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Jandial A, Naseem S, Khadwal A, Varma N, Ray P, Singh C, Jain A, Lad D, Malhotra P, Prakash G. No role of common NOD2 gene variants in predicting sepsis related outcomes in Indian patients undergoing hematopoietic stem cell transplant. Med J Armed Forces India 2023; 79:689-693. [PMID: 37981940 PMCID: PMC10654352 DOI: 10.1016/j.mjafi.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/27/2023] [Indexed: 11/21/2023] Open
Abstract
Background High-risk single nucleotide polymorphisms (SNPs) in nucleotide-binding oligomerization domain-2 (NOD2) gene are associated with high susceptibility for infections and inflammation due to risk of inappropriate cytokine production and NF-κB activation. We studied the incidence of three high-risk NOD2 gene SNPs (8, 12 and 13) among BM-transplant (BMT) recipients. Methods Sequential patients undergoing BMT over 1-year period were prospectively studied. Patients were tested with MspI/HhaI or NlaIV restriction-endonucleases (Euryx, Gdansk, Poland) for NOD2 gene SNPs 8, 12, and 13, respectively. Regimen-related organ toxicity was graded using the Seattle-Bearman criteria. Results Forty patients were enrolled, their median age was 38 years (range 3-64), and 52.5% were males. Twenty patients each (50%) underwent autologous and allogeneic BMT. Majority of the patients (n = 38, 95%) developed febrile-neutropenia in the post-transplant period and 4 patients died due to overwhelming sepsis within day +100. Acute graft-versus-host disease (GVHD) [grade I-II (n = 3) and grade III-IV (n = 6)] was observed in 9/20 allogeneic HSCT recipients. None of our 40 patients showed presence of any of the three NOD2 gene SNPs. Conclusion The 3 commonly observed high risk SNPs (8,12, and 13) of NOD2 genes were not present in study population. It is quite likely that due to geographical and racial variations these polymorphisms are completely absent in North India. NOD2 gene is highly diverse and polymorphic variants can be absolutely different in various populations. Larger studies targeting sequencing of the whole NOD2 gene can convincingly rule out or confirm the role of NOD2 gene variants in Indian population.
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Affiliation(s)
- Aditya Jandial
- Clinical Research Associate (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
| | - Shano Naseem
- Professor (Hematology), PGIMER, Chandigarh, India
| | - Alka Khadwal
- Professor (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
| | - Neelam Varma
- Ex-Professor (Hematology), PGIMER, Chandigarh, India
| | - Pallab Ray
- Professor (Microbiology), PGIMER, Chandigarh, India
| | - Charanpreet Singh
- Clinical Research Associate (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
| | - Arihant Jain
- Associate Professor (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
| | - Deepesh Lad
- Associate Professor (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
| | - Pankaj Malhotra
- Professor & Head (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
| | - Gaurav Prakash
- Professor (Clinical Hematology & Medical Oncology), PGIMER, Chandigarh, India
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Graf L, Stern M. Acute phase after haematopoietic stem cell transplantation. Hamostaseologie 2017; 32:56-62. [DOI: 10.5482/ha-1176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 10/07/2011] [Indexed: 01/24/2023] Open
Abstract
SummaryThe transplantation of allogeneic or autologous haematopoietic stem cells is an established treatment for many malignant and non-malignant diseases of the bone marrow. Intensive cytoreductive regimens administered before transplantation induce prolonged and severe cytopenia of all haematopoietic lineages. Thrombocytopenia leads to an increased risk of bleeding, which may be further aggravated by consumption of plasmatic factors as a result of tumour lysis or after antibody administration. At the same time, patients after transplantation are also at increased risk of thrombotic complications. Endothelial damage induced by radio-and chemotherapy, indwelling catheters, prolonged immobilization and a high incidence of systemic infection all contribute to the frequent occurrence of thromboembolic events in this population.This review discusses the incidence and risk factors for haemorrhagic and thrombotic complications after stem cell transplantation. Special emphasis is given to complications occurring specifically in the context of transplantation such as diffuse alveolar haemorrhage, haemorrhagic cystitis, veno-occlusive disease, and transplant associated microangiopathy.
