We report 4 cases of invasive zygomycosis in hematopoietic stem cell transplant recipients, all occurring after May 2003, when voriconazole began to be used as antifungal prophylaxis. No cases of zygomycosis had been detected in this population in the 3 years prior to May 2003. All 4 patients were receiving immunosuppressive therapy for presumed graft-versus-host disease. Profoundly immunosuppressed patients receiving voriconazole prophylaxis remain at risk for less-common pathogens that are intrinsically resistant to this agent.

Summary:unstimulated peripheral blood contains less than one tenth the number of progenitors as marrow, the total number present in mobilized leukapheresis harvests and infused We evaluated early and late hematopoietic reconstitution in 27 patients with advanced lymphoma, Hodgto reconstitute hematopoiesis may exceed marrow by several fold. 2,3 kin's disease, and breast or ovarian cancer after treatment using high-dose/myeloablative conditioning Clinical studies have shown that 'mobilized' PBSC transplants are associated with earlier hematologic recovregimens and autologous peripheral blood stem cell (PBSC) transplantation. Eighteen patients (67%) ery, fewer complications, and reduced usage of blood components during the post-transplant period. 4-8 Methods received G-CSF 5 g/kg/day following chemotherapy and nine (33%) were mobilized using G-CSF alone.successfully used to augment PBSC levels include collecting the cells shortly after recovery from chemotherapy, 9 Each patient had 7 ؋ 10 8 mononuclear cells (MNC) per kg collected. G-CSF was administered post-PBSC after the administration of hematopoietic growth factors such as granulocyte-macrophage colony-stimulating factor infusion. While all patients showed prompt granulocyte recovery by day 14, platelet recovery failed to occur in (GM-CSF) or granulocyte colony-stimulating factor (G-CSF) 6,10,11 alone, or in combination with chemofour (15%) heavily pretreated patients with non-Hodgkin's lymphoma. Retrospective analysis in 17 patients therapy. [12][13][14][15][16] We report our experience regarding the effectiveness of revealed that the infused number of CD34 surface antigen-positive cells correlated with time to granulocyte (r G-CSF-mobilized PBSC as a source of progenitors in patients with advanced lymphomas and breast or ovarian = 0.59, P = 0.012) and platelet (r = 0.58, P = 0.021) recovery. Patients receiving the higher numbers of CD34 + cancer who received high-dose/myeloablative conditioning regimens. We have examined the relationship between stem cells had consistently better hematologic parameters at all times examined. At 180 days post-transplant, the cell yield and both early engraftment and late hematopoietic reconstitution, and the clinical factors associated with the median Hb level was 124 g/l vs 88 g/l (P = 0.004); platelet count was 202 ؋ 10 9 /l vs 25 ؋ 10 9 /l (P = 0.004); and neufailure of platelet engraftment in several patients that we treated. trophil count was 3100 ؋ 10 6 /l vs 1400 ؋ 10 6 /l (P = 0.15). Hemoglobin strongly correlated with the CD34 + cell dose at 360 days (r = 0.90, P = 0.01). We conclude that graft CD34 + cell content appears to be an indicator Patients and methods of the quality of late as well as early hematopoietic function.

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We investigated the efficacy and toxicity of combining granulocyte-colony stimulating factor (G-CSF) at standard doses with plerixafor, a CXCR4 inhibitor, to mobilize stem cells in patients with non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM). Patients with NHL and MM underwent mobilization with G-CSF (10 microg/kg/day) for up to 9 days and plerixafor (240 microg/kg/day), which started on the evening of day 4. Apheresis began on day 5 and continued daily until either >or= 5 x 10(6) CD34/kg were collected or to a maximum of 5 aphereses. Toxicities, increase in circulating CD34 cells/microL before and after the first dose of plerixafor, percentage of patients collecting >or= 5 x 10(6) CD34/kg, total CD34 cells/kg collected, engraftment, and exploratory efficacy analyses in heavily pretreated patients were examined. Six sites enrolled 49 patients (NHL, 23; MM, 26). All completed mobilization and 47 of 49 (96%) underwent transplant. Circulating CD34 cells/microL increased by 2.5-fold (1.3-6.0-fold) after the first plerixafor dose. The median CD34 cells/kg collected was 5.9 x 10(6) (1.5-22.5) in 2 (1-5) days of aphereses. Median days to neutrophil and platelet engraftment were 11 (8-16) and 14.5 (7-39) days, respectively. Adverse events primarily were mild nausea and diarrhea (n=24). Twenty-eight (57%) were identified as heavily pretreated patients. Their median fold increase in circulating CD34 cells/microL was 2.5 (1.4-5.0) after plerixafor, similar to minimally pretreated patients. Plerixafor and G-CSF increased circulating CD34 cells/microL and led to the adequate collection of stem cells for autotransplant in 96% of the patients. This combination may have particular value in heavily pretreated patients.

West Nile virus (WNV) can cause severe, potentially fatal neurological illnesses, which include encephalitis, meningitis, Guillain-Barré syndrome, and anterior myelitis. Because of the short viremic phase, WNV infection is most commonly diagnosed by detection of immunoglobulin M antibody to WNV in serum or cerebrospinal fluid (CSF). We describe a patient with T cell lymphoma who had undergone a T cell-depleted bone marrow transplantation and developed fatal WNV infection. The results of serological tests of blood samples and of CSF tests were negative. Diagnosis was made postmortem by a positive result of reverse-transcriptase polymerase chain reaction (ABI 7700; TaqMan) for WNV in stored CSF and serum samples.