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1.
Leuk Lymphoma ; 60(7): 1693-1696, 2019 07.
Article in English | MEDLINE | ID: mdl-30741059

ABSTRACT

Epstein-Barr virus (EBV) reactivation and post-transplant lymphoproliferative disorders (PTLD) are common and potentially fatal complications after allogeneic transplantation with mismatched donors and T-cell depletion. Haplo-cord transplantation combines a mismatched UCB graft with third-party cells. Conditioning involves thymoglobulin. EBV reactivation and PTLD were common in initial patients. As of March 2017, we administered a prophylactic dose of rituximab 375 mg/m2 pre-transplant. Among 147 patients who did not receive rituximab, the cumulative incidence of post-transplant EBV reactivation and of EBV PTLD was 13% and 8%, respectively. Among 51 who received pre-transplant rituximab, the incidences were 2% (p = .0017) and 0% (p = .04), respectively. There was no difference in time to hematopoietic recovery, in the incidence of CMV reactivation, of invasive blood stream infections or of proven or probable invasive fungal infections. Pre-transplant administration of rituximab is an effective and nontoxic intervention that drastically reduces EBV reactivation and PTLD in high-risk patients.


Subject(s)
Cord Blood Stem Cell Transplantation/adverse effects , Epstein-Barr Virus Infections/prevention & control , Hematologic Neoplasms/therapy , Lymphoproliferative Disorders/prevention & control , Rituximab/therapeutic use , Transplant Recipients/statistics & numerical data , Virus Activation/drug effects , Adult , Aged , Antineoplastic Agents, Immunological/therapeutic use , Epstein-Barr Virus Infections/epidemiology , Epstein-Barr Virus Infections/etiology , Female , Follow-Up Studies , Herpesvirus 4, Human/isolation & purification , Histocompatibility Testing , Humans , Incidence , Lymphoproliferative Disorders/epidemiology , Lymphoproliferative Disorders/etiology , Male , Middle Aged , New York/epidemiology , Prognosis , Risk Factors , Survival Rate , Transplantation Conditioning , Transplantation, Haploidentical , Young Adult
2.
Leuk Lymphoma ; 59(12): 2829-2835, 2018 12.
Article in English | MEDLINE | ID: mdl-29790808

ABSTRACT

Washing cryopreserved peripheral blood stem cell (PBSC) products can decrease infusion-related adverse reactions but can also result in cell loss and reduced cell viability. To assess the risk and benefit of washing products, we compared the time to neutrophil and platelet engraftment between autologous patients that received washed products (n = 201) and non-washed products (n = 89). The effect of the other variables, including age, gender, diagnosis, transplant dose, method of stem cell mobilization, and growth factor support regimen post-transplant, was assessed. In multivariate analysis, direct thaw and infusion of non-washed products resulted in significantly faster neutrophil engraftment (p = .003) and platelet engraftment (p = .017) than washed products. The mean neutrophil and platelet engraftment times were 1.07 days faster and 2.27 days faster, respectively. In conclusion, direct thaw and infusion of cryopreserved PBSC without washing results in significantly shorter time to recovery of neutrophils and platelets after autologous transplantation.


Subject(s)
Cryopreservation , Hematopoietic Stem Cell Mobilization/methods , Lymphoma/therapy , Multiple Myeloma/therapy , Peripheral Blood Stem Cell Transplantation/methods , Aged , Blood Platelets , Cell Survival , Cryoprotective Agents/adverse effects , Dimethyl Sulfoxide/adverse effects , Female , Hematopoietic Stem Cell Mobilization/adverse effects , Humans , Lymphoma/blood , Male , Middle Aged , Neutrophils , Peripheral Blood Stem Cell Transplantation/adverse effects , Retrospective Studies , Time Factors , Transplantation, Autologous/adverse effects , Transplantation, Autologous/methods , Treatment Outcome
3.
Biol Blood Marrow Transplant ; 24(2): 288-293, 2018 02.
Article in English | MEDLINE | ID: mdl-29061534

ABSTRACT

Administration of granulocyte colony-stimulating factor (G-CSF) after autologous peripheral blood stem cell transplantation (PBSCT) is generally recommended to reduce the duration of severe neutropenia; however, data regarding the optimal timing of G-CSFs post-transplantation are limited and conflicting. This retrospective study was performed at NewYork-Presbyterian/Weill Cornell Medical Center between November 5, 2013, and August 9, 2016, of adult inpatient autologous PBSCT recipients who received G-CSF empirically starting on day +5 (early) versus on those who received G-CSF on day +12 only if absolute neutrophil count (ANC) was <0.5 × 109/L (ANC-driven). G-CSF was dosed at 300 µg in patients weighing <75 kg and 480 µg in those weighing ≥75 kg. One hundred consecutive patients underwent autologous PBSCT using either the early (n = 50) or ANC-driven (n = 50) G-CSF regimen. Patient and transplantation characteristics were comparable in the 2 groups. In the ANC-driven group, 24% (n = 12) received G-CSF on day +12 and 60% (n = 30) started G-CSF earlier due to febrile neutropenia or at the physician's discretion, 6% (n = 3) started after day +12 at the physician's discretion, and 10% (n = 5) did not receive any G-CSF. The median start day of G-CSF therapy was day +10 in the ANC-driven group versus day +5 in the early group (P < .0001). For the primary outcome, the median time to neutrophil engraftment was 12 days (interquartile range [IQR] 11-13 days) in the early group versus 13 days (IQR, 12-14 days) in the ANC-driven group (P = .07). There were no significant between-group differences in time to platelet engraftment, 1-year relapse rate, or 1-year overall survival. The incidence of febrile neutropenia was 74% in the early group versus 90% in the ANC-driven group (P = .04); however, there was no significant between-group difference in the incidence of positive bacterial cultures or transfer to the intensive care unit. The duration of G-CSF administration until neutrophil engraftment was 6 days in the early group versus 3 days in the ANC-driven group (P < .0001). The median duration of post-transplantation hospitalization was 15 days (IQR, 14-19 days) in the early group versus 16 days (IQR, 15-22 days) in the ANC-driven group (P = .28). Our data show that early initiation of G-CSF (on day +5) and ANC-driven initiation of G-CSF following autologous PBSCT were associated with a similar time to neutrophil engraftment, length of stay post-transplantation, and 1-year overall survival.


Subject(s)
Granulocyte Colony-Stimulating Factor/therapeutic use , Peripheral Blood Stem Cell Transplantation/methods , Aged , Female , Graft Survival , Humans , Length of Stay , Male , Middle Aged , Neutrophils/cytology , Peripheral Blood Stem Cell Transplantation/mortality , Retrospective Studies , Survival Rate , Time Factors , Transplantation, Autologous/methods , Transplantation, Autologous/mortality
4.
P T ; 40(7): 430-68, 2015 Jul.
Article in English | MEDLINE | ID: mdl-26185403

ABSTRACT

Ramucirumab (Cyramza): A breakthrough treatment for gastric cancer.

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