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Button E, Chan R, Chambers S, Butler J, Yates P. Signs, Symptoms, and Characteristics Associated With End of Life in People With a Hematologic Malignancy: A Review of the Literature. Oncol Nurs Forum 2017; 43:E178-87. [PMID: 27541560 DOI: 10.1188/16.onf.e178-e187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Identifying people with hematologic cancer who are at risk of deteriorating and dying is essential to enable open, honest discussions, leading to appropriate decision making and effective end-of-life care.
. LITERATURE SEARCH PubMed, CINAHL®, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 2005 to December 2015 for descriptive observational studies.
. DATA EVALUATION Critique of the studies was guided by the Critical Appraisal Skills Programme Cohort Study Checklist.
. SYNTHESIS Twelve studies were included. The majority of studies (n = 8) sampled patients from palliative populations, and most were retrospective (n = 11). A number of signs, symptoms, and characteristics associated with end of life in people with a hematolgic malignancy were identified, including pain, hematopoietic dysfunction, dyspnea, and reduced oral intake.
. CONCLUSIONS The studies described a clinical scenario of deterioration, largely in a palliative population. Findings indicate that people with a hematologic malignancy share certain clinical signs of deterioration with other populations and receive a high level of medical interventions at the end of life.
. IMPLICATIONS FOR PRACTICE Nurses are well positioned to identify many of the signs, symptoms, and characteristics found in this review and can play a key role in identifying when a person is nearing the end of life.
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Evaluation of thromboelastometry parameters as predictive markers for sinusoidal obstruction syndrome in patients undergoing allogeneic stem cell transplantation for acute leukaemia. Oncotarget 2017; 8:60001-60014. [PMID: 28938703 PMCID: PMC5601799 DOI: 10.18632/oncotarget.18499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/29/2017] [Indexed: 12/17/2022] Open
Abstract
Hepatic sinusoidal obstruction syndrome (previously named veno-occlusive disease, SOS/VOD) is a serious complication of allogeneic stem cell transplantation (HSCT). Early identification of patients at risk of SOS/VOD may possibly improve the outcome and reduce mortality. Rotation thromboelastometry (ROTEM) is global assay allowing for the precise assessment of both bleeding and thrombotic conditions, however, its usefulness in patients undergoing HSCT for acute leukaemia has not been studied. We evaluated the thromboelastometry parameters in patients undergoing allogeneic HSCT for acute leukaemia to identify candidate biomarkers of SOS/VOD occurrence. ROTEM assays (INTEM, EXTEM, FIBTEM, APTEM) were performed on day -10, on the day of stem cell infusion (day 0) and on days +12 and +28 post-HSCT. The diagnosis of SOS/VOD was based on the Baltimore criteria. Seven patients (26%) developed SOS/VOD. On day +12, the patients with SOS/VOD had statistically significant longer INTEM-CT (clotting time, 199 ± 33.41vs166 ± 23.65s, p = 0.0033), EXTEM-CT (69.5 ± 6.39vs.52 ± 3.42s, p = 0.0139) and FIBTEM-CT (69.5 ± 22.75vs. 50.8 ± 14.31s, p = 0.0124) compared to SOS/VOD (-). ROC curve on day +12 indicated a cut-off value of 179s in INTEM-CT (AUC = 0.91), 69s in EXTEM-CT (AUC = 0.90) and 102s in FIBTEM-CT (AUC = 0.82) for the prediction of SOS/VOD. This is the first study evaluating the usefulness of ROTEM assays in the early detection of haemostasis abnormalities predictive of SOS/VOD development in patients undergoing HSCT for acute leukemia. Patients with SOS/VOD had a significant delay in the initiation of thrombin formation in the analysed ROTEM assays. The utility of ROTEM assays in the optimal management of patients undergoing HSCT should be clarified in further prospective studies.
