Acute Pulmonary Toxicity By Mycophenolate Mofetil (MMF) after Haploidentical Stem Cell Transplant (SCT)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5860-5860 ◽  
Author(s):  
Rohtesh S. Mehta ◽  
Jonathan Brammer ◽  
Elizabeth J Shpall ◽  
Richard E. Champlin
Keyword(s):  
Mycophenolate Mofetil ◽  
Pulmonary Fibrosis ◽  
Pulmonary Toxicity ◽  
Conflicts Of Interest ◽  
Chronic Phase ◽  
Cell Transplant ◽  
Radiographic Findings ◽  
X Ray ◽  
Post Transplant ◽  
Chest X Ray

Abstract CASE A 49-year old Hispanic male diagnosed with chronic phase CML in 2008 was referred for a SCT for progressive TKI-refractory disease. In May, 2014, he received a haploidentical SCT following treatment with melphalan 140mg/m2 and fludarabine 40mg/m2. GVHD prophylaxis was provided by post-transplant cyclophosphamide 50mg/kg IV on days 3 and 4, tacrolimus 0.015 mg/kg IV and MMF 15mg/kg PO tid. Bacterial, fungal and viral prophylaxis included levofloxacin, voriconazole and valacyclovir respectively. On transplant day 11, he developed asymptomatic neutropenic fever and was started on IV vancomycin and cefepime. The fevers abated by day 14, but he developed acute dyspnea and hypoxia requiring intermittent BiPAP treatment. A CAT scan showed new bilateral lung patchy ground-glass opacities [Figure 1] compared to the baseline chest X-ray. Bronchoscopy could not be performed due to the tenuous respiratory status. MMF was held and methylprednisolone (MP) 1gm/kg IV daily was started for concerns of pulmonary toxicity. His symptoms improved and the chest x-ray normalized within a few days. MMF was resumed at same dose and MP dose was reduced to 0.5 mg/kg/day; within four days there was a rapid recurrence of the pulmonary symptoms and re-emergence of diffuse airspace opacities. MMF was held again and MP was increased to the original dose, resulting in resolution of his symptoms and the radiographic findings within days. During this period, he was afebrile, infectious work-up (including comprehensive viral, bacterial and fungal testing) was negative and no RBC antibodies were detected. Table 1 summarizes his disease course. DISCUSSION To the best of our knowledge, this is the first reported case of potential MMF-related pulmonary toxicity after SCT, although similar associations have been reported in a few cases after renal and cardiac transplants.(1-4) The causal relationship of MMF-induced toxicity in our case is suggested by the temporal association, exclusion of other plausible causes, and temporal re-emergence when challenged again, and subsequent resolution of symptoms and x-ray findings with discontinuation of MMF. The underlying mechanism is unknown, although genetic polymorphisms in UGT, an enzyme involved in its metabolism, may explain unexpected toxicities – a phenomenon known to enhance toxicities of various drugs metabolized by this enzyme. (5) CONCLUSION MMF should be considered as a potential etiology of post-transplant acute pulmonary toxicity in patients undergoing hematopoietic transplantation. REFERENCES: 1. Gorgan M, Bockorny B, et al. Pulmonary hemorrhage with capillaritis secondary to mycophenolate mofetil in a heart-transplant patient. Arch Pathol Lab Med. 2013;137(11):1684-7. 2. Gross DC, Sasaki TM, et al. Acute respiratory failure and pulmonary fibrosis secondary to administration of mycophenolate mofetil. Transplantation. 1997;64(11):1607-9. 3. Morrissey P, Gohh R, et al. Pulmonary fibrosis secondary to administration of mycophenolate mofetil. Transplantation. 1998;65(10):1414. 4. Reynolds BC, Paton JY, et al. Reversible chronic pulmonary fibrosis associated with MMF in a pediatric patient: a case report. Pediatr Transplant. 2008;12(2):228-31. 5. Burchell B, Soars M, et al. Drug-mediated toxicity caused by genetic deficiency of UDP-glucuronosyltransferases. Toxicol Lett. 2000;112-113:333-40. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Sputum smear positivity grade and chest X-ray findings in tuberculosis: A cross-sectional study

2021 ◽  
Author(s):  
R. Behzadmehr ◽  
E. Nejadkehkha
Keyword(s):  
Cross Sectional Study ◽  
Health Concern ◽  
Sputum Smear ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
X Ray ◽  
High Prevalence ◽  
Chest X Ray

