Risk Factors Associated with VOD with RIC and MAC Hematopoietic Stem Cell Transplant and the Early Estimation of VOD

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4315-4315
Author(s):  
Shoichi Nagakura ◽  
Tetsuyuki Kiyokawa ◽  
Michihiro Hidaka ◽  
Takahiro Yano ◽  
Kazutaka Sunami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Goodness Of Fit ◽  
Time Course ◽  
Laboratory Data ◽  
P Value ◽  
Cell Transplant ◽  
Data Set ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Factors Associated

Abstract BACKGROUND: Despite recent increase of reduced intensity conditioning (RIC) transplantation, mortality rates after RIC and myeloabrative conditioning (MAC) HSCT remain high and hepatic veno-occlusive disease (VOD) cannot accurately predicted. OBJECTIVE: To determine the value of risk factors associated with the development of VOD after allergenic HSCT with RIC and MAC. Estimating VOD based on clinical factors may further improve results of allogenic HSCT. PATIENTS AND METHODS: A retrospective review of 415 consecutive allogenic HSCT was performed with attention to VOD, pre-transplant factors and laboratory data in five hematopoietic cell transplantation centers between 2000 and 2005. Patients underwent transplantation with MAC (n=247) or RIC (n=168). Main outcomes and risk factors were analyzed in multivariable analyses (a logistic regression model) with RIC and MAC. Three kind of laboratory data set, pre-transplant (day −10), post-transplant (day 20) and differences from pre-transplant to post-transplantation were analyzed. RESULTS: VOD occurred in 65 of 415(15.7%) transplant recipients; 40 of 247(16.1%) with MAC and 25 of 168(14.9%) with RIC. Multivariate analyses identified risk factors with the development of VOD with MAC (albumin level, creatinine level) and with RIC (HCT-CI, number of prior chemotherapy regimen, ALT) in pre-transplant laboratory data set. The risk factors of VOD were identified in post-transplant and differences (Table). The Akaike’s information criterion (AIC) of risk factors with differences was better than with the post-transplant. CONCLUSION: Our results provided risk factors of VOD with MAC and RIC. The estimation of VOD before transplantation may be useful for the selection of conditioning regimens. Differences of laboratory data with the time course of transplant may be useful for the early diagnosis of VOD. MAC Pre-transpant data Post-transplant data Differences data OR P-Value OR P-Value OR P-Value Age - - 0.945 0.0090 - - Alb 0.290 0.0125 - - - - Cr 10.204 0.0307 1.786 0.0039 1.984 0.0139 TPro - - 0 358 0.0019 - - TBi I - - 1.385 0.0027 1.314 0.0037 Ara-C - - 5.000 0.0139 goodness of fit AIC 106.727 126.499 86.931 RIC Pre-transpant data Post-transplant data Differences data OR P-Value OR P-Value OR P-Value Sex - - 3.401 0.0446 - - HCTCI 3.922 0.0050 2.000 0.0123 - - ImpScore 2.000 0.0314 - - - - TPro - - 0.366 0.0091 - - TBi I - - 1.675 0.0042 2.273 0.0004 ALT 0.969 0.0432 - - - - CY - - - - 5.682 0.0447 goodness of fit AIC 61.552 91.09 52.808

scholarly journals INCIDENCE OF DIARRHEA BY Clostridium difficile IN HEMATOLOGIC PATIENTS AND HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS: RISK FACTORS FOR SEVERE FORMS AND DEATH

2014 ◽  
Vol 56 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Fernanda Spadão ◽  
Juliana Gerhardt ◽  
Thais Guimarães ◽  
Frederico Dulley ◽  
João Nóbrega de Almeida Junior ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Clostridium Difficile ◽  
Underlying Disease ◽  
Severe Form ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Factors Associated ◽  
Potential Factors ◽  
Clostridium Difficile Associated Diarrhea

We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%) undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%) have severe CDAD. Most of the patients (89%) received treatment with oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid.

