Mycobacterium abscessus and massiliense lung infection during macrolide treatment for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation

In patients undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT), post-transplant lung infection is critical for their prognosis. Mycobacterium abscessus complex is not fully recognized as a nontuberculous mycobacteria (NTM) pathogen of post-SCT lung infection. Here, we present three post-allogeneic SCT patients who developed pulmonary infection caused by M. abscessus complex including M. abscessus and M. massiliense. In all three cases, macrolide antibiotics had been administered for bronchiolitis obliterans syndrome (BOS) before the confirmation of their infection, and macrolide resistance was noted in the M. abscessus isolates, one of which resulted in an unfavorable treatment outcome. It is important to consider M. abscessus lung infection as well as other NTM in patients receiving allo-SCT, particularly those receiving macrolide therapy for BOS.     

造血干细胞移植后侵袭性肺曲霉病患者12例的肺功能改变

目的观察12例造血干细胞移植(HSCT)后并发侵袭性肺曲霉病(IPA)对患者肺功能参数及动脉血气的影响。方法 2007年2月~2009年10月本院接受HSCT后并发IPA患者12例,男8例,女4例,中位年龄34岁(26~67岁)。移植前后均行肺功能测试、动脉血气分析以及影像学检查。结果中位随访时间为132 d(97~432 d),无1例发生Ⅲ、Ⅳ度急性移植物抗宿主病(GVHD)。2例在移植1年后发生慢性GVHD。12例均为病理确诊或临床诊断IPA者,移植前肺功能测定仅有弥散功能轻度减退。抗真菌治疗8周后肺功能测试发现所有患者均存在不同程度的阻塞性通气障碍,其中8例患者呈小气道病变[FEF50和FEF75分别为(55.9±3.4)%和(41.9±4.1)%],4例患者则出现混合性通气障碍,总弥散量(DLCO)也显著降低[(47.4±2.9)%预计值],动脉血氧分压(PaO2)仅为(68.7±4.1)mmHg,但弥散常数(DLCO/VA)尚正常,与移植前无显著差异(P0.05)。结论 HSCT后并发IPA可对患者的肺功能造成不同程度的损害,肺内多部位感染或反复发生IPA的患者可出现较严重的混合性通气障碍,弥散也显著减退。     

The experience of allogeneic hematopoietic stem cell transplantation in a patient with X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy (X-ALD), a progressive neurometabolic disorder that is caused by a defect in the gene ABCD1 (ATP-binding cassette, subfamily D, member 1), which encodes the peroxisomal ABC half-transporter ALD protein. Recently, allogeneic hematopoietic stem cell transplantation (alloHSCT) is the only therapy known to prevent disease progression. In this study, we would like to present our experience of alloHSCT for X-ALD from a HLA matched related sibling by the use of reduced intensity conditioning regimen composed of fludarabine, busulfan and ATG which allows us to reduce procedure-related toxicity and prevent mortality while achieving a curative effect.     

Voriconazole for prophylaxis of invasive fungal infections after allogeneic hematopoietic stem cell transplantation

Introduction: Invasive fungal infections (IFIs) following allogeneic hematopoietic stem cell transplantation (alloHSCT) are associated with a high mortality, and accordingly most alloHSCT recipients receive prophylaxis with antifungal agents. Despite some improvement in outcomes of IFIs over time, they continue to represent substantial clinical risk, mortality, and financial burden.

Areas covered: We review the main pathogens responsible for IFIs in recipients of alloHSCT, current treatment recommendations, and discuss clinical and economic considerations associated with voriconazole prophylaxis of IFIs in these patients.

Expert commentary: The clinical efficacy of voriconazole appears to be at least equivalent to other antifungal treatments, and generally well tolerated. Overall, benefit-risk balance is favorable, and findings from cost-effectiveness analyses support the use of voriconazole prophylaxis of IFIs in recipients of alloHSCT.     

