Dynamic change of glycemic status during the early phase after allogeneic hematopoietic stem cell transplantation

Fuji, Shigeo; Yakushijin, Kimikazu; Sw, Kim; Yoshimura, Ken; Kurosawa, Saiko; Fukuda, Takahiro

doi:10.1038/bmt.2015.163

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…1,2 Studies in adults undergoing HSCT demonstrate associations between malglycemia and adverse clinical outcomes, including infection, length of hospital stay, organ dysfunction, GVHD, delayed hematopoietic recovery, and mortality. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] The increased incidence of malglycemia in HSCT patients has been postulated to be related to a combination of factors, including stress hyperglycemia, underlying insulin resistance, decreased insulin secretion, steroid treatment, total parenteral nutrition (TPN), and calcineurin inhibitors. 5,7,9,[14][15][16][17] The underlying pathophysiology of the association between malglycemia and adverse outcomes may relate to known immunologic effects, such as increased inflammation and impaired leukocyte function.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] The increased incidence of malglycemia in HSCT patients has been postulated to be related to a combination of factors, including stress hyperglycemia, underlying insulin resistance, decreased insulin secretion, steroid treatment, total parenteral nutrition (TPN), and calcineurin inhibitors. 5,7,9,[14][15][16][17] The underlying pathophysiology of the association between malglycemia and adverse outcomes may relate to known immunologic effects, such as increased inflammation and impaired leukocyte function. 1,3,12,15,18,19 Hyperglycemia is associated with increased tumor necrosis factor a and interleukin-6 production, impaired neutrophil chemotaxis and degranulation, increased lymphocyte apoptosis, and immune effects.…”

Section: Introductionmentioning

confidence: 99%

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Malglycemia is associated with poor outcomes in pediatric and adolescent hematopoietic stem cell transplant patients

et al. 2019

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Malglycemia (hypoglycemia, hyperglycemia, and/or glycemic variability) in adult hematopoietic stem cell transplant (HSCT) recipients is associated with increased infection, graft-versus-host disease, organ dysfunction, delayed engraftment, and mortality. Malglycemia has not been studied in pediatric HSCT recipients. This study aimed to characterize the incidence and consequences of malglycemia in this population. Medical records for a cohort of 344 patients, age 0 to 30 years, who underwent first HSCT from 2007 to 2016 at Children’s Hospital Colorado were retrospectively reviewed. Glucose data were analyzed in intervals and assessed for potential risk factors and associated outcomes. Malglycemia occurred in 43.9% of patients. Patients with a day 0 to 100 mean glucose of 100 to 124 mg/dL had a 1.76-fold (95% confidence interval [CI], 1.10-2.82; P = .02) increased risk of death and patients with a day 0 to 100 mean glucose ≥ 125 mg/dL had a 7.06-fold (95% CI, 3.84-12.99; P < .0001) increased risk of death compared with patients with a day 0 to 100 mean glucose < 100 mg/dL. For each 10 mg/dL increase in pre-HSCT glucose, there was a 1.11-fold (95% CI, 1.04-1.18; P = .0013) increased risk of post-HSCT infection. These adverse impacts of malglycemia occurred independent of transplant type, graft-versus-host disease, and steroid therapy. Malglycemia in the pediatric HSCT population is independently associated with significantly increased risk of morbidity and mortality. Further research is required to evaluate the utility of glucose control to mitigate these relationships and improve HSCT outcomes. This trial was registered at www.clinicaltrials.gov as #NCT03482154.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Malglycemia is associated with poor outcomes in pediatric and adolescent hematopoietic stem cell transplant patients

et al. 2019

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“…64 Substantial elevation of glucose levels during the early period after allo-HSCT may reflect inflammation-induced insulin resistance, which could possibly be associated with subsequent acute GVHD development. 60,62,64 Hammer et al 61 reported the adverse impact of hyperglycemia between days 0 and 100, which was associated with an increased risk of infectious diseases and NRM. Patients receiving systemic glucocorticoids as GVHD treatment are at higher risk to develop hyperglycemia, which is associated with inferior clinical outcome.…”

Section: Ptdm and Clinical Outcomesmentioning

confidence: 99%

“…52 C-peptide level may be elevated transiently during the early period after allo-HSCT; however, the increased insulin levels are insufficient to compensate for the worsening insulin resistance. 60 Several retrospective studies consistently showed that post-transplant hyperglycemia was associated with an increased risk of subsequent morbidity and mortality after HSCT. [61][62][63][64][65] Patients with hyperglycemia during the neutropenic period after allo-HSCT had an increased risk of subsequent GVHD and NRM.…”

Section: Ptdm and Clinical Outcomesmentioning

confidence: 99%

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Fuji

Rovó

Ohashi

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients frequently develop glucose intolerance and post-transplant diabetes mellitus (PTDM). The clinical importance of PTDM and its detrimental impact on HSCT outcomes are underrecognized. After allo-HSCT, various mechanisms can contribute to the development of PTDM. Here we review information about hyperglycemia and PTDM after allo-HSCT as well as PTDM after solid organ transplantation and describe ways to manage hyperglycemia/PTDM after allogeneic HSCT. Taking into consideration a lack of well-established evidence in the field of allo-HSCT, more studies should be conducted in the future, which will require closer multidisciplinary collaboration between hematologists, endocrinologists and nutritionists.

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“…In particular, glucose control after allogeneic HSCT during the early neutropenic period could be crucial, as the risk of bacterial and fungal infections is high due to profound neutropenia, and the risk of developing hyperglycemia is also high due to various causes such as inflammation associated with conditioning regimens and total parenteral nutrition. 60,61 The development of infectious diseases during the early post-transplant period might lead to an increased risk of subsequent complications. 62,63 In a small prospective study designed to assess the feasibility and effectiveness of intensive glycemic control (IGC) after allogeneic HSCT, there were significantly fewer documented infections in patients undergoing IGC compared with the matched-control group, although the study population was too small to assess the impact of IGC on the incidence of mold infections.…”

Section: Possible Implications Of Glucose Control To Reduce the Risk mentioning

confidence: 99%

Hyperglycemia as a possible risk factor for mold infections—the potential preventative role of intensified glucose control in allogeneic hematopoietic stem cell transplantation

Fuji

Löffler

Savani

et al. 2016

Bone Marrow Transplant

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Diabetes mellitus (DM) is well-known as a disorder that increases the risk of infectious diseases. Various reports have shown that innate immunity is impaired in patients with DM, which is considered to be a major cause of increased risk of infectious diseases. However, there is a paucity of data about the actual risk of mold infections in patients with DM. Several treatment procedures, such as solid organ transplantation and hematopoietic stem cell transplantation (HSCT), are intrinsically associated with a high risk of mold infections and also correlated with an increased risk of post-transplant DM. Therefore, we could assume that organ transplant recipients or HSCT recipients with DM are at quite high risk of mold infections. Here, we aim to summarize the information about the increased risk of mold infections in patients with DM, and propose possible interventions such as intensive glucose control to reduce this risk in patients with DM.

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Dynamic change of glycemic status during the early phase after allogeneic hematopoietic stem cell transplantation

Cited by 6 publications

References 16 publications

Malglycemia is associated with poor outcomes in pediatric and adolescent hematopoietic stem cell transplant patients

Malglycemia is associated with poor outcomes in pediatric and adolescent hematopoietic stem cell transplant patients

How do I manage hyperglycemia/post-transplant diabetes mellitus after allogeneic HSCT

Hyperglycemia as a possible risk factor for mold infections—the potential preventative role of intensified glucose control in allogeneic hematopoietic stem cell transplantation

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