Boes, Jennifer L.

Bule, Maria

Couriel, Daniel R.

Galban, Craig J.

Johnson, Timothy D.

Kazerooni, Ella A.

Kitko, Carrie L.

Lama, Vibha

Meyer, Charles R.

Ponkowski, Michael

Ross, Brian D.

Yanik, Gregory

Elsevier - Publisher Connector 

Abstracts / Biol Blood Marrow Transplant 20 (2014) S184eS210S206Background: Probiotic supplementation has been promoted
for a variety of health conditions. Increased marketing and
over-the-counter (OTC) access in pharmacies, health food
stores and grocery chains has also led to increased avail-
ability of these agents. Since safety of probiotic supplemen-
tation within the hematopoietic cell transplant (HCT)
population is unknown, we sought to evaluate the incidence
and outcomes of bacteremia due to organisms common to
many of these OTC probiotic supplements in a population of
HCT recipients.
Methods: We reviewed all blood culture results from a
cohort of HCT recipients transplanted at Fred Hutchinson
Cancer Research Center in Seattle, WA between 2002-2011.
Patients with at least one positive blood culture for
common probiotic organisms (Lactobacillus species, Biﬁdo-
bacterium species, or Streptococcus thermophilus) within
one-year post-HCT were considered cases for this study.
Patients with evidence of preexisting bacteremia from
these agents (3 months prior to HCT) were excluded. Data
were collected from center databases, which contain
archived laboratory data, patient demographics, and clin-
ical summaries.
Results: A total of 18/3799 (0.47%) HCT recipients developed
bacteremia with Lactobacillus species within one-year post-
HCT; no events with Biﬁdobacterium species or S. thermo-
philus were identiﬁed. Patients who developed these events
had a median age of 49 years (IQR: 41, 53), and the majority
were allogeneic transplant recipients (n¼13, 72%). Most
patients had a singular positive blood culture (n¼17 [94%]);
one patient developed prolonged bacteremia (30 days).
Positive blood cultures for Lactobacillus species occurred at
a median of 84 days post-transplant (IQR: 34, 127), with
most (n¼12 [67%]) occurring within the ﬁrst 100-days. The
overall incidence rate of Lactobacillus bacteremia was 1.54
cases per 100,000 patient-days; the highest incidence
occurred during the ﬁrst 100-days post-transplant (3.31
cases per 100,000 patient-days). Incidence did not deviate
signiﬁcantly by year of transplant. At the time of diagnosis,
most HCT recipients were inpatient (n¼12 [67%]) for a
median of 37 days (IQR: 6, 78) prior to development of
bacteremia. Among outpatients (6/18 [30%]), four were
admitted within 30 days after their ﬁrst positive culture.Eight patients (44%) were diagnosed with acute graft-
versus-host disease of the gut prior to the development of
bacteremia. No Lactobacillus-attributed mortality was
observed during follow-up.
Conclusion: Organisms frequently incorporated in available
OTC probiotic supplements are infrequent causes of bacter-
emia after HCT. Studies evaluating the use of probiotics
among these high-risk patients are needed.312
Parametric Response Mapping as a Diagnostic Indicator
of Bronchiolitis Obliterans Syndrome
Craig J. Galban 1, Jennifer L. Boes 1, Maria Bule 1,
Charles R. Meyer 1, Daniel R. Couriel 2, Carrie L. Kitko 3,
Michael Ponkowski 2, Timothy D. Johnson 4, Vibha Lama 5,
Ella A. Kazerooni 1, Brian D. Ross 1, Gregory Yanik 2. 1 Radiology,
University of Michigan, Ann Arbor, MI; 2 Blood and Marrow
Transplant Program, University of Michigan, Ann Arbor, MI;
3 University of Michigan, Ann Arbor, MI; 4 Biostatistics,
University of Michigan, Ann Arbor, MI; 5 Internal Medicine,
University of Michigan, Ann Arbor, MI
Bronchiolitis obliterans syndrome (BOS) is associated with
signiﬁcant morbidity and mortality following allogeneic
stem cell transplant (SCT). Deﬁned by NIH consensus
criteria, the diagnosis is often confounded by the presence
of concurrent infectious complications in affected patients,
making interpretation of spirometry and imaging studies
difﬁcult. We now report a novel imaging biomarker
that identiﬁes obstructive small airway disease, even in
the presence of infectious pneumonitis. A computed to-
mography (CT)-based image processing technique termed
parametric response mapping (PRM) has been generated
at our center to capture parenchymal alterations conse-
quent to lung disease. PRM is performed from a biphasic
(inspiratory and expiratory) high-resolution-CT (HRCT),
with subsequent image co-registration of the paired HRCT
data, and classiﬁcation of individual voxels within the lung
parenchyma as either (a) normal, (b) severe emphysema-
tous disease, (b) functional small airway disease (fSAD)
Abstracts / Biol Blood Marrow Transplant 20 (2014) S184eS210 S207characteristic of BOS or (d) parenchymal disease (PD)
characteristic of infection (Figure). Spatial information is
retained allowing for visualization and quantiﬁcation of
disease within individual lobes. The relative volumes for
each classiﬁcation are determined by normalizing the sum
of all voxels within a particular class to the total lung
volume. Using HRCT, broncho-alveolar lavage (BAL) and
spirometry data, 55 SCT recipients were classiﬁed into one
of 3 groups: A) Infection, no BOS (n¼11); B) BOS, no
infection (n¼34); and C) BOS + Infection (n¼9). BAL were
