Transplantation stem cell

Infection treatment and prophylaxis Victims of radiological attacks are at risk for infection due to disruption of the skin or mucosal barriers and due immune suppression from a reduction in lymphohematopoietic cells (2). Studies in irradiated dogs have revealed a reduction in mortality following antibiotic administration. During the neutropenic phase, control of infections is especially important. Patients who are not neutropenic shonld receive antibiotics directed at specific foci of infection cansed by the most likely pathogens. On the other hand, nentropenic patients may benefit from prophylaxis with fluoroquinolones. Patients with severe nentropenia (absolute neutrophil count 0.500x10 cells L ) shonld receive prophylaxis with broad-spectrnm antibiotics while the nentropenia lasts. Prophylaxis may include (2)  

In mnrine studies, quinolones have been effective in controlling endogenous gramnegative systemic infections following radiation. Qninolones are also effective in preventing endogenous Klebsiella and Psendomonas infections. In addition, penicillin snpplementation has prevented treatment failnres in cancer patients with treatment-induced neutropenia (2). 

Inununosuppressed radiation victims with positive serology for herpes simplex viruses are at risk for reactivation of HSV infection, with resulting clinical picture that mimics radiation stomatitis. These patients should receive prophylaxis with acyclovir or one of its congeners. If serology results are not available, patients with a history of oral or genital herpes infection should receive acyclovir prophylaxis. Patients who develop severe mucositis require assessment for HSV reactivation (2). 

Studies in patients undergoing allogeneic bone marrow transplantation have revealed that oral fluconazole, 400mg d , is effective in reducing the severity of invasive fungal infections and subsequent mortality. The evidence of fluconazole effectiveness is less clear in patients with bone marrow suppression secondary to chemotherapy. 

Immunosuppressed radiation victims may also be at risk for reactivation of cytomegalovirus (CMV) and Pneumocystis carinii pneumonia. In a limited casualty situation, if resources are available, clinicians should obtain CMV serology. In addition, patients should have a sensitive assay (antigen assessment or polymerase chain reaction test) every 2 weeks for 30 days postexposure, while those with documented previous CMV exposure should have the assay repeated until 100 days postexposure (2). Patients developing lymphopenia should have a CD4 cell count considered at 30 days postexposure. Those with a CD4 count below 0.2000 x 10 cells L are at risk for Pneumocystis carinii pneumonia. Physicians should withhold trimethoprim-suha prophylaxis until the leukocyte count is above 3.0 x 10 cells L or until the absolute neutrophil count is above 1.5 x 10 cells L . Atovaquone, dap-sone and aerosohzed pentamidine are alternative prophylactic agents. Patients should continue prophylactic treatment until the CD4 count reaches or exceeds 0.2000 X 10 cells L, which may occur over several months (2). 

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CXCR4 Anormed III AMD3100 Stem cell transplant ... 

Krishnan A, Molina A, Zaia J, Smith D, Vasquez D, Kogut N, Falk PM, Rosenthal J, Alvamas J, Forman SJ (2005) Durable remissions with autologous stem cell transplantation for high-risk HIV-associated lymphomas. Blood 105 874-878... 

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potential cure for SCD. The best candidates are children with SCD who are younger than 16 years of age with severe complications who have an identical H LA-matched donor, usually a sibling. The transplant-related mortality rate is between 5% and 10%, and graft rejection is approximately 10%. Other risks include secondary malignancies, development of seizures or intracranial bleeding, and infection in the immediate posttransplant period.6,25,32,33... 

Walters MC. Novel therapeutic approaches in sickle cell disease. Stem cell transplantation for sickle cell disease How and when to intervene Hematology 2002 22-29. 

Varicella VAR 0.5 mL Subcutaneous Allergic reaction to gelatin or neomycin Pregnant women Immunocompromised host Recently received a blood transfusion Hematopoietic stem cell transplant... 