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5
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Weissinger EM, Human C, Metzger J, Hambach L, Wolf D, Greinix HT, Dickinson AM, Mullen W, Jonigk D, Kuzmina Z, Kreipe H, Schweier P, Böhm O, Türüchanow I, Ihlenburg-Schwarz D, Raad J, Durban A, Schiemann M, Könecke C, Diedrich H, Holler E, Beutel G, Krauter J, Ganser A, Stadler M. The proteome pattern cGvHD_MS14 allows early and accurate prediction of chronic GvHD after allogeneic stem cell transplantation. Leukemia 2016; 31:654-662. [PMID: 27677743 DOI: 10.1038/leu.2016.259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 08/24/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be curative, but is associated with significant morbidity and mortality. Chronic graft-versus-host disease (cGvHD), characterized by inflammation and fibrosis of multiple target organs, considerably contributes to the morbidity and mortality even years after allo-HSCT. Diagnosis of cGvHD is based on clinical features and histology of biopsies. Here, we report the generation of a urinary cGvHD-specific proteome-pattern (cGvHD_MS14) established by capillary electrophoresis-mass spectrometry to predict onset and severity of cGvHD as an unbiased laboratory test. cGvHD_MS14 was evaluated on samples from 412 patients collected prospectively in four transplant centers. Sensitivity and specificity was 84 and 76% by cGvHD_MS14 classification. Sensitivity further increased to 93% by combination of cGvHD_MS14 with relevant clinical variables to a logistic regression model. cGvHD was predicted up to 55 days prior to clinical diagnosis. Acute GvHD is not recognized by cGvHD_MS14. cGvHD_MS14 consists of 14 differentially excreted peptides, six of those have been sequenced to date and are fragments from thymosin β-4, eukaryotic translation initiation factor 4γ2, fibrinogen β-chain or collagens. In conclusion, the cGvHD_MS14-pattern allows early, highly sensitive and specific prediction of cGvHD as an independent diagnostic criterion of clinical diagnosis potentially allowing early therapeutic intervention.
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Affiliation(s)
- E M Weissinger
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - C Human
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - J Metzger
- Mosaiques-Diagnostics, Hannover, Germany
| | - L Hambach
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - D Wolf
- Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany
| | - H T Greinix
- 1st Department of Internal Medicine, Medical University of Vienna, Vienna, Austria and Division of Hematology, Medical University of Graz, Graz, Austria
| | - A M Dickinson
- Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | - W Mullen
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Z Kuzmina
- 1st Department of Internal Medicine, Medical University of Vienna, Vienna, Austria and Division of Hematology, Medical University of Graz, Graz, Austria
| | - H Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - P Schweier
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - O Böhm
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - I Türüchanow
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - D Ihlenburg-Schwarz
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - J Raad
- Mosaiques-Diagnostics, Hannover, Germany
| | - A Durban
- Mosaiques-Diagnostics, Hannover, Germany
| | | | - C Könecke
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - H Diedrich
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - E Holler
- Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany
| | - G Beutel
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - J Krauter
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany.,Department of Hematology and Oncology, Klinikum Braunschweig, Braunschweig, Germany
| | - A Ganser
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
| | - M Stadler
- Department of Hematology, Hemostasis, Oncology and Stem cell transplantation, Hannover Medical School, Hannover, Germany