scholarly journals 1394. Clinicopathologic Features of Infectious and Noninfectious Tissue Granulomas in Transplant Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S506-S507
Author(s):  
Eliezer Zachary Nussbaum ◽  
Rita Abi Raad ◽  
Maricar Malinis ◽  
Marwan M Azar
Keyword(s):  
Risk Factors ◽  
Organ Transplant ◽  
Severe Infection ◽  
Adverse Outcomes ◽  
Solid Organ ◽  
Cell Transplant ◽  
Clinicopathologic Features ◽  
Hematopoietic Stem ◽  
Cryptogenic Organizing Pneumonia ◽  
Post Transplant

Abstract Background There is a paucity of literature about the implications of granulomatous disease in hematopoietic stem cell transplant (HSCT) and solid-organ transplant (SOT) patients. Given the broad range of infectious and noninfectious etiologies as well as the heightened risk for severe infection, it is important to characterize the clinicopathologic features of granulomas in this population and to develop a framework to guide further evaluation. Methods We performed chart reviews of 1,280 transplant recipients (791 SOT and 489 HSCT) at Yale-New Haven Hospital from 2009 to 2019 to identify patients with granulomas in pathologic specimens obtained peri-transplantation. Data on histopathology, microbiology, indication for biopsy, patient characteristics, and clinical presentation were recorded. Morbidity and mortality were noted at 1, 3, and 12 months after granuloma diagnosis. Results We identified 28 patients with granulomas (9 SOT, 19 HSCT); an incidence of 2.2%. None had explicit risk factors for MTB. Most granulomas (93%) were non-necrotizing. Common sources were lung (n = 9) and lymph node (n = 5). Most were found post-transplant (n = 19) and biopsies were prompted mostly by symptoms (n = 13) or incidental imaging findings (n = 9). Most granulomas were not associated with an infectious process (n = 20). Among infectious granulomas, bacterial soft-tissue infection (n = 2), bartonellosis (n = 2), and fungal infection (1 Cryptococcus and 1 Blastomyces) were most common. MTB PCR was negative in 4 specimens. Among granulomas discovered in SOT patients, 44% were infectious compared with 21% in HSCT recipients. Most infectious granulomas were found in symptomatic patients (75%). One granuloma-related adverse outcome occurred in a case of cryptogenic organizing pneumonia discovered pre-HSCT that worsened with tapering of immunosuppression post-HSCT. Conclusion Granulomas were uncommon in a large transplant population. Most were deemed noninfectious and their presence alone was not associated with adverse outcomes post-transplant or with increased immunosuppression. Granulomas were more likely to be infectious in SOT recipients and those with symptoms. Symptoms should guide the extent of microbiologic evaluation and reflexive MTB PCR testing is not warranted if risk factors are absent. Disclosures All authors: No reported disclosures.

scholarly journals Risk Factors of Clostridium Difficile Infection in Hematopoietic Stem Cell Transplant Recipients: A Systemic Review and Meta-Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4704-4704
Author(s):  
Raseen Tariq ◽  
Fateeha Furqan ◽  
Saad Jamshed ◽  
Sahil Khanna
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Meta Analysis ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Factors Associated ◽  
Cord Blood Transplant ◽  
Increased Risk

Abstract Introduction: C. difficile infection (CDI) is a common nosocomial infection. Immune suppression is thought to be a major risk factor for CDI. Hematopoietic stem cell transplant (HSCT) recipients represent a major subgroup of immunologically vulnerable patients. It is unclear if these patients have novel risk factors for CDI development. We, therefore, performed a systematic review and meta-analysis to evaluate the predictors of CDI in HSCT recipients. Methods: A systematic search of Medline, Embase, and Web of Science was performed from January 2000 up to June 2018. All studies that assessed risk factors associated with CDI development in HSCT recipients were eligible for inclusion. Data on clinical characteristics and risk factors associated with CDI development were collected. Study quality was assessed using the Newcastle-Ottawa scale. Meta-analyses were performed using random effects models and pooled odds ratios with 95% confidence interval (CI) for risk factors reported in ≥ 2 studies were calculated. Results: Overall, 17 studies, including 6328 HSCT patients were included. Of those 874 patients developed CDI. The rate of CDI development in these patients was 13.81% with a follow up ranging from 1- 36 months. A total of 34 different risk factors were studied, of which 20 were identified in ≥ 2 studies. Our analysis showed that cephalosporin use (Odds ratio [OR] 2.21, 95% confidence interval [CI] 1.26-3.87), cord blood transplant (OR 1.36, 95% CI 1.01-1.83), graft versus host disease (GVHD) (OR 1.63, 95% CI 1.07-2.48) & prior hospitalization within 90 days of HSCT (OR 1.85, 95% CI 1.21-2.83) were associated with statistically significant increased risk of CDI in HSCT patients (Figure 1). On the other hand, many characteristics of HSCT patients including age, diabetes, lung disease, fluoroquinolones, proton pump inhibitors, rituximab, mucositis, myeloablative therapy, melphalan use before BMT, total body irradiation, growth factor use during admission, neutropenia, autologous vs allogenic transplant and use of matched related donor were not associated with increased risk of CDI. Conclusion: HSCT recipients are at an increased risk of CDI compared to general population. In addition to the common risk factors like cephalosporin use and prior hospitalization, these patients have novel characteristics including presence of GVHD and cord blood transplant that puts them at a higher risk of CDI. HSCT patients with these risk factors may warrant a closer surveillance for early detection and treatment of CDI. Table 1. Table 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Risk Factors and Management of Osteoporosis Post-Transplant

