scholarly journals Conventional compared to network meta-analysis to evaluate antibiotic prophylaxis in patients with cancer and haematopoietic stem cell transplantation recipients

2020 ◽  
pp. bmjebm-2020-111362
Author(s):  
Juan Pablo Diaz Martinez ◽  
Paula D Robinson ◽  
Bob Phillips ◽  
Thomas Lehrnbecher ◽  
Christa Koenig ◽  
...  
Keyword(s):  
Stem Cell ◽  
Meta Analysis ◽  
Haematopoietic Stem Cell ◽  
Relative Risk Ratio ◽  
Antibacterial Prophylaxis ◽  
Cell Transplant ◽  
Network Approach ◽  
Control Groups ◽  
Eligibility Criteria ◽  
Credible Region

Our purpose was to compare conventional meta-analysis and network meta-analysis to evaluate the efficacy of different prophylactic systemic antibiotic classes in patients undergoing chemotherapy or haematopoietic stem cell transplant (HSCT). We included randomised trials if patients had cancer or were HSCT recipients and the intervention was systemic antibacterial prophylaxis. Three types of control groups were used: (1) placebo, no antibiotic and non-absorbable antibiotic separately; (2) placebo and no antibiotic combined; and (3) all three combined. These gave different network geometries. Strategies synthesised were fluoroquinolone, trimethoprim-sulfamethoxazole, cephalosporin and parenteral glycopeptide versus control groups. In total 113 trials met the eligibility criteria. Where treatment effects could be estimated with both conventional and network meta-analysis, values were generally similar. However, where events were sparse, network meta-analysis could be more precise. For example, trimethoprim-sulfamethoxazole versus placebo for infection-related mortality showed a relative risk ratio (RR) of 0.55, 95% CI (0.21 to 1.44) with conventional, and RR 0.43, 95% credible region (0.20 to 0.82) with network meta-analysis. Cephalosporin versus fluoroquinolone was comparable only indirectly using the network approach and yielded RR 0.59, 95% credible region (0.28 to 1.20) to reduce bacteraemia. Incoherence (difference between direct and indirect estimates raising concerns about network meta-analysis validity) was observed with network geometry where control groups were separated, but not where control groups were combined. In this situation, conventional and network meta-analysis yielded similar results in general. Network meta-analysis results could be more precise when events were rare. Some analysis could only be performed with the network approach. These results identify scenarios in which network meta-analysis may be advantageous.

scholarly journals Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients

2021 ◽  
Vol 8 ◽  
pp. 204993612199137
Author(s):  
Aditya Jandial ◽  
Kundan Mishra ◽  
Rajeev Sandal ◽  
Kamal Kant Sahu
Keyword(s):  
Stem Cell ◽  
Platelet Rich Plasma ◽  
Severe Disease ◽  
Unmet Need ◽  
Bk Virus ◽  
Haematopoietic Stem Cell ◽  
Cellular Immunotherapy ◽  
Cell Transplant ◽  
Clotting Factors ◽  
Haemorrhagic Cystitis

BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC.

Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing

2021 ◽  
Vol 70 (10) ◽  
Author(s):  
Hermes Ryoiti Higashino ◽  
Ana Paula Marchi ◽  
Roberta Cristina Ruedas Martins ◽  
Laina Bubach Carvalho ◽  
Lauro Vieira Perdigão Neto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Klebsiella Pneumoniae ◽  
Genome Sequencing ◽  
Stem Cell Transplant ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Whole Genome ◽  
Carbapenem Resistant ◽  
Overall Mortality

