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Choo H, Yoo SY, Moon S, Park M, Lee J, Sung KW, Cha WC, Shin SY, Son MH. Deep-learning-based personalized prediction of absolute neutrophil count recovery and comparison with clinicians for validation. J Biomed Inform 2023; 137:104268. [PMID: 36513332 DOI: 10.1016/j.jbi.2022.104268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/27/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Neutropenia and its complications are major adverse effects of cytotoxic chemotherapy. The time to recovery from neutropenia varies from patient to patient, and cannot be easily predicted even by experts. Therefore, we trained a deep learning model using data from 525 pediatric patients with solid tumors to predict the day when patients recover from severe neutropenia after high-dose chemotherapy. We validated the model with data from 99 patients and compared its performance to those of clinicians. The accuracy of the model at predicting the recovery day, with a 1-day error, was 76%; its performance was better than those of the specialist group (58.59%) and the resident group (32.33%). In addition, 80% of clinicians changed their initial predictions at least once after the model's prediction was conveyed to them. In total, 86 prediction changes (90.53%) improved the recovery day estimate.
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Affiliation(s)
- Hyunwoo Choo
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Seoul, Republic of Korea
| | - Su Young Yoo
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Suhyeon Moon
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Minsu Park
- Department of Information and Statistics, Chungnam National University, Korea 99 Daehak-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Jiwon Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Yong Shin
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Seoul, Republic of Korea; Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
| | - Meong Hi Son
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Saito Y, Takekuma Y, Kobayashi M, Komatsu Y, Sugawara M. Detection of risk factors related to administration suspension and severe neutropenia in gemcitabine and nab-paclitaxel treatment. Support Care Cancer 2020; 29:3277-3285. [PMID: 33104920 DOI: 10.1007/s00520-020-05842-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The combination of gemcitabine (GEM) and nanoparticle albumin-bound paclitaxel (nab-PTX) is an effective chemotherapeutic regimen for locally advanced and metastatic pancreatic cancer. The dose-limiting toxicities (DLTs) of this treatment are sepsis and neutropenia, while the relative dose intensity (RDI) of GEM is approximately 75% and of nab-PTX is 70-80%. In this study, we evaluated the risk factor(s) regarding treatment suspension, which leads to reduction in the RDI of these agents, enabling appropriate schedule management. METHODS Two hundred patients with pancreatic cancer who received GEM + nab-PTX were retrospectively investigated. Frequency and risk factor(s) of suspension of the treatment and grade 3/4 neutropenia in the first course were evaluated. RESULTS The frequency of treatment suspension in the first course was 61%. The frequency of grade 3/4 neutropenia was 51%, while that of thrombocytopenia was 7.5%. The RDI was 78.0% for GEM and 77.7% for nab-PTX. Univariate and multivariate analyses to identify risk or preventive factors related to treatment suspension suggested that low platelet count at baseline was a risk factor, whereas dose reduction from the treatment initiation was a preventive factor. The most common cause of abeyance was grade 3/4 neutropenia (83.6%), the risk factors of which were low platelet count and age ≥ 65 years at baseline, while dose reduction was a preventive factor. CONCLUSION We found that a low platelet level at baseline was a risk factor, whereas dose reduction from initiation was a preventive factor in regard to treatment suspension and severe neutropenia occurrence in GEM + nab-PTX treatment.
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Affiliation(s)
- Yoshitaka Saito
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Masaki Kobayashi
- Laboratory of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan
| | - Yoshito Komatsu
- Cancer Center, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan. .,Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan.
