Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Chandrasekar, P.H.; Ramesh, Mayur

doi:10.1586/eri.09.105

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…was not observed in our study, probably because of the widespread use of mold-active prophylaxis in our institution. 21,22 Mycobacteria also rarely were isolated, which is congruent with other studies. 12 …”

Section: Discussionsupporting

confidence: 91%

Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center

Sampsonas

Kontoyiannis

Dickey

et al. 2011

Cancer

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BACKGROUND Flexible bronchoscopy with bronchoalveolar lavage (BAL) is performed widely for the diagnosis of pulmonary infections in patients with cancer, but there is no consensus regarding the technical parameters of the lavage procedure in this setting. METHODS The authors evaluated the mechanics (instilled and recovered volumes), diagnostic yield, and safety of a standardized BAL protocol in 284 patients with cancer who underwent bronchoscopy for the evaluation of new radiologic infiltrates. RESULTS Physician adherence to the BAL protocol was > 90%. The most common protocol deviations were reductions in the saline volume instilled because of actual or anticipated oxyhemoglobin desaturation during the procedure. The mean volume instilled was 121.5 ± 13.9 mL, the mean volume recovered was 68.7 ± 18.1 mL, and the mean ratio of volume instilled to that recovered was 56.7% ± 14.5%. The overall diagnostic yield of BAL was 33.8% and was higher in the nonhematologic malignancy group (42.3% vs 29.4%; P = .021). The diagnostic yield in neutropenic patients was significantly higher than in nonneutropenic patients (41.5% vs 24.6%; P = .019). No major complications were encountered. CONCLUSIONS In summary, the diagnostic performance of a standardized BAL protocol was comparable to that of nonprotocolized BAL reported in the literature with few complications. Adherence to a standardized BAL protocol may improve clinical and laboratory comparisons between studies, potentially facilitating research into the diagnosis and management of pneumonia in patients with cancer.

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Section: Discussionsupporting

confidence: 91%

Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center

Sampsonas

Kontoyiannis

Dickey

et al. 2011

Cancer

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“…The incidence of IA among the HSCT recipients has increased since the 1990s; this may be attributed to the grafts obtained from high-risk donors, increased profound immunosuppression, and prophylaxis with fluconazole, which is active against most Candida species but not against Aspergillus species. In recent years, IA has been the most common invasive fungal infection (IFI) following HSCT, accounting for 59% of IFIs [6]. …”

Section: Discussionmentioning

confidence: 99%

Primary renal aspergillosis and renal stones in both kidneys associated with hematopoietic stem cell transplant

et al. 2010

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Invasive aspergillosis (IA) is a leading cause of infectious mortality in patients who have undergone a hematopoietic stem cell transplant (HSCT); the mortality due to IA ranges from 70% to 93% in HSCT patients. Early diagnosis and treatment are the cornerstones for the good prognosis of IA. Primary renal aspergillosis is an extremely rare presentation in patients who have undergone HSCT, and the risk factor for this uncommon presentation is not well known. We report a patient who developed primary renal aspergillosis and renal stones in both the kidneys after HSCT. Invasive renal aspergillosis was diagnosed after a nephrectomy, which was performed to treat massive renal hematoma.

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“…As yet, the tumor DNA microarray has been unable to explain the cellular heterogeneity as well as different proliferative potentiality of subpopulations of tumor cells (95). Nevertheless, the identification of novel diagnostic markers or therapeutic targets by expression analyses of tumor stem cells may be more effective.…”

Section: Therapeutic Implication For Tumor Stem Cellsmentioning

confidence: 99%

Tumor stem cells: A new approach for tumor therapy (Review)

et al. 2012

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Abstract. Recent studies have demonstrated the existence of a minority of tumor cells possessing the stem cell properties of self-renewal and differentiation in leukemia and several solid tumors. However, these cells do not possess the normal regulatory mechanisms of stem cells. Following transplantation, they are capable of initiating tumorigenesis and are therefore known as 'tumor stem cells'. Cellular origin analysis of tumor stem cells has resulted in three hypotheses: Embryonal rest hypothesis, anaplasia and maturation arrest. Several signaling pathways which are involved in carcinogenesis, including Wnt/β-catenin, Notch and Oct-4 signaling pathways are crucial in normal stem cell self-renewal decisions, suggesting that breakdown in the regulation of self-renewal may be a key event in the development of tumors. Thus, tumors can be regarded as an abnormal organ in which stem cells have escaped from the normal constraints on self-renewal, thus, leading to abnormally differentiated tumor cells that lose the ability to form tumors. This new model for maligancies has significance for clinical research and treatment.

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Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Cited by 3 publications

References 19 publications

Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center

Performance of a standardized bronchoalveolar lavage protocol in a comprehensive cancer center

Primary renal aspergillosis and renal stones in both kidneys associated with hematopoietic stem cell transplant

Tumor stem cells: A new approach for tumor therapy (Review)

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