Carbapenem-resistant Klebsiella pneumoniae (CRK) infections are a growing concern in immunocompromised patients. The aim of the present study was to evaluate the impact of CRK colonization and infection in overall mortality for haematopoietic stem-cell transplant (HSCT) patients. We also aimed to investigate resistance and virulence profiles of CRK isolates and assess their epidemiological and genetic relatedness. Patients in the HSCT unit were screened for colonization with CRK with weekly rectal swab or stool cultures and placed under contact precautions. We defined CRK colonization as positive culture from a swab or stool sample grown in MacConkey agar with meropenem at 1 µg ml−1. Demographic and clinical data were retrieved from the patients’ charts and electronic records. According to resistance mechanisms and pulsed field gel electrophoresis profile, isolates were selected based on whole-genome sequencing (WGS) using MiSeq Illumina. Outcomes were defined as overall mortality (death up to D+100), and infection-related death (within 14 days of infection). We report a retrospective cohort of 569 haematopoietic stem-cell transplant patients with 105 (18.4 %) CRK colonizations and 30 (5.3 %) infections. blaKPC was the most frequent carbapenemase in our cohort with three isolates co-harbouring blaKPC and blaNDM. We found no difference in virulence profiles from the CRK isolates. There were also no significant differences in virulence profiles among colonization and infection isolates regarding genes encoding for type 1 and 3 fimbriae, siderophores, lipopolysaccharide and colibactin. In clonality analysis by PFGE and WGS, isolates were polyclonal and ST340 was the most prevalent. Overall survival at D+100 was 75.4 % in in CRK-colonized (P=0.02) and 35.7 % in infected patients and significantly lower than non-colonized patients (85.8 %; P<0.001). We found a higher overall mortality associated with colonization and infection; KPC was the main resistance mechanism for carbapenems. The polyclonal distribution of isolates and findings of CRK infection in patients not previously colonized suggest the need to reinforce antibiotic stewardship.

scholarly journals Identification of Epstein–Barr virus-infected CD27+ memory B-cells in liver or stem cell transplant patients

2011 ◽  
Vol 92 (11) ◽  
pp. 2590-2595 ◽  
Author(s):  
Yoshinori Ito ◽  
Shinji Kawabe ◽  
Seiji Kojima ◽  
Fumihiko Nakamura ◽  
Yukihiro Nishiyama ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Stem Cell ◽  
B Cells ◽  
Epstein Barr Virus ◽  
Peripheral Blood Lymphocytes ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Barr Virus ◽  
Infected Cells ◽  
Epstein Barr

To analyse the phenotype of Epstein–Barr virus (EBV)-infected lymphocytes in EBV-associated infections, cells from eight haematopoietic stem cell/liver transplantation recipients with elevated EBV viral loads were examined by a novel quantitative assay designed to identify EBV-infected cells by using a flow cytometric detection of fluorescent in situ hybridization (FISH) assay. By this assay, 0.05–0.78 % of peripheral blood lymphocytes tested positive for EBV, and the EBV-infected cells were CD20+ B-cells in all eight patients. Of the CD20+ EBV-infected lymphocytes, 48–83 % of cells tested IgD positive and 49–100 % of cells tested CD27 positive. Additionally, the number of EBV-infected cells assayed by using FISH was significantly correlated with the EBV-DNA load, as determined by real-time PCR (r 2 = 0.88, P<0.0001). The FISH assay enabled us to characterize EBV-infected cells and perform a quantitative analysis in patients with EBV infection after stem cell/liver transplantation.

scholarly journals Unusual oral presentation of acyclovir-resistant herpes simplex in an allogeneic haematopoietic stem cell transplant recipient

2021 ◽  
Vol 14 (12) ◽  
pp. e247109
Author(s):  
Thomas Saunsbury ◽  
Molly Harte ◽  
Daniela Ion
Keyword(s):  
Stem Cell ◽  
Herpes Simplex ◽  
Oral Disease ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Myeloablative Conditioning ◽  
Total Body ◽  
Simplex Virus ◽  
Infective Complications ◽  
Early Late

The early engraftment phase of allogeneic haematopoietic stem cell transplantation can be associated with a number of oromucosal infective complications. While the routine use of prophylactic acyclovir has reduced the incidence of herpes simplex virus (HSV) reactivation, there is an increasing prevalence of acyclovir resistance within this cohort of patients. The authors present a case of acyclovir-resistant HSV reactivation in a 26-year-old woman 7 days post T-deplete sibling allograft on a background of combined cyclophosphamide and total body irradiation myeloablative conditioning, successfully treated with foscarnet and cidofovir therapy and discuss the differential diagnoses for early/late engraftment oral disease.

Sign in / Sign up

Export Citation Format

Share Document