Posterior reversible encephalopathy syndrome concurrent with human herpesvirus-6B encephalitis after allogeneic hematopoietic stem cell transplantation

Posterior reversible encephalopathy syndrome (PRES) and human herpesvirus (HHV)-6 encephalitis are both serious neurological complications post hematopoietic stem cell transplantation. Although infection is one of the important causes of PRES, only few cases have reported the relation between PRES and viral infection. Herein, we report the first adult case of PRES concurrent with HHV-6 encephalitis after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. This case suggests that HHV-6 reactivation is associated with the pathogenesis of PRES. Also, PRES and HHV-6 encephalitis cause similar symptoms, and switching the immunosuppressant from calcineurin inhibitor to prednisolone for treating PRES may worsen HHV-6 encephalitis. Therefore, we should pay attention to the complication of HHV-6 encephalitis even after PRES is diagnosed.     

Effect of extracorporeal photopheresis on lung function decline for severe bronchiolitis obliterans syndrome following allogeneic stem cell transplantation

Extracorporeal photopheresis (ECP) is a commonly used treatment for severe graft‐versus‐host‐disease (GVHD). We sought to evaluate the effects of ECP over a prolonged period on forced expiratory volume in 1 s (FEV1) in patients with pulmonary GVHD. We identified eight patients who developed new airflow obstruction following allogeneic stem cell transplantation and a substantial decline in FEV1 despite receiving corticosteroids and standard therapy for pulmonary GVHD. Those eight patients were treated with ECP for a period of 1 year, with a primary endpoint of FEV1 change during this treatment period. Over the first 3 months of ECP, there was no further decline in FEV1 in seven of the eight patients. However, over the 1 year period, only two of the eight patients had stability in FEV1. The rate of FEV1 decline was substantially less once ECP was initiated, though the median FEV1 continued to decline over 1 year of therapy. All patients survived through the first year of ECP therapy. There was a significant decrease in the median dose of prednisone per patient throughout the 12 months of ECP treatment. ECP shows promise in slowing rate of decline of FEV1 in pulmonary GVHD, though the effects may not be long lived. J. Clin. Apheresis 31:347–352, 2016. © 2015 Wiley Periodicals, Inc.     

造血干细胞移植后肺孢子菌肺炎23例临床研究

目的:分析异基因造血干细胞移植（allo-HSCT）后肺部危重并发症-肺孢子菌肺炎（PCP）的高危因素、临床特点及预后转归。方法:回顾性收集并分析2016年1月至2021年1月在本院血液科接受HSCT后发生肺孢子菌肺炎的患者的临床特征、实验室资料、治疗及转归。结果:共纳入23例符合PCP临床诊断标准的患者,PCP中位发病时间为移植后221 d;影像CT以弥漫性磨玻璃样渗出影为主。血清β-1,3-D葡聚糖（BDG）中位数为894.25 ng/L,共有91.3%的患者大于60 ng/L;60.9%患者的淋巴细胞计数低于1×10 9/L;65.2%的CD4 +T淋巴细胞绝对值低于200/μL。21例患者在肺泡灌洗液mNGS中检测到肺孢子菌属序列,15例患者为混合感染。治疗上给予TMP-SMX抗肺孢子菌后18例患者好转出院,5例死亡。 结论:HSCT后患者并发PCP为肺部急症,进展较快,常合并混合感染,血清BDG升高对PCP诊断具有指导意义,肺泡灌洗液中二代测序（mNGS）对肺孢子菌敏感性高,及早进行肺泡灌洗,有助于早期诊治,明显降低病死率;PCP患者进展为需要机械通气及高流量吸氧提示预后不佳。     

