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Graft vs host disease

Christelle Retière, Catherine Willem, Thierry Guillaume, Henri Vié, Laetitia Gautreau-Rolland, Emmanuel Scotet, Xavier Saulquin, Katia Gagne, Marie C Béné, Berthe-Marie Imbert, Beatrice Clemenceau, Pierre Peterlin, Alice Garnier, Patrice Chevallier
We have compared prospectively the outcome and immune reconstitution of patients receiving either post-transplant cyclophosphamide (PTCY) ( n = 30) or anti-thymocyte globulin ATG ( n = 15) as Graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic peripheral blood stem cell (PBSC) transplantation (allo-SCT). The outcome and immune reconstitution of patients receiving either of these two regimens were compared prospectively. This study allowed also to investigate the impact of PTCY between haplo-identical vs matched donors and of clofarabine as part of the RIC regimen...
February 20, 2018: Oncotarget
T Wang, M Remberger, U Axdorph Nygell, M Sundin, A Björklund, J Mattsson, M Uhlin, E Watz
BACKGROUND: The composition of the graft used for allogeneic hematopoietic stem cell transplantation (HSCT) is important for the treatment outcome. Different apheresis devices may yield significant differences in peripheral blood stem cell graft cellular composition. We compared stem cell grafts produced by Cobe Spectra (Cobe) and Spectra Optia (Optia) with use of the mononuclear cell (MNC) protocol, and evaluated clinical outcome parameters such as graft-versus-host disease (GvHD), transplant-related mortality (TRM), relapse, and overall survival...
March 13, 2018: Transfusion
Elizabeth M Catchpoole, Caitlin E Thirunavukarasu, Antiopi Varelias, Sanmarié Schlebusch, Stuart Olver, Nienke Zomerdijk, Emma Osland, Glen A Kennedy, Siok-Keen Tey, Geoffrey R Hill, Kate A Markey
The key complications of allogeneic bone marrow transplant (BMT) remain graft-versus-host disease (GVHD) and opportunistic infection. We have analyzed the blood stream infections (BSI) occurring between day -7 and day 100 in a cohort of 184 adult patients undergoing allogeneic BMT in our center. 167 of the 184 patients (91%) had blood cultures collected, and 69 (38%) patients had a confirmed BSI. Enterobacteriaceae, Pseudomonas aeruginosa, Enterococcus spp. and viridans Streptococcus spp. were the most commonly isolated organisms...
March 5, 2018: Biology of Blood and Marrow Transplantation
Robin K Avery, Fernanda P Silveira, Kaitlin Benedict, Angela Ahlquist Cleveland, Carol A Kauffman, Mindy G Schuster, Erik R Dubberke, Shahid Husain, David Paterson, Tom Chiller, Peter Pappas
BACKGROUND: Most studies of post-transplant CMV infection have focused on either solid organ or hematopoietic cell transplant (HCT) recipients. A large prospective cohort study involving both lung and HCT recipients provided an opportunity to compare the epidemiology and outcomes of CMV infections in these two groups. METHODS: Patients were followed for 30 months in a 6-center prospective cohort study. Data on demographics, CMV infections, tissue-invasive disease, recurrences, rejection, and immunosuppression were recorded...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Pam M Ku, Jennifer L Waller, Claude Sportès, Amber B Clemmons
PURPOSE: Hematopoietic cell transplant (HCT) recipients often require intravenous (IV) magnesium repletion due to poor dietary intake, gastrointestinal loss, and use of concomitant magnesium wasting medications. Prolonging the IV magnesium infusion rate has been postulated to reduce renal clearance and improve retention; however, limited evidence supports this hypothesis. METHODS: We reviewed autologous and allogeneic HCT recipients (n = 82) who received IV magnesium at our institution between 2014 and 2016: 41 patients received IV magnesium at a prolonged rate of 0...
