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Biomedical subjects

A Sureda

Publications and source records attributed to A Sureda.

At least 91 records · Page 5Linked to original sources
PubMed1997

Pentoxifylline, ciprofloxacin and prednisone failed to prevent transplant-related toxicities in bone marrow transplant recipients and were associated with an increased incidence of infectious complications.

TNF-alpha (Tumor necrosis factor-alpha) is involved in many immunological and inflammatory processes, and might be expected to play an important role in the development of BMT-related complications. Triple therapy (pentoxifylline, ciprofloxacin and prednisone) with known anti-TNF activity was tested in 37 patients undergoing a hematopoietic progenitor transplant (HPT). A control group of 16 patients with similar characteristics was selected among consecutive patients receiving a HTP in a neighboring center who did not receive anti-TNF prophylaxis. Major transplant-related complications were registered (VOD, acute GVHD, infectious episodes, renal failure and mucositis) and survival status. TNF plasma concentrations were determined by ELISA, and pentoxifylline plasma concentrations were determined by HPLC. Among patients treated with pentoxifylline (PTX), ciprofloxacin and steroids, no difference in the mean survival time was observed compared with the control group. The incidence of procedure-related death up to day +35 was 11% in the study group and 6% in the control group. In spite of a tendency to a lower incidence of mucositis there was a higher incidence of infections (positive blood cultures) in the study group (49%) than in the control group (16.7%) (P = 0.16). This difference achieved statistical significance in patients receiving an allogeneic HPT (P = 0.05). It is likely that the use of steroids in the early period after transplant increases infectious episodes and makes control of GVHD difficult. The combined administration of steroids with pentoxifylline and ciprofloxacin has not proved beneficial in preventing mucositis, renal failure, VOD or GVHD, or in improving patient survival.

Adolescent↗
PubMed1997

Serum levels of G-CSF, IL-3, IL-6 and GM-CSF after a single intraperitoneal dose of rhG-CSF in lethally irradiated B6D2F1 mice.

The objective of this study was to assess the pharmacokinetics of rhG-CSF after a single intraperitoneal injection 2 h post-TBI in B6D2F1 lethally irradiated mice and to analyze the effect of rhG-CSF on the endogenous response of interleukin-3 (IL-3), interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in these animals. For comparison, these cytokine serum levels have also been measured in nonirradiated mice. The serum concentrations of rhG-CSF in irradiated mice were higher than in nonirradiated mice at all time points during the first 60 min after injection. Furthermore, rhG-CSF administration failed to induce detectable endogenous serum levels of IL-3, IL-6 and GM-CSF, at least in the 72-hour period after administration of the rhG-CSF. The radioprotective effect of rhG-CSF in lethally irradiated mice is not mediated by an increase in endogenous serum levels of these three cytokines.

Animals↗
PubMed1996

Allogeneic bone marrow transplantation versus autologous stem cell transplantation in multiple myeloma: a retrospective case-matched study from the European Group for Blood and Marrow Transplantation.

A retrospective case-matched analysis was performed comparing 189 myeloma patients treated with allogeneic bone marrow transplantation (allo-BMT) with an equal number of patients who received autologous stem cell transplantation (ASCT). Matching was performed with respect to gender and number of treatment lines before transplantation. The groups were comparable with the exception of median age (43 years for allo-BMT v 49 years for ASCT, P = .0001) and median posttransplant follow-up (46 months for allo-BMT v 30 months for ASCT, P = .0003). The overall survival was significantly better for ASCT than for allo-BMT, with a median survival of 34 months and 18 months, respectively (P = .001). However, this survival advantage was only observed in men, but not in women. The statistically significant survival advantage for ASCT was seen in most subgroups, ie, chemotherapy-responsive patients, patients who had received two or more treatment lines before transplantation, patients in partial remission, patients with an IgG-subtype, patients older than 46 years of age, patients with stage II disease, and patients with a low or high serum-beta-2-microglobulin at diagnosis. The main reason for the poorer survival in allo-BMT patients was higher transplant-related mortality (41% v 13% for ASCT, P = .0001), which was not compensated for by a lower rate of relapse and progression. However, in patients alive at 1 year posttransplant, there was a trend for better long-term survival (P = .09) and significantly better progression-free survival (P = .02) for allo-BMT as compared with ASCT. We conclude that the median survival is superior for ASCT. However, allo-BMT has a lower relapse rate, which results in a similar long-term outcome for both approaches, but a longer follow-up is needed to assess the final outcome.

Acute Disease↗
PubMed1996

Bacteremia due to glucose non-fermenting gram-negative bacilli in patients with hematological neoplasias and solid tumors.

