•Center` fluoroquinolone prophylaxis allo-HSCT policy does not influence pre-engraftment Gram-negative rods bacteremia (GNRB) rate.•Low post-engraftment GNRB rate in allo-HSCT patients in ...JACIE/FACT-accredited centers.•High pre-engraftment GNRB rate in auto-HSCT patients with autoimmune diseases.•Low pre-engraftment GNRB rate in auto-HSCT centers with active infection control team.•MDR GNRB associated with increased post-HSCT mortality.
We present here data on Gram-negative rods bacteremia (GNRB) rates, risk factors and associated mortality.
Data on GNRB episodes were prospectively collected in 65 allo-/67 auto-HSCT centers in 24 countries (Europe, Asia, Australia). In patients with and without GNRB, we compared: demography, underlying disease, HSCT-related data, center` fluoroquinolone prophylaxis (FQP) policy and accreditation status, and involvement of infection control team (ICT).
The GNRB cumulative incidence among 2818 allo-HSCT was: pre-engraftment (pre-eng-allo-HSCT), 8.4 (95% CI 7–9%), post-engraftment (post-eng-allo-HSCT), 5.8% (95%CI: 5–7%); among 3152 auto-HSCT, pre-eng-auto-HSCT, 6.6% (95%CI: 6–7%), post-eng-auto-HSCT, 0.7% (95%CI: 0.4–1.1%). GNRB, especially MDR, was associated with increased mortality.
Multivariate analysis revealed the following GNRB risk factors:
(a) pre-eng-allo-HSCT: south-eastern Europe center location, underlying diseases not at complete remission, and cord blood source;
(b) post-eng-allo-HSCT: center location not in northwestern Europe; underlying non-malignant disease, not providing FQP and never accredited.
(c) pre-eng-auto-HSCT: older age, autoimmune and malignant (vs. plasma cell) disease, and ICT absence.
Benefit of FQP should be explored in prospective studies. Increased GNRB risk in auto-HSCT patients transplanted for autoimmune diseases is worrying. Infection control and being accredited are possibly protective against bacteremia. GNRB are associated with increased mortality.
Although infrequently seen, the management of cancer during pregnancy can be difficult for patients, their families and physicians. The concomitant occurrence of pregnancy and chronic myelogenous ...leukemia is uncommon. We describe the successful management of a 26-year-old woman in the first trimester of her pregnancy with chronic myelogenous leukemia (CML) in chronic phase by using only leukapheresis. She was treated with leukapheresis until her delivery at 36 weeks of gestation. The procedure was without significant adverse effects on the patient or fetus. We applied a total of 15 leukapheresis treatments throughout the pregnancy. The patient gave birth vaginally to a healthy 2800 g boy at 36 weeks of gestation. We conclude that leukapheresis may provide an alternative treatment to chemotherapy, α-interferon or imatinib in pregnant patients with CML, particularly with concern over their potential teratogenic and other adverse effects.
Because of the teratogenicity data in rats, it is recommended that women treated with imatinib should be aware of the potential teratogenicity of imatinib and effective contraception should be used ...during imatinib therapy to prevent pregnancy. We describe successful pregnancy and delivery, without any congenital anomaly, in a patient with CML under treatment of imatinib. The fetus had been exposed to imatinib for 8 weeks. The patient remained off treatment during gestation and cytogenetic relapse of CML (5 months after discontinuation of imatinib therapy) developed at seventh month of gestation.
