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Zeller MP, Ellingham D, Devine D, Lozano M, Lewis P, Zhiburt E, van der Linde L, Goldman M, Nakamura A, Inoue S, Takikawa M, Nakajima K, Turek P, Řeháček V, Sakashita AM, Kutner JM, Karim FA, Hindawi S, Jayasekara SBA, Merz EM, Gross S, Woimant G, Djoudi R, Byabazaire KD, Irving DO, Abdrakhmanova S, Khalykova A, Yilmaz S, Örűç NE, Huaynalaya IP, Ramirez LAS, Chuhriiev A. Vox Sanguinis International Forum on Donor Incentives: Summary. Vox Sang 2020; 115:339-344. [PMID: 32394471 DOI: 10.1111/vox.12868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zeller MP, Ellingham D, Devine D, Lozano M, Lewis P, Zhiburt E, der Linde L, Goldman M, Nakamura A, Inoue S, Takikawa M, Nakajima K, Turek P, Řeháček V, Sakashita AM, Kutner JM, Karim FA, Hindawi S, Jayasekara SBA, Merz E, Gross S, Woimant G, Djoudi R, Byabazaire KD, Irving DO, Abdrakhmanova S, Khalykova A, Yilmaz S, Örűç NE, Huaynalaya IP, Ramirez LAS, Chuhriiev A. Vox Sanguinis International Forum on Donor Incentives. Vox Sang 2020; 115:e1-e18. [DOI: 10.1111/vox.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Delaney M, Apelseth TO, Bonet Bub C, Cohn CS, Dunbar NM, Mauro Kutner J, Murphy M, Perelman I, Selleng K, Staves J, Wendel S, Ziman A. Red-blood-cell alloimmunization and prophylactic antigen matching for transfusion in patients with warm autoantibodies. Vox Sang 2020; 115:515-524. [PMID: 32249930 DOI: 10.1111/vox.12914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/26/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Warm autoantibodies (WAA) are antibodies that react with an antigen on a patient's own red-blood-cells and can complicate compatibility testing whether or not they cause clinical haemolysis. The goal of this study was to understand the overall prevalence of WAA, the risk of RBC alloimmunization and determine whether RBC selection practices have an impact on alloimmunization. MATERIALS AND METHODS Records of patients (>1 year of age) with an indirect antibody detection test (IAT) and serologic evidence of WAA over a 10-year-period were included. Eight centres from 5 countries collectively reviewed 1 122 245 patients who had an IAT. RESULTS Of patients having IAT, 1214 had WAA (0·17%). Transfusion information for 1002 of the patients was available; 631 were transfused after identification of the WAA (63%); of the transfused patients, 390 received prophylactic antigen-matched (PAM) RBCs and 241 did not. Of the 372 patients with WAA who were transfused and had serologic testing 30+ days following transfusion (30-2765 days), 56 developed new RBC alloimmunization (15·1%). Patients who were transfused using a PAM strategy were not protected from new RBC alloimmunization [14·6% (31 of 212 patients) having PAM transfusion approach compared with those not receiving PAM approach (15·6%, 25 of 160 patients, P = 0·8837)]. CONCLUSIONS The prevalence of WAA in patients having an IAT is low (<1%). A significant portion of patients with WAA form new RBC alloimmunization (15·1%); however, the use of PAM approach for RBC selection was not found to be protective against new alloimmunization.
