Immunosuppressive agents in hematopoietic stem cell transplantation

Davulcu, Eren Arslan; Vural, Fılız

doi:10.15761/tit.1000240

Cited by 4 publications

(5 citation statements)

References 14 publications

(19 reference statements)

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“…In this study, we chose not to include patients with autologous bone marrow or hematopoietic stem cell transplantation, since in those cases, immunosuppression therapy is not administered. Interestingly, even though the FIE in allogeneic bone marrow or hematopoietic stem cell transplanted patients was as common as in heart transplanted patients, there are more bone marrow transplantations per year in United States than even liver transplantations; thus, it seems that FIE was less frequent in allogeneic bone marrow or hematopoietic stem cell transplant recipients 76‐78 . This could be associated with the universal practice of antifungal prophylaxis with azoles after allogeneic bone marrow or hematopoietic stem cell transplantation that would reduce the possibility of invasive fungal disease 79,80 …”

Section: Discussionmentioning

confidence: 99%

Fungal endocarditis in transplant recipients: A systematic review

Ιωάννου

Papakitsou

Kofteridis

2020

Mycoses

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Summary Background Invasive fungal infections remain a major cause of morbidity and mortality in transplant recipients. Moreover, Fungal Infective Endocarditis (FIE) is a rare infection that carries a higher mortality than bacterial IE in normal host, while in transplant recipients may be even higher. The purpose of this study was to systemically review all published cases of FIE in solid organ and allogeneic bone marrow transplant recipients, describe the epidemiology, microbiology, clinical characteristics, treatment and outcomes of these infections, and to identify risk factors for mortality by FIE. Methods A systematic review of PubMed, Scopus and Cochrane Library (through 20 May 2020) for studies providing epidemiological, clinical, microbiological and treatment data and outcomes of FIE in transplant recipients was performed. Results A total of 60 studies, containing data of 72 patients, were included. The most common transplants were those of the kidney and the liver, while the commonest causative pathogen was Aspergillus. Mitral valve was the commonest infected intracardiac site, followed by mural endocardium. Diagnosis was made with transthoracic echocardiography in 44.3%, while the diagnosis was made at autopsy in 37.3%. Embolic phenomena were the commonest clinical presentation, followed by fever, heart failure and endophthalmitis. Amphotericin B, voriconazole and caspofungin were the commonest antifungals used for treatment of FIE. Clinical cure was noted in 26.9%, while overall mortality was 78.6%. Amphotericin B or caspofungin use was negatively associated with overall mortality. Conclusions This systematic review thoroughly describes IE in transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes.

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Section: Discussionmentioning

confidence: 99%

Fungal endocarditis in transplant recipients: A systematic review

Ιωάννου

Papakitsou

Kofteridis

2020

Mycoses

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“…Haematopoietic Cell Transplant (HCT) is widely used to treat various malignancies and requires a course of immunosuppressants post-transplant [ 83 ]. Some past studies conducted on pediatric patients who had a HCT and were infected with a coronavirus needed a significantly high rate of respiratory support and showed a higher mortality rate.…”

Section: Interrelation Between Covid-19 and Disorders With Strongest mentioning

confidence: 99%

Interrelations between COVID-19 and other disorders

Gasmi

Peana

Pivina

et al. 2021

Clinical Immunology

142

106

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“…Mycophenolate mofetil (MMF), an ester-prodrug of mycophenolic acid (MPA), has been the antiproliferative immunosuppressant of choice for the prevention of graft rejection following solid organ transplantation [ 1 , 2 ]. It has also been increasingly used in some other conditions, such as hematopoietic stem cell transplantation and autoimmune diseases [ 3 , 4 ]. After oral administration, the prodrug MMF is rapidly hydrolyzed to its biologically active form, MPA, resulting in the first MPA peak plasma concentration.…”

Section: Introductionmentioning

confidence: 99%

Gut Microbiota-Mediated Pharmacokinetic Drug–Drug Interactions between Mycophenolic Acid and Trimethoprim-Sulfamethoxazole in Humans

et al. 2023

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Mycophenolic acid (MPA) and trimethoprim-sulfamethoxazole (TMP-SMX) are commonly prescribed together in certain groups of patients, including solid organ transplant recipients. However, little is known about the pharmacokinetic drug–drug interactions (DDIs) between these two medications. Therefore, the present study aimed to determine the effects of TMP-SMX on MPA pharmacokinetics in humans and to find out the relationship between MPA pharmacokinetics and gut microbiota alteration. This study enrolled 16 healthy volunteers to take a single oral dose of 1000 mg mycophenolate mofetil (MMF), a prodrug of MPA, administered without and with concurrent use of TMP-SMX (320/1600 mg/day) for five days. The pharmacokinetic parameters of MPA and its glucuronide (MPAG) were measured using high-performance liquid chromatography. The composition of gut microbiota in stool samples was profiled using a 16S rRNA metagenomic sequencing technique during pre- and post-TMP-SMX treatment. Relative abundance, bacterial co-occurrence networks, and correlations between bacterial abundance and pharmacokinetic parameters were investigated. The results showed a significant decrease in systemic MPA exposure when TMP-SMX was coadministered with MMF. Analysis of the gut microbiome revealed altered relative abundance of two enriched genera, namely the genus Bacteroides and Faecalibacterium, following TMP-SMX treatment. The relative abundance of the genera Bacteroides, [Eubacterium] coprostanoligenes group, [Eubacterium] eligens group, and Ruminococcus appeared to be significantly correlated with systemic MPA exposure. Coadministration of TMP-SMX with MMF resulted in a reduction in systemic MPA exposure. The pharmacokinetic DDIs between these two drugs were attributed to the effect of TMP-SMX, a broad-spectrum antibiotic, on gut microbiota-mediated MPA metabolism.

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Immunosuppressive agents in hematopoietic stem cell transplantation

Cited by 4 publications

References 14 publications

Fungal endocarditis in transplant recipients: A systematic review

Fungal endocarditis in transplant recipients: A systematic review

Interrelations between COVID-19 and other disorders

Gut Microbiota-Mediated Pharmacokinetic Drug–Drug Interactions between Mycophenolic Acid and Trimethoprim-Sulfamethoxazole in Humans

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