Comparison of two different anti-infectious approaches after high-dose chemotherapy and autologous stem cell transplantation for hematologic malignancies in a 12-year period in British Hospital, Uruguay.

Autologous stem cell transplant (ASCT) is a widely used and safe procedure to treat mostly hematologic diseases. These patients are at risk of infectious complications, which represents a major cause of morbidity and it is the second cause of mortality. This retrospective 12-year analysis of the incidence, type, and severity of infections in 266 consecutive unselected ASCT patients at our institution provides novel information addressing this issue. We included 266 ASCT procedures. Patients included in the 2006-2013 period are referred to as group 1 (ciprofloxacin prophylaxis and ceftazidime-amikacin as empirical antibiotics), and those in the 2013-2017 period are group 2 (levofloxacin prophylaxis and meropenem as empirical antibiotics). The incidence of febrile neutropenia was 72% in group 1 and 86.2% in group 2 (p = 0.004). The majority of infectious episodes were associated with fever of unknown origin: 55% in group 1 and 59% in group 2. Febrile of unknown origin episodes were 82.6% in group 1 and 80% in group 2. Significant differences between both groups were found in age, hypogammaglobulinemia, and advanced disease at ASCT. No differences were found between groups regarding the most common agent documented in positive blood cultures (Gram+ were 66.6% in group 1 and 69% in group 2 (p = 0.68)). Mortality within 100 days of transplant was low, 1.87%. Regardless of the prophylactic regimen used, most patients experience febrile episodes in the ASCT setting, fever of unknown origin is the most common infection complication, and Gram+ agents are prevalent in both groups. Mortality rates were low. According to our results, ASCT is a safe procedure and there is no clear benefit in favor of levofloxacin versus ciprofloxacin prophylaxis. Both anti-infectious approaches are acceptable, yielding similar outcomes.

Trasplante autólogo de progenitores hematopoyéticos en pacientes con Linfoma no Hodgkin agresivo: Experiencia de un centro / Autologous transplant of Haematopoietic Stem Cells in Patients with Aggressive Non Hodgkin Lymphoma: Experience of a center

Introducción: El Trasplante Autólogo de Progenitores Hematopoyéticos forma parte del tratamiento de pacientes con Linfoma No Hodgkin (LNH) agresivos en respuesta parcial y recaída. Objetivos: evaluar las respuestas y sobrevida en los pacientes con LNH agresivos trasplantados en Hospital Británico. Material y Métodos: estudio retrospectivo de pacientes con LNH agresivos que se trasplantaron entre el 1/01/1995 y el 1/07/2013. Total 65 pacientes. Resultados: el 95% logró una Remisión Completa post Auto-TPH y el 5% una Remisión Parcial. Con una mediana de seguimiento de 74 meses (5-219), la mediana de SG no se ha alcanzado. La media estimada es de 145 meses (122-169) con una SG a 5 años de 71% y a 10 años es de 60%. La mediana de SLE no se ha alcanzado, a 5 años es de 60% y a 10 años es de 58%. Conclusiones: el trasplante Autólogo de Progenitores Hematopoyéticos es una herramienta terapéutica útil. Los resultados de nuestro grupo son comparables a los reportados por grupos internacionales con una baja mortalidad relacionada al procedimiento.

Introduction: Autologous Hematopoietic Stem Cell Transplantation is part of the treatment of patients with aggressive lymphomas in partial response or relapsed. Objectives: To evaluate the responses and survival in aggressive NHL patients transplanted in Hospital Británico. Material and Methods: Retrospective study of patients with aggressive NHL that were transplanted into... between 01/01/1995 and 07/01/2013. Total 65 patients. Results: 95% achieved a complete remission after Auto-SCT and 5% partial remission. With a median follow up of 74 months (5-219), the median OS has not been reached. The estimated mean is 145 months (122-169) with a 5-year OS of 71% and 60% at 10 years. The median DFS has not been reached, at 5 years is 60 % and at 10 years is 58 %. Conclusions: Autologous Hematopoietic Stem Cell Transplantation is a useful therapeutic tool. The results of our group are comparable to those reported by international groups with low procedure-related mortality.

Trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple: análisis de factores pronósticos y sobrevida: experiencia del Hospital Británico / Autologic transplant of hematopoietic progenitors in patients with multiple myeloma: a study of prognosis and survival at the British Hospital

Introducción: el trasplante autólogo de progenitores hematopoyéticos (TAPH) es considerado estándar en el tratamiento de primera línea en pacientes con mieloma múltiple (MM) menores de 65 años. Objetivo: analizar la sobrevida global (SG) y sobrevida libre de eventos (SLEv) de los pacientes con MM trasplantados en el Hospital Británico. Material y método: se realizó un estudio retrospectivo de los pacientes que recibieron un primer TAPH. Resultados: entre el 1° de julio de 1999 y el 30 de junio de 2010 se realizaron 56 TAPH a 48 pacientes con MM. Del análisis de los pacientes al primer TAPH, 46% eran mujeres y 54%hombres. La mediana de edad fue de 54 años (32-65 años). El 73% eran IgG, 17% IgA y 10% de cadenas livianas. El 60,4% logró una RC/nRC (RC, RC no confirmada y VGPR) posTAPH. Con una media de seguimiento de 58,6 meses (5,84-186,56), la mediana de SG fue de 121,8 meses (IC 95%: 70,1-173,54 meses). No se hallaron diferencias significativas en SG entre los pacientes que lograron RC/nRC posTAPH y quienes no lo lograron (log Rank p=0,162). La mediana de SLEv fue de 56 meses (IC 95%: 42,2-70,4 meses).Conclusiones: el TAPH es una herramienta fundamental en el tratamiento de los pacientes con MM y es un procedimiento seguro en la Unidad de Hematología del Hospital Británico.

Introduction: autologic transplant of hematopoietic progenitors is regarded as the standard in the first line treatmentof patients with multiple myeloma (MM) younger than 65 years old. Objective: to analyse global survival and incident freesurvival in patients with multiple myeloma transplanted at the British Hospital. Method: we conducted a retrospective study of patients who received the first autologic transplant of hematopoietic progenitors. Results: 56 autologic transplants of hematopoietic progenitors were performed from July 1, 1999 through June 30, 2010 in 48 patients with MM. Upon analysis of patients after the first transplant, 46% were women and 54% were men. Median age was 54 years old (32-65 years old). 73% were IgG, 17% were IgA and 10% were light chains.60.4% achieved CR/nCR (CR), non- confirmed CR and VGPR) after transplant. With an average follow-up of 58.6 months (5.84-186.56), the median global survival was121.8 months (IC 95%: 70.1-173.54 months). No significant differences were found in the global survival in patientswho achieved CR/nCR after autologic transplant of hematopoietic progenitors and those who failed to achieve it (log Rank p=0.162. The median incident-free survival was 56 months (IC 95%: 42.2-70.4 months). Conclusions: autologic transplant of hematopoietic progenitors is an essential tool to treat patients with MM and it is a safe procedure at the Hematology Unit of the British Hospital.

Introdução: o transplante autólogo de progenitores hematopoiéticos (TAPH) é considerado um padrão no tratamentode primeira linha de pacientes menores de 65 anos com mieloma múltiple (MM).Objetivo: analisar a sobrevida global (SG) e sobrevida livre de eventos (SLEv) dos pacientes com MMtransplantados no Hospital Britânico.Material e método: um estudo retrospectivo dos pacientes que receberam um primeiro TAPH foi realizado. Resultados: no período 1° de julho de 1999 a 30 de junho de 2010 foram realizados 56 TAPH a 48 pacientes com MM. A análise dos dados dos pacientes no primeiro TAPH mostrou que 46% eram mulheres e 54% homens. A mediana da idade foi 54 anos (32-65 anos). 73% eram IgG, 17% IgA e 10% de cadeias leves. 60,4% conseguiram uma RC/nRC (RC, RC não confirmada e VGPR) pósTAPH. Comuna media de seguimento de 58,6 meses (5,84-186,56), a mediana de SG foi de 121,8 meses (IC 95%: 70,1-173,54meses). Não foram encontradas diferenças significativas na SG entre os pacientes que conseguiram RC/nRCpósTAPH e os que não a conseguiram (log Rank p=0,162). A mediana de SLEv foi 56 meses (IC 95%: 42,2-70,4 meses). Conclusões: o TAPH é uma ferramenta fundamental para o tratamento de pacientes com MM e é umprocedimento seguro na Unidade de Hematologia do Hospital Britânico.