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Escribano-Serrat S, Rodríguez-Lobato LG, Suárez-Lledó M, Pedraza A, Charry P, Cid J, Lozano M, Esteve J, Rosiñol L, Fernández-Avilés F, Carreras E, Díaz-Ricart M, Martínez C, Rovira M, Salas MQ. Improving the EASIX' predictive power for NRM in adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2024:10.1038/s41409-024-02267-6. [PMID: 38521886 DOI: 10.1038/s41409-024-02267-6] [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] [Received: 11/11/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Silvia Escribano-Serrat
- Hematopathology, Pathology Department, CDB, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Alexandra Pedraza
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Paola Charry
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Enric Carreras
- Fundació i Institut de Recerca Josep Carreras contra la leucèmia (Campus Clínic), Barcelona, Spain
| | - Maribel Díaz-Ricart
- Hematopathology, Pathology Department, CDB, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Transplantation Unit and Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), IDIBAPS, Hospital Clínic, Barcelona, Spain.
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2
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Tolosa-Ridao C, Cascos E, Rodríguez-Lobato LG, Pedraza A, Suárez-Lledó M, Charry P, Solano MT, Martinez-Sanchez J, Cid J, Lozano M, Rosiñol L, Esteve J, Urbano-Ispizua Á, Fernández-Avilés F, Martínez C, Carreras E, Díaz-Ricart M, Rovira M, Salas MQ. EASIX and cardiac adverse events after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2024:10.1038/s41409-024-02270-x. [PMID: 38521885 DOI: 10.1038/s41409-024-02270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
This study investigates the interaction between endothelial activation, indirectly measured using EASIX, and the probability of presenting cardiac adverse events (CAE) during the first year after allo-HCT. The 437 consecutive adults undergoing PB allo-HCT from 2012 and 2021 were included. EASIX was retrospectively calculated before and during the first 6 months after allo-HCT and transformed to log2-base to conduct the statistical analysis. The median age was 53, 46 (10.5%) patients had previous history of cardiac disease, MAC allo-HCTs were performed in 186 (42.6%) patients, and PTCY was administered in 242 (55.5%). The 1-year incidence of CAE was 12.6% (n = 55). The most prevalent cardiac events were heart failure and arrhythmias, 32.7% and 23.6% respectively, and the day +100 mortality rate of these patients was 40.5%. During the first 6 months after allo-HCT, EASIX trends were significantly higher in patients who developed CAE. Regression analyses confirmed that higher log2-EASIX values were predictors for higher risk for CAE during the first year after allo-HCT. This analysis identifies a significant association between higher endothelial activation, indirectly measured using EASIX, and higher risk for cardiac toxicity diagnosed during the first year after allo-HCT and extends the applicability of EASIX for identifying patients at risk for CAE.
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Affiliation(s)
- Carles Tolosa-Ridao
- Hematology Department, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enric Cascos
- Cardiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Pedraza
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paola Charry
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Julia Martinez-Sanchez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Enric Carreras
- Fundació i Institut de Reserca Josep Carreras Contra la Leucèmia, Barcelona, Spain
| | - Maribel Díaz-Ricart
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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3
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Cid J, Guinetti-Ortiz K, Charry P, Carbassé G, de Pablo-Miró M, Rubia L, Garcia M, Alcaraz-Quiles J, Cascos E, Martínez-Cibrian N, Salas MQ, Suárez-Lledó M, Rosiñol L, Fernández-Avilés F, Martínez C, Rovira M, Lozano M. Increased Serum Levels of N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) in Mobilized Healthy Donors with G-CSF: A Cohort Study. Transfus Med Rev 2024; 38:150824. [PMID: 38569349 DOI: 10.1016/j.tmrv.2024.150824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
Limited data regarding elevation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in mobilized donors with G-CSF is available. We extended these findings by examining serum NT-proBNP in a cohort study including 35 healthy donors and 69 patients who received G-CSF for CD34+ mobilization as well as 54 patients who did not receive G-CSF but who underwent collection of CD3+ cells for chimeric antigen receptor (CAR) T-cell manufacturing. No donor in the three cohorts experienced significant cardiac adverse events. NT-proBNP levels were measured before and after G-CSF administration and after finishing apheresis procedure. NT-proBNP increase was observed in mobilized healthy donors after G-CSF administration, but was not observed in mobilized or non-mobilized patients. Only in the cohort of healthy donors, pairwise comparisons using Wilcoxon signed ranks test showed a significant increase between the mean serum NT-proBNP level after G-CSF administration and the mean serum NT-proBNP level measured before G-CSF administration (231.09 ± 156.15 pg/mL vs. 58.88 ± 26.84 pg/mL; P < .01). No correlation was observed between NT-proBNP increase and G-CSF dose (rs = 0.09; n = 32; P = .6) and no other variables contributing to predict serum NT-proBNP increase were detected. In conclusion, we observed a statistically, although not clinically, significant increase of NT-proBNP in healthy donors who received G-CSF as CD34+ cell mobilization.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain.
| | - Katia Guinetti-Ortiz
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Paola Charry
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Gloria Carbassé
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Mar de Pablo-Miró
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Laura Rubia
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Marta Garcia
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Jose Alcaraz-Quiles
- CORE Laboratory, Department of Biochemistry and Molecular Genetics, Biomedical Diagnostic Centre, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Enric Cascos
- Department of Cardiology, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Nuria Martínez-Cibrian
- BMT Unit, Department of Hematology, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - María Queralt Salas
- BMT Unit, Department of Hematology, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Maria Suárez-Lledó
- BMT Unit, Department of Hematology, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Laura Rosiñol
- BMT Unit, Department of Hematology, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | | | - Carmen Martínez
- BMT Unit, Department of Hematology, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Montserrat Rovira
- BMT Unit, Department of Hematology, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICAMS, Hospital Clínic, IDIBAPS, Barcelona, UB, Spain
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4
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Pedraza A, Salas MQ, Rodríguez-Lobato LG, Escribano-Serrat S, Suárez-Lledo M, Martínez-Cebrian N, Solano MT, Arcarons J, Rosiñol L, Gutiérrez-García G, Fernández-Avilés F, Moreno-Castaño AB, Molina P, Pino M, Carreras E, Díaz-Ricart M, Rovira M, Palomo M, Martínez C. Easix Score Correlates With Endothelial Dysfunction Biomarkers and Predicts Risk of Acute Graft-Versus-Host Disease After Allogeneic Transplantation. Transplant Cell Ther 2024; 30:187.e1-187.e12. [PMID: 38000709 DOI: 10.1016/j.jtct.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/27/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Plasma biomarkers of endothelial dysfunction have been postulated for the diagnosis and prognosis of acute graft-versus-host disease (aGVHD). However, their use is not validated in clinical practice yet. The endothelial activation and stress index (EASIX), a simple score based on routine laboratory parameters, is considered to be an indirect marker of endothelial damage. High value of EASIX was correlated with worse non-relapse mortality (NRM) and overall survival (OS) and a high risk of sinusoidal obstructive syndrome and transplant-associated thrombotic microangiopathy (TA-TMA). This study investigates the predictive value of plasma biomarkers and the EASIX score for the prediction of aGVHD. We assessed vascular cell adhesion molecule-1 (VCAM-1), tumor necrosis factor receptor 1 (TNFR1), and VWF:Ag plasma levels and the EASIX score before allogeneic hematopoietic stem cell transplantation (allo-HSCT) and on days 0, 3, 7, 14, and 21 in an experimental cohort (n = 33). EASIX was transformed to a base-2 logarithm to perform the analysis. For the most relevant biomarkers, we estimate the optimal cutoff values and the discriminatory ability to differentiate patients with high-risk of aGVHD. The conclusions obtained in the experimental cohort were validated in a large cohort of 321 patients at the same institution. Plasma biomarkers and EASIX showed similar post-transplantation dynamics consisting of a progressive increase. Multivariate analysis showed an association between high TNFR1 levels and Log-2 EASIX score on day 7 after transplantation with an increased likelihood of developing aGVHD (hazard ratio [HR] = 1, P = .002; HR = 2.31, P = .013, respectively). Patients with TNFR1 ≥1300 ng/mL (HR = 7.19, P = .006) and Log2-EASIX ≥3 (HR = 14.7, P <.001) at day 7 after transplantation were more likely to develop aGVHD with high predictive accuracy (C-index of 74% and 81%, respectively). In the validation cohort, patients with Log2-EASIX ≥3 on day 7 after transplantation presented a significantly higher incidence of grade II-IV aGVHD (HR = 1.94, P = .004) independent of GVHD prophylaxis (HR = 0.38, P = .004), conditioning regimen (HR = 0.59, P =.02) and type of donor (HR = 2.38, P = .014). Differential degree of endothelial damage can be measured using both EASIX score and plasma biomarkers in the early post-transplantation period. Patients at risk of developing aGVHD could be easily identified by a high EASIX score. Both indicators of endothelial activation represent a promising approach to predict aGVHD.
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Affiliation(s)
- Alexandra Pedraza
- Blood Bank Department, Biomedical Diagnostic Center, Banc de Sang i Teixits, Hospital Clínic Barcelona, Spain.
| | - María Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Silvia Escribano-Serrat
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain
| | - María Suárez-Lledo
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Nuria Martínez-Cebrian
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - María Teresa Solano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain
| | - Patricia Molina
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain
| | - Marc Pino
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain
| | - Enric Carreras
- Fundació i Institut de Recerca Josep Carreras contra la Leucèmia (Campus Clínic), Barcelona
| | - Maribel Díaz-Ricart
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain; Fundació i Institut de Recerca Josep Carreras contra la Leucèmia (Campus Clínic), Barcelona
| | - Marta Palomo
- Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain; Haematology External Quality Assessment Laboratory, Biomedical Diagnostic Center, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, IDIBAPS, Josep Carreras Institute, Barcelona, Spain; Fundació i Institut de Recerca Josep Carreras contra la Leucèmia (Campus Clínic), Barcelona
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5
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Salas MQ, Pedraza A, Charry P, Suárez-Lledó M, Rodríguez-Lobato LG, Brusosa M, Solano MT, Serrahima A, Nomdedeu M, Cid J, Lozano M, Arcarons J, de Llobet N, Rosiñol L, Esteve J, Urbano-Ispizua Á, Carreras E, Fernández-Avilés F, Rovira M, Martinez C. Post-Transplantation Cyclophosphamide and Tacrolimus for Graft-versus-Host Disease Prevention after Allogeneic Hematopoietic Cell Transplantation from HLA-Matched Donors Has More Advantages Than Limitations. Transplant Cell Ther 2024; 30:213.e1-213.e12. [PMID: 38042256 DOI: 10.1016/j.jtct.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
This study compared the efficacy of graft-versus-host disease (GVHD) prophylaxis with post-transplantation cyclophosphamide (PTCy) and tacrolimus (Tac) versus other regimens in 272 adults undergoing peripheral blood (PB) allogeneic hematopoietic cell transplantation (allo-HCT) from HLA-matched donors. Of these 272 patients, 95 (34.9%) received PTCy/Tac. The times to neutrophil and platelet engraftment were longer in the PTCy/Tac group (20 days versus 16 days for neutrophils and 19 days versus 12 days for platelets). The day +30 cumulative incidence (CuI) of bacterial bloodstream infection was higher in the PTCy/Tac group (43.2% versus 13.0%; P < .001). The CuIs of grade II-IV and grade III-IV acute GVHD (aGVHD) at day +180 were 14.7% and 4.2%, and the CuI of moderate/severe cGVHD at 2 years was 2.4% in the PTCy/Tac group and 41.8% (hazard ratio [HR], .29; P < .001), 15.8%, (HR, .24; P = .007), and 47.0% (HR, .05; P < .001), respectively, in the no-PTCy group. The duration of immunosuppression was shorter in patients receiving PTCy/Tac (6.2 months versus 9.0 months; P < .001). PTCy/Tac patients had higher OS (2 years: 74.3% versus 60.9%; HR, .54; P = .012), lower NRM (2 years: 8.6% versus 15.8%; HR, .54; P = .11), comparable CuI of relapse (2 years: 26.0% versus 24.4%; HR, 1.03; P = .89), and higher GRFS (2 years: 59.1% versus 16.7%; HR, .32; P < .001). Using PTCy/Tac in HLA-matched PB allo-HCT improved transplantation outcomes at out institution compared with previous prophylactic regimens, including a higher probability of survival despite more delayed engraftment and a higher rate of bacterial infection.
