How Does Influenza A (H1N1) Infection Proceed in Allogeneic Stem Cell Transplantation Recipients?

Clinical course of H1N1 infection in Allogeneic Hematopoietic Stem Cell Transplantation (AHSCT) patients is contraversial. We report three AHSCT patients who were infected with Influenza A/H1N1 infection. All of the patients were diagnosed with different hematological diagnosis and were at different stages of transplantation.All of them were treated with oseltamivir,zanamivir was switched with oseltamivir in one patient. All of the three patients were survived without any complication. Swine flu, can display with different courses and progress with bacterial or other viral infections in immunsupressed patients.\u

Intramesenteric Steroid Application for Steroid Refractory Gastrointestinal Graft versus Host Disease

Currently, Steroid refractory severe gastrointestinal (GI) GVHD is one of the important complications in patients undergoing allogeneic transplantation and there has been no standard therapeutical approach of disease yet. We report here the results related to the application of intramesenteric steroid in two cases with steroid refractory GI GvHD. In both cases, the frequency and volume of diarrhea were completely resolved soon after intramesenteric methylprednisolone (MP) injection. In conclusion, intra-arterial steroid injection might be an alternative approach especially steroid refractory GI GvHD

Steroid Dirençli Gastrointestinal Graft Versus Host Hastalığında İntramezenterik Steroid Uygulaması

Günümüzde, steroid dirençli gastrointestinal (Gİ) graft versus host hastalığı (GvHH) allogeneik transplantasyon yapılan hastalarda izlenen en sık komplikasyonlardan biridir ve henüz standart bir tedavi yaklaşımı yoktur. Burada, steroid refrakter GvHH olan iki vakanın intramezenterik steroid uygulamasına dair sonuçları bildirilmiştir. Her iki hastada intramezenterik metilprednizolon (MP) enjeksiyonunu takiben diarenin sıklığı ve miktarı tamamen düzelmiştir. Sonuç olarak, intra-arteriel steroid verilimi bu tip olgularda alternative bir tedavi yaklaşımı olabilir.Currently, steroid-refractory severe gastrointestinal (GI) graft versus host disease (GVHD) is among the most important complications of allogeneic transplantation, and as yet there is no standard approach to its treatment. Herein we report two cases with steroid-refractory GI GVHD that received intramesenteric steroid treatment. In both cases the frequency and volume of diarrhea resolved completely following intramesenteric methylprednisolone (MP) injection. In conclusion, intra-arterial steroid injection might be an alternative treatment approach for steroid-refractory GI GVHD

Addition of thalidomide to oral melphalan/prednisone in patients with multiple myeloma not eligible for transplantation: Results of a randomized trial from the Turkish Myeloma Study Group

The combination of melphalan-prednisone-thalidomide (MPT) has been investigated in several clinical studies that differed significantly with regard to patient characteristics and treatment schedules. This prospective trial differs from previous melphalan-prednisone (MP) vs. MPT trials by treatment dosing, duration, routine anticoagulation, and permission for a crossover. Newly diagnosed patients with multiple myeloma (MM) (n = 122) aged greater than 55 yr, not eligible for transplantation were randomized to receive 8 cycles of M (9 mg/m2/d) and P (60 mg/m2/d) for 4 d every 6 wk (n = 62) or MP and thalidomide (100 mg/d) continuously (n = 60). Primary endpoint was treatment response and toxicities following 4 and 8 cycles of therapy. Secondary endpoints were disease-free (DFS) and overall survival (OS). Overall, MPT-treated patients were younger (median 69 yr vs. 72 yr; P = 0.016) and had a higher incidence of renal impairment (RI, 19% vs. 7%, respectively; P = 0.057). After 4 cycles of treatment (n = 115), there were more partial responses or better in the MPT arm than in the MP arm (57.9% vs. 37.5%; P = 0.030). However, DFS and OS were not significantly different between the arms after a median of 23 months follow-up (median OS 26.0 vs. 28.0 months, P = 0.655; DFS 21.0 vs. 14.0 months, P = 0.342, respectively). Crossover to MPT was required in 11 patients, 57% of whom responded to treatment. A higher rate of grade 3-4 infections was observed in the MPT arm compared with the MP arm (22.4% vs. 7.0%; P = 0.033). However, none of these infections were associated with febrile neutropenia. Death within the first 3 months was observed more frequently in the MP arm (n = 8, 14.0%) than in the MPT arm (n = 2, 3.4%; P = 0.053). Long-term discontinuation and dose reduction rates were also analyzed (MPT: 15.5% vs. MP: 5.3%; P = 0.072). Although patients treated with MPT were relatively younger and had more frequent RI, better responses and less early mortality were observed in all age groups despite more frequent discontinuation.ERKİM İlaç A.Ş.Türk Bilimler Akademis

Addition of thalidomide (t) to oral melphalan/prednisone (mp) in patients with multiple myeloma: Initial results of a randomized trial from the Turkish myeloma study group.

Bu çalışma, 05-08 Aralık 2009 tarihleri arasında New Orleans[Luisana]’da düzenlenen düzenlenen 51. Annual Meeting of the American-Society-of-Hematology’da bildiri olarak sunulmuştur.Amer Soc Hemato

A retrospective comparison of allogeneic peripheral blood stem cell and bone marrow transplantation results from a single center: A focus on the incidence of graft-vs.-host disease and relapse

AbstractTo detect the effect of the stem cell source, allogeneic peripheral blood stem cell transplantations (alloPBSCTs) performed between 1995 and 1997 from human leukocyte antigen (HLA)-identical siblings in 40 patients with acute and chronic hematological disorders were compared with a historical group of 40 patients with similar variables who had received allogeneic bone marrow transplants (alloBMTs) between 1993 and 1995. Patients in both groups were identical except that both the recipient and the donor ages were, on average, higher in the alloPBSCT group (26 vs. 36 [p = 0.005] and 27 vs. 32 [p = 0.024], respectively). Patients received similar therapy excluding posttransplant granulocyte colony-stimulating factor administration (97% in alloBMT vs. 12.5% in alloPBSCT). The median time to reach neutrophil counts >0.5 x 10(9)/L and platelet counts >20 x 10(9)/L was 13 and 14 days, respectively, in patients receiving alloPBSCTs compared with 19 and 27 days in patients receiving alloBMTs (p = 0.0014 and p = 0.0002). The alloPBSCT group required similar transfusions of red blood cells or platelets. The incidence of grade II-IV acute graft-vs.-host disease (aGVHD) was similar in both groups. However, chronic GVHD (cGVHD) of all grades developed in 78.1% of patients in the alloPBSCT group after a median follow-up period of 12.5 (range 0.5-34) months. In alloBMT recipients, cGVHD of all grades developed in 21.4% after a median follow-up period of 38 (range 0.5-62) months (p = 0.00001). Day 100 transplant-related mortality was also similar: 20% (8 of 40) in the alloBMT patients and 17.5% (7 of 40) in the alloPBSCT group. Although not statistically significant, a relatively higher relapse rate occurred in the alloBMT group (21.4 vs. 10.7%). The estimated disease-free survival in month 24 was 51.3% for alloBMT and 54.6% for alloPBSCT, and the estimated overall survival in month 24 was 56.1% for alloBMT and 64.6% for alloPBSCT. In conclusion, this retrospective comparison suggests that alloPBSCT from HLA-identical donors is associated with faster engraftment, fewer transfusions, and no greater incidence of aGVHD, but a high incidence of cGVHD.Biol Blood Marrow Transplant 1999;5(1):28-35