Granulocyte Transfusions for Treatment or Prophylaxis of Severe Infections in Immunocompromized Neutropenic Patients - A Randomized Clinical Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2934-2934
Author(s):  
Christina Peters ◽  
Markus G. Seidel ◽  
H. Northoff ◽  
R. Moog ◽  
A. Boehme ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Therapeutic Option ◽  
Randomized Study ◽  
Underlying Disease ◽  
Disease Stage ◽  
Hematopoietic Growth Factors ◽  
Hematopoietic Stem ◽  
Significant Difference ◽  
Severe Infections ◽  
Neutropenic Patients

Abstract Background: Despite availability of potent anti-bacterial, anti-mycotic drugs and hematopoietic growth factors invasive bacterial or fungal infections remain a severe threat to neutropenic patients after chemotherapy or hematopoietic stem cell transplantation (HSCT). Granulocyte transfusions (GT) from granulocyte colony stimulating factor (G-CSF)-stimulated donors have been shown to increase the leukocyte count prior to expected hematopoietic regeneration, resulting in a shorter period of neutropenia and thus offer a therapeutic option for the control of severe infections. However, published studies rely on clinical observations of individual cases as no statistical comparison with control groups could have been established. The aim of this study was to define the clinical benefit and the leukocyte increment/duration of neutropenia after randomized administration of leukocyte transfusions in immunocompromized neutropenic patients. Patients and methods: Between 1999 and 2005 80 patients with underlying hematological diseases with or without allogeneic or autologous HSCT were randomized to receive either G-CSF, anti-infective treatment according to local standards with or without therapeutic or prophylactic application of GT from G-CSF-stimulated volunteer donors. The mean age was 47 years (range, 14 – 62 y). Indications were either fever in neutropenia and pulmonary infiltrates or soft tissue infiltration (therapeutic) or the history of invasive fungal infection during episodes of neutropenia following earlier chemotherapy courses and anticipated neutropenia of > 10 days (prophylactic). Results: 10 centers participated in the trial, however only five centers recruited patients (n=80) for randomization during the study period. This corresponds to ~50% of the expected sample size of 160 patients, hence results are statistically insignificant. Patient characteristics were comparable within the randomized cohorts (underlying disease, stage of disease, indication for GT, lenght of neutropenia). No significant difference in the clinical outcome was found between patients who received either therapeutic or prophylactic GT from G-CSF stimulated donors or no GT. The probability of survival on day 28 was 85% in both groups. Furthermore, no difference in the incidence and causes of death could be identified within the compared cohorts. Conclusion: The high percentage of infection clearance and survival in patients with severe infections in both groups contrasts with published results and own experiences. We speculate whether this is due a bias in including predominantly patients into the randomized study who presented with relatively favourable prognostic factors, as in the observation period numerous GT were performed in the participating centers without randomization. Most likely, existing clinical evidence for the benefit of this therapeutic measure was sufficient in many cases to exclude patients in serious conditions from randomization. Although well designed, a randomized trial may not always provide the expected results.

Factors Affecting the Development of Atrial Fibrillation and Atrial Flutter (AF) Following Autologous Hematopoietic Stem Cell Transplantation (auto-HSCT).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1754-1754
Author(s):  
Mary Lee H. Villanueva ◽  
Fausto R. Loberiza ◽  
James O. Armitage ◽  
Robert G. Bociek ◽  
Apar Kishor Ganti ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Multivariate Model ◽  
Disease Stage ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Factors Associated ◽  
Mediastinal Irradiation ◽  
Number Of Patients ◽  
Significant Difference ◽  
History Of