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Affiliation(s)
- María Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Alexandra Pedraza
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paola Charry
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - María Teresa Solano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Serrahima
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Meritxell Nomdedeu
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Noemi de Llobet
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundació Josep Carreras Contra la Leucèmia, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carmen Martinez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; University of Barcelona, Barcelona, Spain
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6
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Brusosa M, Ruiz S, Monge I, Solano MT, Rosiñol L, Esteve J, Carreras E, Marcos MÁ, Riu G, Carcelero E, Martinez C, Fernández-Avilés F, Rovira M, Suárez-Lledó M, Salas MQ. Impact of letermovir prophylaxis in CMV reactivation and disease after allogenic hematopoietic cell transplantation: a real-world, observational study. Ann Hematol 2024; 103:609-621. [PMID: 37957371 DOI: 10.1007/s00277-023-05542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Abstract
Letermovir for CMV prevention in CMV-seropositive adults undergoing allo-HCT was implemented at our program in 2021. This study investigates the results from the use of letermovir. The study includes all the 140 CMV-seropositive patients who underwent an allo-HCT during the years 2020, 2021, and 2022 at our institution. Thirty-eight (27.4%) of these patients received letermovir, administered from day + 7 to day + 100 and restarted if patients were on treatment with steroids. The day + 180 and 1-year cumulative incidences of CMV reactivation were 5.3% and 12.1% for patients who received letermovir and 52.9% and 53.9% for those who did not (P < 0.001) (HR 0.19, P < 0.001). Four (10.5%) of these thirty-eight patients had a CMV reactivation, but only 2 (5.3%) cases occurred during the administration of letermovir. During the first year after allo-HCT, 13 (9.2%) patients had CMV disease; the day + 180 and 1-year cumulative incidences were 2.6% and 6.0% for patients who received letermovir and 9.9% and 12.3% for those who did not (P = 0.254) (HR 1.01, P = 0.458). Two (4.2%) of the patients included in the letermovir group had CMV disease, but both of them after letermovir discontinuation. Letermovir induced a protective effect on CMV reactivation risk, but its use was not associated with a significant reduction of CMV disease. The fact that the CMV disease in patients who received letermovir occurred after the discontinuation of the drug, questions whether CMV prophylaxis should be used in patients with high risk for CMV reactivation or disease.
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Affiliation(s)
| | - Sonia Ruiz
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Inés Monge
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
| | - Laura Rosiñol
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Esteve
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Enric Carreras
- Fundació I Institut de Recerca Josep Carreras Contra La Leucèmia, Barcelona, Spain
| | - M Ángeles Marcos
- Department of Microbiology, Hospital Clínic-ISGlobal, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Gisela Riu
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esther Carcelero
- Pharmacy Clinic Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carmen Martinez
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fernández-Avilés
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - María Suárez-Lledó
- University of Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - María Queralt Salas
- University of Barcelona, Barcelona, Spain.
- Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hematopoietic Transplantation Unit, Hospital Clínic de Barcelona, C/ Villarroel 190, 08036, Barcelona, CP, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
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7
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Escribano-Serrat S, Rodríguez-Lobato LG, Charry P, Martínez-Cibrian N, Suárez-Lledó M, Rivero A, Moreno-Castaño AB, Solano MT, Arcarons J, Nomdedeu M, Cid J, Lozano M, Pedraza A, Rosiñol L, Esteve J, Urbano-Ispizua Á, Palomo M, Fernández-Avilés F, Martínez C, Díaz-Ricart M, Carreras E, Rovira M, Salas MQ. Endothelial Activation and Stress Index in adults undergoing allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide-based prophylaxis. Cytotherapy 2024; 26:73-80. [PMID: 37952139 DOI: 10.1016/j.jcyt.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/09/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND AIMS Post-transplant cyclophosphamide (PTCY)-based prophylaxis is becoming widespread for allogeneic hematopoietic cell transplantation (allo-HCT) performed independently of the selected donor source. In parallel, use of the Endothelial Activation and Stress Index (EASIX)-considered a surrogate parameter of endothelial activation-for predicting patient outcomes and clinical complications is gaining popularity in the allo-HCT setting. METHODS We first investigated whether the dynamics of EASIX after allo-HCT differ between patients receiving PTCY and patients receiving other prophylaxis. We then investigated whether the predictive capacity of EASIX persists in PTCY-based allo-HCT. A total of 328 patients transplanted between 2014 and 2020 were included, and 201 (61.2%) received PTCY. RESULTS EASIX trends differed significantly between the groups. Compared with patients receiving other prophylaxis, patients receiving PTCY had lower EASIX on day 0 and higher values between day 7 and day 100. In patients receiving PTCY, higher EASIX correlated significantly with higher non-relapse mortality (NRM) and lower overall survival (OS) when measured before and during the first 180 days after allo-HCT. In addition, higher EASIX scores measured at specific time points were predictors of veno-occlusive disease (VOD), transplant-associated thrombotic microangiopathy (TA-TMA) and grade 2-4 acute graft-versus-host disease (aGVHD) risk. CONCLUSIONS This study demonstrates how EASIX trends vary during the first 180 days after allo-HCT in patients receiving PTCY and those not receiving PTCY and validates the utility of this index for predicting NRM, OS and risk of VOD, TA-TMA and grade 2-4 aGVHD in patients receiving PTCY.
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Affiliation(s)
- Silvia Escribano-Serrat
- Department of Hematology and Hemotherapy, Hospital Clínico San Carlos, IdiSSC, Madrid, Spain; Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paola Charry
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Nuria Martínez-Cibrian
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- Hematopathology, Pathology Department, CDB, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Meritxell Nomdedeu
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandra Pedraza
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Palomo
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Maribel Díaz-Ricart
- Hematopathology, Pathology Department, CDB, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundació i Institut de Recerca Josep Carreras Contra la Leucèmia (Campus Clínic), Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain.
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8
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Ruiz-Boy S, Pedraza A, Prat M, Salas MQ, Carcelero E, Riu-Viladoms G, Suárez-Lledó M, Monge-Escartín I, Rodríguez-Lobato LG, Martínez-Roca A, Rovira M, Martínez C, Gallego C, Urbano-Ispizua Á, Sánchez J, Marcos MÁ, Fernández-Avilés F. At-Home Foscarnet Administration in Patients with Cytomegalovirus Infection Post-Allogeneic Stem Cell Transplantation: A Unicentric, Safe, and Feasible Program. Pharmaceuticals (Basel) 2023; 16:1741. [PMID: 38139867 PMCID: PMC10748136 DOI: 10.3390/ph16121741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Cytomegalovirus (CMV) infection is a relevant cause of morbimortality in patients receiving allogeneic stem cell transplantation (allo-HCT). Foscarnet (FCN) is an effective drug against CMV administered intravenously and usually on an inpatient basis. The Home Care Unit (HCU) for hematologic patients at our hospital designed an at-home FCN administration model to avoid the hospitalization of patients requiring FCN treatment. This study analyzes whether the at-home administration of FCN is as safe and effective as its hospital administration. We collected and compared demographic, clinical, analytical, and economic data of patients with CMV infection post-allo-HCT who received FCN in the hospital (n = 16, 17 episodes) vs. at-home (n = 67, 88 episodes). The proportions of patients with cured CMV infections were comparable between the two groups (65.9% vs. 76.5%, p = 0.395). The median duration of FCN treatment was 15 (interquartile range [IQR] 9-23) and 14 (IQR 11-19) days in the HCU and inpatient cohorts, respectively (p = 0.692). There were no significant differences in the FCN toxicities between groups except for hypocalcemia (26.1% vs. 58.8%, p = 0.007), which was more prevalent in the inpatient cohort. A significant cost-effectiveness was found in the HCU cohort, with a median savings per episode of EUR 5270. It may be concluded that home administration of FCN is a safe, effective, and cost-efficient therapeutic option for patients with CMV infection and disease.
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Affiliation(s)
- Sonia Ruiz-Boy
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Alexandra Pedraza
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
- Blood Bank Department, Biomedical Diagnostic Center, Blood and Tissue Bank, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Marta Prat
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Maria Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Esther Carcelero
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Gisela Riu-Viladoms
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Inés Monge-Escartín
- Pharmacy Service, Division of Medicines, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (M.P.); (E.C.); (G.R.-V.); (I.M.-E.)
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Alexandra Martínez-Roca
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Cristina Gallego
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Álvaro Urbano-Ispizua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
| | - Joan Sánchez
- Financial-Economic Department, Institute of Cancer and Blood Diseases Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clínic de Barcelona, University of Barcelona, ISGlobal, CIBERINFEC (Centro de Investigación Biomédica En Red enfermedades INFECciosas), 08036 Barcelona, Spain;
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases, Hospital Clínic de Barcelona, IDIBAPS (Institut De Investigacions Biomèdiques August Pi i Sunyer), Josep Carreras Institute, 08036 Barcelona, Spain; (A.P.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (A.M.-R.); (M.R.); (C.M.); (Á.U.-I.); (F.F.-A.)
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
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9
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Jiménez-Vicente C, Martínez-Roca A, Pomares H, Castaño-Diez S, Guijarro F, López-Guerra M, Bataller A, Esteban D, Cortés-Bullich A, Pérez-Valencia AI, Guardia-Torrelles A, Zugasti I, Rovira M, Fernández-Avilés F, Colomer D, Arnan M, Díaz-Beyá M, Esteve J. Venetoclax with hypomethylating agents might lead to eradication of measurable residual disease (MRD) persisting after intensive chemotherapy in acute myeloid leukemia (AML) patients with mutated NPM1 and rearranged CBF. Leuk Res 2023; 135:107403. [PMID: 37837718 DOI: 10.1016/j.leukres.2023.107403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Carlos Jiménez-Vicente
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Alexandra Martínez-Roca
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Helena Pomares
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain; Hematology Department, Institut Català d'Oncologia - Hospital Duran i Reynals, Universitat de Barcelona, Barcelona, Spain
| | - Sandra Castaño-Diez
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesca Guijarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hemopathology Unit, Pathology Department. Hospital Clinic Barcelona, Spain
| | - Mònica López-Guerra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hemopathology Unit, Pathology Department. Hospital Clinic Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Alex Bataller
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Daniel Esteban
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Cortés-Bullich
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Amanda Isabel Pérez-Valencia
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Inés Zugasti
- Hematology Department, Hospital Clínic Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dolors Colomer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Hemopathology Unit, Pathology Department, Hospital Clínic de Barcelona, Spain
| | - Montserrat Arnan
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain; Hematology Department, Institut Català d'Oncologia - Hospital Duran i Reynals, Universitat de Barcelona, Barcelona, Spain
| | - Marina Díaz-Beyá
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Jordi Esteve
- Hematology Department, Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain; Josep Carreras Leukemia Research Institute, Barcelona, Spain.
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10
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Salas MQ, Rodríguez-Lobato LG, Charry P, Suárez-Lledó M, Pedraza A, Solano MT, Arcarons J, Cid J, Lozano M, Rosiñol L, Esteve J, Carreras E, Fernández-Avilés F, Martínez C, Rovira M. Applicability and validation of different prognostic scores in allogeneic hematopoietic cell transplant (HCT) in the post-transplant cyclophosphamide era. Hematol Transfus Cell Ther 2023:S2531-1379(23)00162-1. [PMID: 37891074 DOI: 10.1016/j.htct.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/21/2023] [Indexed: 10/29/2023] Open
Abstract
We investigated the predictive capacity of six prognostic indices [Karnofsky Performance Status (KPS), Hematopoietic Cell Transplant-Specific Comorbidity Index (HCT-CI), Disease Risk Index (DRI), European Bone Marrow Transplantation (EBMT) and Revised Pre-Transplantation Assessment of Mortality (rPAM) Scores and Endothelial Activation and Stress Index (EASIX)] in 205 adults undergoing post-transplant cyclophosphamide (PTCy)-based allo-HCT. KPS, HCT-CI, DRI and EASIX grouped patients into higher and lower risk strata. KPS and EASIX maintained appropriate discrimination for OS prediction across the first 2 years after allo-HCT [receiver operating characteristic curve (area under the curve (AUC) > 55 %)]. The discriminative capacity of DRI and HCT-CI increased during the post-transplant period, with a peak of prediction at 2 years (AUC of 61.1 % and 61.8 %). The maximum rPAM discriminative capacity was at 1 year (1-year AUC of 58.2 %). The predictive capacity of the EBMT score was not demonstrated. This study validates the discrimination capacity for OS prediction of KPS, HCT-CI, DRI and EASIX in PTCy-based allo-HCT.
