15 results on '"Krüger, William"'
Search Results
2. Allogeneic stem cell transplantation for mantle cell lymphoma-update of the prospective trials of the East German Study Group Hematology/Oncology (OSHO#60 and #74).
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Krüger WH, Hirt C, Basara N, Sayer HG, Behre G, Fischer T, Grobe N, Maschmeyer G, Neumann T, Schneidewind L, Niederwieser D, Dölken G, and Schmidt CA
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cyclophosphamide therapeutic use, Disease-Free Survival, Doxorubicin therapeutic use, Female, Germany epidemiology, Graft vs Host Disease etiology, Humans, Lymphoma, Mantle-Cell epidemiology, Male, Middle Aged, Prednisone therapeutic use, Progression-Free Survival, Prospective Studies, Quality of Life, Rituximab therapeutic use, Transplantation Conditioning methods, Transplantation, Homologous adverse effects, Transplantation, Homologous methods, Vincristine therapeutic use, Lymphoma, Mantle-Cell therapy, Stem Cell Transplantation adverse effects, Stem Cell Transplantation methods
- Abstract
Mantle cell lymphoma (MCL) is a non-Hodgkin's lymphoma with an often aggressive course, incurable by chemotherapy. Consolidation with high-dose therapy and autologous stem cell transplantation (autoSCT) has a low transplant-related mortality but does not lead to a survival plateau. Allogeneic stem cell transplantation (alloSCT) is associated with a higher early mortality, but can cure MCL. To investigate alloSCT for therapy of MCL, we conducted two prospective trials for de novo MCL (OSHO#74) and for relapsed or refractory MCL (OSHO#60). Fifteen and 24 patients were recruited, respectively. Induction was mainly R-DHAP alternating with R-CHOP. Conditioning was either Busulfan/Cyclophosphamide or Treosulfan/Fludarabin. Either HLA-identical siblings or matched-unrelated donors with not more than one mismatch were allowed. ATG was mandatory in mismatched or unrelated transplantation. Progression-free survival (PFS) was 62% and overall survival (OS) was 68% after 16.5-year follow-up. Significant differences in PFS and OS between both trials were not observed. Patients below 56 years and patients after myeloablative conditioning had a better outcome compared to patients of the corresponding groups. Nine patients have died between day +8 and 5.9 years after SCT. Data from 7 long-term surviving patients showed an excellent Quality-of-life (QoL) after alloSCT. AlloSCT for MCL delivers excellent long-term survival data. The early mortality is higher than after autoSCT; however, the survival curves after alloSCT indicate the curative potential of this therapy. AlloSCT is a standard of care for all feasible patients with refractory or relapsed MCL and should offer to selected patients with de novo MCL and a poor risk profile. For defining the position of alloSCT in the therapeutic algorithm of MCL therapy, a randomized comparison of autoSCT and alloSCT is mandatory.
- Published
- 2021
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- View/download PDF
3. Treatment of relapsed AML and MDS after allogeneic stem cell transplantation with decitabine and DLI-a retrospective multicenter analysis on behalf of the German Cooperative Transplant Study Group.
