CC BY
25IMMUNE COMPLICATIONS |
IC-10
(Extracorporeal photopheresis in the treatment of chronic graft-versus-host disease: experience at the National Center of Hematology
Vera A. Vasilyeva, Larisa A. Kuzmina, Mikhail Yu. Drokov, Mariya V. Dovydenko, Olga M. Koroleva, Darya S. Dubnyak, Anna A. Dmitrova, Natalya M. Nikiforova, Olga S. Starikova, Denis V. Kamelskikh, Alexandra A. Shcherbakova, Tatyana V. Gaponova, Elena N. Parovichnikova, Valery G. Savchenko
National Research Center for Hematology, Moscow, Russia
Contact: Dr. Vera A. Vasilyeva, e-mail: vasilievaVA4@mail.ru
Introduction
Chronic graft versus host disease (GVHD) is a frequent complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) associated with decreased quality of life. Extracorporeal photopheresis (ECP) is a potential second-line treatment modality for steroid-refractory cGvHD. The aim of the study was to evaluate effectiveness of ECP treatment in patients with corticosteroid-refractory, -dependent or -intolerant chronic GVHD at the National Research Center for Hematology.
Materials and methods
24 patients with corticosteroid-refractory (n=19), -dependent (n=4) or -intolerant (n=1) chronic GVHD were included into the study and received ECP therapy. Nine patients had moderate chronic GVHD, and 15 had a severe chronic GVHD defined as per criteria of National Institutes of Health (NIH) [1]. Skin and mucosal barriers were the most frequent sites involved in 21 and 20 of 24 patients, respectively. Liver and lung injuries were detected in 8 and 6 patients, respectively. The median number of ECP procedures was 22 (range 6-48). The median duration of treatment was 9.5 months (range 1-33 months). To assess the response to therapy, special questionnaires were used by physicians and the patients. The doctors used a questionnaire of cGVHD activity by Lee S. et al., whereas an adapted questionnaire by Lee S. et al. was used by the patients [2]. The questionnaires were filled once per 4 ECP procedures.
Results
Clinical response was determined in 23 patients; one patient was excluded from further assessment due to relapse
of acute leukemia. The overall response rate to ECP therapy was 69.5%. Three patients (18.75%) achieved complete response with complete withdrawal of immunosuppressive therapy. The best organ-specific response was observed in patients with the mucosal lesions (n=17, (89.4%); with skin affections (n=17, 85%), and liver involvement (n=7, 75%). In 75% of the patients, ECP therapy resulted in partial tapering or complete withdrawal of immunosuppressive therapy.
Conclusion
ECP is an effective method of therapy of chronic GVHD, especially in patients with involvement of mucous sites, skin and liver. ECP therapy did not seem to be effective in the treatment of chronic GvHD of lungs, however, clinical stabilization could be achieved in 40% of patients.
References:
1. Jagasia M.H., Greinix H.T., Arora M., et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease:
1. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. 2015;21(3):389-401.e1.
2. Lee S.J., Wolff D., Kitko C., et al. Measuring Therapeutic Response in Chronic Graft-versus-Host Disease. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015;21(6):984-99.
Keywords
Chronic graft-versus-host disease, extracorporeal pho-topheresis, second-line therapy.
Экстракорпоральный фотоферез в терапии хронической формы реакции трансплантат против хозяина: опыт ФГБУ НМИЦ гематологии
Вера А. Васильева, Лариса А. Кузьмина, Михаил Ю. Дроков, Мария В. Довыденко, Ольга М. Королева, Дарья С. Дубняк, Анна А. Дмитрова, Наталья М. Никифорова, Ольга С. Старикова, Денис В. Камельских, Александра А. Щербакова, Татьяна В. Гапонова, Елена Н. Паровичникова, Валерий Г. Савченко
Национальный медицинский исследовательский центр гематологии, Москва, Россия
Введение
Хроническая реакция трансплантат против хозяина (хр-РТПХ) частое осложнение после трансплантации алло-генных гемопоэтических клеток (алло-ТГСК), которое снижает качество жизни больных. При неудаче лечения глюкокортикоидами (ГКС), одним из методов терапии является экстракорпоральный фотоферез (ЭКФ). Цель работы: оценка эффективности терапии ЭКФ у пациен-
тов с ГКС-резистентной, -зависимой, -интолерантной хронической формой РТПХ в условиях ФГБУ НМИЦ гематологии Минздрава РФ.
Материалы и методы
В исследование были включены 24 пациента с ГКС-ре-зистентной (п=19), -зависимой (п=4), -интолерантной (п=1) формой хрРТПХ. У 9 больных была установлена средняя степень тяжести, у 15 - тяжелая форма, в со-
82
CTT JOURNAL | VOLUME 9 | NUMBER 3 | SEPTEMBER-OCTOBER 2020
@ cttjournal.com
I POSTTRANSPLANT INFECTIONS
ответствии с критериями Национального института здоровья США (National Institutes of Health (NIH)) [1]. Частыми органами-мишенями были кожа (21 из 24 больных) и слизистые оболочки (20 из 24 больных), печень у 8 пациентов, а у 6 отмечено поражение легких. Комбинация поражения нескольких органов-мишеней встречалась у 21 пациента. Медиана выполненных процедур составила 22 (6-48). Медиана продолжительности лечения составила 9,5 мес (1-33 мес). Для оценки ответа на терапию использовали специально разработанные опросники как для врача, так и для пациента: для оценки активности хрРТПХ врачами - опросник Lee S. и соавт., для оценки ответа на терапию по мнению пациента -адаптированный опросник по Lee S. и соавт. [2]. Врач и пациент заполняли опросники 1 раз за 4 процедуры.
