Yutaka Murata

Central nervous system infection following allogeneic hematopoietic stem cell transplantation.

OBJECTIVE/BACKGROUND Here, we described the clinical characteristics and outcomes of central nervous system (CNS) infections occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a single institution over the previous 6 years. METHODS Charts of 353 consecutive allogeneic transplant recipients were retrospectively reviewed for CNS infection. RESULTS A total of 17 cases of CNS infection were identified at a median of 38 days (range, 10-1028 days) after allo-HSCT. Causative pathogens were human herpesvirus-6 (n=6), enterococcus (n=2), staphylococcus (n=2), streptococcus (n=2), varicella zoster virus (n=1), cytomegalovirus (n=1), John Cunningham virus (n=1), adenovirus (n=1), and Toxoplasma gondii (n=1). The cumulative incidence of CNS infection was 4.1% at 1 year and 5.5% at 5 years. CONCLUSION Multivariate analysis revealed that high-risk disease status was a risk factor for developing CNS infection (p=.02), and that overall survival at 3 years after allo-HSCT was 33% in patients with CNS infection and 53% in those without CNS infection (p=.04).

Steroid Pulse Therapy for Blood Cell Recovery in Allogeneic Hematopoietic Stem Cell Transplantation

OBJECTIVE Steroid pulse therapy is used to relieve pancytopenias in our hospital and is effective in some patients. However, it is unclear which patients will benefit from such therapy. Thus, we retrospectively analyzed the clinical features of patients undergoing allogeneic hematopoietic stem cell transplantation who received steroid pulse therapy to facilitate recovery in their blood cell counts. METHODS Between 2004 and 2012, 24 patients underwent steroid pulse therapy and the medical records of 17 of these evaluable patients (11 men, 6 women) were retrospectively reviewed. Bone marrow smears were assessed to calculate the proportion of hemophagocytic macrophages just prior to receiving pulse therapy. RESULTS Steroid pulse therapy was started at a median of 15 days after transplantation (range, 10-28 days). The median white blood cell count was 0.02×10(3)/μL (range, 0.01-0.4×10(3)/μL). Eight patients responded to pulse therapy and subsequent engraftment was achieved in all responders. None of the patients who underwent cord blood transplantation responded to the pulse therapy. Among the non-responders, only two patients achieved engraftment and four of nine non-responders died within one month. When evaluating the efficacy of steroid pulse therapy according to the ferritin level and proportion of hemophagocytic macrophages among patients undergoing bone marrow or peripheral blood stem cell transplantation, both values were higher in responders than in non-responders. CONCLUSION We speculate that responders have a hemophagocytic syndrome which is responsive to steroid pulse therapy. Thus, our results imply that the use of ferritin levels in combination with the proportion of hemophagocytic macrophages may be useful for the early detection of potential hemophagocytic syndrome after hematopoietic stem cell transplantation.

Clinical Impact of Pre-transplant Pulmonary Impairment on Survival After Allogeneic Hematopoietic Stem Cell Transplantation

We retrospectively analyzed the clinical outcomes of patients with pulmonary impairment before undergoing allogeneic hematopoietic stem cell transplantation (HSCT) for the first time. Among 297 evaluable patients who underwent their first HSCT, 23 had restrictive, obstructive or mixed ventilatory impairment (n = 9, 13 and 1, respectively). Males predominated among the patients with pulmonary impairment (p = 0.037) and received a reduced intensity conditioning (RIC) regimen more frequently, although the difference did not reach statistical significance (p = 0.05). Among 23 patients with pulmonary impairment, 9 underwent post-transplant pulmonary function tests and obstructive ventilatory impairment progressed only in 2 patients, both of whom developed bronchiolitis obliterans. Kaplan-Meier estimates of 3-year overall (OS) among patients with and without pulmonary impairment were 57% and 47%, respectively, and those of relapse-free survival (RFS) were 70%, and 68%, respectively, with no significant differences between the groups (OS, p = 0.235; RFS, p = 0.287). The rates of non-relapse mortality also did not significantly differ (p = 0.835). Our results suggest that allogeneic HSCT is safe for patients with pulmonary impairment. The lower frequency of fatal pulmonary complications after HSCT and the RIC regimen might contribute to favorable survival rates.