1
|
Pérez A, Montoro J, Chorão P, Gómez D, Guerreiro M, Giménez E, Villalba M, Sanz J, Hernani R, Hernández-Boluda JC, Lorenzo I, Navarro D, Solano C, Ljungman P, Piñana JL. Outcome of Human Parainfluenza Virus infection in allogeneic stem cell transplantation recipients: possible impact of ribavirin therapy. Infection 2024:10.1007/s15010-024-02213-0. [PMID: 38653955 DOI: 10.1007/s15010-024-02213-0] [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: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND This retrospective study focused on analyzing community-acquired respiratory virus (CARV) infections, in particular human parainfluenza virus (hPIV) after allogeneic stem cell transplant (allo-SCT) in adults recipients. It aimed to assess the impact of ribavirin treatment, clinical characteristics, and risk factors associated with lower respiratory tract disease (LRTD) progression and all-cause mortality. PATIENTS AND METHODS The study included 230 allo-SCT recipients diagnosed with hPIV between December 2013 and June 2023. Risk factors for the development of LRTD, disease severity, and mortality were analyzed. Ribavirin treatment was administered at physician discretion in 61 out of 230 cases (27%). RESULTS Risk factors for LRTD progression in multivariate analysis were corticosteroids > 30 mg/day (Odds ratio (OR) 3.5, 95% Confidence Interval (C.I.) 1.3-9.4, p = 0.013), fever at the time of hPIV detection (OR 3.89, 95% C.I. 1.84-8.2, p < 0.001), and absolute lymphocyte count (ALC) < 0.2 × 109/L (OR 4.1, 95% C.I. 1.42-11.9, p = 0.009). In addition, the study found that ribavirin therapy significantly reduced progression to LRTD [OR 0.19, 95% C.I. 0.05-0.75, p = 0.018]. Co-infections (OR 5.7, 95% C.I. 1.4-23.5, p = 0.015) and ALC < 0.2 × 109/L (OR 17.7, 95% C.I. 3.6-87.1, p < 0.001) were independently associated with higher day + 100 after hPIV detection all-cause mortality. There were no significant differences in all-cause mortality and infectious mortality at day + 100 between the treated and untreated groups. CONCLUSION ALC, corticosteroids, and fever increased the risk for progression to LRTD while ribavirin decreased the risk. However, mortality was associated with ALC and co-infections. This study supports further research of ribavirin therapy for hPIV in the allo-HSCT setting.
Collapse
Affiliation(s)
- Ariadna Pérez
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Juan Montoro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Dolores Gómez
- Microbiology Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Estela Giménez
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - Marta Villalba
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Rafael Hernani
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
| | - Juan Carlos Hernández-Boluda
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Division, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
- Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - Carlos Solano
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Per Ljungman
- Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet (KI), Huddinge, Sweden
| | - José Luis Piñana
- Department of Hematology, Hospital Clínico Universitario of Valencia, Spain. INCLIVA, Biomedical Research Institute, Valencia, Spain.
- Division of Clinical Hematology, Hospital Clinico Universitario de Valencia, Avda. Blasco Ibañez, N 17, 46010, Valencia, Spain.
| |
Collapse
|
2
|
Lorenzo I, Nogueira-Recalde U, Garcia-Dominguez C, Oreiro N, Pinto Tasende JA, Lotz M, Blanco FJ, Carames B. POS0226 DEFICIENT CHAPERONE-MEDIATED AUTOPHAGY CONTRIBUTES TO JOINT DAMAGE IN OSTEOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn Osteoarthritis (OA), defects in macroautophagy are evident and precede joint damage. Indeed, pharmacological activation of macroautophagy protects against joint damage and disease.ObjectivesTherefore, identifying hallmarks associated with specific autophagy subtypes could shed light to fundamental mechanisms of joint disease and facilitate the development of therapeutic strategies to prevent OA progression.MethodsA gene expression analysis of 35 autophagy genes was performed from blood from a Prospective OA Cohort of A Coruña (PROCOAC) of non-OA (Age:61,44±1,16 years; BMI:25,25±0,52; Females, n=18) and knee OA subjects (Age:65,50±1,05 years; BMI:29,55±0,67; Females, n=18, OA grade III-IV) by using SYBR green array. The differential expression of candidate genes in blood (n=30/group) and knee cartilage (Non-OA, n=12; Knee OA donors, n=21) was confirmed by using Taqman Technology. HSP90AA1, a chaperone mediated autophagy (CMA) mediator, was evaluated in human knee joint tissues (i.e. cartilage, meniscus, ACL and synovium) with different KL grades (0, 2 and 4, n=3/each KL grade) and in both spontaneous aging mice (2, 6, 12, 18, and 30 months old, n=3/each time) and surgically-induced OA mice (10 weeks after surgery, n=4/each) by immunohistochemistry. The functional consequences of HSP90AA1 deficiency on inflammation, oxidative stress, senescence and apoptosis were studied in human OA chondrocytes by gene and protein expression and flow cytometry. The potential contribution of CMA to chondrocyte homeostasis was studied by assessing the capacity of CMA to restore proteostasis upon macroautophagy deficiency by ATG5 knockdown. To study the therapeutic potential of targeting CMA, HSP90AA1 was overexpressed in human OA chondrocytes.Results16 autophagy-related genes were significantly downregulated in knee OA subjects (p<0.05). Macroautophagy-related genes ATG16L2, ATG12, ATG4B and MAP1LC3B, were significantly downregulated (p<0.05). Interestingly, HSP90AA1 and HSPA8, CMA mediators involved in stress response and protein folding, were significantly downregulated (p<0.001). Confirmatory studies showed a downregulation of MAP1LC3B and HSP90AA1 in blood (p<0.001) and cartilage (p<0.05) from knee OA subjects. Moreover, HSP90A was reduced in human joint tissues (i.e. cartilage, meniscus, ACL, p<0.05) and associated to OA severity. In mice, HSP90A reduction was observed not only in OA (p<0.05) but also in aging (p<0.01). LAMP2A, a key CMA mediator, was also reduced in human OA cartilage and associated with aging in mice (p<0.05). Remarkably, HSP90AA1 deficiency was functionally linked to inflammation, oxidative stress, senescence and apoptosis (p<0.05). Moreover, LAMP2A activity was decreased upon HSP90AA1 deficiency, while mTOR signaling pathway, p62 and active caspase 3 were increased (p<0.05), indicating a failure in the autophagy flux that may lead to impaired lysosomal degradation and apoptosis. Human OA chondrocytes with impaired macroautophagy through ATG5 knockdown show reduced LC3II expression and induced activation of prbs6, p16 and p21 (p<0.05). Interestingly, HSP90A was increased, suggesting a compensatory activation of CMA in response to specific macroautophagy defects. Remarkably, HSP90AA1 overexpression itself is sufficient to protect against joint damage by decreasing mTOR signaling and senescence in human OA chondrocytes.ConclusionTaking together, we identified HSP90A, a marker of CMA, as a key regulator of chondrocyte homeostasis underlying a relevant mechanism in OA. A better definition of the cross-talk between CMA and macroautophagy defects might reveal its role as a hallmark of OA.References[1]Caramés B, et al. Arthritis Rheum. 2010, 2015; 2. Caramés B, et al. Ann Rheum Dis. 2012Disclosure of InterestsNone declared
Collapse
|
3
|
Lorenzo I, Tonelli C, Bunn C, Kulshrestha S, Agnew S, Abdelsattar Z, Baker M, Luchette F. ELECTIVE INGUINAL HERNIA REPAIR: IS INCREASED RESIDENT AUTONOMY ASSOCIATED WITH EARLY POSTOPERATIVE CLINICAL OUTCOME? Am J Surg 2022; 223:475-476. [DOI: 10.1016/j.amjsurg.2022.02.021] [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: 11/01/2022]
|
4
|
André F, Rugo H, Juric D, Rubovsky G, Yamashita T, Stemmer S, Lu YS, Miller M, Lorenzo I, Hu H, Ciruelos E. 309P Antineoplastic (ANP) therapies (Tx) after alpelisib (ALP) or placebo (PBO) + fulvestrant (FUL) in patients (Pts) with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–), PIK3CA-mutated (Mut) advanced breast cancer (ABC): An analysis from SOLAR-1. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.592] [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: 11/28/2022] Open
|
5
|
Lorenzo I, Nogueira-Recalde U, Oreiro N, Pinto Tasende JA, Lotz M, Blanco FJ, Carames B. POS0375 CHAPERONE-MEDIATED AUTOPHAGY IS A HALLMARK OF JOINT DISEASE IN OSTEOARTHRITIC PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In Osteoarthritis (OA), defects in macroautophagy (autophagy) are evident and precede joint damage. Indeed, pharmacological activation of autophagy protects against joint damage.Objectives:Therefore, identifying hallmarks associated with specific autophagy subtypes could shed light to fundamental mechanisms of joint disease.Methods:A comparative analysis of 35 autophagy genes was performed from blood from the Prospective OA Cohort of A Coruña (PROCOAC). Non-OA subjects (Age:61,44±1,16 years; BMI:25,25±0,52; Females, n=18) and Knee OA subjects (Age:65,50±1,05 years; BMI:29,55±0,67; Females, n=18, OA grade III-IV) were profiled using an autophagy gene expression array by SYBR green qPCR. Confirmatory studies were performed in blood from Non-OA subjects (Age:60,13±1,12 years; BMI:24,85±0,59; Females; n=30) and Knee-OA subjects (Age:68,4±1,11 years; BMI:29,65±0,55; Females; n=30, OA grade III-IV) by Taqman qPCR. The candidate gene was evaluated in human knee joint tissues (cartilage, meniscus, ligaments, synovium) with different KL grades (Age: KL0=28,3±4,50; KL2=77±6,08; KL4=62,3±3,05, n=3) and in both spontaneous aging (2, 6, 12, 18, and 30 months old, n=3) and surgically-induced OA (10 weeks after surgery, n=4) in mice by IHC. The functional consequences were studied in T/C28a2 and primary human OA chondrocytes. Autophagy, FOXO, Chaperone-mediated autophagy (CMA), inflammation, and cellular senescence were analyzing by gene and protein expression. Moreover, oxidative stress and cell death were evaluated by FACS. The contribution of CMA to chondrocyte homeostasis was evaluated by studying the capacity of CMA to restore proteostasis upon autophagy deficiency by siATG5.Results:15 autophagy-related genes were significantly downregulated in blood from knee OA patients compared to non-OA patients. No significant upregulation was found for any studied gene, although a trend towards upregulation was found in genes involved in the mTOR pathway. Four key autophagy-related genes, including ATG16L2, ATG12, ATG4B and MAP1LC3B were found downregulated in knee OA patients. Interestingly, HSP90AA1 and HSPA8, CMA markers involved in stress response and protein folding, were downregulated. Confirmatory studies showed a significant downregulation of MAP1LC3B and HSP90AA1 in blood from knee OA patients. Remarkably, HSP90A was found reduced in femoral cartilage (medial and lateral), meniscus and ACL. Moreover, this reduction was higher in medial cartilage compared to lateral cartilage and meniscus, while in synovial membrane, HSP90A expression was found increased. This expression signature was dependent on OA grade severity. In addition, we observed a decrease of HSP90A with aging and OA in mice. The functional consequences of HSP90AA1 gene silencing are related to an increase in NFκB, MMP13, and p16 expression. Interestingly, LAMP2A, a key CMA mediator, HSPA8, MAP1LC3B and FoxO1 expression were upregulated in chondrocytes with HSP90AA1 deficiency, which might indicate an early response to maintain homeostasis. On the other hand, LAMP2A protein is decreased upon HSP90AA1 deficiency, while LC3II and p62 were increased, indicating a failure in the autophagy flux that leads to impaired lysosomal degradation.Moreover, p21, p16 and prbS6 were increased upon HSP90AA1 deficiency, besides increasing mitochondrial ROS production and apoptosis. ATG5 silencing blocks autophagy by reducing LC3II and increasing prbs6, p62, p16 and p21. Interestingly, LAMP2A and HSP90A were found increased, indicating a possible compensative activation of CMA in response to autophagy defects. These results support that HSP90A has an important role in chondrocyte homeostasis by participating in the cross-talk between CMA and autophagy.Conclusion:Taking together, we identified HSP90A, a CMA regulator, as critical in chondrocyte homeostasis. These disease mechanisms are relevant in OA and constitute hallmarks potentially useful to prevent OA progression.References:[1]Caramés B, et al. Arthritis Rheum. 2010, 2015;[2]Caramés B, et al. Ann Rheum Dis. 2012.Disclosure of Interests:None declared
Collapse
|
6
|
Romero-González G, Ravassa S, Diaz-Dorronsoro A, De la Fuente A, Garcia-Fernandez N, Rojas MA, Lorenzo I, García-Trigo I, Mateo-De Castro FM, López B, González A, Diez J. MO734CONTRIBUTION OF SOLUBLE ST2 TO THE EFFECT OF RIGHT VENTRICULAR DYSFUNCTION ON MORTALITY IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab097.0014] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Right ventricular dysfunction (RVD) has been shown to predict mortality in patients with kidney failure. It has been proposed that RVD in these patients is mediated by inflammatory and fibrotic mechanisms, which may be enhanced by hemodialysis (HD). The present study aimed to investigate the potential associations between RVD and circulating biomarkers of myocardial inflammation and fibrosis with all-cause mortality in HD patients.
