Infectious Complications in Patients with Hematologic Malignancies and Allogeneic Stem Cell Transplant Recipients

A special issue of Hemato (ISSN 2673-6357).

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 7810

Special Issue Editors


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Guest Editor
Department of Oncology and Hematology, SSD Stem Cell Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
Interests: stem cell transplantation; cellular therapies; CART cells; infectious complications

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Guest Editor
Divison of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Interests: allogeneic hematopoietic stem cell transplantation (HSCT); conditioning regimens; GVHD; regimen-related toxicity; MDS and AML; chronic myeloproliferative disorders; opportunistric infections in onco-hematology; supportive care in onco-hematology and HSCT; administrative support in HSCTY, including JACIE

Special Issue Information

Dear Colleagues,

Over the last 10 to 15 years, the treatment options for patients with hematologic malignancies have seen the blossom of a large number of new agents and new therapeutic strategies like cellular therapies.

Despite achieving remarkable improvements in the management of patients with malignant hematologic disorders, infectious complications still represent a leading cause of morbidity and mortality, thereby limiting the effectiveness of curative strategies.

In this respect, knowledge of the epidemiology and risk factors of infectious complications as well as of the available therapeutic armamentarium may represent a tool of paramount importance to optimize the treatment of hematologic patients.

The aim of this Special Issue is to summarize the current data on bacterial, fungal, and viral infections in hematologic patients, providing the reader with a guide to design an appropriate therapeutic approach to the prophylaxis and treatment of infectious complications.

Dr. Alessandro Busca
Dr. Rodrigo Martino
Guest Editors

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Published Papers (4 papers)

