scholarly journals Vancomycin-Resistant Enterococcus (VRE) Colonization and Blood Stream Infection (BSI): Prevalence, Risk Factors, and Impact on Early Clinical Outcomes after Allogenic Hematopoietic Cell Transplantation

2016 ◽  
Vol 22 (3) ◽  
pp. S322-S323
Author(s):  
Mehrdad Hefazi ◽  
Hassan B. Alkhateeb ◽  
Robin Patel ◽  
Raymund Razonable ◽  
Dennis A. Gastineau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Hematopoietic Cell ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Resistant ◽  
Early Clinical Outcomes

scholarly journals Bloodstream Infection Due to Vancomycin-resistant Enterococcus Is Associated With Increased Mortality After Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome: A Multicenter, Retrospective Cohort Study

2019 ◽  
Vol 69 (10) ◽  
pp. 1771-1779 ◽  
Author(s):  
Genovefa A Papanicolaou ◽  
Celalettin Ustun ◽  
Jo-Anne H Young ◽  
Min Chen ◽  
Soyoung Kim ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Myelodysplastic Syndrome ◽  
Bloodstream Infection ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Disease Stage ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Resistant ◽  
Multivariable Models

Abstract Background We examined the impact of vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research database. Methods Adult and pediatric patients (N = 7128) who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012 were analyzed as 3 groups—VRE BSI, non-VRE BSI, without BSI—according to BSI status at 100 days (D100) after allogeneic HCT. Multivariable models examined the effect of VRE BSI for overall survival (OS) and nonrelapse mortality (NRM) at 1 year. Results Of 7128 patients, 258 (3.2%) had VRE BSI, 2398 (33.6%) had non-VRE BSI, and 4472 (63%) had no BSI. The median time to VRE BSI and non-VRE BSI were D11 and D15, respectively. Compared with non-VRE BSI patients, VRE BSI patients were older, had advanced-stage acute leukemia, and received umbilical cord blood (UCB) allografts. In multivariable models, VRE BSI was associated with lower OS (relative risk [RR], 2.9;(99% confidence interval [CI], 2.2–3.7) and increased NRM (RR, 4.7; 99% CI, 3.6–6.2) (P < .0001) for both. Other predictors for worse OS and increased NRM were non-VRE BSI, older age, advanced disease stage, UCB allograft, – mismatch, comorbidity index ≥3, and cytomegalovirus seropositivity (P < .001 for all variables). Conclusions VRE BSI is associated with lowest OS and highest NRM compared with patients without BSI or non-VRE BSI. Novel interventions that address the pathophysiology of VRE BSI have the potential of improving survival after HCT.

Infectious Complications After Unrelated Donor Allogeneic Hematopoietic Cell Transplantation With Or Without Alemtuzumab Based In Vivo Lymphocyte Depletion

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4580-4580
Author(s):  
Brian C. Shaffer ◽  
Andrew Flynn ◽  
David Moorshead ◽  
Zach Powell ◽  
Jennifer Hsu ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Unrelated Donor ◽  
Lymphocyte Depletion ◽  
Gvhd Prophylaxis

