12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
to a poor prognosis in MM patients, reflecting a high tumour burden.
Renal damage is uncommonly described in the absence of BJP. However,
high prevalence for older age and cardiovascular disease in our population
suggest potential other causes of renal involvement. So, renal
impairment in the MM population needs a particular attention. Even in
the absence of BJP, a mild renal dysfunction must be worthwhile examined
for adequate haematological, cardiovascular and renal care. Cardiovascular
disease and older age are common in our newly diagnosed
MM patients. Either BJP is present or absent, renal function is comparable.
Mild renal dysfunction in MM patients could appear as a multifactorial
entity, needing a multidisciplinary careful analysis for adequate
assessment and treatment.
1292
VALGANCICLOVIR IS SAFE AND EFFECTIVE AS PRE-EMPTIVE TREATMENT FOR CMV
REACTIVATION IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION
R. Pastano, F. Gigli, G. Andreola, F.A. Peccatori, G. Martinelli
European Institute of Oncology, MILAN, Italy
Background. Despite significant advances in prevention and therapy,
cytomegalovirus (CMV) infection still represents an important cause of
morbidity and mortality in patients undergone allogeneic haematopoietic
stem cell transplant (HSCT). The standard pre-emptive treatment
is based on intravenous administration of Ganciclovir (GCV). Valganciclovir
(VGC), the pro-drug formulation of GCV is characterised by an
excellent bio viability, making this drug suitable for oral administration.
Aims. To evaluate the safe and the efficacy of Valganciclovir as preemptive
treatment for CMV reactivation in allogenic hematopoietic
stem cell transplantation. Methods. Since March 2003 patients enrolled
in our Institute to undergo allogeneic HSCT have been started CMVpre-emptive
treatment with VGC, administrated in outpatient setting.
Thirty patients were followed by weekly monitoring both of
CMV/PCR and pp65/assays. Patients resulted positive (3 cells pp65+ or
1000/100000 PCR + ) started oral treatment with VGC 900 mg bid, for the
first fourteen days, followed by 900 mg q.d. up to at least seven days
after assays negativization. Results. Overall 15 episodes of CMV positivity
were detected in seven patients (all with sibling donors). In these
patients, the median duration of therapy was 21 days (range 10-21
days), with a response rate (RR) of 100%, as confirmed by the assays
negativization within fourteen days. No significant toxicity was
encountered. In two patients the oral VGC therapy was changed to the
intravenous administration of Foscavir, because of concomitant neutropenia
and acute GvHD. Conclusions. Pre-emptive treatment of CMV
reactivation with VGC is safe and effective. Furthermore, the oral
administration of this drug in outpatient setting, reduces significantly
the costs compared with a therapy that needs hospitalization as intravenous
Ganciclovir.
1293
COMPARISON OF TWO METHODS OF HEMATOPOIETIC STEM CELL ISOLATION
AND EVALUATION OF THE EX VIVO CULTURED AND DIFFERENTIATED CELLS
WITH CDNA MICROARRAYS
M. Klabusay, 1 V. Hrabcakova, 1 I. Koutna, 2 P. Krontorad, 2 J. Mayer, 1
D. Horky2 1 2 University Hospital Brno, BRNO; Masaryk University, BRNO, Czech
Republic
Background. CD34 + cells are clinically used in transplantation of bone
marrow or peripheral blood stem cells (PBSC) after conditioning regimens
in patients with diagnosis of leukemia or lymphoma. The CD34 +
cell count increases in peripheral blood after stimulation with granulocyte
colony-stimulating factor (G-CSF). Hematopoietic stem cells are
found within the compartment of CD34 + cells and they are able to regenerate
hematopoiesis in all of its lineages, as well as renew themselves.
Aims. We wanted to assemble a suitable method for evaluating gene
expression in enriched populations of hematopoietic stem cells and compare
their biological properties during ex vivo culture in time. Methods.
We used two ways of immunomagnetic separation: positive selection
of CD34 + cells and negative selection of Lin – cells. CD34 + and Lin’ cells
were enriched from PBSC grafts of patients with non Hodgkin’s lymphoma.
After the immunomagnetic separation, the cells were cultivated
in the presence of cytokines stem cell factor, interleukin-3, interleukin-6,
Flt-3-L and G-CSF in serum-free media in order to induce granulocytic
differentiation. At days 0, 4, 6, 8, 10, 12 and 14 cells were harvested
and analyzed by cDNA microarrays. Other analyses included
colony forming assays, immunophenotyping of the surface differentia-
468 | haematologica/the hematology journal | 2007; 92(s1)
tion antigens (CD13, CD33, CD34, CD36, CD65, CD116, CD117,
CD123, CD124 a CD133), electron microscopy, vitality, total cell and
CD34 + cell counts. Results. The purities of CD34 + cells after CD34 + and
Lin – separation procedures were comparable. CD34 + expression was the
highest in the beginning of the cultivation and decreased rapidly in time.
