CMV reactivation in allogeneic hematopoietic stem cell transplant patients receiving post-transplant cyclophosphamide.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18533-e18533
Author(s):  
Paul Markowski ◽  
Dale G. Schaar ◽  
Catherine Wei ◽  
Anne Tyno
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Published Data ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Transplant Patients ◽  
Number Of Patients ◽  
Cmv Reactivation

e18533 Background: Post transplant cyclophosphamide (PTCY) has been shown to be an effective treatment for prevention of graft versus host disease (GVHD). However, this increased immune suppression rates may increase the risk of CMV reactivation. There is limited published data addressing CMV reactivation in this patient population. Additionally there is no data on the efficacy of prophylactic letermovir in the patients who have received PTCY. In this study we analyzed the incidence of CMV reactivation in patients treated with PTCY and those not treated with PTCY, as well as the efficacy of letermovir in preventing CMV reactivation in the PTCY population. Methods: We conducted a retrospective review of MUD, MRD, and haploidentical stem cell transplant patients at our institution from 1/1/2014 until 12/10/2018. We analyzed the incidence of CMV reactivation (PCR > 137 DNA IU/ml), peak of CMV PCR titer and time to reactivation within the first 100 days post-transplant. Results: There were 150 patients with at least 60 days of follow-up that were included in this study. These patients were split into three groups: No post-transplant cyclophosphamide (NPTCY) (N = 64), received post-transplant cyclophosphamide (PTCY) (N = 70), and received PTCY and letermovir prophylaxis. (L-PTCY) (N = 15). The incidence of CMV reactivation was increased in the PTCY patients when compared to the NPTCY (44% vs 29%). In the NPTCY patients the donor (D) serostatus increased the risk of CMV reactivation (Recipient (R)+ D+ 73% vs R+D-36%) conversely in the PTCY group the donor CMV status did not influence reactivation rates (R+D+ 52% vs R+D- 81%). The CMV reactivation rate in the L-PTCY patients was lower when compared to the PTCY patients (21% vs 44%), additionally the L-PTCY patients had much lower peak CMV titers compared to PTCY group (445 vs 2112 IU/ml). Conclusions: This study demonstrates that there is an increased incidence of CMV reactivation in patients who receive PTCY. Additionally, the donor CMV serostatus does not appear to influence the incidence of CMV reactivation in patients receiving post-transplant CY. Although the number of patients in the L-PTCY group is small, it does appear to be an effective prophylactic treatment in patients receiving PTCY.

Risk of Bacterial Infection in Pediatric Hematopoietic Stem Cell Transplant Patients Receiving Cephalosporin Prophylaxis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4497-4497
Author(s):  
Amanda Berger ◽  
Haydar Frangoul ◽  
Katie Bruce ◽  
Steve Ampah
Keyword(s):  
Stem Cell ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Transplant Patients ◽  
Increased Risk

Abstract Abstract 4497 Background: At our institution, all hematopoietic stem cell transplant (HSCT) patients receive a prophylactic cephalosporin starting either at Day -1 of transplant or when the absolute neutrophil count (ANC) is below 500 cells/mm3. Cephalosporin prophylaxis continues until neutrophil engraftment (ANC≥500 cells/mm3 for three consecutive days). We sought to determine the incidence of bacterial infections among pediatric recipients of HSCT during the immediate post-transplant period. Methods: This retrospective review examined all HSCT recipients from September 1999 to August 2011. Data collected included gender, age at transplant, diagnosis, type of transplant, graft-versus-host disease and use of radiation. Post-transplant data collected included time to engraftment, antibacterial prophylaxis regimen administered, and number of positive bacterial cultures during post-transplant neutropenia, including organisms isolated and susceptibilities to the prophylactic cephalosporin administered. Patients with primary immune deficiency were excluded from this analysis. To evaluate the effect of prophylaxis we also collected data on all patients with acute myeloid leukemia (AML) at our center during the same time period. AML patients do not receive any prophylactic antibiotics. For AML patients, data collected included gender, age at time of therapy, and number of positive bacterial cultures during post-chemotherapy neutropenia, including organisms isolated and susceptibilities to cephalosporin. Results: A total of 287 stem cell transplant patients with a median age 8.6 years (range 0.4–25) were included. There were 165 (57%) males, 236 (82%) had malignant diseases and 123 (43%) received a total body irradiation based regimen. 71 (25%) received an autologous, and 216 (75%) received allogeneic transplant (78 related, 138 unrelated, 37 cord blood). The median time to engraftment was 17 days (range (8–78). A total of 96 AML patients were included with a median age of 6.6 years (range 0.6–22). The median time of neutropenia was 32 days (range 15–115). The HSCT and AML patients were comparable in age and gender. A total of 36 (13%) transplants were complicated by at least one bacterial infection. The infections (n=57) included 49 gram positive, 7 gram negative, 1 atypical. A total of 35 (36%) chemotherapy cycles were complicated by at least one bacterial infection. A total of 44 infections occurred in the AML patients (36 gram positive, 7 gram negative, 1 atypical). When comparing the two groups, the AML patients had significantly more bacterial infections than the HSCT recipients (P<0.001). Among the HSCT group, using multivariate analysis neither age at transplant, gender, related versus unrelated donor, use of TBI, or use of steroids were associated with increased risk of bacterial infection. However, there was increased risk of bacterial infections in patients with malignant disease (P=0.046). Conclusion: The use of cephalosporin prophylaxis in pediatric HSCT recipients resulted in a lower number of bacterial infections than has been previously reported. HSCT patients had significantly less infections compared to AML patients who received no bacterial prophylaxis. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

2005 ◽  
Vol 35 (12) ◽  
pp. 1171-1177 ◽  
Author(s):  
U G Kyle ◽  
Y Chalandon ◽  
R Miralbell ◽  
V L Karsegard ◽  
D Hans ◽  
...  
Keyword(s):  
Body Composition ◽  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Transplant Patients

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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