Candida parapsilosis is an exceptional agent in hepatosplenic candidosis. Here we report two cases of hepatosplenic infection caused by Candida parapsilosis in two patients with acute leukaemia. Open liver-spleen biopsy and previously minimal exposure to systemic antifungal drugs led to a cultural diagnosis in both patients. This report confirms the importance of an early diagnosis of these diseases in order to undertake appropriate therapeutic regimens.

Adult↗

PubMedDate not supplied

AIDS-related complex treated by antiviral drugs and allogeneic bone marrow transplantation following conditioning protocol with busulphan, cyclophosphamide and cyclosporin.

A 26-year-old man with AIDS-related complex (ARC) was treated with high-dose busulphan and cyclophosphamide, followed by allogeneic bone marrow transplantation. For 3 months before transplantation he received a combination of four drugs considered active against human immunodeficiency virus (HIV) to reduce the viral burden: zidovudine, acyloguanosine, fusidic acid and phenylidantoin. Although in reduced doses in coincidence with marrow engraftment, zidovudine therapy was scheduled after transplantation in order to protect donor cells from infection with HIV. Engraftment rapidly occurred and was documented by cytogenetic analyses. The post-transplant course was characterized by severe acute GvHD with irreversible hepatorenal failure. The patient died on day 48 after transplantation. Polymerase chain reaction analyses for detecting HIV DNA showed the persistence of positivity at day +30 and +45 after transplantation. Antibodies to specific HIV proteins evaluated with Western blot testing also persisted at days +21 and +35 after transplantation. Circulating immunocomplexes disappeared on day +31, and an increase in the CD4/CD8 ratio occurred. The short survival of the patient, affected by chronic hepatitis too, does not allow final conclusions about the role of BMT in HIV disease.

AIDS-Related Complex↗

PubMedDate not supplied

Autologous blood stem cell transplantation as intensive consolidation therapy in hematological malignancies.

Ten consecutive patients (pts), suffering from hematological malignancies (5 NHL, 3 ANLL and 2 HD), received high doses of radio-chemotherapy and autologous peripheral blood stem cell (PBSC) transplantation. Seven of them were in 1st CR, two in 3rd CR and one in refractory status. The recruitment of PBSC was performed during the conventional non-intensive schedule of therapy. The median interval between the remission and the transplant was 6 months (3-15). The pts received a median of 0.96 x10(9) MNC/Kg b.w. and of 3.8 x10(4) CFU-GM/Kg b.w. Hemopoietic recovery occurred promptly and the median number of days to reach WBC greater than 1.0 x10(9)/L was 10 (7-15), PMN greater than 0.5 x10(9)/L was 12 (10-34), platelets greater than 50 x10(9)/L was 13 (10-41) and reticulocytes greater than 20 x10(9)/L was 12 (10-15). Three pts relapsed after 14, 12 and 6 months, respectively. Two of them achieved a further remission and one died. The remaining seven, are alive and disease-free with a follow-up of 11 months (range 2-27).

Adolescent↗

PubMedDate not supplied

Infection after autologous blood-derived stem cell transplantation.

Ten patients who underwent autologous blood-derived stem cell transplantation (APBSCT) were studied retrospectively to determine the frequency and outcome of transplant associated infections during the hemopoietic reconstitution. Six patients developed an infection after transplant. Severe bacterial infections were unfrequent and mostly caused by gram-positive cocci. In no case pneumonia was observed and this scarce morbility of infection could be the result of early engraftment. None of them died for infection. The frequency of infections in APBSCT patients appears lower than the one observed in autologous bone marrow transplant patients.

Adolescent↗

PubMedDate not supplied

Processing and manipulation of human hemopoietic stem cells. The Italian Cooperative Study Group on Cell Manipulation in Hematology.

In this paper, we reviewed the basic principles and methods of collection, processing and manipulation of marrow and peripheral haemopoietic progenitor cells. The advances in cell separation are due to the progress in blood bank technology and to the introduction of more sophisticated devices. This allows to process larger amounts of blood or marrow and to obtain a final single cell suspension. For this purpose, several procedures have been employed, including the unit gravity sedimentation, the centrifugal elutriation, the isopyknic sedimentation and the positive selection on columns of CD34+ cells. As expected, the emerging problems are the extreme heterogeneity of the methods employed and the unreliability of the quality control. The proposal for standardized protocols for each step of the various procedures is urgent, and the institution of multicenter studies is recommended.