The addition of alemtuzumab to conditioning may decrease the incidence of graft versus host disease (GVHD) after unrelated donor (URD) allogeneic hematopoietic cell transplantation (alloHCT) but may also contribute to impaired pathogen immunity due to donor lymphocyte depletion. We identified and graded infections occurring within 6 months after URD alloHCT in 78 individuals treated either with (N=40) or without (N=38) alemtuzumab during alloHCT for hematologic cancers. Conditioning included fludarabine (120 mg/m2 total) and cyclophosphamide (4,800 mg/m2 total) over 4 days with either alemtuzumab (100 mg total days -8 to -4) followed by cyclosporine (AC) or with tacrolimus, methotrexate, and sirolimus (TMS) based GVHD prophylaxis. Both groups received a filgrastim mobilized peripheral blood graft from an 8/8 or 7/8 HLA-matched unrelated donor and received GVHD prophylaxis for 180 days. Filgrastim was administered post HCT until neutrophil recovery. Infections were graded according to Cordonnier et al. (Transplantation 2006). Only proven/probable pulmonary fungal episodes by EORT/MSG criteria were included. Infection prophylaxis during the study period included trimethoprim/sulfamethoxazole BID thrice weekly after HCT engraftment and daily acyclovir or valacyclovir. Fungal prophylaxis was fluconazole until day 100 or either micafungin or voriconazole in persons receiving 1+ week of >1 mg/kg/d prednisone or equivalent. Ceftazidime was administered to persons with neutrophil count <500/μL until recovery. Persons were monitored for CMV, adenovirus, toxoplasmosis (in seropositive persons), EBV (after 2009), and HHV-6 with at least weekly blood PCR. CMV was treated with pre-emptive therapy according to published guidelines. Blood aspergillus glactomannin and beta D-glucan assays were obtained when clinically indicated. The use of AC compared to TMS resulted in greater total infections per patient (4.4 versus 2.8, P<0.0001) but similar rates of grade 3 (most serious) infections (0.5 versus 0.6, P=0.49). CMV reactivation in recipient seropositive persons was more common in AC (24/24 AC arm versus 11/24 TMS arm, P<0.0001). The median duration of CMV viremia was 6 weeks in AC versus 2 weeks in TMS (P=0.001). CMV colitis or pneumonitis occurred in 3 persons treated with AC and in 1 person treated with TMS at a mean of 47 days post alloHCT (range 15-121). Bacterial infections per patient in AC and TMS were similar (1.6 versus 1.1, P=0.08). Clostridium difficile colitis was relatively common (10 episodes AC; 11 episodes TMS). HHV-6 infections were similar (24/40 AC versus 16/38 TMS, P=0.16). HHV-6 encephalitis developed in five individuals (3 TMS, 2 AC). The median blood titer at the time CNS involvement was identified was 15,950 copies/mL (0-40,000 copies/mL) and was not predictive on onset of encephalopathy (P=0.6). EBV infection developed in 9 persons in AC and 6 persons in TMS. Three cases of EBV lymphoproliferative disorder occurred in persons treated with AC. An additional three persons in each AC and TMS were treated pre-emptively with rituximab for EBV viremia. Adenovirus infection developed in 4 persons in each TMS and AC. One person treated with AC developed adenoviral colitis. There was one episode of invasive fungal infection in TMS (Candida krusei blood stream infection) and 4 episodes in AC (3 episodes Candida blood stream infection [2 parapsilosis, 1 albicans], one pulmonary aspergillosis). In summary, the use of AC versus TMS resulted greater total infections and CMV infections but with similar bacterial and fungal infection incidence. Weekly monitoring of HHV-6 by blood PCR was ineffective at predicting development of HHV-6 CNS disease. The rate of invasive fungal infections in this cohort was low. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Assessment of Endothelial Injury and Pro-Coagulant Activity Using Circulating Microvesicles in Survivors of Allogeneic Hematopoietic Cell Transplantation

2020 ◽  
Vol 21 (24) ◽  
pp. 9768
Author(s):  
Eleni Gavriilaki ◽  
Ioanna Sakellari ◽  
Panagiota Anyfanti ◽  
Ioannis Batsis ◽  
Anna Vardi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cell Transplantation ◽  
Vascular Injury ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Allogeneic Hematopoietic Cell Transplantation ◽  
Coagulant Activity

(1) Background: survivors of allogeneic hematopoietic cell transplantation (alloHCT) suffer from morbidity and mortality due to cardiovascular events. We hypothesized that vascular injury and pro-coagulant activity are evident in alloHCT survivors without existing alloHCT complications or relapse. (2) Methods: we enrolled consecutive adult alloHCT survivors without established cardiovascular disease and control individuals matched for traditional cardiovascular risk factors (January–December 2019). Circulating microvesicles (MVs) of different cellular origins (platelet, erythrocyte, and endothelial) were measured by a standardized flow cytometry protocol as novel markers of vascular injury and pro-coagulant activity. (3) Results: we recruited 45 survivors after a median of 2.3 (range 1.1–13.2) years from alloHCT, and 45 controls. The majority of patients suffered from acute (44%) and/or chronic (66%) graft-versus-host disease (GVHD). Although the two groups were matched for traditional cardiovascular risk factors, alloHCT survivors showed significantly increased platelet and erythrocyte MVs compared to controls. Within alloHCT survivors, erythrocyte MVs were significantly increased in patients with a previous history of thrombotic microangiopathy. Interestingly, endothelial MVs were significantly increased only in alloHCT recipients of a myeloablative conditioning. Furthermore, MVs of different origins showed a positive association with each other. (4) Conclusions: endothelial dysfunction and increased thrombotic risk are evident in alloHCT recipients long after alloHCT, independently of traditional cardiovascular risk factors. An apparent synergism of these pathophysiological processes may be strongly involved in the subsequent establishment of cardiovascular disease.

Sign in / Sign up

Export Citation Format

Share Document