造血干细胞移植后肺孢子菌肺炎23例临床研究

目的:分析异基因造血干细胞移植（allo-HSCT）后肺部危重并发症-肺孢子菌肺炎（PCP）的高危因素、临床特点及预后转归。方法:回顾性收集并分析2016年1月至2021年1月在本院血液科接受HSCT后发生肺孢子菌肺炎的患者的临床特征、实验室资料、治疗及转归。结果:共纳入23例符合PCP临床诊断标准的患者,PCP中位发病时间为移植后221 d;影像CT以弥漫性磨玻璃样渗出影为主。血清β-1,3-D葡聚糖（BDG）中位数为894.25 ng/L,共有91.3%的患者大于60 ng/L;60.9%患者的淋巴细胞计数低于1×10 9/L;65.2%的CD4 +T淋巴细胞绝对值低于200/μL。21例患者在肺泡灌洗液mNGS中检测到肺孢子菌属序列,15例患者为混合感染。治疗上给予TMP-SMX抗肺孢子菌后18例患者好转出院,5例死亡。 结论:HSCT后患者并发PCP为肺部急症,进展较快,常合并混合感染,血清BDG升高对PCP诊断具有指导意义,肺泡灌洗液中二代测序（mNGS）对肺孢子菌敏感性高,及早进行肺泡灌洗,有助于早期诊治,明显降低病死率;PCP患者进展为需要机械通气及高流量吸氧提示预后不佳。     

造血干细胞移植后肺孢子菌肺炎23例临床研究

目的:分析异基因造血干细胞移植（allo-HSCT）后肺部危重并发症-肺孢子菌肺炎（PCP）的高危因素、临床特点及预后转归。方法:回顾性收集并分析2016年1月至2021年1月在本院血液科接受HSCT后发生肺孢子菌肺炎的患者的临床特征、实验室资料、治疗及转归。结果:共纳入23例符合PCP临床诊断标准的患者,PCP中位发病时间为移植后221 d;影像CT以弥漫性磨玻璃样渗出影为主。血清β-1,3-D葡聚糖（BDG）中位数为894.25 ng/L,共有91.3%的患者大于60 ng/L;60.9%患者的淋巴细胞计数低于1×10 9/L;65.2%的CD4 +T淋巴细胞绝对值低于200/μL。21例患者在肺泡灌洗液mNGS中检测到肺孢子菌属序列,15例患者为混合感染。治疗上给予TMP-SMX抗肺孢子菌后18例患者好转出院,5例死亡。 结论:HSCT后患者并发PCP为肺部急症,进展较快,常合并混合感染,血清BDG升高对PCP诊断具有指导意义,肺泡灌洗液中二代测序（mNGS）对肺孢子菌敏感性高,及早进行肺泡灌洗,有助于早期诊治,明显降低病死率;PCP患者进展为需要机械通气及高流量吸氧提示预后不佳。     

儿童异基因造血干细胞移植后可逆性后部白质脑综合征MRI表现

目的 观察儿童异基因造血干细胞移植(allo-HSCT)后可逆性后部白质脑综合征(PRES)MRI表现.方法 纳入23例allo-HSCT后PRES患儿,观察MRI所示病变累及范围、信号特点及随访变化.结果 23例顶枕叶皮质及皮质下白质均受累,21例双侧受累,2例单侧受累;7例累及额颞叶皮质及皮质下白质,3例累及深部白...     

No transmission of SARS-CoV-2 in a patient undergoing allogeneic hematopoietic cell transplantation from a matched-related donor with unknown COVID-19

The Hematology Department and its Hematopoietic Cell Transplantation (HCT) program implemented several measures during COVID-19 outbreak in order to keep clinical activities with the maximum security for both donors and recipients. Nevertheless, there was a lack of evidence whether blood products and specifically bone marrow can cause transfusion-transmitted infection. Initially, there were many uncertainties and did not exist formal recommendations.Before official statements were available, we performed an allogeneic HCT in a 57-year-old male from a related matched donor in the incubation period of COVID-19 where the patient did not develop the disease.Actual epidemiology data suggest that transmission may occur early in the course of infection, even from asymptomatic patients in the incubation period. In our knowledge this is the first case report of an adult hematopoietic cell donor with COVID-19 in the incubation period where the transplant is successfully completed with no transmission of SARS-CoV-2. The low concentration of viral RNA in plasma of patients with COVID-19 could support the safety of blood products, including peripheral blood hematopoietic cells.In conclusion, blood products including hematopoietic stem cells are safe in the context of COVID-19 pandemic.     

