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01-08-2012 | Review Article

Antimicrobial therapy of febrile complications after high-dose chemotherapy and autologous hematopoietic stem cell transplantation—guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Authors: Florian Weissinger, Holger W. Auner, Hartmut Bertz, Dieter Buchheidt, Oliver A. Cornely, Gerlinde Egerer, Werner Heinz, Meinolf Karthaus, Michael Kiehl, William Krüger, Olaf Penack, Stefan Reuter, Markus Ruhnke, Michael Sandherr, Hans-Jürgen Salwender, Andrew J. Ullmann, Dirk T. Waldschmidt, Hans H. Wolf

Published in: Annals of Hematology | Issue 8/2012

Abstract

More than 18,000 autolgous transplantation were performed in Europe in the year 2009. It as a routine procedure in experienced centres. Even if there is a low mortality rate, infections are a major issue after transplantation, occurring in more than 60 % of the patients. In this review we discuss all aspects of infections after autologous stem transplantation, including epidemiology, diagnostics, therapeutic algorithms, prophylaxis and supportive therapy.

Bertz H, Auner HW, Weissinger F et al (2003) Antimicrobial therapy of febrile complications after high-dose chemo-/radiotherapy and autologous hematopoietic stem cell transplantation—guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 82(Suppl 2):S167–S174PubMedCrossRef

Kish MA (2001) Guide to development of practice guidelines. Clin Infect Dis 32(6):851–854PubMedCrossRef

Auner HW, Zebisch A, Ofner P, Sill H, Linkesch W, Krause R (2005) Evaluation of potential risk factors for early infectious complications after autologous peripheral blood stem cell transplantation in patients with lymphoproliferative diseases. Ann Hematol 84(8):532–537PubMedCrossRef

Aksu G, Ruhi MZ, Akan H et al (2001) Aerobic bacterial and fungal infections in peripheral blood stem cell transplants. Bone Marrow Transplant 27(2):201–205PubMedCrossRef

Blijlevens NM, Donnelly JP, de Pauw BE (2001) Empirical therapy of febrile neutropenic patients with mucositis: challenge of risk-based therapy. Clin Microbiol Infect 7(Suppl 4):47–52PubMedCrossRef

Ketterer N, Espinouse D, Chomarat M et al (1999) Infections following peripheral blood progenitor cell transplantation for lymphoproliferative malignancies: etiology and potential risk factors. Am J Med 106(2):191–197PubMedCrossRef

Weaver CH, Hazelton B, Birch R et al (1995) An analysis of engraftment kinetics as a function of the CD34 content of peripheral blood progenitor cell collections in 692 patients after the administration of myeloablative chemotherapy. Blood 86(10):3961–3969PubMed

Olivieri A, Offidani M, Montanari M et al (1998) Factors affecting hemopoietic recovery after high-dose therapy and autologous peripheral blood progenitor cell transplantation: a single center experience. Haematologica 83(4):329–337PubMed

Perez-Simon JA, Martin A, Caballero D et al (1999) Clinical significance of CD34+ cell dose in long-term engraftment following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 24(12):1279–1283PubMedCrossRef

10.

Mossad SB, Longworth DL, Goormastic M, Serkey JM, Keys TF, Bolwell BJ (1996) Early infectious complications in autologous bone marrow transplantation: a review of 219 patients. Bone Marrow Transplant 18(2):265–271PubMed

11.

Larsson K, Bjorkstrand B, Ljungman P (1998) Faster engraftment but no reduction in infectious complications after peripheral blood stem cell transplantation compared to autologous bone marrow transplantation. Support Care Cancer 6(4):378–383PubMedCrossRef

12.

Scheid C, Draube A, Reiser M et al (1999) Using at least 5×10(6)/kg CD34+ cells for autologous stem cell transplantation significantly reduces febrile complications and use of antibiotics after transplantation. Bone Marrow Transplant 23(11):1177–1181PubMedCrossRef

13.

Reich G, Cornely OA, Sandherr M et al (2005) Empirical antimicrobial monotherapy in patients after high-dose chemotherapy and autologous stem cell transplantation: a randomised, multicentre trial. Br J Haematol 130(2):265–270PubMedCrossRef

14.

Gil L, Styczynski J, Komarnicki M (2007) Infectious complication in 314 patients after high-dose therapy and autologous hematopoietic stem cell transplantation: risk factors analysis and outcome. Infection 35(6):421–427PubMedCrossRef

15.