Despite many advances in the diagnosis, screening, and rapid treatment of tuberculosis, it is still a public health concern in the world. Due to the importance of this issue in diagnosis and reduction of transmission of infection and treatment of the disease especially where this study is conducted due to the high prevalence of tuberculosis, this study was done to determine The relationship between sputum smear positivity grade and chest X-ray findings in pulmonary tuberculosis patients in a hospital in southeast of Iran. This cross-sectional study was performed on all patients with pulmonary TB referencing the health centers in Zabol city, southeast of Iran from 1 January 2015 to 30 December 2020. Sputum smear and radiographic findings of the chest X-ray were evaluated. Data was collected using a form of information and finally analyzed by SPSS 22. Out of 101 patients examined in the present study, 71 were women and 30 were men. The mean age of the patients was 62.68 ± 13.61 years. The frequency of opacity in patients with grades 1, 2, and 3 was 71.4, 78.5, and 76.5%, respectively. Frequency of cavitation in patients with Grade 1, 2 and 3 was 11.5%, 28.5% and 52.9% respectively (P value 0.001). The frequency of reticulonodular presentations in patients with grade 1, 2, and 3 was 24.2, 7.1, and 0%, respectively.  In general, the results of this study showed that, with increasing grading of smears (1+, 2+, and 3+), the frequency of cavitation presentation increased significantly and the frequency of reticulonodular presentations decreased significantly. In general, the results of this study showed that, with increasing grading of smears (, the frequency of Cavitation presentation increased significantly and the frequency of reticulonodular presentations decreased significantly. The findings of the present study can help physicians better diagnose TB.

Cyclosporine Versus Cyclosporine/Mycophenolate Mofetil for GVHD Prophylaxis after Matched Related and Unrelated Minimal Intensity Allotransplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5014-5014
Author(s):  
Robert P. Nelson ◽  
Jennifer E. Schwartz ◽  
Menggang Yu ◽  
Michael Robertson ◽  
Paul R. Haut ◽  
...  
Keyword(s):  
Overall Survival ◽  
Mycophenolate Mofetil ◽  
Older Patients ◽  
Hematological Malignancies ◽  
Hematopoietic Cell ◽  
Sinusoidal Obstruction Syndrome ◽  
Cell Transplant ◽  
Post Transplant ◽  
Gvhd Prophylaxis ◽  
Grade 3

Abstract The purpose of this study was to examine the efficacy of cyclosporine (CsA) alone versus CsA/mycophenolate mofetil (MMF) as GVHD prophylaxis in older patients who received a minimally-intensive allogeneic hematopoietic cell transplant (MIHCT) for the treatment of hematological malignancies (AML=26, MDS=15, NHL=8, CLL=5, MM=3, HD=4, CML=1, ALL=1). Patients (median age, 55 years; 41 males, 22 females) received HLA-matched related (n=33) or unrelated (n=30) peripheral blood hematopoietic cell infusions following immunosuppressive dosages of cyclophosphamide and fludarabine (Childs R, et al. Blood 94; 1999). The initial 28 consecutive patients received monitored CsA from day −1 through day +180 (if no GVHD). The next 35 subjects received CsA/MMF: CsA, day −1 through day +180 and MMF, 1000 mg twice daily, day +1 through day +60 (if no GVHD, then a taper). Patients were followed until death or at least 7 months. There were no differences between recipients of MRD and MUD transplants with respect to sex, age of the recipient, disease status, ABO matching, recipient CMV status or number of CMV-negative donor/recipient pairs. MUD donors were significantly younger and more likely to be CMV-negative. There was no difference in disease distribution between those who recieved CsA and those who recieved CsA/MMF prophylaxis. Follow-up ranged from 25–2241 days (median, 461 days for the CSA group; 449 days for the CSA/MMF group, 1290 days for survivors). All patients engrafted without growth factor support and no subjects experienced sinusoidal obstruction syndrome, mucositis or post-transplant lymphoproliferative disease. Thirty and 100-day transplant-related mortality for the cohort was 1.6% and 15.9% respectively. The incidence of Grade 2–4 aGVHD (n=63) was 49.2% (CsA, 57.1%, CsA/MMF, 42.9%, p=0.315). Grade 3 or 4 aGVHD occurred in 30% (CsA, 32.1%, CsA/MMF, 28.6%, p=0.788). Chronic extensive GVHD occurred in 53.8% (CsA, 61.5%, CsA/MMF, 46.2%, p=0.404) of at risk (survival greater than 100 days) recipients. The incidence of acute or chronic GVHD was not statistically different for MRD versus MUD recipients for either prophylaxis group (p=0.32 and 0.23, respectively). One-year, two-year and three-year overall Kaplan-Meier survival analyses were estimated to be 60.7%, 42.9% (CsA group) and 42.9%and 60%, 45.2% and 32.8% (CsA/MMF group, 0.708). Twenty-seven (42.9%) of the entire cohort are alive at a median of 1290 days post-transplant [CSA, 12/28, (42.9%); CsA/MMF, 15/35, (42.9%)]. Grade 3 or 4 aGVHD was associated with poor overall survival (p=0.0001) for the cohort. These findings provide evidence that MMF does not seem to provide substantial GVHD preventive or overall survival benefit when added to CsA after matched related/unrelated cyclophosphamide/fludarabine MIHCT in older patients with hematological malignancies.

