CMV Infection in Hematopoietic Stem Cell Transplantation: Prevention and Treatment Strategies

Abstract Objective To expolore the association of KIR2DS4 and its variant KIR1D with cytomegalovirus(CMV) infection after HLA-matched sibling hematopoietic stem cell transplantation. Methods Polymerase chain reaction with sequence-speciﬁc primers (PCR-SSP) method was used to genotype KIR genes in 267 donor-recipient pairs from Oct 2005 to Apr 2014. Posttransplant monitoring for CMV infection was performed by immune histochemically assays .165 donor-recipient pairs who belong to KIR gene haplotype AA were analyzed for the presence of KIR2DS4 and its variant KIR1D and then further subdivided into the following groups: 2DS4-/1D+ (homozygous for the deletion variant KIR1D), 2DS4+/1D+ (heterozygous), 2DS4+/1D- (two intact KIR2DS4 alleles). Furthermore, we investigated the influence of the KIR2DS4 variants on CMV infection of 165 patients receiving Sibling related HLA matched transplantation. Results There were no significant differences in frequency of KIR2DS4 or KIR1D between donors and recipients in the haplotype AA group. The ratio of 2DS4+ and KIR1D in haplotype AA group was 2:1.There was no difference on neutrophil engraftment and platelet recovery among the three groups after hematopoietic stem cell transplantation. The CMV infection rate was significantly higher in 2DS4+/1D- group compared with 2DS4+/1D+ group (44.0% vs 19.0%，P=0.002)．In 2DS4-/1D+ group ，the CMV infection rate was higer than that in 2DS4+KIR1D+ group (50.0% vs 19%，P=0.028). However，there was no difference in CMV infection rate between 2DS4+/1D-group and 2DS4-/1D+ group. Conclusion KIR2DS4 and its variant KIR1D are associated with CMV infection after HLA-matched sibling hematopoietic stem cell transplantation Disclosures No relevant conflicts of interest to declare.

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Current approaches in oral mucositis prevention, care and treatment in hematopoietic stem cell transplantation: Literature reviewHematopoetik kök hücre naklinde oral mukozitin önlemesi, bakımı ve tedavisinde güncel yaklaşımlar: Literatür incelemesi

Journal of Human Sciences ◽

10.14687/jhs.v13i3.4036 ◽

2016 ◽

Vol 13 (3) ◽

pp. 5721

Author(s):

Ebru Baysal ◽

Dilek Sarı

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Oral Mucositis ◽

Oral Care ◽

Hematopoietic Stem ◽

Transplant Patients ◽

Prevention And Treatment

Oral mucositis is important inflammatory complications affecting the esophagus, oropharyngeal mucosa and gastrointestinal tract in cancer patients receiving chemotherapy and radiotherapy. Oral mucositis’ incidence is depending on the conditioning regimen, type of disease and the applied transmission procedure. It’s incidence is 35-75% in autologous transplant patients and 75-100% in allogeneic transplant patients. The aim of this review, examine the results of the researches for prevention and treatment of oral mucositis in patients undergoing hematopoietic stem cell transplantation. The population of this study is consisted of 1094 articles from accessed by searching with "hematopoietic stem cell transplantation", "oral mucositis" and "oral care" key words on “Medline”, "Ebscohost", "PubMed", "Web of Science" and "Google Scholar" databases by in dates between June-August 2016. In this review, the articles were selected as full text and they were published in English and Turkish languages in the last decade. The sample of the review have occurred total 26 studies of these articles that meet the research’s criteria. In researches were included in the review, palifermin (6 articles) and prophylactic laser therapy (4 articles) was determined the most widely used methods for prevention and treatment of oral mucositis. Most of the research has been conducted in adult patients with Allogeneic Stem Cell Transplantation. The methods used in the 24 researchs have been determined to be effective in the prevention and treatment of oral mucositis. The majority of the methods used in researchs, especially palifermin and prophylactic laser, have been found to be effective in prevention and treatment of oral mucositis, however there is no standardized oral care protocol for hematopoietic stem cell transplantation patients. ÖzetOral mukozit kemoterapi ve radyoterapi alan kanser hastalarında orofarengeal mukoza, özefagus ve gastrointestinal sistemi etkileyen önemli inflamatuar bir komplikasyondur. Hastalığın türüne, uygulanan hazırlık rejimi ve nakil prosedürüne bağlı olarak oral mukozit görülme oranı otolog nakil hastalarında %35-75, allojenik nakil hastalarında ise %75-100’dür. Bu derleme hematopoetik kök hücre nakli yapılan hastalarda oral mukozitin önlenmesine ve tedavisine yönelik yapılan çalışmaların sonuçlarını incelemek amacıyla planlanmıştır. Çalışmanın evrenini Haziran-Ağustos 2016 tarihlerinde “hematopoetic stem cell trasplantation”, “oral mucositis” ve “oral care” anahtar kelimeleriyle “Medline”, “Ebscohost”, “Pubmed”, “Web of Science” ve “Google Scholar” veri tabanları taranarak ulaşılan 1094 makale oluşturmuştur. İncelemede son on yılda yayınlanmış, yayın dili Türkçe ve İngilizce olan ve tam metni bulunan makaleler seçilmiştir. Araştırma kriterlerini karşılayan 26 makale derlemenin örneklemini oluşturmuştur. Derlemeye dahil edilen araştırmalarda oral mukozitin önlenmesi ve tedavisi için en fazla kullanılan yöntemlerin palifermin uygulaması (6 makale) ve profilaktik lazer tedavisi (4 makale) olduğu saptanmıştır. Araştırmaların büyük bir kısmı Allojenik Kök Hücre Nakli yapılan yetişkin hastalarda yapılmıştır. Derleme kapsamındaki 24 araştırmada kullanılan yöntemlerin oral mukozitin önlenmesi ve tedavisinde etkili olduğu belirlenmiştir. Araştırmalarda kullanılan yöntemlerin çoğunluğunun özellikle palifermin ve profilaktik lazer tedavisinin oral mukozitin önlenmesinde ve tedavisinde etkili olduğu fakat hematopoetik kök hücre nakli hastaları için standart ağız bakım protokolü bulunmadığı saptanmıştır.

