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Stewart B, Verdugo M, Guthrie KA, Appelbaum F, Deeg HJ. Outcome following haematopoietic cell transplantation in patients with myelodysplasia and del (5q) karyotypes. Br J Haematol 2003; 123:879-85. [PMID: 14632779 DOI: 10.1046/j.1365-2141.2003.04713.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The deletion (5q) karyotype [del (5q)] in patients with myelodysplastic syndrome (MDS) is considered a good risk feature, while the impact of del (5q) combined with other karyotypic abnormalities [del (5q)+] is less well defined. We analysed the outcome of haematopoietic cell transplants (HCT) in patients with MDS with del (5q) or del (5q)+. Fifty-seven patients, aged 6-72 years, with MDS and del (5q) abnormalities received HCT from related (n = 32) or unrelated (n = 25) donors. By French-American-British (FAB) criteria, 27 patients had refractory anaemia (RA), 10 RA with excess blasts (RAEB), eight RAEB in transformation (RAEB-T) and 12 acute myeloid leukaemia evolving from MDS (tAML). Non-relapse mortality at 1-year post-transplantation was 30% for del (5q) and 38% for del (5q)+ patients. Relapse occurred in one of 20 del (5q) patients and 15 of 37 del (5q)+ patients (P = 0.001). After adjusting for del (5q) status, blast count (<5%) was the only factor significantly associated with relapse-free survival. Patients with del (5q), either as a '5q- syndrome' or with MDS in general, had better outcomes than did patients with del (5q)+. The indication for transplantation in patients with del (5q) was generally severe cytopenias, compared with disease progression to a more advanced FAB stage in patients with del (5q)+. Conceivably, outcome for patients with del (5q)+ would be improved with transplantation earlier in the disease course.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Aged
- Anemia, Refractory/genetics
- Anemia, Refractory/mortality
- Anemia, Refractory/surgery
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/mortality
- Anemia, Refractory, with Excess of Blasts/surgery
- Cause of Death
- Child
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human, Pair 5
- Disease-Free Survival
- Female
- Graft vs Host Disease
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/surgery
- Male
- Middle Aged
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Myelodysplastic Syndromes/surgery
- Recurrence
- Transplantation Conditioning
- Treatment Outcome
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77
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Bloomfield CD. Genetics in the management of adult de novo AML. CLINICAL ADVANCES IN HEMATOLOGY & ONCOLOGY : H&O 2003; 1:640, 645-6. [PMID: 16258460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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78
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Guardiola P, Kurre P, Vlad A, Cayuela JM, Espérou H, Devergie A, Ribaud P, Socié G, Richard P, Traineau R, Storb R, Gluckman E. Effective graft-versus-leukaemia effect after allogeneic stem cell transplantation using reduced-intensity preparative regimens in Fanconi anaemia patients with myelodysplastic syndrome or acute myeloid leukaemia. Br J Haematol 2003; 122:806-9. [PMID: 12930393 DOI: 10.1046/j.1365-2141.2003.04503.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allogeneic transplantation is the only curative treatment for Fanconi anaemia (FA) patients who develop myeloid malignancies. Dose-intensive preparative regimens, to decrease disease recurrence, lead to unacceptable transplant-related toxicity in FA. We report the outcome of three FA patients with such malignancies who underwent transplantation with reduced-intensity preparative regimens. This approach was well tolerated, even as second transplantations, and resulted in complete leukaemic remissions. However, the graft-versus-leukaemia effect was associated with fatal graft-versus-host disease. Even after transplantation, myeloid malignancies remain associated with a poor outcome in FA, and this argues in favour of early intervention when suitable donors are available.