- Author
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Schroeder T, Rautenberg C, Krüger W, Platzbecker U, Bug G, Steinmann J, Klein S, Hopfer O, Nachtkamp K, Kondakci M, Geyh S, Haas R, Germing U, Bornhäuser M, and Kobbe G
- Subjects
- Adult, Aged, Azacitidine therapeutic use, Decitabine, Female, Graft vs Host Disease prevention & control, Humans, Leukemia, Myeloid, Acute immunology, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute pathology, Male, Middle Aged, Myelodysplastic Syndromes immunology, Myelodysplastic Syndromes mortality, Myelodysplastic Syndromes pathology, Recurrence, Remission Induction, Retrospective Studies, Salvage Therapy methods, Survival Analysis, Transplantation, Homologous, Treatment Outcome, Antimetabolites, Antineoplastic therapeutic use, Azacitidine analogs & derivatives, Hematopoietic Stem Cell Transplantation, Leukemia, Myeloid, Acute therapy, Lymphocyte Transfusion, Myelodysplastic Syndromes therapy
- Abstract
In contrast to the evidence regarding azacitidine (Aza), there is limited knowledge about the combination of decitabine (DAC) and donor lymphocyte infusions as salvage therapy for relapse after allogeneic stem cell transplantation (allo-SCT) so far. We retrospectively analyzed data of 36 patients with hematological (n = 35) or molecular relapse (n = 1) of acute myeloid leukemia (AML, n = 29) or myelodysplastic syndrome (MDS, n = 7) collected from 6 German transplant centers. Patients were treated with a median of 2 cycles DAC (range, 1 to 11). DAC was the first salvage therapy in 16 patients (44%), whereas 20 patients (56%) had previously received 1 to 5 lines of salvage therapy including 16 of them had been treated with Aza. In 22 patients (61%), a median of 2 DLI per patient (range, 1 to 5) was administered in addition to DAC. As a result, overall response rate was 25% including 6 complete remissions (CR, 17%) and 3 partial remissions (PR, 8%). Three patients within the first-line group achieved CR, while also 3 patients receiving DAC as second-line treatment reached CR including 2 patients with previous Aza failure. Median duration of CR was 10 months (range, 2 to 33) and no patient relapsed so far. The 2-year OS rate was 11% (± 6%) without any difference between first-line and pretreated patients. Incidence of acute and chronic graft-versus-host disease was 19 and 5%. Taken together, DAC exerts clinical efficacy in patients with AML or MDS relapsing after allo-SCT and is able to induce durable remissions in individual patients suggesting that DAC may be an alternative to Aza or even a second choice after Aza failure.
- Published
- 2018
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4. Nationwide survey of BK polyomavirus associated hemorrhagic cystitis in adult allogeneic stem cell transplantation among haematologists and urologists.
- Author
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Schneidewind L, Neumann T, Kranz J, Knoll F, Pelzer AE, Schmidt C, and Krüger W
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- Adult, Aged, Comorbidity, Cystitis therapy, Female, Germany epidemiology, Graft vs Host Disease etiology, Hemorrhage therapy, Humans, Incidence, Male, Middle Aged, Registries, Surveys and Questionnaires, Transplantation, Homologous, Tumor Virus Infections complications, Urologists, Young Adult, BK Virus, Cystitis epidemiology, Cystitis etiology, Hematopoietic Stem Cell Transplantation adverse effects, Hemorrhage epidemiology, Hemorrhage etiology, Physicians, Polyomavirus Infections complications
- Abstract
There are no epidemiological data on BK virus associated hemorrhagic cystitis (BKHC) in adult allogeneic stem cell transplantation in Germany available and associations with clinical conditions like GvHD are controversially discussed. Therefore, we conducted a nationwide survey among haematologists and urologists about this disease. We developed two questionnaires, one for haematologists (26 items) and one for urologists (20 items) concerning BKHC in adult allogeneic stem cell transplantation with epidemiological data and clinical implications. The survey was sent out at least three times to EBMT registered centres performing at least five transplantations a year, leading to 39 centres. The recruiting time was between January and June 2016. Total response rates were 76.9% among haematologists and 74.4% among urologists. BKHC seems to appear less frequent in this survey than it is described in the literature. Six deaths in the last 5 years due to this disease have been reported. Interestingly, haematologists as well as urologists mostly think that local therapy is most effective while 50.0% stated that there is no real effective oral or intravenous medication. Associations with other clinical conditions mentioned were heterogeneous, e.g. transplantation type, CMV reactivation, acute GvHD, nephropathy and worse clinical outcome. There was a significant discrepancy between haematologists and urologist concerning the association with acute GvHD (p = 0.004). We need prospective, multicentric clinical studies to evaluate local therapy and for developing a risk stratification model since this disease can be severe with morbidity and rarely mortality. In our opinion, this should be an interdisciplinary approach.
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- 2017
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5. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016.
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Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Krüger W, Mousset S, Neuburger S, Neumann S, Penack O, Silling G, Vehreschild JJ, Einsele H, and Maschmeyer G
- Subjects
- Anti-Infective Agents therapeutic use, Bacterial Infections etiology, Germany, Hematology organization & administration, Hematopoietic Stem Cell Transplantation adverse effects, Humans, Medical Oncology organization & administration, Mycoses etiology, Parasitic Diseases etiology, Practice Guidelines as Topic, Societies, Medical, Transplantation, Homologous, Vaccination methods, Virus Diseases etiology, Bacterial Infections prevention & control, Hematopoietic Stem Cell Transplantation methods, Mycoses prevention & control, Parasitic Diseases prevention & control, Virus Diseases prevention & control
- Abstract
Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial agents but includes recommendations on the use of vaccinations. This is the updated version of the AGHIO guideline in the field of allogeneic haematopoietic stem cell transplantation utilizing methods according to evidence-based medicine criteria.
