We characterized coronavirus disease 2019 (COVID-19) breakthrough cases admitted to a single center in Florida. With the emergence of delta variant, an increased number of hospitalizations was seen due to breakthrough infections. These patients were older and more likely to have comorbidities. Preventive measures should be maintained even after vaccination.
Summary:A study was done to compare treatment with Filgrastim (r-metHuG-CSF) given at three different times after unrelated bone marrow transplantation (BMT). Sixtynine patients grafted with HLA-A, -B and -DR-compatible unrelated bone marrow were randomized to Filgrastim (5 g/kg/day) starting on day 0 (n = 23), day +5 (n = 23) or day +10 (n = 23) after BMT. No significant differences were detected in hematological recovery, days with fever, days on antibiotics, incidence of bacteremia or need for erythrocyte, platelet and granulocyte transfusions between the three groups. Patients given Filgrastim starting on day 0, day +5 or day +10, respectively, reached an absolute neutrophil count (ANC) Ͼ Ͼ Ͼ0.5 ؋ 10 9 /l on a median of 17, 16 and 16 days after BMT. Starting Filgrastim treatment on day +10, rather than on day 0, reduced the costs of Filgrastim by $1060, with no significant change in the median number of days-tohospital discharge in the three Filgrastim-treated groups. The incidences of acute and chronic GVHD, transplantation-related mortality, relapse, leukemiafree survival and patient survival (PS) were similar in all groups. Keywords: BMT; unrelated donors; G-CSF; engraftment During the past few years, hematopoietic stem cells (HSC) from unrelated donors have been increasingly used for transplantation.1,2 Almost 4 million volunteer donors of HSC are available worldwide. Therefore, one can find an HLA-A, -B and -DR-identical donor for approximately 70% of all Caucasian patients who need an allogeneic hematopoietic stem cell transplant (HSCT). If unrelated HSC are used, there is an increased risk of acute graft-versushost disease (GVHD), infections and a higher transplantrelated mortality.3,4 It is well established that recombinant human granulocyte-macrophage and granulocyte colonystimulating factors (rHuGM-CSF, rHuG-CSF) can accelerate neutrophil recovery after treatment with chemotherapy and autologous or allogeneic HSCT. penia, and some studies a reduction in the duration of antibiotic treatment, infections and the length of hospitalization.13-18 Experience of G-CSF treatment after unrelated BMT is limited. [19][20][21][22] The present study compares initiation of Filgrastim (r-metHuG-CSF) treatment at 0, +5 or +10 days after HLA-A,-B and -DR-compatible unrelated HSCT. Patients and methods PatientsThe protocol was approved by the local ethics review committee at Huddinge Hospital, and all patients gave informed consent before the study. Sixty-nine consecutive patients receiving bone marrow from HLA-A, -B and -DR-compatible unrelated donors between April 1994 and September 1997 were studied. The patients were stratified for children Ͻ18 years and adults у18 years, and for patients with or without malignancies. Patients were randomized to receive Filgrastim treatment starting on day 0, day +5 or day +10. Conditioning and prophylaxis against GVHDThe conditioning regimen and graft-versus-host disease (GVHD) prophylaxis were the same throughout the study period.23 Sixty-six patients were treated with cyclopho...
Background While COVID‐19 immunization programs attempted to reach targeted rates, cases rose significantly since the emergence of the delta variant. This retrospective cohort study describes the correlation between antispike antibodies and outcomes of hospitalized, breakthrough cases during the delta variant surge. Methods All patients with positive SARS‐CoV‐2 polymerase chain reaction hospitalized at Mayo Clinic Florida from 19 June 2021 to 11 November 2021 were considered for analysis. Cases were analyzed by vaccination status. Breakthrough cases were then analyzed by low and high antibody titers against SARS‐CoV‐2 spike protein, with a cut‐off value of ≥132 U/ml. Outcomes included hospital length of stay (LOS), need for intensive care unit (ICU), mechanical ventilation, and mortality. We used 1:1 nearest neighbor propensity score matching without replacement to assess for confounders. Results Among 627 hospitalized patients with COVID‐19, vaccine breakthrough cases were older with more comorbidities compared to unvaccinated. After propensity score matching, the unvaccinated patients had higher mortality (27 [28.4%] vs. 12 [12.6%], p = 0.002) and LOS (7 [1.0–57.0] vs. 5 [1.0–31.0] days, p = 0.011). In breakthrough cases, low‐titer patients were more likely to be solid organ transplant recipients (16 [34.0%] vs. 9 [12.3%], p = 0.006), with higher need for ICU care (24 [51.1%] vs. 22 [11.0%], p = 0.034), longer hospital LOS (median 6 vs. 5 days, p = 0.013), and higher mortality (10 [21.3%] vs. 5 [6.8%], p = 0.025) than high‐titer patients. Conclusions Hospitalized breakthrough cases were more likely to have underlying risk factors than unvaccinated patients. Low‐spike antibody titers may serve as an indicator for poor prognosis in breakthrough cases admitted to the hospital.
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