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Zhang XH, Wang QM, Chen H, Chen YH, Han W, Wang FR, Wang JZ, Zhang YY, Mo XD, Chen Y, Wang Y, Chang YJ, Xu LP, Liu KY, Huang XJ. Clinical characteristics and risk factors of Intracranial hemorrhage in patients following allogeneic hematopoietic stem cell transplantation. Ann Hematol 2016; 95:1637-43. [PMID: 27485455 DOI: 10.1007/s00277-016-2767-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/22/2016] [Indexed: 01/17/2023]
Abstract
Intracranial hemorrhage (ICH) is one of the most life-threatening neurological complications after allogeneic hematopoietic stem cell transplantation. Although cerebral complications and its causes after allo-HSCT are well documented, assessment of the incidence and risk factors of intracranial hemorrhage following allo-HSCT are less discussed. A nested case-control study was conducted involving 160 subjects drawn from 2169 subjects who underwent HSCT at Peking University People's Hospital between 2004 and 2014. Thirty-two patients (1.5 %) with ICH were identified, and 128 controls were matched for age, gender, transplantation type, and time of transplantation. Intracranial hemorrhage was identified by CT scan and/or MRI by searching hospital records. Among the 32 ICH patients, 27 (82.9 %) developed intraparenchymal hemorrhages (IPH), 2 cases (5.7 %) suffered subdural hematomas (SDH), and 3 cases (8.6 %) had multiple hemorrhage lesions in the brain parenchyma. The median time of appearance for cerebral hemorrhages was 147.5 days. Multivariate analysis showed that systemic infections (hazard ratio 2.882, 95 % confidence interval 1.231-6.746), platelet count (5.894, 1.145-30.339), and fibrinogen levels (3.611, 1.528-8.532) were independent risk factors for intracranial hemorrhage among HSCT patients. The cumulative survival rate in the intracranial hemorrhage and control groups were 43.3 and 74.7 % (P = .001), respectively. Intracranial hemorrhage is associated with high mortality and a decreased overall survival rate. Systemic infections, platelet count, and fibrinogen levels were individual independent risk factors.
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Affiliation(s)
- Xiao-Hui Zhang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Qian-Ming Wang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Xiao-Dong Mo
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Yao Chen
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Ying-Jun Chang
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Institute of Hematology, Beijing Key Laboratory of HSCT, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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7
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Tang Y, Wu Q, Wu X, Qiu H, Sun A, Ruan C, Wu D, Han Y. Use of recombinant factor VIIa in uncontrolled gastrointestinal bleeding after hematopoietic stem cell transplantation among patients with thrombocytopenia. Pak J Med Sci 2016; 31:1389-93. [PMID: 26870102 PMCID: PMC4744287 DOI: 10.12669/pjms.316.8357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background and Objective: Recombinant-activated factor VII (rVIIa) is a vitamin K-dependent glycoprotein that is an analog of the naturally occurring protease. It has an off-label use to control life-threatening bleeding that is refractory to other measures and was shown to decrease transfusion requirements. Gastrointestinal (GI) bleeding is a severe complication following hematopoietic stem cell transplantation (HSCT) in patients with thrombocytopenia, while hemostatic measures based on antifibrinolytic or transfusion therapy may not always be successful. The present study investigated the treatment with rFVIIa in severe GI bleeding among thrombocytopenia patients undergoing HSCT. Methods: rFVIIa was given as a single dose of 60μg/kg in patients with GI bleeding following hematopoietic stem cell transplantation (HSCT). Results: Among all patients enrolled, 12 (75%) of 16 patients obtained a response, of which 5 achieved a complete response and 7 achieved a partial response. The 4 remiaing patients (25%) had no response. Nine patients (56.3%) died in a follow-up of 90 days. No thromboembolic events wereassociated with the drug administration occurred. Conclusions: Our study showed that rFVIIa may represent an additional therapeutic option in such cases.