Vera-Llonch M, Oster G, Ford CM, Lu J, Sonis S (2007) Oral mucositis and outcomes of autologous hematopoietic stem-cell transplantation following high-dose melphalan conditioning for multiple myeloma. J Support Oncol 5(5):231–235PubMed

16.

Krause R, Auner HW, Gorkiewicz G et al (2004) Detection of catheter-related bloodstream infections by the differential-time-to-positivity method and gram stain-acridine orange leukocyte cytospin test in neutropenic patients after hematopoietic stem cell transplantation. J Clin Microbiol 42(10):4835–4837PubMedCrossRef

17.

Child JA, Morgan GJ, Davies FE et al (2003) High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 348(19):1875–1883PubMedCrossRef

18.

Horiuchi T, Gondo H, Miyagawa H et al (2005) Association of MBL gene polymorphisms with major bacterial infection in patients treated with high-dose chemotherapy and autologous PBSCT. Genes Immunol 6(2):162–166CrossRef

19.

Bochud PY, Chien JW, Marr KA et al (2008) Toll-like receptor 4 polymorphisms and aspergillosis in stem-cell transplantation. N Engl J Med 359(17):1766–1777PubMedCrossRef

20.

de Boer MG, Jolink H, Halkes CJ et al (2011) Influence of polymorphisms in innate immunity genes on susceptibility to invasive aspergillosis after stem cell transplantation. PloS One 6(4):e18403PubMedCrossRef

21.

Molle I, Peterslund NA, Thiel S, Steffensen R (2006) MBL2 polymorphism and risk of severe infections in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation. Bone Marrow Transplant 38(8):555–560PubMedCrossRef

22.

Mullighan CG, Heatley S, Doherty K et al (2002) Mannose-binding lectin gene polymorphisms are associated with major infection following allogeneic hemopoietic stem cell transplantation. Blood 99(10):3524–3529PubMedCrossRef

23.

Barton T, Collis T, Stadtmauer E, Schuster M (2001) Infectious complications the year after autologous bone marrow transplantation or peripheral stem cell transplantation for treatment of breast cancer. Clin Infect Dis 32(3):391–395PubMedCrossRef

24.

Reimer P, Kunzmann V, Wilhelm M et al (2003) Cellular and humoral immune reconstitution after autologous peripheral blood stem cell transplantation (PBSCT). Ann Hematol 82(5):263–270PubMed

25.

Locasciulli A, Bruno B, Alessandrino EP et al (2003) Hepatitis reactivation and liver failure in haemopoietic stem cell transplants for hepatitis B virus (HBV)/hepatitis C virus (HCV) positive recipients: a retrospective study by the Italian group for blood and marrow transplantation. Bone Marrow Transplant 31(4):295–300PubMedCrossRef

26.

Kolbe K, Domkin D, Derigs HG, Bhakdi S, Huber C, Aulitzky WE (1997) Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation. Bone Marrow Transplant 19(2):143–147PubMedCrossRef

27.

Salazar R, Sola C, Maroto P et al (1999) Infectious complications in 126 patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 23(1):27–33PubMedCrossRef

28.

Kontoyiannis DP, Marr KA, Park BJ et al (2010) Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis 50(8):1091–1100PubMedCrossRef

29.

Imataki O, Kami M, Kim SW et al (2004) A nationwide survey of deep fungal infections and fungal prophylaxis after hematopoietic stem cell transplantation in Japan. Bone Marrow Transplant 33(12):1173–1179PubMedCrossRef

30.

Molina A, Krishnan AY, Nademanee A et al (2000) High dose therapy and autologous stem cell transplantation for human immunodeficiency virus-associated non-Hodgkin lymphoma in the era of highly active antiretroviral therapy. Cancer 89(3):680–689PubMedCrossRef

31.

Krishnan A, Palmer JM, Zaia JA, Tsai NC, Alvarnas J, Forman SJ (2010) HIV status does not affect the outcome of autologous stem cell transplantation (ASCT) for non-Hodgkin lymphoma (NHL). Biol Blood Marrow Transplant 16(9):1302–1308PubMedCrossRef

32.

Maertens J, Theunissen K, Verbeken E et al (2004) Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipients. Br J Haematol 126(6):852–860PubMedCrossRef

33.

Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M (2002) Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 186(9):1297–1306PubMedCrossRef

34.

Maertens J, Verhaegen J, Lagrou K, Van Eldere J, Boogaerts M (2001) Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 97(6):1604–1610PubMedCrossRef

35.

Frere P, Hermanne JP, Debouge MH, de Mol P, Fillet G, Beguin Y (2004) Bacteremia after hematopoietic stem cell transplantation: incidence and predictive value of surveillance cultures. Bone Marrow Transplant 33(7):745–749PubMedCrossRef

36.

Bavaro MF (2002) Neutropenic enterocolitis. Curr Gastroenterol Rep 4(4):297–301PubMedCrossRef

37.

Gomez L, Martino R, Rolston KV (1998) Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis 27(4):695–699PubMedCrossRef

38.

Gorschluter M, Mey U, Strehl J et al (2005) Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 75(1):1–13PubMedCrossRef

39.

Blot F, Nitenberg G, Chachaty E et al (1999) Diagnosis of catheter-related bacteraemia: a prospective comparison of the time to positivity of hub-blood versus peripheral-blood cultures. Lancet 354(9184):1071–1077PubMedCrossRef

40.

Gaur AH, Flynn PM, Giannini MA, Shenep JL, Hayden RT (2003) Difference in time to detection: a simple method to differentiate catheter-related from non-catheter-related bloodstream infection in immunocompromised pediatric patients. Clin Infect Dis 37(4):469–475PubMedCrossRef

41.

Seifert H, Cornely O, Seggewiss K et al (2003) Bloodstream infection in neutropenic cancer patients related to short-term nontunnelled catheters determined by quantitative blood cultures, differential time to positivity, and molecular epidemiological typing with pulsed-field gel electrophoresis. J Clin Microbiol 41(1):118–123PubMedCrossRef

42.

Ruhnke M, Bohme A, Buchheidt D et al (2012) Diagnosis of invasive fungal infections in hematology and oncology--guidelines from the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology (AGIHO). Ann Oncol 23(4):823–833

43.

Maschmeyer G, Beinert T, Buchheidt D et al (2009) Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: guidelines of the infectious diseases working party of the German Society of Haematology and Oncology. Eur J Cancer 45(14):2462–2472PubMedCrossRef

44.

Harter C, Schulze B, Goldschmidt H et al (2006) Piperacillin/tazobactam vs ceftazidime in the treatment of neutropenic fever in patients with acute leukemia or following autologous peripheral blood stem cell transplantation: a prospective randomized trial. Bone Marrow Transplant 37(4):373–379PubMedCrossRef

45.

Engelhard D, Cordonnier C, Shaw PJ et al (2002) Early and late invasive pneumococcal infection following stem cell transplantation: a European Bone Marrow Transplantation survey. Br J Haematol 117(2):444–450PubMedCrossRef

46.

Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34(6):730–751PubMedCrossRef

47.

Meisenberg BR, Miller WE, McMillan R et al (1997) Outpatient high-dose chemotherapy with autologous stem-cell rescue for hematologic and nonhematologic malignancies. J Clin Oncol 15(1):11–17PubMed

48.

Kumar A, Roberts D, Wood KE et al (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596PubMedCrossRef

49.

Link H, Böhme A, Cornely OA et al (2003) Antimicrobial therapy of unexplained fever in neutropenic patients Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG—German Cancer Society) Ann Hematol 82 (Suppl 2):S105–S117

50.

Ozer H, Armitage JO, Bennett CL et al (2000) 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol 18(20):3558–3585PubMed

51.

Auner HW, Sill H, Mulabecirovic A, Linkesch W, Krause R (2002) Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 81(7):374–377PubMedCrossRef

52.

Holmberg LA, Boeckh M, Hooper H et al (1999) Increased incidence of cytomegalovirus disease after autologous CD34-selected peripheral blood stem cell transplantation. Blood 94(12):4029–4035PubMed

53.

Kohno K, Nagafuji K, Tsukamoto H et al (2009) Infectious complications in patients receiving autologous CD34-selected hematopoietic stem cell transplantation for severe autoimmune diseases. Transpl Infect Dis 11(4):318–323PubMedCrossRef

54.

