Determining Toxoplasma high-risk autologous and allogeneic hematopoietic stem cell transplantation patients by systematic pre-transplant PCR screening of stem cell originated buffy coat

Caner, Ayşe; Dönmez, Ayhan; Döşkaya, Mert; Değirmenci, Aysu; Tombuloğlu, Murat; Cagirgan, Seckin; Guy, Edward; Francis, Janet; Soyer, Nur; Gürüz, Yüksel

doi:10.1016/j.parint.2012.05.005

Cited by 9 publications

(18 citation statements)

References 31 publications

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“…In 67 cases (19%), the toxoplasma serostatus pre-HCT was unknown. These findings are consistent with several observational studies demonstrating a higher incidence of toxoplasmosis in allo pre-HCTSP vs. allo pre-HCTSN [3,5,6,9,11,[15][16][17][18][19][20][21][22][23].…”

Section: Allo-haematopoietic Cell Transplant Recipientssupporting

confidence: 92%

“…In a recent multicentre retrospective study of toxoplasmosis among 71 allo-HCT recipients, overall survival was found to be higher in centres that performed routine toxoplasma PCR follow-up than centres that did not (86 vs. 50%, P < 0.01) [46 && ]. Other smaller studies have also shown an earlier detection of toxoplasma reactivation by serial PCR monitoring before symptom onset with an incidence rate up to 23% in pre HCT-seropositive allogenic recipients [5,6,17,19,22,47]. This has allowed prompt initiation of antitoxoplasma therapy and thus possibly preventing end-organ disease and ensuing mortality.…”

Section: Preemptive Strategy Using Pcrmentioning

confidence: 97%

“…Eighty per cent of toxoplasma disease was proven or probable and CNS and disseminated disease accounted for 82% cases. In auto-HCT, the incidence of toxoplasmosis is generally less than 1% despite the fact that more patients undergo auto-HCT than allo-HCT [3][4][5]9,12,14,22,24].…”

Section: Auto-haematopoietic Cell Transplant Recipientsmentioning

confidence: 99%

See 2 more Smart Citations

Toxoplasma prophylaxis in haematopoietic cell transplant recipients

Gajurel

Dhakal

Montoya

2015

Current Opinion in Infectious Diseases

137

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Section: Allo-haematopoietic Cell Transplant Recipientssupporting

confidence: 92%

Section: Preemptive Strategy Using Pcrmentioning

confidence: 97%

See 1 more Smart Citation

Toxoplasma prophylaxis in haematopoietic cell transplant recipients

Gajurel

Dhakal

Montoya

2015

Current Opinion in Infectious Diseases

137

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“…The main risk factor for reactivation is immune suppression with a higher incidence of toxoplasmosis seen in cord blood, haploidentical and unrelated mismatched donor HSCT. 8,12,13 Low CD4+ cell count, myeloablative conditioning, TBI and use of antithymocyte globulin have also been associated with reactivation. 4,12,13 GvHD is seen in 59% of allo pre-transplant seropositive patients, but has not been consistently associated with reactivation.…”

Section: Letter To the Editormentioning

confidence: 99%

“…8,12,13 Low CD4+ cell count, myeloablative conditioning, TBI and use of antithymocyte globulin have also been associated with reactivation. 4,12,13 GvHD is seen in 59% of allo pre-transplant seropositive patients, but has not been consistently associated with reactivation. 3,13 Prophylaxis to prevent toxoplasma reactivation has been recommended in HSCT recipients, with different dosing regimens that vary from daily to twice weekly regimens 4 but is not followed consistently, as evidenced by several case reports and observational studies, 4,5 mainly because of myelosuppressive effects of trimethoprim-sulfamethoxazole, the most commonly used prophylactic agent.…”

Section: Letter To the Editormentioning

confidence: 99%

Toxoplasmosis disease in paediatric hematopoietic stem cell transplantation: do not forget it still exists

Decembrino

Comelli

Genco

et al. 2017

Bone Marrow Transplant

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Toxoplasmosis is a rare but severe complication after allogenic hematopoietic stem cell transplantation (allo-HSCT) that, in the vast majority of cases, develops as a reactivation of a latent infection; 1,2 however primary infection is also possible. 2-4 Patients who were toxoplasmosis seropositive before transplantation are at higher risk when the donor is seronegative. 1,4,5 Toxoplasmosis disease is associated with high morbidity and mortality rate in~60-90% when the onset is early after transplantation. 4-6 In most cases, patients develop localised central nervous system infection, but disseminated disease is also possible. 1,5,7 In adult patients who undergo HSCT, the reported incidence of toxoplasmosis is~1% with an important variability between geographic areas depending on seroprevalence. 1 When screening PCR is performed in patients at high risk of infectious complications, the incidence of infection (without disease) is 12-18%. 1-3 Here, we report the frequency of toxoplasmosis disease, its presentation, diagnosis and outcome in paediatric patients who underwent allogeneic HSCT in the Paediatric Haematology and Oncology Department at Fondazione IRCCS Policlinico San Matteo of Pavia between 1 January 2011 and 31 December 2015. HSCT data and medical records were collected retrospectively. All patients and, when possible, all donors were tested before and after transplant in order to assess their immunological status with LIAISON XL Toxo-IgG II/IgM (DiaSorin, Saluggia, Italy). In all suspected cases VIDAS TOXO-IgG II and IgG AVIDITY, Toxo-ISAGA IgM (Biomerieux, Marcy l'Etoile, France), ETI-ToxoA (DiaSorin) were performed. To assess their humoral immunological status and in house Interferon Gamma Release Assay, QuantiFERON-ELISA (Cellestis Limited, Carnegie, Victoria, Australia), with Toxoplasma antigen (kindly provided by Diasorin) was also used. The commercial real-time PCR test ELITE-MGB (ELITech Group, Torino Italia) was performed on peripheral blood, and/or cerebrospinal fluid in all the suspected cases and was also used to monitor the recovery. The 187 allo-HSCTs analysed in the study included 15 second allo-HSCT (8%) and 5 patients who received a previous auto-HSCT. Mean age at transplant was 9 years. Underlying disease included malignant (66.3%) and non-malignant (33.7%) disorders. Forty-three patients with a malignant disease (23%) received allo-HSCT in advanced disease status, 81 (43.3%) in early disease status. Only 4 patients received a reduced intensity conditioning regimen. Thirty-seven (19.8%) were matched family donor (MFD), 86 (45.9%) matched unrelated donor (MUD) and 64 (34.2%) partially matched family donor. Main characteristics of the cohort analysed are summarised in Table 1. Of 187 HSCT recipients, 28.8% (54/187) were toxo-IgG positive before transplant and 71.2% (133/187) were naive for protozoan infection. Toxoplasma serology was available only for 152/187 donors: 23% were toxo-IgG positive and 77% were toxo-IgG negative. We found a high number of non-tested donors (18.7%, 35/187), wh...

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Toxoplasmosis After Hematopoietic Stem Cell Transplantation

Martino¹

2016

Transplant Infections

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Determining Toxoplasma high-risk autologous and allogeneic hematopoietic stem cell transplantation patients by systematic pre-transplant PCR screening of stem cell originated buffy coat

Cited by 9 publications

References 31 publications

Toxoplasma prophylaxis in haematopoietic cell transplant recipients

Toxoplasma prophylaxis in haematopoietic cell transplant recipients

Toxoplasmosis disease in paediatric hematopoietic stem cell transplantation: do not forget it still exists

Toxoplasmosis After Hematopoietic Stem Cell Transplantation

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