Septic shock and multiple organ failure after hematopoietic stem cell transplantation: Treatment with recombinant human activated protein C Journal Article

  


Authors: Pastores, S. M.; Papadopoulos, E.; Van Den Brink, M.; Alicea, M.; Halpern, N. A.
Article Title: Septic shock and multiple organ failure after hematopoietic stem cell transplantation: Treatment with recombinant human activated protein C
Abstract: Severe sepsis with multiple organ failure after hematopoietic stem cell transplantation (HSCT) results in extremely high morbidity and mortality. Recent studies have highlighted the importance of sepsis-induced activation of the coagulation system in the pathophysiology of severe sepsis. Activated protein C is an important modulator of coagulation and inflammatory derangements during severe sepsis. Low levels of protein C occur in severe sepsis and are predictive of poor outcome. Recombinant human activated protein C (drotrecogin alfa (activated)) was recently approved by the Food and Drug Administration (FDA) for severe sepsis. The phase III trial that resulted in the approval of this agent, however, enrolled a general sepsis population and excluded patients undergoing HSCT. We report a case of fulminant septic shock and multiple organ failure after HSCT that was treated with drotrecogin alfa (activated) in addition to standard therapy, and recovered. The high mortality rates of patients who develop severe sepsis after HSCT demand that new avenues of treatment be considered for this very high-risk patient population. This case illustrates the potential application of a novel therapeutic approach. Clinical trials are warranted to further investigate the safety and efficacy of drotrecogin alfa (activated) in patients with severe sepsis after HSCT.
Keywords: adult; treatment outcome; antibiotic agent; fludarabine; prednisone; mortality; cancer recurrence; case report; doxorubicin; drug efficacy; drug safety; drug approval; pathophysiology; infection; lorazepam; morbidity; aciclovir; cyclophosphamide; immunoglobulin; melphalan; vincristine; hematopoietic stem cell transplantation; food and drug administration; chronic myeloid leukemia; prediction; thiotepa; high risk patient; disease severity; graft failure; drug mechanism; recombinant proteins; recombinant protein; comorbidity; ciprofloxacin; folic acid; multivitamin; phase 3 clinical trial; vancomycin; chronic lymphatic leukemia; azithromycin; metronidazole; fluconazole; ganciclovir; cyclosporin; alemtuzumab; multiple organ failure; piperacillin plus tazobactam; blood clotting; abscess; lansoprazole; septic shock; amphotericin b lipid complex; leukemia, lymphocytic, chronic; protein c; calcium carbonate; shock, septic; severe sepsis; drotrecogin; drotrecogin alfa (activated); humans; human; female; priority journal; article; recombinant human activated protein c; activated protein c
Journal Title: Bone Marrow Transplantation
Volume: 30
Issue: 2
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2002-07-02
Start Page: 131
End Page: 134
Language: English
DOI: 10.1038/sj.bmt.1703618
PUBMED: 12132053
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-0036053453&partnerID=40&md5=38de683cf2f3ca5ffb0ed25b713098d9
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Marcel R M Van Den Brink
    616 Van Den Brink
  2. Neil A Halpern
    151 Halpern
  3. Stephen Pastores
    249 Pastores
  4. Esperanza B Papadopoulos
    415 Papadopoulos
  5. Margarita Alicea
    12 Alicea
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