Uptake and Outcome of Artificial Reproductive Techniques Following Allogeneic Stem Cell Tranplantation: A Single Centre Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2257-2257
Author(s):  
Anna Babb ◽  
Nadine Farah ◽  
Jane Apperley ◽  
John Goldman ◽  
Edward Kanfer ◽  
...  
Keyword(s):  
Stem Cell ◽  
Conflicts Of Interest ◽  
Ovarian Tissue ◽  
Median Number ◽  
Cell Transplant ◽  
Successful Pregnancy ◽  
Post Transplant ◽  
Co Morbidity ◽  
Reproductive Techniques ◽  
Insufficient Time

Abstract Abstract 2257 Poster Board II-234 Introduction: Infertility is common following allogeneic stem cell transplant (allo-SCT). Very little data are available on the use and success of artificial reproductive techniques in patients who have undergone allo-SCT as treatment for cancer. Patients and Methods: We have performed a retrospective survey to assess the uptake of gamete/embryo storage prior to SCT, their use following SCT and the success rate of these techniques. Two hundred patients (95 female) who received allo-SCT between 1979 and 2007 responded to a questionnaire at a median of 12 years (range 2-30 years) post transplant. The median age at SCT was 35 years (range 17-61 years). Results: Ninety-four men (90%) recalled being counselled about post transplant infertility. Seventy-two recalled being offered sperm storage and 36 men stored sperm prior to allo-SCT. Of the 68 men who did not store sperm, 43 did not wish to have children after SCT; 37/43 had completed their families or did not want children, 4/43 considered themselves too old and 2/43 were homosexual. Of the remainder the reasons were various; no semen storage available in country of residence (n=1), pre-pubertal at first allo-SCT (n=1), previous chemotherapy had induced infertility (n=4), sperm of insufficient quality to permit storage (n=7), insufficient time pre-transplant to arrange storage (n=5), unknown (n=8). Of the 36 men who stored sperm, 21 attempted pregnancy post SCT. 14 men fathered a total of 24 children (17 successful pregnancies including 7 twin pregnancies). In these men intracytoplasmic sperm injection (ICSI) was used in 12 pregnancies and inter-uterine insemination was used in 2 pregnancies. The method was not specified in 3 pregnancies. The median number of attempts for a successful pregnancy was 1 (range 1-10). The median number of attempts for men who were unsuccessful was 2 (1-4). In addition, three men fathered children with donated sperm and one man conceived naturally post transplant. Fifty-nine women (63%) recalled being counselled about post transplant infertility. Of these, 32 were offered storage of gametes/embryos. Ten patients undertook storage; oocytes (n=1), ovarian tissue (n=1), embryos (n=6) or a combination of these (n=2). The women who did not store gametes/embryos most had either completed their families (n=28), were too old (n=17) or there was insufficient time prior to transplant (n=13). In 6 cases, the technology was not available or insufficiently advanced to be successful at the time of SCT. Other given reasons included chemotherapy induced infertility, concerns about medical co-morbidity and worries about contamination of the stored tissue with malignant cells. Three women attempted to become pregnant with stored embryos. One was successful on her second attempt after a spontaneous abortion. One had 3 attempts and although succeeded in becoming pregnant unfortunately miscarried at 12 weeks. The third woman had one failed attempt. Of the other patients, one woman had 2 successful pregnancies with donated eggs and one woman adopted her child. Two women delayed their transplant in order to have children. Conclusions: The uptake of gamete storage was relatively high for male patients. Over half of men who had not already completed their families elected to store sperm. Subsequently two thirds of these men were successful in fathering children with stored sperm. Unfortunately the potential for women to store gametes/embryos is much lower. Less than a fifth of young women who had not completed their families undertook gamete / embryo storage prior to SCT and only one patient proceeded to have a successful pregnancy. Disclosures: No relevant conflicts of interest to declare.