Method
We performed a retrospective single-centre cohort study of prevalent patients admitted in a chronic HD program for more than 3 months. Clinical characteristics and echocardiographic parameters were assessed in all patients. Pre-dialysis blood samples for measurement of inflammatory (e.g., C reactive protein, interleukin-1, interleukin-18) and fibrotic (e.g., soluble suppression of tumorigenesis-2 [sST2], galectin-3, C-terminal pro-peptide of procollagen type I and N-terminal pro-peptide of procollagen type III) biomarkers were collected. Right ventricular dysfunction (RVD) was defined using tricuspid annular plane systolic excursion (TAPSE) <1.7 cm or pulsed Doppler peak annular velocity (S´) <9.5 cm/s. The ability of sST2 to discriminate between mortality was assessed using AuROC curve.
Results
We enrolled 48 patients (mean age 74 [64–79] years, 62.5% males) followed over a period of 1.4 years. Mortality was higher 45.5% (log-rank, p=0.003) in patients with RVD as diagnosed by S' than in patients without RVD. No difference in mortality was observed for RVD defined by TAPSE. There were no differences in the morphology and function parameters of the left ventricle between patients with and without RVD. From all biomarkers measured only sST2 was associated with RVD. Indeed, an age- and sex-adjusted analyses showed that doubling of sST2 was inversely associated with a decreased in S´ (estimate=-2.03, 95% CI [-3.04 to -1.00] cm/s; P=0.002). Mortality was increased in patients with sST2 ≥40.45 ng/mL compared to patients with sST2 <40.45 ng/mL (66.7% vs. 18.9%, log-rank; p=0.004). Crude analysis showed that patients presenting with S’ <9.5 cm/s and sST2 ≥40.45 ng/mL exhibited higher mortality (log-rank; p=0.001) than patients with S’ >9.5 cm/s and sST2 <40.45pg/mL.
Conclusion
Albeit preliminary these findings suggest that an excess of sST2 may be involved in RVD and on its effect on mortality in HD patients. The myocardial pro-remodeling effect of sST2 among HD patients with RVD warrants further investigation.
Collapse
Affiliation(s)
- Gregorio Romero-González
- Complejo Hospitalario de Navarra, Nephrology, Pamplona, Spain
- Centre for Applied Medical Research - University of Navarra, Program of Cardiovascular Disease, Pamplona, Spain
| | - Susanna Ravassa
- Centre for Applied Medical Research - University of Navarra, Program of Cardiovascular Disease, Pamplona, Spain
| | | | | | | | - Miguel A Rojas
- Clinica Universidad de Navarra, Nephrology, Pamplona, Spain
| | | | | | | | - Begoña López
- Centre for Applied Medical Research - University of Navarra, Program of Cardiovascular Disease, Pamplona, Spain
| | - Arantxa González
- Centre for Applied Medical Research - University of Navarra, Program of Cardiovascular Disease, Pamplona, Spain
| | - Javier Diez
- Centre for Applied Medical Research - University of Navarra, Program of Cardiovascular Disease, Pamplona, Spain
- Clinica Universidad de Navarra, Cardiology, Pamplona, Spain
- Clinica Universidad de Navarra, Nephrology, Pamplona, Spain
| |
Collapse
|
7
|
Boluda B, Solana-Altabella A, Cano I, Acuña-Cruz E, Rodríguez-Veiga R, Ballesta-López O, Megías-Vericat JE, Martínez-Cuadrón D, Gómez I, Solves P, Lorenzo I, Piñana JL, Sanz J, Guerreiro M, Montoro Gómez J, Díaz-González A, Marco J, Blanco A, Sanz MÁ, Montesinos P. Extracorporeal photopheresis vs standard therapies for steroid-refractory chronic graft-vs-host disease: Pharmacoeconomic assessment of hospital resource use in Spain. J Clin Apher 2021; 36:612-620. [PMID: 33964038 PMCID: PMC8453768 DOI: 10.1002/jca.21901] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022]
Abstract
Background This study assessed pharmacoeconomic costs associated with extracorporeal photopheresis (ECP) compared with other available second‐line therapies for chronic graft‐vs‐host disease (cGvHD) in a tertiary Spanish institution. Methods Patients (≥18 years) diagnosed with steroid‐refractory cGvHD were eligible. Data were collected retrospectively from index date until 1 year or relapse. Patients were distributed in two cohorts (ECP vs non‐ECP), matched by age (≤ or > 40), hematopoietic stem cell transplant (HLA‐identical sibling donor or other) and number of previous immunosuppressive lines (1, 2, or ≥ 3). Costs were assigned using the 2016 diagnosis‐related group (DRG) system: DRG 579 (€22 383) overnight stay due to major complication (ie, sepsis, pneumonia, parenteral nutrition, or respiratory failure), and DRG 875 (€5154) if no major complication. The primary endpoint was healthcare resource utilization per patient. Results Forty patients (n = 20 per cohort) were included. Median age was 49, and 37.5% were female. Mean total cost per patient was €25 319 (95% CI: €17 049–€33 590) across the two cohorts, with a slightly lower mean cost per ECP‐treated patient (€23 120) compared with the non‐ECP cohort (€27 519; P = .597). Twenty‐seven inpatient hospitalizations occurred among ECP‐treated patients, vs 33 in the non‐ECP cohort. Day hospital and external consultations were more frequent in the ECP cohort. However, fewer inpatient admissions included DRG 579 compared with the non‐ECP cohort (44% vs 58%). Inpatient length of stay was slightly shorter in the ECP cohort (30 vs 49 days; P = .298). Conclusions ECP treatment may yield economic savings in Spain through resource savings and moving costs toward outpatient care.
Collapse
Affiliation(s)
- Blanca Boluda
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Isabel Cano
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Evelyn Acuña-Cruz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Octavio Ballesta-López
- Pharmacy Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | | | - David Martínez-Cuadrón
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ines Gómez
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Solves
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jose Luis Piñana
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Manuel Guerreiro
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro Gómez
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Alvaro Díaz-González
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Javier Marco
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Albert Blanco
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Á Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Haematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| |
Collapse
|
8
|
Rodon J, Demanse D, Rugo H, André F, Janku F, Mayer I, Burris H, Simo R, Farooki A, Hu H, Lorenzo I, Quadt C, Juric D. 96MO A risk analysis of alpelisib (ALP)-induced hyperglycemia (HG) using baseline factors in patients (pts) with advanced solid tumours and breast cancer (BC): A pooled analysis of X2101 and SOLAR-1. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.110] [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: 10/21/2022] Open
|
9
|
Hernani R, Piñana JL, Pérez A, Quintero A, Montoro J, Hernández‐Boluda JC, Carretero C, Balaguer‐Roselló A, Guerreiro M, Lorenzo I, Aguilar C, Giménez E, Navarro D, Sanz MA, Sanz J, Solano C. Sirolimus versus cyclosporine in haploidentical stem cell transplantation with posttransplant cyclophosphamide and mycophenolate mofetil as graft‐versus‐host disease prophylaxis. eJHaem 2021; 2:236-248. [PMID: 35845283 PMCID: PMC9175741 DOI: 10.1002/jha2.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/12/2022]
Abstract
Sirolimus has emerged as an alternative to calcineurin inhibitors‐based (CNI) graft‐versus‐host disease (GVHD) prophylaxis. This retrospective study compares the outcome of 133 consecutive adult patients with haematological malignancies undergoing haploidentical stem cell transplantation with posttransplant cyclophosphamide (PTCy) and mycophenolate mofetil (MMF), combined with cyclosporine A (PTCy–CsA–MMF, n = 67) or sirolimus (PTCy–Sir–MMF, n = 66) as GVHD prophylaxis strategy. The median follow‐up was 48 (range 22–83) and 13 (range 3–33) months, respectively. PTCy–CsA–MMF was associated in multivariate analyses with a higher risk of acute kidney injury (HR 2.1, 95% CI, 1.21–3.57, p = .008) and thrombotic microangiopathy (HR 12.5, 95% CI, 1.66–93.5, p = .014), whereas PTCy–Sir–MMF was associated with a higher risk of hepatic sinusoidal obstruction syndrome (SOS) (HR 10.8, 95% CI, 1.52–77, p = .018), especially late‐onset forms, which totally resolved and none of the patients needed discontinuation of sirolimus. Two SOS‐related deaths were detected, both in the PTCy–CsA–MMF subgroup. Both GVHD prophylaxis strategies were otherwise comparable in terms of engraftment, GVHD incidence and survival.
Collapse
Affiliation(s)
- Rafael Hernani
- Department of Haematology Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
| | - José Luis Piñana
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
| | - Ariadna Pérez
- Department of Haematology Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
| | - Abdiel Quintero
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Juan Montoro
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Juan C. Hernández‐Boluda
- Department of Haematology Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
- Department of Medicine University of Valencia Valencia Spain
| | - Carlos Carretero
- Department of Haematology Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
| | | | - Manuel Guerreiro
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Ignacio Lorenzo
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Cristóbal Aguilar
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
| | - Estela Giménez
- Microbiology Service Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
| | - David Navarro
- Microbiology Service Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
- Department of Microbiology University of Valencia Valencia Spain
| | - Miguel A. Sanz
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
- Department of Medicine University of Valencia Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
| | - Jaime Sanz
- Department of Haematology Hospital Universitari i Politècnic La Fe Valencia Spain
- Department of Medicine University of Valencia Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
| | - Carlos Solano
- Department of Haematology Hospital Clínico Universitario Institute for Research INCLIVA Valencia Spain
- Department of Medicine University of Valencia Valencia Spain
| |
Collapse
|
10
|
Serra-Prat M, Terradellas M, Lorenzo I, Arús M, Burdoy E, Salietti A, Ramírez S, Palomera E, Papiol M, Pleguezuelos E. Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial. J Frailty Aging 2021; 11:91-99. [DOI: 10.14283/jfa.2021.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. Objective: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. Design: Randomized controlled trial with 2 parallel arms. Setting and participants: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. Intervention: 6-month multimodal intervention based on diet and a physical activity program. Control group: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. Results: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. Conclusions: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.