- Published
- 2016
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6. Allogeneic stem cell transplantation for mantle cell lymphoma--final report from the prospective trials of the East German Study Group Haematology/Oncology (OSHO).
- Author
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Krüger WH, Hirt C, Basara N, Sayer HG, Behre G, Fischer T, Grobe N, Maschmeyer G, Niederwieser D, and Dölken G
- Subjects
- Adult, Aged, Clinical Trials as Topic statistics & numerical data, Female, Germany epidemiology, Graft vs Host Disease epidemiology, Graft vs Host Disease etiology, Humans, Male, Middle Aged, Retrospective Studies, Salvage Therapy statistics & numerical data, Survival Analysis, Transplantation, Homologous, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Lymphoma, Mantle-Cell surgery
- Abstract
This study was conducted in order to evaluate allogeneic stem cell transplantation (alloSCT) as consolidation for patients with mantle cell lymphoma (MCL). Patients with MCL were included into two prospective trials OSHO #060 (refractory/relapsed) and #074 (de novo). Induction was rituximab and chemotherapy. Responding patients proceeded to alloSCT. Minimal residual disease was monitored by quantitative RT-PCR detecting either t(11;14) or clonospecific CDR-III regions. In case of circulating lymphoma cells, immunomodulation (cyclosporine A withdrawal, rituximab, donor lymphocyte infusion) was initiated. Thirty-three of 39 patients underwent alloSCT after myeloablative (n = 7) or toxicity-reduced (n = 26) conditioning. Leukocytes engrafted at day +16 (median, range 0-101) and platelets at day +14 (0-142). Acute graft-versus-host disease stages I-II occurred in 42 % and stages III-IV in 15 %. Five patients have relapsed after SCT. The overall mortality after SCT was 24 % (n = 8). Median follow-up after SCT was 2.8 years (range 0.0-10.9). Five-year progression-free survival was 67 %, and overall survival 73 % after SCT. The results were comparable for primary MCL and refractory/relapsed disease as well as for related vs. unrelated SCT. Younger patients had a significantly better outcome than the elderly. AlloSCT is a feasible and promising consolidation therapy for relapsed and refractory disease and an attractive option for young patients with de novo MCL of high risk.
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- 2014
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7. Treatment of invasive fungal infections in cancer patients-updated recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
- Author
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Mousset S, Buchheidt D, Heinz W, Ruhnke M, Cornely OA, Egerer G, Krüger W, Link H, Neumann S, Ostermann H, Panse J, Penack O, Rieger C, Schmidt-Hieber M, Silling G, Südhoff T, Ullmann AJ, Wolf HH, Maschmeyer G, and Böhme A
- Subjects
- Amphotericin B administration & dosage, Amphotericin B adverse effects, Amphotericin B therapeutic use, Antifungal Agents administration & dosage, Antifungal Agents adverse effects, Candidiasis, Invasive drug therapy, Candidiasis, Invasive etiology, Catheter-Related Infections drug therapy, Catheter-Related Infections prevention & control, Chemotherapy-Induced Febrile Neutropenia complications, Clinical Trials as Topic, Combined Modality Therapy, Drug Monitoring, Drug Therapy, Combination, Echinocandins administration & dosage, Echinocandins adverse effects, Echinocandins therapeutic use, Fungemia drug therapy, Fungemia prevention & control, Humans, Immunocompromised Host, Immunotherapy, Invasive Pulmonary Aspergillosis drug therapy, Invasive Pulmonary Aspergillosis etiology, Invasive Pulmonary Aspergillosis surgery, Mycoses etiology, Mycoses surgery, Mycoses therapy, Salvage Therapy, Triazoles administration & dosage, Triazoles adverse effects, Triazoles therapeutic use, Antifungal Agents therapeutic use, Mycoses drug therapy, Neoplasms complications
- Abstract
The Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) here presents its updated recommendations for the treatment of documented fungal infections. Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. In recent years, new antifungal agents have been licensed, and agents already approved have been studied in new indications. The choice of the most appropriate antifungal treatment depends on the fungal species suspected or identified, the patient's risk factors (e.g., length and depth of neutropenia), and the expected side effects. This guideline reviews the clinical studies that served as a basis for the following recommendations. All recommendations including the levels of evidence are summarized in tables to give the reader rapid access to the information.
