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Xhaard A, Villate A, Hamane S, Michonneau D, Menotti J, Robin M, Sicre de Fontbrune F, Dhédin N, Peffault de la Tour R, Socié G, Bretagne S. A 10-year retrospective analysis of Toxoplasma gondii qPCR screening in allogeneic hematopoietic stem cell transplantation recipients. Bone Marrow Transplant 2023; 58:152-159. [PMID: 36335254 DOI: 10.1038/s41409-022-01861-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/08/2022]
Abstract
Weekly blood Toxoplasma gondii DNA screening using real-time quantitative polymerase chain reaction (qPCR) has been implemented in all allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients at our hospital. We retrospectively analyzed the consequences of a positive blood qPCR in the management of Toxoplasma infection (TI) and disease (TD).From 2011 to 2020, 52 (4.13%) of 1 257 alloHSCT recipients had at least one positive qPCR, 45 (3.5%) with TI and seven (0.56%) with TD (central nervous system involvement). Forty-four patients were qPCR-positive before day 100, 30 without and 14 with anti-Toxoplasma prophylaxis. Twenty-five of them (56.8%) started or continued prophylactic dosage treatment: all became qPCR-negative, including 20 (80%) receiving only prophylactic dosage treatment. Twenty-four of them (54.5%) received non-prophylactic dosage treatment: qPCR became negative in 22/24 (91.7%), while TI contributed to death in two cases. Six of the eight patients diagnosed after D100 had breakthrough TI or TD. No death was attributable to TI or TD. qPCR kinetics available for 24 patients increased until anti-Toxoplasma treatment began, then decreased with all treatment regimens.Clinical follow-up and qPCR monitoring with quantification of the parasitic load appears a reasonable strategy to avoid TD and to use minimal effective dosage of anti-Toxoplasma treatments.
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Affiliation(s)
- Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.
| | - Alban Villate
- Service d'hématologie et thérapie cellulaire, CHRU Tours, Tours, France
| | - Samia Hamane
- Laboratoire de mycologie-parasitologie, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - David Michonneau
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,INSERM UMR 976 (Team Insights), Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
| | - Jean Menotti
- Laboratoire de mycologie-parasitologie, Hospices Civils de Lyon, Lyon, France
| | - Marie Robin
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Flore Sicre de Fontbrune
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Nathalie Dhédin
- Service d'hématologie adolescents jeunes adultes, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Régis Peffault de la Tour
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
| | - Gérard Socié
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,INSERM UMR 976 (Team Insights), Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
| | - Stéphane Bretagne
- Laboratoire de mycologie-parasitologie, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
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Nawej Tshikung O, Porto V, Nabergoj M, Deffert C, Masouridi-Levrat S, Chalandon Y, Van Delden C, Neofytos D. Intracellular Pathogen in the Cerebrospinal Fluid of an Allogeneic Hematopoietic Cell Transplant Recipient With Graft-Versus-Host Disease and Brain Lesions. Clin Infect Dis 2021; 71:3005-3008. [PMID: 33386855 DOI: 10.1093/cid/ciaa235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Violaine Porto
- Division of Hematology, Bone Marrow Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mitja Nabergoj
- Division of Hematology, Bone Marrow Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christine Deffert
- Division of Laboratory, University Hospital of Geneva, Geneva, Switzerland
| | - Stavroula Masouridi-Levrat
- Division of Hematology, Bone Marrow Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yves Chalandon
- Division of Hematology, Bone Marrow Unit, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Van Delden
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
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Raquel CC, Lucía TC, Carmen VM, Ana RV, Antonio TG, Juan PL, Carmen AG. Cerebral toxoplasmosis in patient with relapsing-remitting multiple sclerosis under treatment with alemtuzumab. Mult Scler Relat Disord 2019; 39:101885. [PMID: 31838310 DOI: 10.1016/j.msard.2019.101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Calle-Calle Raquel
- Department of Neurology of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain.