Collapse
|
11
|
Balaguer-Rosello A, Piñana JL, Bataller L, Montoro J, Romero S, Navarro I, Lorenzo I, Andreu R, Guerreiro M, Aguilar C, Gorriz D, Dominguez L, de la Puerta R, Gómez I, Solves P, Jarque I, Sanz MÁ, Sanz G, Sanz J. Central Nervous System Involvement in Epstein-Barr Virus-Related Post-Transplant Lymphoproliferative Disorders after Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2020; 27:261.e1-261.e7. [PMID: 33781531 DOI: 10.1016/j.jtct.2020.12.019] [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: 10/28/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 11/12/2022]
Abstract
Central nervous system (CNS) involvement in Epstein-Barr virus-related post-transplant lymphoproliferative disorders (EBV-PTLDs) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is poorly defined. We analyzed the incidence, clinical and pathological characteristics, and impact on outcomes of EBV-PTLDs with CNS involvement (CNS-PTLDs) in 1009 consecutive adult patients undergoing allo-HSCT at a single-center institution. Four hundred eighty-two patients received matched sibling donor (MSD) transplants, 388 umbilical cord blood transplants (UCBTs), 56 matched unrelated donor (MUD) transplants, and 83 haploidentical transplants. We detected 25 cases of biopsy-proven EBV-PTLDs. Of these, nine patients (36%) had CNS-PTLDs: six after UCBT (67%), one after MSD transplantation (11%), one after MUD transplantation (11%), and one after haploidentical transplantation (11%). The 5-year cumulative incidence risk of CNS-PTLDs was 0.9%. Median time from transplant to CNS-PTLDs was 187 days, and all patients had neurological symptoms at diagnosis. Six out of the nine cases (67%) occurred with systemic involvement, and three cases (33%) had isolated CNS involvement. The most frequent histological subtype was monomorphic EBV-PTLD, and laboratory characteristics were similar to EBV-PTLDs without CNS involvement. We observed statistical differences in the rate of positive EBV DNA detection in plasma between isolated CNS-PTLDs (detection in one out of three, 33%) and the rest of the EBV-PTLDs (100%) (P = .01). Treatment strategies included chemotherapy, radiotherapy, and T cell therapy. However, seven out of nine patients died due to progression of the CNS-PTLDs at a median time of 17 days (range, 8 to 163) from diagnosis. The 5-years overall survival in patients who developed CNS-PTLDs was 22% (95% confidence interval [CI], 7% to 75%) and 5-year treatment-related mortality was 78% (95% CI, 51% to 100%), with no statistically significant differences between CNS-PTLDs and the rest of the EBV-PTLDs. In conclusion, despite advances in EBV monitoring and treatment strategies, CNS-PTLDs remain an uncommon but serious complication after allo-HSCT, with very poor prognosis.
Collapse
Affiliation(s)
- Aitana Balaguer-Rosello
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
| | - José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Luis Bataller
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Samuel Romero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Irene Navarro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rafael Andreu
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Cristobal Aguilar
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - David Gorriz
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lara Dominguez
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rosalia de la Puerta
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Inés Gómez
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Solves
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| |
Collapse
|
12
|
Piñana JL, Pérez A, Montoro J, Giménez E, Gómez MD, Lorenzo I, Madrid S, González EM, Vinuesa V, Hernández-Boluda JC, Salavert M, Sanz G, Solano C, Sanz J, Navarro D. Clinical Effectiveness of Influenza Vaccination After Allogeneic Hematopoietic Stem Cell Transplantation: A Cross-sectional, Prospective, Observational Study. Clin Infect Dis 2020; 68:1894-1903. [PMID: 30239624 PMCID: PMC7108095 DOI: 10.1093/cid/ciy792] [Citation(s) in RCA: 28] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Vaccination is the primary method for preventing influenza respiratory virus infection (RVI). Although the influenza vaccine is able to achieve serological responses in some allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, its clinical benefits are still uncertain. METHODS In this prospective, cross-sectional study, we retrospectively analyzed the effect of inactivated trivalent influenza vaccination on the prevalence of influenza RVI in a consecutive cohort of 136 allo-HSCT adult recipients who developed 161 RVI over 5 flu seasons (from 2013 to 2018). Respiratory viruses in upper- and/or lower-respiratory tract specimens were tested using multiplex polymerase chain reaction panel assays. RESULTS Overall, we diagnosed 74 episodes (46%) of influenza RVI in 70 allo-HSCT recipients. Influenza RVI occurred in 51% of the non-vaccinated compared to 36% of the vaccinated recipients (P = .036). A multivariate analysis showed that influenza vaccination was associated with a lower prevalence of influenza RVI (odds ratio [OR] 0.39, P = .01). A multivariate risk factor analysis of lower-respiratory tract disease (LRTD) identified 2 conditions associated with the probability of influenza RVI progression: influenza vaccination (OR 0.12, 95% confidence interval [CI] 0.014-1, P = .05) and a high-risk immunodeficiency score (OR 36, 95% CI 2.26-575, P = .011). Influenza vaccination was also associated with a lower likelihood of an influenza-related hospital admission (14% vs 2%, P = .04). CONCLUSIONS This study shows that influenza vaccination may have a clinical benefit in allo-HSCT recipients with virologically-confirmed RVI, in terms of a lower influenza RVI prevalence, slower LRTD progression, and lower likelihood of hospital admission.
Collapse
Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ariadna Pérez
- Hematology Department, Institute for Research INCLIVA, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Estela Giménez
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Spain
| | | | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Silvia Madrid
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Spain
| | - Eva María González
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Spain
| | - Víctor Vinuesa
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Spain
| | | | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carlos Solano
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Spain.,Department of Medicine, School of Medicine, University of Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Spain
| |
Collapse
|
13
|
Romero-González G, Diaz-Dorronsoro A, De la Fuente A, Ravassa S, Garcia-Fernandez N, Martin-Moreno PL, Lavilla J, González O, Rojas MA, Lorenzo I, García-Trigo I, Ania N, Osácar E, Sabalza A, Amézqueta P, López B, González A, Diez J. P1309RIGHT VENTRICULAR-PULMONARY ARTERIAL UNCOUPLING IN PATIENTS ON CHRONIC HEMODIALYSIS WITH SEVERE RIGHT VENTRICULAR REMODELING. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1309] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Patients on chronic hemodialysis (HD) may present right ventricular (RV) dysfunction and increased pulmonary artery pressure (PA). The aim of the current study is to describe the RV-PA coupling in chronic patients on HD.
Method
This study explored the adequacy of RV-PA coupling in 41 patients on HD. They underwent a comprehensive transthoracic Doppler echocardiography, and were stratified in accordance with the severity of RV remodeling defined by the presence of RV dilation (tricuspid annulus ≥40 mm) and RV systolic dysfunction (tricuspid annulus systolic excursion plane [TAPSE] <17 mm). RV-PA coupling was estimated by the TAPSE to PA systolic pressure (TAPSE:PASP) ratio.
Results
Three groups of patients were identified: No RV remodeling (Group 1, n=26), mild-to-moderate RV remodeling (Group 2, n=11) and severe RV remodeling (Group 3, n=4). Compared to patients from Groups 1 and 2, patients from Group 3 exhibited significant lower TAPSE values (p<0.001), a tendency to higher PASP values (p=0.054) and significant lower TAPSE:PASP ratio values (p=0.012). C-reactive protein levels and were directly correlated with PASP (r=0.405, p=0.017) and inversely with TAPSE (r=-0.311, p=0.041) and the TAPSE:PASP ratio (r= -0.392, p=0.015) in all patients. These echocardiographic parameters were not correlated with other biochemical, hemodynamic or anthropometric parameters.
Conclusion
These findings suggest that RV-PA coupling is markedly decreased in HD patients with severe RV remodeling. The role of systemic inflammation in RV remodeling and RV-PA uncoupling in HD patients warrants further studies.
Collapse
Affiliation(s)
- Gregorio Romero-González
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
- CIMA (Center for Applied Medical Research) University of Navarre, Cardiovascular Disease, Pamplona, Spain
| | - Agnes Diaz-Dorronsoro
- CIMA (Center for Applied Medical Research) University of Navarre, Cardiovascular Disease, Pamplona, Spain
- University of Navarra Clinic, Cardiology Department, Pamplona, Spain
| | - Ana De la Fuente
- University of Navarra Clinic, Cardiology Department, Pamplona, Spain
| | - Susanna Ravassa
- CIMA (Center for Applied Medical Research) University of Navarre, Cardiovascular Disease, Pamplona, Spain
| | | | | | - Javier Lavilla
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Omar González
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Miguel A Rojas
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Ignacio Lorenzo
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | | | - Noelia Ania
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Elena Osácar
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Ana Sabalza
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Pilar Amézqueta
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
| | - Begoña López
- CIMA (Center for Applied Medical Research) University of Navarre, Cardiovascular Disease, Pamplona, Spain
| | - Arantxa González
- CIMA (Center for Applied Medical Research) University of Navarre, Cardiovascular Disease, Pamplona, Spain
| | - Javier Diez
- University of Navarra Clinic, Nephrology Department, Pamplona, Spain
- CIMA (Center for Applied Medical Research) University of Navarre, Cardiovascular Disease, Pamplona, Spain
- University of Navarra Clinic, Cardiology Department, Pamplona, Spain
| |
Collapse
|
14
|
Pérez A, Montoro J, Hernani R, Lorenzo I, Hernández‐Boluda JC, Giménez E, Gómez MD, Balaguer‐Roselló A, Gonzalez‐Barberá E, Guerreiro M, Aguilar C, Navarro D, Solano C, Sanz J, Piñana JL. Assessment of immunodeficiency scoring index performance in enterovirus/rhinovirus respiratory infection after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2020; 22:e13301. [DOI: 10.1111/tid.13301] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Ariadna Pérez
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
| | - Juan Montoro
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - Rafael Hernani
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
| | - Ignacio Lorenzo
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - Juan Carlos Hernández‐Boluda
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
| | - Estela Giménez
- Microbiology Service Hospital Clínico Universitario Valencia Spain
| | - María Dolores Gómez
- Department of Microbiology School of Medicine University of Valencia Valencia Spain
| | | | - Eva Gonzalez‐Barberá
- Department of Microbiology School of Medicine University of Valencia Valencia Spain
| | - Manuel Guerreiro
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - Cristóbal Aguilar
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
| | - David Navarro
- Department of Medicine School of Medicine University of Valencia Valencia Spain
- Microbiology Service Hospital Clínico Universitario Valencia Spain
| | - Carlos Solano
- Department of Hematology Hospital Clínico Universitario Fundación INCLIVA Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
| | - Jaime Sanz
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
- Department of Medicine School of Medicine University of Valencia Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
| | - José Luis Piñana
- Department of Hematology Hospital Universitari I Politècnic la Fe Valencia Spain
- CIBERONC Instituto Carlos III Madrid Spain
| |
Collapse
|
15
|
Montoro J, Sanz J, Lorenzo I, Balaguer-Roselló A, Salavert M, Gómez MD, Guerreiro M, González Barberá EM, Aguado C, Tofán L, Sanz GF, Sanz MA, Piñana JL. Community acquired respiratory virus infections in adult patients undergoing umbilical cord blood transplantation. Bone Marrow Transplant 2020; 55:2261-2269. [PMID: 32415227 PMCID: PMC7227453 DOI: 10.1038/s41409-020-0943-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 01/24/2023]
Abstract
Characteristics and risk factors (RFs) of community-acquired respiratory virus (CARV) infections after umbilical cord blood transplantation (UCBT) are lacking. We retrospectively analyzed CARV infections in 216 single-unit myeloablative UCBT recipients. One-hundred and fourteen episodes of CARV infections were diagnosed in 62 (29%) patients. Upper respiratory tract disease (URTD) occurred in 61 (54%) whereas lower respiratory tract disease (LRTD) in 53 (46%). The 5-year cumulative incidence of CARV infection was 29%. RFs for developing CARV infections were: prednisone-based graft-versus-host disease (GVHD) prophylaxis and grade II–IV acute GVHD. RFs analysis of CARV progression to LRTD identified 2007–2009 period and absolute lymphocyte count (ALC) < 0.5 × 109/L. ALC < 0.5 × 109/L had a negative impact on day 60 mortality in both overall CARV and those with LRTD, whereas proven LRTD was associated with higher day 60 mortality. CARV infections had a negative effect on non-relapse mortality. Overall survival at day 60 after CARV detection was significantly lower in recipients with LRTD compared with URTD (74% vs. 93%, respectively). In conclusion, CARV infections after UCBT are frequent and may have a negative effect in the outcomes, in particular in the context of lymphocytopenia.