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Affiliation(s)
- María Queralt Salas
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Luis Gerardo Rodríguez-Lobato
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Paola Charry
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Suárez-Lledó
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Alexandra Pedraza
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Arcarons
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain
| | - Miquel Lozano
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain; University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain
| | - Francesc Fernández-Avilés
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain; University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Josep Carreras Leukemia Research Institute (Clinic Campus), Barcela, Spain; University of Barcelona, Barcelona, Spain
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11
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Aiello TF, Puerta-Alcalde P, Chumbita M, Lopera C, Monzó P, Cortes A, Fernández-Avilés F, Suárez-Lledó M, Correa J, Ortiz-Maldonado V, Cuesta G, Martinez-Cibrian N, Esteve J, Marcos MÁ, Mensa J, Soriano A, Garcia-Vidal C. Current outcomes of SARS-CoV-2 Omicron variant infection in high-risk haematological patients treated early with antivirals. J Antimicrob Chemother 2023; 78:1454-1459. [PMID: 37051877 DOI: 10.1093/jac/dkad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES We aimed to describe the clinical outcomes and duration of viral shedding in high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predominance who received early treatment with antivirals. METHODS We conducted a prospective observational study on high-risk haematological patients admitted in our hospital between December 2021 and March 2022. We performed detection techniques on viral subgenomic mRNAs until negative results were obtained to document active, prolonged viral replication. RESULTS This analysis included 60 consecutive adults with high-risk haematological malignancies and COVID-19. All of these patients underwent early treatment with remdesivir. Thirty-two (53%) patients received combined antiviral strategies, with sotrovimab or hyperimmune plasma being added to remdesivir. The median length of viral replication-as measured by real-time RT-PCR and/or subgenomic RNA detection-was 20 (IQR 14-28) days. Prolonged viral replication (6 weeks after diagnosis) was documented in six (10%) patients. Only two patients had prolonged infection for more than 2 months. Overall mortality was 5%, whereas COVID-19-related mortality was 0%. CONCLUSIONS Current outcomes of high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predminance are good with the use of early antiviral strategies. Persistent viral shedding is uncommon.
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Affiliation(s)
- Tommaso-Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Mariana Chumbita
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlos Lopera
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Patricia Monzó
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Albert Cortes
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Correa
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Valentín Ortiz-Maldonado
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Genoveva Cuesta
- Department of Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nuria Martinez-Cibrian
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Department of Haematology, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Ángeles Marcos
- Department of Microbiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
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12
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Moreno-Castaño AB, Fernández S, Ventosa H, Palomo M, Martinez-Sanchez J, Ramos A, Ortiz-Maldonado V, Delgado J, Fernández de Larrea C, Urbano-Ispizua A, Penack O, Nicolás JM, Téllez A, Escolar G, Carreras E, Fernández-Avilés F, Castro P, Diaz-Ricart M. Characterization of the endotheliopathy, innate-immune activation and hemostatic imbalance underlying CAR-T cell toxicities: laboratory tools for an early and differential diagnosis. J Immunother Cancer 2023; 11:jitc-2022-006365. [PMID: 37045474 PMCID: PMC10106034 DOI: 10.1136/jitc-2022-006365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Chimeric antigen receptor (CAR)-T cell-based immunotherapy constitutes a revolutionary advance for treatment of relapsed/refractory hematological malignancies. Nevertheless, cytokine release and immune effector cell-associated neurotoxicity syndromes are life-threatening toxicities in which the endothelium could be a pathophysiological substrate. Furthermore, differential diagnosis from sepsis, highly incident in these patients, is challenging. Suitable laboratory tools could be determinant for their appropriate management. METHODS Sixty-two patients treated with CAR-T cell immunotherapy for hematological malignancies (n=46 with CD19-positive diseases, n=16 with multiple myeloma) were included. Plasma samples were obtained: before CAR-T cell infusion (baseline); after 24-48 hours; at suspicion of any toxicity onset and 24-48 hours after immunomodulatory treatment. Biomarkers of endothelial dysfunction (soluble vascular cell adhesion molecule 1 (sVCAM-1), soluble TNF receptor 1 (sTNFRI), thrombomodulin (TM), soluble suppression of tumorigenesis-2 factor (ST2), angiopoietin-2 (Ang-2)), innate immunity activation (neutrophil extracellular traps (NETs), soluble C5b-9 (sC5b-9)) and hemostasis/fibrinolysis (von Willebrand Factor antigen (VWF:Ag), ADAMTS-13 (A13), α2-antiplasmin (α2-AP), plasminogen activator inhibitor-1 antigen (PAI-1 Ag)) were measured and compared with those in cohorts of patients with sepsis and healthy donors. RESULTS Patients who developed CAR-T cell toxicities presented increased levels of sVCAM-1, sTNFRI and ST2 at the clinical onset versus postinfusion values. Twenty-four hours after infusion, ST2 levels were good predictors of any CAR-T cell toxicity, and combination of ST2, Ang-2 and NETs differentiated patients requiring intensive care unit admission from those with milder clinical presentations. Association of Ang-2, NETs, sC5b-9, VWF:Ag and PAI-1 Ag showed excellent discrimination between severe CAR-T cell toxicities and sepsis. CONCLUSIONS This study provides relevant contributions to the current knowledge of the CAR-T cell toxicities pathophysiology. Markers of endotheliopathy, innate immunity activation and hemostatic imbalance appear as potential laboratory tools for their prediction, severity and differential diagnosis.
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Affiliation(s)
- Ana Belen Moreno-Castaño
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sara Fernández
- Intensive Care Unit, Clinical Institute of Medicine and Dermatology (ICMID), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Helena Ventosa
- Intensive Care Unit, Clinical Institute of Medicine and Dermatology (ICMID), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marta Palomo
- Hematology External Quality Assessment Laboratory, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alex Ramos
- Institut de Recerca Contra la Leucèmia Josep Carreras, Campus Clínic, Barcelona, Spain
| | - Valentín Ortiz-Maldonado
- Hematology Department, Clinical Institute of Hematologic and Oncologic Diseases (ICMHO), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Julio Delgado
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematologic and Oncologic Diseases (ICMHO), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematologic and Oncologic Diseases (ICMHO), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alvaro Urbano-Ispizua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematologic and Oncologic Diseases (ICMHO), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Olaf Penack
- Hematology Department, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J M Nicolás
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
- Intensive Care Unit, Clinical Institute of Medicine and Dermatology (ICMID), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Adrian Téllez
- Intensive Care Unit, Clinical Institute of Medicine and Dermatology (ICMID), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gines Escolar
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundación Josep Carreras contra la Leucemia, Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
- Hematology Department, Clinical Institute of Hematologic and Oncologic Diseases (ICMHO), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
- Intensive Care Unit, Clinical Institute of Medicine and Dermatology (ICMID), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Barcelona, Spain
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13
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Gómez-Hernando M, Quintana LF, Suárez-Lledo M, Martínez-Cibrian N, Rivero A, Ruiz-Boy S, Carcelero E, Mate P, Riu G, Monge I, Serrahima A, Solano MT, Rosiñol L, Esteve J, Urbano-Ispizua A, Carreras E, Fernández-Avilés F, Martínez C, Rovira M, Salas MQ. Hyponatremia induced by post-transplant cyclophosphamide in allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2023; 58:212-214. [PMID: 36335256 DOI: 10.1038/s41409-022-01864-7] [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] [Received: 10/12/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Marta Gómez-Hernando
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Clinical Nephrology Section, Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, ICNU, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledo
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Martínez-Cibrian
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Andrea Rivero
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Ruiz-Boy
- Pharmacy Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ester Carcelero
- Pharmacy Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paula Mate
- Pharmacy Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gisela Riu
- Pharmacy Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Inés Monge
- Pharmacy Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Serrahima
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Teresa Solano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Alvaro Urbano-Ispizua
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundació i Institut de Recerca Josep Carreras contra la leucèmia (Campus Clínic), Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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14
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Margarit-Soler A, Deyà-Martínez À, Canizales JT, Vlagea A, García-García A, Marsal J, Del Castillo MT, Planas S, Simó S, Esteve-Sole A, Grande MSL, Badell I, Tarrats MR, Fernández-Avilés F, Alsina L. Case report: Challenges in immune reconstitution following hematopoietic stem cell transplantation for CTLA-4 insufficiency-like primary immune regulatory disorders. Front Immunol 2022; 13:1070068. [PMID: 36636328 PMCID: PMC9831655 DOI: 10.3389/fimmu.2022.1070068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022] Open
Abstract
Cytotoxic T-lymphocyte antigen-4 (CTLA-4) haploinsufficiency is a T-cell hyperactivation disorder that can manifest with both immunodeficiency and immune dysregulation. Approximately one-third of patients may present mild symptoms and remain stable under supportive care. The remaining patients may develop severe multiorgan autoimmunity requiring lifelong immunosuppressive treatment. Hematopoietic stem cell transplantation (HSCT) is potentially curable for patients with treatment-resistant immune dysregulation. Nevertheless, little experience is reported regarding the management of complications post-HSCT. We present case 1 (CTLA-4 haploinsufficiency) and case 2 (CTLA-4 insufficiency-like phenotype) manifesting with severe autoimmunity including cytopenia and involvement of the central nervous system (CNS), lung, and gut and variable impairment of humoral responses. Both patients underwent HSCT for which the main complications were persistent mixed chimerism, infections, and immune-mediated complications [graft-versus-host disease (GVHD) and nodular lung disease]. Detailed management and outcomes of therapeutic interventions post-HSCT are discussed. Concretely, post-HSCT abatacept and human leukocyte antigen (HLA)-matched sibling donor lymphocyte infusions may be used to increase T-cell donor chimerism with the aim of correcting the immune phenotype of CTLA-4 haploinsufficiency.
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Affiliation(s)
- Adriana Margarit-Soler
- Bone Marrow Transplant Unit, Oncology Service, Hospital Sant Joan de Déu, Barcelona, Spain,*Correspondence: Adriana Margarit-Soler, ; Laia Alsina,
| | - Àngela Deyà-Martínez
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain,Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain,Clinical Immunology Program Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Juan Torres Canizales
- Clinical Immunology Unit, Department of Immunology, Biomedical Diagnostic Center, Hospital Clínic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandru Vlagea
- Clinical Immunology Unit, Department of Immunology, Biomedical Diagnostic Center, Hospital Clínic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana García-García
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain,Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain,Clinical Immunology Program Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Júlia Marsal
- Bone Marrow Transplant Unit, Oncology Service, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Sílvia Planas
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sílvia Simó
- Infectious Diseases Unit, Department of Pediatrics, Hospital Sant Joan de Déu, Barcelona, Spain,Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ana Esteve-Sole
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain,Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain,Clinical Immunology Program Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - María Suárez-Lledó Grande
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Badell
- Bone Marrow Transplant Unit, Oncology Service, Hospital Sant Joan de Déu, Barcelona, Spain,Pediatric Haematology and Stem Cell Transplantation Unit, Pediatric Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat Rovira Tarrats
- Bone Marrow Transplant Unit, Oncology Service, Hospital Sant Joan de Déu, Barcelona, Spain,Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain,Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain,Clinical Immunology Program Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain,Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain,*Correspondence: Adriana Margarit-Soler, ; Laia Alsina,
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15
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Marco DN, Salas MQ, Gutiérrez-García G, Monge I, Riu G, Carcelero E, Roma JR, Llobet N, Arcarons J, Suárez-Lledó M, Martínez N, Pedraza A, Domenech A, Rosiñol L, Fernández-Avilés F, Urbano-Ispízua Á, Rovira M, Brunet M, Martínez C. Impact of Early Intrapatient Variability of Tacrolimus Concentrations on the Risk of Graft-Versus-Host Disease after Allogeneic Stem Cell Transplantation Using High-Dose Post-Transplant Cyclophosphamide. Pharmaceuticals (Basel) 2022; 15:ph15121529. [PMID: 36558980 PMCID: PMC9784628 DOI: 10.3390/ph15121529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Tacrolimus (Tac) is a pivotal immunosuppressant agent used to prevent graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (alloHSCT). Tac is characterized by a narrow therapeutic window and a high inter-patient and intra-patient pharmacokinetic variability (IPV). Although high IPV of Tac concentrations has been associated with adverse post-transplant outcomes following solid organ transplantation, the effects of Tac IPV on alloHSCT recipients have not been determined. Tac IPV was therefore retrospectively evaluated in 128 alloHSCT recipients receiving high-dose post-transplant cyclophosphamide (PTCy) and the effects of Tac IPV on the occurrence of acute GVHD (aGVHD) were analyzed. Tac IPV was calculated from pre-dose concentrations (C0) measured during the first month after Tac initiation. The cumulative rates of grades II-IV and grades III-IV aGVHD at day +100 were 22.7% and 7%, respectively. Higher Tac IPV was associated with a greater risk of developing GVHD, with patients having IPV > 50th percentile having significantly higher rates of grades II-IV (34.9% vs. 10.8%; hazard ratio [HR] 3.858, p < 0.001) and grades III-IV (12.7% vs. 1.5%; HR 9.69, p = 0.033) aGVHD than patients having IPV ≤ 50th percentile. Similarly, patients with IPV > 75th percentile had higher rates of grades II-IV (41.9% vs. 16.5%; HR 3.30, p < 0.001) and grades III-IV (16.1% vs. 4.1%; HR 4.99, p = 0.012) aGVHD than patients with IPV ≤ 75th percentile. Multivariate analyses showed that high Tac IPV (>50th percentile) was an independent risk factor for grades II-IV (HR 2.99, p = 0.018) and grades III-IV (HR 9.12, p = 0.047) aGVHD. Determination of Tac IPV soon after alloHSCT could be useful in identifying patients at greater risk of aGVHD.