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Pang L, Zhao X, Dickens BL, Lim JT, Cook AR, Netea MG, Donnelly JP, Herbrecht R, Johnson EM, Maertens JA, Kullberg BJ, Troke PF, Marr KA, Chai LYA. Using routine blood parameters to anticipate clinical outcomes in invasive aspergillosis. Clin Microbiol Infect 2019; 26:781.e1-781.e8. [PMID: 31669427 DOI: 10.1016/j.cmi.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In invasive aspergillosis (IA), monitoring response to antifungal treatment is challenging. We aimed to explore if routine blood parameters help to anticipate outcomes following IA. METHODS Post hoc secondary analysis of two multicenter randomized trials was performed. The Global Comparative Aspergillosis Study (GCA, n = 123) and the Combination Antifungal Study (CAS, n = 251) constituted the discovery and validation cohorts respectively. The outcome measures were response to treatment and survival to 12 weeks. Interval platelet, galactomannan index (GMI) and C-reactive protein (CRP) levels prior and during antifungal treatment were analysed using logistic regression, Kaplan-Meier survival and receiver operating characteristic (ROC) analyses. RESULTS The 12-week survival was 70.7% and 63.7% for the GCA and CAS cohorts respectively. In the GCA cohort, every 10 × 109/L platelet count increase at week 2 and 4 improved 12-week survival odds by 6-18% (odds ratio (OR) 1.06-1.18, 95% confidence interval (CI) 1.02-1.33). Survival odds also improved 13% with every 10 mg/dL CRP drop at week 1 and 2 (OR 0.87, 95% CI 0.78-0.97). In the CAS cohort, week 2 platelet count was also associated with 12-week survival with 10% improved odds for every 10 × 109/L platelet increase (OR, 1.10, 95% CI 1.04-1.15). A GMI drop of 0.1 unit was additionally found to increase the odds of treatment response by 3% at the baseline of week 0 (OR 0.97, 95% CI 0.95-0.99). Week 2 platelet and CRP levels performed better than GMI on ROC analyses for survival (area under ROC curve 0.76, 0.87 and 0.67 respectively). A baseline platelet count higher than 30 × 109/L clearly identified patients with >75% survival probability. CONCLUSIONS Higher serial platelets were associated with overall survival while GMI trends were linked to IA treatment response. Routine and simple laboratory indices may aid follow-up of response in IA patients.
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Affiliation(s)
- L Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - X Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - B L Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - J T Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - A R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - M G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J P Donnelly
- Department of Hematology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R Herbrecht
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E M Johnson
- Mycology Reference Laboratory, Public Health England National Infection Services, Bristol, UK
| | - J A Maertens
- University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - B J Kullberg
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - K A Marr
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Y A Chai
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Lee M, Yee J, Kim JY, Kim JY, An SH, Lee KE, Gwak HS. Risk factors for neutropenia and febrile neutropenia following prophylactic pegfilgrastim. Asia Pac J Clin Oncol 2019; 15:231-237. [PMID: 30997742 DOI: 10.1111/ajco.13152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/25/2019] [Indexed: 01/26/2023]
Abstract
AIM Neutropenia is a common side effect of myelosuppressive chemotherapy. Administration of granulocyte colony-stimulating factor is being used for neutropenia prophylaxis, but there are patients who develop neutropenia or febrile neutropenia despite prophylaxis. We attempted to identify potential risk factors for chemotherapy-induced neutropenia in patients with pegfilgrastim prophylaxis. METHODS This was a single-center, retrospective, observational study of patients with breast cancer or diffuse large B-cell lymphoma. We obtained patients' data from electronic medical records, including baseline demographics and clinical characteristics regarding diseases, treatments and laboratory values. The outcome measures assessed were the incidence of neutropenia and febrile neutropenia. RESULTS There were a total of 127 patients, including 77 patients with diffuse large B-cell lymphoma (DLBCL) and 50 patients with breast cancer, and we analyzed 722 chemotherapy cycles. We found 88 cases (12.2%) of grade 3 or 4 neutropenia and 39 cases of febrile neutropenia (5.4%). In the univariate analysis, variables associated with both grade 3 or 4 neutropenia and febrile neutropenia were age, cancer type, cancer stage, radiotherapy and platelet count. A multivariate logistic regression model revealed that age, radiotherapy and platelet count were significant factors in severe neutropenia, whereas platelet count was the only statistically significant factor in febrile neutropenia. Platelet counts of less than 150 000/mm3 increased the risk of neutropenia and febrile neutropenia approximately fourfold. In the subgroup analysis of patients with DLBCL, it was found that platelet count was a significant factor for both neutropenia and febrile neutropenia. CONCLUSION Among cancer patients with pegfilgrastim prophylaxis, advanced age, absence of radiation therapy and low platelet count were independent predictors of neutropenia, and low platelet count was the predictor of febrile neutropenia.