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Research

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12 pages, 740 KiB  
Article
Temporal Changes in SARS-CoV-2 Infection Pattern in Patients Admitted with Hematological Diseases—A Single Center Experience from North India
by Rohan Halder, Dipti Talaulikar, Reema Singh, Nidhi Menon, Bhaarat Folbs, Pallavi Mehta, Jyotsna Kapoor, Vishvdeep Khushoo, Megha Verma, Nitin Bansal, Narendra Agrawal, Rayaz Ahmed and Dinesh Bhurani
Hemato 2023, 4(1), 100-111; https://doi.org/10.3390/hemato4010010 - 14 Mar 2023
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Abstract
Previous studies have shown the vulnerability of hematological patients with the Coronavirus disease of 2019 (COVID-19). We aimed to compare the outcomes and risk factors for poor survival in patients with hematological conditions hospitalized with COVID-19 infection. Single centre, retrospective, cohort study included [...] Read more.
Previous studies have shown the vulnerability of hematological patients with the Coronavirus disease of 2019 (COVID-19). We aimed to compare the outcomes and risk factors for poor survival in patients with hematological conditions hospitalized with COVID-19 infection. Single centre, retrospective, cohort study included all patients with a hematological condition admitted to Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India between 1 April 2020 and 31 May 2021. Of a total of 154 patients, 81 were in the pre-delta group and 73 were in the delta group out of which 21 (25.97%) in the pre-delta group and 24 (33.88%) patients in the delta group died. Haematological characteristics—age > 60 years, progressive hematological cancer, more than two lines of anti-cancer therapy, and active chemo-immunotherapy or targeted therapy were associated with higher mortality in the delta group. COVID-19 characteristics associated with higher mortality during the delta wave were severity of COVID infection, higher oxygen requirements, and COVID plasma therapy There were no deaths in individuals (n = 15) within the delta group who received COVID-19 vaccination. This study adds to the evidence that patients with hematological diseases are a particularly vulnerable group and the delta variant of the virus is associated with higher mortality. We could identify patient characteristics and features related to COVID-19 infection and underlying hematological conditions that were associated with poor outcomes in the delta sub-group. Vaccination was found to be an effective strategy for overcoming mortality and morbidity in these patients. Full article
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14 pages, 1004 KiB  
Review
SARS-CoV-2 Immunity in Hematopoietic Stem Cell Transplant and Cell Therapy Recipients: What Do We Know, and What Remains to Be Determined?
by José Luis Piñana, Manuel Guerreiro and Carlos Solano
Hemato 2023, 4(2), 170-183; https://doi.org/10.3390/hemato4020014 - 26 May 2023
Cited by 2 | Viewed by 2013
Abstract
Hematopoietic stem cell transplantation (HSCT) results in profound immunosuppression for the first few months after the procedure, requiring patients to be revaccinated against childhood vaccine-preventable infectious diseases. Patients who undergo allo-HSCT are at high risk of bacterial, fungal, and viral infections, with infectious [...] Read more.
Hematopoietic stem cell transplantation (HSCT) results in profound immunosuppression for the first few months after the procedure, requiring patients to be revaccinated against childhood vaccine-preventable infectious diseases. Patients who undergo allo-HSCT are at high risk of bacterial, fungal, and viral infections, with infectious complications responsible for at least one third of deaths. Even before the COVID-19 pandemic, respiratory virus infections were known to be more severe in HSCT recipients. The pandemic has highlighted the vulnerability of HSCT recipients, who experience an increased risk of morbidity and mortality after COVID-19 compared with healthy populations due to their severe immunodeficiency status. However, the current pandemic has also provided an exceptional scenario to better understand the immune response to SARS-CoV-2 cases and mRNA vaccines in HSCT recipients, including those receiving CD19-directed chimeric antigen receptor T cell (CAR-T) therapy. Researchers have focused on the role of the immune system in protecting against severe SARS-CoV-2 in patients with hematologic malignancies, including HSCT recipients. Insights gained during the pandemic will likely soon be used to improve preventive strategies in this population against viral infections in the near future. This narrative review summarizes the current knowledge on SARS-CoV-2 immunity in HSCT and cell therapy recipients following SARS-CoV-2 cases or vaccination. Full article
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12 pages, 814 KiB  
Review
Use of Letermovir for CMV Prophylaxis after Allogeneic Hematopoietic Stem Cell Transplantation: Review of the Literature and Single-Center Real-Life Experience
by Jessica Gill, Davide Stella, Irene Dogliotti, Chiara Dellacasa, Luisa Giaccone and Alessandro Busca
Hemato 2023, 4(2), 158-169; https://doi.org/10.3390/hemato4020013 - 28 Apr 2023
Cited by 1 | Viewed by 2261
Abstract
Cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplant (allo-HSCT) is mainly due to an increase of latent viremia in previously exposed patients. Furthermore, CMV reactivation in this setting has a significant impact on patient survival. Traditional approach to CMV reactivation post allo-HSCT [...] Read more.
Cytomegalovirus (CMV) reactivation after allogeneic hematopoietic stem cell transplant (allo-HSCT) is mainly due to an increase of latent viremia in previously exposed patients. Furthermore, CMV reactivation in this setting has a significant impact on patient survival. Traditional approach to CMV reactivation post allo-HSCT was a pre-emptive treatment with antivirals in the case of increased viremia. However, since 2017, a new antiviral compound, letermovir, has been introduced in clinical practice and is deeply changing the common CMV approach. The toxicity profile of letermovir allowed its use in prophylaxes in patients at high risk of CMV reactivation. This review will focus on the present role of letermovir post allo-HSCT and discuss some possible future applications of the drug. Finally, our single center CMV management in view of the recent introduction of letermovir will be discussed. Full article
14 pages, 242 KiB  
Review
Quantitative PCR for the Diagnosis of HCMV Pneumonia in HSCT Recipients and Other Immunocompromised Hosts
by Carla Berengua and Rodrigo Martino
Hemato 2023, 4(1), 76-89; https://doi.org/10.3390/hemato4010008 - 2 Mar 2023
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Abstract
Pneumonia is among the most serious manifestations of HCMV infection, with high morbidity and mortality. Probable pneumonia is defined as the detection of HCMV in bronchoalveolar lavage (BAL) by viral isolation or DNA quantification (qPCR) combined with symptoms and/or signs of respiratory infection. [...] Read more.
Pneumonia is among the most serious manifestations of HCMV infection, with high morbidity and mortality. Probable pneumonia is defined as the detection of HCMV in bronchoalveolar lavage (BAL) by viral isolation or DNA quantification (qPCR) combined with symptoms and/or signs of respiratory infection. However, currently, there is no reproducible and well-defined viral load (VL) from BAL that can reliably differentiate patients with pneumonia from the much more common detection of viral DNA in seropositive patients without true HCMV pneumonia. Several studies have been published with the aim of establishing an optimal VL for differentiating pneumonia from viral lung shedding. The aim of this review is to collect and analyze the methodology and the conclusions obtained in studies whose objectives included the correlation between HCMV VL in BAL and/or the plasma and the occurrence of HCMV pneumonia. For this purpose, a total of 14 articles have been included. There are some conclusions on which they all agree. PCR techniques were more sensitive and had a higher NPV than culture techniques but were less specific and had a low PPV. The mean HCMV loads in both BAL and the plasma were significantly higher in patients with pneumonitis than in those without. The HCMV load in patients with pneumonitis was higher in BAL than in the plasma, making qPCR in BAL a better predictor of HCMV pneumonitis than in the plasma. Nevertheless, this review highlights the difficulty of establishing a universal VL value, both in BAL and in the blood, to differentiate patients with HCMV pneumonia from those without. To complete the information available in these studies, prospective multicentre studies would be required. Methodologically, a large number of patients with HCMV pneumonitis would have to be included, and a subclassification of the type of immunosuppression of each patient should be made in order to obtain an optimal VL threshold in different host groups. Full article
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