Outcomes and Treatments of Relapsed AL Amyloidosis Following Stem Cell Transplant

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1858-1858 ◽  
Author(s):  
Rahma Warsame ◽  
Soo-Mee Bang ◽  
Shaji K. Kumar ◽  
Martha Q Lacy ◽  
Francis K Buadi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Plasma Cells ◽  
Conflicts Of Interest ◽  
Treatment Options ◽  
Autologous Stem Cell Transplant ◽  
Al Amyloidosis ◽  
Cell Transplant ◽  
Post Transplant

Abstract Abstract 1858 Systemic light chain amyloidosis (AL amyloidosis) is a condition where clonal plasma cells produce misfolded insoluble immunoglobulin light chains that deposit in various organs causing progressive organ dysfunction. Chemotherapy and autologous stem cell transplant (ASCT) when eligible is the standard treatment options for patients with AL amyloidosis. There are several studies who report long term outcomes of patient post ASCT. However, there is a paucity of literature describing the outcomes of patients who have received ASCT but have relapsed. We performed a retrospective study to assess the outcomes and treatment regimens employed following relapse after ASCT. Between 1996 and 2009, 410 patients received ASCT at the Mayo Clinic as first line therapy. Of those 410 patients 42 patients died within 3 months of transplant, 64 patients died without documented relapse, 158 patients were alive without documented progression, and 146 patients had documented progression. Those 146 patients are the subject of our study. The median time to hematologic relapse was 2 years (range: 0.2–15.5 years). At relapse, 59 patients were treated with IMiD based therapy, 36 with alkylator based therapy, 24 with bortezomib, 15 with steroids, and 5 with second ASCT. The respective hematologic response rates were 58%, 33%, 50%, 53%, and 60%. The remaining six patients were not evaluable for response for one other following reasons: organ transplants; no further therapy; inevaluable disease. With a median post relapse follow up of 3.6 years, the median overall survival (OS) from the first post ASCT relapse was 4.6 years. The median post transplant follow up was 6.1 years, the median OS for these patients was 7.3 years from the time of transplant. These data provide novel information about outcomes after SCT relapse, which should be useful not only for patients and doctors but also for investigators designing studies for salvage therapies post-transplant. Disclosures: No relevant conflicts of interest to declare.

Late Relapse in Leukemia: Does the Niche Matter?

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4793-4793
Author(s):  
Paolo Bernasconi ◽  
Marina Boni ◽  
Paola Maria Cavigliano ◽  
Barbara Rocca ◽  
Rita Zappatore ◽  
...  
Keyword(s):  
Drug Exposure ◽  
Acute Gvhd ◽  
Conflicts Of Interest ◽  
Rare Event ◽  
Chronic Phase ◽  
Leukemic Cells ◽  
Haematopoietic Stem Cell ◽  
Rt Pcr ◽  
Post Transplant ◽  
Leukemic Clone

