Successful Use of Interferon-Gamma for Refractory Disseminated Candida Tropicalis Infection in a Pediatric Patient with Acute Myeloid Leukemia and Heterozygous CARD9 Mutation

Invasive fungal infections remain among the most frequent severe and fatal complications of oncology, despite effective antifungal agents. Genetic aberrations may additionally increase the individual patient’s susceptibility to invasive mycosis, with the need for an intensified treatment, such as adjunctive immunotherapy combined with standard antifungal medication. Interferon-gamma (IFN-γ) as an immunostimulatory agent may represent a promising surrogate to reactivate the cytotoxic activity of macrophages in patients with ‘blind spots’. We report the case of a pediatric patient with AML and disseminated candida tropicalis infection, bearing a heterozygous CARD9 mutation, who was treated successfully with combined IFN-γ and conventional antifungal therapy

Granulocyte transfusions made with modified fluid gelatin in pediatric and adolescent patients with prolonged neutropenia

Background Granulocyte transfusions (GT) are used to treat progressive systemic or local infections in prolonged neutropenic patients with antibiotic or antifungal resistance. Granulocytes are most commonly collected from whole blood by apheresis using hydroxyethyl starch (HES) as the red blood cell (RBC) sedimentation agent. This is the first study on the safety and efficacy of transfusing granulocytes collected with modified fluid gelatin (MFG) instead of HES to pediatric patients. Methods Clinical data from 46 pediatric and adolescent patients receiving at least one MFG-based granulocyte transfusion and in total 295 granulocyte concentrates from July 2013 to August 2019 at our local university medical center were evaluated retrospectively. Results Forty-one patients (89%) survived at least 21 days after their last granulocyte transfusion. These survivors had lower CRP values and higher leukocyte counts after GT than non-survivors (mean delta of −5.34 mg/dl vs. –11.99 mg/dl and + 0.62 × 103/μl vs. +0.18 × 103/μl of all GT, respectively). The neutrophil corrected count increment (CCI) was 68.72 mm2/ml in survivors versus 28.00 mm2/ml in non-survivors. There were no major or severe adverse events. Conclusion This study suggests that modified fluid gelatin is a safe and effective alternative to hydroxyethyl starch for the collection of granulocytes for transfusion to prolonged neutropenic patients with progressive systemic or local infections refractory to antibiotic or antifungal therapy

Haploidentical CD3 or α/β T-cell depleted HSCT in advanced stage sickle cell disease

Despite significant improvements in the supportive care, sickle cell disease (SCD) leads to significant morbidity and mortality. Allogeneic hematopoietic stem cell transplantation (HSCT), the only curative option, is limited due to matched donor availability. This could be met with T-cell-depleted haploidentical HSCT. Twenty advanced-stage SCD patients, median age 15 years, and 9 patients, median age 14 years, were transplanted with CD3/CD19- or TCR alpha beta/CD19-depleted grafts and from matched sibling donors (MSDs). The conditioning consisted of ATG, thiotepa, fludarabine, and treosulfan. The median follow-up in the T-haplo-HSCT and the MSD patients was 21 (9-62) and 25 (7-60) months, respectively. The OS in the T-haplo-HSCT and MSD was 90% and 100%, respectively. In the T-haplo-HSCT group, two patient succumbed to a CMV pneumonitis and a macrophage activation syndrome (MAS). One patient in the T-haplo-HSCT group requires renal replacement therapy because of BK virus nephritis. None developed grade III-IV acute GvHD. In the T-haplo-HSCT and in the MSD, 20% and 22%, respectively, developed a mild or moderate chronic GvHD. These results demonstrate the feasibility, safety, and efficacy of T-haplo-HSCT also for adult advanced stage SCD patients

Feasibility of peripheral blood stem cell collection from sickle cell trait donors with an intensified G‐CSF regimen

Objectives Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCD and bone marrow from an HLA-matched sibling is currently the standard of care. Haploidentical HSCT from a family donor with a TCR αβ/CD19 depleted graft (T-haplo) is an increasingly successful alternative, which requires the generation of G-CSF stimulated peripheral stem cell (PBSC) from haploidentical relatives. These sickle cell trait (SCT) donors reported to develop SCD-related complications in conditions of severe stress. Methods In this retrospective analysis, we compared the safety and efficacy of PBSC mobilization with a G-CSF intensified mobilization regimen in SCT donors with a conventional G-CSF mobilization regimen in healthy donors. Results The reported adverse events were similar during intensified G-CSF mobilization, apheresis, and shortly after stem cell apheresis in SCT and control donors. In SCT and control donors, we were able to mobilize high yields of CD34+ stem cells and the harvested CD34+ cell count was comparable with control donors. Conclusions Peripheral stem cell mobilization using an intensified G-CSF regimen is safe, and well tolerated among SCT donors. SCT donors are a valid alternative for collection of peripheral CD34+ stem cells for T-cell-depleted haploidentical stem cell transplantation