bluuebunny/crossref_metadata_2025_split huggingface dataset:
First Report of Dengue Virus Infection in a Bone Marrow Transplant Patient.
Authors: Figueroa Myrna S. , Clavell Luis A. 
Published: April 2020

Abstract
Dengue virus infections are a frequent cause of morbidity and mortality in certain endemic areas of the world but it has never been reported to occur in a bone marrow transplant patient. We describe a pediatric patient with ALL on her first bone marrow relapse undergoing allogeneic bone marrow transplant who developed sepsis and irreversible shock that on postmortem autopsy proved to be secondary to dengue virus infection Type 4. A 6 years old female with ALL underwent an allogeneic bone marrow transplant from her sibling (6/6 match) on Nov 10, 1994. She received TBI (1200 rads) and ARA-C (3gm/m2 per dose per 12 doses) as preparative regimen. She developed generalized skin erythema on day +5 followed by fever on day +6. The following days were characterized by continued fever spikes, severe mucositis, persistence of the erythematous skin rash (first degree burn like) and gross hematuria in spite of broad spectrum antibiotic coverage. Blood cultures were reported negative. She developed irreversible shock and finally died on day +11 post-transplant. At autopsy (Nov 22, 1994), Dengue virus type 4 was isolated from blood, ascitic fluid, liver and spleen by routine viral culture at San Juan C.D.C. Dengue Branch. Results were confirmed by polymerase chain reaction. Her donor also developed low grade fever the day after bone marrow donation. Further blood testing on donor (Dec 2, 1994) showed positive IgM antibodies against Dengue virus Type 4. The recipient viral cultures matches with donor acute titers for Dengue Type 4, suggesting infection through bone marrow transplant. Dengue virus infection may cause significant morbidity and mortality to blood and bone marrow recipients in endemic areas of the world.
Steroid Complications in Patients with Acute Graft Versus Host Disease.
Authors: Betul Oran , Lee Hun , de Lima Marcos , Couriel Daniel , Giralt Sergio , Saliba Rima 
Published: April 2020

Abstract
Background: High dose steroid treatment remains to be the first line therapy for acute graft versus host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). Although effective in controlling aGVHD, high dose steroids can cause multiple serious complications which can result in increased morbidity and mortality.
Purpose: Our aim was to determine the frequency of steroid induced complications and to analyze risk factors for steroid-myopathy in patients with AML who developed grade 2 aGVHD after allogeneic HSCT.
Patients and Methods: Inclusion criteria were:
1) AML/MDS patients who received allogeneic HSCT between 1/1996 and 12/2001
2) grade 2 aGVHD treated with at least 2mg/kg of methylprednisolone
3) post transplantation overall survival at least 100 days.
Steroid induced complications reviewed were: cataracts, headaches, mood swings, hypertension, gastritis, hyperglycemia, osteopenia, myopathy, avascular necrosis, edema, hypokalemia and infections. Pre- and post-transplantation characteristics analyzed as risk factors for steroid-myopathy were: age, gender, race, history of diabetes, body mass index, HLA types, steroid use after HSCT prior to grade 2 acute GVHD and duration of steroid use for acute GVHD. Logistic regression analysis was used for risk factor evaluation. Steroid-myopathy was defined as proximal muscle weakness, atrophy and myalgia in the absence of genetic, inflammatory or drug-induced etiologies other than steroid use.
Results: 178 AML /MDS patients were transplanted during the study period. 70 patients (37 males and 33 females) with a median age of 43 (range, 21–66) were eligible for our study. Median duration of follow-up and median duration of steroid use after grade 2 aGVHD were 269 days and 127 days respectively. The number of patients and their frequency distribution of steroid induced complications were as follows: hyperglycemia, 43 (61.4%); hypertension, 35 (50%); cataracts, 10(14.3%); headaches, 7 (10%); mood swings,12(17.1%); gastritis, 7 (10%); myopathy, 32(45.7%); avascular necrosis, 1 (1.4%); edema, 22 (31.4%); hypokalemia, 52 (74.3%); bacterial infections, 55 (78.6%); viral infections, 39(55.7%); and fungal infections, 22(31.4%). For steroid-induced myopathy, male gender (RR=4.0, 95% CI=1.01–16.4, p=0.05), steroid use before acute GVHD grade II (RR=5.5, 95% CI=1.35–22.14, p=0.02) or steroid use more than 4 months after developing acute GVHD grade II (HR=6.4, 95% CI=1.38–29.94, p=0.02) were independent risk factors. 47 of 70 patients died with median overall survival of 10 months. 22 of 47 (46.8%) had steroid-myopathy and there was no increased mortality with steroid induced myopathy.
Conclusion: Steroid therapy for aGVHD after allogeneic HSCT in AML/MDS patients is associated with frequent toxicities. The possibility of identifying prognostic factors for steroid toxicities support the study and development of strategies that may ameliorate or prevent steroid induced complications.
Safety of a Weekly Administration of 7.5 mg/kg of Liposomal Amphotericin B (LAB) for Antifungal Prophylaxis in Patients Receiving High Dose Corticosteroids (CS) for Acute GVHD after Reduced Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation (allo-SCT).
Authors: El-Cheikh Jean , Faucher Catherine , Furst Sabine , de Lavallade Hugues , Blaise Didier , Mohty Mohamad 
Published: April 2020