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Affiliation(s)
- Daniel N. Marco
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Inés Monge
- Department of Pharmacy, Pharmacy Service, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Gisela Riu
- Department of Pharmacy, Pharmacy Service, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Esther Carcelero
- Department of Pharmacy, Pharmacy Service, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Joan Ramón Roma
- Department of Pharmacy, Pharmacy Service, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Noemí Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Nuria Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Alexandra Pedraza
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Ariadna Domenech
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Álvaro Urbano-Ispízua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Mercè Brunet
- Pharmacology and Toxicology Laboratory, Biochemistry and Molecular Genetics Department, Biomedical Diagnostic Center, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-227-54-28; Fax: +34-93-227-54-84
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16
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Salas MQ, Charry P, Puerta-Alcalde P, Martínez-Cibrian N, Solano MT, Serrahima A, Nomdedeu M, Cid J, Lozano M, Chumbinta M, Aiello TF, Arcarons J, LLobet ND, Pedraza A, Rosiñol L, Esteve J, Urbano-Ispizua Á, Carreras E, Martínez C, Fernández-Avilés F, García-Vidal C, Suárez-Lledó M, Rovira M. Bacterial Bloodstream Infections in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation With Post-Transplantation Cyclophosphamide. Transplant Cell Ther 2022; 28:850.e1-850.e10. [PMID: 36089250 DOI: 10.1016/j.jtct.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/22/2022] [Accepted: 09/01/2022] [Indexed: 12/24/2022]
Abstract
This study investigates the incidence and predictors for bacterial bloodstream infection (BSI) in 330 adults undergoing allo-HCT, and explores the effect of post-transplantation cyclophosphamide (PTCY) on the probability of presenting this complication. All patients received levofloxacin during the aplastic phase. Only the first episode of BSI was counted as an event. Patients were classified into 2 groups: PTCY-based (n = 200) versus other prophylaxis (n = 130). One hundred twenty-four patients were diagnosed with a first episode of BSI, most of them during the first 30 days (70.2%). Proportions of BSIs caused by Gram-positive bacteria were comparable to those caused by Gram-negative bacteria (48.3% versus 45.9%). The cumulative incidence of BSI was higher in patients receiving PTCY than in those receiving other prophylaxis (days 30 and 100: 35.0% and 37.0% versus 13.1% and 18.5%, P < .001). At day 30, the likelihood of BSI was 2.41 (P = .012) times higher in the PTCY group than in the non-PTCY group. The 30-day mortality rate in all patients with BSI was 8.0%, lower (P = .002) in the PTCY group (2.3%) than in the non-PTCY group (21.6%). Finally, the overall survival of patients receiving PTCY and diagnosed with BSI was similar to that of patients without presenting this complication. © 2023 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Affiliation(s)
- María Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Paola Charry
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Nuria Martínez-Cibrian
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ana Serrahima
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Meritxell Nomdedeu
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Joan Cid
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Mariana Chumbinta
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Tommaso Francesco Aiello
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Noemi de LLobet
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alexandra Pedraza
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundació Josep Carreras Contra la Leucèmia, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carolina García-Vidal
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Suárez-Lledó
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Monserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; University of Barcelona, Barcelona, Spain
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17
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Velao SR, Garcia Cadenas I, Cuesta MA, Sanchez-Ortega I, Fernández-Avilés F, Roldan E, Torrent A, Viguria MC, Villar S, Bento L, Yáñez L, Martino R, Piñana JL. Low rate of infectious enterocolitis in allogeneic stem cell transplant recipients with acute diarrhea: A prospective study by the GETH-TC. Acta Haematol 2022; 146:161-165. [PMID: 36446336 DOI: 10.1159/000528242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
Acute diarrhea is a common and debilitating complication in recipients of an allogeneic hematopoietic stem cell transplantation (HCT). In this prospective, observational, and multi-center study we examined all episodes occurring in the first 6 months of 142 consecutive adult patients who underwent a reduced-intensity conditioning (RIC) HCT in 10 Spanish tertiary University Hospitals. Fifty-four patients (38%) developed a total of 75 acute diarrhea episodes. The median time from HCT to the first episode was 38 days (4-157). The main cause of enterocolitis was lower GI-aGVHD (38%), followed by infections (21%) and drug-related toxicity (8%). Causative infectious causes were identified in only 16/75 episodes (21%). C. difficile-related infection (CDI) was the most common infectious agent with an incidence and recurrence of 13% and 2%, respectively. With a median follow-up for survivors of 32 months, the NRM and the overall survival (OS) at 1 year, were 20% (95% C.I.: 14-28%) and 69% (95% C.I.: 61-77%), respectively. Development of enterocolitis was not associated with higher NRM (p = 0.37) or worse OS (p = 0.9). This real-life study confirms that the diagnosis and management of acute diarrhea in the early stages after HCT is challenging. Nosocomial infections, seem to be relatively uncommon, probably due to more rational use of antibiotics.
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Affiliation(s)
- Sara Redondo Velao
- Department of Hematology and Hemotherapy. Hospital de La Santa Creu I Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Irene Garcia Cadenas
- Department of Hematology and Hemotherapy. Hospital de La Santa Creu I Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mª Angeles Cuesta
- Department of Hematology and Hemotherapy, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | - Elisa Roldan
- Department of Hematology and Hemotherapy, Hospital Vall D'Hebron, Barcelona, Spain
| | - Anna Torrent
- Department of Hematology and Hemotherapy, Institut Català d'Oncologia Badalona, Barcelona, Spain
| | - M Cruz Viguria
- Department of Hematology and Hemotherapy, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sara Villar
- Department of Hematology and Hemotherapy, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leyre Bento
- Department of Hematology and Hemotherapy, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Lucrecia Yáñez
- Department of Hematology and Hemotherapy, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rodrigo Martino
- Department of Hematology and Hemotherapy. Hospital de La Santa Creu I Sant Pau. IIB-Sant Pau and José Carreras Leukemia Research Institutes. Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jose Luis Piñana
- Department of Hematology and Hemotherapy, Hospital Universitario Clinico de Valencia, Valencia, Spain
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18
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Garcia-Montero M, Ortiz-Bautista C, Valerio M, Olmedo M, Muñoz P, Zatarain Nicolás E, Fernandez-Cordon C, Fernández-Avilés F. Herpes zoster complicated with aseptic meningitis after cardiac transplantation: Report of two cases and review of the literature. Rev Esp Quimioter 2022; 35:415-417. [PMID: 35818634 PMCID: PMC9333122 DOI: 10.37201/req/033.2022] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- M Garcia-Montero
- Marta García Montero, Cardiology Department, Hospital General Universitario Gregorio Marañón. Calle Doctor Esquerdo 46, 28007, Madrid, Spain.
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19
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Del Castillo C, Castrodeza J, Blázquez Z, Ortiz-Bautista C, Valerio M, Valero M, Navas P, Villa A, Sousa I, Zatarain E, Martínez-Sellés M, Fernández-Avilés F. Late Cytomegalovirus Primoinfection in a Heart Transplant Recipient After COVID-19 Vaccine. J Heart Lung Transplant 2022. [PMCID: PMC8988561 DOI: 10.1016/j.healun.2022.01.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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21
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Moreno-Castaño AB, Salas MQ, Palomo M, Martinez-Sanchez J, Rovira M, Fernández-Avilés F, Martínez C, Cid J, Castro P, Escolar G, Carreras E, Diaz-Ricart M. Early vascular endothelial complications after hematopoietic cell transplantation: Role of the endotheliopathy in biomarkers and target therapies development. Front Immunol 2022; 13:1050994. [PMID: 36479117 PMCID: PMC9720327 DOI: 10.3389/fimmu.2022.1050994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
This work aims to review the role of endothelial dysfunction underlying the main complications appearing early after autologous and allogeneic hematopoietic cell transplantation (HCT). The endothelial damage as the pathophysiological substrate of sinusoidal obstruction syndrome (SOS) is well established. However, there is growing evidence of the involvement of endothelial dysfunction in other complications, such as acute graft-versus-host disease (aGVHD) and transplant-associated thrombotic microangiopathy (TA-TMAs). Moreover, HCT-related endotheliopathy is not only limited to the HCT setting, as there is increasing evidence of its implication in complications derived from other cellular therapies. We also review the incidence and the risk factors of the main HCT complications and the biological evidence of the endothelial involvement and other linked pathways in their development. In addition, we cover the state of the art regarding the potential use of the biomarkers of endotheliopathy in the prediction, the early diagnosis, and the follow-up of the HCT complications and summarize current knowledge points to the endothelium and the other linked pathways described as potential targets for the prevention and treatment of HCT-complications. Lastly, the endothelium-focused therapeutic strategies that are emerging and might have a potential impact on the survival and quality of life of post-HCT-patients are additionally reviewed.
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Affiliation(s)
- Ana Belén Moreno-Castaño
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, Barcelona, Spain.,Clínic, Institut Josep Carreras, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - María Queralt Salas
- Hematology Department, Bone Marrow Transplantation Unit, Institut Clínic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic, Barcelona, Spain
| | - Marta Palomo
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, Barcelona, Spain.,Clínic, Institut Josep Carreras, Barcelona, Spain.,Campus Clinic, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Julia Martinez-Sanchez
- Clínic, Institut Josep Carreras, Barcelona, Spain.,Campus Clinic, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Bone Marrow Transplantation Unit, Institut Clínic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematology Department, Bone Marrow Transplantation Unit, Institut Clínic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic, Barcelona, Spain
| | - Carmen Martínez
- Hematology Department, Bone Marrow Transplantation Unit, Institut Clínic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic, Barcelona, Spain
| | - Joan Cid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, Institut Clínic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Clínic, Institut Josep Carreras, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Medical Intensive Care Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gines Escolar
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, Barcelona, Spain.,Clínic, Institut Josep Carreras, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Clínic, Institut Josep Carreras, Barcelona, Spain.,Campus Clinic, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Hemostasis and Erythropathology Laboratory, Hematopathology, Pathology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic, Barcelona, Spain.,Clínic, Institut Josep Carreras, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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22
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Martínez-Roca A, Rodríguez-Lobato LG, Ballestar N, Gallego C, Fernández-Avilés F. Personalized at-home autologous hematopoietic stem cell transplantation during the SARS-CoV-2 outbreak. Leuk Res 2021; 106:106589. [PMID: 33971562 PMCID: PMC8064822 DOI: 10.1016/j.leukres.2021.106589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra Martínez-Roca
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain.
| | - Luis Gerardo Rodríguez-Lobato
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Ballestar
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain
| | - Cristina Gallego
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain
| | - Francesc Fernández-Avilés
- Home Care and Bone Marrow Transplantation Unit, Department of Hematology, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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23
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Puerta-Alcalde P, Chumbita M, Charry P, Castaño-Díez S, Cardozo C, Moreno-García E, Marco F, Suárez-Lledó M, Garcia-Pouton N, Morata L, Fernández-Avilés F, Martínez-Roca A, Rodríguez G, Martínez JA, Martínez C, Mensa J, Urbano Á, Rovira M, Soriano A, Garcia-Vidal C. Risk Factors for Mortality in Hematopoietic Stem Cell Transplantation Recipients with Bloodstream Infection: Points To Be Addressed by Future Guidelines. Transplant Cell Ther 2021; 27:501.e1-501.e6. [PMID: 33891882 DOI: 10.1016/j.jtct.2021.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/05/2023]
Abstract
In recent years, important epidemiologic changes have been described in hematopoietic stem cell transplantation (HSCT) recipients with bloodstream infection (BSI), with increases in gram-negative bacilli and multidrug resistant (MDR) gram-negative bacilli. These changes have been linked to a worrisome increase in mortality. We aimed to define the risk factors for mortality of HSCT patients experiencing BSI. All episodes of BSI in patients with HSCT between 2008 and 2017 were prospectively collected. Multivariate analyses were performed. A total of 402 BSI episodes were documented in 293 patients who had undergone HSCT (75.4% allogenic, 32.3% autologous, 19.3% second HSCT). The median time from HSCT to BSI was 62 days (interquartile range, 9 to 182 days). Gram-positive cocci accounted for 56.7% of the episodes; gram-negative bacilli, for 42%. The most common microorganisms were coagulase-negative staphylococci (30.6%) and Pseudomonas aeruginosa (15.9%). MDR gram-negative bacilli caused 11.9% of all episodes. Clinical characteristics, source of BSI, etiology, and outcomes changed depending on time since HSCT. Globally, 26.6% of episodes were treated with inappropriate empiric antibiotic therapy, more frequently in BSI episodes caused by P. aeruginosa, MDR P. aeruginosa, and MDR gram-negative bacilli. The 30-day mortality was 19.2%. Independent risk factors for mortality were BSI occurring ≥30 days after HSCT (odds ratio [OR], 11.21; 95% confidence interval [CI], 4.63 to 27.19), shock (OR, 7.10; 95% CI, 2.98 to 16.94), BSI caused by MDR P. aeruginosa (OR, 4.45; 95% CI, 1.12 to 17.72), and inappropriate empiric antibiotic therapy for gram-negative bacilli or Candida spp. (OR, 3.73; 95% CI, 1.27 to 10.89). HSCT recipients experiencing BSI have high mortality related to host and procedure factors, causative microorganism, and empiric antibiotic therapy. Strategies to identify HSCT recipients at risk of MDR P. aeruginosa and reducing inappropriate empiric antibiotic therapy are paramount to reduce mortality.