Abstract Abstract 4793 Very late recurrence (LR) of AML, defined as relapse after ≥5 years of complete remission (CR), has an incidence of 1.1–3% (Verma et al, 2010; Medeiros et al, 2010) and may be due to the re-growth of the original dormant leukemic clone which may have acquired additional genetic changes or to the emergence of a new leukemic clone favoured by previous drug exposure. In CML LRs after allogeneic haematopoietic stem cell transplantation (allo-HSCT) are also very rare (1.5% per year) and it is unknown whether rare BCR-ABL transcripts are true manifestations of the original leukemic clone or the results of a “benign” BCR-ABL rearrangement seen in healthy subjects (Sobrinho-Simòes et al, 2010). In order to highlight LR biology, most studies have focused on alterations of cellular dormancy, whereas very few on the disruption of bone marrow (BM) microenvironment. The present study, which reports three patients (two AML and one CML) who experienced LR 5–16 years after CR achievement, was aimed at establishing the incidence of LR, the origin of the leukemic clone, and a potential association between LR and infective episodes. In our AML series the incidence of LR was 0.8% (2/245). The first patient, a 23 year-old male who carried a t(1;3)(p36;q26), was diagnosed as AML M5 and achieved a I CR after four courses of Etoposide (VP16) followed by one course of Daunorubicine (DNR) and a 2-years maintenance with VP16. He remained in CR for eight years when he developed a BM relapse after a viral infection. The leukemic clone presented the same chromosomal defect revealed at the onset of the disease. A II CR was achieved after a re-induction with VP16+Mitoxantrone (M). Two courses of this same regimen were used as consolidation and were followed by an auto-HSCT preceded by a conditioning with BCNU-VP16-Ara-C. Fifteen months later a second relapse occurred. Leukemic cells presented the same original t(1;3)(p36;q26). The patient did not respond to various chemotherapy schedules and died of sepsis. The second patient, a 46 year-old male who carried a t(3;11)(q26;q23), was diagnosed as AML M5 and achieved a I CR after three courses of DNR+Ara-C. Subsequently, he received a HSCT from his daughter after a conditioning with Busulfan+Cyclophosphamide (BU+CY). Take occurred at day +14 without any sign of acute GvHD, but on day +183 the patient developed a chronic extensive GvHD. Two months post-transplant FISH with sex chromosome probes (XY-FISH) revealed 0.5% of male cells, but from day +100 onwards it revealed a complete chimera. Five years later the patient complained of fever and a chest X-ray showed a left pulmonary infection. A BM biopsy revealed the almost exclusive presence of leukemic cells which karyotype was 50,XY,t(3;11)(q26;q23),+4,+8,t(12;?)(p21;?),-14,+mar1,+mar2, +mar3[13]. XY-FISH showed 60% of male cells. The patient died of sepsis. The CML patient was the only one who relapsed 16 years after a sibling allo-HSCT in I chronic phase. HSCT was performed as the patient was intolerant to alpha-interferon which had been replaced by hydroxyurea. Pre-transplant conditioning consisted of BU+CY, take occurred at day +17 without any sign of acute GvHD, but on day +329 the patient developed a chronic limited GvHD. On day +100 XY-FISH revealed a complete chimera, a chromosomal analysis a male karyotype and a BM nested RT PCR the absence of BCR-ABL transcripts. Subsequent analyses including quantitative RT PCR confirmed these findings. However, 16 years post-transplant the patient complained of otitis and fever. Her blood count showed: Hb 11.6g/dl, WBC 8.1×109/l with 22% myelolasts, Plts 5×109/L. A BM aspiration revealed the almost exclusive presence of CD34+, TdT+, CD10+ lymphoblasts having the following karyotype: 46,XY[4]/45,X,t(9;14;22)(q34;p10;q11)[6]. A XY-FISH showed 27% of female cells and a quantitative RT PCR a BCR-ABL/ABL ratio =214,2 (International scale). Tyrosine kinase inhibitors were immediately started. In our series LR was i) a very rare event, ii) always due to the re-growth of the original leukemic clone, iii) always preceded by an infective episode which might have interrupted leukemic cells dormancy through a transient angiogenic burst within the BM microenvironment (Indraccolo et al, 2006). This suggestion is further strengthened by recent data which support a strict interaction between cancer cell metabolism and niche metabolism (Yusuf et al, 2012). Disclosures: No relevant conflicts of interest to declare.

Favorable Results of Allo-HSCT from MRD in Patients with Myelofibrosis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5934-5934
Author(s):  
Miroslaw Markiewicz ◽  
Monika Dzierzak-Mietla ◽  
Patrycja Zielinska ◽  
Agata Wieczorkiewicz-Kabut ◽  
Sylwia Mizia ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Collagen Type ◽  
Conflicts Of Interest ◽  
Chronic Gvhd ◽  
Graft Loss ◽  
Chronic Phase ◽  
Curative Treatment ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Post Transplant