Abstract
Background. RIC regimens are increasingly used for allo-SCT in elderly or patients not eligible for standard myeloablative allo-SCT. Such regimens have yielded promising results in terms of decreasing early transplant-related toxicities. However, acute GVHD remains a matter of concern in this setting. Of note, the use of high dose CS for GVHD treatment increases the risk of severe fungal infections in this high risk population usually presenting several comorbidities. Therefore, prophylactic strategies aiming to reduce this risk are needed.
Patient and Methods. We conducted a pilot single centre study in 15 adult patients receiving high dose CS (2 mg/Kg/day) for acute GVHD therapy after RIC allo-SCT. Treatment consisted of a 2 hour weekly infusion of 7.5 mg/kg LAB with a maximum of 8 total doses. The primary endpoint was the incidence of serious adverse events occurring during the course of prophylaxis treatment. Of note, safety was monitored with particular attention to nephrotoxicity in this relatively elderly population receiving concomitant nephrotoxic drugs such as cyclosporin A.
Results. Median age of these 15 patients with various hematological and non-hematological malignancies was 54 years (range, 40–70). Patients received a median of 4 weekly doses of LAB (range, 1–8), with 8 patients (53%) receiving at least 4 consecutive weekly doses. In terms of toxicity, 6 patients (40%) didn’t experience any sign of toxicity. One patient experienced a violent chest pain with transient extra-systoles, during the first infusion of LAB, and did not receive any subsequent infusions. Other mild and transient infusion-related reactions (fever, flush, tachycardia, orthostatic hypotension, pruritous, bone pain, abdominal pain) were observed in 5 patients, usually at time of first LAB infusion. Despite concomitant administration of cyclosporin A in all 15 patients, only 4 patients (27%) had to interrupt the course of prophylactic LAB (respectively after 3 (n=2), 4 and 7 infusions) because of renal toxicity (increase of serum creatinine ≥1.5 times from baseline values).
Conclusions. Although long term efficacy of such antifungal prophylactic strategy is yet to be established, the results of this feasibility study demonstrate that a weekly dose of 7.5 mg/Kg of LAB is relatively safe and well tolerated when given as prophylaxis in high-risk immuno-compromised patients receiving high dose CS for GVHD after RIC allo-SCT, despite concomitant administration of multiple nephrotoxic drugs.
PBSCT Similar to BMT Allows Active B-Lymphopoiesis Unless Severe GVHD Occurs.
Authors: Winkler Julia , Biller Armin , Schub Natalie , Rösler Wolf , Eckart-Schäfer Kerstin , Wandt Hannes , Kluender Claudia N. , Schwerdtfeger Rainer , Hahn Joachim , Holler Ernst , Winkler Thomas H. , Gramatzki Martin 
Published: April 2020