| | - Triguero-Cueva Lucía
- Department of Neurology of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain
| | - Valderrama-Martín Carmen
- Department of Neurology of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain
| | - Romero-Villarrubia Ana
- Department of Neurology of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain
| | - Tapia-Gómez Antonio
- Unit of Infectious Diseases of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain
| | - Pasquau-Liaño Juan
- Unit of Infectious Diseases of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain
| | - Arnal-García Carmen
- Department of Neurology of the Virgen de las Nieves, University Hospital of Granada, Granada, Spain
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Tan CS. Reactivation of Multiple Infectious Pathogens after Hematopoietic Stem Cell Transplantation. Acta Haematol 2017; 138:1-2. [PMID: 28595168 DOI: 10.1159/000477532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/16/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Chen Sabrina Tan
- Division of Infectious Diseases, Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Gajurel K, Dhakal R, Montoya JG. Toxoplasma prophylaxis in haematopoietic cell transplant recipients: a review of the literature and recommendations. Curr Opin Infect Dis 2015; 28:283-92. [PMID: 26098500 DOI: 10.1097/QCO.0000000000000169] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Toxoplasmosis in haematopoietic cell transplant (HCT) recipients is associated with high morbidity and mortality rates. Prophylaxis following HCT is recommended for high-risk pre-HCT toxoplasma-seropositive (pre-HCTSP) recipients. However, there is no agreement or consistency among programmes on whether to adopt prophylaxis or not, or if used, on the chosen antitoxoplasma prophylactic regimen. This review discusses the role of prophylaxis, and preemptive treatment, for toxoplasmosis in the setting of HCT. RECENT FINDINGS Approximately two-thirds of toxoplasmosis cases following HCT are reported in allogeneic pre-HCTSP (allo pre-HCTSP) patients. This finding confirms a major role of reactivation of latent infection in the pathogenesis of toxoplasmosis in this patient population. Toxoplasma disease-related mortality in allo pre-HCTSP patients was reported at 62%, but it can be significantly decreased with early detection and treatment of toxoplasma infection. There are no randomized trials comparing the efficacy of different prophylactic agents to prevent toxoplasmosis after HCT. Several observational studies have demonstrated the efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in decreasing the incidence of toxoplasmosis following HCT. There is limited information regarding efficacy of other prophylactic agents. Preemptive treatment using routine blood PCR monitoring seems to be beneficial in detecting infection early and preventing disease in several observational studies and has been adopted for allo pre-HCTSP HCT patients when universal prophylaxis is not possible. SUMMARY Universal prophylaxis with TMP/SMX in allo pre-HCTSP patients should be implemented by all transplant programmes. Preemptive treatment with routine blood PCR monitoring is an option if prophylaxis cannot be used.
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Nigro MG, Figueroa C, Ledesma BA. [Retrospective study of the implementation of the qualitative PCR technique in biological samples for monitoring toxoplasmosis in pediatric patients receiving hematopoietic stem cell transplantation]. Rev Argent Microbiol 2014; 46:24-9. [PMID: 24721270 DOI: 10.1016/S0325-7541(14)70043-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/16/2014] [Indexed: 11/22/2022] Open
Abstract
Toxoplasmosis is an opportunistic infection caused by the parasite Toxoplasma gondii. The infection is severe and difficult to diagnose in patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Twelve patients receiving HSCT were monitored post-transplant, by qualitative PCR at the Children's Hospital S.A.M.I.C. "Prof. Dr. Juan P. Garrahan". The monitoring of these patients was defined by a history of positive serology for toxoplasmosis in the donor or recipient and because their hematologic condition did not allow the use of trimethoprim-sulfamethoxazole for prophylaxis. During the patients' monitoring, two of them with positive PCR results showed signs of illness by T. gondii and were treated with pyrimethamine-clindamycin. In two other patients, toxoplasmosis was the cause of death and an autopsy finding, showing negative PCR results. Four patients without clinical manifestations received treatment for toxoplasmosis because of positive PCR detection. In four patients there were no signs of toxoplasmosis disease and negative PCR results during follow-up. The qualitative PCR technique proved useful for the detection of toxoplasmosis reactivation in HSCT recipients, but has limitations in monitoring and making clinical decisions due to the persistence of positive PCR over time and manifestations of toxicity caused by the treatment.