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Affiliation(s)
| | - Mariana Chumbita
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Paola Charry
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | | | - Celia Cardozo
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | | | - Francesc Marco
- Microbiology Department, Biomedical Diagnostic Center, Hospital Clinic, Barcelona, Spain; ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Laura Morata
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | | | | | | | - Jose A Martínez
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Josep Mensa
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Álvaro Urbano
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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24
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Giavedoni P, Martinez C, Podlipnik S, Suárez-Lleidó M, Martí-Martí I, Morgado-Carrasco D, Rovira M, Fernández-Avilés F, Gutiérrez G, Rosiñol L, Cid J, Lozano M, Mascaró JM. Assessment of Sclerodermoid Chronic Graft-versus-host Disease with Colour Doppler Ultrasound. Acta Derm Venereol 2021; 101:adv00395. [PMID: 33475145 PMCID: PMC9366684 DOI: 10.2340/00015555-3747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sclerodermoid chronic graft-versus-host disease (scGVHD) is a severe complication of allogeneic haema-- topoietic stem cell transplantation. The aim of this study was to investigate the usefulness of high-frequency ultrasound of the skin in assessing the inflammatory patterns and prognosis of patients with scGVHD. A prospective study was carried out with patients who developed scGVHD in the period June 2016 to April 2018. Clinical and ultrasound examinations were performed on the first visit and at 6-month follow-up. A total of 24 patients were included in the study. A 6-month follow-up high-frequency ultrasound of the skin was performed on 20 of the 24 patients. Abnormal B-mode findings in high-frequency ultrasound of the skin consisted of hypoechogenic dermis, hypoechogenicity of septa and hyperechogenicity of lobules in hypodermis. No differences were observed in these basal parameters between treatment progressive/non-responding and inactive/responding scGVHD groups of patients. Basal Doppler showing increased vascular flow with a systolic peak ≥10 cm/s and a vascular resistance index ≥ 0.70 was observed only in those patients who developed progressive/non-responding scGVHD (62.5% vs 0% p = 0.006). In conclusion, Doppler ultrasound is a useful tool to assess the inflammatory activity and outcome of scGVHD. These findings could enhance patient management and help to guide treatment decisions.
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Affiliation(s)
- Priscila Giavedoni
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel 170, ES-08036 Barcelona, Spain. E-mail:
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25
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Rodríguez-Lobato LG, Martínez-Roca A, Castaño-Díez S, Palomino-Mosquera A, Gutiérrez-García G, Pedraza A, Suárez-Lledó M, Rovira M, Martínez C, Fernández de Larrea C, Cibeira MT, Rosiñol L, Lozano E, Marín P, Cid J, Lozano M, Moreno-Castaño AB, Palomo M, Díaz-Ricart M, Gallego C, Hernando A, Segura S, Carreras E, Urbano-Ispizua Á, Bladé J, Fernández-Avilés F. The avoidance of G-CSF and the addition of prophylactic corticosteroids after autologous stem cell transplantation for multiple myeloma patients appeal for the at-home setting to reduce readmission for neutropenic fever. PLoS One 2020; 15:e0241778. [PMID: 33147257 PMCID: PMC7641449 DOI: 10.1371/journal.pone.0241778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT. METHODS Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning +1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT. RESULTS The incidence of NF among the groups was reduced (64%, 44%, and 24%; P<0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI >2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P<0.001); and for hospital readmission: age ≥60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05). CONCLUSIONS G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT. This approach should be explored in a prospective randomized clinical trial.
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Affiliation(s)
- Luis-Gerardo Rodríguez-Lobato
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Martínez-Roca
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Sandra Castaño-Díez
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Alicia Palomino-Mosquera
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Pedraza
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carmen Martínez
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Fernández de Larrea
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María-Teresa Cibeira
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Rosiñol
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ester Lozano
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Marín
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joan Cid
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- Department of Hematopathology, Laboratory of Hemostasis and Eritropathology, Biomedical Diagnosis Center (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Marta Palomo
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hematopathology, Laboratory of Hemostasis and Eritropathology, Biomedical Diagnosis Center (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Hospital Clínic/University of Barcelona Campus, Barcelona, Spain
| | - Maribel Díaz-Ricart
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Hematopathology, Laboratory of Hemostasis and Eritropathology, Biomedical Diagnosis Center (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Cristina Gallego
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Adelina Hernando
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Susana Segura
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
- Josep Carreras Leukemia Research Institute, Hospital Clínic/University of Barcelona Campus, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Bladé
- Department of Hematology, Amyloidosis and Multiple Myeloma Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fernández-Avilés
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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26
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Sanz-Ruiz R, Janssens S, Pompilio G, Badimon L, Fernández-Avilés F. The ESC Working Group on Cardiovascular Regenerative and Reparative Medicine. Eur Heart J 2020; 41:2721-2723. [PMID: 32738050 DOI: 10.1093/eurheartj/ehaa438] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain.,Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - S Janssens
- Department of Cardiovascular Medicine, University Hospitals and KU Leuven, Leuven, Belgium
| | - G Pompilio
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino-IRCCS, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Badimon
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiovascular Research Center (CSIC-ICCC), Hospital de la Santa Creu i Sant Pau (HSCSP), Barcelona, Spain
| | - F Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain.,Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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27
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Rodríguez-Lobato LG, Martínez-Roca A, Moreno DF, Gutiérrez-García G, Suárez-Lledó M, Rovira M, Martínez C, Rosiñol L, Almeida Jorge AS, Pedraza A, Cardozo C, Puerta-Alcalde P, Garcia-Vidal C, Marín P, Cid J, Lozano M, Gallego C, Hernando A, Segura S, Urbano-Ispizua Á, Fernández-Avilés F. Impact of intensifying primary antibiotic prophylaxis in at-home autologous stem cell transplantation program for lymphoma patients. Leuk Lymphoma 2020; 61:1565-1574. [PMID: 32208787 DOI: 10.1080/10428194.2020.1742901] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite the use of fluoroquinolone (FQ) prophylaxis, neutropenic fever (NF) is the most frequent cause of hospital readmission in ambulatory care programs for patients treated with autologous stem cell transplantation (ASCT). We analyzed the impact of intensifying primary prophylaxis with the addition of piperacillin/tazobactam (PT) to FQ. Between January 2002 and August 2018, 154 lymphoma patients conditioned with BEAM were included (40% received ceftriaxone (Ct) plus FQ and 60% PT plus FQ). NF and hospital readmission were required in 84 vs. 41% (p < .0001) and 12 vs. 1% (p = .007) of patients within the Ct and PT groups, respectively. The multivariate analysis showed that PT plus FQ retained its independent protective factor for NF (odds ratio (OR): 0.13; p < .001) and for hospital readmission (OR: 0.07; p = .01). The use of PT and FQ prophylaxis may effectively prevent episodes of NF and hospitalizations in lymphoma patients managed in our at-home ASCT care model.
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Affiliation(s)
- Luis Gerardo Rodríguez-Lobato
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alexandra Martínez-Roca
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David F Moreno
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ana Sofía Almeida Jorge
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alexandra Pedraza
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Pedro Marín
- Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Joan Cid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Hemotherapy and Hemostasis, Apheresis and Cellular Therapy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Gallego
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Adelina Hernando
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Susana Segura
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Fernández-Avilés
- Department of Hematology, Home Care and Bone Marrow Transplantation Unit, Hospital Clinic of Barcelona, Barcelona, Spain
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28
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Cid J, Castillo C, Marín P, Carbassé G, Herrera D, Monfort N, Fernández-Avilés F, Gutiérrez-García G, Martínez C, Rosiñol L, Suárez-Lledó M, Rovira M, Urbano-Ispizua Á, Lozano M. Increased collection efficiency of CD34+ cells after mobilization with preemptive use of plerixafor followed by leukocytapheresis on the same day. Transfusion 2020; 60:779-785. [PMID: 32064638 DOI: 10.1111/trf.15711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Plerixafor should be administered 6 to 11 hours before starting leukocytapheresis. However, we have been using plerixafor followed by leukocytapheresis according to different time schedules since 2007. Our objective was to compare the CD34+ cell collection efficiency (CE1) of the first leukocytapheresis performed after using plerixafor at different time intervals. STUDY DESIGN AND METHODS Same-day schedule refers to the administration of plerixafor at 10:00 AM and starting the leukocytapheresis on the same day at 4:00 PM (6 hours interval). Next-day schedule refers to the administration of plerixafor at 8:00 PM and starting the leukocytapheresis on the next day (10:00 AM or 4:00 PM; either a 14- or 20-hr interval). Variables that might influence the CE1 of CD34+ cells were analyzed by longitudinal linear regression with a random effects model derived by generalized estimating equations. RESULTS The median CE1 of CD34+ cells was higher in the group of 30 patients who underwent leukocytapheresis on the same day when compared with the group of 62 patients who underwent leukocytapheresis on the next day (65.8% vs. 56.7%; p < 0.01). In the longitudinal linear regression analysis, only the time from plerixafor administration to leukocytapheresis start was associated with a statistically significant decrease in the CE1 of CD34+ cells (CE1 change -0.034%; p < 0.01). CONCLUSION Higher CE1 of CD34+ cells was observed when patients underwent leukocytapheresis on the same day after receiving plerixafor in comparison with administering plerixafor and underwent leukocytapheresis on the next day. Larger studies are necessary to confirm present results.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Castillo
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Marín
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gloria Carbassé
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Dolores Herrera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Nuria Monfort
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hematopoietic Stem Cell transplantation Unit, Department of Hematology, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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29
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Gutiérrez-García G, Rovira M, Arab N, Gallego C, Sánchez J, Ángeles Álvarez M, Ayora P, Domenech A, Borràs N, Gerardo Rodríguez-Lobato L, Rosiñol L, Marín P, Pedraza A, Martínez-Roca A, Carcelero E, Dolores Herrera M, Teresa Solano M, Ramos C, de Llobet N, Serrahima A, Lozano M, Cid J, Martínez C, Suárez-Lledó M, Urbano-Ispizua Á, Fernández-Avilés F. A reproducible and safe at-home allogeneic haematopoietic cell transplant program: first experience in Central and Southern Europe. Bone Marrow Transplant 2020; 55:965-973. [PMID: 31932656 DOI: 10.1038/s41409-019-0768-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/09/2022]
Abstract
In 2015, we implemented an at-home allogeneic haematopoietic cell transplant (allo-HCT) program. Between 2015 and 2018, 252 patients underwent allo-HCT; 41 patients underwent allo-HCT in the at-home program (46% myeloablative; 63% unrelated donor; 32% posttransplant cyclophosphamide), and these patients were compared with 39 in-patients; safety, capacity to release beds for other programs, and economic efficiency cost were evaluated. We observed a lower incidence of febrile neutropenia in the at-home group compared with that in the in-patient group (32% versus 90%; p < 0.0001), whereas the incidence of aspergillosis was similar among groups (at-home 1% versus in-patient 3%; p = 0.5). The at-home patients showed a lower incidence of 1-year severe graft-versus-host disease (GVHD; 10% versus 29%; p = 0.03). There were no differences in 1-year transplant-related mortality, relapse, or overall survival among groups. The re-admission rate in the at-home group was 7%. The at-home setting was less expensive (9087 €/transplant), and its implementation increased capacity by 10.5 allo-HCTs/year. Moreover, a chimeric antigen receptor T-cell program could be established without increasing beds. Thus, our at-home allo-HCT program may be a safe modality to reduce febrile neutropenia and acute GVHD, resulting in lower re-admission rates.