Lee MY, Chiou TJ, Hsiao LT et al (2008) Rituximab therapy increased post-transplant cytomegalovirus complications in non-Hodgkin’s lymphoma patients receiving autologous hematopoietic stem cell transplantation. Ann Hematol 87(4):285–289PubMedCrossRef

55.

Ng AP, Worth L, Chen L et al (2005) Cytomegalovirus DNAemia and disease: incidence, natural history and management in settings other than allogeneic stem cell transplantation. Haematologica 90(12):1672–1679PubMed

56.

Nichols WG, Guthrie KA, Corey L, Boeckh M (2004) Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy. Clin Infect Dis 39(9):1300–1306PubMedCrossRef

57.

Schiffer JT, Kirby K, Sandmaier B, Storb R, Corey L, Boeckh M (2009) Timing and severity of community acquired respiratory virus infections after myeloablative versus non-myeloablative hematopoietic stem cell transplantation. Haematologica 94(8):1101–1108PubMedCrossRef

58.

Doucette K, Fishman JA (2004) Nontuberculous mycobacterial infection in hematopoietic stem cell and solid organ transplant recipients. Clin Infect Dis 38(10):1428–1439PubMedCrossRef

59.

Zihlif M, Khanchandani G, Ahmed HP, Soubani AO (2005) Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: improved outcome with specific diagnosis. Am J Hematol 78(2):94–99PubMedCrossRef

60.

Cherif H, Martling CR, Hansen J, Kalin M, Bjorkholm M (2007) Predictors of short and long-term outcome in patients with hematological disorders admitted to the intensive care unit for a life-threatening complication. Support Care Cancer 15(12):1393–1398PubMedCrossRef

61.

Maschmeyer G, Bertschat FL, Moesta KT et al (2003) Outcome analysis of 189 consecutive cancer patients referred to the intensive care unit as emergencies during a 2-year period. Eur J Cancer 39(6):783–792PubMedCrossRef

62.

Owczuk R, Wujtewicz MA, Sawicka W, Wadrzyk A, Wujtewicz M (2005) Patients with haematological malignancies requiring invasive mechanical ventilation: differences between survivors and non-survivors in intensive care unit. Support Care Cancer 13(5):332–338PubMedCrossRef

63.

Avery R, Pohlman B, Adal K et al (2000) High prevalence of diarrhea but infrequency of documented Clostridium difficile in autologous peripheral blood progenitor cell transplant recipients. Bone Marrow Transplant 25(1):67–69PubMedCrossRef

64.

Arango JI, Restrepo A, Schneider DL et al (2006) Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma. Bone Marrow Transplant 37(5):517–521PubMedCrossRef

65.

Feld R (1999) Vancomycin as part of initial empirical antibiotic therapy for febrile neutropenia in patients with cancer: pros and cons. Clin Infect Dis 29(3):503–507PubMedCrossRef

66.

Nosanchuk JD, Sepkowitz KA, Pearse RN, White MH, Nimer SD, Armstrong D (1996) Infectious complications of autologous bone marrow and peripheral stem cell transplantation for refractory leukemia and lymphoma. Bone Marrow Transplant 18(2):355–359PubMed

67.

Nucci M, Landau M, Silveira F, Spector N, Pulcheri W (2001) Application of the IDSA guidelines for the use of antimicrobial agents in neutropenic patients: impact on reducing the use of glycopeptides. Infect Control Hosp Epidemiol 22(10):651–653PubMedCrossRef

68.

Freifeld AG, Bow EJ, Sepkowitz KA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52(4):427–431PubMedCrossRef

69.

Cordonnier C, Chevret S, Legrand M et al (2003) Should immunoglobulin therapy be used in allogeneic stem-cell transplantation? A randomized, double-blind, dose effect, placebo-controlled, multicenter trial. Ann Intern Med 139(1):8–18PubMed

70.

McQuaker IG, Hunter AE, Pacey S, Haynes AP, Iqbal A, Russell NH (1997) Low-dose filgrastim significantly enhances neutrophil recovery following autologous peripheral-blood stem-cell transplantation in patients with lymphoproliferative disorders: evidence for clinical and economic benefit. J Clin Oncol 15(2):451–457PubMed

71.

Dekker A, Bulley S, Beyene J, Dupuis LL, Doyle JJ, Sung L (2006) Meta-analysis of randomized controlled trials of prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor after autologous and allogeneic stem cell transplantation. J Clin Oncol 24(33):5207–5215PubMedCrossRef

72.

