Aleman, A.S.

Cleeland, C.S.

Cohen, M.Z.

Giralt, S.

Gning, I.

Mendoza, T.R.

Neumann, J.L.

Elsevier - Publisher Connector 

401
VANCOMYCIN RESISTANT ENTEROCOCCUS (VRE) BLOODSTREAM IN-
FECTIONS (BSI) IN PATIENTS WITH MALIGNANT HEMATOLOGICAL
DISORDERS: IS THE SICK GETTING SICKER?
Dubberke, E.R.1, DiPersio, J.F.1, Mundy, L.1, Khoury, H.J.2 1. Wash-
ington University School of Medicine, St. Louis, MO; 2. Emory Uni-
versity Scool of Medicine, Atlanta, GA.
Patients with hematologic malignancies and hematopoietic stem
cell transplant (HSCT) recipients are at high risk for bacterial BSI.
Data describing the prognosis and outcomes of VRE BSI in this
patient population is limited. We performed a retrospective chart
review of all cases of VRE BSI occurring between February 1996
and December 2002 on the Leukemia/HSCT unit at Barnes-
Jewish Hospital. Sixty-eight episodes of VRE BSI were observed in
60 patients with acute (53%) or chronic (8%) leukemia, NHL
(22%), or other malignant hematologic disorders (17%). Thirteen
percent, 32%, and 32% were recipients of autologous, related, and
VUD transplant, respectively. Forty days prior to the VRE BSI,
70% were colonized with VRE, 95% had broad-spectrum antibi-
otic exposure and 42% had non-VRE BSI, 35% pneumonia, 22%
CMV reactivation, 10% fungal infection. At the time of the VRE
BSI, 42% of allograft recipients had active acute GVHD and 32%
chronic GVHD. Only 57% were neutropenic, 52% had refractory/
relapsed malignancy, and 60% had end organ dysfunction with a
median APACHE II score of 17. VRE was easily eradicated from
the bloodstream after initiation of anti-VRE therapy (median time
to clearance 1 (range 1–9) days). Three patients died within 48
hours of the VRE BSI from causes unrelated to the BSI. Median
survival after VRE BSI was 19 days. Only 4 deaths were directly
attributable to the VRE BSI. Age, ECOG PS  2 on admission,
HSCT, pneumonia, mechanical ventilation, acute neurologic dys-
function, receipt of anti-fungal drugs, and low APACHE II score
were signiﬁcant factors associated with death by univariate analysis,
while pneumonia, receipt of anti-fungal drugs, and low APACHE
II score at the time of the VRE BSI remained signiﬁcant after
multivariate analysis. In summary, our analysis suggests that in
patients with hematological malignancies, VRE does not have the
microbiologic behavior of a virulent pathogen and that VRE BSI
may simply be a marker of these patients’s already existing critical
medical condition.
402
IMPACT OF NEUTRALIZING ANTIBODY TO RESPIRATORY SYNCYTIAL
VIRUS (RSV) ON RESPIRATORY DISEASE PROGRESSION IN HEMATO-
POIETIC STEM CELL TRANSPLANT RECIPIENTS (HCT)
Englund, J.A.1,2, Walsh, E.3, Falsey, A.3, Kim, H.1, Corey, L.1,4,
Boeckh, M.1,4 1. Fred Hutchinson Cancer Research Center, Seattle, WA;
2. Children’s Hospital and Regional Medical Center, Seattle, WA; 3.
Univ. Rochester, Rochester, NY; 4. University of Washington, Seattle,
WA.
RSV-speciﬁc antibody is important in preventing severe RSV
disease in young children when given prophylactically, but the
importance of RSV-speciﬁc antibody (Ab) in preventing progres-
sion of RSV disease during HCT is not known. We prospectively
collected serum in HCT recipients and their donors pre- and in
recipients during transplant (Tx). Symptomatic patients were eval-
uated with nasal wash if symptoms of upper tract respiratory tract
infection (URI) were noted; patients with evidence of respiratory
distress, oxygen requirement, or radiographic changes, and detec-
tion of RSV in the lower airways were determined to have lower
respiratory tract infection (LRI). RSV-speciﬁc neutralizing Ab was
retrospectively measured using standard microneutralization as-
says. Sixty-two HCT recipients diagnosed with RSV infection
were evaluated; 25 (40%) had RSV diagnosed within the ﬁrst 30
days postTx. Subsequently, 39 patients (67%) had URI disease
which progressed to lower respiratory tract infection (LRI). Pro-
gression occurred in 13/25 (48%) of patients diagnosed at 30
days postTx compared with 11/37 (30%) of those with RSV at	30
days postTx. Ab levels obtained in HCT two weeks prior to the
time RSV infection was diagnosed did not appear to protect pa-
tients from more serious RSV disease: mean log2 antibody level
two weeks prior to diagnosis was 10.2 for patients who developed
RSV-related URI compared with levels of 9.7 in patients who