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79
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Sanli H, Ekmekci P, Kusak F, Arat M, Beksaç M. Hyperkeratosis of the Nipple Associated with Chronic Graft versus Host Disease after Allogeneic Haematopoietic Cell Transplantation. Acta Derm Venereol 2003; 83:385-6. [PMID: 14609115 DOI: 10.1080/00015550310012665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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80
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Petti MC, Tafuri A, Latagliata R, Aloe Spiriti MA, Montefusco E, Mancini M, Meloni G, Petrucci MT, Spadea A, Redi R, Alimena G, Mandelli F. High-dose hydroxyurea in the treatment of poor-risk myeloid leukemias. Ann Hematol 2003; 82:476-480. [PMID: 12835916 DOI: 10.1007/s00277-003-0693-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2003] [Accepted: 05/15/2003] [Indexed: 11/28/2022]
Abstract
The aim of the study was to evaluate the antileukemic effectiveness and toxicity of high-dose hydroxyurea (HHY) and to assess its acute toxicity. Between August 1997 and October 1998, 12 consecutive adult patients (>18 years) with high-risk acute myeloid leukemia (AML) (four patients in first early relapse, seven patients with secondary AML, and one patient with de novo AML concomitant to a lymphoproliferative disorder) were enrolled to receive a single course of HY (100 mg/kg per day) until bone marrow aplasia or for a maximum of 30 days. Of the 12 patients, 5 (41.6%) achieved complete remission (CR), 1 achieved partial remission (PR), 4 were resistant to treatment, and 2 died during induction from infection. No patient with relapsed AML achieved CR, while it was achieved by five of eight patients with secondary AML at diagnosis; five of six MDR1+ patients achieved CR. As concerns follow-up of the CR patients, one did not receive any further treatment and died in CR from pulmonary aspergillosis, and one with a concomitant chronic lymphocytic leukemia (CLL) received two courses of FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) regimen with disappearance of the clonal Ig rearrangement, but relapsed after 11 months and died from pneumonia. The remaining three patients were consolidated with two courses of high-dose cytosine arabinoside (AraC), followed by peripheral blood stem cell transplantation (PBSCT) in one patient. One of them relapsed after 3 months, while the other two are still in continuous complete remission (CCR) after 16 and 28 months, respectively. This study has demonstrated the safety and efficacy of HHY in inducing CR in AML patients with unfavorable prognosis. Despite the small number of patients, these encouraging results warrant further studies.
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MESH Headings
- Adult
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Bone Marrow Transplantation
- Cytogenetic Analysis
- Dose-Response Relationship, Drug
- Female
- Gene Expression
- Genes, MDR
- Humans
- Hydroxyurea/administration & dosage
- Hydroxyurea/adverse effects
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/surgery
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/etiology
- Lymphoproliferative Disorders/complications
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Neoplasm Recurrence, Local
- Prognosis
- Remission Induction
- Treatment Outcome
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81
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Lie SO, Abrahamsson J, Clausen N, Forestier E, Hasle H, Hovi L, Jonmundsson G, Mellander L, Gustafsson G. Treatment stratification based on initial in vivo response in acute myeloid leukaemia in children without Down's syndrome: results of NOPHO-AML trials. Br J Haematol 2003; 122:217-25. [PMID: 12846889 DOI: 10.1046/j.1365-2141.2003.04418.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three consecutive protocols for childhood acute myeloid leukaemia (AML) have been used in the Nordic countries since 1984: the Nordic Society for Paediatric Haematology and Oncology (NOPHO)-AML84 was of moderate intensity, NOPHO-AML88 of high intensity with upfront loading and aggressive consolidation. NOPHO-AML93 utilized the same treatment blocks as NOPHO-AML88, but after the first block those children with a hypoplastic non-leukaemic bone marrow were allowed to recover from aplasia. Poor responders received intensified induction therapy. Between January 1993 and December 2000, 219 children without Down's syndrome were entered on NOPHO-AML93. Compared with NOPHO-AML88, the event-free survival (EFS) at 7 years increased from 41% to 49% (P = 0.06) and 7-year overall survival increased from 47% to 64% (P < 0.01). Toxic death during induction was reduced from 10% to 3%. Survival was similar in patients receiving stem cell transplantation or chemotherapy only in first remission. The major prognostic factors in NOPHO-AML93 were response to therapy and cytogenetics. A total of 67% of patients achieved remission after the first induction course and showed an EFS of 56% compared with 35% in those not in remission (P < 0.01). Cytogenetic results were obtained in 95% of patients. Patients with t(9;11) (p22;q23) (n = 16) experienced a significantly better EFS (86%) than other cytogenetic groups. The overall outcome was improved by employing the previous toxic protocol with different timings, and through individualizing therapy according to the initial response of the patient.