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Affiliation(s)
- Gonzalo Gutiérrez-García
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain. .,Josep Carreras Leukemia Research Institute, Barcelona, Spain.
| | - Montserrat Rovira
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Nacira Arab
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Cristina Gallego
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joan Sánchez
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - María Ángeles Álvarez
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Pilar Ayora
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ariadna Domenech
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Nuria Borràs
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Laura Rosiñol
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Pedro Marín
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Alexandra Pedraza
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Alexandra Martínez-Roca
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Esther Carcelero
- Department of Pharmacy, Hospital Clínic of Barcelona, Barcelona, Spain
| | - María Dolores Herrera
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Carla Ramos
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Noemí de Llobet
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Anna Serrahima
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Department of Hemotherapy and Homeostasis, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Joan Cid
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Department of Hemotherapy and Homeostasis, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - María Suárez-Lledó
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Josep Carreras Leukemia Research Institute, Barcelona, Spain
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30
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Sanz-Ruiz R, Climent AM, Fernández-Santos ME, Fernández-Baza A, Fernández-Avilés F. Call to action from the cardiovascular reparative medicine community. Eur Heart J 2019; 40:2661-2662. [DOI: 10.1093/eurheartj/ehz574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - A M Climent
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - M E Fernández-Santos
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - A Fernández-Baza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - F Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, Universidad Complutense, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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31
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Suárez-Lledó M, Marcos MÁ, Cuatrecasas M, Bombi JA, Fernández-Avilés F, Magnano L, Martínez-Cibrián N, Llobet N, Rosiñol L, Gutiérrez-García G, Jorge S, Martínez C, Rovira M, Urbano-Ispizua Á. Quantitative PCR Is Faster, More Objective, and More Reliable Than Immunohistochemistry for the Diagnosis of Cytomegalovirus Gastrointestinal Disease in Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2281-2286. [PMID: 31325586 DOI: 10.1016/j.bbmt.2019.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
Diagnosis of gastrointestinal (GI) cytomegalovirus (CMV) disease relies on the presence of GI symptoms and detection of CMV, mainly by immunohistochemistry (IHC), in GI biopsy specimens. Thus, in a symptomatic patient, a positive CMV-IHC result is accepted as a diagnosis of CMV disease. However, a positive CMV-PCR in GI tissue is considered "possible" CMV disease. Therefore, it would be very useful if, in practice, both techniques showed equal sensitivity and reliability. This is because PCR has many practical advantages over IHC for detecting CMV. The aim of this study was to compare quantitative PCR with IHC for the diagnosis of GI CMV disease. A total of 186 endoscopic GI biopsy specimens from 123 patients with GI symptoms after an allogeneic stem cell transplantation (allo-SCT; 2004-2017) were analyzed by IHC and PCR on 113 paraffin-embedded and 73 fresh samples. The results were then compared. Of the patients with macroscopic lesions in the mucosa and CMV-IHC-positive biopsy specimens (eg, "proven" CMV disease, n = 28), all but 1 were CMV-PCR positive. Of the patients without macroscopic lesions in the mucosa and CMV-IHC-positive biopsy specimens (eg, probable CMV disease, n = 4), only 1 was CMV-PCR positive. Eight patients had CMV-IHC-negative/CMV-PCR-positive gut biopsy specimens. These cases fall within the current definition of possible CMV disease. In 6 of these 8 cases (75%), the viral load in GI tissue was very high (>10,000 copies/µg). Taken together, the results from the proven and probable cases revealed that CMV-PCR shows the same sensitivity (100%), specificity (98%), and positive (93%) and negative predictive value (100%) as CMV-IHC. Detection of CMV in fresh GI mucosa by quantitative PCR is as useful as IHC for the diagnosis of GI CMV disease. The results show that quantitative PCR has the same sensitivity, specificity, and positive/negative predictive value as IHC.
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Affiliation(s)
- María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain.
| | - Maria Ángeles Marcos
- Clinical Microbiology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; University of Barcelona, Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Miriam Cuatrecasas
- Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Josep Antoni Bombi
- Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Pathology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Campus Clínic, Barcelona, Spain
| | - Laura Magnano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Núria Martínez-Cibrián
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Noemi Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Campus Clínic, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sofía Jorge
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Campus Clínic, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Campus Clínic, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Campus Clínic, Barcelona, Spain
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32
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Viasus D, Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, Marco F, Chumbita M, Moreno-García E, Fernández-Avilés F, Gutiérrez-Garcia G, Martínez JA, Mensa J, Rovira M, Esteve J, Soriano A, Garcia-Vidal C. Predictors of multidrug-resistant Pseudomonas aeruginosa in neutropenic patients with bloodstream infection. Clin Microbiol Infect 2019; 26:345-350. [PMID: 31295551 DOI: 10.1016/j.cmi.2019.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/07/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess risk factors for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) infection in neutropenic patients. METHODS Single-centre retrospective analysis of consecutive bloodstream infection (BSI) episodes (2004-2017, Barcelona). Two multivariate regression models were used at BSI diagnosis and P. aeruginosa detection. Significant predictors were used to establish rules for stratifying patients according to MDR-PA BSI risk. RESULTS Of 661 Gram-negative BSI episodes, 190 (28.7%) were caused by P. aeruginosa (70 MDR-PA). Independent factors associated with MDR-PA among Gram-negative organisms were haematological malignancy (OR 3.30; 95% CI 1.15-9.50), pulmonary source of infection (OR 7.85; 95% CI 3.32-18.56), nosocomial-acquired BSI (OR 3.52; 95% CI 1.74-7.09), previous antipseudomonal cephalosporin (OR 13.66; 95% CI 6.64-28.10) and piperacillin/tazobactam (OR 2.42; 95% CI 1.04-5.63), and BSI occurring during ceftriaxone (OR 4.27; 95% CI 1.15-15.83). Once P. aeruginosa was identified as the BSI aetiological pathogen, nosocomial acquisition (OR 7.13; 95% CI 2.87-17.67), haematological malignancy (OR 3.44; 95% CI 1.07-10.98), previous antipseudomonal cephalosporin (OR 3.82; 95% CI 1.42-10.22) and quinolones (OR 3.97; 95% CI 1.37-11.48), corticosteroids (OR 2.92; 95% CI 1.15-7.40), and BSI occurring during quinolone (OR 4.88; 95% CI 1.58-15.05) and β-lactam other than ertapenem (OR 4.51; 95% CI 1.45-14.04) were independently associated with MDR-PA. Per regression coefficients, 1 point was assigned to each parameter, except for nosocomial-acquired BSI (3 points). In the second analysis, a score >3 points identified 60 (86.3%) out of 70 individuals with MDR-PA BSI and discarded 100 (84.2%) out of 120 with non-MDR-PA BSI. CONCLUSIONS A simple score based on demographic and clinical factors allows stratification of individuals with bacteraemia according to their risk of MDR-PA BSI, and may help facilitate the use of rapid MDR-detection tools and improve early antibiotic appropriateness.
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Affiliation(s)
- D Viasus
- Health Sciences Division, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia
| | - P Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Cardozo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Suárez-Lledó
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - O Rodríguez-Núñez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - L Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - C Fehér
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - F Marco
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - M Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - E Moreno-García
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | | | - G Gutiérrez-Garcia
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J A Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - M Rovira
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - J Esteve
- Haematology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - A Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - C Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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33
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Bento L, Bastida JM, García-Cadenas I, García-Torres E, Rivera D, Bosch-Vilaseca A, De Miguel C, Martínez-Muñoz ME, Fernández-Avilés F, Roldán E, Chinea A, Yáñez L, Zudaire T, Vaz CP, Espigado I, López J, Valcárcel D, Duarte R, Cabrera R, Herrera C, González-Porras JR, Gutiérrez A, Solano C, Sampol A. Thrombopoietin Receptor Agonists for Severe Thrombocytopenia after Allogeneic Stem Cell Transplantation: Experience of the Spanish Group of Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2019; 25:1825-1831. [PMID: 31152794 DOI: 10.1016/j.bbmt.2019.05.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 12/11/2022]
Abstract
Persistent thrombocytopenia is a common complication after allogeneic hematopoietic stem cell transplantation (allo-SCT). Romiplostim and eltrombopag are the currently available thrombopoietin receptor agonists (TPO-RAs), and some studies with very small numbers of cases have reported their potential efficacy in the allo-SCT setting. The present retrospective study evaluated the safety and efficacy of TPO-RAs in 86 patients with persistent thrombocytopenia after allo-HSCT. Sixteen patients (19%) had isolated thrombocytopenia (PT), and 71 (82%) had secondary failure of platelet recovery (SFPR). TPO-RA therapy was started at a median of 127 days (range, 27 to 1177 days) after allo-SCT. The median initial and maximum administered doses were 50 mg/day (range, 25 to 150 mg/day) and 75 mg/day (range, 25 to 150 mg/day), respectively, for eltrombopag and 1 µg/kg (range, 1 to 7 µg/kg) and 5 µg/kg (range, 1 to 10 µg/kg), respectively, for romiplostin. The median platelet count before initiation of TPO-RA therapy was 14,000/µL (range, 1000 to 57,000/µL). Platelet recovery to ≥50,000/µL without transfusion support was achieved in 72% of patients at a median time of 66 days (range, 2 to 247 days). Eighty-one percent of the patients had a decreased number of megakaryocytes before treatment, showing a slower response to therapy (P = .011). The median duration of treatment was 62 days (range, 7 to 700 days). Grade 3-4 adverse events (hepatic and asthenia) were observed in only 2% of the patients. At last follow-up, 81% of patients had discontinued TPO-RAs and maintained response, and 71% were alive. To our knowledge, this is the largest series analyzing the use of TPO-RAs after allo-SCT reported to date. Our results support the efficacy and safety in this new setting. Further prospective trials are needed to increase the level of evidence and to identify predictors of response.
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Affiliation(s)
- Leyre Bento
- Hematology Department, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Islas Baleares, Palma de Mallorca, Spain.
| | - José María Bastida
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | | | - Daniel Rivera
- Hematology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Carlos De Miguel
- Hematology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | - Elisa Roldán
- Hematology Department, Hospital Vall D'hebron, Barcelona, Spain
| | - Anabelle Chinea
- Hematology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Lucrecia Yáñez
- Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Teresa Zudaire
- Hematology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Carlos Pinho Vaz
- Hematology Department, Instituto Português de Oncologia, Oporto, Spain
| | | | - Javier López
- Hematology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - David Valcárcel
- Hematology Department, Hospital Vall D'hebron, Barcelona, Spain
| | - Rafael Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Rafael Cabrera
- Hematology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Concepción Herrera
- Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Antonio Gutiérrez
- Hematology Department, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Islas Baleares, Palma de Mallorca, Spain
| | | | - Antonia Sampol
- Hematology Department, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Islas Baleares, Palma de Mallorca, Spain
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34
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Cid J, Carbassé G, Suárez-Lledó M, Moreno DF, Martínez C, Gutiérrez-García G, Fernández-Avilés F, Rosiñol L, Giavedoni P, Mascaró JM, Agustí C, Marín P, Rovira M, Urbano-Ispizua Á, Lozano M. Efficacy and safety of one-day offline extracorporeal photopheresis schedule processing one total blood volume for treating patients with graft-versus-host disease. Transfusion 2019; 59:2636-2642. [PMID: 31135994 DOI: 10.1111/trf.15384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has been increasingly used as a second-line therapy for graft-versus-host disease (GVHD) but there is no consensus regarding the best therapeutic schedule. STUDY DESIGN AND METHODS Our offline ECP schedule for treating patients with GVHD was retrospectively reviewed. Patients with acute GVHD were treated on 2 days per week for the first 2 weeks, followed by 1 day per week for 2 more weeks. After the first month of treatment, patients received treatment 1 day every 2 weeks for a minimum of 16 ECP procedures. Patients with chronic GVHD were treated on 1 day per week for 4 weeks followed by 1 day every 2 weeks for a minimum of 14 ECP procedures. RESULTS Our series comprises 21 (45%) patients with acute GVHD and 26 (55%) patients with chronic GVHD who received 667 ECP procedures. A median (interquartile range [IQR]) of 1.0 (1.0-1.12) total blood volume was processed. Patients with acute and chronic GVHD received ECP procedures during a median of 49 (IQR, 14-103) and 180 (IQR, 111-274) days, respectively. Mild citrate-induced symptoms were present in 98 (46%) and 232 (51%) procedures in patients with acute and chronic GVHD, respectively. Overall response rate (ORR) and overall survival (OS) were 57 and 38% (95% confidence interval [CI], 17%-59%), respectively, for patients with acute GVHD. For patients with chronic GVHD, ORR and OS were 77 and 61% (95% CI, 18%-87%), respectively. CONCLUSION Our new offline ECP schedule for treating patients with acute and chronic GVHD was efficacious and safe.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gloria Carbassé
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - David F Moreno
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Priscila Giavedoni
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Dermatology ICMiD, ICMiD, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José M Mascaró
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Dermatology ICMiD, ICMiD, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carles Agustí
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Pneumology and Respiratory Allergy, ICR, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Marín
- GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Montserrat Rovira
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d''Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,GVHD and Long-Term Follow-up Unit, Hematopoietic Stem Cell Transplantation Unit, Department of Hematology ICMHO, ICMHO, Hospital Clínic, University of Barcelona, Barcelona, Spain
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35
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Gutiérrez-García G, Cibeira MT, Rovira M, Fernández de Larrea C, Tovar N, Rodríguez-Lobato LG, Rosiñol L, Marín P, Solano-Vega J, Suárez-Lledó M, Bataller A, Solano MT, de Llobet N, Domenech A, Borràs N, Lozano M, Cid J, Martínez C, Urbano-Ispizua Á, Esteve J, Carreras E, Fernández-Avilés F, Bladé J. Improving security of autologous hematopoietic stem cell transplant in patients with light-chain amyloidosis. Bone Marrow Transplant 2019; 54:1295-1303. [DOI: 10.1038/s41409-019-0447-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 12/17/2022]
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36
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Vicent L, Figueiras-Graillet L, Devesa C, Bruña V, Miriam J, Sousa I, Martìnez-Sellés M, Fernández-Avilés F. PO476 An Overview of End-of-Life Issues In the Cardiology Department. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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37
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Hernáez Á, Delgado J, Cinca J, Fernández-Avilés F, Marrugat J. Prevalence and incidence of hyperkalemia in the Spanish population with heart failure with reduced ejection fraction: A systematic review and populational relevance. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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38
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Suárez-Lledó M, Martínez-Cibrián N, Gutiérrez-García G, Dimova-Svetoslavova V, Marcos MA, Martín-Antonio B, Martínez-Trillos A, Villamor N, Rosiñol L, Martínez C, Fernández-Avilés F, García-Vidal C, Urbano-Ispizua Á, Rovira M. Deleterious Effect of Steroids on Cytomegalovirus Infection Rate after Allogeneic Stem Cell Transplantation Depends on Pretransplant Cytomegalovirus Serostatus of Donors and Recipients. Biol Blood Marrow Transplant 2018; 24:2088-2093. [PMID: 29753162 DOI: 10.1016/j.bbmt.2018.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/01/2018] [Indexed: 10/16/2022]
Abstract
This study examined the impact of prednisone (PDN) on cytomegalovirus (CMV) infection after allogeneic stem cell transplantation (allo-SCT) according to donor and recipient CMV serostatus. Seventy-five patients underwent allo-SCT from June 2010 to July 2012. The risk of CMV infection according to donor and recipient serostatus was defined as follows: high risk (HR; D-/R+), intermediate risk (IR; D+/R+ and D+/R-), and low risk (D-/R-). Forty-five patients (60%) developed CMV infection, and 46 patients (61%) received steroids (PDN ≥ 1 mg/kg/day) to treat acute graft-versus-host disease. CMV infection was more common in those treated with steroids than in those not treated with steroids (70% versus 44%, respectively, P < .05). Overall, 40% of patients had recurrent CMV infection (50% PDN versus 24% no PDN, P < .05). Steroids had no impact on the incidence of CMV infection or its recurrence in HR patients; however, steroids did prolong the need for antiviral treatment. The incidence of CMV infection in IR patients was higher in those receiving PDN (80% PDN versus 41% no PDN, P = .01); recurrence rates were also higher (55% PDN versus 18% no PDN, P = .02). We analyzed CMV-specific immune reconstitution in the first 22 patients of the series and observed that patients on steroids had lower levels of CMV-specific lymphocytes TCD8 (P < .05 on days +60, +100, and +180) and that CMV-specific immune reconstitution (defined as lymphocytes CD8/IFN ≥ 1 cell/µL) was achieved later (after day +100 post-SCT) in the steroid group.