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Affiliation(s)
- Mirinae Lee
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Asan Medical Center, Seoul, Korea
| | - Jeong Yee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
| | - Jae Youn Kim
- Department of Pharmacy, Asan Medical Center, Seoul, Korea
| | - Ju Young Kim
- College of Pharmacy, Chungbuk National University, Cheongju-si, Korea
| | - Sook Hee An
- College of Pharmacy, Wonkwang University, Jeonbuk, Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, Cheongju-si, Korea
| | - Hye Sun Gwak
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
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5
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Valtola J, Varmavuo V, Ropponen A, Selander T, Kuittinen O, Kuitunen H, Keskinen L, Vasala K, Nousiainen T, Mäntymaa P, Pelkonen J, Jantunen E. Early immune recovery after autologous transplantation in non-Hodgkin lymphoma patients: predictive factors and clinical significance. Leuk Lymphoma 2016; 57:2025-32. [DOI: 10.3109/10428194.2015.1129537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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6
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Valtola J, Varmavuo V, Ropponen A, Nihtinen A, Partanen A, Vasala K, Lehtonen P, Penttilä K, Pyörälä M, Kuittinen T, Silvennoinen R, Nousiainen T, Pelkonen J, Mäntymaa P, Jantunen E. Blood graft cellular composition and posttransplant recovery in non-Hodgkin's lymphoma patients mobilized with or without plerixafor: a prospective comparison. Transfusion 2015; 55:2358-68. [DOI: 10.1111/trf.13170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Antti Ropponen
- Department of Clinical Microbiology; University of Eastern Finland; Kuopio Finland
| | - Anne Nihtinen
- Department of Medicine; Central Hospital of Northern Carelia; Joensuu Finland
| | - Anu Partanen
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
| | - Kaija Vasala
- Department of Oncology; Central Hospital of Central Finland; Jyväskylä Finland
| | - Päivi Lehtonen
- Department of Medicine; Central Hospital of South Carelia; Lappeenranta Finland
| | - Karri Penttilä
- Department of Medicine; Savonlinna Central Hospital; Savonlinna Finland
- Finnish Medicines Agency
| | | | | | | | | | - Jukka Pelkonen
- Department of Clinical Microbiology; University of Eastern Finland; Kuopio Finland
- Laboratory of Eastern Finland
| | | | - Esa Jantunen
- Department of Medicine; Kuopio University Hospital
- University of Eastern Finland/Clinical Medicine; Kuopio Finland
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Liu X, Wu M, Peng Y, Chen X, Sun J, Huang F, Fan Z, Zhou H, Wu X, Yu G, Zhang X, Li Y, Xiao Y, Song C, Xiang AP, Liu Q. Improvement in poor graft function after allogeneic hematopoietic stem cell transplantation upon administration of mesenchymal stem cells from third-party donors: a pilot prospective study. Cell Transplant 2015; 23:1087-98. [PMID: 23294601 DOI: 10.3727/096368912x661319] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Poor graft function (PGF) is a refractory complication that occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the present study, we prospectively evaluated the efficacy and safety of mesenchymal stem cells (MSCs) expanded from the bone marrow of a third-party donor to patients with PGF after allo-HSCT. Twenty patients with PGF (7 with primary and 13 with secondary PGF) received MSCs (1 × 10(6)/kg) one to three times at 28-day intervals. Seventeen patients were responsive to MSCs, whereas three were not. Within the first 100 days after MSC treatment, 13 patients developed 20 episodes of infection. Moreover, five patients experienced cytomegalovirus-DNA viremia, and seven experienced Epstein-Barr virus (EBV)-DNA viremia within the first 100 days after MSC treatment; three of the latter developed EBV-associated posttransplant lymphoproliferative disorders (PTLD) within the follow-up period. Grade II acute graft-versus-host disease (GVHD) occurred in one patient, and local chronic GVHD occurred in two patients after receiving MSC treatment, including one acute GVHD and one chronic GVHD, respectively, after accepting donor lymphocyte infusions due to PTLD. After a follow-up period of an average of 508 days (range 166-904 days) posttransplantation, 11 patients died. No short-term toxic side effects were observed after MSC treatment. Two patients experienced leukemic relapse. With the exception of three patients with PTLD, no secondary tumors occurred. These results indicate that MSCs derived from the bone marrow of a third-party donor are beneficial in the treatment of both primary and secondary PGF that develops after allo-HSCT. However, additional studies will be needed to determine whether such treatment might increase the risk of EBV infection and reactivation or the development of EBV-associated PTLD.
