RESUMEN
A young patient with relapsed diffuse large B-cell lymphoma presented with new onset respiratory symptoms and hypereosinophilia in the early stage post high-dose therapy/autologous stem cell rescue. Here, we present a step-wise practical approach to this unexpected laboratory finding for a not uncommon infective complication in the immunosuppressed patient.
Asunto(s)
Antibacterianos/uso terapéutico , Eosinofilia/sangre , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Linfoma de Células B Grandes Difuso/terapia , Recurrencia Local de Neoplasia/terapia , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis/diagnóstico , Adulto , Antibacterianos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica , Nalgas , Tos/sangre , Tos/diagnóstico , Tos/etiología , Diagnóstico Diferencial , Disnea/sangre , Disnea/diagnóstico , Disnea/etiología , Eosinofilia/microbiología , Humanos , Linfoma de Células B Grandes Difuso/patología , Masculino , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neumonía por Pneumocystis/sangre , Neumonía por Pneumocystis/etiología , Neumonía por Pneumocystis/microbiología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Trasplante Autólogo/efectos adversosRESUMEN
BACKGROUND: Cytomegalovirus (CMV) continues to be an important complication of hematopoietic stem cell transplantation and solid organ transplantation. METHODS: In this study, 314 patients who underwent hematopoietic stem cell transplantation between January 2003 and October 2011 were tested serially for CMV DNA by real-time quantitative polymerase chain reaction (qPCR) for 90 days post transplantation. Patients with CMV viremia >3000 genomes/mL (equivalent to 2520 IU/mL) received pre-emptive therapy and were compared with previously published data from solid organ transplant (SOT) patients monitored and treated in exactly the same way. RESULTS: After stem cell transplant (SCT), 48% of patients developed at least 1 episode of viremia. The median duration of a viremic episode was 25 days and the peak viral load (VL) was 4784 genomes/mL whole blood (equivalent to 4019 IU/mL). The data demonstrated that recipients with positive CMV serostatus were at increased risk of developing viremia, with 0% of donor-negative/recipient-negative (D-R-), 3.7% of D+R-, 79.5% of D-R+, and 74.2% of D+R+ groups developing viremia over follow-up (adjusted hazard ratio for D+R- vs. D+R+ group 0.03; 95% confidence interval 0.004, 0.18; P = 0.0013). In contrast with SOT patients, where 58/74 (78%) D+R- patients had viremia, a low risk of CMV infection was seen after stem cell transplantation (1/27; 3.7%). CONCLUSION: As both groups of patients, the previously published SOT patients and the present hematopoietic SCT patients, were monitored using the same protocol and qPCR assay with pre-emptive therapy administered at the same VL cutoffs, the distinct differences seen cannot be explained by differences in testing or management and thus emphasize distinct aspects of the natural history of CMV infection post transplant in these 2 patient groups.
Asunto(s)
Antivirales/administración & dosificación , Infecciones por Citomegalovirus/prevención & control , Citomegalovirus/efectos de los fármacos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante de Órganos/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Citomegalovirus/genética , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/virología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Factores de Riesgo , Carga Viral/efectos de los fármacos , Viremia , Adulto JovenAsunto(s)
Neoplasias del Sistema Nervioso Central/inmunología , Infecciones por VIH/complicaciones , Linfoma no Hodgkin/etiología , Trasplante de Células Madre/métodos , Adulto , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Femenino , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) is characterized by expression of oncogenic fusion product BCR-ABL1, resulting from reciprocal translocation between chromosomes 9 and 22 [t(9;22)(q34;q11.2)]. Previously perceived to confer poor outcome with at least 10 % lower chance of remission than standard-risk ALL. With the advent of targeted BCR-ABL specific tyrosine-kinase inhibitors (TKIs), higher remission rates were achieved, thus allowing more patients to proceed with the definitive treatment modality--allogeneic hematopoietic stem cell transplantation (alloHSCT). Prime challenges to treatment of Ph+ ALL include appropriate integration of TKIs into remission induction chemotherapeutic regimes, appropriate understanding and implementation of BCR-ABL monitoring for guiding therapeutic intervention(s), and minimizing transplant-related toxicities.