Abstract
Long-term engraftment after stem cell transplantation is dependent on pluripotent hematopoietic stem cells capable to multi-lineage reconstitution. The engraftment and prolonged repopulation of B lymphoid progenitor cells is dependent on pluripotent hematopoietic stem cells. We have recently shown that a high number of B-cell progenitors is detectable in the bone marrow from patients both after allogeneic PBSCT and after allogeneic BMT. The percentage of CD19/CD10+ pro-B/pre-B cells showed a high variability and ranged from 0 to 98% of all B-lymphocytes. Interestingly, no difference in numbers of precursor B-lymphocytes between BM recipients and PBSC recipients was found. In micro-satellite analysis, both in PBSC and in BM recipients the B cell precursors were derived exclusively from the donor. To identify predictors of B lymphopoiesis in the bone marrow after stem cells transplantation, a stepwise, multiple regression analysis was performed. The stem cell source, BM or PBSC, the occurrence of GVHD, the conditioning with or without TBI and whether ATG was given, were entered as categorical variables. Time point of BM sampling after transplantation, age of the donor and the recipient, the quantity of stem cell transplanted and the T cell content of the BM sample served as continuous variables. Time elapsed after transplantation (p=0.002) and severe GVHD (aGVHD grade III/IV or extensive cGVHD) (p=0.036) could be identified as parameters with an independent influence on the percentage of B cell precursors. The highest percentage of precursor B cells was found during the first year after transplantation, unless severe GvHD was present, leading to neglible precursor B-cells. This hyperactive B lymphopoiesis in the first year after transplantation contrasts to low circulating B cell counts. Finally, it could be formally demonstrated, that G-CSF mobilized PBSC contain hematopoietic stem cells capable of long-term reconstitution of the B cell compartment.
Cidofovir: A Treatment for BK Virus Cystitis after Allogenic Bone Marrow Transplantation.
Authors: Le Du Katell , Rohrlich Pierre-Simon , Larosa Fabrice , Herbein Georges , Deconinck Eric 
Published: April 2020

Abstract
Late-onset hemorrhagic cystitis (HC) is a common complication after bone marrow transplantation (BMT) with an incidence ranging from 7 to 70 %. Viral infections are the main risk factors of HC and the BK virus (BKV) is an emerging micro-organism implicated in interstitial nephritis, ureteral stenosis and HC in immunocompromised patients. Most of anti-viral treatments (aciclovir, foscavir, ganciclovir, ribavirine, vidarabine) are inefficient, excepted cidofovir, a cytosine nucleoside analog, usually used in the treatment of cytomegalovirus retinitis in AIDS patients.
The pathogenicity of BKV after BMT remains to be precised. Ten allogenic bone marrow transplanted patients were treated with cidofovir for a severe and refractory HC between December 02 and January 05. BKV replication was diagnosed by real-time Polymerase Chain Reaction on blood and urinary samples. The majority of patients had a severe cellular immunosuppression (absolute lymphocyte count &lt;100 cells/microl) and they were all treated with immunosuppressive drugs (steroids, tacrolimus, mycophenolate, ciclosporine) for an uncontrolled graft versus host disease (GVHD). Cidofovir was administered by intravenous injection (5 mg/kg) with an average of four doses per patient and was generally well tolerated. Complete remission was obtained in 5/10 patients with a clinical improvement and a significant decreasing of urinary viral load in 60 days.
In conclusion, cidofovir might be proposed in the treatment of refractory BKV hemorrhagic cystitis after allogenic stem cell transplantation.
Improved Outcome of Patients with Invasive Pulmonary Fungal Infection Complicated by Respiratory Failure Due to the Use of New Antimycotis Agens and Early Tracheostomy after Allogeneic Transplantation.
Authors: Koldehoff Michael , Elmaagacli Ahmet H. , Steckel Nina K. , Trenschel Rudolf , Hlinka Michal , Ditschkowski Markus , Biersack Harald , Beelen Dietrich W. 
Published: April 2020

Abstract
The mortality rate associated with respiratory failure due to invasive fungal infections (IFI) after allogeneic hematopoietic stem cell transplantation (HSCT) is exceedingly high. Here we compared in a retrospective analysis the influence of the antimycotic agents and early tracheostomy on the outcome of patients (pts) with required artificial respiration (AV) due to pulmonary IFI. The first cohort presented pts, who were treated at our center before the new antimycotic agents became available. This cohort consisted 16 pts from 236 consecutive allogeneic transplant recipients (median age 38 years [range 22–59], 88% had a leukemic disorder) died during or soon after weaning from AV (median survival: 64 days). The mean weaning time was 16 days, only one patient could be tracheotomized. In contrast to this, within a second cohort of 24 pts from 279 consecutive allogeneic transplant recipients, who required AV after the introduction of the new antimycotic agents 9 (38 %) pts could be brought back to spontaneous breathing. The median survival of these pts was 370 days. The weaning time was 24 days, 67% of those pts underwent tracheotomy within ten days after initiation of AV. There were no differences between the two cohorts regarding the underlying diseases, engraftment time or the ratio of myeloablative and reduced intensity conditioning regimens. However, the cohort of pts who were transplanted during the era of new antimycotic agents had a higher median age (43 years, range 20–65, not significantly) and included more mismatched and unrelated grafts with a higher incidence of GVHD grade II-IV (79% vs. 69%). To date, four of those pts are still alive and well (mean survival 463 days, range 240 to 732). We propose that our observations reflect an improved management of these pts nowadays mainly due to the use of new antimycotics and more effective antifungal treatment approaches, as well as the advantages of early tracheostomy may contribute to better outcomes in the treatment of respiratory failure due to pulmonary IFI following allogeneic HSCT.
T Cell Receptor Excision Circles (TRECs) Decrease in Patients after Allogeneic Stem Cell Transplantation.
Authors: Du Xin , Li Yangqiu , Geng Shuxia , Weng Jianyu , Lu Zesheng , Guo Rong 
Published: April 2020

Abstract
Human thymus is required for establishment of a T-cell pool in fetal life, T-cell emigration from thymus (thymic recent emigrants [TRECs]) is a continuous thymic-dependent process. To analyze the content of signal joint Tcell receptor excision DNA circles signal joint T cell receptor excision DNA circles(sjTRECs) within peripheral blood mononuclear cells (PBMCs), thereby to infer the level of naive T cells and the recent thymic output function in patients with allogeneic stem cell transplantation. We used real-time polymerase chain reaction (PCR) to quantify SjTRECs in 5 patients with chronic myeloid leukemia-chronic phase. Five patients(4 males, 1 females; median age 37 years,) who underwent HLA-matching sibling BMT and/or peripheral blood stem cell transplantation (PBSCT) at our department. Quantitative detection of sjTRECs in DNA of peripheral blood mononuclear cells from 13 normal individuals. The median value of sjTRECs copies P1 000 PBMCs was 4.37±3.64 in normal individuals whereas it was 0.57±0.51 copies P1 000 PBMCs in patients at least two years after allogeneic stem cell transplantation (P &lt; 0. 03). We conclude that these Patients decrease in recent thymic output function,. Therefore, measurement of sjTREC may provide an important tool for predicting thymus-dependent T-cell reconstitution after transplantation.
Successful Treatment of Severe Hemorrhagic Cystitis Following Allogeneic Stem Cell Transplantation by Selective Embolization of Bilateral Hypogastric Arteries.
Authors: Tang Xiaowen , Wu De Pei , Liu Yizhi 
Published: April 2020

Abstract
Objective Hemorrhagic cystitis(HC) is a common complication of allogeneic stem cell transplantation occurring in 7–52% of transplant recipients. The severity of HC can range from mild hematuria to life-threatening bleeding with urinary tract obstruction or renal insufficiency. Severe HC is often refractory to the conventional therapy. Currrent treatment modalities for severe HC include selective embolization of the hypogastric arteries and hyperbaric oxygen. We studied 6 patients with refractory severe HC to investigate the therapeutic value of embolization in severe HC following allogeneic stem cell transplantation. Methods 6 patients underwent allogeneic stem cell transplantation developed severe HC with a median onset time of 33 d after transplatation. All these patients had been resistant to conservative managements and received the treatment of selective embolization of hypogastric arteries. Results 8 times of embolizations were performed for 6 patients. The HC resolved in 4 patients and the HC improved in 1 patient, yielding a response rate of 83%. One patient didn’t respond to this measure. For the patients with response, macroscopic hematuria disappeared 7 to 10 days after the treatments and microscopic hematuria vanished 20 to 30 days after the intervention therapy. Both procedures were tolerated well and no severe adverse effects were observed. Conclusion It suggest that selective embolization of hypogastric arteries seems to be a safe and effective treatment for severe HC. This measure can be proposed for patients undergoing refractory and persistent severe HC.
The Effect of Dipeptiven in Patients after Allogenic Hematologic Stem Cell Transplantation.
Authors: Huang He , Shou Lihong , Luo Yi , Shi Jimin , Zhu Xiaoli , Cai Zhen , Lin Maofang 
Published: April 2020