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MESH Headings
- Acute Disease
- Antimetabolites, Antineoplastic/therapeutic use
- Child
- Child, Preschool
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 9
- Clinical Protocols
- Cytarabine/therapeutic use
- Cytogenetic Analysis
- Disease-Free Survival
- Drug Administration Schedule
- Female
- Humans
- Infant
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/surgery
- Leukemia, Myeloid/therapy
- Male
- Patient Selection
- Prognosis
- Remission Induction
- Stem Cell Transplantation
- Survival Rate
- Translocation, Genetic
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82
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Ditschkowski M, Einsele H, Schwerdtfeger R, Bunjes D, Trenschel R, Beelen DW, Elmaagacli AH. Improvement of inflammatory bowel disease after allogeneic stem-cell transplantation. Transplantation 2003; 75:1745-7. [PMID: 12777867 DOI: 10.1097/01.tp.0000062540.29757.e9] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Because causes of inflammatory bowel disease (IBD) remain obscure and a curative therapy is still lacking, the influence of stem-cell transplantation (SCT) on IBD is of major interest. We retrospectively analyzed the course of seven patients with Crohn's disease and four patients with idiopathic ulcerative colitis who underwent allogeneic SCT between July 1994 and August 2002 for acute and chronic myeloid leukemia and myelodysplastic syndrome. After a median follow-up of 34 months posttransplantation, 10 patients are alive. None of the patients showed IBD activity after SCT, except one patient with mild persistent symptoms of Crohn's disease early after transplant. Colonoscopy after complete discontinuation of prophylactic posttransplant immunosuppression revealed no pathologic findings. These observations imply that host immune dysregulation plays a central role in the perpetuation of IBD. It may be influenced by the implementation of a new allogeneic immune system resulting from the transplantation of hematopoietic stem cells.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Colitis, Ulcerative/complications
- Colitis, Ulcerative/physiopathology
- Crohn Disease/complications
- Crohn Disease/physiopathology
- Female
- Humans
- Inflammatory Bowel Diseases/complications
- Inflammatory Bowel Diseases/pathology
- Inflammatory Bowel Diseases/physiopathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/surgery
- Male
- Retrospective Studies
- Stem Cell Transplantation
- Transplantation, Homologous
- Treatment Outcome
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83
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Bertz H, Potthoff K, Finke J. Allogeneic stem-cell transplantation from related and unrelated donors in older patients with myeloid leukemia. J Clin Oncol 2003; 21:1480-4. [PMID: 12697870 DOI: 10.1200/jco.2003.09.110] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To improve outcome for older patients with poor-prognosis myeloid malignancies by using allogeneic hematopoietic stem-cell transplantation (alloHSCT) from unrelated and sibling donors after reduced-intensity conditioning (RIC). PATIENTS AND METHODS Nineteen older patients (median age, 64 years; range, 60 to 70 years) with active myeloid malignancies were treated with an RIC regimen that was based on fludarabine, melphalan, and carmustine followed by alloHSCT from matched unrelated (n = 12) or sibling donors (n = 7). Before transplantation, patients had a median of 50% bone marrow blasts (range, 0% to 70%). Graft-versus-host-disease (GvHD) prophylaxis consisted of cyclosporine and mycophenolate mofetil or methotrexate. Eleven of 12 patients with an unrelated donor also received anti-T-lymphocyte globulin (ATG). RESULTS Engraftment was successful for all 19 patients. Seventeen assessable patients achieved complete response (CR). Four patients experienced relapse; three achieved CR again after donor lymphocyte infusion (n = 1) or a second alloHSCT (n = 2). Six patients died as a result of relapse (n = 2), GvHD-associated complications (n = 2), or fungal infections (n = 2), resulting in a 1-year nonrelapse mortality rate of 22%. With a median follow-up of 825 days (range, 595 to 1,028 days), 13 of 19 patients are alive, resulting in a 1-year survival rate of 68% (95% confidence interval, 48% to 89%). CONCLUSION In older patients with untreated poor-prognosis leukemia, this RIC regimen combined with alloHSCT sufficiently reduces the leukemic burden, resulting in a high CR rate. When ATG is added, matched unrelated donor transplantation can be performed safely in older patients. For these patients, early transplantation after diagnosis offers a fair chance of cure.
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84
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Jacobs P, Wood L, Du Toit A, Esterhuizen K. Eradication of invasive mucormycosis--effectiveness of the Echinocandin FK463. Hematology 2003; 8:119-23. [PMID: 12745662 DOI: 10.1080/1024533031000090810] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Invasive rhinocerebral mucormycosis is a rare and often fatal opportunistic fungal infection. It is encountered in immunocompromised hosts exemplified by those with diabetes, human immunodeficiency viruses and particularly haematologic malignancies typically after high-dose chemotherapy and stem cell transplantation. In contrast to the more usual outcome with rapid progression and death. We now describe a successful eradication attributable to the use of a newly available antifungal agent. SETTING Haematology department and bone marrow transplantation unit. MATERIAL AND METHOD Two patients are contrasted. The first with acute leukaemia developed rapidly progressive facial swelling with mucormycosis proven on biopsy. Treatment over 2 months with maximally tolerated doses of amphotericin failed to halt intracranial extension and death resulted. The second, presented with acute lymphoblastic leukaemia in August 1997, underwent successful autologous bone marrow transplantation in February 1998. Relapse followed in March 1999 and after reinduction and consolidation receive a matched unrelated volunteer allograft in September 1999. A second recurrence was documented in April 2000 and in spite of achieving remission he developed a fever that was managed empirically with intravenous amphotericin and, on discharge, oral itraconazole. Left-sided facial swelling expanded rapidly and biopsy showed extensive invasion of the maxillary sinus with mucormycosis. FK463 was added on 5 June 2000 with gradual reduction in facial pain and within 1 month all clinical signs and resolved. Serial biopsies that included histopathologic investigation and microbiologic cultures confirmed eradication of the invasive mucor. In view of the potential danger of recrudescence this treatment regimen was continued through further chemotherapy and, once again disease-free, a second matched unrelated volunteer allograft took place in August 2000. Full reassessment at the time failed to demonstration any residual fungus. Engraftment was confirmed but neutropenic sepsis resulted in severe inflammatory response syndrome with progression to multiple organ dysfunction to which he succumbed without any evidence of leukaemic or systemic mycosis. CONCLUSION Echinocandin FK463 is of documented value in managing invasive candidiasis and aspergillosis. This is believed to be the first case of successful outcome with one of the angiotrophic zygomycetes.
