Anti-Fungal Prophylaxis Using Intermediate Dose Ambisome is Associated with Delayed Methotrexate Clearance in Pediatric Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

TRAEs leading to death occurred in 3.9% of leukemia patients and 2.1% of nonleukemia patients, with the most common being pulmonary hemorrhage (1%/.6%). Conclusions: At Day +100, survival profiles and safety profiles in leukemia and nonleukemia post-HSCT patients were consistent with prior defibrotide studies and with the overall HSCT population in this study. There was a trend toward improved Day +100 survival in the nonleukemia group. Between the AML and ALL subgroups, Day +100 survival rates were similar. Support: Jazz Pharmaceuticals.Dry eye disease (DED) is one of the most common and challenging manifestation of cGVHD and ocular symptoms are largely related to patient's quality of life. This cross-sectional study aimed to describe the incidence, clinical features, outcome of DED, and Meibomian gland dysfunction (MGD) associated with ocular graft-versus-host disease (oGVHD). The patients referred to the oGVHD Unit at University of Campinas, due to ocular surface discomfort any time after allo-HSCT or for routine ocular exam prior to the procedure were included. Patients were diagnosed with cGVHD per NIH Consensus criteria. The ancillary ophthalmological examination, including Schirmer's test, Ocular Surface Disease Index (OSDI), Corneal Fluorescein Staining (CFS), Conjunctival hyperemia (CH), Tear Breakup time (TBUT) and Meibomian Gland Dysfunction (MGD) were compared to NIH ocular score at the onset of the ocular symptoms. All the data was analysed using descriptive tools and Spearman's/Pearson's test using SPSS 21 version software. Forty-one out of fifty (82%) patients had cGVHD. The median month of cGVHD onset was 7 (2-74). The median of organs involved was 3 (1-6). Mouth, skin and liver were the main organs involved (93%, 63% and 63% respectively). The ocular involvement was present in 22/41 (54%) cGVHD patients. Comparing all cGVHD patients, with or without ocular involvement, Schirmer <10 mm (−67% P < .0001), CH > 1 (67% P < .0001), CSF > 1 (43% P = .005) and OSDI > 20 (65% P < .0001) had a significant association with oGVHD. Considering just the patients with oGVHD, the Schirmer <10 mm (−54% P = .01) was the only test associated with NIH ocular score ≥1. Therefore, Schirmer's test, CH, CFS and OSDI might be important tools to refine the evaluation of oGVHD and should be considered in clinical trials addressing ocular involvement.