Assuntos
Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Testemunhas de Jeová , Adolescente , Adulto , Idoso , Transfusão de Sangue , Feminino , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Condicionamento Pré-Transplante , Transplante Autólogo , Transplante Homólogo , Resultado do Tratamento , Adulto JovemAssuntos
Inibidores da Angiogênese/uso terapêutico , Antineoplásicos/uso terapêutico , Bortezomib/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/terapia , Inibidores de Proteassoma/uso terapêutico , Talidomida/uso terapêutico , Idoso , Inibidores da Angiogênese/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Ciclofosfamida/farmacologia , Feminino , Filgrastim , Fator Estimulador de Colônias de Granulócitos/farmacologia , Mobilização de Células-Tronco Hematopoéticas , Humanos , Interferon-alfa/administração & dosagem , Masculino , Mieloma Múltiplo/tratamento farmacológico , Polietilenoglicóis , Inibidores de Proteassoma/administração & dosagem , Proteínas Recombinantes/farmacologia , Indução de Remissão , Estudos Retrospectivos , Talidomida/administração & dosagem , Condicionamento Pré-Transplante , Transplante Autólogo , Resultado do TratamentoRESUMO
Infections by carbapenem-resistant Klebsiella pneumoniae (CRKp) represent a challenging problem after SCT. A retrospective survey (January 2010 to July 2013) involving 52 Italian centers was performed to assess the epidemiology and the prognostic factors of CRKp infections in auto- and allo-SCT. Cases of CRKp infection were reported in 53.4% of centers. CRKp infections were documented in 25 auto-SCTs and 87 allo-SCTs, with an incidence of 0.4% (from 0.1% in 2010 to 0.7% in 2013) and 2% (from 0.4% in 2010 to 2.9% in 2013), respectively. A CRKp colonization documented before or after transplant was followed by an infection in 25.8% of auto-SCT and 39.2% of allo-SCT patients. The infection-related mortality rates were 16% and 64.4%, respectively. A pre-transplant CRKp infection (hazard ratio (HR) 0.33, 95% confidence intervals (CIs) 0.15-0.74; P=0.007) and a not CRKp-targeted first-line treatment (HR 2.67, 95% CI 1.43-4.99; P=0.002) were independent factors associated with an increased mortality in allo-SCT patients who developed a CRKp infection. Our study shows challenging findings of CRKp infections in SCT patients in Italy particularly after allo-SCT. The detection of carriers and the definition of early therapeutic strategies represent critical aspects of the management of CRKp infections after SCT.
Assuntos
Carbapenêmicos , Farmacorresistência Bacteriana , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Aloenxertos , Autoenxertos , Feminino , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Humanos , Itália , Infecções por Klebsiella/etiologia , Infecções por Klebsiella/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Hematological malignancies in Jehovah's Witnesses are often difficult to cure since these patients deny transfusions. By a retrospective analysis, we report the possibility of treating some tumors, mostly hematological, with either autologous or allogeneic bone marrow transplantation (BMT) without blood support. Eight patients were evaluated, including lymphoma (two patients), acute lymphoblastic (one patient) and myeloblastic (one patient) leukemia, chronic lymphocytic leukemia (one patient), refractory anemia with blasts in transformation (one patient), chronic myeloid leukemia (one patient) and metastatic breast cancer (one patient). All patients experienced a severe cytopenia with no major side effects or life-threatening complications. We had four deaths: three from relapse and progression of the disease (at 5, 8 and 15 months after the stem cell infusion), and one from acute intestinal GVHD (at 2 months after the stem cell infusion). Four patients are in complete clinical remission (at 8, 10, 16 and 26 months after the stem cell infusion), and this was related to the disease outcome. We conclude that autologous and allogeneic BMT are feasible without the support of transfusions. We believe that this should be performed as soon as possible in the course of the disease.