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Zalpuri S, Romeijn B, Allara E, Goldman M, Kamel H, Gorlin J, Vassallo R, Grégoire Y, Goto N, Flanagan P, Speedy J, Buser A, Kutner JM, Magnussen K, Castrén J, Culler L, Sussmann H, Prinsze FJ, Belanger K, Compernolle V, Tiberghien P, Cardenas JM, Gandhi MJ, West KA, Lee C, James S, Wells D, Sutor LJ, Wendel S, Coleman M, Seltsam A, Roden K, Steele WR, Bohonek M, Alcantara R, Di Angelantonio E, den Hurk K. Variations in hemoglobin measurement and eligibility criteria across blood donation services are associated with differing low‐hemoglobin deferral rates: a BEST Collaborative study. Transfusion 2020; 60:544-552. [DOI: 10.1111/trf.15676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 12/22/2022]
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Crusoe EDQ, Higashi F, Martinez G, Bittencourt R, Pinto Neto JV, Sousa L, Santucci R, Magalhães RJP, Colli G, Nunes RFM, Ribeiro G, Nicacio J, Zanella KR, Kutner JM, Magalhaes A, Leao D, Hallack Neto AE, Braga W, Souza EG, Guimaraes AJAM, Durigon GS, Laks D, Maiolino A, Hungria VTDM. Superiority of the triple combination of bortezomib, cyclophosphamide and dexamethasone versus cyclophosphamide, thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma, eligible for transplantation. Hematol Transfus Cell Ther 2019; 42:118-124. [PMID: 31537476 PMCID: PMC7248497 DOI: 10.1016/j.htct.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/05/2018] [Accepted: 05/01/2019] [Indexed: 11/30/2022] Open
Abstract
Background The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. Methods We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. Results We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p = 0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. Conclusion Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.
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Santos LD, Bub CB, Aravechia MG, Bastos EP, Kutner JM, Castilho L. The rare holley antibody associated with a severe hemolytic transfusion reaction: the importance of this antibody identification to find a compatible blood unit. EINSTEIN-SAO PAULO 2019; 18:eRC4582. [PMID: 31531557 PMCID: PMC6905162 DOI: 10.31744/einstein_journal/2020rc4582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/30/2019] [Indexed: 11/05/2022] Open
Abstract
The correct identification of erythrocyte antibodies is fundamental for the searching for compatible blood and haemolytic transfusion reactions prevention. Antibodies against antigens of high prevalence are difficult to identify because of the rarity of their occurrence and unavailability of negative red cells for confirmation. We report a case of 46-years-old woman, diagnosed with hemoglobinopathy, and who had symptomatic fall in hemoglobin levels (5.3g/dL) after blood transfusion suggestive of transfusion reaction. The patient's blood type was O RhD-positive. Irregular antibody screening was positive and demonstrated a panreaction against all erythrocytes tested, but this result was not reactive with dithiothreitol. Using negative red cells for antigens of high prevalence of our inventory we could identify in the serum of the same erythrocytes an anti-Holley antibody associated with anti-E. Molecular analysis confirmed that the patient was negative for E and Holley antigens. The crossmath with compatible units confirmed the results. Holley is a high prevalence antigen of the Dombrock blood system whose negative phenotype is extremely rare in all populations and is associated with hemolytic transfusion reactions. This is an antibody that is difficult to identify because laboratories need to have experience in solving complex cases, and have available a large stock of rare sera and erythrocytes, as well other tools such as enzymes, thiol reagents and molecular tests. The correct identification of a rare antibody is initial and mandatory for searching of compatible donors, and to guarantee a satisfactory transfusional support.