- Published
- 2014
- Full Text
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8. Low-dose alemtuzumab vs. standard policy for prevention of graft-versus-host disease in unrelated and related allogeneic stem cell transplantation-a matched pair analysis.
- Author
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Busemann C, Neumann T, Schulze M, Klenner A, Thiele T, Greinacher A, Dölken G, and Krüger WH
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- Adult, Aged, Alemtuzumab, Antibodies, Monoclonal, Humanized administration & dosage, Antigens, CD immunology, Antigens, Neoplasm immunology, Antilymphocyte Serum, Antineoplastic Agents therapeutic use, CD52 Antigen, Drug Evaluation, Female, Glycoproteins immunology, Graft vs Host Disease etiology, Granulocyte Colony-Stimulating Factor therapeutic use, Hematologic Neoplasms drug therapy, Hematologic Neoplasms surgery, Hematopoietic Stem Cell Mobilization, Histocompatibility, Humans, Immunosuppressive Agents therapeutic use, Kaplan-Meier Estimate, Male, Matched-Pair Analysis, Middle Aged, Multiple Myeloma drug therapy, Multiple Myeloma surgery, Retrospective Studies, Transplantation, Autologous adverse effects, Transplantation, Homologous adverse effects, Whole-Body Irradiation, Young Adult, Antibodies, Monoclonal, Humanized therapeutic use, Graft vs Host Disease prevention & control, Hematopoietic Stem Cell Transplantation adverse effects, Lymphocyte Depletion methods, T-Lymphocytes immunology, Transplantation Conditioning
- Abstract
Antibody-mediated in vivo T cell depletion is common prior to unrelated (URD) or mismatched allogeneic stem cell transplantation (alloSCT) and optional in HLA-identical sibling (FAM) alloSCT. While anti-thymocyte globulin (ATG) is the current standard, alemtuzumab is an alternative. The optimal dose of alemtuzumab has not been defined. This retrospective analysis compares low-dose alemtuzumab with ATG in URD alloSCT and with no antibody in FAM alloSCT. Twenty-eight patients treated with alemtuzumab (10 mg; HLA mismatch, 20 mg) were matched to 28 patients who have either received ATG (URD) or no antibody (noAB) according to disease, disease stage, age, transplant type and risk state. Both groups were compared for engraftment, outcome, disease-free (DFS) and overall survival (OS), graft-versus-host disease (GvHD), freedom from GvHD (ffGvHD) and transplant-related mortality (TRM). No significant differences were found between the groups for leukocyte engraftment, GvHD, ffGvHD, TRM, DFS and OS. There was a trend for reduction of cGvHD by alemtuzumab (p = 0.05). A transplant-type stratified subanalysis consolidated equivalency of alemtuzumab and ATG in URD-SCT and indicates possible superiority of low-dose alemtuzumab compared to noAB in FAM-SCT. Low-dose alemtuzumab, as part of conditioning regimen prior to alloSCT, is safe and comparable to standard ATG. Prospective trials, particularly comparing alemtuzumab vs. noAB in FAM alloSCT, should be conducted.
