Recombinant Human Factor VIIa for Alveolar Hemorrhage Following Allogeneic Stem Cell Transplantation
Por:
Elinoff J.M., Bagci U., Moriyama B., Dreiling J.L., Foster B., Gormley N.J., Salit R.B., Cai R., Sun J., Beri A., Reda D.J., Fakhrejahani F., Battiwalla M., Baird K., Cuellar-Rodriguez J.M., Kang E.M., Pavletic S.Z., Fowler D.H., John Barrett A., Lozier J.N., Kleiner D.E., Mollura D.J., Childs R.W., Suffredini A.F.
Publicada:
1 ene 2014
Resumen:
The mortality rate of alveolar hemorrhage (AH) after allogeneic hematopoietic stem cell transplantation is greater than 60% with supportive care and high-dose steroid therapy. We performed a retrospective cohort analysis to assess the benefits and risks of recombinant human factor VIIa (rFVIIa) as a therapeutic adjunct for AH. Between 2005 and 2012, 57 episodes of AH occurred in 37 patients. Fourteen episodes (in 14 patients) were treated with steroids alone, and 43 episodes (in 23 patients) were treated with steroids and rFVIIa. The median steroid dose was 1.9 mg/kg/d (interquartile range [IQR], 0.8 to 3.5 mg/kg/d; methylprednisolone equivalents) and did not differ statistically between the 2 groups. The median rFVIIa dose was 41 µg/kg (IQR, 39 to 62 µg/kg), and a median of 3 doses (IQR, 2 to 17) was administered per episode. Concurrent infection was diagnosed in 65% of the episodes. Patients had moderately severe hypoxia (median PaO2/FiO2, 193 [IQR, 141 to 262]); 72% required mechanical ventilation, and 42% survived to extubation. The addition of rFVIIa did not alter time to resolution of AH (P =.50), duration of mechanical ventilation (P =.89), duration of oxygen supplementation (P =.55), or hospital mortality (P =.27). Four possible thrombotic events (9% of 43 episodes) occurred with rFVIIa. rFVIIa in combination with corticosteroids did not confer clear clinical advantages compared with corticosteroids alone. In patients with AH following hematopoietic stem cell transplantation, clinical factors (ie, worsening infection, multiple organ failure, or recrudescence of primary disease) may be more important than the benefit of enhanced hemostasis from rFVIIa. © 2014.
Filiaciones:
Elinoff J.M.:
Critical Care Medicine Department, Clinical Center National Institutes of Health, Bethesda, MD, United States
Bagci U.:
Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center National Institutes of Health, Bethesda, MD, United States
Moriyama B.:
Pharmacy Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
Dreiling J.L.:
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Foster B.:
Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center National Institutes of Health, Bethesda, MD, United States
Gormley N.J.:
Hematology Branch National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
Salit R.B.:
Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Cai R.:
Critical Care Medicine Department, Clinical Center National Institutes of Health, Bethesda, MD, United States
Sun J.:
Critical Care Medicine Department, Clinical Center National Institutes of Health, Bethesda, MD, United States
Beri A.:
Laboratory for Informatics Development, Biomedical Translational Research Information System, Clinical Center National Institutes of Health, Bethesda, MD, United States
Reda D.J.:
Critical Care Medicine Department, Clinical Center National Institutes of Health, Bethesda, MD, United States
Fakhrejahani F.:
Critical Care Medicine Department, Clinical Center National Institutes of Health, Bethesda, MD, United States
Battiwalla M.:
Hematology Branch National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
Baird K.:
Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Cuellar-Rodriguez J.M.:
Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Kang E.M.:
Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
Pavletic S.Z.:
Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Fowler D.H.:
Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
John Barrett A.:
Hematology Branch National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
Lozier J.N.:
Hematology Service, Department of Laboratory Medicine, Clinical Center National Institutes of Health, Bethesda, MD, United States
Kleiner D.E.:
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
Mollura D.J.:
Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center National Institutes of Health, Bethesda, MD, United States
Childs R.W.:
Hematology Branch National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
Suffredini A.F.:
Critical Care Medicine Department, Clinical Center National Institutes of Health, Bethesda, MD, United States
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