ABSTRACT
There is limited and conflicting information on the prevalence of contamination of haematopoietic stem and progenitor cell products (HPCPs), and their optimal management remains unclear. The authors reviewed the microbial surveillance data of HPCPs collected between January 2002 and December 2019 for autologous transplantation at the study institution to determine the prevalence of microbial contamination and the potential infectious complications among recipients. Among 3935 HPCPs, 25 (0.6%) were contaminated. Ultimately, 22 patients received contaminated grafts, with pre-emptive antimicrobial therapy initiated in six of these patients. No patients developed subsequent infectious complications. These data suggest that microbial contamination of autologous HPCPs and associated adverse outcomes are rare.
Subject(s)
Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cells , Humans , Prevalence , Retrospective Studies , Transplantation, Autologous/adverse effectsSubject(s)
Filgrastim/administration & dosage , Hematopoietic Stem Cell Mobilization , Hematopoietic Stem Cells , Leukemia, Myeloid, Acute/drug therapy , Vinblastine/analogs & derivatives , Adult , Aged , Disease-Free Survival , Female , Humans , Leukemia, Myeloid, Acute/mortality , Male , Middle Aged , Survival Rate , Vinblastine/administration & dosage , VinorelbineABSTRACT
The occurrence of varicella zoster virus (VZV) reactivation is increased after allogeneic transplantation, whereas limited data are available for herpes zoster (HZ) after autologous SCT (ASCT). We determined the incidence and the prognostic significance of HZ and its correlation with VZV serology in 191 consecutive myeloma patients undergoing high-dose melphalan chemotherapy with ASCT. We found that VZV reactivation occurred in 57 (30%) patients, in 8.5% during induction and in 21.5% after ASCT peaking at 8 months after ASCT. Disease burden due to HZ was assessed as high or rather high in 70% of the patients. By immune fluorescence and Serion Elisa VZV IgG assessment, 90.8% of all patients had specific anti-VZV antibodies at ASCT. Lower specific antibody titers at transplantation were observed in patients with HZ after ASCT than in those without reactivation (P=0.009). Finally, OS was better in myeloma patients with HZ after ASCT compared with patients without HZ (P=0.007). Our data indicate that VZV reactivation after ASCT is a frequent event carrying a significant disease burden and it is associated with improved survival. Low levels of specific VZV antibodies at ASCT suggest increased vulnerability for VZV reactivation.
Subject(s)
Antibodies, Viral/blood , Herpes Zoster , Herpesvirus 3, Human/physiology , Multiple Myeloma , Stem Cell Transplantation , Virus Activation , Adult , Aged , Autografts , Disease-Free Survival , Female , Herpes Zoster/blood , Herpes Zoster/etiology , Herpes Zoster/mortality , Humans , Male , Middle Aged , Multiple Myeloma/blood , Multiple Myeloma/mortality , Multiple Myeloma/therapy , Multiple Myeloma/virology , Survival RateSubject(s)
Blood Preservation/methods , Erythrocytes , 2,3-Diphosphoglycerate/blood , Adenine , Adenosine Triphosphate/blood , Adult , Blood Component Removal , Citrates , Erythrocyte Deformability , Erythrocytes/chemistry , Female , Glucose , Humans , Hydrogen-Ion Concentration , Leukocytes , Male , Middle Aged , Phosphates , Plasma Substitutes , Prospective Studies , Rheology , Time FactorsSubject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Blood Loss, Surgical , Protein C/physiology , Anticoagulants/pharmacology , Confidence Intervals , Erythrocyte Count , Fibrinolytic Agents/pharmacology , Humans , Partial Thromboplastin Time , Protein C/pharmacology , Reagent Kits, DiagnosticABSTRACT
UNLABELLED: Acquired factor VIII (FVIII) inhibitors in non-haemophiliacs may pose serious treatment problems. MATERIALS AND METHODS: For IgG-adsorptions we utilized an automated plasma separation device and a plasma flow monitor. CASE REPORTS: A 63-year old woman showed life-threatening bleeding because of an inhibitor. After stabilization by porcine FVIII three cycles of a modified Malmoe treatment protocol were applied, followed by long-term cyclophosphamide p.o. and weekly IgG-adsorptions. Within twelve months the patient exhibited a complete remission. A 54-year old man presented a comparable history. Because of a good response after the first cycle he was subsequently switched to the long-term therapy. Up to now (> 7 months) FVIII activities and inhibitor titers remained stable (10-20% rsp. < 3 BU/ml). In both cases no FVIII substitution therapy was necessary. CONCLUSIONS: A modified Malmoe protocol combined with long-term cyclophosphamide p.o. and weekly IgG-adsorptions seems to be an efficient, safe and cost-effective regimen for non-haemophiliacs with FVIII inhibitors.
Subject(s)
Autoantibodies/isolation & purification , Factor VIII/immunology , Immunosorbent Techniques , Immunosuppressive Agents/therapeutic use , Staphylococcal Protein A , Female , Humans , Male , Middle Aged , Time FactorsABSTRACT
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction caused by antibodies against the nicotinic acetylcholine receptor (AChR-Ab). We report a 16-year-old girl with severe MG who showed a poor response to plasma exchange and tryptophan-linked polyvinylalcohol gel immunoadsorption. Further improvement of muscle strength and decline of AChR-Ab could be achieved after initiation of protein-A immunoadsorption (PA-IA). Maintenance therapy with PA-IA and intravenous pulses of cyclophosphamide resulted in a stabilisation of the disease, with a complete remission during the follow-up period of six months. We suggest that PA-IA may be valuable and safe in the management of patients with severe MG, and maintenance therapy with PA-IA and cyclophosphamide may prevent serious and potentially life-threatening relapses of the disease.