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 302
Author(s):  
Karthik Kovvuru ◽  
Swetha Rani Kanduri ◽  
Pradeep Vaitla ◽  
Rachana Marathi ◽  
Shiva Gosi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diagnostic Tests ◽  
Negative Impact ◽  
Bone Biopsy ◽  
Solid Organ ◽  
Cell Transplant ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Parathyroid Dysfunction

Bone and mineral disorders are common after organ transplantation. Osteoporosis post transplantation is associated with increased morbidity and mortality. Pathogenesis of bone disorders in this particular sub set of the population is complicated by multiple co-existing factors like preexisting bone disease, Vitamin D deficiency and parathyroid dysfunction. Risk factors include post-transplant immobilization, steroid usage, diabetes mellitus, low body mass index, older age, female sex, smoking, alcohol consumption and a sedentary lifestyle. Immunosuppressive medications post-transplant have a negative impact on outcomes, and further aggravate osteoporotic risk. Management is complex and challenging due to the sub-optimal sensitivity and specificity of non-invasive diagnostic tests, and the underutilization of bone biopsy. In this review, we summarize the prevalence, pathophysiology, diagnostic tests and management of osteoporosis in solid organ and hematopoietic stem cell transplant recipients.

scholarly journals 1153. Characterization of Invasive Mold Infections in Acute Leukemia and Hematopoietic Stem Cell Transplant Recipient Patients and Risk Factors for Mortality - a Single Center Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S603-S604
Author(s):  
Ryan Kubat ◽  
Praveen Subramanian ◽  
Yanming Li ◽  
Kassem Hammoud ◽  
Albert Eid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Acute Leukemia ◽  
Regression Model ◽  
Hematopoietic Stem Cell ◽  
Cox Model ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Invasive Mold Infections