Abstract Background: The use of auto-HSCT has expanded to include older patients. Age is a risk factor for the development of AF in the general population. As more elderly patients undergo auto-HSCT, the risk of developing AF post-transplant may also increase. The development of AF may increase morbidity, may prolong hospitalization, and may increase the cost of hospitalization. However, few data exist evaluating the factors that contribute to the development of AF following auto-HSCT. At our institution, we have observed a large number of patients with this complication. Therefore, we performed a retrospective case-control study to determine the incidence of AF following auto-HSCT and to determine risk factors associated with the development of AF. Patients and Methods: We performed a chart review on all patients at our institution who received an auto-HSCT from November 1999 to May 2004. Cases were identified by reviewing EKGs performed post-transplant. Controls consisted of patients with similar age, year of transplant, and underlying hematologic malignancy. The following variables were examined for their association with AF: age, sex, diagnosis, disease stage at transplant, conditioning regimen, year of transplant, previous medical history including cardiac history, pre-transplant cardiology work-up, and electrolyte abnormalities immediately following auto-HSCT. Patients who developed AF were compared to controls. Multivariate logistic regression was done to evaluate the factors associated with the development of AF. Results: During the study period, 44 patients developed AF at a median of four days (range days 1–9) following auto-HSCT; incidence of 8.5%. We identified 516 patients who did not develop AF who had auto-HSCT in the same time period. Of these, 179 patients with similar characteristics were used as controls. The following variables were associated with developing AF in the multivariate model: age at transplant; median age 63 yrs (50–72) for cases vs 57 (49–72) for controls (p<0.001), abnormal renal function as determined by serum creatinine (p=0.008), history of previous arrhythmia (p<0.001), and a history of mediastinal irradiation (p=0.003). Although not significant in the multivariate model, we observed that 45% of the patients who developed AF had increased left atrial size on a pre-transplant echocardiogram as opposed to none in the controls (p<0.001). There was no difference in the length of hospital stay between the cases and controls (p=0.13). We did not detect a significant difference in the 100d survival between those who did and did not develop AF (90% vs 96%, p=0.25). However, patients who did not develop AF had a better overall survival (Log-rank p=0.04). Conclusions: Patients with older age, elevated serum creatinine level, history of previous arrhythmia, or history of previous mediastinal irradiation are more likely to develop AF following an auto-HSCT. Future studies should investigate whether interventions such as prophylactic beta-blockers can decrease the incidence of AF following auto-HSCT.

Superior Survival after Autologous vs. Allogeneic Hematopoietic Stem Cell Transplantation (HCT) for Diffuse Large B-Cell Lymphoma (DLBCL) Not Explained by Differences in Chemosensitivity.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3021-3021
Author(s):  
Brandon Hayes-Lattin ◽  
Jeanette Carreras ◽  
Mei-Jie Zhang ◽  
Koen van Besien ◽  
Julie M. Vose ◽  
...  
Keyword(s):  
B Cell Lymphoma ◽  
Older Age ◽  
Disease Stage ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Significant Difference ◽  
Risk Of Progression ◽  
The Difference ◽  
Induction Failure ◽  
Autologous Hct