performed within 1 week of the HRCT, in all 55 patients.
Mean values (SE) for functional small airway disease
(fSAD), parenchymal (infectious) disease (PD), and normal
lung parenchyma were determined for each group
(Figure).
Results: Distinct imaging proﬁles were identiﬁed for pa-
tients with BOS and for patients with an acute infectious
pneumonitis. In particular, the %fSAD was signiﬁcantly
greater in patients with BOS when compared to those with
infection alone, 382% vs 174%, p¼0.05. There was no
difference in the %fSAD for subjects with BOS, whether a
concurrent infection was present or not, 353% (BOS) vs
382% (BOS + Infection), p¼31. Patients with an acute in-
fectious pneumonitis had signiﬁcantly higher levels of PD
than patients with BOS, 304% vs 171.5%. In 7 of the 34
(21%) BOS cases, signiﬁcant increases in fSAD (>30%) were
present when radiographic features characteristic for BOS
(air trapping, bronchiectasis, septal lines) were either ab-
sent or minimal on HRCT. There were no differences in
PRM imaging by the type of infection. PRM provides a
major advance in our ability to diagnose small airway
obstruction that characterizes BOS, even in the presence of
an active pulmonary infection. A prospective trial
comparing PRM with spirometry and standard HRCT as an
early indicator of BOS is planned.CRA -DATA MANAGEMENT313
Transplant Center Survey of CIBMTR Internal Assessments
Nicolette Maria Minas, Kathleen Ruehle. Greenebaum Cancer
Center, University of Maryland, Baltimore, MD
Background: The University of Maryland Blood and Marrow
Transplant (BMT) team has ﬁrmly established a culture of
continuous quality improvement to assure the utmost ac-
curacy of CIBMTR data. In early 2012, Minas and Ruehlereported the signiﬁcance of auditing 10 commonly used
data points. In early 2013, Minas and Ruehle set out to
further improve CIBMTR data accuracy by combining their
original set of commonly used data points with 19 addi-
tional ones.
Methods: To explore the internal assessments (IA) audit
activities used by other transplant centers to ensure
CIBMTR data accuracy, the University of Maryland BMT
team developed an anonymous survey consisting of 6
quantitative and 3 qualitative questions. One hundred and
thirty seven NMDP (National Marrow Donor Program) and
CIBMTR (Center for International Blood and Marrow
Transplant Research) afﬁliated transplant centers (TC) were
invited to participate. The survey was administered using
Survey Monkey.
Results: A total of 86 (62.8%) responses were received. Of
these, 57% were from centers that transplanted over 100
patients per year. Most TC (89%) performed some type of IA
for their CIBMTR forms. Centers reported that IA were most
often conducted by a quality assurancemanager (46%). Of the
TC that performed IA, 76% reported using FACT (Foundation
for the Accreditation of Cellular Therapy) and additional data
points as opposed to only FACT data points. Fifty-six percent
of TC that conducted IA reported that audits were performed
on 10%-30% of patient data on a regular basis, while another
19% reported performing IA for 100% of patient data. Internal
assessments were most commonly performed on a quarterly
basis (35%).
Conclusion: Most TC participate in some sort of IA. The
majority of TC perform IA using FACT and additional data
points, which likely improves accuracy of the data. Although
time is a consideration, completing 100% IA assures the most
accurate data. Surveys such as these provide us with
knowledge of how all transplant centers assure quality
CIBMTR data and prepare for external audits, such as CIBMTR
and FACT.
N.M. Minas, K. Ruehle. CIBMTR Monthly Internal Assess-
ment Improves Quality of Registry Data. Biology of Blood
and Marrow Transplantation. Volume 18, Issue 2, Supple-
ment, Page S239, February 2012 [abstract].
N.M. Minas, K. Ruehle. A Culture of Continuous Quality
Improvement Improves Registry Data. Biology of Blood and
Marrow Transplantation. Volume 19, Issue 2, Supplement,
Pages S169-S170, February 2013 [abstract].314
Extending the Bridg Model with Hematopoietic Cell
Transplant Concepts
Jane Pollack 1, Kirt Schaper 2, Robinette Renner 3,
Charles Martinez 4, Sandra Sorensen 5, Bob Milius 6,
Colleen O’Neill 7, Roy B. Jones 8, J. Douglas Rizzo 9.
1 Bioinformatics Research, CIBMTR/Minneapolis Campus,
Minneapolis, MN; 2 CIBMTR - Minneapolis, Minneapolis, MN;
3 CIBMTR IT, CIBMTR/Minneapolis Campus, Minneapolis, MN;
4M.D. Anderson Cancer Center, Houston, Texas; 5 Research
Operations, CIBMTR - Minneapolis, Minneapolis, MN;
6 Bioinformatics Research, NMDP, Minneapolis, MN; 7National
Marrow Donor Program, CIBMTR/Minneapolis Campus,
Minneapolis, MN; 8 Stem Cell Transplantation & Cellular
Therapy, UT M.D. Anderson Cancer Center, Houston, TX;
9 CIBMTR, CIBMTR/Medical College of Wisconsin, Milwaukee,
WI
Organizing data into coherent groups, i.e. data domains, is
key to understanding relations between complex subject
areas such as information collected around one simple


Parametric Response Mapping as a Diagnostic Indicator of Bronchiolitis Obliterans Syndrome 

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Parametric Response Mapping as a Diagnostic Indicator of Bronchiolitis Obliterans Syndrome

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