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Immunosuppression withdrawal

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https://www.readbyqxmd.com/read/29758393/phase-i-trial-of-brentuximab-vedotin-for-steroid-refractory-chronic-graft-versus-host-disease-after-allogeneic-hematopoietic-cell-transplantation
#1
Zachariah DeFilipp, Shuli Li, Maria E Kempner, Jami Brown, Candice Del Rio, Betsy Valles, Chrisa Hunnewell, Meredith Saylor, Julie Vanderklish, Bimalangshu R Dey, Areej El-Jawahri, Steven L McAfee, Thomas R Spitzer, Yi-Bin Chen
We conducted a phase I study of brentuximab vedotin (BV), an antibody-drug conjugate targeting CD30, for the treatment of steroid-refractory chronic graft-versus-host disease (cGVHD). A modified 3+3 study design was used with the primary endpoint to determine the maximum tolerated dose (MTD) of BV in this population. Escalating doses of BV were planned, starting with 0.6 mg/kg q3weeks (dose level 0) and increasing by 0.3 mg/kg per dose level. BV was administered in 21-day cycles for up to 16 cycles of therapy...
May 11, 2018: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/29756637/withdrawal-of-immunosuppressant-or-biologic-therapy-for-patients-with-quiescent-crohn-s-disease
#2
REVIEW
Ray K Boyapati, Joana Torres, Carolina Palmela, Claire E Parker, Orli M Silverberg, Sonam D Upadhyaya, Tran M Nguyen, Jean-Frédéric Colombel
BACKGROUND: Crohn's disease (CD) is a chronic, relapsing and remitting disease of the gastrointestinal tract that can cause significant morbidity and disability. Current treatment guidelines recommend early intervention with immunosuppressant or biological therapy in high-risk patients with a severe disease phenotype at presentation. The feasibility of therapeutic de-escalation once remission is achieved is a commonly encountered question in clinical practice, driven by patient and clinician concerns regarding safety, adverse events, cost and national regulations...
May 12, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29738100/steroid-free-three-drug-maintenance-regimen-for-pancreas-transplant-alone-comparison-of-induction-with-rabbit-antithymocyte-globulin-rituximab
#3
Jonathan Fridell, Richard Mangus, Jeanne Chen, Tim Taber, Arianna E Cabrales, Asif Sharfuddin, Muhammad Yaqub, John Powelson
Graft survival following pancreas transplant alone (PTA) is inferior to other pancreas transplants. Steroid elimination is appealing, but a two drug maintenance strategy may be inadequate. Additionally, recipients tend to have diabetic nephropathy and do not tolerate nephrotoxic medications. A three-drug maintenance strategy permits immunosuppression through different mechanisms as well as an opportunity to use lower doses of the individual medications. Induction consisted of five doses of rabbit antithymocyte globulin (1 mg/kg/dose)...
May 8, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29731938/treatment-of-a-patient-with-merkel-cell-skin-carcinoma-using-radiation-therapy-a-case-report
#4
Andrej Petrov, Slavica Kraleva, Katerina Kubelka-Sabit, Deva Petrova
BACKGROUND: Merkel cell carcinoma (MCC) is a rare, very aggressive tumour. The pathogenesis remains unclear, but UV radiation, immunosuppression, and the presence of Merkel cell polyomavirus in the tumour genome appear to have a key role. Merkel cell carcinoma is a highly aggressive tumour that often has a lethal end. CAS REPORT: A patient at 93 years of age comes for an examination by a dermatologist due to a rapidly growing nodular tumour growth in the forehead area...