Following hematopoietic stem cell transplantation the patient will need virtually all routine vaccines to be administered again however, the patient will not be able to mount an adequate response for 6 to 12 months post-transplant. Diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, hepatitis B, pneumococcal, and inactivated poliovirus should be given at 12,14, and 24 months post-hematopoietic stem cell transplantation. Inactivated influenza vaccine should be given yearly, starting 6 months after transplant. Measles, mumps and rubella can be given 2 years after transplant and varicella vaccine is contraindicated.16... 

Assess the role of autologous hematopoietic stem cell transplantation in relapsed Hodgkin s lymphoma and non-Hodgkin s lymphoma. 

BCV (high-dose with autologous stem cell transplant)3 Carmustine 400 mg/m2 IV x 1 day Etoposide 800 mg/m2 IV daily x 3 days Cyclophosphamide 1800 mg/m2 IV daily x 4 days... 

BEAM (high-dose with autologous stem cell transplant)3... 

Allogeneic hematopoietic stem cell transplantation (HSCT) has been used in the treatment of pediatric AML in first complete remission. In most clinical trials, the availability of HLA-matched sibling donors determined whether patients underwent HSCT as postremission treatment. To facilitate this process, it is important to obtain HLA typing on all younger patients with AML and siblings shortly after diagnosis. Patients who do not have an HLA-matched sibling will proceed to postremission therapy. 

Allogeneic stem cell transplantation is the only curative treatment for chronic myelogenous leukemia (CML). 

The primary goal in the treatment of multiple myeloma is to decrease tumor burden and minimize complications associated with the disease. A watch and wait approach is an option for asymptomatic patients who have no lytic lesions in the bone. Once symptoms occur, treatment is required. Chemotherapy can be used to reduce tumor burden in patients with symptomatic disease, but increasingly, immunomodula-tors such as thalidomide and dexamethasone are initial therapy. Almost all patients will become refractory to initial treatment and will require the use of salvage therapies such as bortezomib. Autologous stem cell transplantation prolongs overall survival in patients who can tolerate high-dose chemotherapy and may be the treatment of choice for many patients. 

Melphalan (Alkeran) Myelosuppression, secondary malignancies, pulmonary fibrosis, sterility, alopecia Dose of 0.15 mg/kg for 7 days given orally once daily, repeated every 4-6 weeks IV formulation used for stem cell transplantation... 

Discuss whether this patient is a candidate for autologous stem cell transplantation. 

Early in the diagnosis, patients should be evaluated for allogeneic stem cell transplantation. Ideal candidates include younger patients in chronic-phase CML who have an HLA-matched related or unrelated donor. 

Baron F, Sandmaier BM. Current status of hematopoietic stem cell transplantation after nonmyeloablative conditioning. Curr Opin Hematol 2005 12 435 43. 

Copelan EA. Hematopoietic stem-cell transplantation. New Engl J Med 2006 354 1813-1826. 

Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 2000 49 1-125, CE1-7. 

Leather HL. Drug interactions in the hematopoietic stem cell transplant (HSCT) recipient What every transplanter needs to know. Bone Marrow Transplant 2004 33 137-152. 

Hematopoietic Stem Cell Transplantation/Leukemia Shands... 

CXCR4 AMD-3100 AnorMED Phase II Phase I Stem cell transplantation Repair cardiac tissue after myocardial infarction 111, 112 111, 112... 

SMPT or sulfo-LC-SMPT has been used to develop conjugates for in vivo delivery of siRNA to hepatocytes (Rozema et al., 2007), in preparing an anti-CD25-immunotoxin conjugate (Mielke et al., 2007), and in preparing conjugates for selective depletion of donor lymphocytes in stem cell transplantation (Solomon et al., 2005). 

Solomon, S.R., Mielke, S., Savani, B.N., Montero, A., Wisch, L., Childs, R., Hensel, N., Schindler, J., Ghetie, V., Leitman, S.F., Mai, T., Carter, C.S., Kurlandcr, R., Read, E.J., Vitetta, E.S., and Barrett, A.J. (2005) Selective depletion of alloreactive donor lymphocytes A novel method to reduce the severity of graft-versus-host disease in older patients undergoing matched sibling donor stem cell transplantation. Blood 106,1123-1129. 

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