Piccirillo N, Sica S, Laurenti L et al (1999) Optimal timing of G-CSF administration after CD34+ immunoselected peripheral blood progenitor cell transplantation. Bone Marrow Transplant 23(12):1245–1250PubMedCrossRef

73.

Martino M, Pratico G, Messina G et al (2006) Pegfilgrastim compared with filgrastim after high-dose melphalan and autologous hematopoietic peripheral blood stem cell transplantation in multiple myeloma patients. Eur J Haematol 77(5):410–415PubMedCrossRef

74.

Bucaneve G, Micozzi A, Menichetti F et al (2005) Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 353(10):977–987PubMedCrossRef

75.

Micozzi A, Bucaneve G (2005) Prophylaxis and treatment of bacterial infections: do we need new strategies? Rev Clin Exp Hematol 9(2):E4PubMed

76.

Reuter S, Kern WV, Sigge A et al (2005) Impact of fluoroquinolone prophylaxis on reduced infection-related mortality among patients with neutropenia and hematologic malignancies. Clin Infect Dis 40(8):1087–1093PubMedCrossRef

77.

Goodman JL, Winston DJ, Greenfield RA et al (1992) A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 326(13):845–851PubMedCrossRef

78.

Rotstein C, Bow EJ, Laverdiere M, Ioannou S, Carr D, Moghaddam N (1999) Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: benefit based on purpose and intensity of cytotoxic therapy. The Canadian Fluconazole Prophylaxis Study Group. Clin Infect Dis 28(2):331–340PubMedCrossRef

79.

Sandherr M, Einsele H, Hebart H et al (2006) Antiviral prophylaxis in patients with haematological malignancies and solid tumours: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 17(7):1051–1059PubMedCrossRef

80.

Ljungman P, Reusser P, de la Camara R et al (2004) Management of CMV infections: recommendations from the infectious diseases working party of the EBMT. Bone Marrow Transplant 33(11):1075–1081PubMedCrossRef

81.

Huiqiang H, Qingqing C, Tianxin L et al (2009) Lamivudine for the prevention of hepatitis B virus reactivation after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for patients with advanced or relapsed non-Hodgkin’s lymphoma single institution experience. Expert Opin Pharmacother 10(15):2399–2406CrossRef

82.

Ma SY, Lau GK, Cheng VC, Liang R (2003) Hepatitis B reactivation in patients positive for hepatitis B surface antigen undergoing autologous hematopoietic cell transplantation. Leuk Lymphoma 44(8):1281–1285PubMedCrossRef

83.

Borentain P, Colson P, Coso D et al (2010) Clinical and virological factors associated with hepatitis B virus reactivation in HBsAg-negative and anti-HBc antibodies-positive patients undergoing chemotherapy and/or autologous stem cell transplantation for cancer. J Viral Hepat 17(11):807–815PubMedCrossRef

84.

Matsue K, Aoki T, Odawara J et al (2009) High risk of hepatitis B-virus reactivation after hematopoietic cell transplantation in hepatitis B core antibody-positive patients. Eur J Haematol 83(4):357–364PubMedCrossRef

85.

Ljungman P, Engelhard D, de la Camara R et al (2005) Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT. Bone Marrow Transplant 35(8):737–746PubMedCrossRef

86.

Ljungman P, Nahi H, Linde A (2005) Vaccination of patients with haematological malignancies with one or two doses of influenza vaccine: a randomised study. Br J Haematol 130(1):96–98PubMedCrossRef

Title: Antimicrobial therapy of febrile complications after high-dose chemotherapy and autologous hematopoietic stem cell transplantation—guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)
Authors: Florian Weissinger
Holger W. Auner
Hartmut Bertz
Dieter Buchheidt
Oliver A. Cornely
Gerlinde Egerer
Werner Heinz
Meinolf Karthaus
Michael Kiehl
William Krüger
Olaf Penack
Stefan Reuter
Markus Ruhnke
Michael Sandherr
Hans-Jürgen Salwender
Andrew J. Ullmann
Dirk T. Waldschmidt
Hans H. Wolf
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Annals of Hematology / Issue 8/2012
Print ISSN: 0939-5555
Electronic ISSN: 1432-0584
DOI: https://doi.org/10.1007/s00277-012-1456-8

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Abstract

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