The utility of cognitive changes in identifying those with acute graft vs. host disease following allogeneic hematopoietic cell transplant

2019 ◽  
Vol 34 (5) ◽  
pp. 969-980
Author(s):  
John Stratton ◽  
Allison Sylvia ◽  
Flora Hoodin ◽  
Sung Won Choi ◽  
Attaphol Pawarode ◽  
...  
Keyword(s):  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Cognitive Changes ◽  
Host Disease ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Graft Vs Host Disease ◽  
Acute Graft

scholarly journals Pretransplant β 2 -Microglobulin Is Associated with the Risk of Acute Graft-versus-Host-Disease after Allogeneic Hematopoietic Cell Transplant

2016 ◽  
Vol 22 (7) ◽  
pp. 1329-1332 ◽  
Author(s):  
Carolina Costa-Lima ◽  
Eliana Cristina Martins Miranda ◽  
Marcos Paulo Colella ◽  
Francisco Jose Penteado Aranha ◽  
Carmino Antonio de Souza ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Host Disease ◽  
Graft Versus Host ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Acute Graft

Risk factors for cefepime nonsusceptible Gram-negative infections in allogeneic hematopoietic cell transplant recipients

2017 ◽  
Vol 25 (2) ◽  
pp. 279-288 ◽  
Author(s):  
AM Boyd ◽  
AJ Perissinotti ◽  
JL Nagel ◽  
DG Frame ◽  
BL Marini
Keyword(s):  
Risk Factors ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Host Disease ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Transplant Patients ◽  
Increased Risk ◽  
Graft Vs Host Disease

Purpose Allogeneic hematopoietic cell transplant recipients undergo myelosuppressive chemotherapy to allow engraftment of stem cells and are at particularly high risk for bacterial infections and adverse outcomes. Patients undergoing hematopoietic cell transplant are at increased risk for healthcare-associated infections, including infections with multidrug-resistant pathogens. Cefepime is a commonly prescribed antibiotic for empiric therapy in hematopoietic cell transplant patients, but there is minimal data describing cefepime resistance rates, risk factors for resistance, and clinical outcomes associated with cefepime-resistant infections. Methods Adult (≥18 years old) allogeneic hematopoietic cell transplant recipients with a culture positive for a gram-negative rod between January 2010 and January 2016 were spilt into two groups: cefepime susceptible and cefepime nonsusceptible . The primary objective of this study was to identify risk factors for cefepime nonsusceptible through multivariable logistic regression. Results A total of 107 patients were included (27 cefepime nonsusceptible, 80 cefepime-susceptible), yielding a 25.2% nonsusceptibility rate. Multivariable analysis yielded age >60 years old, Klebsiella spp. infection, Acinetobacter spp. infection, healthcare exposures within 90 days, acute gastrointestinal graft-vs-host-disease, and chronic graft-vs-host-disease at multiple locations as significant risk factors for cefepime nonsusceptible. The receiver operating characteristic area under the curve of the model was 0.851. Thirty-day all-cause mortality (29.6% versus 16.3%, p = 0.13) and length of hospitalization (19 versus 12.5 days, p = 0.0650) were numerically higher in the cefepime nonsusceptible group. Conclusions Hematopoietic cell transplant patients with acute gastrointestinal graft versus host disease, extensive chronic graft-vs-host-disease, advanced age, previous healthcare exposures, or infections with Klebsiella and Acinetobacter are at increased risk for cefepime nonsusceptible. Patients infected with cefepime nonsusceptible pathogens may have higher rates of mortality and length of hospitalization.

Sirolimus Yields High Response Rates in Hematopoietic Allograft Recipients with Steroid-Refractory Acute Graft-Versus-Host Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2235-2235
Author(s):  
Joseph A. Pidala ◽  
Daanish Hoda ◽  
Norma Salgado-Vila ◽  
Jongphil Kim ◽  
Janelle Perkins ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Immunosuppressive Agents ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Host Disease ◽  
Graft Versus Host ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Maximum Decrease ◽  
Steroid Refractory ◽  
Acute Graft

Abstract Abstract 2235 Poster Board II-212 Acute graft-versus-host disease (aGVHD) remains the major cause of morbidity and mortality in allogeneic hematopoietic cell transplant recipients. There is no consensus in regards to the best therapy for patients who fail to respond to, or do not tolerate, systemic glucocorticoids. We evaluate the efficacy of sirolimus in 34 pts, median age of 49 (23-67) years, with steroid-refractory (N=31) or steroid-intolerant (N=3) aGVHD. The diagnosis of aGVHD was established at a median of 34 (7-1042) days after transplantation, and confirmed by biopsy in all cases. Initial treatment of aGVHD consisted of prednisone up to 2 mg/kg. Sirolimus was initiated at a median of 9 (1-255) days after glucocorticoid initiation. A loading dose of sirolimus was administered to 19 (56%) of 34 pts, median 6 (3-8) mg, followed by maintenance therapy of 1-2 mg per day with doses adjusted to target therapeutic trough levels between 4 and 12 ng/ml; therapeutic levels were achieved in all cases. The overall response rate was 76%. Fifteen (44%) of the 34 pts achieved a CR after sirolimus initiation and without requiring additional immune suppressive agents. CR was achieved in 11/31 (42%) steroid-refractory patients, and in 2/3 (67%) steroid-intolerant patients. The median overall survival (OS) after initiation of sirolimus was 5.6 months, and one year OS was 44% (95% C.I. 27%-60%). Maximum decrease in dose of steroids over 12 weeks following sirolimus was a median of 50% (range 0-100%). Fourteen (42%) of 33 pts reached a dose < 20 mg of prednisone at a median of 4 months (95% CI: 3.5-13.5) after initiation of sirolimus. Seven (21%) of 34 pts were free from steroids after a median of 20 months (95% CI: 9.2-20.0) after initiation of sirolimus. Two pts were shown to be successfully liberated from all immunosuppressive agents without recurrent GVHD at 2.7 and 7.1 months after initiation of sirolimus, respectively. These data indicate the sirolimus is effective in controlling steroid-refractory aGVHD. Further studies are needed to determine the most appropriate timing for sirolimus after transplantation, whether prophylaxis, primary or secondary GVHD therapy. Disclosures: Off Label Use: Sirolimus for graft-versus-host disease.

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