April 15, 2018: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29722128/five-year-outcomes-in-kidney-transplant-patients-randomized-to-everolimus-with-cyclosporine-withdrawal-or-low-exposure-cyclosporine-versus-standard-therapy
#5
Claudia Sommerer, Michael Duerr, Oliver Witzke, Frank Lehner, Wolfgang Arns, Volker Kliem, Daniel Ackermann, Markus Guba, Johannes Jacobi, Ingeborg A Hauser, Rolf Stahl, Petra Reinke, Thomas Rath, Justyna Veit, Arianeb Mehrabi, Martina Porstner, Klemens Budde
HERAKLES was a one-year randomized, multicenter trial. Patients were randomized at three months after kidney transplantation to remain on cyclosporine-based therapy, switch to everolimus without a calcineurin inhibitor (CNI), or switch to everolimus with low-exposure cyclosporine. Overall, 417/497 (83.9%) patients from the core study entered a four-year extension study. The randomized regimen was continued to year 5 in 75.9%, 41.9% and 24.6% of patients in the standard-CNI, CNI-free and low-CNI groups, respectively...
May 2, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29721441/indolent-t-cell-large-granular-lymphocytic-leukaemia-in-a-dog-presenting-with-severe-neutropenia-and-an-absence-of-lymphocytosis
#6
James Elliott, Elizabeth Villiers
In humans, large granular lymphocytic leukaemia (LGLL) is a low-grade, indolent lymphoproliferative disorder of large granular lymphocytes (LGL) associated with autoimmune disorders; including rheumatoid arthritis and single or multiple cytopenias; particularly neutropenia. Therapy largely centres around immunosuppression which aims to resolve the immune-mediated secondary pathology, often without eradicating the neoplastic clone. The most effective agents appear to be cyclophosphamide, cyclosporine and methotrexate...
2018: Open Veterinary Journal
https://www.readbyqxmd.com/read/29709248/identifying-risk-profiles-in-liver-transplant-candidates-and-implications-for-induction-immunosuppression
#7
REVIEW
Umberto Cillo, Wolf O Bechstein, Gabriela Berlakovich, Philipp Dutkowski, Frank Lehner, Silvio Nadalin, Faouzi Saliba, Hans J Schlitt, Johann Pratschke
Changes in recipient and donor characteristics are redefining the role of induction in liver transplant recipients. Older recipients are more common, with greater concomitant comorbidity. Moderate or severe renal dysfunction is now estimated to affect 40% of liver transplant recipients. Donors are also becoming older, and other factors such as more frequent non-alcoholic fatty liver disease (NAFLD) compromise the quality of some grafts. Rejection rates are now relatively low (~10%) but some patients have a markedly increased risk such as younger recipients and those undergoing re-transplantation...
April 13, 2018: Transplantation Reviews
https://www.readbyqxmd.com/read/29657868/outcomes-of-hydralazine-induced-renal-vasculitis
#8
Homa Timlin, Jason E Liebowitz, Khusleen Jaggi, Duvuru Geetha
Objective: Hydralazine has been implicated as an etiologic agent for lupus-like syndrome and vasculitis. Hydralazine-induced vasculitis frequently affects the kidney, but the long-term renal outcomes in these patients have not yet been studied. Methods: Patients who had a diagnosis of ANCA-associated vasculitis (AAV) and were on hydralazine at the time of AAV diagnosis were included in this retrospective cohort study. Clinical and laboratory data were obtained from the review of medical records...
March 2018: European Journal of Rheumatology
https://www.readbyqxmd.com/read/29657214/kaposi-s-sarcoma-in-patients-with-membranous-nephropathy
#9
Weihua Liu, Feiyue Lin, Xin Chen, Lixin Wei, Jiabin Wu
Although the relationship between Kaposi's sarcoma (KS) and renal transplant has been well described, there are rare cases of KS concurrent with membranous glomerulonephritis or other glomerular diseases. In this report, a patient with membranous glomerulonephritis that accepted long-term prednisolone and cyclosporine immunosuppressive therapy developed skin KS. Withdrawal of immunosuppressive treatment resulted in the disappearance of KS.