1例AML-M2a单倍体造血干细胞移植后患者 感染新型冠状病毒的护理

总结1例单倍体造血干细胞移植后患者感染新型冠状病毒的护理经验。包括个性化经鼻高流量氧疗、应用新型抗病毒药物、兼顾免疫抑制及针对药物不良反应的护理措施；应对皮肤排斥反应、营养支持、消毒隔离与保护性隔离、人文关怀等护理经验。经一周的治疗患者新冠病毒核酸检测转阴性，CT检查结果示两肺感染性病变较前明显好转，无其他并发症，最终好转出院。我们案例报道以期为新型冠状病毒常态化管控下造血干细胞移植后患者感染重型病例的护理提供经验。     

Acute graft‐versus‐host disease and bronchiolitis obliterans after autologous stem cell transplantation in a patient with multiple myeloma

Sixty‐seven‐year‐old patient, diagnosed with multiple myeloma who had received autologous stem cell transplantation, following bortezomib, dexamethasone and thalidomide conventional regimen, achieving complete response, developed rash, diarrhea, and severe respiratory failure, 80 days after the transplantation procedure. He was diagnosed with graft‐versus‐host disease and bronchiolitis obliterans syndrome.     

First case of breakthrough pulmonary Aspergillus niveus infection in a patient after allogeneic hematopoietic stem cell transplantation

Aspergillus niveus is a species uncommon in clinical samples, and to date, invasive fungal infections caused by this fungal pathogen have not been described. This is the 1st report on a pulmonary breakthrough aspergillosis caused by A. niveus in a 21-year-old woman after allogeneic hematopoietic stem cell transplantation for Fanconi anemia.     

供者淋巴细胞输注联合化疗治疗异基因造血干细胞移植后白血病复发的护理

探讨供者淋巴细胞输注(DLI)联合化疗治疗异基因造血干细胞移植( Allo - HSCT)后白血病复发的疗效、并发症及护理方法.对Allo - HSCT后白血病复发的6例患者予分次逐渐提高单次剂量方案(EDR)的DLI联合化疗治疗,观察输注后白血病血液学完全缓解(CR)率、无病生存(DFS)率、移植物抗宿主病(GVHD)和骨髓抑制发生率、输注时尿常规,患者的反应情况.输注过程仅有2例轻微发热,6例均获得血液学CR,CR率100％,STR - PCR测定证实恢复为供者基因型;随访70 d至14个月,2例DLI后50 d发生慢性GVHD,发生率33.2％,无1例发生急性GVHD,2例全血细胞减少骨髓抑制,发生率33.2％;5例DFS,1例于DLI后70 d死于CMV性间质性肺炎.随访至今,5例DFS患者血象和骨髓象一直正常.EDR、DLI联合化疗治疗Allo - HSCT后白血病复发疗效显著、副作用小、应用安全.     

HLA—Cw配型与异基因造血干细胞移植后GVHD关系的临床初探

目的探讨HLA-Cw配型在异基因造血干细胞移植中与GVHD的发生和复发的关系。方法对HLA6个位点（A、B、DR／DQ）全相合的同胞供者9例异基因外周血干细胞移植和10例脐带血移植进一步进行HLA-Cw配型,分析HLA-Cw配型与GVHD发生的关系。结果16例HLA-Cw相合者,共植入15例（94％）,其中Ⅰ-Ⅱ度急性GVHD发生11例（69％）,Ⅲ度急性GVHD2例（12．5％）,慢性GVHD15例（94％）,无复发病例。在HLA—Cw不相合3例中,2例发生Ⅲ度GVHD并且早期死亡,1例早期复发。在HLA—Cw配型相合与不相合两组间,急性Ⅰ～Ⅱ度及Ⅲ度GVHD的发生其差异均具有统计学意义（P〈0．05）。结论HLA—Cw配型相合供体造血干细胞移植有利于减少植入后急性GVHD发生及复发,提示HLA-Cw位点配型在造血干细胞移植,尤其是异基因移植中具有重要意义。     