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85
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Hänel M, Thiede C, Helwig A, Prange-Krex G, Babatz J, Haack M, Kroschinsky F, Fetscher S, Ehninger G, Bornhäuser M. Successful combination of anti-CD33 antibody (gemtuzumab ozogamicin) and minimal conditioning before second allografting in recurrent acute myeloid leukaemia. Br J Haematol 2003; 120:1093-4. [PMID: 12648086 DOI: 10.1046/j.1365-2141.2003.04208_4.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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86
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Hiltermann TJN, Bredius RGM, Gesink-vd Veer BJ, Corrin B, Rabe KF, Brahim JJ. Bilateral cavitary pulmonary consolidations in a patient undergoing allogeneic bone marrow transplantation for acute leukemia. Chest 2003; 123:929-34. [PMID: 12628896 DOI: 10.1378/chest.123.3.929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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87
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Feinstein LC, Sandmaier BM, Hegenbart U, McSweeney PA, Maloney DG, Gooley TA, Maris MB, Chauncey TR, Bruno B, Appelbaum FR, Niederwieser DW, Storb RF. Non-myeloablative allografting from human leucocyte antigen-identical sibling donors for treatment of acute myeloid leukaemia in first complete remission. Br J Haematol 2003; 120:281-8. [PMID: 12542488 DOI: 10.1046/j.1365-2141.2003.04057.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many patients with acute myeloid leukaemia (AML) in first complete remission (CR1) are ineligible for allogeneic transplantation as a result of age or medical problems other than leukaemia. Eighteen patients (median age 59 years, range 36-73 years) with de novo (n = 13) and secondary (n = 5) AML in morphological CR1, who were not candidates for conventional allografting, received non-myeloablative peripheral blood stem cell transplants from human leucocyte antigen identical sibling donors after conditioning with 2 Gy total body irradiation (TBI; n = 10) or 2 Gy TBI and 90 mg/m2 of fludarabine (n = 8). Postgrafting immunosuppression was with cyclosporine and mycophenolate mofetil. Two rejections were observed in patients not given fludarabine and one died with relapse. Overall, 10 patients died between 77 and 841 d, seven from relapse and three from non-relapse mortality (NRM). Day +100 NRM was 0% with a 1-year estimated NRM of 17%[95% confidence interval (CI) 0-35%]. The median follow-up among the eight survivors was 766 d (range, 188-1141 d). Seven of these eight survivors remain in complete remission (CR). One-year estimates of overall and progression-free survivals were 54% (95% CI 31-78%) and 42% (95% CI 19-66%) respectively. While follow-up is short, this analysis demonstrates that the procedure is sufficiently safe to be studied in a wider group of patients.
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88
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Imashuku S, Naya M, An B, Nakabayashi Y, Kuriyama K, Udeda I, Morimoto A, Hibi S, Todo S. Constitutional pericentric inversion of chromosome 9 and haemopoietic stem cell transplantation: delayed engraftment. Br J Haematol 2002; 118:1195-6. [PMID: 12199814 DOI: 10.1046/j.1365-2141.2002.36618.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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89
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Flotho C, Strahm B, Kontny U, Duffner U, Peters AMJ, Dupuis W, Niemeyer CM. Stem cell transplantation for paroxysmal nocturnal haemoglobinuria in childhood. Br J Haematol 2002; 118:124-7. [PMID: 12100135 DOI: 10.1046/j.1365-2141.2002.03543.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paroxysmal nocturnal haemoglobinuria (PNH) is a clonal haematopoietic disorder characterized by chronic or intermittent intravascular haemolysis, variable cytopenia and an increased risk of thrombosis. Stem cell transplantation (SCT) is a curative therapeutic option, but its risks must be carefully weighed against the natural course of PNH. World-wide experience with SCT for PNH in the paediatric age group is scarce. We report on two adolescents suffering from PNH with life-threatening complications who were successfully transplanted from unrelated donors. Indications and techniques of SCT in childhood PNH are discussed and an overview of the literature is given.
