[Show abstract][Hide abstract] ABSTRACT: The addition of cladribine to the standard regimen consisting of daunorubicin and cytarabine has been reported to increase the efficacy of induction therapy in acute myeloid leukemia (AML). The goal of this study was to determine the effect of this modification on the incidence and spectrum of infectious complications.
Case report forms of 309 patients with newly diagnosed AML who had been enrolled in the prospective, randomized 'DAC-7 vs. DA-7' trial were reviewed. The frequency, etiology, localization, severity, and outcome of infections were compared for patients receiving only daunorubicin and cytarabine (DA-7) and those additionally treated with cladribine (DAC-7).
A total of 443 febrile episodes were reported with no significant difference between the treatment groups. A trend towards a higher frequency of bacteremias was observed among DA-7 patients compared to those in the DAC-7 group (31% vs. 21%; p=0.08). The treatment arms did not differ in terms of the distribution of the isolated Gram-positive, Gram-negative, fungal, and viral organisms. However, when bacteremias were considered, Gram-positive blood cultures tended to be more frequent in the DA-7 compared to the DAC-7 group (16% vs. 8.5%; p=0.07). This difference reached statistical significance when major blood bacteremias were analyzed separately (13% vs. 5%; p=0.02). Complete recovery from infections was observed in the majority of patients across both treatment arms and no significant difference was noted regarding infection-related mortality.
The addition of cladribine to standard induction chemotherapy has no impact on the incidence and spectrum of infectious complications in newly diagnosed AML patients.
Full-text · Article · Aug 2009 · International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Acute graft-versus-host-disease (aGvHD) is a major cause of mortality after allogeneic hematopoietic cell transplantation (alloHCT). The goal of this study was to evaluate the incidence and risk factors for this complication.
330 consecutive patients (183 male and 147 female), aged 29 (10-56) years, treated with alloHCT in a single center between 1992-2003 were included in the analysis. AlloHCT was performed after myeloablative conditioning from either related donor (rel-HCT) (n=223) or unrelated voulnteer (URD-HCT) (n=107). GVHD prophylaxis consisted of cyclosporin, methotrexate +/- prednisolone.
Cumulative incidence of grade II-IV and grade III-IV aGvHD equaled 31% and 17%, respectively. In multivariate analysis the following factors were associated with increased risk of grade II-IV aGvHD: the diagnosis of chronic myeloid leukemia (CML) or myelodysplastic syndrome (MDS) (vs. other diagnoses), URD-HCT (vs. Rel-HCT), years of alloHCT 1992-2001 (vs. 2002-2003), donor age > or =35 years, and CD34+ cell dose > or = 4.0 x 10(6)/kg. Increased risk of grade III-IV aGVHD was associated with: the use of prednisolone for aGvHD prophylaxis, the diagnosis of CML or MDS, and CD3+ cell dose > or =100 x l0(6)/kg.
Incidence of aGvHD depends on various recipient-, donor-, and procedure-related factors. This should be taken into account when planning treatment for every individual patient.
No preview · Article · Oct 2006 · Annals of transplantation: quarterly of the Polish Transplantation Society
[Show abstract][Hide abstract] ABSTRACT: To reduce the risk of graft rejection after allogeneic hematopoietic cell transplantation (alloHCT) for patients with acquired severe aplastic anemia (SAA), we introduced an intensified preparative regimen consisting of treosulfan 10 g/m2/d on days -7, -6, cyclophosphamide 40 mg/kg/d on days -5, -4, -3, -2 and anti-thymocyte globulin 2 mg/kg/d on days -3, -2, -1. Six patients with the history of multiple transfusions were treated with alloHCT from either HLA-identical sibling (n=3) or an unrelated volunteer (n=3). Each, bone marrow and peripheral blood was used as a source of stem cells in three cases. All patients engrafted and achieved complete donor chimerism. None of the patients experienced severe organ toxicity. No severe acute graft-versus-host-disease (GVHD) was observed; two patients experienced extensive chronic GVHD. At the median follow-up of 14.5 (13-27) months all patients remained alive and disease-free. Our observation indicates that treosulfan + cyclophosphamide + antithymocyte globulin conditioning is well-tolerated and allows stable engraftment in acquired SAA.
No preview · Article · Feb 2006 · Annals of transplantation: quarterly of the Polish Transplantation Society
[Show abstract][Hide abstract] ABSTRACT: Fungal infections are one of the most serious infections, concerning largely neutropenic and immunodeficiency cancer patients, mainly after intensive antibiotic, glicocorticosteroid and cytostatic therapy. Optimal therapy procedures for fungal infections include: proper prophylaxis, staging for risk factors, proper microbiological examinations and conducting the best possible antifungal treatment based on available antifungal drugs. The Infections Section for the Polish Adult Leukaemia Group (PALG), has worked out Polish recommendations for anti-fungal therapy in neutropenic and immunodeficiency cancer patients.
No preview · Article · Jan 2006 · Acta haematologica Polonica
[Show abstract][Hide abstract] ABSTRACT: Sepsis represents a substantial health care burden and the number of septic patients increases. There is limited information about the frequency of sepsis among neutropenic patients. We investigated the frequency of sepsis in Polish hematological hospitals on just one day, November 26th, 2002. Forty two patients were included into the study. Sepsis was diagnosed in 14 patients, systemic inflammatory response syndrome (SIRS) in 14 cases. One patient had bacteraemia. Seven patients had positive blood cultures. Twelve groups of antibiotics were used empirically. Procalcitonin (PCT) concentrations were measured in 38 patients. In spite of suspicion of sepsis, blood for cultures was not taken in 26,2% of patients. Common practice of instituting empirical broad-spectrum antibiotics from many groups indicates lack of standardized principles in the use of antibiotics. PCT seems to be a useful clinical marker in diagnosing of sepsis.
No preview · Article · Jan 2004 · Acta haematologica Polonica
[Show abstract][Hide abstract] ABSTRACT: Medical antimicrobial therapy during neutropenia is very difficult not only for physicians, but also for specialists in medical departments. Authors of this work, basing on their experience and the experience of specialists of the major haematological centres in Poland (with special inter-centre Infections Section operating at the Polish Adult Leukaemia Group), and utilizing the current world-wide references and medical news, have developed Polish guidelines for therapy of the infections in patients with malignancy. Moreover, authors give some practical advice relevant to neutropenia and to problems which may appear during treatment of neutropenic patients.
No preview · Article · Jan 2003 · Acta haematologica Polonica