Abstract Introduction: Myelofibrosis (MF), chronic myeloid malignancy associated with shortened survival, in majority of patients develops de novo as Primary MF, but also polycythemia vera (PV) or essential thrombocythemia (ET) may progress into post-PV or post-ET MF. Although management of MF includes several treatment options, the only potentially curative treatment approach in MF is allogeneic hematopoietic stem cell transplantation (allo-HSCT). Aim of this study was to evaluate the results of allo-HSCT in patients with MF treated in Katowice, Poland. Material and Methods: 27 pts (14 male and 13 female) with median age 51 years (range 21–63) were treated with allo-HCT due to PMF (20), post-PV (4) or post-ET (3) MF. 11,7,11,26 and 41% of pts had DIPSS 0,1,2,3 and 4, respectively. Median bone marrow cellularity was 70% (10-100%), fibrosis was collagen-type (14 pts including 2 with osteosclerosis), reticulin (10) or it was not specified (3). Splenomegaly was present in all pts: 13-20 cm (14 pts), > 20 cm (13 pts). JAK2V617F point mutation was present in 18 pts. Karyotype was available in 14 pts: in 9 normal, in 5 with variable abnormalities. Median time from diagnosis to allo-HCT was 1.5 (0.4–9.5) years. 16 pts (59.3%) received cells from HLA-matched related donor (MRD), 11 pts (40.7%) from unrelated donor: 10/10 (9) or 9/10 (2) HLA-A,B,C,DR,DQ alleles matched. Reduced intensity conditioning (RIC) was used in 26 pts, 1 patient received myeloablative conditioning (MC). Sources of stem cells were: peripheral blood (21), bone marrow (4) and both (2). All pts but one had chronic phase of MF at time of transplantation. Results: 14/27 (52%) pts are alive at median 3.4 (0.4-5.4) years after allo-HSCT: 11/16(69%) from MRD and 3/11(27%) from MUD, p=0.032. Graft failure, graft loss or PRCA were observed in 3, 5 and 1 pt, respectively. Absolute neutrophil count >0.5×109/L and platelet count >50×109/L were achieved at median 16 and 28 days, respectively. 12/27 (44%) pts reached complete blood count of Hb>10 g/dl, Plt>100 G/l and WBC>3.5 G/l; 11 of them (92%) are alive. 6/27 (22%) pts remained either RBC or PLT transfusions dependent post-transplant; 3 of them (50%) died. 9/27 (33%) pts remained both RBC and PLT transfusion dependent and all of them died. JAK2V617F mutation was completely eradicated in 11/16 evaluated previously positive patients (69%), decreased in 4 (25%) and stable in 1(6%) pt. Acute graft-versus-host disease (aGVHD) III-IV developed in 5/27 (19%) and extensive chronic GVHD in 5/19 (26%) pts. Relapse occurred in 4 pts and was treated with subsequent second transplant (in 1 pt thereafter by 3-rd allo-HSCT). Spleen length decreased at median by 5 (0.3-9.2) cm. Out of 7 pts with initial collagen fibrosis who were evaluated post-transplant, 1 had no fibrosis, 5 reticulin type and only in 1 pt collagen fibrosis was stable. Out of 3 pts with initial reticulin fibrosis it disappeared in 2 and progressed to collagen type in 1. Causes of death were GVHD (5 pts: 3 aGVHD, 2 cGVHD) and pancytopenia with either infection (7 pts) or CNS hemorrhage (1 pt). Conclusions: Allo-HSCT, the only curative treatment of myelofibrosis, provides chance of long survival, regression of the disease (lower stage of fibrosis, JAK2V617F eradication) and improved quality of life (transfusion independency, decreased splenomegaly). Transfusion independency may indicate good outcome. Favorable results are observed after allo-HSCT from MRD. Disclosures No relevant conflicts of interest to declare.

scholarly journals Amiodarone-Induced Pulmonary Toxicity – A Frequently Missed Complication

2016 ◽  
Vol 9 ◽  
pp. CCRep.S39809 ◽  
Author(s):  
Alexander J. Sweidan ◽  
Navneet K. Singh ◽  
Natasha Dang ◽  
Vinh Lam ◽  
Jyoti Datta
Keyword(s):  
Coronary Artery ◽  
Lung Disease ◽  
Interstitial Pneumonitis ◽  
Pulmonary Toxicity ◽  
Pulmonary Nodules ◽  
Ground Glass ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
New Onset

