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Markus Resch,
Katrin Kurz,
Wulf Schneider-Brachert,
Kathrin Tintelnot,
Christoph Birner,
Thomas Schichtl,
Matthias Lubnow, Christina Hart,
Clemens Jilek,
Simone Bertz,
Michael Hilker,
Günter A J Riegger,
Andreas Luchner,
Thomas Müller
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ABSTRACT: In fulminant blastomycosis with multiorgan failure, the earliest diagnosis possible is crucial for successful treatment. If severe acute respiratory distress syndrome (ARDS) develops, miniaturised veno-venous extracorporeal membrane oxygenation (ECMO) might provide a unique and efficacious possibility to prolong the time frame for diagnosis and the beginning of treatment. This is the first report on a case of fatal blastomycosis in Germany. It reminds us to add exotic infections to the differential diagnosis in patients with refractory pneumonia in the era of worldwide tourism.
Case Reports 01/2009; 2009.
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ABSTRACT: Hematopoietic progenitor cells (HPC) as well as tissue committed stem cells expressing mRNA specific to various somatic tissues are thought to be part of the CD34+ bone marrow compartment. In this study, we explore and quantify their mobilization in patients with multiple myeloma undergoing chemotherapy upon administration of granulocyte colony-stimulating factor (G-CSF) plus/minus erythropoietin (EPO).
HPC were quantified by flow cytometry and functional assays within the blood of healthy donors and myeloma patients before and after chemotherapy followed by G-CSF or G-CSF + EPO given subcutaneously. The mRNA expression was studied by quantitative polymerase chain reaction (PCR). Cytokines and peripheral blood protease levels were measured by an enzyme-linked immunosorbent assay.
EPO did not significantly alter the number of HPC mobilized by G-CSF alone, and mRNA specific for liver, brain, muscle and kidney was detected in both treatment groups. Quantitative PCR analysis revealed a 2.7-fold increased expression of glial fibrillary acidic protein after G-CSF + EPO administration compared to G-CSF alone (P = 0.003). The concentration of G-CSF rose from 62 +/- 22 pg/mL and 48 +/- 10 pg/mL to 28 +/- 9 ng/mL and 85 +/- 10 ng/mL after 10 d of treatment with G-CSF and G-CSF + EPO, respectively. The concentration of neutrophil elastase (NE) rose only in the G-CSF group by a factor 1.5.
The alteration of G-CSF and NE levels as well as the expression of tissue committed RNA after the administration of EPO in addition to G-CSF indicate that different growth factors mobilize different stem cells that might potentially be used for the support of tissue repair in future treatment protocols.
European Journal Of Haematology 02/2008; 80(1):20-30. · 2.61 Impact Factor
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ABSTRACT: High-dose chemotherapy with autologous stem cell support is an effective treatment in advanced multiple myeloma. In this study, we compare chemotherapy with ifosfamide, epirubicin, and etoposide (IEV) or cyclophosphamide and etoposide (CE) in 47 patients with multiple myeloma with regard to stem cell mobilization, toxicity, and tumor response. The proportion of patients reaching the threshold of >6 x 10(6) CD34+ cells/kg body weight was significantly higher in the IEV group (97% vs 71%), and more CD34+ cells (10 x 10(6) vs 3.5 x 10(6) cells/kg; p = 0.002) could be collected by the first leukapheresis associated with less leukaphereses needed. Non-hematopoietic side effects were mild with nausea being more frequent after IEV treatment (30% vs 7%). Grade 3/4 neutropenia (thrombocytopenia) occurred in 89 and 100% (55 and 44%) of the patients. There was one treatment-related death due to septic shock in the IEV group. Grade 3/4 anemia was more frequent in the IEV group (19% vs 0%). Forty-two percent (IEV) and 50% (CE) received inpatient treatment for neutropenic fever. In 20 and 7% of the patients, a partial response was observed after IEV and CE. However, the overall response rate (complete response and partial tumor response) after mobilization and tandem high-dose chemotherapy was 75% after IEV and 78% after CE and, thus, independent of the mobilization. In summary, both treatment protocols can readily be used for the mobilization of peripheral blood stem cells with comparable major toxicities and similar tumor response rates. However, the efficiency of the stem cell mobilization was significantly higher after IEV treatment.
Annals of Hematology 08/2007; 86(8):575-81. · 2.62 Impact Factor
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ABSTRACT: Hematopoietic stem cell (HSC) homing from blood to bone marrow is a multistep process involving rolling, extravasation, migration, and finally adhesion in the correct microenvironment. With view to the hematopoietic recovery after clinical stem cell transplantation, we investigated the effect of stem cell factor (SCF) on the expression and the adhesive function of the alpha4beta1 and alpha5beta1 integrins very-late antigen (VLA)-4 and VLA-5 on peripheral blood-derived hematopoietic progenitor cells. After SCF stimulation, the expression of VLA-4 and VLA-5 on CD34+/c-kit+ cells obtained from healthy donors increased from 54% to 90% and from 3% to 82%, respectively. For patient-derived cells, the increase was 67% to 90% and 12% to 46%. The proportion of mononuclear cells adhering to the fibronectin fragment CH296 increased by stimulation with SCF from 14% to 23%. Accordingly, functional studies showed an approximate 30% increase of adherent long-term culture-initiating cell. The improvement of the homing abilities of SCF-stimulated HSC was confirmed by transplantation into sublethally irradiated nonobese diabetic-scid/scid mice. Six weeks after the transplantation, in eight of eight animals receiving human HSC with the addition of SCF, a profound multilineage hematopoietic engraftment was detected, whereas in the control group receiving only HSC, none of eight animals engrafted. Our data provide the first in vivo evidence that stimulation with cytokines improves the homing ability of transplanted human hematopoietic progenitor cells.
Stem Cells 02/2004; 22(4):580-9. · 7.78 Impact Factor