Fungemia due to Fusarium solani under low-dose liposomal amphotericin B in a patient after cord blood transplantation

The introduction of the prophylactic use of antifungal drugs caused the increased occurrence of invasive fungal infections due to previously rare molds, such as fusariosis, after allogeneic hematopoietic stem cell transplantation. We herein report the case of a patient with diffuse large B-cell lymphoma who developed fungemia due to Fusarium solani during liposormal amphotericin B on day 25 after cord blood transplantation (CBT). Because Fusarium species might differ in virulence and drug susceptibility, the sequencing of the internal transcribed spacer region of the ribosomal RNA gene accurately identified Fusarium solani to be the cause of fungemia at the species level. This case highlights Fusarium solani as the cause of fungemia in a patient under liposormal amphotericin B treatment after CBT.     

儿童异基因造血干细胞移植术后肺急性移植物抗宿主病与感染CT表现

目的 观察儿童异基因造血干细胞移植(allo-HSCT)术后肺部急性移植物抗宿主病(aGVHD)的CT表现,并与感染性病变鉴别.方法 纳入148例allo-HSCT后出现肺部病变患儿,分为aGVHD组(n=85)和感染组(n=63).比较组间年龄、术后发病时间及肺部CT征象及分布模式差异.结果 aGVHD组与感染组年龄...     

减低剂量预处理异基因造血干细胞移植治疗骨髓增生异常综合征的研究进展

异基因造血干细胞移植(allo-HSCT)为可能治愈国际预后积分系统(IPSS)中、高危骨髓增生异常综合征(MDS)患者的方法.然而,MDS患者多为中、老年人,难以耐受清髓性异基因造血干细胞移植(MAC-HSCT).减低剂量预处理异基因造血干细胞移植(RIC-HSCT)具有低毒、高效等特点,被广泛应用于MDS的治疗.目前,常用的预处理方案为氟达拉滨联合烷化剂,但各种预处理方案的疗效差异较大.RIC-HSCT对IPSS中、高危老年MDS患者有其独特优势,但不同移植类型、allo-HSCT前肿瘤负荷、IPSS危险度分层及移植前合并症对RIC-HSCT疗效的影响尚无定论.笔者拟就近年来RIC-HSCT应用于MDS治疗的研究进展进行综述.     

Evaluation and management of hepatitis B virus infection in hematopoietic stem cell transplantation: before and after transplantation

HBV infection remains a major global health problem and continues to be a common cause of liver-related morbidity and mortality in both immunocompetent and immunosuppressed individuals. Reactivation of HBV is a serious complication of chemotherapy/immunosuppressive therapy in patients with HBV infection. In this article, we aim to describe the diagnosis, prevention and management of HBV infection in allogeneic hematopoietic stem cell transplant candidates, from the pre- to post-transplant period. The data currently available suggest that all individuals with hemato-/onco-logical malignancies who undergo chemotherapy/immunosuppressive therapy should be screened for hepatotropic viruses such as HBV and HCV. HBV surface antigen-positive individuals who receive chemotherapy/immunosuppressive therapy are at considerable risk of HBV reactivation. Antiviral prophylaxis prevents HBV reactivation, decreases reactivation-related morbidity and mortality, and prevents interruptions in chemotherapy/immunosuppressive therapy in such individuals. The optimal duration of antiviral prophylaxis remains to be elucidated. The vaccination of HBV-naive recipients and their donors against HBV infection prior to transplantation plays an important role in preventing acquired HBV infection. The presence of hepatitis B surface antigen positivity is not an absolute contraindication for allogeneic hematopoietic stem cell transplantation.