Introduction Amiodarone is often used in the suppression of tachyarrhythmias. One of the more serious adverse effects includes amiodarone pulmonary toxicity (APT). Several pulmonary diseases can manifest including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules or masses, and pleural effusion. Incidence of APT varies from 5–15% and is correlated to dosage, age of the patient, and preexisting lung disease. Description A 56-year-old male with a past medical history of coronary artery disease and chronic obstructive pulmonary disease was admitted for a coronary artery bypass graft. Post-operatively, the patient was admitted to the ICU for ventilator management and continued to receive his home dose of amiodarone 400 mg orally twice daily, which he had been taking for the past 3 months. The patient was found to be hypoxemic with a PaO2 52 mmHg and bilateral infiltrates on chest x-ray. Patient also complained of new onset dyspnea. Physical exam found bilateral rhonchi with bibasilar crackles and subcutaneous emphysema along the left anterior chest wall. Daily chest x-rays showed worsening of bilateral interstitial infiltrates and pleural effusions. A chest high-resolution computed tomography on post-operative day 3 showed extensive and severe bilateral ground glass opacities. APT was suspected and amiodarone was discontinued. A course of oral prednisone without antibiotics was initiated, and after one week of treatment the chest film cleared, the PaO2 value normalized and dyspnea resolved. Discussion APT occurs via cytotoxic T cells and indirectly by immunological reaction. Typically the lungs manifest a diffuse interstitial pneumonitis with varying degrees of fibrosis. Infiltrates with a ‘ground-glass’ appearance appreciated on HRCT are more definitive than chest x-ray. Pulmonary nodules can be seen, frequently in the upper lobes. These are postulated to be accumulations of amiodarone in areas of previous inflammation. Those undergoing major cardiothoracic surgery are known to be predisposed to APT. Some elements require consideration: a baseline pulmonary function test (PFT) did not exist prior. APT would manifest a restrictive pattern of PFTs. In APT diffusing capacity (DLCO) is generally >20 percent from baseline. A DLCO was not done in this patient. Therefore, not every type of interstitial lung disease could be ruled out. Key features support a clinical diagnosis: (1) new dyspnea, (2) exclusion of lung infection, (3) exclusion of heart failure, (4) new radiographic features, (5) improvement with withdrawal of amiodarone. Our case illustrates consideration of APT in patients who have extensive use of amiodarone and new onset dyspnea.

scholarly journals Amiodarone and its Pulmonal Toxicity

2014 ◽  
pp. 113-25
Author(s):  
Kemalasari Nas Darisan ◽  
Jamal Zaini ◽  
Yoga Yuniadi
Keyword(s):  
Pulmonary Toxicity ◽  
Ventricular Arrhythmias ◽  
Treatment Guidelines ◽  
High Resolution Computed Tomography ◽  
X Ray ◽  
Risk Patients ◽  
Life Threatening ◽  
Amiodarone Treatment ◽  
Chest X Ray ◽  
Modest Reduction

Amiodarone is an antiarrhythmic agent commonly used to treat supraventricular and ventricular arrhythmias. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. This drug is an iodine-containing compound that tends to accumulate in several organs, including the lungs. It has been associated with a variety of adverse events. Of these events, the most serious is amiodarone pulmonary toxicity. Although the incidence of this complication has decreased with the use of lower doses of amiodarone, it can occur with any dose. Because amiodarone is widely used, all clinicians should be vigilant of this possibility. Pulmonary toxicity usually manifests as an acute or subacute pneumonitis, typically with diffuse infiltrates on chest x-ray and high-resolution computed tomography. Other, more localized, forms of pulmonary toxicity may occur, including pleural disease, migratory infiltrates, and single or multiple nodules. With early detection, the prognosis is good. Most patients diagnosed promptly respond well to the withdrawal of amiodarone and the administration of corticosteroids, which are usually given for four to 12 months. It is important that physicians be familiar with amiodarone treatment guidelines and follow published recommendations for the monitoring of pulmonary as well as extrapulmonary adverse effects.

scholarly journals The Diagnostic Yield and Clinical Impact of a Chest X-Ray after Percutaneous Dilatational Tracheostomy: A Prospective Cohort Study

2007 ◽  
Vol 35 (3) ◽  
pp. 393-397 ◽  
Author(s):  
S. H. Haddad ◽  
A. S. Aldawood ◽  
Y. M. Arabi
Keyword(s):  
Diagnostic Yield ◽  
Perioperative Complications ◽  
Percutaneous Dilatational Tracheostomy ◽  
Chest Physiotherapy ◽  
Radiographic Findings ◽  
X Ray ◽  
Dilatational Tracheostomy ◽  
New Finding ◽  
Chest X Ray ◽  
Tube Malposition