Abstract No randomized trials have compared autologous HCT (autoHCT) to allogeneic HCT (alloHCT) for DLBCL. We analyzed the outcomes of 916 patients (pts) (837 autoHCT and 79 alloHCT) ages 18–60yrs after a first autoHCT or HLA-identical sibling alloHCT for DLBCL between 1995 and 2003 reported to the CIBMTR. Pts receiving T-cell depleted allografts or reduced-intensity conditioning were excluded. There were significant baseline differences between the groups in disease stage, B symptoms, extranodal disease and marrow involvement. AlloHCT pts were significantly more likely to have >3 chemo regimens prior to HCT (53 vs 40%), and resistant induction failure or relapse (39 vs 16%). At 1yr, treatment-related mortality (TRM) was higher after alloHCT (41%, 95% CI, 30–52%) than after autoHCT (11%, 95% CI, 9–14%, p<0.001), but risks of relapse/progression were similar (30%, 95% CI, 21–41%) and (33%, 95% CI, 29–36%, p=0.69), respectively. Cumulative incidence of outcomes and univariate probabilities of progression free (PFS) and overall survival (OS) at 5 yrs are summarized in table 1. In multivariate analysis, allo and autoHCT had differential early and late effects on outcomes. In the first 12 mo after transplant, alloHCT was associated with higher TRM (RR 4.76, 95% CI, 3.14–7.22, p<0.001), treatment failure (RR 2.08, 95% CI, 1.56–2.77, p<0.001) and mortality (RR 2.78, 95% CI, 2.06–3.77, p<0.001) but similar risk of progression (RR 1.14, 95% CI, 0.75–1.74, p=0.54) compared to autoHCT. Among pts surviving 12 mo post-transplant, no significant difference was observed between autoHCT and alloHCT for TRM, progression, PFS, or OS. Covariates that increased the risks of TRM and OS were older age (51–60 years), KPS <90%, chemoresistance at transplant, and earlier transplant yr (before 2001 vs later). Older age and chemoresistance were also associated with progression and lower PFS. There were no significant interactions between graft type and other prognostic variables; in particular, relative risk of outcomes with allo vs autoHCT were similar for patients with chemosensitive and chemoresistant disease. In summary, myeloablative alloHCT increased risks of early TRM and mortaliy without an effect on progression (compared to autoHCT). Transplant type did not affect outcomes after 12 months post-transplant. AutoHCT was associated with superior survival (fig 1), and the difference was not explained by differences in chemosensitivity at the time of transplant. AutoHCT AlloHCT Outcomes (95%CI) (95%CI) AGVHD @ day 100 N/A 42 (31–53) CGVHD @ 5yrs N/A 27 (18–38) TRM @ 5yrs 18 (15–20) 45 (34–57) Relapse/progression @ 5yrs 39 (36–43) 33 (23–44) PFS @ 5yrs 43 (40–46) 26 (18–37) OS @ 5yrs 49 (46–53) 27 (18–27) Figure 1 Figure 1.

Early lymphocyte recovery (ELR) impact on disease outcome following autologous hematopoietic stem cell transplantation (HDT/ASCT) for multiple myeloma (MM) in the era of novel agents.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19539-e19539
Author(s):  
Jeremy Scott McDuffie ◽  
Bipin N. Savani ◽  
Wichai Chinratanalab ◽  
Stacey Goodman ◽  
John P. Greer ◽  
...  
Keyword(s):  
Minimal Residual Disease ◽  
Residual Disease ◽  
Disease Status ◽  
Novel Agents ◽  
Disease Outcome ◽  
Disease Stage ◽  
Response Criteria ◽  
Hematopoietic Stem ◽  
Significant Difference ◽  
Minimal Residual

e19539 Background: Absolute lymphocyte count (ALC) > 500 cells/ µL on day 15 (ELR+) after HDT/ASCT, has been reported to be an independent prognostic indicator, for improved OS and PFS in patients with MM. Novel agents (immunomodulatory drugs (IMiDs) and proteasome inhibitors), mediate there effect through T-cell stimulation, NK cell activation, anti-proliferation, and are now main stay of therapy for MM. We sought to determine their effects on ELR, and correlated to disease outcome. Methods: A retrospective review of all MM patients seen at our institution undergoing HDT/ASCT from January 2008 to December 2012 was performed. Patients were identified from our CIBMTR database. ALC was determined pre-HDT/ASCT (T1), on day15 (T2) and d30 (T3) post-HDC/ASCT. No restrictions on inclusion were made based upon the International Myeloma Working Group response criteria. All had novel agents as part of their initial induction regimen. Disease response was determined by standard clinical and laboratory CIBMTR response criteria, and minimal residual disease status (MRD) by multiparameter flow cytometry. Results: In our study (n= 184), 52/184 patients had ELR+ while 132/184 had ALC < 500 cells/mL (ELR-) at T2. 21% received IMiDs, 33% proteasome inhibitor and 46% combination therapies. 52% of the ELR+ patients were MRD negative (-) at T1, and improved to 74% and 89% at D100, and 1 year post-HDC/ASCT respectively. Similarly 63%, 70%, and 80% of the ELR- patients, were MRD (-) at similar time-points. Chi squared analysis showed no significant difference in rates of MRD (-) based on ELR. ELR also had no impact on disease status as determined by CIBMTR response criteria, or 1 year PFS and OS (p = 0.383), (p = 0.577) respectively. Multivariate analyses, using cox-regression showed no impact of ALC at T1, T2, T3, age, sex, race, cytogenetic risk, or disease stage on disease outcome. Conclusions: Novel agents improve disease control independent of ELR following HDC/ASCT. Understanding their biologic effect on immune-reconstitution will provide a platform for adoptive immunotherapy to better target minimal residual disease.