Collapse
Affiliation(s)
- Juan Montoro
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | - Jaime Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ignacio Lorenzo
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | | | - Miguel Salavert
- Department of Infectious Diseases, University Hospital La Fe, Valencia, Spain
| | | | - Manuel Guerreiro
- Department of Hematology, University Hospital La Fe, Valencia, Spain
| | | | - Cristina Aguado
- Department of Laboratory Medicine, University Hospital La Fe, Valencia, Spain
| | - Luiza Tofán
- Department of Laboratory Medicine, University Hospital La Fe, Valencia, Spain
| | - Guillermo F Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Miguel A Sanz
- Department of Hematology, University Hospital La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Department of Hematology, University Hospital La Fe, Valencia, Spain. .,CIBERONC, Instituto Carlos III, Madrid, Spain.
| |
Collapse
|
16
|
Ciruelos E, Delea T, Moynahan A, Mayer I, Park J, Chandiwana D, Ridolfi A, Lorenzo I, Rugo H. 163P Population-adjusted comparison of SOLAR-1 and BOLERO-2: PFS with second-line alpelisib + fulvestrant vs everolimus + exemestane in postmenopausal pts with PIK3CA-mut hormone-receptor positive (HR+) human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.263] [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: 10/24/2022] Open
|
17
|
Piñana J, Montoro J, Aznar C, Lorenzo I, Gómez MD, Guerreiro M, Carretero C, González-Barberá EM, Balaguer-Roselló A, Sanz R, Salavert M, Navarro D, Sanz MA, Sanz G, Sanz J. The clinical benefit of instituting a prospective clinical community-acquired respiratory virus surveillance program in allogeneic hematopoietic stem cell transplantation. J Infect 2020; 80:333-341. [PMID: 31972212 PMCID: PMC7112613 DOI: 10.1016/j.jinf.2019.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 09/25/2019] [Revised: 11/11/2019] [Accepted: 12/05/2019] [Indexed: 02/06/2023]
Abstract
Rapid detection methods used as first diagnostic test for CARVs may delayed the start of antiviral therapy in a significant number of influenza and RSV cases. Syndromic multiplex RT-PCR-based prospective clinical CARV survey in allo-HCT recipients translates into a lower mortality rate as compared to standard clinical practice based on RSV and influenza virus rapid detection test. We found that donor/recipient HLA mismatch, CARV LRTD and high-risk ISI were also associated with higher mortality.
Background There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections. Methods We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center. Results CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs. 57%, hospital admission 69% vs. 28% and lower respiratory tract 58% vs. 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs. 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs. 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n = 23, 37% vs. n = 10, 7%, p < 0.0001). Multivariate logistic regression analysis showed that recipients included in ProClinCarvSur-P had lower mortality rate [odds ratio 0.31, 95% confidence interval 0.12–0.7, p = 0.01]. Conclusion This study report on outcome differences when reporting retrospective vs. prospective CARV infections after allo-HCT. Recipients included in a ProClinCarvSur-P had lower mortality.
Collapse
Affiliation(s)
- JoséLuis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain.
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carla Aznar
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Dolores Gómez
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Rosa Sanz
- Outpatient hematology/Oncology nursing unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| |
Collapse
|
18
|
Lorenzo I, Li Z, Torres M, Machaty Z, Nolte D. 1 Assessing the energy status of porcine embryos by means of biodynamic imaging. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Assisted reproductive technologies are powerful tools for enhancing production in livestock or treating infertility in humans. Unfortunately, the success rate of the technologies is rather low. A major reason for the poor efficiency is the lack of methods to reliably assess the developmental potential of the embryos before transfer into recipients. Therefore, a noninvasive method to ensure the selection of only the best embryos for transfer would be highly desirable. Biodynamic imaging is a compelling new microscopy that uses intracellular Doppler spectroscopy to perform label-free, noninvasive optical measurements of cellular fitness. The aim of this study was to investigate whether biodynamic imaging can be used to assess the energy status of the embryos, which may be indicative of their viability. Porcine oocytes matured invitro were parthenogenetically activated by an electrical pulse and cultured for 2 days. The parthenotes were then divided into two groups, and approximately half of them were incubated for an additional 2 days in the presence of 20mM sodium azide. Sodium azide is an inhibitor of oxidative phosphorylation and is known to block ATP production. The rest of the embryos were cultured without sodium azide and used as a control to indicate normal ATP levels. At the end of the culture period embryos that reached the 8- to 16-cell stage were evaluated by our biodynamic imaging system to assess their energy status, after which they were lysed and their ATP contents were determined by means of a bioluminescence assay. A total of 68 embryos (32 treated with the inhibitor and 36 control) were evaluated. The ATP content analysis showed that the control embryos had significantly more ATP than those treated with sodium azide as determined by Student's t-test (5.04±1.07 vs. 1.31±0.57; P<0.05). A correlative study was then completed where biodynamic biomarkers were used to classify embryos to estimate the ability of biodynamic imaging to identify embryos with high or low energy status. A set of 13 biomarkers representing each embryo as a feature vector was used to train a classifier. We found that the cross-validated classifier had a sensitivity and specificity of ~80%. In addition, a receiver-operator curve constructed by varying the ATP threshold of the independent bioluminescence assay had an area-under-the-curve of 0.81. These results indicate that biodynamic imaging is able to determine the energy status of the embryos noninvasively and has great potential in the assessment of embryo viability.
Collapse
|
19
|
Sanz J, Montoro J, Solano C, Valcárcel D, Sampol A, Ferrá C, Parody R, Lorenzo I, Montesinos P, Ortí G, Hernández-Boluda JC, Balaguer-Roselló A, Guerreiro M, Carretero C, Sanz GF, Sanz MA, Piñana JL. Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies. Biol Blood Marrow Transplant 2019; 26:358-366. [PMID: 31655119 DOI: 10.1016/j.bbmt.2019.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 07/17/2019] [Revised: 09/30/2019] [Accepted: 10/12/2019] [Indexed: 12/19/2022]
Abstract
In this prospective randomized study, we compared the outcomes of single-unit umbilical cord blood transplantation (UCBT) and unmanipulated haploidentical stem cell transplantation (haplo-SCT) with post-transplantation cyclophosphamide (PTCy) in adults with hematologic malignancies. All patients received a myeloablative conditioning (MAC) regimen consisting of thiotepa, busulfan, and fludarabine, with antithymocyte globulin (ATG) added for UCBT recipients. Nineteen patients were randomized to UCBT and the other 26 to haplo-HSCT. Four patients (15%) allocated to the haplo-HSCT arm lacked a suitable donor and were crossed over to the UCBT arm. Finally, 23 underwent UCBT and 22 underwent haplo-HSCT. The cumulative incidence of neutrophil recovery was 87% at a median of 19 days (range, 13 to 24 days) in the UCBT arm versus 100% at a median of 17 days (range, 13 to 25 days) in the haplo-SCT arm (P = .04). Platelet recovery was 70% at a median of 40 days (range, 18 to 129 days) in the UCBT arm versus 86% at a median of 24 days (range, 12 to 127 days) in the haplo-HCT arm (P = .02). Rates of acute graft-versus-host disease (GVHD) grade II-IV or grade III-IV, overall chronic GVHD, and extensive chronic GVHD in the UCBT and Haplo-SCT arms were 43% versus 36% (P = .8), 9% versus 9% (P = 1), 66% versus 43% (P = .04), and 41% versus 23% (P = .2), respectively. Two-year nonrelapse mortality and relapse in the 2 arms were 52% versus 23% (P = .06) and 17% versus 23% (P = .5), respectively. Two-year disease-free survival, overall survival, and GVHD/relapse-free survival in the 2 arms were 30% versus 54% (P = .2), 35% versus 59% (P = .1), and 17% versus 40% (P = .04), respectively. Our data show that in the context of an MAC regimen, haplo-SCT with PTCy provides improved outcomes compared with ATG-containing single-unit UCBT.
Collapse
Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cancer, Instituto Carlos III, Madrid, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Carlos Solano
- Department of Medicine, University of Valencia, Valencia, Spain; Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - David Valcárcel
- Hematology Department, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Antonia Sampol
- Hematology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Christelle Ferrá
- Hematology Department, Institut Català d'Oncologia, Institut de Recerca contra la Leucemia Josep Carreras, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Rocío Parody
- Hematology Department, Instituto Catalán de Oncología-Hospital Duran i Reynals, Barcelona, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cancer, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cancer, Instituto Carlos III, Madrid, Spain
| | - Guillermo Ortí
- Hematology Department, Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | - Juan C Hernández-Boluda
- Department of Medicine, University of Valencia, Valencia, Spain; Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Aitana Balaguer-Roselló
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Guillermo F Sanz
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cancer, Instituto Carlos III, Madrid, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cancer, Instituto Carlos III, Madrid, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - José Luis Piñana
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Cancer, Instituto Carlos III, Madrid, Spain
| |
Collapse
|
20
|
Rugo H, André F, Yamashita T, Cerda H, Toledano I, Stemmer S, Cruz Jurado J, Juric D, Mayer I, Ciruelos E, Iwata H, Conte P, Campone M, Wilke C, Mills D, Lorenzo I, Miller M, Loibl S. Alpelisib (ALP) + fulvestrant (FUL) for patients with hormone receptor–positive (HR+), HER2− advanced breast cancer (ABC): Management and time course of key adverse events of special interest (AESIs) in SOLAR-1. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
21
|
Campone M, Rugo H, Rubovszky G, André F, Loibl S, Iwata H, Conte P, Mayer I, Juric D, Yamashita T, Lorenzo I, Ridolfi A, Ciruelos E. Alpelisib (ALP) + fulvestrant (FUL) in hormone-receptor positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC): Subgroup analysis by presence of visceral metastasis (VM) in the SOLAR-1 trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.037] [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: 11/14/2022] Open
|
22
|
Hernando Cubero J, Taberna Sanz M, Carmona Bayonas A, Iglesias L, Grande E, Trigo Perez J, Grau J, Lopez-Picazo J, Castelo B, Alonso Gordoa T, Lorenzo I, Casado Herraez A, Ugidos L, Munarriz J, Lavernia J, Capdevila J. Durvalumab plus tremelimumab for the treatment of patients (pts) with refractory and progressive advanced thyroid carcinoma: A phase II multicohort trial (DUTHY / GETNE T1812). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz267.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
Sanz J, Moscardó F, Montoro J, Cano I, Guerreiro M, Dasí MA, Solves P, Lorenzo I, Gómez-Segui I, Montesinos P, Mora E, Arnao M, Sempere A, Jarque I, Carretero C, Senent L, Vicente A, Andreu R, Luna I, Balaguer-Roselló A, Carpio N, Sanz GF, Sanz MA, Piñana JL. Partial T Cell-Depleted Peripheral Blood Stem Cell Transplantation from HLA-Identical Sibling Donors for Patients with Severe Aplastic Anemia. Biol Blood Marrow Transplant 2019; 26:83-87. [PMID: 31493538 DOI: 10.1016/j.bbmt.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/07/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
Abstract
We analyzed the outcomes of 26 consecutive patients with acquired severe aplastic anemia (SAA) undergoing peripheral blood stem cell transplantation (PBSCT) with partial ex vivo T cell depletion with a targeted T cell dose from HLA-identical sibling donors. The median patient age was 37 years (range, 3 to 63 years). Four patients with uncontrolled pneumonia at the time of transplantation died, on days +1, +2, +21, and +26. All evaluable patients engrafted, with a median time to neutrophil recovery of 11 days (range, 10 to 14 days) and a median time to platelet recovery of 19 days (range, 8 to 53 days). Two patients had transient grade I acute graft-versus-host disease (GVHD) with skin involvement, but no patients developed grade II-IV acute GVHD. Two patients had mild skin chronic GVHD, and 1 patient had moderate chronic GVHD with ocular involvement. No relapse was observed after a median follow-up of 114 months (range, 4 to 233 months). The overall cumulative incidence of TRM at 10 years was 19%, whereas it was 5% for those with a Karnofsky Performance Status (KPS) score >60 at the time of transplantation. Disease-free survival, overall survival, and GVHD and relapse-free survival at 10 years were 81%, 81%, and 80%, respectively, for all patients and 95%, 95%, and 90%, respectively, for patients with a KPS score >60 at transplantation. Our data indicate that PBSCT with partial ex vivo T cell-depleted targeted cell dose grafts from an HLA-identical sibling donor is a feasible, safe, and effective approach to reduce GVHD and cure patients with SAA.