Abstract Background Invasive mold infections (IMIs) remain a significant cause of morbidity and mortality in patients with acute leukemia (AL) and those undergoing hematopoietic stem cell transplantation (HSCT). We describe the epidemiology of IMIs, the incidence of IMI in patients with acute myelogenous Leukemia (AML) post HSCT, and risk factors for mortality. Methods Patients were identified using ICD9 and ICD10 codes using a University of Kansas internal database from 2009-2019, microbiology records, and an AML HSCT database and were followed through May 1st, 2020. Patients’ electronic medical records were reviewed for inclusion. IMI was defined as proven or probable using the 2009 National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) guidelines. Incidence was calculated as IMI cases/100-person-years. Risk factors for overall mortality were evaluated using a Cox regression model. Results We included 138 patients: 79 developed IMI after HSCT (8 autologous, 71 allogeneic) and 59 developed IMI after AL diagnosis. Seventeen of the AL patients underwent HSCT after IMI diagnosis (12 within 100 days of IMI). Proven IMI occurred in 45 (32.6%) and probable IMI occurred in 93 (67.4%) patients. The most common prophylactic agent prior to IMI diagnosis was fluconazole (31.2%), with 21.0% receiving none. Aspergillus was the most commonly identified mold with 91 (65.9%) cases. The average treatment duration was 101 (range 0 - 799) days. The incidence of IMI in patients with AML who underwent HSCT was 2.35 cases/100 person-years. All-cause mortality among patients with AL or HSCT who developed IMI was 23.1% at 6 weeks, 34.1% at 12 weeks, and 61.2% at 1 year. On univariate Cox model, Karnofsky performance status > 70 was associated with lower mortality (hazard ratio (HR) 0.317, 95% confidence interval (CI) [0.110, 0.914]) among HSCT recipients. ICU admission within 7 days prior to IMI diagnosis (HR 6.469, 95% CI [1.779, 23.530]) and each one point increase in BMI (HR 1.051, CI [1.001, 1.103]) were associated with increased mortality in the AL group. Figure 1 - Invasive mold infections by pathogen in HSCT-recipients and acute leukemia patients from 2009-2019. Figure 2 - Antifungal prophylactic agents prescribed for at least one week at time of IMI diagnosis Table 1 - Univariate survival analysis calculated using a Cox proportional-hazards regression model among patients who developed IMI after HSCT and patients who developed IMI after acute leukemia diagnosis Conclusion IMIs are associated with significant mortality in HSCT recipients and AL patients; patients at higher risk for mortality include those with lower baseline Karnofsky scores, recent ICU admissions, and higher BMI at time of IMI diagnosis. Disclosures Wissam El Atrouni, MD, ViiV (Advisor or Review Panel member)

scholarly journals Dark energy survey internal consistency tests of the joint cosmological probes analysis with posterior predictive distributions

2021 ◽  
Vol 503 (2) ◽  
pp. 2688-2705
Author(s):  
C Doux ◽  
E Baxter ◽  
P Lemos ◽  
C Chang ◽  
A Alarcon ◽  
...  
Keyword(s):  
Dark Energy ◽  
Internal Consistency ◽  
Goodness Of Fit ◽  
Small Scale ◽  
P Value ◽  
Posterior Predictive Distribution ◽  
Data Set ◽  
Dark Energy Survey ◽  
Data Vector ◽  
Energy Survey

ABSTRACT Beyond ΛCDM, physics or systematic errors may cause subsets of a cosmological data set to appear inconsistent when analysed assuming ΛCDM. We present an application of internal consistency tests to measurements from the Dark Energy Survey Year 1 (DES Y1) joint probes analysis. Our analysis relies on computing the posterior predictive distribution (PPD) for these data under the assumption of ΛCDM. We find that the DES Y1 data have an acceptable goodness of fit to ΛCDM, with a probability of finding a worse fit by random chance of p = 0.046. Using numerical PPD tests, supplemented by graphical checks, we show that most of the data vector appears completely consistent with expectations, although we observe a small tension between large- and small-scale measurements. A small part (roughly 1.5 per cent) of the data vector shows an unusually large departure from expectations; excluding this part of the data has negligible impact on cosmological constraints, but does significantly improve the p-value to 0.10. The methodology developed here will be applied to test the consistency of DES Year 3 joint probes data sets.

scholarly journals A Novel Secondary Neoplasm Following Allogeneic Hematopoietic Stem Cell Transplant: Mixed Donor-Recipient Primitive Mesenchymal Proliferation of the Liver

2021 ◽  
pp. 109352662110016
Author(s):  
Brian Earl ◽  
Zi Fan Yang ◽  
Harini Rao ◽  
Grace Cheng ◽  
Donna Wall ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Graft Versus Host Disease ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
Post Transplant

Post-hematopoietic stem cell transplant secondary solid neoplasms are uncommon and usually host-derived. We describe a 6-year-old female who developed a mixed donor-recipient origin mesenchymal stromal tumor-like lesion in the liver following an unrelated hematopoietic stem cell transplant complicated by severe graft-versus-host disease. This lesion arose early post-transplant in association with hepatic graft-versus-host disease. At 12 years post-transplant, the neoplasm has progressively shrunken in size and the patient remains well with no neoplasm-associated sequelae. This report characterizes a novel lesion of mixed origin post-transplant and offers unique insights into the contribution of bone marrow-derived cells to extra-medullary tissues.

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