March 5, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Alessandra Forcina, Francesca Lorentino, Vincenzo Marasco, Chiara Oltolini, Magda Marcatti, Raffaella Greco, Maria Teresa Lupo-Stanghellini, Matteo Carrabba, Massimo Bernardi, Jacopo Peccatori, Consuelo Corti, Fabio Ciceri
Multidrug-resistant Gram-negative bacteria (MDR-GNB) are an emerging cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Three-hundred-forty-eight consecutive patients transplanted at our hospital from July 2012 to January 2016 were screened for a pre-transplant MDR-GNB colonization and evaluated for clinical outcomes. A pre-transplant MDR-GNB colonization was found in 16.9% of allo-HSCT and in 9.6% of auto-HSCT recipients. Both in auto- and in allo-HSCT, carriers of a MDR-GNB showed no significant differences in overall survival (OS), transplant-related mortality (TRM) nor infection-related mortality (IRM) compared to non-carriers...
March 1, 2018: Biology of Blood and Marrow Transplantation
Xiaofei Yang, Shuo Yang, Aining Sun, Huiying Qiu, Xiaowen Tang, Yue Han, Depei Wu
This paper aims to study whether cyclosporine-A (CSA) levels have an impact on the clinical outcome of patients with T-cell replete haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). We analyzed 140 consecutive patients who had been given T-cell replete haploidentical allo-HSCT in our institute to assess the effect of CSA concentration in the early stages of allo-HSCT on clinical outcomes, such as hematopoietic recovery, acute graft vs host disease (aGVHD), infection, disease-free survival (DFS), and overall survival (OS)...
February 28, 2018: Clinical Transplantation
Simone Cesaro, Gloria Tridello, Nicole Blijlevens, Per Ljungman, Charles Craddock, Mauricette Michallet, Alexander Martin, John A Snowden, Mohamad Mohty, Johan Maertens, Jacob Passweg, Eefke Petersen, Anne Nihtinen, Cecilia Isaksson, Noel Milpied, Pierre-Simon Rohlich, Eric Deconinck, Charles Crawley, Marie-Pierre Ledoux, Jennifer Hoek, Arnon Nagler, Jan Styczynski
Objectives: To assess the incidence of, and risk factors for, Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival. Methods: outcome analysis of 28,542 acute leukemia patients who underwent HSCT from 2000 to 2012: 347 with candidemia by day +100, and 28,195 without candidemia or any other type of Candida infection. Results: The incidence of candidemia by day +100 was 1...
February 22, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Karina Tozatto-Maio, Federica Giannotti, Myriam Labopin, Annalisa Ruggeri, Fernanda Volt, Annalisa Paviglianiti, Chantal Kenzey, Hiromi Hayashi, Jan Cornelissen, Mauricette Michallet, Dimitrios Karakasis, Eric Deconinck, Pierre-Simon Rohrlich, Regis Peffault de la Tour, Didier Blaise, Eefke Petersen, Maud D'Aveni, Henrik Sengeloev, Thierry Lamy, Nigel H Russell, Edouard Forcade, Charles F Craddock, Arnon Nagler, Eliane Gluckman, Vanderson Rocha
Usually, after double umbilical cord blood transplant (DUCBT) only one of the transplanted units persists long term. The characteristics of the winning cord blood unit (W-CBU) that determine unit dominance and how they influence the outcomes of DUCBT remain unclear. We retrospectively analysed 347 patients with acute leukaemia transplanted with a DUCBT (694 CBU) from 2005 to 2013 who had documented neutrophil engraftment and a W-CBU identified by chimerism analysis, in order to identify unit characteristics impacting on dominance...
February 22, 2018: Biology of Blood and Marrow Transplantation
Stephanie J Lee, Betty K Hamilton, Joseph Pidala, Amin Alousi, Chareeni Kurukulasuriya, Lynn Onstad, Madan Jagasia, George Chen, Corey Cutler, Raewyn Brody, Mukta Arora, Sally Arai, Stefanie Sarantopoulos, Mary E Flowers
In 2014, the National Institutes of Health sponsored the second Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-vs-Host (GVHD). The purpose was to update recommendations about key elements of chronic GVHD research, including definitions for diagnosis, severity scoring, and response measures, based on empirical data published since the first 2005 Consensus Conference. The most significant modifications were to the response assessments, since studies demonstrated difficulty with the first consensus definitions...