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Affiliation(s)
| | | | | | | | - Ma Angeles Marcos
- Clinical Microbiology Department, Hospital Clínic Barcelona, Barcelona, Spain
| | - Beatriz Martín-Antonio
- Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Barcelona, Spain
| | | | - Neus Villamor
- Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Hematopathology Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Barcelona, Spain
| | | | - Álvaro Urbano-Ispizua
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clínic Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Institut Josep Carreras, Barcelona, Spain
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39
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Gutiérrez-García G, Rovira M, Magnano L, Rosiñol L, Bataller A, Suárez-Lledó M, Cibeira MT, de Larrea CF, Garrote M, Jorge S, Moreno A, Rodríguez-Lobato LG, Carreras E, Díaz-Ricart M, Palomo M, Martínez C, Urbano-Ispizua A, Bladé J, Fernández-Avilés F. Innovative strategies minimize engraftment syndrome in multiple myeloma patients with novel induction therapy following autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2018; 53:1541-1547. [PMID: 29706650 DOI: 10.1038/s41409-018-0189-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 12/29/2022]
Abstract
Autologous stem cell transplantation (PBSCT) is standard for young patients in MM and its TRM has decreased after the 2000s. Bortezomib and immunomodulatory agents (IMiDs) in MM have improved the outcome. However, they seem to boost pro-inflammatory stage increasing the incidence of engraftment syndrome (ES). Favorable factors in PBSCT such as G-CSF could increase inflammatory stage during transplant. Corticosteroids have shown an excellent response of ES and some authors propose them as prophylaxis for ES. The aim was to analyze the impact of G-CSF avoidance and corticosteroids' prophylaxis in 170 patients diagnosed of MM treated with bortezomib/IMiDs that underwent PBSCT. We established three groups: Group-I [(G-CSF_administration), 60 patients (35%)], group-II [(nonG-CSF), 60 patients (35%)] and group-III [(nonG-CSF plus corticosteroid's prophylaxis), 50 patients (30%)]. A decreased ES incidence among groups was observed: 62, 42, and 22% (P < 0.0001). The incidence of symptoms mimicking a capillary leak syndrome associated with ES dropped: 43, 32, and 0% (P = 0.03). The G-CSF avoidance and corticosteroids had impact over admission 24, 21, and 20 days (P = 0.001). The most important variables related to ES were HCT-CI >2 (p < 0.0001; HR 8.5) and risk groups (p < 0.0001; HR 7.2). Hence, G-CSF avoidance and corticosteroid's prophylaxis decrease morbidity in patients undergoing PBSCT with MM treated with bortezomib/IMiDs.
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Affiliation(s)
- Gonzalo Gutiérrez-García
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.
| | - Montserrat Rovira
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Laura Magnano
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Amyloidosis and Multiple Myeloma/AL Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Amyloidosis and Multiple Myeloma/AL Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Alex Bataller
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - María Suárez-Lledó
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - María Teresa Cibeira
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Amyloidosis and Multiple Myeloma/AL Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Carlos Fernández de Larrea
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Amyloidosis and Multiple Myeloma/AL Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Garrote
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Sofia Jorge
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Ana Moreno
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Enric Carreras
- University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Maribel Díaz-Ricart
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain.,Hematopathology Unit, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Palomo
- University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team (BET), Josep Carreras Leukemia Research Institute, Barcelona, Spain
| | - Carmen Martínez
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Alvaro Urbano-Ispizua
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Joan Bladé
- University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain.,Amyloidosis and Multiple Myeloma/AL Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Bone Marrow Transplant Unit, Department of Hematology, Hospital Clínic of Barcelona, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Institut de Recerca Biomèdica August Pi i Sunyer, Barcelona, Spain
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40
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Hernáez Á, Delgado JF, Cinca J, Fernández-Avilés F, Marrugat J. Prevalence and incidence of hyperkalaemia in the Spanish population with heart failure with reduced ejection fraction: a systematic review and populational relevance. Rev Clin Esp 2018; 218:253-260. [PMID: 29496276 DOI: 10.1016/j.rce.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/01/2017] [Accepted: 01/23/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Hyperkalaemia (K+ levels≥5.5mmol/L) is a severe ion imbalance that occurs in patients who have heart failure (HF) with reduced ejection fraction (HFrEF) and increases the risk of ventricular fibrillation. Given that there are no estimates on the number of patients with this complication, the aim of this study was to estimate the prevalence and incidence of hyperkalaemia in patients with HFrEF in Spain. MATERIAL AND METHODS Based on a systematic literature search and through a meta-analysis, we calculated an HFrEF prevalence of ≤40% in the European and U.S. POPULATION Based on another systematic literature search, we calculated the prevalence of hyperkalaemia in patients with HF and its annual incidence rate. Considering the previous values and the Spanish population pyramid in 2016, we estimated the number of individuals with HFrEF who currently have hyperkalaemia and those who develop it each year in Spain. RESULTS Approximately 17,100 (10,000 men and 7100 women) of the 508,000 patients with HFrEF in Spain have hyperkalaemia. Furthermore, approximately 14,900 patients with HFrEF (9500 men and 5400 women) develop hyperkalaemia each year. CONCLUSIONS Approximately 1 of every 30 patients with HFrEF has plasma potassium values >5.5 mmol/L.
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Affiliation(s)
- Á Hernáez
- Grupo de investigación en Riesgo Cardiovascular y Nutrición-REGICOR, Institut Hospital d'Investigacions Mèdiques IMIM, Barcelona, España; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - J F Delgado
- Fundación Investigación i+12, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - J Cinca
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - F Fernández-Avilés
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Departamento de Cardiología, Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Marrugat
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Epidemiología y Genética Cardiovascular-REGICOR, Institut Hospital d'Investigacions Mèdiques IMIM, Barcelona, España.
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41
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Jorge AS, Suárez-Lledó M, Pereira A, Gutierrez G, Fernández-Avilés F, Rosiñol L, Llobet N, Solano T, Urbano-Ispízua Á, Rovira M, Martínez C. Single Antigen-Mismatched Unrelated Hematopoietic Stem Cell Transplantation Using High-Dose Post-Transplantation Cyclophosphamide Is a Suitable Alternative for Patients Lacking HLA-Matched Donors. Biol Blood Marrow Transplant 2018; 24:1196-1202. [PMID: 29410343 DOI: 10.1016/j.bbmt.2018.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022]
Abstract
The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing 2 contemporaneous groups: PTCy MMUD (n = 26) versus matched unrelated donor (MUD) (n = 60). Graft source was primarily peripheral blood (92%). All PTCy MMUD were HLA 7/8 (differences in HLA class I loci in 92% of patients) and received PTCy plus tacrolimus ± mofetil mycophenolate as GVHD prophylaxis. No differences were observed between PTCy MMUD and MUD in the 100-day cumulative incidence of acute GVHD grades II to IV (31% versus 22%, respectively; P = .59) and III to IV (8% versus 10%, P = .67). There was a trend for a lower incidence of moderate to severe chronic GVHD at 1 year after PTCy MMUD in comparison with MUD (22% versus 41%, P = .098). No differences between PTCy MMUD and MUD were found regarding nonrelapse mortality (25% versus 18%, P = .52) or relapse rate (11% versus 19%, P = .18). Progression-free survival and overall survival at 2 years were similar in both cohorts (67% versus 54% [HR, .84; 95% CI, .38 to 1.88; P = .68] and 72% versus 57% [HR, .71; 95% CI, .31 to 1.67; P = .44], respectively). The 2-year cumulative incidence of survival free of moderate to severe chronic GVHD and relapse tended to be higher in the PTCy MMUD group (47% versus 24%; HR, .60; 95% CI, .31 to 1.14; P = .12). We conclude that HLA 7/8 MMUD transplantation using PTCy plus tacrolimus is a suitable alternative for those patients who lack a MUD.
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Affiliation(s)
- Ana Sofia Jorge
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Arturo Pereira
- Hemotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain
| | - Gonzalo Gutierrez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Noemí Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Teresa Solano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Álvaro Urbano-Ispízua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain.
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42
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López-García A, Rovira M, Jauregui-Amezaga A, Marín P, Barastegui R, Salas A, Ribas V, Feu F, Elizalde JI, Fernández-Avilés F, Martínez C, Gutiérrez G, Rosiñol L, Carreras E, Urbano A, Lozano M, Cid J, Suárez-Lledó M, Masamunt MC, Comas D, Giner A, Gallego M, Alfaro I, Ordás I, Panés J, Ricart E. Autologous Haematopoietic Stem Cell Transplantation for Refractory Crohn's Disease: Efficacy in a Single-Centre Cohort. J Crohns Colitis 2017; 11:1161-1168. [PMID: 28419282 DOI: 10.1093/ecco-jcc/jjx054] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Haematopoietic stem cell transplantation [HSCT] is considered a therapeutic option for patients with severe Crohn's disease [CD] unresponsive to currently available therapies. METHODS Autologous HSCT was considered for CD patients with active disease, unresponsive or intolerant to approved medications and unsuitable for surgery. After HSCT, patients were closely followed up every 6 weeks during the first 2 years and every 6 months thereafter up to 5 years. Colonoscopy and/or magnetic resonance imaging were performed at Months 6, 12, 24, and 48 after HSCT. RESULTS From December 1, 2007 to December 31, 2015, 37 CD patients were assessed for HSCT. Of these, 35 patients [13 within the ASTIC trial] underwent mobilisation. Six patients did not complete the transplant for various reasons and 29 patients were finally transplanted. Patients were followed up during a median of 12 months [6-60]. At 6 months, 70% of patients achieved drug-free clinical remission (Crohn's Disease Index of Severity [CDAI] < 150). The proportion of patients in drug-free remission (CDAI < 150, Simple Endoscopic activity Score [SES]-CD < 7] was 61% at 1 year, 52% at 2 years, 47% at 3 years, 39% at 4 years, and 15% at 5 years. Patients who relapsed were re-treated and 80% regained clinical remission. Six out of the 29 [21%] required surgery. One patient died due to systemic cytomegalovirus infection 2 months after transplant. CONCLUSIONS HSCT is a salvage therapy for patients with extensive and refractory CD. Although relapse occurs in a majority of patients within 5 years after transplant, drug responsiveness is regained and clinical remission achieved in 80% of cases.