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Kerbauy LN, Kerbauy MN, Bautzer V, Chapchap EC, de Mattos VRP, da Rocha JDA, Esteves I, Kutner JM, Kerbauy FR, Ribeiro AAF, Machado CM, Hamerschlak N, Santos FPDS. Severe hemorrhagic cystitis caused by the BK polyomavirus is associated with decreased survival post‐allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2019; 21:e13101. [DOI: 10.1111/tid.13101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 12/17/2022]
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De Vooght KMK, Lozano M, Bueno JL, Alarcón A, Romera I, Suzuki K, Zhiburt E, Holbro A, Infanti L, Buser A, Hustinx H, Deneys V, Frélik A, Thiry C, Murphy M, Staves J, Selleng K, Greinacher A, Kutner JM, Bonet Bub C, Castilho L, Kaufman RM, Colling ME, Perseghin P, Incontri A, Dassi M, Brilhante D, Macédo A, Cserti-Gazdewich C, Pendergrast JM, Hawes J, Lundgren MN, Storry JR, Jain A, Marwaha N, Sharma RR. International Forum on typing and matching strategies in patients on anti-CD38 monoclonal therapy. Vox Sang 2018; 113. [PMID: 29947125 DOI: 10.1111/vox.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Vooght KMK, Lozano M, Bueno JL, Alarcón A, Romera I, Suzuki K, Zhiburt E, Holbro A, Infanti L, Buser A, Hustinx H, Deneys V, Frélik A, Thiry C, Murphy M, Staves J, Selleng K, Greinacher A, Kutner JM, Bonet Bub C, Castilho L, Kaufman R, Colling ME, Perseghin P, Incontri A, Dassi M, Brilhante D, Macêdo A, Cserti-Gazdewich C, Pendergrast JM, Hawes J, Lundgren MN, Storry JR, Jain A, Marwaha N, Sharma RR. Vox Sanguinis International Forum on typing and matching strategies in patients on anti-CD38 monoclonal therapy: summary. Vox Sang 2018; 113:492-498. [PMID: 29781081 DOI: 10.1111/vox.12653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kerbauy MN, Kerbauy LN, Esteves I, Rocha JD, Stanzione RL, Rodrigues M, Fernandes JF, Kutner JM, Sobrinho JJ, Mantovani LFAL, Kerbauy FR, Ribeiro AF, Hamerschlak N. Hospital Length of Stay and Impact of Readmission in the First 100 Days of Allogeneic Stem Cell Transplantation: Comparison among Alternative Donor in Pediatric and Adult Population. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cohn CS, Dumont LJ, Lozano M, Marks DC, Johnson L, Ismay S, Bondar N, T'Sas F, Yokoyama APH, Kutner JM, Acker JP, Bohonek M, Sailliol A, Martinaud C, Pogłód R, Antoniewicz-Papis J, Lachert E, Pun PBL, Lu J, Cid J, Guijarro F, Puig L, Gerber B, Alberio L, Schanz U, Buser A, Noorman F, Zoodsma M, van der Meer PF, de Korte D, Wagner S, O'Neill M. Vox Sanguinis International Forum on platelet cryopreservation: Summary. Vox Sang 2017; 112:684-688. [PMID: 28929502 DOI: 10.1111/vox.12533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yazer MH, van de Watering L, Lozano M, Sirdesai S, Rushford K, Wood EM, Yokoyama AP, Kutner JM, Lin Y, Callum J, Cserti-Gazdewich C, Lieberman L, Pendergrast J, Pendry K, Murphy MF, Selleng K, Greinacher A, Marwaha N, Sharma R, Jain A, Orlin Y, Yahalom V, Perseghin P, Incontri A, Masera N, Okazaki H, Ikeda T, Nagura Y, Zwaginga JJ, Pogłod R, Rosiek A, Letowska M, Yuen J, Cid J, Harm SK, Adhikari P. Development of RBC transfusion indications and the collection of patient-specific pre-transfusion information. Vox Sang 2017; 112:e22-e47. [PMID: 28524359 DOI: 10.1111/vox.