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90
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Auner HW, Sill H, Mulabecirovic A, Linkesch W, Krause R. Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 2002; 81:374-7. [PMID: 12185506 DOI: 10.1007/s00277-002-0484-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2002] [Accepted: 05/02/2002] [Indexed: 11/26/2022]
Abstract
It is yet undetermined whether patients with different hematological malignancies have different propensities to infectious complications after high-dose chemotherapy (HDC) and autologous hematopoietic stem cell transplantation (HSCT). We retrospectively analyzed 136 cycles of HDC and autologous HSCT in 114 patients with acute myeloid leukemia (AML, 24 cycles), non-Hodgkin's lymphoma/Hodgkin's disease (NHL/HD, 55 cycles), and multiple myeloma (MM, 57 cycles) with respect to early infectious complications. Median duration of neutropenia was longer in patients with AML and NHL/HD than in patients with MM (11 days vs 8 days) and after conditioning including total body irradiation (TBI) compared with chemotherapy only preparative regimens (11 days vs 7 days). Fever requiring antimicrobial therapy was observed in 88 percent of cycles, with fever of unknown origin (FUO) accounting for 60 percent of febrile episodes. There was no proven fungal infection, but one case of probable invasive pulmonary aspergillosis. Microbiologically documented infections were seen in 29 percent and clinically documented infections in 11 percent. Response to first-line empirical antibiotic therapy was better for FUO than for documented infections (70 percent vs 40 percent). Patients with TBI as part of their conditioning regimen had more overall infections than patients without TBI (96 percent vs 82 percent). There were no differences with respect to the type or incidence of infections between patients with AML, NHL/HD, and MM. Patients with different hematological malignancies have similar rates of early infectious complications after HDC and autologous HSCT. TBI may be associated with an increased risk for infections in the early post-transplant period.
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91
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Goetz M, Behre G, Heussel G, Steinmetz HT, Eigler A, Hiddemann W, Weiss M. Soluble tumor necrosis factor receptor type II in the early diagnosis of fever in neutropenia. Ann Hematol 2002; 81:382-5. [PMID: 12185508 DOI: 10.1007/s00277-002-0482-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2002] [Accepted: 05/13/2002] [Indexed: 11/29/2022]
Abstract
Sepsis in chemotherapy-associated neutropenia is a major cause of mortality in the treatment of acute myeloid leukemia (AML). Early diagnosis of sepsis is crucial for patient survival. We analyzed the value of prospectively measuring serum concentrations of soluble tumor necrosis factor receptor type II (sTNF-RII) in patients with AML for early diagnosis of sepsis in neutropenia. Therefore, 54 adult patients with AML and neutropenia were followed around the onset of fever. A total of 59 febrile episodes were documented. We could not demonstrate a significant increase in sTNF-RII levels prior to fever. sTNF-RII concentrations were not predictive of the severity of a febrile episode. Based on these data, we cannot recommend the routine screening of sTNF-RII for early detection of septic complications in patients undergoing cytoreductive therapy of AML.
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92
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Kalwak K, Gorczyńska E, Toporski J, Turkiewicz D, Slociak M, Ussowicz M, Latos-Grazyńska E, Król M, Boguslawska-Jaworska J, Chybicka A. Immune reconstitution after haematopoietic cell transplantation in children: immunophenotype analysis with regard to factors affecting the speed of recovery. Br J Haematol 2002; 118:74-89. [PMID: 12100130 DOI: 10.1046/j.1365-2141.2002.03560.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Immune reconstitution was studied prospectively in 66 children who underwent 77 haematopoietic cell transplantations (HCT): 46 autologous HCTs in 39 patients and 31 allogeneic HCTs in 27 patients. We studied the dynamic analysis of immune recovery with regard to potential factors affecting its speed, including age, type of HCT, diagnosis, graft-versus-host disease (GvHD) and cytomegalovirus (CMV) infection reactivation. Absolute counts of different lymphocyte subsets and immunoglobulin serum levels were determined in peripheral blood of patients on d -7 and +16, and then at various intervals up to 24 months post transplant. Common patterns of immune recovery after both allogeneic and autologous HCT were identified: (i) CD4+CD45RO+ peripheral T-cell expansion on d +16; (ii) inverted CD4+:CD8+ ratio from d +30 onwards; (iii) rapid natural killer (NK) cell (CD16+/-CD56+) count normalization. We observed prolonged T-cell lymphopenia (CD3+, CD3+CD4+, CD4+CD45RA+) until 24 months after autologous HCT, whereas in the allogeneic setting CD3+CD4+ cells, including naive CD45RA+ cells, returned to normal values at 9 months post transplant. Age > 10 years and coexistence of GvHD and CMV reactivation were associated with a substantial delay in T- (CD4+, including CD45RA+) and B-cell recovery after allogeneic HCT. Multidrug GvHD prophylaxis resulted in impaired T- (CD4+, CD4+CD45RA+) and B-cell reconstitution only in the early phase after allogeneic HCT (up to 4 months). Our results demonstrated that T-cell recovery was severely impaired in children after autologous HCT. It should be emphasized that specific approaches to enhance immune reconstitution are necessary to control minimal residual disease and avoid the risk of infectious complications in the autologous setting. Thymic involution after allogeneic HCT seems to be associated with age and coexistence of GvHD and CMV reactivation.
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MESH Headings
- Acute Disease
- Adolescent
- B-Lymphocytes/immunology
- Child
- Child, Preschool
- Cytomegalovirus Infections/complications
- Female
- Follow-Up Studies
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunoglobulins/blood
- Immunophenotyping
- Killer Cells, Natural/immunology
- Leukemia/immunology
- Leukemia/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid/immunology
- Leukemia, Myeloid/surgery
- Lymphocyte Count
- Male
- Myelodysplastic Syndromes/immunology
- Myelodysplastic Syndromes/surgery
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Prospective Studies
- Statistics, Nonparametric
- T-Lymphocytes/immunology
- Transplantation, Autologous
- Transplantation, Homologous
- Virus Activation
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93
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Yazaki M, Takahashi T, Mizutani K, Ito Y, Wakiguchi H, Inoue M, Kawa K, Kato K, Kato T, Saito H, Togari H. Human leucocyte antigen-Cw-specific cytotoxic T lymphocytes generated from naive cord blood used for cord blood stem cell transplantation. Br J Haematol 2002; 117:893-8. [PMID: 12060128 DOI: 10.1046/j.1365-2141.2002.03504.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Human leucocyte antigen (HLA)-Cw-reactive cytotoxic T lymphocytes (CTL) were generated from cord blood (CB) lymphocytes of two cases used for cord blood stem cell transplantation (CBSCT). In both cases, the CTL were cytotoxic against the patient's leukaemic cells, as well as the patient's Epstein-Barr virus (EBV)-lymphoblastoid cell line (EBV-LCL) and phytohaemagglutinin blasts, and the cytotoxicity was blocked by anti-HLA-class I monoclonal antibodies. In the first case, the CTL recognized Cw 3 (Cw 9 and Cw 10)-positive EBV-LCL, while in the second case, the CTL recognized Cw1 and/or Cw7. These cases suggest that CB T cells may be competent enough for generating CTL to induce a graft-versus-leukaemia effect and/or graft-versus-host disease in patients with CBSCT and that the mismatching of Cw antigens between patient and CB may be related to the outcome of CBSCT.
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94
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Seipelt G, Germing U, Koschmieder S, Böhme A, Aul C, Hoelzer D. Secondary acute myeloid leukaemia with monosomy 7 in identical adult twins. Br J Haematol 2002; 116:338-40. [PMID: 11841435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We report the development of secondary acute myeloid leukaemia (AML) with monosomy 7 in identical twins, both at the age of 52 years. In the first twin, induction therapy resulted in complete remission (CR). At relapse 9 months later monosomy 7 was found. The patient died of sepsis 11 months after diagnosis. The other twin presented with leucopenia and thrombocytopenia and refractory anaemia (RA) was diagnosed. During follow-up, fluorescence in situ hybridization analysis demonstrated a monosomy 7 in 11% of the cells. Twenty-eight months following diagnosis the patient progressed to RA with excess blasts in transformation and induction chemotherapy was initiated without achieving CR. Three months later an allogeneic stem cell transplantation from a niece was performed, resulting in CR of the secondary AML.
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MESH Headings
- Acute Disease
- Anemia, Refractory/complications
- Anemia, Refractory/genetics
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/genetics
- Chromosomes, Human, Pair 7
- Diseases in Twins/genetics
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/surgery
- Male
- Middle Aged
- Monosomy
- Remission Induction
- Transplantation, Homologous
- Twins, Monozygotic
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95
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Agarwal A, Sahu D, Bose N. Radial artery cannulation in edematous patients. Can J Anaesth 2002; 49:109-10. [PMID: 11782345 DOI: 10.1007/bf03020435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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96
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Klein SA, Martin H, Schreiber-Dietrich D, Hermann S, Caspary WF, Hoelzer D, Dietrich CF. A new approach to evaluating intestinal acute graft-versus-host disease by transabdominal sonography and colour Doppler imaging. Br J Haematol 2001; 115:929-34. [PMID: 11843829 DOI: 10.1046/j.1365-2141.2001.03221.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
An objective and non-invasive method to assess the extent, severity, course and prognosis of acute graft-versus-host disease (aGvHD) of the gastrointestinal tract would be of great importance. As high-resolution ultrasonography (HRU) and colour Doppler imaging (CDI) are used in inflammatory and ischaemic bowel diseases, we introduced these techniques to evaluate acute intestinal GvHD. In this study, 12 patients with suspected intestinal and/or severe cutaneous aGvHD were investigated by HRU and CDI. The structure and thickness of the bowel wall and the blood flow pattern in the superior mesenteric artery (SMA) as well as in the bowel wall were evaluated. All patients showed thickened bowel wall segments, especially in the ileocaecal region. Even in patients without any clinical signs of intestinal involvement (3/12), sonographic changes were observed. In six patients with severe diarrhoea, sonographic signs of secretory diarrhoea were observed. In 4/12 patients, an increased arterial blood flow in the bowel wall was demonstrated as a typical characteristic of an inflammatory bowel process. In contrast, in 4/12 patients, ischaemic bowel wall lesions with high-resistance flow pattern in the SMA were found. These patients did not respond to immunosuppressive therapy and died. In conclusion, HRU is a useful tool for detecting acute bowel GvHD even before clinical symptoms. Moreover, HRU and CDI can be applied to define the severity of aGvHD and to identify patients with a poor prognosis.
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MESH Headings
- Acute Disease
- Adult
- Case-Control Studies
- Female
- Gastrointestinal Diseases/diagnostic imaging
- Graft vs Host Disease/diagnostic imaging
- Hematopoietic Stem Cell Transplantation
- Humans
- Intestines/blood supply
- Intestines/diagnostic imaging
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging
- Leukemia, Lymphocytic, Chronic, B-Cell/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid/diagnostic imaging
- Leukemia, Myeloid/surgery
- Male
- Mesenteric Artery, Superior/diagnostic imaging
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnostic imaging
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Regional Blood Flow
- Transplantation, Homologous
- Ultrasonography, Doppler, Color
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97
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Nishi T, Okazaki K, Fujii S, Uchida K, Uose S, Nakase H, Ohana M, Nishihara T, Chiba T. Successful treatment with steroids of upper gastrointestinal acute graft vs. host disease after hematopoietic stem cell transplantation. Endoscopy 2001; 33:985-7. [PMID: 11668409 DOI: 10.1055/s-2001-17922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
A 39-year-old man with acute myeloid leukemia underwent completely matched related hematopoietic stem cell transplantation. On post-transplantation day 83 he was diagnosed as having upper gastrointestinal graft-versus-host disease (GVHD) by endoscopic examination and pathological examination of endoscopic biopsy specimens, and daily administration of 60 mg of water-soluble prednisolone and 50 mg of cyclosporine was started. After steroid therapy, the symptoms of upper gastrointestinal GVHD disappeared completely and endoscopic findings dramatically improved.
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98
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Ooi J, Iseki T, Nagayama H, Tomonari A, Ito K, Shirafuji N, Tojo A, Tani K, Asano S. Unrelated cord blood transplantation for adult patients with myelodysplastic syndrome-related secondary acute myeloid leukaemia. Br J Haematol 2001; 114:834-6. [PMID: 11564071 DOI: 10.1046/j.1365-2141.2001.03049.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seven adult patients with myelodysplastic syndrome (MDS)-related secondary acute myeloid leukaemia (AML) were treated with total body irradiation (TBI), cytosine arabinoside (Ara-C) and cyclophosphamide (CY), followed by unrelated human leucocyte antigen (HLA)-mismatched cord blood transplantation (CBT). Granulocyte colony-stimulating factor (G-CSF) was infused continuously from 12 h before until the end of Ara-C therapy to enhance the antileukaemia effect of Ara-C. Five patients are alive and free of disease at 7-31 months after transplantation. These preliminary results suggest that adult MDS-related secondary AML patients without suitable related or unrelated bone marrow donors should be considered as candidates for CBT.