scholarly journals Diagnosis of invasive fungal infections

2012 ◽  
Vol 3 (1S) ◽  
pp. 15
Author(s):  
Anna Maria Barbui ◽  
Corrado Girmenia ◽  
Giorgio Limerutti
Keyword(s):  
Multidisciplinary Approach ◽  
Medical Decision Making ◽  
Immune Status ◽  
Fungal Infections ◽  
Underlying Disease ◽  
Infectious Complications ◽  
Invasive Fungal Infections ◽  
Disease Stage ◽  
Medical Decision ◽  
Diagnostic Strategy

A proper diagnostic strategy of invasive fungal infections (IFI) is a very important component in the management of infectious complications in hematological patients. A good diagnostic approach should be adapted to the patient in relation to the underlying disease, stage of disease, localization of infection and immune status. None of the diagnostic markers can be entirely adopted for medical decision making, and sometimes it’s useful to use the combination of several microbiological tests.The diagnosis of IFI must therefore have a multidisciplinary approach that includes clinical suspicion, microbiological results and radiological evidence.

scholarly journals Fungal infections in neutropenic patients: a 8-year prospective study

1995 ◽  
Vol 37 (5) ◽  
pp. 397-406 ◽  
Author(s):  
Marcio Nucci ◽  
Wolmar Pulcheri ◽  
Nelson Spector ◽  
Ana Paula Bueno ◽  
Paulo Cesar Bacha ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prospective Study ◽  
Death Rate ◽  
Fungal Infections ◽  
Venous Catheter ◽  
Good Prognosis ◽  
Significant Difference ◽  
Patients At Risk ◽  
Neutropenic Patients ◽  
Fusarium Sp

In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p<0.001), longer duration of profound (<100/mm³) neutropenia (p<0.001), the use of corticosteroids (p<0.001), gram-positive bacteremia (p=0.002) and younger age (p=0.03). In multivariate analysis only recovery of the neutropenia (p<0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p=0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.

Itraconazole for Antifungal Prophylaxis in Neutropenic Patients: An Update of a Meta-Analysis with Now 3846 Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3224-3224
Author(s):  
Axel Glasmacher ◽  
Corinna Hahn ◽  
Marie von Lilienfeld-Toal ◽  
Katjana Orlopp ◽  
Ingo Schmidt-Wolf ◽  
...  
Keyword(s):  
Relative Risk ◽  
Randomized Clinical Trials ◽  
Fungal Infections ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Significant Difference ◽  
Neutropenic Patients ◽  
Related Mortality