Twenty-six patients with hematological or solid tumors who developed bacteremia caused by Stenotrophomonas maltophilia (n = 10), Pseudomonas putida (n = 6), Sphingomonas paucimobilis complex (n = 4) or Alcaligenes xylosoxidans (n = 6) in the period between 1993 and 1995 were studied. Seventeen patients were neutropenic during the infection, and 13 were undergoing bone marrow or peripheral blood stem cell transplantation. Twenty-three patients had catheter-related infections; only 3 of the 26 patients developed septic complications (all due to Stenotrophomonas maltophilia). Twenty patients were cured following catheter removal, either as primary measure (n = 8) or salvage measure (n = 12). Four responded to antibiotic therapy only, and two died of septic complications. Such infections in hematological and oncological patients have increased in this hospital from no cases in 1975 to 11 cases in 1995.

Adolescent↗
PubMed1996

Hematopoietic growth factor (G-CSF or GM-CSF) after salvage chemotherapy in refractory or relapsed adult de novo acute leukemia.

Nineteen adults with primary refractory or relapsed acute leukemia (12 ALL and 7 ANLL) were treated with an intensive salvage chemotherapy (intermediate-dose ara-C, intermediate-dose methotrexate, vindesine, cyclophosphamide, mitoxantrone and prednisolone) followed by a hematopoietic growth factor (HGF), either granulocyte colony-stimulating factor (5 micrograms/kg) or granulocyte-macrophage colony-stimulating factor (10 micrograms/kg). Both were given from the day after chemotherapy ended and until the neutrophil count rose above 1 X 10(9)/l for three consecutive days. Eleven patients (58%, 95% CI 33% to 82%) achieved complete remission, and 15 courses of salvage therapy were given to these complete responders. In a historical control group that did not receive HGF, 23 out of 38 patients (60%, 95% CI 44% to 77%) achieved complete remission, and 27 courses of therapy were delivered to complete responders. Treatment with a HGF accelerated the recovery of neutrophils to 0.5 X 10(9)/l significantly, shortening it from a mean of 28 to 22 days (p = .0002), with no effect on platelet recovery. There were no differences in the rates of documented and fatal infections, which were relatively high in both groups. In the patients with ANLL, there was no evidence that HGF accelerated leukemic regrowth. We conclude that HGF accelerates neutrophilic recovery following intensive salvage chemotherapy for acute leukemia, although no reduction in documented infections was found. Many factors, including the small patient sample, may have contributed to this latter finding.

Acute Disease↗
PubMed1996

Changes in reticulocyte fractions during peripheral stem cell harvesting: role in monitoring stem cell collection.

We prospectively evaluated the changes in immature reticulocyte fractions during peripheral blood stem cell mobilization to determine any possible relationship with mobilization of stem cells into the peripheral blood. Circulating neutrophils, immature reticulocyte fractions (% of HFR + MFR) (HMFR) (measured by flow cytometry), circulating CD34+ cells (measured by flow cytometry) and CFU-GM (measured by semisolid media assay in the apheresis fluid) were closely monitored following priming with chemotherapy and colony-stimulating factors in 15 patients with hematological or solid tumors (group I). Day 0 was defined as the day on which the neutrophil count fell below 0.5 x 10(9)/l. In a second group of nine patients (group II) reticulocyte fractions and CD34+ cells were measured directly on the days on which they were predicted to increase using the data from group I. Reticulocyte counts and HMFR were also monitored in 18 patients who were mobilized with G-CSF alone. In group I, a significant rise in HMFR and CD34+ cells occurred on days 2, 4 and 6, and a linear correlation between HMFR on day 2 and CD34+ cells on day 4 was demonstrated (P = 0.0068, r = 0.74). In group II similar patterns of recovery were found. During mobilization with G-CSF alone HMFR significantly increased on days 2, 4 and 6 of treatment with respect to baseline values, and a multiplicative relationship between the increase of HMFR and neutrophils was observed (r = 0.707, P < 0.00001). Unfortunately, patients who did not mobilize CD34+ cells (one in groups I and II and three in the G-CSF group) showed similar HMFR kinetics to those who mobilized CD34+ cells. An increase in immature reticulocyte fractions precedes the presence of circulating CD34+ cells by about 2 days in patients mobilized with chemotherapy and growth factors, and it could thus serve as an indirect surrogate marker for monitoring the timing of stem cell harvesting. An unexpected increase of HMFR during treatment with G-CSF alone was found, indicating an effect of this factor on erythropoiesis in vivo.

Adult↗
PubMed1996

Mobilization of peripheral blood progenitor cells by cyclophosphamide and rhGM-CSF in multiple myeloma.

Fifteen consecutive patients with multiple myeloma (MM) scheduled for peripheral blood progenitor cell (PBPC) transplantation, were randomly selected to receive cyclophosphamide (CY) (4 g/m2) alone (group I) or associated with recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) (5 micrograms/kg/day) (group II). The mean time of neutropenia after CY administration was 9.8 +/- 4.3 days in group I and 6.4 +/- 1.2 days in group II (P = 0.0228). One hundred and eight aphereses were performed (7.1 +/- 1.8 aphereses per patient in group I and 6.4 +/- 2.8 aphereses per patient in group II). rhGM-CSF administration after CY allowed a higher collection of CD34+ cells in apheresis products (1.42 +/- 1.68 x 10(6) CD34+ cells/kg) in comparison to without factor administration (0.47 +/- 0.52 x 10(6) CD34+ cells/kg) (P = 0.0165). The mean number of cells infused per patient was 6.56 +/- 4.02 x 10(8) MNC/kg and 7.64 +/- 3.00 x 10(4) CFU-GM/kg in group I and 6.25 +/- 4.03 x 10(8) MNC/kg and 8.16 +/- 9.73 x 10(4) CFU-GM/kg in group II. The mean time to recover 0.5 x 10(9) granulocytes/I, 20 and 50 x 10(9) platelets/I in peripheral blood (PB) was 17.2 +/- 7.4, 13.4 +/- 3.7 and 16.5 +/- 6.9 days respectively, in group I and 13.3 +/- 1.7, 11.6 +/- 1.6 and 15 +/- 6.3 days, in group II. rhGM-CSF administration after CY treatment for PBPC mobilization in MM patients reduces the neutropenic period after CY and enhances apheresis CD34+ cell collection.

Adult↗
PubMed1996

Tuberculosis in bone marrow transplant recipients: report of two cases and review of the literature.

Over a 6 year period we have seen two cases of tuberculosis among 118 allogeneic and 237 autologous bone marrow (BMT) or peripheral blood transplants. Both patients had received an HLA-identical related allogeneic BMT. The first case suffered from extensive chronic graft-versus-host disease (GVHD) and developed pulmonary tuberculosis 19 months after BMT. An open-lung biopsy was required to establish the diagnosis, and response to antituberculosis agents was complete, with no relapse at 49 months post-BMT. The second patient received a CD4+ T lymphocyte-depleted BMT, was receiving steroids for acute GVHD and developed rapid-onset meningeal tuberculosis on day +107 post-BMT. Despite initial severe neurologic deterioration, response to antituberculosis agents was good, and she remains alive and well 11 months from BMT. Review of the scant literature on this topic reveals that this is a relatively rare infection in BMT recipients despite their often severely immunosuppressed condition, occurring mainly in recipients of T cell-depleted allogeneic grafts or those who develop GVHD.

Adult↗
PubMed1995

Translocation (1;14)(p34;q11) and trisomy 8 in a T-cell acute lymphoblastic leukemia patient.

A case of T-cell acute lymphoblastic leukemia (T-ALL) in a 25-year-old man cytogenetically characterized by a t(1;14)(p34;q11) and trisomy 8 is reported. These chromosome abnormalities were observed in 82% of the analyzed metaphases. Fluorescence in situ hybridization (FISH) with a probe for the centromere of chromosome 8 was used to correlate cellular morphology in bone marrow (BM) cells with May-Grünwald-Giemsa smears and the cytogenetic alterations. By FISH analysis, trisomy 8 (and presumably the associated t[1;14]) was demonstrated only in lymphoid blast cells but not in the rest of the cells belonging to other hematopoietic lineages.

Adult↗
PubMed1995

Ogilvie's syndrome from disseminated varicella-zoster infection and infarcted celiac ganglia.

We report a patient who had refractory Hodgkin's disease and who received an autologous bone marrow transplantation and 8 months later developed abdominal pain associated with acute colonic dilation. The course of the patient was rapidly fatal due to a lobar pneumonia. Autopsy revealed signs of disseminated herpesvirus infection with marked hemorrhagic infarction of celiac sympathetic ganglia. This finding supports the hypothesis that denervation caused by virus reactivation and secondary hemorrhage is a main mechanism of acute colonic pseudoobstruction.

Adult↗
PubMed1995

Viridans streptococcal shock syndrome during bone marrow transplantation.

Of 320 patients receiving a marrow transplant at the Hospital de Sant Pau between 1986 and 1992, 12% developed viridans streptococcal bacteremia during severe neutropenia. Five of these patients (13%) developed a rapidly progressive fatal shock syndrome characterized by bilateral pulmonary infiltrates, acute respiratory failure (ARDS) and septic shock early in the transplantation course (6 or 7 days posttransplantation). All patients were transplanted for acute leukemia in remission, and 2 received an allogeneic and 3 an autologous transplant. Four of these subjects were younger than 15 years of age and all had received cyclophosphamide and total body irradiation as conditioning regimen for marrow transplantation. All 5 patients died, and postmortem examinations revealed diffuse pulmonary lesions characteristic of the ARDS. These observations contribute to defining the clinical and pathologic characteristics of this serious complication of intensive anticancer treatment.

Acute Disease↗