Abstract
Total parenteral nutrition (TPN) is provided to patients undergoing allogenic hematologic stem cell transplantation (allo-HSCT) to help minimize nutritional consequences of both conditioning regimens as well as complications resulting from the procedure such as GVHD, VOD and so on, and glutamine could to improve the clinical course of patients after transplantation while given with parenteral nutrition as it is considered that it has stimulatory effects on lymphocytes and mucosa cells in vitro. In the study, we investigated the effect of dipeptiven, N(2)-L-Alanyl-L-Glutamine, which has dipeptides as free glutamine is rather unstable and poorly soluble, added to standard TPN preparations on complication and recovery of patients with allo-HSCT. 40 patients who suffered hematologic malignancies and received allo-HSCT were randomly assigned to receive either standard TPN (control group, n=20), or dipeptiven supplemented TPN (DPT group, n=20). The Bu/Cy2 regimen was used in conditioning with Bu (16mg/kg) plus Cy (120mg/kg) and all patients were given mycophenolate mofetil, CsA and MTX to prevent GVHD. The nutritiona support was started about 1 to 12 days after transplantation and 1.5ml/kg.d dipeptiven was added to the DPT group. During the period of nutritiona support, serum albumin, total protein, creatinine, total bilirubin, leukocytes, lymphocytes were monitored, and time to neutrophil engraftment, decrease of body weight, hospital stays, and other data related to hospital infection and acute GVHD were evaluated for all patients. As a result, the levels of serum albumin fell in the two groups on the 7-day, but on the 28-day those in the DPT group returned to normal and were significantly better than those in the control group (P&lt;0.05). The total bilirubin and creatinine concentration did not change much. And lymphocytes of the patients in the DPT group recovered more rapidly than in the control group (P&lt;0.05). There were less cases with clinical infection and microbial colonization in the DPT group than the control group (10 vs 16,11 vs 17, P&lt;0.05). Also days for antibiotic requirements, days of diarrhea, changes of body weight and hospital stays reduced in the DPT group (16.5±10.6d vs 25.4±16.3d, 4.7±4.5d vs 8.2±6.0d, 2.0±2.0kg vs 3.3±1.6kg, 49.2±18.8d vs 58.0±20.2d, P&lt;0.05, respectively). There were no different between the two groups of incidence of acute GVHD. In the conclusion, DPT-supplemented parenteral nutrition was beneficial in allo-HSCT patients for the nutritional status improving, the incidence of infection and damage of intestine, liver diminishing were all reduced, and the incidence of acute GVHD not increasing.
Vancomycin Resistant Enterococcus (VRE) Bloodstream Infections (BSI) in Patients with Hematological Malignancies: Is the Sick Getting Sicker?.
Authors: Dubberke Erik R. , Holland James , Georgantopolis Peter , Augustin Kristan , Dipersio John F. , Mundy Linda , Khoury Hanna J. 
Published: April 2020

Abstract
Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial BSI. Data describing the prognosis and outcomes of VRE BSI in this patient population is limited. We performed a retrospective chart review of all cases of VRE BSI occurring between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital. 68 episodes of VRE BSI were observed in 60 patients with acute (53%) or chronic (8%) leukemia, NHL (22%), or other malignant hematologic disorders (17%).46 were autologous (13%), related (32%) and URD (32%) transplant recipients. Forty days prior to the VRE BSI, 70% were colonized with VRE, 95% had broad-spectrum antibiotic exposure and 42% had non-VRE BSI, 35% pneumonia, 22% CMV reactivation, 10% fungal infection. At the time of the VRE BSI, 42% of allograft recipients had active acute GVHD and 32% chronic GVHD. Only 57% were neutropenic, 52% had refractory/relapsed malignancy, and 60% had end organ dysfunction with a median APACHE II score of 17. VRE was easily eradicated from the bloodstream after initiation of anti-VRE therapy (median time to clearance 1 (range 1–9) day). 3 patients died within 48 hours of the VRE BSI from causes unrelated to the BSI. Median survival after VRE BSI was 19 days. Only 4 deaths were directly attributable to the VRE BSI. Age, ECOG PS ≥ 2 on admission, HSCT, pneumonia, mechanical ventilation, acute neurologic dysfunction, receipt of anti-fungal drugs, and low APACHE II score were significant factors associated with death by univariate analysis, while pneumonia, receipt of anti-fungal drugs, and low APACHE II score at the time of the VRE BSI remained significant after multivariate analysis.
In summary, our analysis suggests that in patients with hematological malignancies, VRE does not have the microbiologic behavior of a virulent pathogen. VRE BSI may simply be a marker of these patients’s already existing critical medical condition.