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Affiliation(s)
- Yaqiong Tang
- Yaqiong Tang, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Qian Wu
- Qian Wu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaojin Wu
- Xiaojin Wu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- Huiying Qiu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Aining Sun
- Aining Sun, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Changgeng Ruan
- Changgeng Ruan, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- Depei Wu, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yue Han
- Yue Han, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis & Hemostasis of Ministry of Health, The First Affiliated Hospital of Soochow University, Suzhou, China. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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Donor Nucleotide-Binding Oligomerization–Containing Protein 2 (NOD2) Single Nucleotide Polymorphism 13 Is Associated with Septic Shock after Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:1399-404. [DOI: 10.1016/j.bbmt.2015.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/13/2015] [Indexed: 01/26/2023]
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9
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Labrador J, López-Corral L, Vazquez L, Sánchez-Guijo F, Guerrero C, Sánchez-Barba M, Lozano FS, Alberca I, del Cañizo MC, Caballero D, González-Porras JR. Incidence and risk factors for life-threatening bleeding after allogeneic stem cell transplant. Br J Haematol 2015; 169:719-25. [DOI: 10.1111/bjh.13344] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jorge Labrador
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
- Servicio de Hematología; Hospital Universitario de Burgos; Burgos Spain
- Centro de Investigación del Cáncer; IBMC Departamento de Medicina; USAL; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Lucia López-Corral
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Lourdes Vazquez
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Fermin Sánchez-Guijo
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Carmen Guerrero
- Centro de Investigación del Cáncer; IBMC Departamento de Medicina; USAL; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | | | - Francisco S. Lozano
- Servicio de Angiología y Cirugía Vascular; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Ignacio Alberca
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - María C. del Cañizo
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
- Centro de Investigación del Cáncer; IBMC Departamento de Medicina; USAL; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Dolores Caballero
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
| | - Jose R. González-Porras
- Servicio de Hematología; Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Salamanca Spain
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Abstract
Until recovery of hematopoiesis, pediatric hematopoietic stem cell transplant (HSCT) patients are dependent on red blood cell and platelet transfusions to avoid the complications associated with anemia and thrombocytopenia, respectively. Despite the fact that these patients are high utilizers of blood components, there are no evidence-based guidelines regarding optimal transfusion practices in this patient population. A web-based survey was designed to examine current transfusion thresholds used by institutions that perform pediatric HSCT. This survey was sent to department directors identified through the Children's Oncology Group directory with a response rate of 69%. The majority of institutions use 8 g/dL as the hemoglobin threshold for red blood cell transfusions (60%), but a significant minority use 7 g/dL (25%). With respect to platelet transfusion thresholds, 47% of respondents report using 20×10/L and 44% use 10×10/L. Respondents were also asked about specific clinical scenarios that would prompt an increase in a patient's threshold. This survey revealed that there is variation in transfusion practices among pediatric HSCT institutions with respect to both baseline transfusion threshold and what prompts an increase in threshold. Future clinical trials are needed to determine optimal transfusion thresholds in pediatric HSCT patients, which can lead to improved standardization in practices.
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11
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Wagner JA, Langenfeld H, Klett L, Störk S. Activated protein C in patients with septic shock: a consecutive case series. Int J Clin Pharm 2011; 34:23-6. [PMID: 22120699 DOI: 10.1007/s11096-011-9588-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 11/14/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND The recommendation to restrict the use of activated protein C (APC) to patients with severe sepsis and the highest risk of death originates from large trials that were subject to major exclusion criteria. OBJECTIVE To investigate the effect of APC on prognosis in 'real world' patients. METHOD Consecutive case series at tertiary care hospital including 63 adults with septic shock and multi-organ failure treated with APC (24 mcg/kg/h) for up to 96 h in addition to standard care. RESULTS Median APACHE score was 35 (quartiles, 29-41), mean number of failing organs was 4 (quartiles, 4-5), and overall 30-day mortality was 48%. Independent predictors of 30-day mortality risk were the number of failing organs and number of antibiotics given. Risk of dying was significantly lower if compared with the mortality rates expected per APACHE II score category (P for trend per 5-point increment <0.001). This association was most prominent in patients with an APACHE II score of 30-44. Intracranial or major bleeding during APC treatment did not occur. CONCLUSION These findings support the view that targeting APC treatment to patients with septic shock and a very high risk is a sound and safe approach. However, due to lack of consistent evidence from randomized studies APC was recently removed from the market.
