodstream infections (BSI) are frequent and potentially severe complications in allogeneic hematopoietic stem cell transplant (AHSCT) recipients. In patients on steroids, surveillance blood cultures (SBCs) are routinely performed to detect asymptomatic BSI but their usefulness remains controversial. METHODS: We performed a 1-year, observational, prospective, single-center study to assess the utility of daily SBCs in AHSCT recipients on steroids and a case-control study to identify risk factors associated with positive SBCs. All blood cultures (BCs) obtained from adults hospitalized in the HSCT unit were prospectively studied throughout 1 year. Characteristics, treatments, and outcome of patients were retrieved from medical charts. RESULTS: A total of 3594 BCs were obtained in 177 patients, including 1450 SBCs in 82 AHSCT recipients on steroids. In 33 patients, 103 SBCs (7%) were positive. Low-virulence bacteria were identified in 74% of episodes. When analyzing first episode of positive SBCs (28 patients), 6 (21%) true BSI were identified. CONCLUSIONS: Patients with positive SBCs were receiving antibiotic treatment less frequently at the time of SBCs (P < 0.001) and had more frequently BCs obtained through central venous access (P < 0.04) when compared to patients with negative SBCs. Daily SBCs in AHSCT recipients on steroids only rarely identify BSI and clear benefit for patients could not be demonstrated.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Asymptomatic Infections/therapy , Bacteremia/diagnosis , Bacteremia/drug therapy , Blood Culture/methods , Glucocorticoids/adverse effects , Graft vs Host Disease/drug therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Bacteremia/microbiology , Bacteremia/prevention & control , Case-Control Studies , Feasibility Studies , Female , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Monitoring, Physiologic/methods , Prospective Studies , Retrospective Studies , Risk Factors , Transplantation, Homologous/adverse effects , Treatment Outcome , Young AdultABSTRACT
Despite major improvements in allogeneic hematopoietic cell transplantation over the past decades, corticosteroid-refractory (SR) acute (a) and chronic (c) graft-versus-host disease (GVHD) cause high mortality. Preclinical evidence indicates the potent anti-inflammatory properties of the JAK1/2 inhibitor ruxolitinib. In this retrospective survey, 19 stem cell transplant centers in Europe and the United States reported outcome data from 95 patients who had received ruxolitinib as salvage therapy for SR-GVHD. Patients were classified as having SR-aGVHD (n=54, all grades III or IV) or SR-cGVHD (n=41, all moderate or severe). The median number of previous GVHD-therapies was 3 for both SR-aGVHD (1-7) and SR-cGVHD (1-10). The overall response rate was 81.5% (44/54) in SR-aGVHD including 25 complete responses (46.3%), while for SR-cGVHD the ORR was 85.4% (35/41). Of those patients responding to ruxolitinib, the rate of GVHD-relapse was 6.8% (3/44) and 5.7% (2/35) for SR-aGVHD and SR-cGVHD, respectively. The 6-month-survival was 79% (67.3-90.7%, 95% confidence interval (CI)) and 97.4% (92.3-100%, 95% CI) for SR-aGVHD and SR-cGVHD, respectively. Cytopenia and cytomegalovirus-reactivation were observed during ruxolitinib treatment in both SR-aGVHD (30/54, 55.6% and 18/54, 33.3%) and SR-cGVHD (7/41, 17.1% and 6/41, 14.6%) patients. Ruxolitinib may constitute a promising new treatment option for SR-aGVHD and SR-cGVHD that should be validated in a prospective trial.
Subject(s)
Adrenal Cortex Hormones/pharmacology , Drug Resistance, Neoplasm/drug effects , Graft vs Host Disease/drug therapy , Hematologic Neoplasms/complications , Hematopoietic Stem Cell Transplantation/adverse effects , Pyrazoles/therapeutic use , Salvage Therapy , Adult , Aged , Animals , Disease Models, Animal , Female , Follow-Up Studies , Graft vs Host Disease/etiology , Graft vs Host Disease/mortality , Hematologic Neoplasms/therapy , Humans , Janus Kinases/antagonists & inhibitors , Male , Mice , Middle Aged , Neoplasm Staging , Nitriles , Prognosis , Pyrimidines , Recurrence , Retrospective Studies , Survival Rate , Transplantation, Homologous , Young AdultABSTRACT
We report 3 consecutive episodes of invasive aspergillosis in a single hematopoietic stem cell transplant patient successively attributed to TR(34) /L98H azole-resistant Aspergillus fumigatus and to a first occurrence of invasive Emericella sublata infection. This case illustrates potential selection of resistant molds during antifungal therapy in hematological patient.
Subject(s)
Antifungal Agents/pharmacology , Aspergillus fumigatus/isolation & purification , Emericella/isolation & purification , Hematopoietic Stem Cell Transplantation/adverse effects , Invasive Pulmonary Aspergillosis/microbiology , Adult , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , Azoles/pharmacology , Cytochrome P-450 Enzyme System/genetics , DNA, Fungal/genetics , Drug Resistance, Fungal , Fatal Outcome , Female , Fungal Proteins/genetics , Humans , Invasive Pulmonary Aspergillosis/drug therapy , Microbial Sensitivity Tests , Promoter Regions, GeneticABSTRACT
Veno-occlusive disease (VOD) of the liver is mainly described after chemo-irradiation conditioning regimens during haematopoietic stem cell transplantation (SCT) and has been sporadically reported after kidney and liver transplantation. In the latter cases, it is commonly attributed to azathioprine and/or tacrolimus. One case of tacrolimus-induced hepatic VOD developing after lung transplantation (LT) has been recently reported. Here we describe another case of VOD occurring after LT, but in which the causative role was played by azathioprine.