Collapse
Affiliation(s)
- Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain.
| | - Federico Moscardó
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isabel Cano
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María A Dasí
- Hematology Unit, Department of Pediatrics, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Solves
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Inés Gómez-Segui
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Elvira Mora
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Mario Arnao
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Amparo Sempere
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Isidro Jarque
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Leonor Senent
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain
| | - Ana Vicente
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Rafael Andreu
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Irene Luna
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Nelly Carpio
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Guillermo F Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Miguel A Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigacion Biomédica en Red de Cáncer, Instituto Carlos III, Madrid, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain
| | - José L Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
24
|
Piñana JL, Gómez MD, Montoro J, Lorenzo I, Pérez A, Giménez E, González-Barberá EM, Carretero C, Guerreiro M, Salavert M, Sanz G, Hernández-Boluda JC, Borrás R, Sanz J, Solano C, Navarro D. Incidence, risk factors, and outcome of pulmonary invasive fungal disease after respiratory virus infection in allogeneic hematopoietic stem cell transplantation recipients. Transpl Infect Dis 2019; 21:e13158. [PMID: 31402532 PMCID: PMC7169787 DOI: 10.1111/tid.13158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/04/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is growing evidence that community-acquired respiratory virus (CARV) increases the risk of pulmonary invasive fungal disease (IFD) in the allogeneic hematopoietic stem cell transplantation (allo-HSCT) setting. To date, there is a lack of knowledge regarding the risk factors (RFs), as well as the most critical period for subsequent onset of IFD after CARV infections in allo-HSCT recipients. METHODS In this prospective longitudinal observational CARV survey, we analyzed the effect of CARV on subsequent IFD development in 287 adult allo-HSCT recipients diagnosed with 597 CARV episodes from December 2013 to December 2018. Multiplex PCR panel assays were used to test CARVs in respiratory specimens. FINDINGS Twenty-nine out of 287 allo-HSCT recipients (10%) developed IFD after a CARV episode. The median time of IFD onset was 21 days (range, 0-158 days) from day of the first CARV detection. Generalized estimating equation model identified 4 risk factors for IFD: ATG-based conditioning regimen [odds ratio (OR) 2.34, 95% confidence interval (CI) 1.05-5.2, P = .038], CARV lower respiratory tract disease (OR 10.6, 95% CI 3.7-30.8, P < .0001), CARV infection during the first year after transplant (OR 5.34, 95% CI 1.3-21.8, P = .014), and corticosteroids during CARV (OR 2.6, 95% CI 1.1-6.3, P = .03). CONCLUSION Allo-HSCT recipients conditioned with ATG and under corticosteroid therapy at the time of CARV LRTD during the first year after transplant may require close monitoring for subsequent IFD.
Collapse
Affiliation(s)
- José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - María Dolores Gómez
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | - Estela Giménez
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | | | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Rafael Borrás
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain.,Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain.,Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| |
Collapse
|
25
|
Boluda B, Rodríguez-Veiga R, Martínez-Cuadrón D, Lorenzo I, Sanz J, Regadera A, Sempere A, Senent L, Cervera JV, Solves P, Reitan J, Gea S, Sanz MA, Montesinos P. Time and Cost of Hospitalisation for Salvage Therapy in Adults with Philadelphia Chromosome-Negative B Cell Precursor Relapsed or Refractory Acute Lymphoblastic Leukaemia in Spain. Pharmacoecon Open 2019; 3:229-235. [PMID: 30324566 PMCID: PMC6533337 DOI: 10.1007/s41669-018-0098-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Philadelphia chromosome-negative (Ph-) relapsed or refractory (R/R) B-cell precursor acute lymphoblastic leukaemia (ALL) is rare, and information on its impact on healthcare systems is scarce. OBJECTIVE To quantify the time and reimbursement associated with hospitalisations of patients with R/R ALL in a Spanish hospital. METHODS Retrospective review of medical charts identified patients aged ≥ 18 years with Ph- R/R ALL hospitalised between 1998 and 2014. Data were collected from the date of first diagnosis of R/R ALL (index) until death or loss to follow-up. The primary endpoint was the proportion of time hospitalised during chemotherapy. Reimbursement associated with hospitalisations (including associated chemotherapy) was also assessed. RESULTS Thirty-two patients were eligible for inclusion. Their median age was 41 years, and 50% had a first remission duration of ≤ 1 year; 34% had undergone allogeneic haematological stem-cell transplantation (alloHSCT). Overall, 31 patients had received intensive salvage chemotherapy, during which there were 42 hospitalisations (mean 1.4/patient; mean duration 26 days). Patients spent a mean of 71% of the chemotherapy period in hospital. Total mean reimbursement was €26,417 per patient, almost all (€25,723) attributable to inpatient stays (€18,986/hospitalisation). From the index date to death or loss to follow-up (excluding alloHSCT-related hospitalisations), there were 80 hospitalisations (mean duration 24 days); mean reimbursement was €16,692 per hospitalisation and €41,730 per patient. AlloHSCT (n = 8) involved 18 hospitalisations (mean reimbursement €39,782/hospitalisation; €89,510/patient). CONCLUSION Data from this sample of patients suggest that hospitalisations in R/R ALL are lengthy and associated with high costs in Spain.
Collapse
Affiliation(s)
- Blanca Boluda
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - David Martínez-Cuadrón
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ignacio Lorenzo
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ana Regadera
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Amparo Sempere
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Leonor Senent
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jose Vicente Cervera
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pilar Solves
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | | | - Miguel Angel Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain.
- CIBERONC, Instituto Carlos III, Madrid, Spain.
| |
Collapse
|
26
|
Lavilla Royo FJ, Alfaro C, Gonzalez O, Rojas M, Lorenzo I, Romero-Gonzalez G, Paloma M, Garcia-Fernandez N. FP317USE OF CORPORAL AND HEMODINAMIC BIOIMPEDANCE IN ACUTE KIDNEY INJURY. PROGNOSIS AND EFFICIENCY IN PATIENT MANAGEMENT. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Balaguer-Rosello A, Bataller L, Piñana JL, Montoro J, Lorenzo I, Villalba A, Freiria C, Santiago M, Sevilla T, Muelas N, Guerreiro M, Carretero C, Gómez I, Solves P, Sanz MÁ, Sanz G, Sanz J. Noninfectious Neurologic Complications after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1818-1824. [PMID: 31132454 DOI: 10.1016/j.bbmt.2019.05.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 04/01/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/19/2022]
Abstract
Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be associated with neurologic complications, data on noninfectious etiologies are scanty. Therefore, we analyzed the incidence, clinical characteristics, risk factors, and influence on outcomes of noninfectious neurologic complications (NCs) in 971 consecutive patients with hematologic malignancies undergoing allo-HSCT at our center between January 2000 and December 2016. We evaluated NCs affecting the central nervous system (CNS) and peripheral nervous system (PNS). The median duration of follow-up of survivors was 71 months (range, 11 to 213 months). A total of 467 patients received a matched sibling donor (MSD) transplant, 381 received umbilical cord blood (UCB), 74 received a haploidentical transplant, and 49 received a matched unrelated donor (MUD) transplant. One hundred forty-nine (15.3%) NCs were documented at a median of 78 days after transplantation (range, 5 days before to 3722 days after). The cumulative incidence risk of developing NC was 7.5% (95% confidence interval, 6% to 8.2%) at day +90 and 13% at 5 years. The 5-year cumulative incidence of NCs was 10.8% after MSD allo-HSCT and 15.3% after alternative donor (UCB, MUD, haploidentical) allo-HSCT (P = .004). There were 101 (68%) CNS complications, including encephalopathy, n = 46 (31%); headache, n = 20 (13%); stroke, n = 15 (10%); seizures, n = 9 (6%), posterior reversible encephalopathy syndrome, n = 6 (4%), and myelopathy, n = 5 (3%). PNS complications (32%) included neuropathies, n = 25 (17%), and myopathies and neuromuscular junction disorders, n = 23 (17%), with 17% of the total PNS complications being immune-related. In multivariable analysis, donor type other than MSD, age ≥40 years, development of acute graft-versus-host disease (GVHD) grade II-IV (hazard ratio [HR], 3.3; P < .00001), and extensive chronic GVHD (HR, 3.2; P = .0002) were independently associated with increased risk of NCs. The 5-year overall survival (OS) was 21% in patients who developed NCs and 41% for those who did not (P < .0001). This difference in OS was observed in patients developing CNS NCs, but not in those developing PNS complications. In conclusion, our study reveals NCs as a frequent and heterogeneous complication that, when affecting CNS, is associated with poor prognosis following allo-HSCT.
Collapse
Affiliation(s)
| | - Luis Bataller
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana Villalba
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carmen Freiria
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marta Santiago
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Teresa Sevilla
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Nuria Muelas
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Inés Gómez
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pilar Solves
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; CIBERONC, Instituto Carlos III, Madrid, Spain
| |
Collapse
|
28
|
Lorenzo I, Calvo-Ortega J, Femenia SM, Laosa-Bello C, Casals J. EP-2182 Skin dose calculation in breast cancer when the air surrounding the patient contour is considered. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32602-7] [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: 10/26/2022]
|
29
|
Centellas-Pérez FJ, Tébar A, Llamas F, Lorenzo I, Sarduy P, Martínez-Díaz M, Martínez-Antolinos C, Piqueras-Sánchez S, Cucchiari D, Masiá-Móndejar J, Ortega-Cerrato A, Gómez-Roldán C. Analysis of Kidney Donation and Its Relationship With Graft Failure of the Recipient at 1 Year. Transplant Proc 2019; 51:314-320. [PMID: 30879531 DOI: 10.1016/j.transproceed.2018.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/29/2018] [Accepted: 12/09/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Currently, the shortage of organs available for kidney transplantation and a change in donors' and recipients' profiles (elderly, with cardiovascular risk, donors after cardiac death), it is becoming necessary to assess grafts from expanded-criteria donors (ECD) in order to have methods that allow us to predict viability and graft survival. OBJECTIVE The aim of this study was to analyze the different methods of renal donor assessment (estimated glomerular filtration rate [eGFR], preimplantation biopsy, and Kidney Donor Profile Index [KDPI] score) as predictors of graft survival and renal function of our recipient at 1 year. METHODS We performed a descriptive and retrospective study of 183 deceased donor kidney transplantations performed at our center between 2011 and 2015. We calculated the KDPI scores, donor eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration Formula equation, and biopsies were evaluated using Banff classification. RESULTS ECDs comprised 59.60%, 93% of donors had an eGFR ≥ 60 mL/min/1.73 m2, and 41% presented with a KDPI score ≥ 90%. The most frequent range in the biopsy score was 0-3. The 1-year graft survival rate was 86.90%. Factors that negatively influenced graft survival were donor/recipient age, ECD, KDPI, and cold ischemia time (CIT). CONCLUSION Prolonged CIT and KDPI ≥ 90% were donor variables that were related to graft failure at 1 year in our center.