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Affiliation(s)
- Alicia López-García
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aranzazu Jauregui-Amezaga
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Marín
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rebeca Barastegui
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Azucena Salas
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Vicent Ribas
- EURECAT, Centre Tecnològic de Catalunya, Barcelona, Spain
| | - Faust Feu
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Ignasi Elizalde
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Carmen Martínez
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enric Carreras
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alvaro Urbano
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miguel Lozano
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Carme Masamunt
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dolors Comas
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Angel Giner
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Gallego
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ignacio Alfaro
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ingrid Ordás
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Julian Panés
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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43
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García-Carreño J, Sousa-Casasnovas I, Díez-Delhoyo F, Juárez-Fernández M, Devesa-Cordero C, Sarnago-Cebada F, Zatarain-Nicolás E, Martínez-Sellés M, Fernández-Avilés F. Vein thrombosis after ECMO decannulation, a frequent and sometimes missed complication. Int J Cardiol 2016; 223:538-539. [DOI: 10.1016/j.ijcard.2016.08.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/06/2016] [Indexed: 11/27/2022]
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44
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Jauregui-Amezaga A, Rovira M, Marín P, Salas A, Pinó-Donnay S, Feu F, Elizalde JI, Fernández-Avilés F, Martínez C, Gutiérrez G, Rosiñol L, Carreras E, Urbano A, Lozano M, Cid J, Suárez-Lledó M, Mensa J, Rimola J, Rodríguez S, Masamunt MC, Comas D, Ruíz I, Ramírez-Morros A, Gallego M, Ordás I, Panés J, Ricart E. Improving safety of autologous haematopoietic stem cell transplantation in patients with Crohn's disease. Gut 2016; 65:1456-62. [PMID: 26585938 DOI: 10.1136/gutjnl-2015-309836] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/24/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the feasibility and toxicity of autologous haematopoietic stem cell transplantation (HSCT) for the treatment of refractory Crohn's disease (CD). DESIGN In this prospective study, patients with refractory CD suffering an aggressive disease course despite medical treatment, impaired quality of life and in whom surgery was not an acceptable option underwent HSCT. Toxicity and complications during the procedure and within the first year following transplantation were evaluated, along with the impact of the introduction of supportive measures on safety outcomes. RESULTS 26 patients were enrolled. During mobilisation, 16 patients (62%) presented febrile neutropaenia, including one bacteraemia and two septic shocks. Neutropaenia median time after mobilisation was 5 days. 5 patients withdrew from the study after mobilisation and 21 patients entered the conditioning phase. Haematopoietic recovery median time for neutrophils (>0.5×10(9)/L) was 11 days and for platelets (>20×10(9)/L) 4 days. Twenty patients (95%) suffered febrile neutropaenia and three patients (27%) presented worsening of the perianal CD activity during conditioning. Among non-infectious complications, 6 patients (28.5%) presented antithymocyte globulin reaction, 12 patients (57%) developed mucositis and 2 patients (9.5%) had haemorrhagic complications. Changes in supportive measures over the study, particularly antibiotic prophylaxis regimes during mobilisation and conditioning, markedly diminished the incidence of severe complications. During the first 12-month follow-up, viral infections were the most commonly observed complications, and one patient died due to systemic cytomegalovirus infection. CONCLUSIONS Autologous HSCT for patients with refractory CD is feasible, but extraordinary supportive measures need to be implemented. We suggest that this procedure should only be performed in highly experienced centres.
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Affiliation(s)
| | - Montserrat Rovira
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pedro Marín
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Azucena Salas
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Susana Pinó-Donnay
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Faust Feu
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - J Ignasi Elizalde
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - Carmen Martínez
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gonzalo Gutiérrez
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enric Carreras
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alvaro Urbano
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miguel Lozano
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Cid
- Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jordi Rimola
- Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sonia Rodríguez
- Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mari Carme Masamunt
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Dolors Comas
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Irene Ruíz
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Ramírez-Morros
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Marta Gallego
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Ingrid Ordás
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Julian Panés
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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45
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de Lorenzo-Pinto A, Bueno H, Cuéllar-Basterrechea B, Herranz-Alonso A, Pérez-Sanz C, Rodríguez-González CG, Iglesias-Peinado I, Fernández-Avilés F, Sanjurjo-Sáez M. Optimisation of antithrombotic therapy in patients with acute coronary syndrome to reduce bleeding episodes. Int J Clin Pract 2016; 70:156-62. [PMID: 26709847 DOI: 10.1111/ijcp.12766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of the study was to evaluate the effectiveness of a multidisciplinary intervention to reduce the risk of bleeding associated with antithrombotic drugs in patients with acute coronary syndrome (ACS). METHODS We designed a pre-post quasi-experimental intervention study using retrospective cohorts. The first cohort was analysed to detect correctable measures contributing to bleeding (PRE: January-July 2010). Second, a bundle of interventions was implemented and third, a second cohort of patients was evaluated to investigate the impact of our measures in bleeding reduction (POST: September 2011-February 2012). RESULTS A total of 677 patients were included (377 in PRE and 300 in POST). The bundle of interventions was: Overdose avoidance measures: the percentage of patients overdosed was reduced by 66.3% (p < 0.001). Institutional protocol update to include the latest recommendations regarding bleeding prevention: In POST, the percentage of patients treated with fondaparinux increased (2.4% vs. 50.7%; p < 0.001). In PRE, 11 patients were treated with the combination of abciximab and bivalirudin; whereas in POST, only one patient received the combination (p = 0.016). Mandatory measurement of body weight: the percentage of patients with unknown body weight was reduced by 35% (p = 0.0001). In POST, the total bleeding rate was reduced by 29.2% (31.6% in PRE vs. 22.4%, p < 0.05, OR: 0.62; 95% CI: 0.44-0.88). It was necessary to implement the interventions in 11 patients to prevent one bleeding episode (95% CI: 7-39). CONCLUSION The multidisciplinary programme has been effective in reducing bleeding episodes. The interventions were effective in reducing antithrombotic drugs overdosage, incorporating the use of fondaparinux to the NSTE-ACS therapeutic arsenal, limiting the use of bivalirudin with abciximab and obtaining body weight for most patients.
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Affiliation(s)
- A de Lorenzo-Pinto
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - H Bueno
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - B Cuéllar-Basterrechea
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - A Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - C Pérez-Sanz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - C G Rodríguez-González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - F Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - M Sanjurjo-Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Martínez-Sellés M, Pérez-David E, Yotti R, Jiménez-Borreguero J, Loughlin G, Gallego L, Ayesta A, Olivera MJ, Bermejo J, Fernández-Avilés F. Gender differences in right ventricular function in patients with non-ischaemic cardiomyopathy. Neth Heart J 2015; 23:578-84. [PMID: 26446052 PMCID: PMC4651963 DOI: 10.1007/s12471-015-0753-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIM To evaluate sex-related differences in right ventricular (RV) function, assessed with cardiac magnetic resonance imaging, in patients with stable non-ischaemic dilated cardiomyopathy. METHODS Prospective multicentre study. We included 71 patients (38 men) and 14 healthy volunteers. RESULTS Mean age was 60.9 ± 12.2 years. Men presented higher levels of haemoglobin and white blood cell counts than women, and performed better in cardiopulmonary stress testing. A total of 24 patients (12 women) presented severe left ventricular (LV) systolic dysfunction, 32 (13 female) moderate and 15 (8 women) mild LV systolic dysfunction. In the group with severe LV systolic dysfunction, average right ventricular ejection fraction (RVEF) was normal in women (52 ± 4 %), whereas it was reduced in men (39 ± 3 %) p = 0.035. Only one woman (8 %) had severe RV systolic dysfunction (RVEF < 35 %) compared with 6 men (50 %) p < 0.001. In patients with moderate and mild LV dysfunction , the mean RVEF was normal in both men and women. In the 14 healthy volunteers, the lowest value of RVEF was 48 % and mean RVEF was normal in women (56 ± 2 %) and in men (51 ± 1 %), p = 0.08. CONCLUSIONS In patients with dilated cardiomyopathy, RV systolic dysfunction is found mainly in male patients with severe LV systolic dysfunction.
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Affiliation(s)
- M Martínez-Sellés
- Cardiology Department, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, and Universidad Europea de Madrid, Calle Dr. Esquerdo 46, 28007, Madrid, Spain.
| | - E Pérez-David
- Cardiology Department, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - R Yotti
- Cardiology Department, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - J Jiménez-Borreguero
- Radiology and Cardiology Departments, Hospital Universitario de la Princesa, Madrid, Spain
| | - G Loughlin
- Cardiology Department, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L Gallego
- Cardiology Department, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - A Ayesta
- Cardiology Department, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M J Olivera
- Radiology and Cardiology Departments, Hospital Universitario de la Princesa, Madrid, Spain
| | - J Bermejo
- Cardiology Department, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, and Universidad Europea de Madrid, Calle Dr. Esquerdo 46, 28007, Madrid, Spain
| | - F Fernández-Avilés
- Cardiology Department, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, and Universidad Europea de Madrid, Calle Dr. Esquerdo 46, 28007, Madrid, Spain
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Díez-del Hoyo F, Sousa I, Díez-Villanueva P, Juárez M, Fernández-Avilés F. Encefalopatía anóxica simulada por sobredosis atropínica durante la reanimación cardiopulmonar. Rev Clin Esp 2015; 215:360-1. [DOI: 10.1016/j.rce.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/02/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
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48
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Díez F, Sousa I, Juárez M, Díez-Villanueva P, Elízaga J, Fernández-Avilés F. Resucitación cardiopulmonar mediante ECMO percutáneo: una nueva herramienta en el laboratorio de hemodinámica. Med Intensiva 2015; 39:251-3. [DOI: 10.1016/j.medin.2014.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/05/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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49
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Rosiñol L, Jiménez R, Rovira M, Martínez C, Fernández-Avilés F, Marín P, Suárez-Lledó M, Gutiérrez-García G, Fernández de Larrea C, Carreras E, Urbano-Ispizua A, Bladé J. Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution. Bone Marrow Transplant 2015; 50:658-62. [PMID: 25621810 DOI: 10.1038/bmt.2014.320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/11/2014] [Accepted: 12/15/2014] [Indexed: 01/14/2023]
Abstract
The role of allogeneic hematopoietic SCT (allo-HCT) in multiple myeloma (MM) remains controversial. A total of 58 patients received an allo-HCT (25 of them with myeloablative conditioning-allo-MAC-and 33 with reduced-intensity conditioning-allo-RIC) at our institution over a 28-year period. The CR rate for allo-MAC was 36%. The incidence of grade III-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) was 28% and 39%, respectively The TRM at any time was 60% and the main causes of death were aGVHD or infectious complications not directly related to GVHD. The estimated PFS and OS at 15 years were 8% and 15%, respectively. The CR rate with allo-RIC was 45%. The incidence of grade III-IV aGVHD and cGVHD were 24% and 41%, respectively. The TRM at any time was 33% and was mainly related to aGVHD. The estimated PFS and OS at 5 years were 22% and 38%, respectively. Despite its high TRM, a proportion of patients with high-risk myeloma (early relapse and newly diagnosed ultrahigh risk) may obtain long-term disease control with allo-HCT. New approaches aimed at decreasing the incidence of aGVHD, and consequently to decrease the TRM, are needed.
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Affiliation(s)
- L Rosiñol
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain [3] Amyloid and Myeloma Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - R Jiménez
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Amyloid and Myeloma Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - M Rovira
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - C Martínez
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - F Fernández-Avilés
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - P Marín
- 1] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Hemostherapy and Hemostasis Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - M Suárez-Lledó
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - G Gutiérrez-García
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - C Fernández de Larrea
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Amyloid and Myeloma Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - E Carreras
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - A Urbano-Ispizua
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Bone Marrow Transplant Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain [3] Institut of Research Josep Carreras, Barcelona, Spain
| | - J Bladé
- 1] Hematology Department, Hospital Clínic, IDIBAPS, Barcelona, Spain [2] Amyloid and Myeloma Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain
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50
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Díez-del Hoyo F, Sanz-Ruiz R, Díez-Villanueva P, Núñez-García A, Casado-Plasencia A, Angulo-Llanos R, Clavero-Olmos M, Elízaga Corrales J, Fernández-Avilés F. A novel cardiovascular presentation of Alport Syndrome: spontaneous coronary artery dissection. Int J Cardiol 2014; 177:e133-4. [PMID: 25294178 DOI: 10.1016/j.ijcard.2014.09.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022]
Affiliation(s)
- F Díez-del Hoyo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
| | - R Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain.
| | - P Díez-Villanueva
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
| | - A Núñez-García
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
| | - A Casado-Plasencia
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
| | - R Angulo-Llanos
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
| | - M Clavero-Olmos
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio, Marañón, Madrid, Spain
| | - J Elízaga Corrales
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
| | - F Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Complutense University, Madrid, Spain
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