Non-myeloablative allogeneic transplantation (‘microallograft’) for refractory myeloma after two preceding autografts: feasibility and efficacy in a patient with active aspergillosis

Singhal, Seema; Safdar, Amar; Chiang, Kuang‐Yueh; Godder, Kamar; Rhee, Frits van; Garner, Fredric B.; Foster, Brandon; D, Dubovsky; Henslee‐Downey, P. Jean; Mehta, Jayesh

doi:10.1038/sj.bmt.1702713

Cited by 16 publications

(5 citation statements)

References 13 publications

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“…For example, according to the limited literature, whether procedures that reduce neutropenia durations, such as reduced-intensity conditioning regimens and use of peripheral blood as a stem cell source, reduce the risk of relapsing fungal infections is unclear [10,13,[27][28][29]49].…”

Section: Clinical Factors That Affect Relapsing Iamentioning

confidence: 99%

Clinical Issues Regarding Relapsing Aspergillosis and the Efficacy of Secondary Antifungal Prophylaxis in Patients with Hematological Malignancies

Sipsas¹,

Kontoyiannis²

2006

Clinical Infectious Diseases

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Advancements in early diagnosis and the introduction of effective agents have improved the rates of response of aspergillosis to primary antifungal therapy. These changes allow the subsequent continuation of cytotoxic chemotherapy and/or performance of hematopoietic stem cell transplantation in an increasing number of patients with hematological malignancies. These developments have increased interest in secondary prophylaxis of aspergillosis, because the resumption of myelotoxic chemotherapy in these patients is associated with high rates of relapse of this opportunistic mycosis in the absence of prophylaxis. However, the risk factors for relapsing invasive aspergillosis and the strategies for reducing risk are not well defined. Furthermore, differentiating aspergillosis relapse from reinfection with a new Aspergillus isolate is problematic when using the available laboratory tools. We summarize the existing knowledge regarding the pathogenesis of, risk factors for, and natural history of relapsing invasive aspergillosis and review the limited data regarding the role of secondary antifungal prophylaxis.

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Section: Clinical Factors That Affect Relapsing Iamentioning

confidence: 99%

Clinical Issues Regarding Relapsing Aspergillosis and the Efficacy of Secondary Antifungal Prophylaxis in Patients with Hematological Malignancies

Sipsas¹,

Kontoyiannis²

2006

Clinical Infectious Diseases

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“…[11][12][13] In fact, several case series report successful outcomes after RIC in patients with prior IA, although successful outcomes have also been obtained with conventional conditioning if supported by intensive medical and surgical care. 10,[14][15][16][17][18][19] However, very little data exist on factors that could predict adverse outcomes in patients with prior IA, although such data would be helpful for developing optimal management strategies for these patients. Only 2 studies with a patient sample size larger than 20 cases have been published to date.…”

Section: Introductionmentioning

confidence: 99%

Impact of the intensity of the pretransplantation conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: a retrospective survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation

Martino

Parody

Fukuda

et al. 2006

Blood

120

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In this retrospective study, we analyzed the outcomes of 129 patients who underwent an allogeneic hematopoietic stem cell transplantation (allo-HSCT) and had a history of probable or proven invasive aspergillosis (IA), of whom 57 (44%) received a reduced-intensity conditioning (RIC). Overall, 27 patients with IA progressed after the allo-HSCT (cumulative incidence [CumInc] at 2 years, 22%). The variables that increased the 2-year CumInc of IA progression were (1) longer duration of neutropenia after transplantation; (2) advanced status of the underlying disease; and (3) less than 6 weeks from start of systemic anti-Aspergillus therapy and the allo-HSCT. In addition, (4) conventional myeloablative conditioning increased the risk of progression early after transplantation (before day 30) only, while 3 variables increased the risk beyond day 30 were (5) cytomegalovirus disease; (6) bone marrow or cord blood as source of stem cells; and (7) grades II to IV acute graft-versus-host disease (GVHD). A risk model for progression was generated, defined as low (0-1 risk factors, 6% incidence), intermediate (

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“…[1][2][3][4][5][6] Especially for transplantation protocols in gene therapy, or treatment of autoimmune diseases, a nonmyeloablated bone marrow environment is desired for autologous stem cells to engraft effectively. [7][8][9][10] Most clinical transplantation protocols still use high-dose conditioning regimens to prevent rejection of the donor graft and to create a microenvironment in which transplanted (stem) cells are able to migrate efficiently to the bone marrow and "home" to appropriate niches.…”

Section: Introductionmentioning

confidence: 99%

Growth factor treatment prior to low-dose total body irradiation increases donor cell engraftment after bone marrow transplantation in mice

Noach

Ausema

Dillingh

et al. 2002

Blood

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Non-myeloablative allogeneic transplantation (‘microallograft’) for refractory myeloma after two preceding autografts: feasibility and efficacy in a patient with active aspergillosis

Cited by 16 publications

References 13 publications

Clinical Issues Regarding Relapsing Aspergillosis and the Efficacy of Secondary Antifungal Prophylaxis in Patients with Hematological Malignancies

Clinical Issues Regarding Relapsing Aspergillosis and the Efficacy of Secondary Antifungal Prophylaxis in Patients with Hematological Malignancies

Growth factor treatment prior to low-dose total body irradiation increases donor cell engraftment after bone marrow transplantation in mice

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