Excretion of Ascaris lumbricoides following reduced‐intensity allogeneic hematopoietic stem cell transplantation and consecutive treatment with mebendazole

Here, we present the unique case of a 51‐year‐old German patient with multiple myeloma excreting Ascaris lumbricoides in his stool five weeks after allogeneic hematopoietic stem cell transplantation. Stool analysis remained negative for the presence of eggs, and there was no eosinophilia in the peripheral blood at any time around stem cell transplantation. The patient was commenced on a three‐day treatment with mebendazole, which was well tolerated. No serious interactions with the concomitant post‐transplant medication or negative effects on the hematopoiesis were observed, and the myeloma still is in complete remission. To our knowledge, this is the first report on excretion of A lumbricoides in the context of allogeneic stem cell transplantation. The case is remarkable with view to the fact that the parasite has supposedly survived all courses of myeloma treatment including autologous and allogeneic conditioning. Parasitosis with A lumbricoides has a worldwide prevalence of about a billion and is extremely rare in northern Europe. Possibly the patient got infected during a trip to Egypt years before multiple myeloma was diagnosed.     

Phase II clinical trial for the evaluation of bortezomib within the reduced intensity conditioning regimen (RIC) and post‐allogeneic transplantation for high‐risk myeloma patients

The current study was designed to assess the safety and efficacy of bortezomib in combination with fludarabine and melphalan as reduced intensity conditioning before allogeneic stem cell transplantation in patients with high risk multiple myeloma. Sixteen patients were evaluable. The median number of previous line of treatment was 3; all patients had relapsed following a prior autograft and 13 had previously received bortezomib. Fifteen of them either remained stable or improved disease status at day +100 post‐transplant, including 11 patients with active disease. More specifically, nine patients (56%) and five patients (31%) reached complete remission and partial response, respectively. 25% developed grade III acute graft‐versus‐host disease. The cumulative incidence of non‐relapse mortality, relapse and overall survival were 25%, 54% and 41%, respectively, at 3 years. Regarding the non‐haematological toxicity (grade>2), two patients developed peripheral neuropathy, two patients liver toxicity and 1 pulmonary toxicity early post‐transplant. The haematological toxicity was only observed during the first three cycles mostly related to low haemoglobin and platelet levels. The current trial is the first one evaluating the safety and efficacy of bortezomib as part of a reduced intensity conditioning regimen among patients with high risk multiple myeloma.     

Relationship between cytomegalovirus (CMV) reactivation,CMV‐driven immunity,overall immune recovery and graft‐versus‐leukaemia effect in children

The interplay between immune recovery, cytomegalovirus (CMV)‐reactivation, CMV‐driven immunity and graft‐versus‐leukaemia effect (GVL) was analysed in 108 children (median age: 8 years) who underwent haematopoietic‐stem cell transplantation (HSCT) for acute leukaemia. Follow‐up was 2 years unless death or relapse occurred. CMV‐polymerase chain reaction (PCR) was programmed weekly until month +3 post‐HSCT. Immunomonitoring consisted of sequential lymphocyte subset enumerations and analyses of T‐cell proliferative and γ‐interferon responses to CMV and to adenovirus. In the 108 recipients, the 2‐year relapse rate (RR) was 25% (median time to onset 4·5 months; range: 24 d–17 months). CMV reactivation occurrence was 31% (median time to onset 26 d). Donor/recipient CMV serostatus did not influence RR. Among the 89 recipients disease‐free after day +120, i) early CMV‐reactivation before day +30 was more frequent (P = 0·01) in the relapse recipient group opposed to the non‐relapse group. ii) CD8⁺/CD28^? and CD4⁺CD45RA^? T‐cell expansions induced by CMV did not influence RR, iii) Recovery of anti‐CMV and also anti‐adenovirus immunity and of naïve CD4⁺ T‐cells was faster in the non‐relapse group (P = 0·008; 0·009 and 0·002 respectively). In contrast to adult acute myeloid leukaemia, CMV reactivation was associated with increased RR in this paediatric series. Accelerated overall immune recovery rather than CMV‐driven immunity had a favourable impact on RR.