Invasive aspergillosis (IA) remains a major complication following allogeneic hematopoietic stem cell transplant (HSCT). In contrast to conventional HSCT, few investigators have examined risk factors of IA associated with nonmyeloablative (NMA) regimens characterized by outpatient administration, immunosuppression rather than cytoreduction, and short duration of neutropenia posttransplant. We report our results on a cohort of 125 patients treated homogenously who received a 6/6 matched sibling NMA HSCT designed to be performed on an outpatient basis. Conditioning regimen included fludarabine (30 mg/m(2) x 5 days) and cyclophosphamide (300 mg/m(2) x 5 days) followed by reinfusion of a minimum of 4 x 10(6) CD34(+) cells/kg. Acute graft-versus-host disease (aGVHD) prophylaxis consisted of tacrolimus and mycophenolate mofetil (MMF). Overall, 13 patients developed IA (5 proved, 6 probable, 2 possible) 44-791 days (median 229) after NMA HSCT, with a risk of 7% at 1, 11% at 2, and 15% at 3 years. Patients who suffered from IA had poorer overall survival (crude hazard ratio 2.3; 95% confidence interval [CI] 1.0-5.4; P = .045). Intestinal aGVHD or chronic GVHD (cGVHD) was significantly associated with IA at 1 (27% versus 3%, P = .003), 2 (27% versus 8%, P = .01), and 3 years (37% versus 10%, P = .005). The use of daclizumab was also significantly associated with IA at 3 years (47% versus 12%, P = .02). Age, sex, diagnosis, previous autologous transplant, duration of neutropenia, occurrence of cytomegalovirus viremia, duration of steroids or MMF intake, aGVHD, cGVHD, and cumulative number of days spent in hospital were not associated with IA. After multivariate analysis, intestinal GVHD remained the only statistically significant risk factor for IA at 1 (P = .003), 2 (P = .01), and 3 years (P = .005). We conclude that in NMA HSCT, the risk of IA increases over time and is significantly associated with intestinal GVHD. Because there is currently no surrogate in vitro markers of immunocompetence following NMA HSCT, this clinical finding is of particular importance to identify a population at higher risk who should be targeted for antimold prophylaxis.
The observation of neutrino oscillations establishes that neutrinos (ν ) have non-zero mass and provides one of the more compelling arguments for physics beyond the standard model (SM) of particle physics. We present a feasibility study to search for hypothetical Majorana neutrinos (N ) with TeV scale masses, predicted by extensions of the SM to explain the small but non-zero ν mass, using vector boson fusion (VBF) processes at the 13 TeV LHC. In the context of the minimal Type-I seesaw mechanism (mTISM), the VBF N production cross-section surpasses that of the Drell-Yan process at approximately mN = 1.4 TeV. We consider µNµ and τ Nτ production through VBF processes (e.g. qq → τ Nτ qq ), with subsequent Nµ and Nτ decays to µjj and τ jj, as benchmark cases to show the effectiveness of the VBF topology for N seaches at the 13 TeV LHC. The requirement of a dilepton pair combined with four jets, two of which are identified as VBF jets with large separation in pseudorapidity and a TeV scale dijet mass, is effective at reducing the SM background. This criteria may provide expected exclusion bounds, at 95% confidence level, of mN < 1.7 (2.4) TeV, assuming 100 (1000) fb −1 of 13 TeV data from the LHC and mixing |V N | 2 = 1. The use of the VBF topology to search for mN increases the discovery reach at the LHC, with expected significances greater than 5σ (3σ) for N masses up to 1.7 (2.05) TeV using 1000 fb −1 of 13 TeV data from the LHC.
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