In leukemias, the monitoring techniques on the response after the treatment have clinical importance for evaluating new therapeutic approaches and identifying the risk of relapse. In this study, ...genetic changes before and after chemotherapy in interphase and metaphase nuclei of bone morrow of adults with provisional diagnosis of leukemia were compared to understand the molecular characterization and pathogenesis of the leukemia for the classification of diagnosis and prognosis. We examined bone morrow cells of 47 chronic myeloid leukemia (CML) cases (29 of 47 at the time of diagnosis, 31 of 47 after chemotherapy) with the bcr/abl translocation probes and of 10 acute promyelocytic leukemia (APL) cases (7 of 10 at the time of diagnosis, 4 of 10 after chemotherapy) with the PML/RARalpha translocation probes by using dual color-flourescence in situ hybridization (DC-FISH). For each case, 400 interphase nuclei and 11 to 25 metaphases nuclei were analysed. The ratios of translocations before and after chemotherapy were compared between interphase and metaphase nuclei. After chemotherapy, though, translocations were detected in interphase nuclei of 29 of the 31 CML and 4 of the 4 APL cases, these translocations were determined in metaphase nuclei of only 14 of the 31 CML and 1 of the 4 APL cases with very low ratios (p < 0.01). The results showed that the rates of translocation positive interphase nuclei were higher than the rates of translocation positive metaphase nuclei (p < 0.01) after chemotherapy, so there may be some factors effecting proliferative activity of metaphase formation in leukemias.
Aim: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (AHCT). As GVHD prophylaxis regimen, post-transplant cyclophosphamide (Post-Cy) has ...been associated with less acute and chronic GVHD. Anti-Thymocyte Globulin (ATG), which is another GVHD prophylaxis regimen, could reduce the risk of chronic but not acute GVHD. Anti-thymocyte globulin (ATG) in association with a calcineurin inhibitor (CNI) and methotrexate or mycophenolate mofetil (MMF) is widely used in the setting of unrelated donor transplantation (UDT). Recent studies proned non-inferior results of haplotype matched donor transplantation (HMDT) using Post-Cy in comparison with UDT. However, there is no consensus about the optimal GVHD prophylaxis regimen or choosing wisely. Aim of this study was to compare the outcome of two GVHD prophylaxis regimens; Post-Cy used in HIDT or UDT and ATG used for unrelated donors in a single-cohort of consecutive transplant recipients.
Material and Methods: Two hundred adult (17-72 years) patients who underwent HIDT and UDT with a minimum 100 days follow-up at Florence Nightingale Hospital Hematopoietic Stem Cell Transplantation Center between 2011 and 2017 were included in this study. Medical records of patients were reviewed retrospectively. Transplantation was performed in cases with high or very high DRI. HIDT was performed in 73 cases and UDT in 127 cases. One hundred eighty five out of 200 cases with a complete follow-up were included in the statistical analysis. Sixty-seven patients underwent HIDT with Post-Cy (Group 1), 97 patients with UDT receiving ATG (Group 2) and 21 with UDT receiving Post-Cy (Group 3). Patients who completed minimum 100 days post-transplantation follow-up were identified as eligible for survival analysis.
Results: Median age of patients was 42.8±14.9 years. Percentage of male patients was 65.6%, 68% and 38% for HIDT with Post-Cy (Group 1), UDT with ATG (Group 2) and UDT with Post-Cy groups (Group 3), respectively, which is significantly different (p=0.03). Bone marrow was used in 58.2% patients as stem cell source in HIDT, contrary to UDT, which is below 1% (p<0.0001). Median follow-up time was 398 days. Patient characteristics (Table 1), were mainly similar, such as donor age, gender, recipient cytomegalovirus (CMV) status, Karnofsky performance status, conditioning regimens, median neutrophil and platelet engraftment time, engraftment failure, acute GVHD incidence and disease status at post-transplant D100. Since the incidence of donor CMV IgG was significantly higher due to regional reasons in HIDT group, CMV activation rate was also significantly higher in this HIDT (p=0.001). No significant difference was found in Kaplan-Meier survival analysis among the HIDT with Post-Cy, UDT with ATG and UDT with Post-Cy groups, even if they were classified according to primary disease, and post transplant 100th day disease status. Transplant related mortality at 30th and 100th days were similar among three groups. Also, donor CMV status (CMV IgG positivity or negativity) and CMV reactivation was not an important factor on survival (for donor CMV status p=0.307; for CMV reactivation p=0.274).
