1.
Risk factors associated with development and mortality by invasive fungal diseases in pediatric allogeneic stem cell transplantation. A pediatric subgroup analysis of data from a prospective study of the Gruppo Italiano Trapianto di Midollo Osseo (GITMO)
Castagnola, E., Bagnasco, F., Menoni, S., Muraca, M., Prete, A., Belotti, T., Iori, A. P., Barberi, W., Severino, A., Proia, A., et al
Bone marrow transplantation. 2018
2.
Incidence, risk factors and outcome of pre engraftment Gram-negative bacteremia after allogeneic and autologous hematopoietic stem cell transplantation: an Italian prospective multicenter survey
Girmenia, C., Bertaina, A., Piciocchi, A., Carotti, A., Algarotti, A., Busca, A., Cattaneo, C., Raiola, A. M., Guidi, S., Iori, A. P., et al
Clinical Infectious Diseases. 2017
-
-
Free full text
-
Abstract
Background: Gram-negative bacteremia (GNB) is a major cause of morbidity and mortality in Hematopoietic Stem Cell Transplant (HSCT) and updated epidemiological investigation is advisable. Methods: We prospectively evaluated the epidemiology of pre-engraftment GNB in 1,118 allogeneic HSCT (allo-HSCT) and 1,625 autologous HSCT (auto-HSCT) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant. SIGNB-GITMO-AMCLI is registered with ClinicalTrials.gov, number NCT02088840. Results: The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis variables associated with GNB were a diagnosis of acute leukemia, a transplant from HLA-mismatched donor and from cord-blood, older age and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age and no antibacterial prophylaxis in auto-HSCT. A pre-transplant infection by a resistant pathogen was significantly associated with an increased risk of post-transplant infection by the same microorganism in allo-HSCT. Colonization by resistant Gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4-months both in allo-HSCT (HR 2.13, 95% CI 1.45-3.13;p=.0001) and auto-HSCT (HR 2.43, 95% CI 1.22-4.84;p=.012). Conclusions: Pre-engraftment GNB is an independent factor associated with increased mortality at four months from auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB.
3.
Recommendations for screening, monitoring, prevention, prophylaxis and therapy of hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation-a position paper
Sarmati, L., Andreoni, M., Antonelli, G., Arcese, W., Bruno, R., Coppola, N., Gaeta, G. B., Galli, M., Girmenia, C., Mikulska, M., et al
Clinical Microbiology & Infection. 2017;23(12):935-940
Abstract
SCOPE Hepatitis B virus (HBV) infection reactivation is associated with high morbidity and mortality in patients with haematologic malignancy and/or haematopoietic stem cell transplantation (HSCT). However, information on this issue is limited. The scope of this position paper is to provide recommendations on HBV screening, monitoring, prophylaxis, treatment and vaccination in the patients described above. METHODS These recommendations were developed from one meeting of experts attended by different Italian scientific societies as well as from a systematic literature review (of articles published through December 31, 2016) on HBV infection in haematologic patients and in patients who underwent haematopoietic stem cell transplantation published in the same issue of the journal. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess each recommendation's quality. QUESTIONS ADDRESSED These recommendations provide the answers to the following questions: (a) HBV screening and monitoring: Who should be screened before chemotherapy? Which screening tests should be used? Should HBV-DNA detection be used to monitor HBV reactivation before starting antivirals? What is the best timeline to monitor HBV reactivation? (b) Prophylaxis in HBsAg-positive patients: Which antiviral drugs should be used to treat HBsAg-positive patients? How long should antiviral prophylaxis be provided to HBsAg-positive patients? (c) Prophylaxis in patients with resolved HBV infection: Which patients with resolved HBV infection should receive antiviral prophylaxis? Which antiviral drug should be used? How long should antiviral prophylaxis be provided? (d) HBV infection management strategy in autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT): Which HSCT recipients should receive antiviral prophylaxis? Which antiviral drug should be used? How long should antiviral prophylaxis be provided? (e) Choice of antiviral drugs in the treatment of HBV reactivation: Should third-generation anti-HBV drugs be preferred to first- or second-generation antiviral drugs in the treatment of HBV reactivation with or without hepatitis flare in haematologic patients? (f) Immunization against HBV in patients with haematologic malignancies and/or patients who underwent HSCT Should these patients be vaccinated? Which HBV vaccination schedule should be adopted? RECOMMENDATIONS Haematologic patients should be screened for hepatitis B surface antigen (HBsAg) plus anti-hepatitis B core protein (HBc), and HBV DNA before chemotherapy. HBV DNA levels should be monitored monthly in all HBV-positive patients who do not receive prophylaxis. HBsAg-positive haematologic patients and those undergoing HSCT should receive third-generation antiviral therapy as prophylaxis. Anti-HBc-positive lymphoma patients and those receiving HSCT should receive antiviral prophylaxis. All HBV-negative haematologic patients should be vaccinated for HBV. The acquisition of data from well-designed studies is desirable in the near future.Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.