Abstract Invasive fungal infections, esp. from Aspergillus spp., still are a major cause of mortality and morbidity in neutropenic patients with haematological malignancies. We have published a meta-analysis on the use of itraconazole for antifungal prophylaxis (Glasmacher et al., JCO2003; 21: 4615) and now present updated results. Methods: In a continuous search of electronic databases and abstracts we identified randomized clinical trials in neutropenic patients that compared itraconazole with either nothing, oral polyenes or fluconazole. Again, analysis was restricted to proven invasive fungal infections according to EORTC/MSG criteria. Statistical analyses were performed with the Cochrane Review Manager (Version 2.4.8), relative risk ratios (RR) with their 95% confidence intervals (95%CI) and appropriate P values were reported. Subgroups were defined by itraconazole preparation and the comparator. A RR below 1 indicates better results for itraconazole. Results - New Trials: Two new trials with 54 and 195 evaluable patients (pts) were identified and the data of one unpublished trials was updated. Both studies used itraconazole solution (400 mg/d) and compared it to 400 mg/d fluconazole. One study applied intravenous solutions of both drugs if necessary. No study was powered to detect a significant difference in proven invasive fungal infections between the two drugs. One study reported a reduction of fungal-related mortality in the itraconazole arm (fluconazole 9/12, 75%, vs. itraconazole 5/11, 45%; P=0.154). Results - Meta-Analysis: The incidence of proven invasive fungal infection from all studies and arms was 4.1% and 8.3% if suspected infections were included. The reduction in the incidence of proven breakthrough invasive mycosis was significant (Table 1). As in the original analysis, the relative risk is reduced only in the group provided with itraconazole solution and with a relative risk reduction of 46%. Results - Itraconazole vs. Fluconazole: Table 2 reports a comparison of itraconazole solution vs. fluconazole for different relevant outcomes. There is a significant superiority of itraconazole for the reduction of all proven invasive fungal infections and for invasive Aspergillus infections and reductions are in the same range but not significant for the other outcomes. Conclusions: Itraconazole is still and significantly superior to its comparators, including fluconazole, in reducing the rate of breakthrough invasive fungal infections. This effect is only seen with the itraconazole oral or intravenous solution (at least 400 mg/d) which also reduce the rate of proven invasive Aspergillus infections. Table 1: Incidence of proven invasive fungal infections Subgroup No. Pts (Trials) Relative Risk 95%CI P All studies 3846 (15) 0.62 0.45–0.77 0.003 Itraconazole capsules 735 (5) 0.93 0.51–1.69 0.81 Itraconazole solution 3111 (10) 0.54 0.37–0.77 0.0008 Table 2: Comparison of itraconazole solution vs fluconazole (proven only) Outcome No. of trials Itraconazole (n/N) Fluconazole (n/N) Relative Risk 95%CI P Abbrev.: n= pts. with event; N=total pts. Invasive fungal infections 6 23/883 43/874 0.52 0.32–0.84 0.008 Invasive yeast infections 6 9/851 16//854 0.56 0.25–1.24 0.15 Invasive Aspergillus infections 5 12/850 24/853 0.50 0.26–0.98 0.04 Fungal-related Mortality 4 20/754 31/754 0.64 0.38–1.09 0.10

Optimal Trough Concentration of Teicoplanin in Febrile Neutropenic Patients with Hematological Malignancy

Chemotherapy ◽  
2017 ◽  
Vol 63 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Yuhki Sato ◽  
Kazufumi Hiramatsu ◽  
Yosuke Suzuki ◽  
Ryota Tanaka ◽  
Tetsuya Kaneko ◽  
...  
Keyword(s):  
Trough Concentration ◽  
Operating Characteristic ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Hematological Malignancy ◽  
Therapeutic Drug ◽  
Receiver Operating Characteristic Curves ◽  
Significant Difference ◽  
Observational Cohort ◽  
Severe Infections ◽  
Neutropenic Patients

Background: Teicoplanin is a glycopeptide antibiotic currently used for the treatment of methicillin-resistant Staphylococcus aureus. The need for therapeutic drug monitoring of teicoplanin has been increasingly highlighted as important. It is generally accepted that whereas a plasma trough concentration (Cmin) of ≥10 mg/L is appropriate for the majority of infections, it should exceed 20 mg/L for severe infections. The target Cmin of teicoplanin in patients with febrile neutropenia (FN) has not been reported. The aim of this study was to estimate the target Cmin for the treatment of FN in patients with hematological malignancy. Methods: In this retrospective, single-center, observational cohort study, the records of 52 hospitalized patients with hematological malignancy who were treated with teicoplanin for FN due to bacteriologically documented or presumptive gram-positive infections were analyzed. Results: A significant difference in the first Cmin of teicoplanin was observed between the response and nonresponse groups in patients with bacteremia. The areas under the receiver operating characteristic curves were 0.80 for clinical efficacy. The cut-off value of teicoplanin Cmin on days 4-6 was 15.2 mg/L (sensitivity 80.0%, specificity 75.0%). Conclusions: The authors propose a target teicoplanin Cmin of ≥15.2 mg/L for FN in patients with hematological malignancy.