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Intensive sequential chemoterapy with etoposide, mitoxantrone and cytarabine (EMA) as salvage in patients with AML relapsing after hematopoietic stem cell transplantation.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18537 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18537-e18537

Author(s):

Ayla Gokmen ◽

Ender Soydan ◽

Zafer Gokgoz ◽

Kerem ozan Ozkumur ◽

Onder Arslan ◽

...

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Salvage Therapy ◽

Treatment Strategies ◽

Response To Treatment ◽

Sequential Chemotherapy ◽

Hematopoietic Stem

e18537 Background: Relapse after allogeneic hematopoietic stem cell transplantation ( HSCT) for AML is the main cause of treatment failure.The optimal treatment strategy for patients with AML relapsing after HSCT remains controversial. We evaluated the efficacy of intensive sequential chemotherapy with etoposide,mitoxantrone and cytarabine as salvage therapy in patients with AML relapsing after alloHSCT. Methods: Fifteen AML patients relapsing after HSCT who were treated with EMA regimen between January 2015 and December 2016 were analysed retrospectively. EMA regimen consisted of mitoxantrone 12 mg/m² on days 1-3, etoposide 200 mg/m² on days 8-10 and cytarabine 500 mg/m² on days 1-3 and 8-10. Results: Median age was 49 ( range 22-64) years. At transplantation , 12 patients were in CR ( 10 CR1 and 2 CR2) , 3 patients had active disease. 9 donors were matched related, 3 were matched unrelated and 3 were haploidentical. Median time from transplantation to relapse was 163 ( 62-576) days. Complete response ( CR) was achieved in 7 of 15 patients ( 46.6 %). Five patients died during treatment before assessment of response to treatment with a median day of 32 due to infection. Three patients did not respond to treatment. All patients suffered grade 4 neutropenia and thrombocytopenia. Neutropenic fever was obseved in all patients. Grade 2-3 a GVHD was observed in 10 patients (66%) during EMA chemotherapy at a median day of 15. Further treatment was given in 6 patients who achieved CR with EMA : 2 patients underwent second allogeneic HSCT, 1 patient underwent second haploidentical HSCT, 2 patients were treated with DLI, 1 patient was treated with azacytidine-DLI combination. Median OS was 100 d ( range 24-402). Median duration of OS in responding patients were 248 d ( 67-402). At last folllow-up 3 patients are still alive and disease free. Conclusions: Intensive sequential chemotherapy with EMA is an efficacious option as salvage therapy in patients with AML relapsing after HSCT. However further treatment strategies such as second transplantation, DLI after chemoterapy or maintanence with targeted drugs are required to obtain long term remission.

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