scholarly journals A Case of Pneumocystis jirovecii Pneumonia under Belatacept and Everolimus: Benefit-Risk Balance between Renal Allograft Function and Infection

2021 ◽  
pp. 10-15
Author(s):  
Quentin Perrier ◽  
Antoine Portais ◽  
Florian Terrec ◽  
Yann Cerba ◽  
Thierry Romanet ◽  
...  
Keyword(s):  
Immunosuppressive Treatment ◽  
T Cell Subsets ◽  
Pneumocystis Jirovecii ◽  
Post Transplantation ◽  
Opportunistic Disease ◽  
Safety Studies ◽  
History Of ◽  
Risk Balance ◽  
Early Late

<i>Pneumocystis jirovecii</i> pneumonia is an opportunistic disease usually prevented by trimethoprim-sulfamethoxazole. A 49-year-old HLA-sensitized male with successful late conversion from tacrolimus-based to belatacept-based immunosuppression developed <i>P. jirovecii</i> pneumonia for which he presented several risks factors: low lymphocyte count with no CD4+ T cells detected since 2 years, hypogammaglobulinemia, history of acute cellular rejection 3 years before, and immunosuppressive treatment (belatacept, everolimus). Because of respiratory gravity in the acute phase, the patient was given oxygen, corticosteroids, and trimethoprim-sulfamethoxazole. Thanks to the improvement of respiratory status, and because of the renal impairment, trimethoprim-sulfamethoxazole was converted to atovaquone for 21 days. Indeed, after 1 week on intensive treatment, the benefit-risk balance favored preserving renal function according to respiratory improvement status. <i>P. jirovecii</i> pneumonia prophylaxis for the next 6 months was monthly aerosol of pentamidine. Long-term safety studies or early/late conversion to belatacept did not report on <i>P. jirovecii</i> pneumonia. Four other cases of <i>P. jirovecii</i> pneumonia under belatacept therapy were previously described in patients having no <i>P. jirovecii</i> pneumonia prophylaxis. Studies on the reintroduction of <i>P. jirovecii</i>pneumonia prophylaxis after conversion to belatacept would be of interest. It could be useful to continue regular evaluation within the second-year post-transplantation regarding immunosuppression: T-cell subsets and immunoglobulin G levels.

scholarly journals Solid Organ Transplantation in Patients With a History of Lymphoma

2018 ◽  
Vol 14 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Philip J. Bierman
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Supporting Evidence ◽  
Solid Organ ◽  
Post Transplantation ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Lymphoma Treatment ◽  
History Of

There is an increasing number of long-term survivors of Hodgkin and non-Hodgkin lymphoma. These people may have a need for subsequent solid organ transplantation, often as a result of late effects of their lymphoma treatment. There is abundant literature demonstrating that patients with a history of lymphoma are appropriate candidates for solid organ transplantation. Long-term survival without relapse and with a functioning graft is possible. Patients with a history of post-transplantation lymphoproliferative disorders and patients who have received a prior hematopoietic stem-cell transplantation may also be candidates. Although high-level supporting evidence is not available, most guidelines recommend a waiting period of 2 to 5 years after lymphoma treatment before patients undergo solid organ transplantation. Each patient with a history of lymphoma requires a multidisciplinary approach and should be evaluated on a case-by-case basis before consideration of solid organ transplantation.

PD-1 blockade for disseminated Kaposi sarcoma in a patient with atopic dermatitis and chronic CD8 lymphopenia

Immunotherapy ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 451-457
Author(s):  
Thilo Gambichler ◽  
Laura Susok
Keyword(s):  
Atopic Dermatitis ◽  
Soft Tissues ◽  
Immunosuppressive Treatment ◽  
Kaposi Sarcoma ◽  
Unknown Origin ◽  
Rare Association ◽  
Mixed Response ◽  
Heavily Pretreated ◽  
History Of

We describe a 53-year-old male patient with a history of long-standing atopic dermatitis (AD) who presented with disseminated Kaposi sarcoma (KS). Although he never had received long-term immunosuppressive treatment for his AD, he had a 16-year history of CD8 lymphopenia. Because of his heavily pretreated progressive KS in lymph nodes and soft tissues, we treated the patient using pembrolizumab 2 mg/kg body weight 3-weekly. On PET-computed tomography 3-months after the initiation of pembrolizumab therapy, a solid treatment response was detected in all tumor sites – 6-months later a mixed response was observed. Pembrolizumab therapy for further 10 months resulted in stable disease. Notably, his AD also improved during the pembrolizumab treatment period. This report highlights a rare association between AD and KS that was complicated by chronic CD8 lymphopenia of unknown origin. Even though our patient was immunocompromised, he showed an overall good response to pembrolizumab treatment.