scholarly journals Randomized Trial of Micafungin Versus Fluconazole in Prophylaxis Against Invasive Fungal Infections in Hematopoietic Stem Cell Transplant Recipients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1904-1904
Author(s):  
Silvia Park ◽  
Kihyun Kim ◽  
Jun Ho Jang ◽  
Seok Jin Kim ◽  
Won Seog Kim ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Hematopoietic Stem ◽  
Significant Difference ◽  
Anti Fungal ◽  
Related Mortality

Abstract Introduction: Invasive fungal infections cause significant morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients. Although fluconazole has been widely used as an antifungal prophylactic agent in these patients, it is not reliably effective against mold infection including invasive aspergillosis. Micafungin provides antifungal activity against Candida and Aspergillus species, and previous studies have demonstrated its efficacy when used as a prophylactic agent for fungal infection in neutropenic patients. Here, we evaluated and compared the incidence rate of proven or probable invasive fungal infections (IFIs) with antifungal prophylaxis using micafungin or fluconazole. Methods: This is a prospective, single center, phase II study involving adult patients who received allogeneic or autologous HSCT. Patients were randomly assigned to micafungin or fluconazole arms in the ratio of 2:1, and the treatment was initiated within 24 hour of hematopoietic stem cell infusion and maintained for up to 21 days. Primary objective was the incidence of proven or probable invasive fungal infections (IFIs) during the 100 days after HSCT. Secondary objectives involved the incidence of possible, proven or probable IFIs, need for change of anti-fungal agents before engraftment, IFI-related mortality and survival within 100 days after transplantation. Results: Between March 2010 and May 2015, a total of 257 patients were enrolled. Excluding 7 patients who did not receive at least one dose of study treatment, 250 patients (micafungin, n=165; fluconazole, n=85) were examined for clinical efficacy. The median age was 47 years (20-64) and allogeneic and autologous transplantation comprised 56.0% (n=140) and 44.0% (n=110) of the patients. Baseline characteristics were well balanced between the two groups. Overall, the incidence of proven and probable IFIs within 100 days of HSCT was 7.6% (n=19), and there was no significant difference in the proportion of patients who experienced proven or probable IFIs between the micafungin and the fluconazole groups (7.3% in micafungin group versus 8.2% in fluconazole group, p=0.786). Thirteen patients of micafungin arm (7.9%) and 8 patients of fluconazole arm (9.4%) had to have changed antifungals before engraftment (p=0.824). There was no significant difference in the mortality within 100 days after HSCT (9.1% in micafungin arm vs 12.9% in fluconazole arm, p=0.345). Conclusion: Micafungin is comparable to fluconazole in the prevention of IFIs in HSCT recipients. Table 1. Clinical outcomes including invasive fungal infections within 100 days after transplantation Characteristics (total n=250) Total patients(n=250) Fluconazole(n=85) Micafungin(n=165) p-value Proven IFIs AllCandidiasisAspergillosisMucormycosis 5 (2.0%) 2 (0.8%) 1 (0.4%) 2 (0.8%) 3 (3.5%) 1 (1.2%) 0 (0.0%) 2 (2.4%) 2 (1.2%) 1 (0.6%) 1 (0.6%) 0 (0.0%) 0.341 1.000 1.000 0.115 Probable IFIs 16 (6.4%) 5 (5.9%) 11 (6.7%) 0.810 Possible IFIs 7 (2.8%) 1 (1.2%) 6 (3.6%) 0.428 Proven, probable IFIs 19 (7.6%) 7 (8.2%) 12 (7.3%) 0.786 Proven, probable, possible IFIs 26 (10.4%) 8 (9.4%) 18 (10.9%) 0.713 Invasive mold infections Proven, probable Proven, probable, possible 18 (7.2%)25 (10.0%) 6 (7.1%)7 (8.2%) 12 (7.3%)18 (10.9%) 0.9510.504 Need for anti-fungal agents change before engraftment 21 (8.4%) 8 (9.4%) 13 (7.9%) 0.824 Mortality within 100 days after HSCT 26 (10.4%) 11 (12.9%) 15 (9.1%) 0.345 IFI related mortality within 100 daysafter HSCT 5 (2.0%) 3 (3.5%) 2 (1.2%) 0.341 28 invasive fungal infections were observed in 26 patients Abbreviations: IFI=invasive fungal infection, HSCT=Hematopoietic stem cell transplantation Disclosures No relevant conflicts of interest to declare.