Collapse
Affiliation(s)
- F J Centellas-Pérez
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - A Tébar
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - F Llamas
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - I Lorenzo
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Pablo Sarduy
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - M Martínez-Díaz
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - C Martínez-Antolinos
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - S Piqueras-Sánchez
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - D Cucchiari
- Nephrology and Renal Transplant Unit, Hospital Clinic, Barcelona, Spain
| | - J Masiá-Móndejar
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - A Ortega-Cerrato
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - C Gómez-Roldán
- Nephrology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| |
Collapse
|
30
|
Rodríguez-Veiga R, Montesinos P, García E, Boluda B, Rojas R, Serrano J, Martínez-Cuadrón D, Martín C, Sanz J, Tabares S, Piñana JL, Lorenzo I, Montoro J, Salavert M, Pemán J, Jarque I, Solves P, Sanz GF, Torres A, Sanz MA. Validation of a multivariable prediction model for post-engraftment invasive fungal disease in 465 adult allogeneic hematopoietic stem cell transplant recipients. Mycoses 2019; 62:418-427. [PMID: 30633829 DOI: 10.1111/myc.12891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/05/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Recently, we reported a simple prognostic score for post-engraftment invasive fungal disease (IFD) obtained in 404 adult allogeneic hematopoietic stem cell transplant (alloSCT) (training cohort). OBJECTIVES We aim to validate this score in an external cohort assessing the 1-year cumulative incidence (CI) of post-engraftment IFD. Additionally, we analyse the type of IFD and incidence of IFD according to type of prophylaxis. PATIENTS/METHODS We included 465 consecutive adult recipients surviving >40 days who engrafted and were discharged without prior IFD (median age 45 years, range, 14-69). RESULTS Patients classified as low-risk, 139; intermediate-risk, 162; and high-risk, 164 (35% vs 27% in the training cohort, P = 0.03). The CI of probable/proven IFD in the validation cohort was 8% vs 11% in the training cohort (P = 0.006). The only voriconazole prophylaxis used in the training cohort was 100 mg/12 h, 65% vs 27% in the validation cohort, but 38% received 200 mg/12 h. Thus, the validation cohort showed a lower CI of IFD (P = 0.009). The post-engraftment IFD score was validated, showing a CI of IFD for low-, intermediate- and high-risk of 3%, 6% and 14%, respectively (P < 0.001). CONCLUSION To our knowledge, this is the first prognostic index to predict the occurrence of post-engraftment IFD after alloSCT that has been validated in an external cohort.
Collapse
Affiliation(s)
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Estefanía García
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Blanca Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Rafael Rojas
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Josefina Serrano
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - David Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Carmen Martín
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Jaime Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Salvador Tabares
- Department of Hematology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - José L Piñana
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Ignacio Lorenzo
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Juan Montoro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Javier Pemán
- Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Isidro Jarque
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pilar Solves
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Guillermo F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Antonio Torres
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Asociación Medicina e Investigación (A.M.I.), Córdoba, Spain
| | - Miguel A Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,CIBERONC, Instituto Carlos III, Madrid, Spain
| |
Collapse
|
31
|
Serra-Prat M, Lorenzo I, Palomera E, Ramírez S, Yébenes JC. Total Body Water and Intracellular Water Relationships with Muscle Strength, Frailty and Functional Performance in an Elderly Population. J Nutr Health Aging 2019; 23:96-101. [PMID: 30569076 DOI: 10.1007/s12603-018-1129-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND As a person ages, total body water (TBW), intracellular water (ICW), muscle mass and muscle strength tend to decline. The decline in ICW may reflect losses in the number of muscle cells but may also be responsible for less hydrated muscle cells. AIM To assess whether TBW and ICW are associated with muscle strength, functional performance and frailty in an aged population, independently of muscle mass. METHODOLOGY Design: An observational cross-sectional study of community-dwelling individuals aged 75 years and older. TBW, ICW, fat mass, lean mass and muscle mass were assessed by bioelectrical impedance analysis, frailty status was measured according to Fried criteria, handgrip strength was measured using the hand-held JAMAR dynamometer, and functional performance was measured according to the Barthel index and gait speed. RESULTS A total of 324 subjects were recruited (mean age 80.1 years, 47.5% women). TBW and ICW were closely correlated with muscle mass in both sexes. ICW was also associated with Barthel score, gait speed and frailty in both sexes and with handgrip in men. Considerable variability in ICW was observed for the same muscle mass. Multivariate analysis showed a positive effect of ICW on handgrip, functional performance and gait speed and a protective effect of ICW on frailty, independently of age, sex, body mass index and number of comorbidities. CONCLUSIONS In elderly individuals with similar muscle mass, those with higher ICW had a better functional performance and a lower frailty risk, suggesting a protective effect of cell hydration, independently of muscle mass.
Collapse
Affiliation(s)
- M Serra-Prat
- Mateu Serra Prat, Research Unit, Hospital of Mataró, Carretera de Cirera s/n, 08304 Mataró, Barcelona, Spain, Tel. 34 93 741 77 30, Fax. 34 93 757 33 21, e-mail:
| | | | | | | | | |
Collapse
|
32
|
Lorenzo I, Calvo-Ortega J, Moragues-Femenia S, Laosa-Bello C, Casals J. EP-1716: Using Portal Dosimetry To Check The Photon Mu Linearity And Output Vs. Gantry Angle Of A Linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32025-5] [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: 11/24/2022]
|
33
|
Senent L, Lorenzo I, Vicente A, Alonso E, Sanzo C, Ramos F, Arenillas L, Orero M, Navarro B, Marco V, Campelo MD, Jérez A, Montoro J, Arrizabalaga B, Bonanad S, Lluch R, Paz R, Font P, Gomis F, Sanz G. Prognostic Implication of the Percentage of Erythroid Cells in Bone Marrow at Diagnosis in Patients with Myelodysplastic Syndrome. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30375-2] [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: 10/19/2022]
|
34
|
Balaguer Rosello A, Bataller L, Lorenzo I, Jarque I, Salavert M, González E, Piñana JL, Sevilla T, Montesinos P, Iacoboni G, Muelas N, Romero S, Carretero C, Montoro J, Ibáñez-Juliá MJ, Sanz G, Sanz MÁ, Sanz J. Infections of the Central Nervous System after Unrelated Donor Umbilical Cord Blood Transplantation or Human Leukocyte Antigen-Matched Sibling Transplantation. Biol Blood Marrow Transplant 2016; 23:134-139. [PMID: 27794456 DOI: 10.1016/j.bbmt.2016.10.005] [Citation(s) in RCA: 16] [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] [Received: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
We analyzed the incidence, clinical characteristics, prognostic factors, and outcome of central nervous system (CNS) infections in consecutive patients with receiving umbilical cord blood transplantation (UCBT) (n = 343) or HLA-matched sibling donor stem cell transplantation (MST) (n = 366). Thirty-four CNS infections were documented at a median time of 116 days after transplantation (range, 7 to 1161). The cumulative incidence (CI) risk of developing a CNS infection was .6% at day +30, 2.3% at day +90, and 4.9% at 5 years. The 5-year CI of CNS infection was 8.2% after UCBT and 1.7% after MST (P < .001). The causative micro-organisms of CNS infections were fungi (35%), virus (32%), Toxoplasma spp. (12%), and bacteria (12%). Fungal infections occurred in 11 patients after UCBT and 1 after MST and were due to Aspergillus spp. (n = 8), Cryptococcus neoformans (n = 2), Scedosporium prolificans (n = 1), and Mucor (n = 1). Except for 1 patient, all died from CNS fungal infection. Viral infections occurred in 9 patients after UCBT and 1 after MST and were due to human herpes virus 6 (n = 7), cytomegalovirus (n = 2), and varicella zoster virus (n = 1). CNS toxoplasmosis was diagnosed in 3 patients after UCBT and 1 after MST. Other pathogens were Staphylococcus spp, Nocardia spp, Streptococcus pneumoniae, and Mycobacterium tuberculosis. Twenty of the 34 patients (59%) died from the CNS infection. In multivariable analysis, UCBT and disease stage beyond first complete remission were independently associated with the risk of developing CNS infections. The 5-year overall survival was 19% in patients who developed a CNS and 39% for those who did not (P = .006). In conclusion, our study showed that CNS infections are a significant clinical problem after stem cell transplantation associated with poor survival. They were more frequent after UCBT compared to MST.
Collapse
Affiliation(s)
| | - Luis Bataller
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva González
- Microbiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - José Luis Piñana
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Teresa Sevilla
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pau Montesinos
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Gloria Iacoboni
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Nuria Muelas
- Neurology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Samuel Romero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Carlos Carretero
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Guillermo Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Universidad de Valencia, Valencia, Spain
| |
Collapse
|
35
|
Megías-Vericat JE, Montesinos P, Herrero MJ, Moscardó F, Bosó V, Rojas L, Martínez-Cuadrón D, Hervás D, Boluda B, García-Robles A, Rodríguez-Veiga R, Martín-Cerezuela M, Cervera J, Sendra L, Sanz J, Miguel A, Lorenzo I, Poveda JL, Sanz MÁ, Aliño SF. Impact of ABC single nucleotide polymorphisms upon the efficacy and toxicity of induction chemotherapy in acute myeloid leukemia. Leuk Lymphoma 2016; 58:1197-1206. [PMID: 27701910 DOI: 10.1080/10428194.2016.1231405] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 01/11/2023]
Abstract
Anthracycline uptake could be affected by efflux pumps of the ABC family. The influence of 7 SNPs of ABC genes was evaluated in 225 adult de novo acute myeloid leukemia (AML) patients. After multivariate logistic regression there were no significant differences in complete remission, though induction death was associated to ABCB1 triple variant haplotype (p = .020). The ABCB1 triple variant haplotype was related to higher nephrotoxicity (p = .016), as well as this haplotype and the variant allele of ABCB1 rs1128503, rs2032582 to hepatotoxicity (p = .001; p = .049; p < .001). Furthermore, the variant allele of ABCC1 rs4148350 was related to severe hepatotoxicity (p = .044), and the variant allele of ABCG2 rs2231142 was associated to greater cardiac (p = .004) and lung toxicities (p = .038). Delayed time to neutropenia recovery was observed with ABCB1 rs2032582 variant (p = .047). This study shows the impact of ABC polymorphisms in AML chemotherapy safety. Further prospective studies with larger population are needed to validate these associations.
Collapse
Affiliation(s)
- Juan Eduardo Megías-Vericat
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Pau Montesinos
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - María José Herrero
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain
| | - Federico Moscardó
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Virginia Bosó
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Luis Rojas
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,e Department of Internal Medicine, Faculty of Medicine , Pontificia Universidad Católica de Chile. Avda , Santiago , Chile
| | - David Martínez-Cuadrón
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - David Hervás
- f Unidad de Bioestadística, Instituto investigación Sanataria La Fe. Avda , Valencia , Spain
| | - Blanca Boluda
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Ana García-Robles
- b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Rebeca Rodríguez-Veiga
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - María Martín-Cerezuela
- b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - José Cervera
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Luis Sendra
- d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain
| | - Jaime Sanz
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Antonio Miguel
- d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain
| | - Ignacio Lorenzo
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - José Luis Poveda
- b Servicio de Farmacia, Área del Medicamento. Hospital Universitario y Politécnico La Fe Avda , Valencia , Spain
| | - Miguel Ángel Sanz
- c Servicio de Hematología y Hemoterapia. Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| | - Salvador F Aliño
- a Unidad de Farmacogenética, Instituto Investigación Sanataria La Fe and Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain.,d Departamento Farmacología, Facultad de Medicina , Universidad de Valencia. Avda , Valencia , Spain.,g Unidad de Farmacología Clínica, Área del Medicamento, Hospital Universitario y Politécnico La Fe. Avda , Valencia , Spain
| |
Collapse
|
36
|
Pedrero-Perez EJ, Ruiz-Sanchez de Leon JM, Rojo-Mota G, Morales-Alonso S, Pedrero-Aguilar J, Lorenzo I, Gonzalez A. [Prefrontal Symptoms Inventory (PSI): ecological validity and convergence with neuropsychological measures]. Rev Neurol 2016; 63:241-251. [PMID: 27600738] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The Prefrontal Symptoms Inventory (PSI) is a self-reported questionnaire, created in Spain, which asks about cognitive, emotional and behavioural alterations in activities of daily living and which can be applied in both the general population and in multiple clinical populations. There is a shorter 20-item version (PSI-20) with excellent psychomotor properties for screening. AIM To study the convergent and divergent validity of the PSI and PSI-20, by analysing how their scales reflect the day-to-day consequences of real deficits found in neurological assessment performed by means of performance tests. PATIENTS AND METHODS A sample of 52 persons undergoing treatment for substance addiction (31 males and 21 females) were administered the PSI together with an abbreviated neuropsychological examination battery focused on describing attentional, mnemonic and executive processes. RESULTS Both versions of the PSI present optimal psychometric properties (0.78 > alpha > 0.94 for the complete 46-item version and 0.7 > alpha > 0.89 for the abbreviated 20-item version). The results confirm the hypotheses regarding their validity: the performance problems scale is related with the capacity to resolve tests that supposedly rate the executive functions of a prefrontal origin (convergent validity), whereas the scales of problems in emotional control and problems with social behaviour are not related with those cognitive capabilities (discriminant validity). CONCLUSIONS The PSI is a test that is clinically useful, psychometrically valid and applicable in multiple clinical populations.