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99
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Schuler US, Renner UD, Kroschinsky F, Johne C, Jenke A, Naumann R, Bornhäuser M, Deeg HJ, Ehninger G. Intravenous busulphan for conditioning before autologous or allogeneic human blood stem cell transplantation. Br J Haematol 2001; 114:944-50. [PMID: 11564090 DOI: 10.1046/j.1365-2141.2001.03044.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was undertaken to evaluate the toxicity and pharmacokinetics of a dimethyl sulphoxide (DMSO)-based intravenous formulation of busulphan in the conditioning of 45 patients undergoing allogeneic or autologous stem cell transplantation (SCT). Busulphan was given as a single daily dose. In 15 patients a single dose of intravenous busulphan, given over 3 h in 1 d, was combined with additional oral (single daily) doses. Thirty patients received all four daily doses intravenously. Busulphan plasma levels were analysed using high performance liquid chromatography. There was no major acute toxicity with daily intravenous doses of 2.8-3.1 mg/kg infused over 3 h. No veno-occlusive disease (VOD) was seen in 30 patients receiving busulphan as an intravenous formulation over 4 d. In the group of 15 patients receiving three oral doses and one intravenous single daily dose, one patient experienced mild VOD. Pharmacokinetic samples were taken over at least 2 d of treatment in 44 patients. The area under the concentration time curve (AUC) values normalized for a dose of 1 mg/kg were 7000 ng/ml x h on d 1 and 5890 ng/ml x h on d 4, thus showing a moderate decrease over time. This was accompanied by a moderate increase of the clearance from 2.6 to 3.0 ml/min/kg. Administration of busulphan as a DMSO-based intravenous formulation was well tolerated. The total dose of busulphan can be given in four (rather than the typical 16) doses. With such a regimen, the intravenous administration becomes feasible on an outpatient basis.
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100
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van Esser JW, Niesters HG, Thijsen SF, Meijer E, Osterhaus AD, Wolthers KC, Boucher CA, Gratama JW, Budel LM, van der Holt B, van Loon AM, Löwenberg B, Verdonck LF, Cornelissen JJ. Molecular quantification of viral load in plasma allows for fast and accurate prediction of response to therapy of Epstein-Barr virus-associated lymphoproliferative disease after allogeneic stem cell transplantation. Br J Haematol 2001; 113:814-21. [PMID: 11380475 DOI: 10.1046/j.1365-2141.2001.02789.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Epstein-Barr virus lymphoproliferative disease (EBV-LPD) following allogeneic stem cell transplantation (allo-SCT) has a poor prognosis. We used a sensitive real-time polymerase chain reaction (PCR) assay for quantitative detection of EBV-DNA in plasma and serially measured EBV-DNA levels to assess the response to treatment in allo-SCT recipients with EBV-LPD. Fourteen allo-SCT recipients with EBV-LPD who received a T cell-depleted (TCD) sibling (n = 5) or matched unrelated donor (n = 9) graft were monitored from the time of EBV-LPD diagnosis, during therapy and assessment of clinical response. Seven patients had complete responses of EBV-LPD to therapy, of whom 21% (3 out of 14) survived beyond 6 months from EBV-LPD diagnosis. Clinically responding patients showed a rapid decline of EBV-DNA plasma levels within 72 h from the start of therapy. In contrast, all clinical non-responders showed an increase of EBV-DNA levels. Absolute EBV-DNA levels at the time of EBV-LPD diagnosis did not predict for response, but the pattern of EBV-DNA levels within 72 h from the start of therapy (> 50% decrease versus increase) strongly predicted for clinical response (P = 0.001). Quantitative monitoring of EBV-DNA levels from the start of and during therapy for EBV-LPD rapidly and accurately predicts for response to therapy as early as within 72 h. It may thus provide a powerful tool to adjust and select treatment in individuals with EBV-LPD following allo-SCT.
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MESH Headings
- Acute Disease
- Adult
- Anemia, Aplastic/mortality
- Anemia, Aplastic/surgery
- Anemia, Aplastic/virology
- DNA, Viral/blood
- Female
- Follow-Up Studies
- Hematopoietic Stem Cell Transplantation
- Herpesvirus 4, Human/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology
- Leukemia, Myeloid/mortality
- Leukemia, Myeloid/surgery
- Leukemia, Myeloid/virology
- Leukemia, Myelomonocytic, Chronic/mortality
- Leukemia, Myelomonocytic, Chronic/surgery
- Leukemia, Myelomonocytic, Chronic/virology
- Lymphoproliferative Disorders/mortality
- Lymphoproliferative Disorders/surgery
- Lymphoproliferative Disorders/virology
- Male
- Middle Aged
- Multiple Myeloma/mortality
- Multiple Myeloma/surgery
- Multiple Myeloma/virology
- Polymerase Chain Reaction/methods
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/virology
- Prognosis
- Survival Rate
- Transplantation, Homologous
- Viral Load
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