Conclusion: We did not find any significant difference among three groups with regards to survival rate and acute GVHD development. Reactivation of CMV does not effect 100th day survival. These findings support our hypothesis that post-Cy infusion regimen is an important factor for higher survival rate rather than the donor type. We believe that post Cy infusion GVHD prophylaxis platform along with MMF and CNI is maturing, proved itself as a standard immune suppressive regimen for alternative donor transplantation. The related donor switch will be expectedly soon, and we have to wait for maturation of data both on related matched and alternative donor AHCT using post Cy infusion.
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No relevant conflicts of interest to declare.
Purpose: Turkish Stem Cell Coordination Center (TURKOK) was established by the Turkish Ministry of Health in April 2015 in order to facilitate unrelated hematopoietic stem cell (HSC) transplantation ...in Turkey. The donor recruitment task has been linked to the Turkish Crescent's (National Blood Product Provider) nationwide distributed branches. As of July 2017, more than 300.000 volunteer donors are registered into the database. As of July 2017 they have facilitated more than 300 HSCTs. Transplant Registry Istanbul (TRIS) and Transplant Registry Ankara (TRAN) are two University affiliated donor search - co-ordination centers, which are officially responsible for the search, matching and organization of the delivery for unrelated donor HSC in Turkey. The foundation of TURKOK should have theoretically decreased our time spent to find a suitable matched donor. The aim of this study is to compare the time frames between admission, confirmation, work-up, and infusion of HSC between TURKOK and other WMDA or NMDP facilitated International Volunteer Donor Registries.
Subjects & Methods: In 2015 1000 allogeneic HSCTs were peformed in Turkey and only 18% were from MUDs. This is a single center analysis of a dedicated active HSCT center, which is performing >70 allogeneic HSCTs per year and utilizing alternative donor sources >50%. Patient charts were reviewed retrospectively and 51 patients who admitted to our center within 2015-2017 for various high risk hematological malignancies (mostşy acute leukemia, in which allogeneic HSCT was indicated, were identified for this study. Patients were divided into two groups: (1) Patients who had received HSC from matched unrelated donors (MUD-T) (10/10-9/10) facilitated by TURKOK (N=36) ; (2) 15 patients who had received HSC from International Registries facilitated by TRIS or TRAN (MUD-I) . The duration between application and finding a suitable match (tAM), duration between matching and confirmation (tMC) and time from application to HSC transplantation (tATX) were calculated for each of these two groups. The time duration between admission and donor identification and admission to HSCT were not distributed normally. The mean values were compared between two groups by Mann-Whitney U test. p < 0.05 was considered statistically significant.
Results: In 51 HSC recipients the overall median durations for tAM, tMC and tATX were 71 (range, 1-172), 33 (range, 1-181) and 97 (range, 13-172), respectively. In MUD-I overall median durations for tAM, tMC and tATX were 90 (range, 1-170), 40.5 (range, 1-181) and 98 (range, 13-172), whereas in MUD-T the timelines for tAM, tMC and tATX were 37 (range, 4-172), 17 (range, 6-151) and 96 (range, 73-128), respectively. The p values for comparative analysis betwen MUD-I and MUD-T for tAM, tMC and tATX were p=0.005, p=0.007 and p>0.05, respectively.
Conclusion: In this relative limited size of HSC recipients from MUDs we observed accelerated kinetics for tAM and tMC, which means having a National Registry have a positive impact on finding an available match and confirmation process. On the other hand this improvement did not translate into rapid HSCT. The tATX between MUD-I and MUD-T are not significant. TURKOK has to establish and improve the organization of confirmed donor for collection of HSCs. The decreased timeline from application to confirmation is encouraging, but the time spent from confirmation to work/up and collection are still high. As TURKOK is a recently established donor bank, there is room for improvement.
No relevant conflicts of interest to declare.
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