Febril Nötropenik Pediatrik Onkoloji Hastalarında Donör Granülosit Transfüzyonları

Bu çalışmada febril nötropeni gelişen kanserli çocuk hastaların granülosit transfüzyonu sonrası klinik durumlarının izlenmesi amaçlandı. Eylül 2009 ile Eylül 2011 yılları arasında üniversite hastanesinde, nötropenik ateş nedeniyle granülosit tranfüzyonu verilen hastaların retrospektif olarak dosyaları incelenmiştir. Otuz yedi hasta toplam ellibir granülosit transfüzyonu almıştır. Febril atakların 35’inde lösemi, 16 atakta ise solid tümör tanısı mevcut idi. Üç hastaya HLA uygun kardeşten allojeneik kök hücre nakli yapılmış idi. Ortalama ateş ve nötropeni süresi 18.5±17.5 gün saptandı. Hastaların %21’inde (n= 11) sebebi bilinmeyen ateş, %44’ünde (n= 23) mikrobiyolojik olarak kanıtlanmış enfeksiyon, %35’inde (n= 18) klinik enfeksiyon vardı. Granülosit ürün verimi 3.1±1.2x1010/ünite, ortalama ürün beyaz küre sayısı 158.6±66.4x103 / mm3 ve ortalama ürün granülosit sayısı 134.5±62x 103 /mm3 bulundu. Lökaferezde vericinin ortanca beyaz küre sayısı 32.91x109 /L olarak saptandı. Granülosit transfüzyonları bir hastada transfüzyon sırasında gelişen ateş dışında iyi tolere edilmişti. Otuz dokuz atakta (%76.5) hastalar iyileşerek taburcu edilmiş; 12 (%23.5) atak sonrasında hasta kaybedilmiştir. Kaybedilen hastaların yedisinde refrakter hastalık, iki tanesi yeni tanı ve üçünde de relaps hastalık saptanmıştı. Bu makalede 51 granülosit transfüzyonu alan septik nötropenik 37 pediatrik onkoloji hastasının kliniği incelenmiştir. Granülosit transfüzyonlarının iyi tolere edildiği ve kısa dönemde sağkalımı iyi yönde etkilediği görülmüştür.To describe the clinical course of febrile neutropenic pediatric oncology patients undergoing granulocyte transfusions (GTF), we performed a retrospective chart review of all pediatric oncology patients with febrile neutropenia receiving granulocyte transfusions between September 2009 and September 2011 in a University Hospital setting. Thirty-seven patients received a total of 51 courses of GTFs. In 35 febrile episodes patients had leukemia and in 16 episodes patients had solid tumors. Three patients received allogeneic hematopoietic stem cell transplantation from their HLA identical sibling. Mean duration of fever and neutropenia was 18.5±17.5 days. Infections were classified as fever of unknown origin (21%, n= 11), microbiologically documented infection (44%, n= 23), clinically suspected infection (35%, n= 18). The mean granulocyte yield, WBC count and granulocyte count of the products were 3.1±1.2x1010/unit, 158.6±66.4x103 /mm3 and 134.5±62x 103 /mm3 , respectively. The median donor WBC count at leukapheresis was 32.91x109 /L. GTFs were well tolerated except one patient who had fever during transfusion. Thirty-nine (76.5%) of the episodes resolved from infection and discharged from the hospital. Of the 12 patients (23.5%) who died, seven of them were refractory to treatment, three patients had relapsed disease and two patients had newly diagnosed disease. This case series documents the course of 37 septic neutropenic pediatric oncology patients who underwent a total of 51 GTF courses. GTFs were generally well tolerated and improve short-term outcome in neutropenic pediatric oncology patients

NAD+ augmentation with nicotinamide riboside improves lymphoid potential of Atm−/− and old mice HSCs

NAD+ supplementation has significant benefits in compromised settings, acting largely through improved mitochondrial function and DNA repair. Elevating NAD+ to physiological levels has been shown to improve the function of some adult stem cells, with implications that these changes will lead to sustained improvement of the tissue or system. Here, we examined the effect of elevating NAD+ levels in models with reduced hematopoietic stem cell (HSC) potential, ATM-deficient and aged WT mice, and showed that supplementation of nicotinamide riboside (NR), a NAD+ precursor, improved lymphoid lineage potential during supplementation. In aged mice, this improved lymphoid potential was maintained in competitive transplants and was associated with transcriptional repression of myeloid gene signatures in stem and lineage-committed progenitor cells after NR treatment. However, the altered transcriptional priming of the stem cells toward lymphoid lineages was not sustained in the aged mice after NR removal. These data characterize significant alterations to the lineage potential of functionally compromised HSCs after short-term exposure to NR treatment