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yazer MH, van de Watering L, Lozano M, Sirdesai S, Rushford K, Wood EM, Yokoyama AP, Kutner JM, Lin Y, Callum J, Cserti-Gazdewich C, Lieberman L, Pendergrast J, Pendry K, Murphy MF, Selleng K, Greinacher A, Marwaha N, Sharma R, Jain A, Orlin Y, Yahalom V, Perseghin P, Incontri A, Masera N, Okazaki H, Ikeda T, Nagura Y, Zwaginga JJ, Pogłod R, Rosiek A, Letowska M, Yuen J, Cid J, Harm SK, Adhikari P. Development of RBC transfusion indications and the collection of patient-specific pre-transfusion information: summary. Vox Sang 2017; 112:487-494. [PMID: 28524235 DOI: 10.1111/vox.12496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Levi JE, Lira SM, Bub CB, Polite MB, Terzian CC, Kutner JM. Contrasting HCV and HIV seroepidemiology in 11 years of blood donors screening in Brazil. Transfus Med 2017; 27:286-291. [PMID: 28524366 DOI: 10.1111/tme.12427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 04/07/2017] [Accepted: 04/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blood donors are, in principle, healthy individuals who may be revealed as infectious for blood-borne agents by the laboratory screening process, depicting the asymptomatic burden of the disease. Therefore, monitoring hepatitis C virus (HCV)-infected donor and human immunodeficiency virus (HIV)-infected donor and associating to their demographical and behavioural characteristics may shed light on the dynamics and contemporary changes in these viruses' epidemiology. METHODS Donors presenting repeatedly reactive HCV or HIV serology/nucleic acid testing (NAT) screening results were submitted to confirmatory testing. Confirmed positive donors were invited to return to the blood bank for notification and counselling when a follow-up sample was obtained and an interview performed to eventually disclose potential risks. HCV- or HIV-infected donors identified over 11 years of screening (2004-2015) were evaluated for demographic and behavioural parameters. RESULTS In the period, 139 160 donations were screened, and 36 (0.025%) were found positive for HIV, stemming from 29 male and 7 female donors. Among those, eight subjects were repeat donors. A total of 95 donations were found repeatedly reactive for HCV (0.068%), obtained from 60 men and 35 women. Noticeably, in despite of a higher HCV prevalence in the donor population, the incidence of HIV among repeat donors was 10 times that of HCV (18 × 1.6/100 000 persons-year, respectively). On average, HIV-seroreactive men were found to be younger (mean = 34 years old) than women (mean = 40 years old). A total of 10 donors acknowledged sexual behaviours not previously informed, including 2 who were aware of their HIV-positive status and another 2 who admitted to be seeking HIV testing. No window period donation was verified. DISCUSSION The majority of the HIV-infected donors are young males who deny risk factors in the interview and also ignore the confidence self-exclusion opportunity. As they may reiterate this behaviour in serial donations, use of the most sensitive laboratory testing is justified in this setting.
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Ribeiro AF, Fernandes JF, da Silva CC, Sobrinho JJ, Kutner JM, Rodrigues M, Esteves I, Kerbauy FR, Kerbauy MN, Kerbauy LN, Hamerschlak N. Unmanipulated Haploidentical Transplants Using Post-Transplant Cyclophosphamide CAN Safely Extend Hematopoietic STEM CELL Transplantation for Patients Without an HLA Matched DONOR: Preliminary Results in Brazil. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cruz RDO, Mota MA, Conti FM, Pereira RAD, Kutner JM, Aravechia MG, Castilho L. Prevalence of erythrocyte alloimmunization in polytransfused patients. EINSTEIN-SAO PAULO 2016; 9:173-8. [PMID: 26760811 DOI: 10.1590/s1679-45082011ao1777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. METHODS A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The records of all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. RESULTS During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most common specificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolated or combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. CONCLUSION Polytransfused patients have a high probability of developing alloantibodies whether alone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to prevent alloimmunization and hemolytic transfusion reactions.