Collapse
Affiliation(s)
- E J Pedrero-Perez
- Madrid Salud. Ayuntamiento de Madrid. Centro de Atencion a Drogodependientes (CAD 4-San Blas), Madrid, Espana
| | - J M Ruiz-Sanchez de Leon
- Madrid Salud. Ayuntamiento de Madrid. Centro de Prevencion del Deterioro Cognitivo, Madrid, Espana
- Universidad Complutense de Madrid, Pozuelo de Alarcon, Espana
| | - G Rojo-Mota
- Universidad Rey Juan Carlos, 28922 Madrid, Espana
- Madrid Salud. Ayuntamiento de Madrid. Centro de Atencion a Drogodependientes (CAD 4-San Blas), Madrid, Espana
| | - S Morales-Alonso
- Madrid Salud. Ayuntamiento de Madrid. Centro de Atencion a Drogodependientes (CAD 4-San Blas), Madrid, Espana
| | - J Pedrero-Aguilar
- Madrid Salud. Ayuntamiento de Madrid. Centro de Atencion a Drogodependientes (CAD 4-San Blas), Madrid, Espana
| | - I Lorenzo
- Madrid Salud. Ayuntamiento de Madrid. Centro de Atencion a Drogodependientes (CAD 4-San Blas), Madrid, Espana
| | - A Gonzalez
- Madrid Salud. Ayuntamiento de Madrid. Centro de Atencion a Drogodependientes (CAD 4-San Blas), Madrid, Espana
| |
Collapse
|
37
|
Montesinos P, Rodríguez-Veiga R, Boluda B, Martínez-Cuadrón D, Cano I, Lancharro A, Sanz J, Arilla MJ, López-Chuliá F, Navarro I, Lorenzo I, Salavert M, Pemán J, Calvillo P, Martínez J, Carpio N, Jarque I, Sanz GF, Sanz MA. Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis. Bone Marrow Transplant 2015; 50:1465-72. [PMID: 26281032 DOI: 10.1038/bmt.2015.181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/01/2015] [Accepted: 07/03/2015] [Indexed: 01/24/2023]
Abstract
Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.
Collapse
Affiliation(s)
- P Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - R Rodríguez-Veiga
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - B Boluda
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - D Martínez-Cuadrón
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Cano
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - A Lancharro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M J Arilla
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - F López-Chuliá
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Navarro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Lorenzo
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Pemán
- Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - P Calvillo
- Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - J Martínez
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - N Carpio
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - I Jarque
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - G F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
| | - M A Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.,Departament de Medicina, Universitat de València, Valencia, Spain
| |
Collapse
|
38
|
Montesinos P, Rodríguez-Veiga R, Martínez-Cuadrón D, Boluda B, Navarro I, Vera B, Alonso CM, Sanz J, López-Chulia F, Martín G, Jannone R, Sanz G, Lancharro A, Cano I, Palau J, Lorenzo I, Jarque I, Salavert M, Ramírez P, Sanz MÁ. Treatment of invasive fungal disease using anidulafungin alone or in combination for hematologic patients with concomitant hepatic or renal impairment. Rev Iberoam Micol 2015; 32:185-9. [PMID: 25858598 DOI: 10.1016/j.riam.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/07/2014] [Revised: 07/16/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) treatment is challenging in hematologic patients due to drug interactions and toxicities that limit the use of the antifungal agents. AIMS To analyze retrospectively in terms of safety and potential efficacy anidulafungin therapy, alone or in combination. METHODS Our institutional guidelines recommended anidulafungin treatment in hematologic patients with suspected IFD and concomitant renal or liver impairment (to avoid drug interactions and preserve organ function). RESULTS From 2008 to 2013, 24 episodes of IFD occurring in 21 patients were classified as proven (4 cases), probable (15 cases) and possible (5 cases). Anidulafungin was administered alone (13%) or in combination (88%). Eight (33%) episodes were resolved, using monotherapy (1 out of 3, 33%) or a combined therapy (7 out of 21, 33%). Twelve cases (50%) were registered as failure (death due to IFD progression in 4 patients, and treatment change due to lack of efficacy in 8), and 4 cases (17%) were not evaluable (death unrelated to the IFD). Anidulafungin was not withdrawn in any case due to toxicity. CONCLUSIONS Anidulafungin therapy, alone or in combination, could be considered in hematologic patients with IFD and concomitant liver or renal impairment. Due to the low number of patients, we cannot draw any conclusion about efficacy.
Collapse
Affiliation(s)
- Pau Montesinos
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
| | | | | | - Blanca Boluda
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Inés Navarro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Belen Vera
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Carmen M Alonso
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | | | - Guillermo Martín
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Rosa Jannone
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Aima Lancharro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isabel Cano
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Javier Palau
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit of the Hospital Universitario La Fe, Valencia, Spain
| | - Paula Ramírez
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| |
Collapse
|
39
|
Sanz J, Cano I, González-Barberá EM, Arango M, Reyes J, Montesinos P, Lorenzo I, Jarque I, Martínez J, López F, Arilla MJ, Lancharro A, Moscardó F, López-Hontangas JL, Salavert M, Sanz MA, Sanz GF. Bloodstream infections in adult patients undergoing cord blood transplantation from unrelated donors after myeloablative conditioning regimen. Biol Blood Marrow Transplant 2015; 21:755-60. [PMID: 25585274 DOI: 10.1016/j.bbmt.2014.12.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 11/08/2014] [Accepted: 12/31/2014] [Indexed: 12/29/2022]
Abstract
The incidence, epidemiology, and risk factors of bloodstream infection (BSI) and their impact on transplant outcomes after umbilical cord blood transplantation (UCBT) are not well defined. Between May 1997 and December 2012, 202 isolates in 189 episodes of BSI were registered in 134 of 241 patients who underwent single-unit myeloablative UCBT. Cumulative incidence (CI) of developing at least 1 episode of BSI was 21%, 29%, 34%, 42%, and 52% at days +7, +14, +30, +100, and +365, respectively. The median time of onset for the first BSI episode was day +10 (range, day -7 to +1217). Early BSI before day 7 was associated with increased nonrelapse mortality (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; P = .04), whereas BSI before day 14 was an independent adverse risk factor for neutrophil recovery (RR, .6; 95% CI, .5 to .9; P = .002). A higher CD8(+) cell dose of the graft was the only variable independently associated with reduced risk of BSI (RR, .1; 95% CI, .02 to .7; P = .02). The gram-negative rod (GNR) to gram-positive bacteria ratio was .9 before day +30 and 1.6 thereafter (P = .03). Escherichia coli (31%) and Pseudomonas sp. (28%) were the most frequently isolated among GNR. The overall crude mortality rate was 12% at day 7 and was higher for GNR (18%) compared with gram-positive bacteria (7%) (P = .03). These findings emphasize the importance of preventing bacterial infections during conditioning and the very early post-UCBT period.
Collapse
Affiliation(s)
- Jaime Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - Isabel Cano
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Marcos Arango
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jheremy Reyes
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isidro Jarque
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jesús Martínez
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Francisca López
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María J Arilla
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Aima Lancharro
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Federico Moscardó
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Miguel Salavert
- Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel A Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Guillermo F Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
40
|
Blanes M, González JD, Lahuerta JJ, Ribas P, Lorenzo I, Boluda B, Sanz MA, de la Rubia J. Bortezomib-based induction therapy followed by intravenous busulfan–melphalan as conditioning regimen for patients with newly diagnosed multiple myeloma. Leuk Lymphoma 2014; 56:415-9. [DOI: 10.3109/10428194.2014.922182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
41
|
Moscardó F, Sanz J, Carbonell F, Sanz MA, Larrea L, Montesinos P, Lorenzo I, Vera B, Boluda B, Salazar C, Cañigral C, Planelles D, Jarque I, Solves P, Martín G, López F, de la Rubia J, Martínez J, Carpio N, Martínez-Cuadrón D, Puig N, Montoro JA, Roig R, Sanz GF. Effect of CD8⁺ cell content on umbilical cord blood transplantation in adults with hematological malignancies. Biol Blood Marrow Transplant 2014; 20:1744-50. [PMID: 25008329 DOI: 10.1016/j.bbmt.2014.06.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 03/13/2014] [Accepted: 06/30/2014] [Indexed: 01/04/2023]
Abstract
Total nucleated (TNCs) and CD34(+) cells are considered major determinants of outcome after umbilical cord blood (UCB) transplantation but the effect of other cell subtypes present in the graft is unknown. This single-center cohort study included patients with hematological malignancies who received UCB transplantation after a myeloablative conditioning regimen. UCB units were primarily selected according to cell content, both TNCs and CD34(+) cells, and also according to the degree of HLA matching. Counts of several cell subtypes of the infused UCB unit, together with HLA disparities and other patient- and transplantation-related characteristics, were analyzed by multivariable methodology for their association with myeloid and platelet engraftment, graft-versus-host disease, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS). Two hundred patients (median age, 32 years) were included in the study. In multivariable analyses, a greater number of CD8(+) cells was significantly associated with better results for myeloid (P = .001) and platelet (P = .008) engraftment, NRM (P = .02), DFS (P = .007), and OS (P = .01). CD34(+) cell content was predictive of myeloid engraftment (P < .001). This study suggests that the outcome after UCB transplantation in adults with hematological malignancies could be better when UCB grafts had a greater CD8(+) cell content.