Результаты
Оценка ответа на терапию проведена у 23 пациентов, одна пациентка исключена из оценки ответа, в связи с рецидивом основного заболевания. У 16 (69,5%) пациентов достигнут общий ответ на терапию ЭКФ. У трех
пациентов (18,75%) констатирован полный ответ и отменена иммуносупрессивная терапия. При оценке орга-носпецифического ответа чаще всего отмечалось улучшение со стороны слизистых оболочек - 17 пациентов (89,4%), кожи - 17 (85%), и печени - 7 (75%). У больных с поражением легких в 80% случаев (4 пациента) отсутствовал ответ на терапию ЭКФ. Наряду с достижением общего ответа, у 75% больных удалось снизить или полностью отменить иммуносупрессивную терапию.
Заключение
ЭКФ в рамках терапии хрРТПХ показал себя как эффективный метод лечения особенно у пациентов с поражением слизистых, кожи и печени, в нашем исследовании не получена высокая эффективность ЭКФ при терапии хрРТПХ с поражением легких, однако 40% из этих больных на фоне ЭКФ не имели прогрессии хрРТПХ легких.
Ключевые слова
Хроническая реакция трансплантат против хозяина, экстракорпоральный фотоферез, вторая линия терапии.
PI-01
I Bloodstream infections in allogeneic hematopoietic stem cell transplant recipients: epidemiology, risk factors and outcomes
Mobil I. Akhmedov, Galina A. Klyasova, Elena N. Parovichnikova, Larisa A. Kuzmina, Vera A. Vasilyeva, Mikhail Yu. Drokov, Mariya V. Dovydenko, Anastasia V. Fedorova, Natalia N. Popova, Zoya V. Konova, Feruza A. Omarova, Olga S. Starikova, Ulyana V. Maslikova, Ekaterina D. Mikhaltsova, Olga M. Koroleva, Anna A. Dmitrova, Darya S. Dubnyak, Valery G. Savchenko
National Research Center for Hematology, Moscow, Russia
Contact: Dr. Mobil I. Akhmetov, e-mail: mobilakhmedov@gmail.com
Introduction
Bloodstream infections (BSI) are a major cause of morbidity and mortality among allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. The purpose of this study was to analyze the incidence, risk factors and the outcomes of BSI after allo-HCT.
Materials and methods
This retrospective study included 207 patients (50.7% females and 49.3% males) who underwent allo-HCT in the National Research Center for Hematology during the period from January 2018 till August 2020. Median age was 35 years (range 17-65). Matched related transplantations (MRD) were performed in 57 (27.7%) cases; matched unrelated (MUD), in 48 (23.3%); mismatched unrelated (MMUD), in 37 (18.0%); haploidentical, in 64 (31.1%). Fluoroquinolone prophylaxis was received by 97 (46.6%) patients with no extended-spectrum beta-lactamase producing bacteria obtained from rectal swabs. A single allo-HCT was performed in 193 (93.7%) cases; two or more, in 13 (6.2%). Engraftment failure was detected in 35 (17.0%) patients, and acute GvHD was documented in 53 cases (25.7%).
Results
A total of 88 (42.5%) patients developed BSI: 71 (81.0%) patients had only 1 episode, 17 (19.0%), two or more; overall number of BSI episodes was 111. Median time from allo-
HCT until BSI was 13 days (range 0-283). One pathogen was isolated in 93 episodes (83.7%); two or more, in 17 cases (15.3%). Overall number of microbial isolates was 133: 78 (58.6%), Gram-negative bacteria; 54 (40.6%), Gram-positive bacteria, and Candida parapsilosis was isolated in 1 case (0.8%). The ratios of Gram-negative and Gram-positive bacteria rates were as follows: 57.0% (n=49), versus 43.0% (n=37) at the day 0 to +30; 63.6% (n=14), and 36.2% (n=8) over days +30 to +100; 75.0% (n=15), and 25.0% (n=5) by day 100 and later (p>0.05). Bloodstream isolates were represented by: Escherichia coli (28.6%, n=38), Klebsiella spp (15.0%, n=20), coagulase-negative staphylococci in 13.5% (n=18); Staphylococcus aureus, 6.8% (n=9); Enterobacter spp, 8.3% (n=11); Pseudomonas aeruginosa, 3.0% (n=4), Acineto-bacter spp, 1.5% (n=2), others, 5.3% (n=7).
Stem cell donor type, GvHD prophylaxis strategy, time to neutrophil engraftment of >20 days, and engraftment failure on day +28 were significantly associated in univariate analysis with higher risk of pre-engraftment BSI, whereas donor type and acute GvHD correlated with post-engraftment BSI (Table 1). MMUD compared to MRD and time to neutrophil engraftment more than 20 days were significantly associated with the higher risk of pre-engraftment BSI in the mul-tivariate model (HR=4.78; 95% CI 1.52-14.90; p=0.007 and HR=2.83; 95% CI 1.40-2.83; p=0.004 respectively), whereas MUD and acute GvHD correlated with post-engraftment BSI (HR=5.93; 95% CI 1.28-27.52; p=0.023 and HR=3.69
CTT JOURNAL | VOLUME 9 | NUMBER 3 | SEPTEMBER-OCTOBER 2020 83