February 21, 2018: Biology of Blood and Marrow Transplantation
Musa Alzahrani, Maryse Power, Yasser Abou Mourad, Michael Barnett, Raewyn Broady, Donna Forrest, Alina Gerrie, Donna Hogge, Stephen Nantel, David Sanford, Kevin Song, Heather Sutherland, Cynthia Toze, Thomas Nevill, Sujaatha Narayanan
BACKGROUND: The natural history of patients with myelodysplastic syndromes (MDS) is variable. The revised international prognostic score (IPSS-R) is commonly used in practice to predict outcome in patients with MDS both at diagnosis and pre-transplant. However the effect of change in IPSS-R pre-allogeneic stem cell transplant with chemotherapy or hypomethylating agents on post-transplant outcomes is currently unknown. AIM: We assessed if improvement in IPSS-R prognostic score pre HSCT would result in improvement in clinical outcomes post-transplant...
February 20, 2018: Biology of Blood and Marrow Transplantation
Can Boga, Mahmut Yeral, Ciğdem Gereklioglu, Suheyl Asma, Erkan Maytalman, Pelin Aytan, Ilknur Kozanoglu, Cagla Sariturk, Hakan Ozdogu
OBJECTIVE/BACKGROUND: Anti-T lymphocyte globulin Fresenius (rATG-F; ATG-Fresenius) and antithymocyte globulin (thymoglobulin), which are included in transplant protocols, are used to reduce the risk of chronic graft-versus-host disease (cGVHD) or suppress allograft rejection. Available clinical studies have been conducted in heterogenous patient populations and with different administration protocols including stem cell sources. Additionally, the pharmacokinetics of ATG is variable, and the clinically effective dose of rATG-F, in particular, is not exactly known...
February 20, 2018: Hematology/oncology and Stem Cell Therapy
Simona Sestili, Myriam Labopin, Annalisa Ruggeri, Andrea Velardi, Fabio Ciceri, Johan Maertens, Lothar Kanz, Franco Aversa, Philippe Lewalle, Donald Bunjes, Mohamad Mohty, Arnon Nagler
BACKGROUND: T-cell-depleted, haploidentical transplantations (haplos) are commonly offered to patients who have high-risk, acute leukemia in the absence of a human leukocyte antigen (HLA) full-matched donor. METHODS: To determine the effect of transplantation period, the authors divided 308 adults with de novo, acute leukemia who underwent T-cell-depleted haplo from 2005 to 2015 into 2 groups, according the year in which they underwent transplantation (2005-2011 [n = 191] and 2012-2015 [n = 117])...
February 22, 2018: Cancer
Ali Bazarbachi, Ariane Boumendil, Hervé Finel, Mohamad Mohty, Luca Castagna, Karl S Peggs, Didier Blaise, Boris Afanasyev, José L Diez-Martin, Jorge Sierra, Adrian Bloor, Carmen Martinez, Stephen Robinson, Ram Malladi, Jean El-Cheikh, Paolo Corradini, Silvia Montoto, Peter Dreger, Anna Sureda
Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate. Preliminary data suggest that BV might improve outcomes after allogeneic stem cell transplantation (SCT) for Hodgkin lymphoma (HL) when used as pre-transplant salvage therapy. Between 2010 and 2014, 428 adult patients underwent an allogeneic SCT for classical HL at participating centres of the European Society for Blood and Marrow Transplantation. We compared the outcomes of 210 patients who received BV prior to allogeneic SCT with that of 218 patients who did not receive BV...