March 2018: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/29657140/longterm-safety-and-efficacy-of-adalimumab-and-infliximab-for-uveitis-associated-with-juvenile-idiopathic-arthritis
#10
Vanessa Cecchin, Maria Elisabetta Zannin, Daniele Ferrari, Irene Pontikaki, Elisabetta Miserocchi, Maria P Paroli, Claudia Bracaglia, Denise Pires Marafon, Serena Pastore, Fulvio Parentin, Gabriele Simonini, Cinzia De Libero, Fernanda Falcini, Antonella Petaccia, Giovanni Filocamo, Riccardo De Marco, Francesco La Torre, Silvana Guerriero, Silvana Martino, Francesco Comacchio, Valentina Muratore, Giorgia Martini, Fabio Vittadello, Francesco Zulian
OBJECTIVE: Anti-TNF-α agents have significantly changed the management of juvenile idiopathic arthritis (JIA). We evaluated the safety and efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of JIA-associated uveitis in patients treated for ≥ 2 years. METHODS: Patients with JIA-associated uveitis treated with IFX and ADA were managed by a standardized protocol and data were entered in the ORCHIDEA registry. At baseline, all patients were refractory to standard immunosuppressive treatment or were corticosteroid-dependent...
April 15, 2018: Journal of Rheumatology
https://www.readbyqxmd.com/read/29644081/risk-of-adverse-events-from-different-drugs-for-sle-a-systematic-review-and-network-meta-analysis
#11
Jingru Tian, Yien Luo, Haijing Wu, Hai Long, Ming Zhao, Qianjin Lu
Objective: The comparative safety of immunosuppressive drugs, biologicals and glucocorticoids (GC) for patients with SLE remains controversial. We aimed to investigate the specific side effects of the available SLE drugs in this population of patients. Methods: Electronic databases were systematically searched through September 2017 for randomised trials in patients with SLE. The primary outcomes were all-cause mortality and withdrawal related to adverse events (AEs)...
2018: Lupus Science & Medicine
https://www.readbyqxmd.com/read/29603637/carpe-diem-time-to-transition-from-empiric-to-precision-medicine-in-kidney-transplantation
#12
Chris Wiebe, Julie Ho, Ian W Gibson, David N Rush, Peter W Nickerson
The current immunosuppressive pipeline in kidney transplantation is limited. In part, this is due to excellent 1-year allograft outcomes with the current standard of care (i.e. calcineurin inhibitor in combination with anti-proliferative agents). Despite this success, a recent Federal government sponsored systematic review has identified gaps/limits in the evidence of what constitutes optimal calcineurin inhibitor use in the short- and long-term. Moreover, recent empiric approaches to minimize/withdraw/convert from calcineurin inhibitors have come with the price of increased alloreactivity...
March 30, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29589850/reconstituting-donor-t-cells-increase-their-biomass-following-hematopoietic-stem-cell-transplantation
#13
Kevin A Leslie, Mahmood Rasheed, Roy T Sabo, Catherine C Roberts, Amir A Toor, Jason Reed
In this study, we used a rapid, highly-sensitive, single-cell biomass measurement method, Live Cell Interferometry (LCI), to measure biomass in populations of CD3 + T cells isolated from hematopoietic stem cell transplant (SCT) patients at various times pre- and post-transplant (days 0-100). CD3 + T cell 'mass spectra' were obtained from five autologous and 20 allogenic transplant recipients. We found a pronounced rise in median T cell biomass (+25%; p <0.001) shortly after transplant (day 14), which moderated by day 60...
March 28, 2018: Analyst
https://www.readbyqxmd.com/read/29588843/protracted-severe-systemic-cytomegalovirus-disease-in-an-immunosuppressed-patient-with-ulcerative-colitis
#14
Matthew James Armstrong, Tom Thomas, Tariq Iqbal, Ralph Boulton, Jason Goh
A 33-year-old man with ulcerative colitis presented with 5-day history of fever, night sweats, abdominal pain and increased stool frequency. He was on mesalazine M/R 1 g once daily, 6-mercaptopurine (6-MP) 75 mg once daily and prednisolone 40 mg once daily. Examination revealed fever and tachycardia. Blood examinations identified a persistent leucopenia, C reactive protein of 23 mg/L and an initial alanine transaminase of 855 IU/L. Flexible sigmoidoscopy revealed well-demarcated, punched-out ulcers in the proximal rectum and distal sigmoid, with histology pathognomonic of cytomegalovirus (CMV)...
