RESUMEN
Unrelated cord blood transplantation (UCBT) after a reduced intensity conditioning regimen (RIC) has extended the use of UCB in elderly patients and those with co-morbidities without an HLA-identical donor, although post-transplant relapse remains a concern in high-risk acute myeloid leukemia (AML) patients. HLA incompatibilities between donor and recipient might enhance the alloreactivity of natural killer (NK) cells after allogeneic hematopoietic stem-cell transplantation (HSCT). We studied the reconstitution of NK cells and KIR-L mismatch in 54 patients who underwent a RIC-UCBT for AML in CR in a prospective phase II clinical trial. After RIC-UCBT, NK cells displayed phenotypic features of both activation and immaturity. Restoration of their polyfunctional capacities depended on the timing of their acquisition of phenotypic markers of maturity. The incidence of treatment-related mortality (TRM) was correlated with low CD16 expression (P=0.043) and high HLA-DR expression (P=0.0008), whereas overall survival was associated with increased frequency of NK-cell degranulation (P=0.001). These features reflect a general impairment of the NK licensing process in HLA-mismatched HSCT and may aid the development of future strategies for selecting optimal UCB units and enhancing immune recovery.
Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical , Células Asesinas Naturales/inmunología , Leucemia Mieloide Aguda/inmunología , Recuperación de la Función/inmunología , Sistema de Registros , Acondicionamiento Pretrasplante , Adulto , Aloinjertos , Supervivencia sin Enfermedad , Femenino , Humanos , Leucemia Mieloide Aguda/mortalidad , Leucemia Mieloide Aguda/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de SupervivenciaRESUMEN
Burkholderia pseudomallei (melioidosis) is usually found in endemic areas of Southeast Asia and Northern Australia. However, a few cases of confirmed melioidosis indigenous to Puerto Rico and the Americas have been reported previously. We describe the occurrence of a B. pseudomallei infection in a female with insulin-dependent diabetes mellitus exposed to flood waters in Puerto Rico. We conclude that B. pseudomallei should be considered a potential pathogen in high-risk patients with severe community-acquired pneumonia and sepsis in Puerto Rico especially in individuals exposed to flood waters during rainy seasons. A more thorough epidemiologic and microbiologic surveillance with environmental sampling may be warranted in the island
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Burkholderia pseudomallei/aislamiento & purificación , Infecciones Comunitarias Adquiridas/microbiología , Melioidosis/microbiología , Neumonía Bacteriana/microbiología , Sepsis/microbiología , Antibacterianos/uso terapéutico , Resultado Fatal , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Melioidosis/diagnóstico , Melioidosis/tratamiento farmacológico , Desastres Naturales , Puerto Rico , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/tratamiento farmacológico , Respiración Artificial/métodos , Sepsis/diagnóstico , Sepsis/tratamiento farmacológicoRESUMEN
We describe a patient with a non-0:1, non-0:139 Vibrio cholerae septicemia associated with ecythema gangrenosa-like skin lesions. The patient acquired the infection in Puerto Rico. Given the high fatality rate, it is important for the medical community to consider the diagnosis in high risk patients with exposures in Puerto Rico tropical waters
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Bacteriemia/microbiología , Cólera/microbiología , Vibrio cholerae/aislamiento & purificación , Bacteriemia/complicaciones , Susceptibilidad a Enfermedades , Resultado FatalRESUMEN
We describe a patient with a non-0:1, non-0:139 Vibrio cholerae septicemia associated with ecythema gangrenosa-like skin lesions. The patient acquired the infection in Puerto Rico. Given the high fatality rate, it is important for the medical community to consider the diagnosis in high risk patients with exposures in Puerto Rico tropical waters.