Collapse
Affiliation(s)
- Federico Moscardó
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Jaime Sanz
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Miguel A Sanz
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Larrea
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - Pau Montesinos
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Belén Vera
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Blanca Boluda
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Claudia Salazar
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carolina Cañigral
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Isidro Jarque
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Solves
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Guillermo Martín
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Francisca López
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier de la Rubia
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jesús Martínez
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Nelly Carpio
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - David Martínez-Cuadrón
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Nieves Puig
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - José A Montoro
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - Roberto Roig
- Centro de Trasfusión de la Comunidad Valenciana, Valencia, Spain
| | - Guillermo F Sanz
- Hematopoietic Cell Transplantation Unit, Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
42
|
Moscardó F, Romero S, Sanz J, Sanz MA, Montesinos P, Lorenzo I, Solves P, Carpio N, Sanz GF. T Cell–Depleted Related HLA-Mismatched Peripheral Blood Stem Cell Transplantation as Salvage Therapy for Graft Failure after Single Unit Unrelated Donor Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2014; 20:1060-3. [DOI: 10.1016/j.bbmt.2014.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/19/2014] [Indexed: 11/15/2022]
|
43
|
Peinado AB, Benito PJ, Barriopedro M, Lorenzo I, Maffulli N, Calderón FJ. Heart rate recovery in elite Spanish male athletes. J Sports Med Phys Fitness 2014; 54:264-270. [PMID: 24739288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM During postexercise recovery, heart rate (HR) initially falls rapidly, followed by a period of slower decrease, until resting values are reached. The aim of the present work was to examine the differences in the recovery heart rate (RHR) between athletes engaged in static and dynamic sports. METHODS The study subjects were 294 federated sportsmen competing at the national and international level in sports classified using the criteria of Mitchell et al. as either prevalently static (N.=89) or prevalently dynamic (N.=205). Within the dynamic group, the subjects who practised the most dynamic sports were assigned to further subgroups: triathlon (N.=20), long distance running (N.=58), cycling (N.=28) and swimming (N.=12). All athletes were subjected to a maximum exertion stress test and their HR recorded at 1, 2, 3 and 4 min (RHR1,2,3,4) into the HR recovery period. The following indices of recovery (IR) were then calculated: IR1=(HRpeak-RHR1,2,3,4)/(HRmax-HRrest)*100, IR2=(HRpeak-RHR1,2,3,4)/(HRmax/HRpeak), and IR3=HRpeak-RHR1,2,3,4. The differences in the RHR and IR for the static and dynamic groups were examined using two way ANOVA. RESULTS The RHR at minutes 2 (138.7±15.2 vs. 134.8±14.4 beats·min⁻¹) and 3 (128.5±15.2 vs. 123.3±14.4 beats·min⁻¹) were significantly higher for the static group (Group S) than the dynamic group (Group D), respectively. Significant differences were seen between Group D and S with respect to IR1 at minutes 1 (26.4±8.7 vs. 24.8±8.4%), 2 (43.8±8.1 vs. 41.5±7.8%), 3 (52.1±8.3 vs. 49.1±8%) and 4 (56.8±8.6 vs. 55.4±7.4%) of recovery. For IR2, significant differences were seen between the same groups at minutes 2 (59.7±12.5 vs. 55.9±10.8 beats·min⁻¹) and 3 (71.0±13.5 vs. 66.1±11.4 beats·min⁻¹) of recovery. Finally, for IR3, the only significant difference between Group D and S was recorded at minute 3 of recovery (72.2±12.5 vs. 66.2±11.5 beats·min⁻¹). CONCLUSION This work provides information on RHR of a large population of elite Spanish athletes, and shows marked differences in the way that HR recovers in dynamic and static sports.
Collapse
Affiliation(s)
- A B Peinado
- Departamento de Salud y Rendimiento Humano, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, Madrid, Spain
| | | | | | | | | | | |
Collapse
|
44
|
Sánchez-García J, del Cañizo C, Lorenzo I, Nomdedeu B, Luño E, de Paz R, Xicoy B, Valcárcel D, Brunet S, Marco-Betes V, García-Pintos M, Osorio S, Tormo M, Bailén A, Cerveró C, Ramos F, Diez-Campelo M, Such E, Arrizabalaga B, Azaceta G, Bargay J, Arilla MJ, Falantes J, Serrano-López J, Sanz GF. Multivariate time-dependent comparison of the impact of lenalidomide in lower-risk myelodysplastic syndromes with chromosome 5q deletion. Br J Haematol 2014; 166:189-201. [DOI: 10.1111/bjh.12876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Elisa Luño
- Hospital Central de Asturias; Oviedo Spain
| | | | - Blanca Xicoy
- Institut Català d'Oncologia; Josep Carreras Research Institute-Hospital Germans Trias i Pujol; Badalona Spain
| | | | - Salut Brunet
- Hospital Sant Pau; Universitat Autónoma; Barcelona Spain
| | | | | | - Santiago Osorio
- Hospital General Universitario Gregorio Marañon; Madrid Spain
| | - Mar Tormo
- Hospital Clínico Universitario; Instituto de Investigación INCLIVA; Valencia Spain
| | | | | | - Fernando Ramos
- Hospital Universitario de León and IBIOMED (University of Leon); León Spain
| | | | - Esperanza Such
- Hospital Universitario y Politécnico La Fe; Valencia Spain
| | | | - Gemma Azaceta
- Hospital Clínico Universitario Lozano Blesa; Zaragoza Spain
| | - Joan Bargay
- Hospital Son Llatzer; Palma de Mallorca Spain
| | | | - José Falantes
- Hospital Universitario Virgen del Rocio; Sevilla Spain
| | | | | | | |
Collapse
|
45
|
Sanz J, Jaramillo FJ, Planelles D, Montesinos P, Lorenzo I, Moscardó F, Martin G, López F, Martínez J, Jarque I, de la Rubia J, Larrea L, Sanz MA, Sanz GF. Impact on Outcomes of Human Leukocyte Antigen Matching by Allele-Level Typing in Adults with Acute Myeloid Leukemia Undergoing Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
46
|
Sanz J, Jaramillo FJ, Planelles D, Montesinos P, Lorenzo I, Moscardó F, Martin G, López F, Martínez J, Jarque I, de la Rubia J, Larrea L, Sanz MA, Sanz GF. Impact on outcomes of human leukocyte antigen matching by allele-level typing in adults with acute myeloid leukemia undergoing umbilical cord blood transplantation. Biol Blood Marrow Transplant 2014; 20:106-110. [PMID: 24516896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This retrospective study analyzed the impact of directional donor-recipient human leukocyte antigen (HLA) disparity using allele-level typing at HLA-A, -B, -C, and -DRB1 in 79 adults with acute myeloid leukemia (AML) who received single-unit umbilical cord blood (UCB) transplant at a single institution. With extended high-resolution HLA typing, the donor-recipient compatibility ranged from 2/8 to 8/8. HLA disparity showed no negative impact on nonrelapse mortality (NRM), graft-versus-host (GVH) disease or engraftment. Considering disparities in the GVH direction, the 5-year cumulative incidence of relapse was 44% and 22% for patients receiving an UCB unit matched ≥ 6/8 and < 6/8, respectively (P = .04). In multivariable analysis, a higher HLA disparity in the GVH direction using extended high-resolution typing (Risk ratio [RR] 2.8; 95% confidence interval [CI], 1.5 to 5.1; P = .0009) and first complete remission at time of transplantation (RR 2.1; 95% CI, 1.2 to 3.8; P = .01) were the only variables significantly associated with an improved disease-free survival. In conclusion, we found that in adults with AML undergoing single-unit UCBT, an increased number of HLA disparities at allele-level typing improved disease-free survival by decreasing the relapse rate without a negative effect on NRM.
Collapse
|
47
|
Sanz J, Arango M, Senent L, Jarque I, Montesinos P, Sempere A, Lorenzo I, Martín G, Moscardó F, Mayordomo E, Salavert M, Cañigral C, Boluda B, Salazar C, López-Hontangas JL, Sanz MA, Sanz GF. EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases. Bone Marrow Transplant 2013; 49:397-402. [PMID: 24292521 DOI: 10.1038/bmt.2013.190] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/06/2013] [Accepted: 09/30/2013] [Indexed: 11/09/2022]
Abstract
We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (P<0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.
Collapse
Affiliation(s)
- J Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Arango
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - L Senent
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Jarque
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - P Montesinos
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A Sempere
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - I Lorenzo
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - G Martín
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - F Moscardó
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - E Mayordomo
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Salavert
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Cañigral
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - B Boluda
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - C Salazar
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J L López-Hontangas
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M A Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - G F Sanz
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
48
|
Luna I, Such E, Cervera J, Barragán E, Ibañez M, Gómez-Seguí I, López-Pavía M, Llop M, Fuster O, Dolz S, Oltra S, Alonso C, Vera B, Lorenzo I, Martínez-Cuadrón D, Montesinos P, Senent ML, Moscardó F, Bolufer P, Sanz MA. WT1 isoform expression pattern in acute myeloid leukemia. Leuk Res 2013; 37:1744-9. [PMID: 24211094 DOI: 10.1016/j.leukres.2013.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 05/10/2013] [Revised: 09/11/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022]
Abstract
WT1 plays a dual role in leukemia development, probably due to an imbalance in the expression of the 4 main WT1 isoforms. We quantify their expression and evaluate them in a series of AML patients. Our data showed a predominant expression of isoform D in AML, although in a lower quantity than in normal CD34+ cells. We found a positive correlation between the total WT1 expression and A, B and C isoforms. The overexpression of WT1 in AML might be due to a relative increase in A, B and C isoforms, together with a relative decrease in isoform D expression.
Collapse
Affiliation(s)
- Irene Luna
- Department of Hematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Sanz J, Wagner JE, Sanz MA, DeFor T, Montesinos P, Bachanova V, Lorenzo I, Warlick E, Sanz GF, Brunstein C. Myeloablative cord blood transplantation in adults with acute leukemia: comparison of two different transplant platforms. Biol Blood Marrow Transplant 2013; 19:1725-30. [PMID: 24090598 DOI: 10.1016/j.bbmt.2013.09.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 08/24/2013] [Accepted: 09/21/2013] [Indexed: 12/26/2022]
Abstract
We compared the clinical outcomes of adults with acute leukemia that received single-unit umbilical cord blood transplantation (sUCBT) after conditioning with a busulfan/antithymocyte globulin (BU-ATG)-based regimen at University Hospital La Fe (n = 102) or double-unit UCBT (dUCBT) after conditioning with a total body irradiation (TBI)-based regimen at the University of Minnesota (n = 91). Nonrelapse mortality, relapse and disease-free survival were similar in the 2 groups. Multivariate analyses, showed more rapid neutrophil (hazard ratio [HR], .6; 95% confidence interval [CI], .45 to .80; P = .0006) and platelet recovery (HR, .59; 95% CI, .43 to.83; P = .002) after the BU-ATG-based conditioning and sUCBT. Although there was a lower risk of acute graft-versus-host disease (GVHD) grade II to IV (HR, 2.81; 95% CI, 1.75 to 4.35; P < .001) after BU-ATG and sUCBT, the incidences of grade III to IV acute and chronic GVHD were similar between the 2 groups. Regarding disease-specific outcomes, disease-free survival in both acute myeloid leukemia and acute lymphoblastic leukemia (ALL) patients were not significantly different; however, a significantly lower relapse rate was found in patients with ALL treated with TBI and dUCBT (HR, .3; 95% CI, .12 to .84; P = .02). In the context of these specific treatment platforms, our study demonstrates that sUCB and dUCBT offer similar outcomes.
Collapse
Affiliation(s)
- Jaime Sanz
- Department of Hematology, Hospital Universitari y Politècnic La Fe, Valencia, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Lorenzo I, Constenla M, Palacios P, García-Arroyo FR, Fernández I, Campos B, Salgado L, Carrete N. Docetaxel as single-agent treatment in elderly patients with advanced breast cancer. Clin Drug Investig 2012; 25:249-56. [PMID: 17523775 DOI: 10.2165/00044011-200525040-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the efficacy and safety profile of docetaxel, as a single agent, in the treatment of elderly patients with advanced breast cancer. METHODS Twenty-eight patients, with a median age of 72 (range 66-84) years, were included in the study and received docetaxel (50-100 mg/m(2)) every 3-4 weeks as first- or second-line treatment of advanced breast cancer. Granulocyte colony-stimulating factor (G-CSF) was administered as primary prophylaxis in 97% of cycles. RESULTS The overall response rate was 50% (95% CI 32, 69). The median time to disease progression was 10.7 months (95% CI 10.0, 11.5), and the median overall survival was 26.6 months (95% CI 16.6, 36.7). Neutropenia was the most frequent grade 3/4 toxicity (18% of patients and 5% of cycles). There was just one case of febrile neutropenia that resulted in toxic death. Severe neutropenia only occurred in patients who did not receive G-CSF support from the start of the study treatment. Vomiting was the most frequent grade 3/4 non-haematological toxicity (11% of patients and 2% of cycles). CONCLUSION Docetaxel as a single agent is active in elderly patients with advanced breast cancer. The use of prophylactic G-CSF allowed the administration of high doses of docetaxel with minimal myelosuppression.
Collapse
Affiliation(s)
- I Lorenzo
- Servicio de Oncología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | | | | | | | | | | | | | | |
Collapse
|