February 22, 2018: British Journal of Haematology
Raynier Devillier, Faezeh Legrand, Jérôme Rey, Luca Castagna, Sabine Fürst, Angela Granata, Aude Charbonnier, Samia Harbi, Evelyne d'Incan, Thomas Pagliardini, Catherine Faucher, Claude Lemarie, Colombe Saillard, Boris Calmels, Bilal Mohty, Valerio Maisano, Pierre-Jean Weiller, Christian Chabannon, Norbert Vey, Didier Blaise
Haploidentical related donor (HRD) allogeneic hematopoietic stem cell transplantation (Allo-HSCT) was developed as a valid option for the treatment of acute myeloid leukemia (AML) in the absence of a matched donor. However, many investigators are reluctant to consider the use of this alternative in elderly patients, anticipating high morbidity. Here, we report a single-center comparison of HRD vs. matched sibling donor (MSD) and unrelated donor (UD) Allo-HSCT for patients with AML aged ≥60 years. Ninety-four patients (MSD: n = 31; UD: n = 30; HRD: n = 33) were analyzed...
February 12, 2018: Biology of Blood and Marrow Transplantation
Patrizia Chiusolo, Gesine Bug, Attilio Olivieri, Mats Brune, Nicola Mordini, Paolo Emilio Alessandrino, Alida Dominietto, Anna Maria Raiola, Carmen Di Grazia, Francesca Gualandi, Maria Teresa Van Lint, Felicetto Ferrara, Olimpia Finizio, Emanuele Angelucci, Andrea Bacigalupo
We are reporting a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants (HAPLO), in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg, on days +3 and +5. The median age was 51 years (17-74), 51 patients (34%) had active disease at transplant, and the median follow up of surviving patients 903 days (150-1955). The cumulative incidence (CI) of engraftment, acute graft versus host disease (GVHD) grade II-IV and moderate/severe chronic GvHD was respectively 92%, 17% and 15%...
February 5, 2018: Biology of Blood and Marrow Transplantation
Nailyn Rasool, Katherine Boudreault, Simmons Lessell, Sashank Prasad, Dean M Cestari
BACKGROUND: Tacrolimus (FK506, Prograf) is a potent immunosuppressant, which inhibits cytokine synthesis and blocks T-cell development. Optic neuropathy from tacrolimus toxicity is very uncommon but, when present, can result in severe vision loss. METHODS: Case series and review of the literature. RESULTS: We present 3 patients with tacrolimus optic neuropathy after bone marrow transplantation complicated by graft-vs-host disease and demonstrate the differing clinical and radiologic presentation of this presumed toxic optic neuropathy...
February 7, 2018: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Hakan Ozdogu, Can Boga, Suheyl Asma, Ilknur Kozanoglu, Cigdem Gereklioglu, Mahmut Yeral, Nurhilal Turgut Buyukkurt, Soner Solmaz, Aslı Korur, Pelin Aytan, Erkan Maytalman, Mutlu Kasar
The Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients...
February 2018: Medicine (Baltimore)
Ana Sofia Jorge, María Suárez-Lledó, Arturo Pereira, Gonzalo Gutierrez, Francesc Fernández-Avilés, Laura Rosiñol, Noemí Llobet, Teresa Solano, Álvaro Urbano-Ispízua, Montserrat Rovira, Carmen Martínez
The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA-disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing two contemporaneous groups: PTCyMMUD (n=26) vs...
February 1, 2018: Biology of Blood and Marrow Transplantation
Ashleigh Scott, Siok-Keen Tey, Jason Butler, Glen A Kennedy
BACKGROUND / AIM: Acute gastrointestinal graft versus host disease (GI-GVHD) following haematopoietic progenitor cell transplantation (HPCT) is a common and life-threatening complication. Endoscopic biopsy of the gastrointestinal tract is required for diagnosis. However, clear evidence to optimise this diagnostic approach is lacking, leading to variation in diagnostic sensitivity between institutions. We aimed to assess the clinical, endoscopic and histological findings of endoscopies performed for suspected acute GI-GVHD at our institution to better define the optimal use of this strategy...
February 1, 2018: Biology of Blood and Marrow Transplantation
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