progressed to LRI (P  .10). Controlling for lymphopenia, higher
Ab levels in donors also did not appear to protect from the devel-
opment of LRI in Tx recipients. However, Ab levels in HCT
recipients after 	30 days postTX did appear to prevent RSV
disease progression: the mean log2 Ab levels in 27 HCT recipients
with RSV after 	30 days postTx was 10.5 (95% CI, 9.3–11.4) in
URI patients vs 9.3 (95% CI, 8.6–10.6) in LRI patients, P  .04.
These results suggest that RSV-speciﬁc neutralizing Ab may con-
tribute to the prevention of RSV disease progression in HCT
recipients later postTX.
403
LONGITUDINAL ASSESSMENT OF QUALITY OF LIFE AND SYMPTOMS OF
ETHNICALLY DIVERSE BLOOD AND MARROW TRANSPLANTATION PA-
TIENTS
Neumann, J.L.1, Cohen, M.Z.2, Mendoza, T.R.1, Gning, I.1,
Aleman, A.S.1, Giralt, S.1, Cleeland, C.S.1 1. University of Texas MD
Anderson Cancer Center, Houston, TX; 2. University of Texas School of
Nursing, Houston, TX.
Studies that have examined the effects of BMT on quality of life
(QOL) have found a signiﬁcant reduction in QOL and persistent
symptoms of fatigue, insomnia, anorexia, and nausea in the ﬁrst
year after BMT (Kopp, Schweigkoﬂer, Holzner, et al 1998, Winer,
Lindley, Hardee, et al 1999, Hann, Jacobsen, Martin, et al 1997).
The long-term impact of BMT on quality of life has also been
examined (Andrykowski, Carpenter, et al 1997, Andrykowski,
Brady, et al 1995 and Andrykowski, Bishop, Hahn, Cella, et al,
2005). None of these studies examined differences of quality of life
and symptoms among ethnically diverse patients. In our recently
completed National Institute of Health sponsored study, the cor-
relation of quality of life and symptoms was evaluated at multiple
time points over the course of 100 days in 164 patients, including
African-Americans (n  24), Hispanics (n  38) and non-minority
(n  102) patients. Data collected included the Functional Assess-
ment of Cancer Therapy (FACT-BMT) measuring quality of life
and MD Anderson Symptom Inventory (MDASI) assessing symp-
toms and symptom interference with life. Other variables examined
included disease, type of transplant, age, graft-versus-host disease
(GVHD) and survival. Preliminary results indicate that patients
receiving myeloablative regimen experienced severe symptoms
such as fatigue (P  .02) and pain (P  .03) and poorer quality of
life (P  .01) across time. Symptom severity correlated (r  .59 to
.75) with quality of life across time. In addition, there were no
signiﬁcant differences in symptom severity, symptom interference
and ECOG performance status among the 3 ethnic groups over
time. There were signiﬁcant differences in symptom severity,
symptom interference, and ECOG performance across time com-
paring minority and non-minority BMT patients. This project,
Symptom Management in Blood and Marrow Transplantation,
was funded by grant no.1 RO1 NR05188-01A2, funded by Na-
tional Institutes of Health, National Institute of Nursing Research,
to Principal Investigator Marlene Zichi Cohen.
404
LONG TERM SUPPRESSIVE ACYCLOVIR (ACV) REDUCES VZV DISEASE
AND ACV-RESISTANT HSV AFTER HCT
Erard, V.1, Wald, A.1, Leisenring, W.1, Varley, C.1, Heugel, J.1,
Corey, L.1, Boeckh, M.1 Fred Hutchinson Cancer Research Center and
the University of Washington, Seattle, WA.
Background: Acyclovir given for 1 year prevents reactivation
VZV disease during the ﬁrst year after HCT, but the risk persists
after the ﬁrst year in patients with continued need for immuno-
suppressive drugs (Boeckh et al Blood, in press). The purpose of
this study was to determine the efﬁcacy of 2 sequentially intro-
duced long-term suppressive ACV regimens at the FHCRC.
Methods: Three cohorts of VZV seropositive recipients were
examined: cohort 1 (no ACV; before 1999, n  932), cohort 2
(ACV 800 mg or VACV 500 mg BID for 1 year; 1999–2002; n 
1117), and cohort 3 (ACV/VACV as in cohort 2 plus extended use
in patients who were still taking immunosuppressive drugs at 1
Poster Session II
140


Longitudinal assessment of quality of life and symptoms of ethnically diverse blood and marrow transplantation patients 

file:///data/core-remote/dit/data/elsevier/pdf/b68/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA4Mzg3OTEwNTAxMjMxMA==.pdf

Longitudinal assessment of quality of life and symptoms of ethnically diverse blood and marrow transplantation patients

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector