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  • Nakano, Nobuaki  (4)
  • 2010-2014  (4)
  • 2010  (4)
  • 1
    Online Resource
    Online Resource
    Late Viral Infections After Cord Blood Transplantation: Comparison with Unrelated Bone Marrow Transplantation
    American Society of Hematology ; 2010
    In:  Blood Vol. 116, No. 21 ( 2010-11-19), p. 1260-1260
    Details
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 1260-1260
    Abstract: Abstract 1260 Although the efficacy of cord blood transplantation (CBT) from unrelated donors as viable alternative for patients in need of hemtopoietic stem cell transplantation (HSCT) is supported by growing evidences, viral infections related to delayed immune reconstitution remains important problems for further improvement of clinical outcomes. To evaluate incidences and outcomes of late viral infections after CBT by comparison with those after unrelated bone marrow transplantation (uBMT), we retrospectively analyzed the records of 281 Japanese adult patients who underwent allogeneic unrelated HSCT for the first time at the Toranomon Hospital between January, 2002 and March, 2010, and who survived more than 100 days after HSCT without the lost-to-follow-up or retransplantation before day 100. Between 50 days and 5 years after HSCT, 116 patients had at least one late infectious episode with a cumulative incidence of 52.2%, at a median of 157 (50-1597) days after HSCT. The 5-year cumulative incidence of any late viral infections was greater in CBT versus uBMT recipients (60.7% vs. 42.2%, respectively; P=0.039, Figure 1). Thirty-three patients (28.4%) had 2 or more episodes caused by different viruses, and a total of 152 late infectious episodes were documented. The median onset of the episodes was similar between the both groups (median onset 226 days vs 222 days, P=0.89). The most common late viral infection is varicella-zoster virus (VZV) reactivation, accounting for 28.8% (disseminated 10, localized 34), followed by hemorrhagic cystitis associated with adeno- and/or BK viruria (28.2%), cytomegalovirus (CMV) diseases (16.4%; gastrointestinal diseases 23, retinitis 1, pneumonia 1), and respiratory tract infections caused by influenza virus, parainfluenza virus or respiratory syncytial virus (15.8%; upper 26, lower 8), and Epstein-barr virus lymphoproliferative diseases (4.6%). The remaining 10 infectious episodes were caused by relatively rare type of viruses including herpes simplex virus, JC virus, measles virus, mumps virus, norovirus and parvovirus, all of which occurred only in CBT recipients. Of all these viral infections, only VZV reactivation developed significantly more frequent in CBT than in uBMT recipients (P=34.0% vs 17.0%, P=0.023). There was no difference of dissemination rate between the both groups, and all the patients responded well to treatment with antiviral agents. The late viral infection was a primary cause of death in 3 episodes, all of which were pneumonia caused by CMV, influenza virus and parainfluenza virus. The 5-year incidence of infection-related mortality did not differ between CBT and uBMT recipients (0.7% vs 3.1%, P=0.46). Non-relapse mortality occurred in 11.8 % and 16.4 % patients in the CBT and uBMT groups (P=0.71). These findings suggested that cord blood might be as an acceptable and useful stem-cell source as bone marrow from unrelated donors in terms of risks of viral infection in the late posttransplant period. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V116.21.1260.1260
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
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    Monobactam and aminoglycoside combination therapy against metallo-β-lactamase-producing multidrug-resistant Pseudomonas aeruginosa screened using a ‘break-point checkerboard plate’
    Informa UK Limited ; 2010
    In:  Scandinavian Journal of Infectious Diseases Vol. 42, No. 3 ( 2010-01), p. 231-233
    Details
    In: Scandinavian Journal of Infectious Diseases, Informa UK Limited, Vol. 42, No. 3 ( 2010-01), p. 231-233
    Type of Medium: Online Resource
    ISSN: 0036-5548 , 1651-1980
    URL: Article
    DOI: 10.3109/00365540903443157
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2010
    detail.hit.zdb_id: 2805836-7
    detail.hit.zdb_id: 1484328-6
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  • 3
    Online Resource
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    Outocomes of Second Unrelated Cord Blood Transplant for Relapse After First Allogeneic Transplant In Adult Patients with Progressive Acute Myeloid Leukimia/Myelodysplastic Syndrome.
    American Society of Hematology ; 2010
    In:  Blood Vol. 116, No. 21 ( 2010-11-19), p. 1295-1295
    Details
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 1295-1295
    Abstract: Abstract 1295 〈 Objective 〉 Disease relapse following allogeneic hematopoietic stem cell transplant (allo-HSCT) remains a major cause of treatment failure, often with a poor outcome. Some recent reports have demonstrated successful treatment receiving 2nd allo-HSCT with bone marrow (BM) and peripheral blood (PB) following relapse. However, there are few reports about unrelated cord blood transplant (UCBT). Therefore, we retrospectively analyzed the results of 2nd allo-HSCT using UCB for 34 adult patients with acute myeloid leukemia (AML) / myelodysplastic syndrome (MDS), who relapsed after 1st HSCT. 〈 Patients and methods 〉 We reviewed medical records of 130 adult patients with AML/MDS who received 1st HSCT between March 2006 and May 2009 at Toranomon Hospital, Tokyo, Japan. Fifty-three of these patients relapsed after 1st allo-HSCT including 12 recipients of related peripheral blood (RPB), 13 unrelated bone marrow (UBM) and 28 UCB. In these relapsed patients, 34 proceeded to 2nd transplant with UCB. The remaining 19 patients did not receive 2nd transplants because of severe organ dysfunction or uncontrolled active infection and continued complete remission by donor lymphocyte infusion. The median age at 2nd UCBT was 54 years (18-69) and interval between 1st allo-HSCT and 2nd UCBT was 9 months (1-54). Diagnoses include de novo AML (n=21) and MDS overt AML (n=13). Disease status at 1st allo-HSCT were as follows; 4 patients in CR, 25 patients in chemo-refractory and 5 patients in progressive desease without chemotherapy. All patients at 2nd UCBT were in progressive disease. All patients received a single cord blood unit with median TNC/CD34 cell dose of 2.8×107/kg (range, 1.4–4.8) and 0.7×105/kg (range, 0.2–2.2), respectively. HLA disparities were 3/6 match (n=4), 4/6 (n=25), 5/6 (n=4) and 6/6 (n=1). Conditioning regimen consisted of fludarabine and alkylating agent. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus (Tac) alone in 15, Tac plus mycophenolate mofetil in 11, and cyclosporine alone in 8. 〈 Results 〉 Ten patients died by day 28 because of progressive disease (n=5) and transplant related mortality (n=5) and 21 of 24 patients, who survived more than 28 days, were engrafted with complete donor type chimerism (median 19 days). Acute GVHD developed in 14, and chronic GVHD in 4 of these 21 engrafted patients. Estimated 3-year over all survival (OS), transplant related mortality rate and relapse mortality rate were 16%, 32%, and 52%. In univariate analysis, a variable associated with worsened survival were early relapse within 100 days after 1st allo-HSCT (0 vs 21% in late relapses; P=0.01), while other factors were not significant. Eighteen of 19 patients who did not undergo 2nd UCBT died of progressive disease or multiple organ failure. 〈 Conclusion 〉 3 year-OS of 16% with 2nd UCBT following relapsed AML/ MDS was comparable with that of 2nd BMT or PBCST. Considering that all patients in this study were in non-remission and in relatively higher age (median age 54 years), 2nd UCBT following relapse of AML/MDS could be a viable therapeutic option. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V116.21.1295.1295
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
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    Online Resource
    Incidence and Clinical Features of Idiopathic Pneumonia Syndrome and Diffuse Alveolar Hemorrhage After Unrelated Cord Blood Transplantation.
    American Society of Hematology ; 2010
    In:  Blood Vol. 116, No. 21 ( 2010-11-19), p. 4535-4535
    Details
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 4535-4535
    Abstract: Abstract 4535 Incidence and clinical features of idiopathic pneumonia syndrome and diffuse alveolar hemorrhage after unrelated cord blood transplantation. Aya Nishida 1, Atsushi Wake 1, Hisashi Yamamoto 1, Kazuya Ishiwata 1, Nobuaki Nakano 1, Masanori Tsuji 1, Yuki-Asano Mori 1, Naoyuki Uchida 1, Koji Izutsu 1, Kazuhiro Masuoka 1, Akiko Yoneyama 3, Shigeyoshi Makino 4, Shuichi Taniguchi 1. 1 Department of Hematology, Toranomon Hospital, Tokyo, Japan; 2 Department of Pathology, Toranomon Hospital, Tokyo, Japan; 3 Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan; 4 Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan [Background] Idiopathic pneumonia syndrome (IPS) and diffuse alveolar hemorrhage (DAH) are non-infectious pulmonary complications of hematopoietic stem cell transplantation (HSCT) with unclear pathogenesis and treatment. [Objective and method] To investigate the incidence and clinical features of IPS/DAH after unrelated cord blood transplantation (uCBT), we retrospectively analyzed 370 patients underwent uCBT from January 2005 to June 2010 at Toranomon Hospital. Diagnosis of IPS/DAH was made by multilobar infiltrates on CXR or CT, clinical signs of pneumonia: cough, dyspnea, or rales, abnormal physiology: increased arterial-alveolar oxygen gradient, or the needfor supplemental oxygen support, and no evidence of respiratory tract infection. [Result:] Twenty five cases of IPS/DAH were identified, with incidence of 6.8%. The median-age was 59 years (range; 26–72). Nineteen patients underwent transplantation for leukemia, 4 for malignant lymphoma, and 2 for aplastic anemia. IPS/DAH was diagnosed at a median of 34 days (range; 8–93) after uCBT. All patients were administered mPSL therapy. Nine of 25 patients were administered etanercept combined with mPSL pulse therapy. Five of 9 had not responded, while 4 responders had worse their respiratory condition after discontinuation of etanercept therapy. Twenty four of 25 died of respiratory failure. [Conclusion] IPS/DAH after uCBT are fetal pulmonary complications. It is suggested that the incidence of IPS/DAH after uCBT appears similar to that observed after transplantation using other sources. But our results suggested that the existing treatment such as etanercept combined mPSL pulse have only limited efficacy as a therapy for IPS/DAH after uCBT. Further research is needed to characterize the condition of this syndrome and to investigate the optimal therapy and prophylaxis. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V116.21.4535.4535
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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