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Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J, Wingard JR, Young JAH, Boeckh MJ, Boeckh MA. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143-238. [PMID: 19747629 PMCID: PMC3103296 DOI: 10.1016/j.bbmt.2009.06.019] [Citation(s) in RCA: 1138] [Impact Index Per Article: 75.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/23/2009] [Indexed: 02/07/2023]
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Bertz H, Spyridonidis A, Wäsch R, Grüllich C, Egger M, Finke J. A novel GVHD-prophylaxis with low-dose alemtuzumab in allogeneic sibling or unrelated donor hematopoetic cell transplantation: the feasibility of deescalation. Biol Blood Marrow Transplant 2009; 15:1563-70. [PMID: 19896080 DOI: 10.1016/j.bbmt.2009.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 08/02/2009] [Indexed: 12/01/2022]
Abstract
Prophylaxis of acute graft-versus-host disease (aGVHD), while maintaining the graft-versus-leukemia (GVL)/lymphoma effect and preventing severe infectious diseases, remains the main challenge in allogeneic hematopoetic cell transplantation (allo-HCT). To evaluate this, we examined the feasibility of deescalating the dose of alemtuzumab (MabCampath) in combination with cyclosporine (CsA) as the sole GVHD-prophylaxis in patients after fludarabine (Flu)-based reduced-intensity conditioning (RIC) in an observational cohort study. We included 127 consecutive patients (median age 63 years) with an unrelated (UD; n=69) or related donor (SIB; n=58) after their first transplantation, mostly presenting with advanced disease. The first 30 patients received 20 mg/day on day -2 and -1 (40 mg), the following 48 patients 10 mg/day on day -2 and -1 (20 mg), and the last 49 patients 10 mg on day -1 (10 mg) alemtuzumab intravenous (i.v.) prior to transplant. We observed no statistical differences comparing the 40 mg, 20 mg, or 10 mg dose groups, in terms of cumulative incidences of aGVHD grade III-IV 7% (confidence interval [CI] 95%; 1-51), 12% (1-40), 6% (1-40), extensive chronic GVHD (cGVHD) 24.4% (3.3-55.8), 17% (2.5-42), and 14.2% (1.5-41.5) and of aGVHD grade II-IV 7 % (0-51.5), 29% (11.9-49.1), 21% (15.3-43.1), respectively. The difference between the 20-mg and 40-mg groups was significant for aGVHD grade II-IV(P < .05). In conclusion, we demonstrate the feasibility of reducing the dose of alemtuzumab as GVHD-prophylaxis to 10 mg absolute in combination with CsA only for UD transplantation in particular.
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Affiliation(s)
- Hartmut Bertz
- Albert Ludwigs-University Medical Center Freiburg, Department of Hematology and Oncology, Freiburg, Germany
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10
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Schmidt-Hieber M, Zweigner J, Uharek L, Blau IW, Thiel E. Central nervous system infections in immunocompromised patients: update on diagnostics and therapy. Leuk Lymphoma 2009; 50:24-36. [PMID: 19031169 DOI: 10.1080/10428190802517740] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infections of the central nervous system (CNS) are increasingly reported in patients with malignancies. Heavily immunocompromised patients like those after allogeneic stem cell transplantation (SCT) or previous T cell depleting treatment regimens (e.g. with fludarabine or alemtuzumab) are at highest risk for cerebral infections. The spectrum of causative organisms may vary greatly, depending on the underlying malignancy, its treatment and various other factors. Toxoplasma gondii and fungi are the leading causative organisms in patients after allogeneic SCT, but also viruses such as herpes simplex virus or JC virus may be detected in these patients. Definitive diagnosis of cerebral infection still remains a high challenge, although diagnostics have improved by the wide availability of imaging techniques and polymerase chain reaction in recent years. Novel therapeutic options are arising, particularly for fungal CNS infections. Here, we summarise aspects on epidemiology, clinical symptoms and prognosis of CNS infections in patients with malignancies. Additionally, we give an overview on the diagnostics and management of cerebral infections in these patients including evidence evaluation of efficacy of treatment.
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Affiliation(s)
- Martin Schmidt-Hieber
- Medizinische Klinik III, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Fricker‐Hidalgo H, Bulabois C, Brenier‐Pinchart M, Hamidfar R, Garban F, Brion J, Timsit J, Cahn J, Pelloux H. Diagnosis of Toxoplasmosis after Allogeneic Stem Cell Transplantation: Results of DNA Detection and Serological Techniques. Clin Infect Dis 2009; 48:e9-e15. [DOI: 10.1086/595709] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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von Lilienfeld-Toal M, Gilleece M, Cook G. Systemic Toxoplasmosis Post Allogeneic Stem Cell Transplantation (Allo-SCT): Lessons Learned from HIV? Biol Blood Marrow Transplant 2007; 13:871-2. [PMID: 17580266 DOI: 10.1016/j.bbmt.2007.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 11/24/2022]
MESH Headings
- Animals
- Fatal Outcome
- Female
- Graft Survival
- HIV
- HIV Infections
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/parasitology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Middle Aged
- Multiple Organ Failure/etiology
- Multiple Organ Failure/parasitology
- Multiple Organ Failure/pathology
- Stem Cell Transplantation
- Toxoplasma
- Toxoplasmosis/etiology
- Toxoplasmosis/pathology
- Transplantation Chimera/parasitology
- Transplantation Conditioning/adverse effects
- Transplantation, Homologous
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