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Affiliation(s)
- Jens A Wagner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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12
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Abstract
Patients with a variety of haematological conditions are at risk of infection and its most serious complication: septic shock. Mortality for septic shock remains high and especially so in patients with haematological malignancy and following bone marrow transplantation. However, advances in the treatment of severe sepsis have improved mortality rates even though evidence for the management of severe sepsis in haematology patients is limited. Wherever possible this review will concentrate on evidence directly applicable to haematology patients but inevitably will have to extrapolate evidence from other patient groups. The Surviving Sepsis Guidelines 2008 provide information on best practice in the management of patients with severe sepsis and septic shock and are broadly applicable though not specific to haematology patients. This review summarizes a practical approach to the management of severe sepsis in haematology patients and highlights areas of research which may bring new treatments in the future. The review is limited to the management and initial resuscitation of septic shock in adult haematology patients and will not address the detailed intensive care management of these patients or the management of severe sepsis in children.
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Affiliation(s)
- Jon Cohen
- Department of Infectious Diseases, Brighton and Sussex Medical School, Brighton Consultant in Intensive Care, Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, UK.
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13
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Abstract
An estimated 50,000 to 60,000 patients undergo hematopoietic stem cell transplantation (HSCT) worldwide annually, of which 15.7% are admitted to the intensive care unit (ICU). The most common reason for ICU admission is respiratory failure and almost all develop single or multiorgan failure. Most HSCT recipients admitted to ICU receive invasive mechanical ventilation (MV). The overall short-term mortality rate of HSCT recipients admitted to ICU is 65%, and 86.4% for those receiving MV. Patient outcome has improved over time. Poor prognostic indicators include advanced age, poor functional status, active disease at transplant, allogeneic transplant, the severity of acute illness, and the development of multiorgan failure. ICU resource limitations often lead to triage decisions for admission. For HSCT recipients, the authors recommend (1) ICU admission for full support during their pre-engraftment period and when there is no evidence of disease recurrence; (2) no ICU admission for patients who refuse it and those who are bedridden with disease recurrence and without treatment options except palliation; (3) a trial ICU admission for patients with unknown status of disease recurrence with available treatment options.
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Affiliation(s)
- Bekele Afessa
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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14
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Rysler C, Stoffel N, Buser A, Gratwohl A, Tsakiris DA, Stern M. Effect of beta-blockers, Ca2+ antagonists, and benzodiazepines on bleeding incidence in patients with chemotherapy induced thrombocytopenia. Platelets 2010; 21:77-83. [PMID: 19929239 DOI: 10.3109/09537100903388359] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Beta-1-adrenoreceptor antagonists, Ca(2+) antagonists, and benzodiazepines negatively affect platelet aggregation in vitro. Few data exists on whether platelet function in vivo is relevantly influenced by exposure to any these substances. We analysed in three cohorts of 100 patients each treated with allogeneic hematopoietic stem cell transplantation (HSCT), autologous HSCT, and intensive chemotherapy, respectively, whether treatment with these drugs was associated with an increased risk of bleeding. Cumulative incidences of bleeding in the three cohorts were 47 +/- 5% after allogeneic transplants, 30 +/- 5% after autologous transplant, and 46 +/- 5% after chemotherapy (p = 0.008). Exposure to beta-blockers (hazard ratio [HR] 0.71, p = 0.32), Ca(2+) antagonists (HR 0.90, p = 0.73), and benzodiazepines (HR 1.18, p = 0.29) did not significantly increase the risk of bleeding in any cohort. Instead, bleeding risk was determined by platelet count, presence of inflammation, azotemia, presence of graft-versus-host disease and treatment with low-molecular weight heparin. After correcting for these factors, no differences in bleeding risk were seen between the three cohorts. In conclusion, therapy with Beta-1-adrenoreceptor antagonists, Ca(2+) antagonists, and benzodiazepines did not appear to significantly increase the risk for hemorrhagic complications in patients with iatrogenic severe thrombocytopenia.
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Affiliation(s)
- Christine Rysler
- Stem Cell Transplant Team, University Hospital, Basel, Switzerland
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15
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Platelet recovery and transfusion needs after reduced intensity conditioning allogeneic peripheral blood stem cell transplantation. Exp Hematol 2010; 38:55-60. [DOI: 10.1016/j.exphem.2009.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/29/2009] [Accepted: 10/01/2009] [Indexed: 11/20/2022]
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