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Levi JE, Cabral SPN, Nishiya A, Ferreira S, Romano CM, Polite MBC, Pereira RAA, Mota MA, Kutner JM. Absence of nonprimate hepacivirus-related genomes in blood donors seroreactive for hepatitis C virus displaying indeterminate blot patterns. J Viral Hepat 2014; 21:e164-6. [PMID: 24689976 DOI: 10.1111/jvh.12252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 02/13/2014] [Indexed: 12/09/2022]
Abstract
Despite intensive search, no primate homologue to the Hepatitis C Virus (HCV) has ever been found. The search for a zoonotic origin for HCV has been renewed recently when a virus, now known as non-primate hepacivirus (NPHV), with a high homology to HCV was found in dogs. A variable proportion of anti-HCV reactive blood donors submitted to the immunoblot (IB) to confirm their HCV status, present indeterminate results. The degree of homology between HCV and NPHV suggests that humans may be infected by NPHV or NPHV-like viruses. Maximum similarity between NHPV and HCV is observed in the nonstructural regions 3 and 5. Peptides representing both domains are present in IB assays, so it is reasonable to suppose that blood donors harboring such viruses may display cross-reactivity to the HCV antigenic fractions. Fifty-nine plasma samples from blood donors found reactive for anti-HCV and presenting IB indeterminate results were submitted to five distinct PCR reactions under low-stringency conditions, employing primers targeting GBV-C 5'UTR and NS3, Flavivirus-genus NS5 and NPHV 5'UTR and NS3. No amplification was obtained with all primer pairs tested except for five samples that amplified both 5'UTR and NS3 fragments from GBV-C. Unbiased next-generation sequencing may prove or rule out the existence of HCV-related viruses in IB indeterminate samples.
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Hosing C, Saliba RM, Hamerschlak N, Kutner JM, Sakashita AM, Kondo AT, Rodrigues M, Fernande JF, Chiattone A, Chiattone VC, Barros JC, Chiattone CS, Chiattone R, Popat U, Qazilbash M, Tang XW, Wu D, Majilis A, de Lima M, Anguita T. Peripheral blood stem cell yield calculated using preapheresis absolute CD34+ cell count, peripheral blood volume processed, and donor body weight accurately predicts actual yield at multiple centers. Transfusion 2014; 54:1081-7. [PMID: 24118027 DOI: 10.1111/trf.12435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate prediction of stem cell yield is important for planning leukapheresis procedures. A formula has been published (Pierelli et al., Vox Sang 2006;91:126-34) to estimate the CD34+ dose collected on the first day of leukapheresis that was based on the preapheresis peripheral blood (PB) CD34+ counts, the blood volume processed, and the donor's weight. The aim of this study was to assess the predictive value of this formula. STUDY DESIGN AND METHODS Data were retrospectively collected on 1126 consecutive PB stem cell harvests conducted at five institutions. Information on age, sex, diagnosis, weight, preapheresis absolute peripheral CD34+ count, total blood volume processed, and CD34+ cells harvested per kilogram of body weight on the first day of apheresis was collected. RESULTS Among donors at least 18 years old, Pearson's correlation coefficient (r) between actual yield (AY) and predicted yield (PY) was 0.76. To characterize this correlation, AY and PY were classified as being within the conventionally acceptable CD34+ doses (>2 × 10(6) -5 × 10(6) cells/kg), below this range (≤2 × 10(6) cells/kg), or above it (>5 × 10(6) cells/kg). The positive predictive value (PPV) of PY was estimated considering the distribution of AY as the "gold standard." PPV was relatively high for PY of more than 5 × 10(6) cells/kg (85%), moderate for PY of not more than 2 × 10(6) cells/kg (72%), and low for PY more than 2 × 10(6) to 5 × 10(6) cells/kg (56%). A consistent pattern was observed within institutions. CONCLUSION The formula of Pierelli et al. is associated with a PPV that is high, moderate, and relatively low for the corresponding predicted CD34+ doses.
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Rodrigues M, Costa EM, de Moura Almeida A, Alves de Assis R, Cardoso Santos FN, Oliveira EA, da Cunha Pasqualin D, Bezerra AM, Esteves I, Barroso KS, Kerbauy FR, Kutner JM, Ribeiro AF, Sobrinho JJ, Torres M, Ganc A, Hamerschlak N. Endoscopy Biopsy in Different Sites for the Diagnosis of Lower and Upper Gastrointestinal Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2014. [DOI: 10.1016/j.bbmt.2013.12.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mota M, Dezan M, Valgueiro MC, Sakashita AM, Kutner JM, Castilho L. RHD allelic identification among D-Brazilian blood donors as a routine test using pools of DNA. J Clin Lab Anal 2012; 26:104-8. [PMID: 22467325 DOI: 10.1002/jcla.21489] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND RHD alleles leading to a reduced expression of D antigen of the red blood cell (RBC) surface may be erroneously typed as D- by serology and may cause anti-D immunizations when transfused to recipients. METHODS To determine the occurrence of such alleles among apparent D- blood donors, molecular typing was implemented as a routine test using a pool of DNA. A total of 2,450 pretyped D- samples were tested in pools of 10 for the RHD-specific polymorphism in intron 4 and exon 7. Samples in polymer chain reaction (PCR) positive pools were individually reevaluated by exon-specific PCRs, sequencing, and serologic methods. RESULTS Among 2,450 serologically D- blood donor samples tested, 101 (4.1%) carried the RHD gene. Nonfunctional RHD (RHDψ, RHD*CE(2-9)-D, and RHD*CE(3-7)-D), different weak D alleles such as RHD*weak D type 1, RHD*weak D type 4.3, RHD*weak D type 5, RHD*weak D type 38, and RHD*DEL were identified. CONCLUSION We employed a PCR-based assay for RHD as a routine test using pools of ten DNA blood donor samples. The integration of RHD genotyping into the routine screening program using pools of DNA samples was straightforward. As a consequence, 19 (0.8%) blood donors carrying a weak D and Del phenotypes with the potential of causing anti-D immunizations in recipients were reclassified as D+. For each population, it would be necessary to adapt the RHD genotyping strategy to the spectrum of prevalent alleles.
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Fernandes JF, Kerbauy FR, Ribeiro AAF, Kutner JM, Camargo LFA, Stape A, Troster EJ, Zamperlini-Netto G, Azambuja AMPD, Carvalho B, Dorna MDB, Vilela MDS, Jacob CMA, Costa-Carvalho BT, Cunha JM, Carneiro-Sampaio MM, Hamerschlak N. Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience. EINSTEIN-SAO PAULO 2011; 9:140-4. [PMID: 26760806 DOI: 10.1590/s1679-45082011ao2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. METHODS Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. RESULTS Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood: n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftment due to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. CONCLUSION Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.
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Sakashita AM, Kondo AT, Ribeiro AAF, Cipolletta ANF, Colesanti MV, Hamerschlak N, Kutner JM. Factors affecting autologous peripheral blood hematopoietic stem cell collections by large-volume leukapheresis: a single center experience. EINSTEIN-SAO PAULO 2011; 9:196-200. [PMID: 26760815 DOI: 10.1590/s1679-45082011ao1932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate factors affecting peripheral blood hematopoietic stem cell yield in patients undergoing large-volume leukapheresis for autologous peripheral blood stem cell collection. METHODS Data from 304 consecutive autologous peripheral blood stem cell donors mobilized with hematopoietic growth factor (usually G-CSF), associated or not with chemotherapy, at Hospital Israelita Albert Einstein between February 1999 and June 2010 were retrospectively analyzed. The objective was to obtain at least 2 × 106 CD34+ cells/kg of body weight. Pre-mobilization factors analyzed included patient's age, gender and diagnosis. Post mobilization parameters evaluated were pre-apheresis peripheral white blood cell count, immature circulating cell count, mononuclear cell count, peripheral blood CD34+ cell count, platelet count, and hemoglobin level. The effect of pre and post-mobilization factors on hematopoietic stem cell collection yield was investigated using logistic regression analysis (univariate and multivariate approaches). RESULTS Pre-mobilization factors correlating to poor CD34 + cell yield in univariate analysis were acute myeloid leukemia (p = 0.017) and other hematological diseases (p = 0.023). Significant post-mobilization factors included peripheral blood immature circulating cells (p = 0.001), granulocytes (p = 0.002), hemoglobin level (p = 0.016), and CD34+ cell concentration (p < 0.001) in the first harvesting day. However, according to multivariate analysis, peripheral blood CD34+ cell content (p < 0.001) was the only independent factor that significantly correlated to poor hematopoietic stem cell yield. CONCLUSION In this study, peripheral blood CD34+ cell concentration was the only factor significantly correlated to yield in patients submitted to for autologous collection.
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Perini GF, Santos FPDS, Esteves I, Nascimento CMDBD, Rodrigues M, Assis RAD, Helman R, Kutner JM, Ribeiro AAF, Hamerschlak N. Use of gemtuzumab ozogamycin combined with conventional chemotherapy in patients with acute myeloid leukemia. EINSTEIN-SAO PAULO 2011; 9:190-5. [DOI: 10.1590/s1679-45082011ao1987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To analyze the outcome of patients treated with gemtuzumab ozogamycin combined with conventional therapy treated at Hospital Israelita Albert Einstein. Methods: 14 patients who had high risk features (secondary leukemia, unfavorable cytogenetics, and refractory disease) were treated with gemtuzumab ozogamycin combined with conventional therapy and their outcome was analysed by reviewing their medical records. Results: Overall response rate was 58%, with 43% achieving complete response, with a median follow-up of 11 months, event-free survival was 3 months. Eleven patients died, 6 of them due to refractory acute myeloid leukemia. Only four patients presented with grade 3 to 4 toxicities and only one patient had sinusoidal obstruction syndrome after bone marrow transplant. Conclusion: gemtuzumab ozogamycin combined with chemotherapy is a feasible treatment regimen in acute myeloid leukemia patients. However, further studies are necessary to clarify which subgroup of patients may beneft from this treatment.
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Hamerschlak N, Rodrigues M, Moraes DA, Oliveira MC, Stracieri ABPL, Pieroni F, Barros GMN, Madeira MIA, Simões BP, Barreira AA, Brum DG, Ribeiro AAF, Kutner JM, Tylberi CP, Porto PP, Santana CL, Neto JZ, Barros JC, Paes AT, Burt RK, Oliveira EA, Mastropietro AP, Santos AC, Voltarelli JC. Brazilian experience with two conditioning regimens in patients with multiple sclerosis: BEAM/horse ATG and CY/rabbit ATG. Bone Marrow Transplant 2009; 45:239-48. [DOI: 10.1038/bmt.2009.127] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mota M, Bley C, Aravechia MG, Hamerschlak N, Sakashita A, Kutner JM, Castiho L. Autoantibody formation after alloimmunization inducing bystander immune hemolysis. Immunohematology 2009; 25:9-12. [PMID: 19856726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The development of RBC autoantibodies resulting from or associated with allogeneic blood transfusions is not an easily determined complication of RBC transfusions. This report discusses one patient who developed RBC autoantibodies in association with an allogeneic blood transfusion and alloimmunization leading to a temporary bystander immune hemolysis. A 72-year-old woman was hospitalized as a result of severe anemia and received two units of ABO- and D-compatible RBCs. She had a history of two pregnancies 40 years before, but no history of RBC transfusion, and her antibody screen was negative. On the tenth day after transfusion her hemoglobin dropped, and alloanti-c was identified in her serum and eluate. At this time she received another two units of compatible blood according to her phenotype (group O, R1R1, K:-1). After 48 hours, she developed joint pain, pyrexia, and hemoglobinuria, and her Hb dropped from 9.2 g/dL to 5.3 g/ dL. The direct antiglobulin test was positive, an IgG autoantibody was present in the eluate, and the antibody investigation revealed the presence of anti-Jk(b) in addition to the previously identified alloanti-c. Her genotype was determined, and, based on the findings, two additional units were selected, found to be compatible, and transfused without incident. Transfusions were discontinued, and she was treated with IVIG and corticosteroids. Her Hb increased to 9.7 g/dL, and the patient made an uneventful recovery. It was concluded that transfusion of incompatible RBCs induced the formation of an autoantibody in this patient, resulting in lysis of bystander RBCs. The need for additional blood transfusion was successfully avoided by treatment with IVIG, steroid therapy, and rituximab.
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