Post-Transplantation High Dose Cyclophosphamide (Cy) Is Effective Single Agent for Prevention of Acute and Chronic Graft Versus Host Disease after Myeloablative HLA Matched Related and Unrelated Bone Marrow Transplantation (BMT)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 56-56 ◽  
Author(s):  
Leo Luznik ◽  
Javier Bolanos-Meade ◽  
Robert Brodsky ◽  
B. Douglas Smith ◽  
Carol A. Huff ◽  
...  
Keyword(s):  
Acute Gvhd ◽  
De Novo ◽  
Chronic Gvhd ◽  
Immunosuppressive Treatment ◽  
High Dose ◽  
Post Transplantation ◽  
Gvhd Prophylaxis ◽  
History Of ◽  
Grade Ii ◽  
Low Incidence

Abstract Based on our results in animal models and promising results in HLA-haploidentical setting (L. Luznik, Blood 2002 and BBMT 2008), we studied whether high dose Cy alone is sufficient as GVHD prophylaxis after myeloablative HLA-matched related or unrelated BMT in patients with advanced, poor risk, hematologic malignancies. One hundred and seventeen consecutive patients (median age 48, range 23–65; 36 de novo AML, 23 2° AML (arising from previous MDS/MPD or therapy-related), 13 high-risk MDS, 9 ALL, 8 CML, 3 CLL, 5 MM, 9 NHL and 11 HL), of whom the majority (57%) were not in remission, received HLA-matched related (n=78) or unrelated (n=39) BMT. Conditioning consisted of oral or IV busulfan (pharmacokinetically adjusted) on days −7 to −3 and Cy (50 mg/kg/day) on days −2 and −1. Cy (50 mg/kg/day) was also given on days +3, and +4 as a sole agent for GVHD prophylaxis. All patients received bone marrow allografts without growth factor support. Three patients failed to engraft, but two were successfully rescued with a second allograft. The cumulative incidence of non-relapse mortality (NRM) at day 100 and 1 year after transplantation was 8.5% and 16%, respectively. Of the 18 patients dying of NRM, 2 were from VOD, 3 from non infectious pneumonia, 3 were from GVHD, 3 from sepsis/bacterial infections, 4 from MOF, and 3 of CNS/organ hemorrhage. The incidences of acute grade II–IV and grade III–IV GVHD were 43% and 11%, respectively. With a median follow-up of 19 months, 66 (56.4%) patients are alive, of whom 52 (44.4%) are in complete remission. Only 7/66 related and 4/32 unrelated patients developed chronic GVHD (classic limited in 7, overlap syndrome limited in 1, and classic extensive in 3 patients). Since in a competing risk model (relapse and death as competing risks) the cumulative incidence of chronic GVHD remained low, we analyzed the impact of the preceding history of acute GVHD and systemic immunosuppressive treatment given beyond the originally prescribed prophylaxis with high dose Cy on the incidence of chronic GVHD. Only one patient without a preceding history of acute GVHD developed de novo chronic GVHD. Overall, 3 patients with grade II–IV acute GVHD were untreated, 10 patients received steroids alone, 31 received steroids + a calcineurin inhibitor (CNI), and 7 received steroids + non CNI-based agents. The use of CNI for the treatment of acute GVHD did not appear to influence the development of chronic GVHD: 6/31 (19%) patients who received CNI-based immunosuppressive treatment developed chronic GVHD compared to 3/20 (15%) patients who did not. These results suggest that highdose of post-transplantation Cy is effective as the sole prophylaxis for acute and chronic GVHD after HLA-matched related or unrelated BMT. This approach is associated with rapid immunologic recovery as indicated by the low incidence of opportunistic infections, as well as a low incidence of acute and especially chronic GVHD. Further clinical and correlative studies are needed to elucidate the mechanisms behind the unique effectiveness of post-transplantation Cy on the prevention of acute and chronic GVHD.

