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Mobilization and Conditioning Regimens in Stem Cell Transplant for Autoimmune Diseases
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Patients with SLE may have a long history of high dose immune suppression prior to the referral for HSCT. Prophylactic anti-fungal, anti-viral, and anti-bacterial therapy should be considered during any neutropenia interval. HSCT studies indicate that high-dose cyclophosphamide may be used safely in patients with end stage renal failure (ESRF). While the pharmacokinetics of cyclophosphamide and its metabolites are not understood in ESRF, if dialysis is performed the morning after each cyclophosphamide infusion, treatment appears to be well tolerated. Patients in renal failure may produce residual urine that may allow stagnation of cyclophosphamide metabolites in the bladder, resulting in hemorrhagic cystitis. In order to minimize this, a Foley catheter with bladder irrigation and intravenous Mesna may be used during and for 24 hours after cyclophosphamide. SLE nephritis with renal insufficiency may be unusually sensitive to diuresis resistant volume overload, requiring aggressive volume-status monitoring and correction by dialysis. SLE patients may also be prone to thrombus formation from anti-phospholipid antibodies. Prophylactic anti-coagulation with subcutaneous Lovenox or fragmin has generally been well tolerated without bleeding during the HSCT.
Tribo-electrification of pharmaceutical powder blends
Published in Particulate Science and Technology, 2019
Antonella Rescaglio, Frederic De Smet, Luc Aerts, Geoffoy Lumay
Mesna (sodium 2-sulfanylethanesulfonate) sold under the brand name Mesnex® among others, is a medication used to reduce the incidence of hemorrhagic cystitis and hematuria when a patient receives ifosfamide or cyclophosphamide for cancer chemotherapy, Shaw and Graham (1987). Mesna is also used as a mucolytic agent, working in the same way as acetylcysteine; it is sold for this indication as Mistabron®, van de Walle, Lauwers, and Adriaensen (1976).