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- 2013
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9. Antimicrobial therapy of febrile complications after high-dose chemotherapy and autologous hematopoietic stem cell transplantation--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
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Weissinger F, Auner HW, Bertz H, Buchheidt D, Cornely OA, Egerer G, Heinz W, Karthaus M, Kiehl M, Krüger W, Penack O, Reuter S, Ruhnke M, Sandherr M, Salwender HJ, Ullmann AJ, Waldschmidt DT, and Wolf HH
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- Antineoplastic Combined Chemotherapy Protocols administration & dosage, Communicable Diseases epidemiology, Dose-Response Relationship, Drug, Germany, Hematology legislation & jurisprudence, Hematology organization & administration, Hematopoietic Stem Cell Transplantation statistics & numerical data, Humans, Medical Oncology legislation & jurisprudence, Medical Oncology organization & administration, Occupational Medicine legislation & jurisprudence, Occupational Medicine organization & administration, Societies, Medical, Transplantation, Autologous adverse effects, Transplantation, Autologous statistics & numerical data, Anti-Infective Agents therapeutic use, Antineoplastic Combined Chemotherapy Protocols adverse effects, Communicable Diseases drug therapy, Fever drug therapy, Hematopoietic Stem Cell Transplantation adverse effects, Practice Guidelines as Topic
- Abstract
More than 18,000 autolgous transplantation were performed in Europe in the year 2009. It as a routine procedure in experienced centres. Even if there is a low mortality rate, infections are a major issue after transplantation, occurring in more than 60 % of the patients. In this review we discuss all aspects of infections after autologous stem transplantation, including epidemiology, diagnostics, therapeutic algorithms, prophylaxis and supportive therapy.
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- 2012
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10. Toxoplasmosis after allogeneic stem cell transplantation--a single centre experience.
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Busemann C, Ribback S, Zimmermann K, Sailer V, Kiefer T, Schmidt CA, Schulz K, Steinmetz I, Dombrowski F, Dölken G, and Krüger WH
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- Acute Disease, Aged, Cohort Studies, Fatal Outcome, Female, Graft vs Host Disease complications, Humans, Leukemia, Myeloid, Acute therapy, Male, Middle Aged, Multiple Myeloma therapy, Retrospective Studies, Transplantation, Homologous adverse effects, Hematopoietic Stem Cell Transplantation adverse effects, Toxoplasmosis diagnosis, Toxoplasmosis etiology
- Abstract
Toxoplasmosis is a rare but possibly underestimated complication following allogeneic stem cell transplantation with a high mortality rate. One reason might be the limitation of the diagnostic instruments relying mainly on imaging and molecular-based techniques. In this report, we present three cases of toxoplasmosis identified among 155 allograft recipients treated at Greifswald University Hospital. Widely disseminated toxoplasmosis was detected post-mortem in two patients allografted for high-risk multiple myeloma. Clinical signs suspicious for toxoplasmosis occurred after days +32 and +75, respectively. In one case, serology and conventional Toxoplasma gondii PCR, targeting the B1 gene, revealed negative results, while in the other patient, toxoplasmosis was not investigated. Both patients received pentamidine for Pneumocystis jirovecii pneumonia (PcP) prophylaxis. The third patient, a 68-year-old woman allografted for AML, developed cerebral toxoplasmosis from day +395 after allogeneic SCT with typical signs in magnetic resonance tomography. Toxoplasma DNA was amplified from one of two samples of cerebrospinal fluid. The patient died of disseminated toxoplasmosis despite immediate initiation of therapy. Retrospective comparative testing of clinical specimens by the conventional T. gondii PCR and by a real-time PCR targeting a 529-bp genomic fragment suggests a higher sensitivity of the latter method in our patients. In conclusion, we suggest a rigorous real-time PCR monitoring for high-risk patients or patients with signs of infections suspicious for toxoplasmosis, even though low-copy results are presently difficult to interpret. Our reported cases might also encourage the use of trimethoprim-sufmethoxazole instead of pentamidine for PcP prophylaxis in those patients.
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- 2012
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11. Treatment of invasive fungal infections in cancer patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
- Author
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Böhme A, Ruhnke M, Buchheidt D, Cornely OA, Einsele H, Enzensberger R, Hebart H, Heinz W, Junghanss C, Karthaus M, Krüger W, Krug U, Kubin T, Penack O, Reichert D, Reuter S, Silling G, Südhoff T, Ullmann AJ, and Maschmeyer G
- Subjects
- Animals, Germany, Hematology, Humans, Neoplasms immunology, Neoplasms therapy, Societies, Medical, Antifungal Agents therapeutic use, Mycoses complications, Mycoses drug therapy, Neoplasms complications
- Abstract
Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive Candida infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection.
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- 2009
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12. Erdheim-Chester disease with hemophagocytosis.