scholarly journals Diagnosis of invasive fungal infections

2012 ◽  
Vol 3 (1S) ◽  
pp. 15-25
Author(s):  
Anna Maria Barbui ◽  
Corrado Girmenia ◽  
Giorgio Limerutti
Keyword(s):  
Multidisciplinary Approach ◽  
Medical Decision Making ◽  
Immune Status ◽  
Fungal Infections ◽  
Underlying Disease ◽  
Infectious Complications ◽  
Invasive Fungal Infections ◽  
Disease Stage ◽  
Medical Decision ◽  
Diagnostic Strategy

A proper diagnostic strategy of invasive fungal infections (IFI) is a very important component in the management of infectious complications in hematological patients. A good diagnostic approach should be adapted to the patient in relation to the underlying disease, stage of disease, localization of infection and immune status. None of the diagnostic markers can be entirely adopted for medical decision making, and sometimes it’s useful to use the combination of several microbiological tests.The diagnosis of IFI must therefore have a multidisciplinary approach that includes clinical suspicion, microbiological results and radiological evidence.

Thymoglobulin ® Rabbit Anti-Thymocyte Globulins (r-ATG) Induces Faster Platelet Recovery and Does Not Suppress Granulocyte Engraftment in a Non-Myeloablative Stem Cell Transplantation Setting.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4942-4942
Author(s):  
Michael Y. Shapira ◽  
Igor B. Resnick ◽  
Benjamin Gesundeheidt ◽  
Menachem Bitan ◽  
Aliza Ackerstein ◽  
...  
Keyword(s):  
Stem Cell ◽  
Median Time ◽  
Randomized Study ◽  
Graft Function ◽  
Underlying Disease ◽  
Control Groups ◽  
Hematopoietic Stem ◽  
Platelet Recovery ◽  
Stem Cell Graft ◽  
And Control

Abstract Introduction: The role of anti thymocyte globulin in GVHD prevention is well established, but it is also known that anti thymocyte globulin induces leucopenia and thrombocytopenia and as such might theoretically delay engraftment. Additionally, fast platelet engraftment is a marker for good hematopoietic stem cell graft function. We have prospectively compared the effect of Thymoglobulin on engraftment of granulocytes and platelets following a single non-myeloablative conditioning protocol in a randomized study. Methods: 28 consecutive patients undergoing SCT were conditioned with the NST protocol (I.V.fludarabine 30mg/m2/day (days −10 to −5) and I.V. busulfex (3.2 mg\kg on days −6 and −5), with or without I.V. Thymoglobulin according to randomization (days −4 to −1). Thymoglobulin dosing schedule: a cumulative dose of 7.5 mg/kg r-ATG was given with the following program 0.5 mg/kg day −4, 2.0 mg/kg day −3, 2.5 mg/kg day −2, 2.5 mg/kg day −1. Patients were followed for engraftment of leukocytes and platelets. Results: only one patient rejected the graft (conditioned without Thymoglobulin, NS). In 4 patients underlying disease progression prevented engraftment of either ANC or platelets (2 per group). The median time to ANC engraftment was similar between the groups, 15±2.8 and 14±2.9 days for the Thymoglobulin and control groups respectively (figure 1, p=0.21). However, the median time for platelet engraftment was significantly shorter in patients receiving Thymoglobulin as part of the conditioning. Platelet recovery occurred 9.5±1.2 and 11±2.5 days for the Thymoglobulin and control groups respectively (figure 2, p=0.018). Conclusions: in the non-myeloablative setting, Thymoglobulin induces faster platelet recovery and does not delay ANC engraftment. Figure Figure Figure Figure

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