Blood Component Removal↗

PubMedDate not supplied

A preliminary survey of Italian experience on bone marrow harvesting, processing and manipulation. The Italian Cooperative Study Group on Cell Manipulation in Hematology.

The following report describes the initial stage of the activity of the Italian Cooperative Study group on cellular manipulation in hematology consisting of a retrospective evaluation of data regarding bone marrow (BM) harvesting processing, and proceedings from 20 Italian Centers. Two thousand, three hundred and eighty-four BM have considered: 1073 were performed for autografts and 1311 for allografts. A cohort of adverse effects in marrow harvesting were reported by 7 Centers out of 20, including one death caused by tracheomalacia during the anesthesia. Twelve Centers used blood separators as a mean for marrow processing. Eight Centers used the RBC removal technique in major donor/recipient AB0 incompatibility. Ficol-Hipaque gradient was employed in 7 Centers. T-depletion were accomplished with monoclonal antibodies in 7 Centers and elutriation in two Centers. Fifteen Centers provided to purge the residual tumour cells with chemicals (11), immunological (4) and chemo-physical means (1).

Bone Marrow Transplantation↗

PubMedDate not supplied

Collection of peripheral blood stem cells in normal donors.

Although committed progenitor cells have been harvested during the standard plateletpheresis, only few experiences were specifically carried out in normal donors. The major drawback is the very low number of circulating haemopoietic stem cells and, besides a donor manipulation, a good harvesting technology is a fundamental prerequisite. To verify the effectiveness of an automate system, twenty normal volunteer donors were randomly assigned to four protocols of simultaneous PBSC and platelet collection. A Baxter separator CS 3000 was employed and we compared the yields and the efficiency of the modified Program 1 plus isoradial chamber (Protocol A), the modified Program 1 plus granulo chamber (Protocol B), the standard Program 3 plus isoradial chamber (Protocol C) and the standard Program 3 plus granulo chamber (Protocol D). The absolute yields for WBC (x10(9)), MNC (x10(9)), platelets (x10(11)) and CFU-GM (x10(4)) were respectively: 10.4, 10.1, 6.5 and 29.5 for Protocol A; 10.1, 9.9, 5.2 and 14.7 for Protocol B; 10.0, 9.9, 5.2, 14.7 for Protocol C, and 12.7, 12.4, 6.8 and 57.4 for Protocol D. The best CFU-GM efficiency was achieved with Protocol D (33%) vs. Protocol A (27.5%), Protocol B (14.5%) and Protocol C (27%). The above differences, although remarkable, were not statistically significant. Though preliminary, this study demonstrates the feasibility of a combined platelet and PBSC collection in normal donors.

Blood Component Removal↗

PubMedDate not supplied

Human bone marrow processing using Cobe 2991 and CS 3000 blood cell separators for further ex vivo manipulation.

Several automated procedures are now available to enrich stem cells from large bone marrow (BM) volumes prior to ex vivo treatment or cryopreservation. This report details our experience using a ficoll-hypaque (F/H) gradient on Cobe 2991 cell washer and a CS 3000 continuous flow separator, on 90 BM processed for allogeneic and autologous transplantation. In the Cobe series, from 70 BM aspirates, 89 +/- 5% of the original mononuclear cells (MNC) was found in the light density fraction with a erythrocytes (RBC) and granulocytes (PMN) removal of 98 +/- 1 and 97 +/- 4.5%, respectively. Over 80% of the initial myeloid precursors (CFU-GM) were recovered in a small final volume. Twenty BM processing were performed with a CS 3000 separator using program "3" and granulo chamber. This technique yielded 86 +/- 9% of the initial MNC while 85 +/- 10% of RBC and 90 +/- 1.1% of PMN was removed. Over 75% of the original CFU-GM was recovered in the final product. Both techniques are effective to large-scale purification of progenitor cells and readily available as routine procedures for marrow processing.

Adolescent↗

PubMedDate not supplied