A chest X-ray (CXR) is routinely performed after percutaneous dilatational tracheostomy (PDT). The purpose of this study was to evaluate the diagnostic yield of routine CXR following PDT and its impact on patient management and to identify predictors of post-PDT CXR changes. Two-hundred-and-thirty-nine patients who underwent PDT in a 21-bed intensive care unit were included prospectively in the study. The following data were collected: patient demographics, APACHE III scores, pre-PDT FiO2 and PEEP, PDT technique, perioperative complications and the use of bronchoscopic guidance. We compared post-PDT CXR with the last pre-PDT CXR. We documented any post-PDT new radiographic findings including atelectasis, pneumothorax, pneumomediastinum, surgical emphysema, pulmonary infiltrates or tracheostomy tube malposition. We also recorded management modifications based on post-PDT radiographic changes, including increased PEEP, chest physiotherapy, therapeutic bronchoscopy or chest tube insertion. Atelectasis was the only new finding detected on post-PDT CXRs of 24 (10%) patients. The new radiographic findings resulted in a total of 14 modifications of management in 10 (4%) patients including increased PEEP in six, chest physiotherapy in six and bronchoscopy in two patients. Trauma and pre-PDT PEEP >5 cmH2O were independent predictors of post-PDT CXR changes. Routine CXR following PDT has a low diagnostic yield, detecting mainly atelectasis and leading to a change in the management in only a minority of patients. Routine CXR after apparently uncomplicated PDT performed by an experienced operator may not be necessary and selective use may improve its diagnostic yield. Further studies are required to validate the safety of selective versus routine post-PDT CXR.

Impact on Pulmonary Function of Pre-Transplant Radiotherapy in Hodgkin Lymphoma Patients Undergoing Autologous Stem Cell Transplant (ASCT).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3279-3279
Author(s):  
Christy Stotler ◽  
Paul Elson ◽  
Brian Bolwell ◽  
Matt Kalaycio ◽  
Brad Pohlman ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Hodgkin Lymphoma ◽  
Pulmonary Toxicity ◽  
Cleveland Clinic ◽  
High Dose Chemotherapy ◽  
Autologous Stem Cell Transplant ◽  
High Dose ◽  
Cell Transplant ◽  
Post Transplant ◽  
Significant Difference

Abstract For patients (pts) with Hodgkin lymphoma (HL) undergoing initial treatment with chemotherapy, often in conjunction with radiation therapy (RT), the rate of relapse ranges from 10 to 15 % in favorable prognosis stage I-II disease to 30 to 40 % in advanced disease. Patients with poor prognosis after first relapse, those with a second relapse, and pts with progressive disease are candidates for high dose chemotherapy followed by ASCT. A noted risk factor in HL patients following ASCT is development of pulmonary toxicity. The effect of prior conditioning regimens and RT on lung function has been implicated. Scant data is available regarding whether proximity of RT to time of transplant increases the risk for development of subsequent pulmonary toxicity. To address this question we retrospectively reviewed 172 sequential HL patients with pre-and post-transplant pulmonary function data who underwent ASCT at the Cleveland Clinic between 1985 and 2008 using a prospectively maintained, IRB approved, database. Bu/Cy/VP was the preparative regimen in 83% of pts (n=142), BCNU/Cy/VP in 13% of pts (n=22), and Melphalan in 4% of pts (n=7). The post-transplant change in pulmonary function (percent predicted DLCO and FEV1) in pts who received RT prior to ASCT was compared to those who did not receive RT. The timing of the RT was also examined. Statistical analysis was performed using the Wilcoxon rank sum test. 67 pts (39%) received pre-transplant RT at a median of 14.1 months prior to ASCT; 10 pts received RT ≤6 months prior to ASCT, 50 pts received RT >6 months before, and timing was unknown for seven pts. Overall, pts experienced a median 3.2% decline in DLCO (range 53.7% decline to 137.5% improvement) and a 2.9% decline in FEV1 (range 71.8% decline to 33.3% improvement) following transplant. The decline in DLCO and/or FEV1 was significant (>25%) in 16% of patients. The change in DLCO post-ASCT was not significantly different between pts who did or did not receive pre-transplant RT (median declines of 2.7% vs. 3.7%, respectively, p=1.0). There was, however, a significant difference with respect to FEV1. Pts who had prior RT experienced a median 6.4% decline in FEV1 following ASCT compared to a median 1.1% decline in pts who did not have prior RT (p=.03). The proportion of pts in whom the decline in FEV1 was significant however was similar in the two groups (7% vs. 6% respectively, p=1.0). Pts treated with pre-transplant RT within 6 months of ASCT tended to have greater declines in both DLCO and FEV1 following ASCT than patients not treated with RT (median declines: DLCO: 8.8% versus 0%; FEV1: 7.7% versus 4.8%, respectively); however the differences were not significant (p=.25 and .98, respectively). Conclusions: Pts treated with RT prior to ASCT experience a greater decline in FEV1 post-transplant than RT-naïve patients. The decline, however, is not generally of clinical significance, and the proportion of pts with clinically significant impairment of pulmonary function is similar in the two groups.

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