23.94±10.29 (average±s.d.) fold expansion of the CFU-GM and
2.56±3.31 fold expansion of CFU-Meg in CD34 + cultures were reached.
In Lin – cultures, 30.39±16.64 fold expansion of the CFU-GM and
1.28±1.93 fold expansion of the CFU-Meg were observed. Comparison
of gene expression maps of two different types of hematopoietic cell
enrichment pointed to a suitability of cDNA microarray analysis of ex
vivo cultured and differentiating hematopoietic cells. Equivalence of the
two enrichment methods from PBSC samples was demonstrated. Summary/Conclusions.
Microarray analysis of the short-term ex vivo cultured
hematopoietic cells enabled us to investigate up- and down- regulation
of the gene expression during granulocytic differentiation. This methodological
approach is helpful in characterizing ex vivo cultured cells, but
it is also suitable for more general purposes. Equivalence of CD34 + and
Lin – selection methods from PBSC samples proved by cDNA microarray
may have an implication for graft manipulation in an experimental
setting of hematopoietic stem cell transplantation.
This work was supported by research grant MSM CR No. 0021622430.
1294
AN AUDIT ON THE USE OF 20% HUMAN ALBUMIN IN A TERTIARY CARE HOSPITAL
G.A. Zakout, 1 M.A. Greiss2 1 Aberdeen Royal Infirmary, ABERDEEN; 2 Aberdeen Blood Transfusion Center,
ABERDEEN, United Kingdom
Background. The use of human albumin has been looked into for
almost a decade. Most of the evidence we have comes from systemic
review of randomised-controlled trials as well as meta-analysis. The
main conclusions from such evidence were that current data suggest the
lack of evidence of mortality benefits from human albumin and
increased cost when compared to cheaper alternatives such as crystalloids.
Moreover, fluid resuscitation with albumin or saline produced
similar outcomes irrespective of patients’ baseline serum albumin concentration.
Certainly the use of albumin in the United Kingdom
decreased by at least 40% following these publications. Nevertheless
there is growing evidence to support the use of 20% human albumin
in terms of mortality reduction in specific patient populations such as
following large volume paracentesis in diuretic refractory ascites and in
preventing renal failure in spontaneous bacterial peritonitis associated
with cirrhosis. Aim. Based on this evidence, we ask through this audit
how far does our hospital practice comply with the current data and
what possible economic repercussions may result from inappropriate
use. Methods. We carried out a retrospective review of all the requests
for 20% human albumin, which North East of Scotland Blood Transfusion
Service (NESNBTS) received from 1st May 2005 to 31st April
2006 from the Aberdeen Royal Infirmary; a tertiary care hospital. The
use of 20% human albumin was deemed appropriate in: 1. Ascites for
drainage 2. Hepatorenal syndrome. 3. Spontaneous bacterial peritonitis.
Results. NESNBTS received a total of 461 orders from the 1st May
2005-31st April 2006 from different subspecialties at the Aberdeen Royal
infirmary, which was mainly from the gastroenterology ward-around
79% (n=364). 130 adult patients aged 19-92 years received a total of 1-
77 vials. A total of 1056 total vials (each of which was 100ml) were
issued . 4% (n=43) of the vials had to be discarded, as they were not
required after being dispensed to the ward (as per MRHA regulations).
Indications ranged variably but paracentesis in cirrhotic patients was
the most common - 66% (n=304) of the total orders. 81% (n=855) of
the total orders were considered appropriate. 14.96% (n=158) did not
comply with evidence to support its use and this comes mainly from
medical wards. The total expenditure for the amount of human albumin
issued over the audit year was approximately £38300. It is estimated
that approximately £4000 worth of human albumin has been wasted
through discarded and inappropriately used vials. Summary. Our
hospital practice is reasonably appropriate. This might well be due to
the controlled 20% human albumin prescription by the medical officer
at the NESNBTS. Although these results are encouraging there still
remains space for improvement through further educational measures.
The use of 20% human albumin remains controversial even to this
date. We still require more well-conducted, large scale, randomised
controlled trials of sufficient statistical power to determine its indications.
However till then, we are bound to justify and rationalise its use.