PI-04. Sepsis in early post-transplant period: new approaches to treatment
Nune V. Matinyan, Tatyana V. Gorbunova, Timur T. Valiev, Irina O. Kostareva, Timur. Z. Aliev, Natalya A. Burlaka, Natalya A. Batmanova,Vasiliy P. Akimov, Elena G. Gromova, Kirill I. Kirgizov, Svetlana R. Varfolomeeva
Research Institute of Pediatric Oncology and Hematology, N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
Contact: Dr. Nune V. Matinyan, phone: +7 (910) 409-70-70, e-mail: n9031990633@yandex.ru
Summary
Sepsis is a life-threatening clinical condition in immunocompromised patients, especially after hematopoietic stem cell transplantation (HSCT). Sepsis could lead to unregulated inflammation, causing multiple organ failure and hypercytokinemia with lethal outcome. Urgent hemosorbtion could be considered a potential option in complex therapy of sepsis after HSCT. Our aim was to estimate effectiveness of hemoperfusion with polymyxin B-immobilized cartridge (PMX-hemoperfusion) in the early posttransplant period.
Patients and methods
PMX-perfusion was performed in 3 patients who developed Gram-negative sepsis at early terms after HSCT. Pt. 1: Female, 15 y.o., ALL relapse, HSCT from MUD, conditioning: TBI/VP/Flu/ATG, +15 d. after HSCT as the start day of PMX-hemoperfusion. WBC: 1000/mcL. Pt. 2: Female, 15 y.o., AML relapse, HSCT from haploidentical donor with TCR a/b/CD19-depletion. Conditioning: FLAM followed by Treo/Mel. Day at the start of PMX-hemoperfusion: +20. WBC: 2500/mcL. Pt. 3: Male, 17 y.o., ALL relapse, HSCT from haploidentical donor with TCR a/b/CD19-depletion. Conditioning: TBI/VP/Flu. Day at the start of PMX-hemoperfusion: +20. WBC: 2000/mcL. All patients have stable arterial pressure. Antibacterial therapy upon starting the PMX: ceftazidime/avibactam, polymyxin, linezolid. Indications for starting PMX were as follows: endotoxemia due to Gram-negative bacteria, EAA more than 0.6 U (with WBC more than 1000/mkl), continuous fever, tachycardia, tachypnea, urination <0.5 mL/kg/hour, lactic acidemia, elevated PCT and CRP (to exclude immunological genesis of fever). CVC for hemodialysis were installed in all patients into femoral vein, and selective sorption was performed with Toraymixin B cartridge for, at least, 2 hours, in 2 procedures with 24-hour period.
Results
All children improved with reduced fever and stabilization of inflammatory markers, with diuresis of 2.5-3.0 mL/kg/hour. Standard posttransplant care was performed with antibiotics de-escalation. All patients are alive now. The follow-up period was 12 months in Pt. 1; 9 months in Pt. 2; 3 months in Pt.3.
Conclusion
Timely PMX-hemoperfsuion for selective sorption of endotoxin is associated with decreased risk of septic shock and lethal outcome after HSCT. We showed high importance of starting this therapy in order to avoid multiple organ failure. EAA in the patients with high WBC counts (>1000/mcL) is crucial to starting the hemoperfusion. Reduction of septicemia allows to continue standard posttransplant care.
Keywords
Oncology/hematology, pediatric, HSCT, sepsis, endotoxin, endotoxemia, hemoperfusion.