Atypical Femoral Fracture in McCune-Albright Syndrome

2020 ◽  
Vol 7 (3) ◽  
pp. 147-152
Author(s):  
Salman Ghaffari ◽  
◽  
Mehran Razavipour ◽  
Parastoo Mohammad Amini ◽  
◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Dynamic Compression ◽  
Plate Fixation ◽  
Medullary Canal ◽  
Mccune Albright Syndrome ◽  
Café Au Lait Spots ◽  
History Of ◽  
Albright Syndrome ◽  
Mccune Albright

McCune-Albright Syndrome (MAS) is characterized by endocrinopathies, café-au-lait spots, and fibrous dysplasia. Bisphosphonates are the most prescribed treatment for reducing the pain but their long-term use has been associated with atypical fractures of cortical bones like femur in patients. We present a 23-year-old girl diagnosed with MAS. She had an atypical mid-shaft left femoral fracture that happened during simple walking. She also had a history of long-term use of alendronate. Because of the narrow medullary canal, we used 14 holes hybrid locking plate for the lateral aspect of the thigh to fix the fracture and 5 holes dynamic compression plate (instead of the intramedullary nail) in the anterior surface to double fix it, reducing the probability of device failure. With double plate fixation and discontinuation of alendronate, the complete union was achieved five months after surgery

European Integration

2020 ◽  
Author(s):  
Johann P. Arnason
Keyword(s):  
European Integration ◽  
Eastern European ◽  
The European Union ◽  
Historical Processes ◽  
History Of ◽  
External Conditions ◽  
Eastern European Countries ◽  
Totalitarian Regimes ◽  
The Eu

Different understandings of European integration, its background and present problems are represented in this book, but they share an emphasis on historical processes, geopolitical dynamics and regional diversity. The introduction surveys approaches to the question of European continuities and discontinuities, before going on to an overview of chapters. The following three contributions deal with long-term perspectives, including the question of Europe as a civilisational entity, the civilisational crisis of the twentieth century, marked by wars and totalitarian regimes, and a comparison of the European Union with the Habsburg Empire, with particular emphasis on similar crisis symptoms. The next three chapters discuss various aspects and contexts of the present crisis. Reflections on the Brexit controversy throw light on a longer history of intra-Union rivalry, enduring disputes and changing external conditions. An analysis of efforts to strengthen the EU’s legal and constitutional framework, and of resistances to them, highlights the unfinished agenda of integration. A closer look at the much-disputed Islamic presence in Europe suggests that an interdependent radicalization of Islamism and the European extreme right is a major factor in current political developments. Three concluding chapters adopt specific regional perspectives. Central and Eastern European countries, especially Poland, are following a path that leads to conflicts with dominant orientations of the EU, but this also raises questions about Europe’s future. The record of Scandinavian policies in relation to Europe exemplifies more general problems faced by peripheral regions. Finally, growing dissonances and divergences within the EU may strengthen the case for Eurasian perspectives.

The natural history of pituitary apoplexy: long term follow-up study

2019 ◽  
Author(s):  
Ayesha Shaikh ◽  
Natasha Shrikrishnapalasuriyar ◽  
Giselle Sharaf ◽  
David Price ◽  
Maneesh Udiawar ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Apoplexy ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
History Of

Hashimoto encephalopathy

2013 ◽  
Vol 154 (33) ◽  
pp. 1312-1316 ◽  
Author(s):  
Gábor Pocsay ◽  
Andrea Gazdag ◽  
József Engelhardt ◽  
István Szaniszló ◽  
Zoltán Szolnoki ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Immunosuppressive Treatment ◽  
Unknown Origin ◽  
Corticosteroid Treatment ◽  
Thyroid Peroxidase ◽  
Thyroid Autoantibodies ◽  
Thyroglobulin Antibodies ◽  
Hashimoto Encephalopathy ◽  
Generalized Seizures

The authors present a case report and review the literature on Hashimoto encephalopathy. The onset of the disease may be marked by focal and then progressively generalized seizures or other neurological symptoms, but a cognitive decline or various psychiatric symptoms may also emerge. High levels of anti-thyroid peroxidase antibodies and/or anti-thyroglobulin antibodies are present in the serum. Corticosteroid treatment usually results in an improvement of symptoms. The syndrome is frequently overlooked and, therefore, the authors strongly recommend testing serum thyroid autoantibodies in cases with encephalopathy of unknown origin independently on the presence of thyroid disease in the patient or family history. The importance of long-term immunosuppressive treatment should also be stressed. Orv. Hetil., 2013, 154, 1312–1316.

1386-P: Long-Term Weight Change after Pregnancy and Type 2 Diabetes Risk in Women with a History of Gestational Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1386-P
Author(s):  
SYLVIA E. BADON ◽  
FEI XU ◽  
CHARLES QUESENBERRY ◽  
ASSIAMIRA FERRARA ◽  
MONIQUE M. HEDDERSON
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Weight Change ◽  
Diabetes Risk ◽  
History Of
Sign in / Sign up

Export Citation Format

Share Document