- Author
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Busemann C, Kallinich B, Schwesinger G, Krüger W, Schüler F, Schmidt CA, and Dölken G
- Subjects
- Bone and Bones diagnostic imaging, Fatal Outcome, Hepatomegaly, Humans, Male, Middle Aged, Osteosclerosis, Radionuclide Imaging, Splenomegaly, Technetium Tc 99m Medronate, Erdheim-Chester Disease diagnostic imaging, Erdheim-Chester Disease pathology
- Published
- 2007
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13. Epstein-Barr virus reactivation after allogeneic stem cell transplantation without lymph node enlargement.
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Krüger WH, Schüler F, Lotze C, Schwesinger G, Mentel R, Busemann C, and Dölken G
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- Humans, Lymph Nodes pathology, Male, Middle Aged, Multiple Myeloma pathology, Multiple Myeloma virology, Transplantation, Homologous, Epstein-Barr Virus Infections pathology, Epstein-Barr Virus Infections virology, Herpesvirus 4, Human, Lymph Nodes virology, Multiple Myeloma therapy, Stem Cell Transplantation, Virus Activation
- Published
- 2005
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14. Infectious complications after allogeneic stem cell transplantation: epidemiology and interventional therapy strategies--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
- Author
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Einsele H, Bertz H, Beyer J, Kiehl MG, Runde V, Kolb HJ, Holler E, Beck R, Schwerdfeger R, Schumacher U, Hebart H, Martin H, Kienast J, Ullmann AJ, Maschmeyer G, Krüger W, Niederwieser D, Link H, Schmidt CA, Oettle H, and Klingebiel T
- Subjects
- Humans, Incidence, Infections epidemiology, Risk Factors, Transplantation, Homologous adverse effects, Infections etiology, Infections therapy, Stem Cell Transplantation adverse effects
- Abstract
The risk of infection after allogeneic stem cell transplantation is determined by the underlying disease, the intensity of previous treatments and complications that may have occurred during that time, but above all, the risk of infection is determined by the selected transplantation modality (e.g. HLA-match between the stem cell donor and recipient, T cell depletion of the graft, and others). In comparison with patients treated with high-dose chemotherapy and autologous stem cell transplantation, patients undergoing allogeneic stem cell transplantation are at a much higher risk of infection even after hematopoietic reconstitution, due to the delayed recovery of T and B cell functions. The rate at which immune function recovers after hematopoietic reconstitution greatly influences the incidence and type of post-transplant infectious complications. Infection-associated mortality, for example, is significantly higher following engraftment than during the short neutropenic period that immediately follows transplantation.
- Published
- 2003
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15. Prophylaxis of invasive fungal infections in patients with hematological malignancies and solid tumors--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
- Author
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Cornely OA, Böhme A, Buchheidt D, Glasmacher A, Kahl C, Karthaus M, Kern W, Krüger W, Maschmeyer G, Ritter J, Salwender HJ, Sandherr M, Schiel X, Schüttrumpf S, Sieniawski M, Silling G, Ullmann AJ, and Wolf HH
- Subjects
- Humans, Hematologic Neoplasms therapy, Mycoses prevention & control, Neoplasms therapy, Preventive Medicine
- Abstract
Morbidity and mortality in patients with malignancies, especially leukemia and lymphoma, are increased by invasive fungal infections. Since diagnosis of invasive fungal infection is often delayed, antifungal prophylaxis is an attractive approach for patients expecting prolonged neutropenia. Antifungal prophylaxis has obviously attracted much interest resulting in dozens of clinical trials since the late 1970s. The non-absorbable polyenes are probably ineffective in preventing invasive fungal infections, but may reduce superficial mycoses. Intravenous amphotericin B and the newer azoles were used in clinical trials, but their role in antifungal prophylaxis is still not well defined. Allogeneic stem cell transplant recipients are at particularly high risk for invasive fungal infections. Other well described risk factors are neutropenia >10 days, corticosteroid therapy, sustained immunosuppression, graft versus host disease, and concomitant viral infections. The enormous study efforts are contrasted by a scarcity of risk stratified evidence based recommendations for clinical decision making. The objective of this review accumulating information on about 10.000 patients is to assess evidence based criteria primarily regarding the efficacy of antifungal prophylaxis in neutropenic cancer patients.
- Published
- 2003
- Full Text
- View/download PDF
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