April 2018: Frontline Gastroenterology
https://www.readbyqxmd.com/read/29536029/de-novo-circulating-antidonor-s-cell-antibodies-during-induced-acute-rejection-of-allogeneic-myofibers-in-myogenic-cell-transplantation-a-study-in-nonhuman-primates
#15
Daniel Skuk, Jacques P Tremblay
Background: Transplantation of myogenic cells has potential applications in the treatment of muscle pathologies. Excluding purely autologous cell transplantation, graft viability depends on an adequate control of acute rejection (AR). To contribute in understanding AR in this context, we analyzed whether de novo circulating antibodies against donor's cells are detected during induced AR of graft-derived myofibers in nonhuman primates. Methods: We allotransplanted satellite cell-derived myoblasts in macaques immunosuppressed with tacrolimus...
December 2017: Transplantation Direct
https://www.readbyqxmd.com/read/29512853/dengue-fever-in-renal-allograft-recipients-clinical-course-and-outcome
#16
Arunkumar Subbiah, Soumita Bagchi, Dipankar Bhowmik, Sandeep Mahajan, Raj K Yadav, Yogesh Chhabra, Sanjay Agarwal
BACKGROUND: There are annual outbreaks of dengue infection in tropical and subtropical countries. This retrospective study aimed to assess the clinical manifestation of dengue and outcome in renal transplant recipients. METHODS: Renal transplant recipients diagnosed with dengue in the nephrology department during the outbreak from August 2015 to December 2015 were included in the study. RESULTS: Twenty patients developed dengue presenting during the outbreak...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/29496886/statin-related-myopathies
#17
REVIEW
David Hilton-Jones
Statins are the Marmite ('You either love it or hate it!') of the drug world, both in terms of therapeutic benefit and risk of side effects. Proponents think that they are potential life-savers, opponents that their main benefit is lining the pockets of pharma. Some consider side effects to be a major issue, outweighing any therapeutic benefit, others that they are rare and essentially innocuous. Statin-induced myalgia is relatively common but often mild and for most people does not limit treatment. In others, reducing the dose or changing the preparation may help...
April 2018: Practical Neurology
https://www.readbyqxmd.com/read/29492991/tacrolimus-interaction-with-oral-oestrogen-in-kidney-transplant-recipients-a-case-control-study
#18
M Ghadimi, S Dashti-Khavidaki, M Shahali, M Gohari, M-R Khatami, A Alamdari
WHAT IS KNOWN AND OBJECTIVE: Oestrogens could inhibit the metabolism of drugs, such as calcineurin inhibitors, that are substrates for cytochrome P-450 microsomal enzymes. This study assessed the potential tacrolimus interaction with oral conjugated oestrogen in kidney transplant recipients who received conjugated oestrogen as prophylaxis against bleeding, before kidney biopsy. METHODS: In this case-control study, 13 kidney transplant recipients who received oral conjugated oestrogen as prophylaxis against uraemic bleeding before allograft biopsy were considered as cases...
February 28, 2018: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/29492382/current-state-of-pediatric-cardiac-transplantation
#19
REVIEW
Anne I Dipchand
Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing...
January 2018: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29486803/seroclearance-of-hepatitis-b-surface-antigen-following-hepatitis-e-exacerbation-on-chronic-hepatitis-e-and-b-dual-infection-in-a-renal-transplant-recipient-a-case-report
#20
Chau-Ting Yeh, Christopher Sung-Huan Yeh, Yu-De Chu, Yang-Jen Chiang
BACKGROUND: Hepatitis E virus infection usually causes an acute and self-resolving hepatitis. In areas where chronic hepatitis B virus infection is prevalent, acute hepatitis E virus superinfection on chronic hepatitis B virus infection occurs sporadically. In recent years, however, chronic hepatitis E virus infection has been recognized in patients under immunosuppressant therapy. To the best of our knowledge, cases involving patients with chronic hepatitis E virus and hepatitis B virus dual infection have never been reported...
February 28, 2018: Journal of Medical Case Reports
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