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Affiliation(s)
- Xiaodan Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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8
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Aging Impairs Long-Term Hematopoietic Regeneration after Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:865-71. [DOI: 10.1016/j.bbmt.2014.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/01/2014] [Indexed: 01/22/2023]
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Gilreath JA, Stenehjem DD, Rodgers GM. Diagnosis and treatment of cancer-related anemia. Am J Hematol 2014; 89:203-12. [PMID: 24532336 DOI: 10.1002/ajh.23628] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 10/25/2013] [Accepted: 10/31/2013] [Indexed: 01/04/2023]
Abstract
Cancer-related anemia (CRA) is due to multiple etiologies, including chemotherapy-induced myelosuppression, blood loss, functional iron deficiency, erythropoietin deficiency due to renal disease, marrow involvement with tumor as well as other factors. The most common treatment options for CRA include iron therapy, erythropoietic-stimulating agents (ESAs), and red cell transfusion. Safety concerns as well as restrictions and reimbursement issues surrounding ESA therapy for CRA have resulted in suboptimal treatment. Similarly, many clinicians are not familiar or comfortable using intravenous iron products to treat functional iron deficiency associated with CRA. This article summarizes our approach to treating CRA and discusses commonly encountered clinical scenarios for which current clinical guidelines do not apply.
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Affiliation(s)
- Jeffrey A. Gilreath
- Department of Pharmacy; Huntsman Cancer Institute; University of Utah Hospitals and Clinics; Salt Lake City Utah
| | - David D. Stenehjem
- Department of Pharmacy; Huntsman Cancer Institute; University of Utah Hospitals and Clinics; Salt Lake City Utah
- Department of Pharmacotherapy; Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah; Salt Lake City Utah
| | - George M. Rodgers
- Department of Medicine; University of Utah Hospitals and Clinics; Salt Lake City Utah
- Department of Pathology; University of Utah Hospitals and Clinics; Salt Lake City Utah
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Woolthuis CM, Brouwers-Vos AZ, Huls G, de Wolf JTM, Schuringa JJ, Vellenga E. Loss of quiescence and impaired function of CD34(+)/CD38(low) cells one year following autologous stem cell transplantation. Haematologica 2013; 98:1964-71. [PMID: 24038022 DOI: 10.3324/haematol.2013.086744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients who have undergone autologous stem cell transplantation are subsequently more susceptible to chemotherapy-induced bone marrow toxicity. In the present study, bone marrow primitive progenitor cells were examined one year after autologous stem cell transplantation and compared with normal bone marrow and mobilized peripheral blood stem cells. Post-transplantation bone marrow contained a significantly lower percentage of quiescent cells in the CD34(+)/CD38(low) fraction compared to normal bone marrow. In addition, we observed a strong decrease in stem cell/primitive progenitor frequency in post-transplantation CD34(+) cells as defined by long-term culture assays. Measurement of the levels of reactive oxygen species by flow cytometry revealed comparable levels in post-transplantation and normal bone marrow CD34(+)/CD38(low) cells, while significantly higher levels of reactive oxygen species were observed in CD34(+)/CD38(high) cells following autologous stem cell transplantation compared to normal bone marrow. Moreover, post-transplantation CD34(+) bone marrow cells demonstrated an increased sensitivity to buthionine sulfoximine, a trigger for endogenous production of reactive oxygen species. Gene expression analysis on CD34(+) cells revealed a set of 195 genes, including HMOX1, EGR1, FOS and SIRPA that are persistently down-regulated in mobilized peripheral blood cells and post-transplantation bone marrow compared to normal bone marrow. In conclusion, our data indicate that the diminished regenerative capacity of bone marrow following autologous stem cell transplantation is possibly related to a loss of quiescence and a reduced tolerability to oxidative stress.
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Katragadda L, Shahid Z, Restrepo A, Muzaffar J, Alapat D, Anaissie E. Preemptive intravenous immunoglobulin allows safe and timely administration of antineoplastic therapies in patients with multiple myeloma and parvovirus B19 disease. Transpl Infect Dis 2013; 15:354-60. [DOI: 10.1111/tid.12067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/18/2012] [Accepted: 10/29/2012] [Indexed: 11/30/2022]
Affiliation(s)
- L. Katragadda
- The Myeloma Institute; University of Arkansas for Medical Sciences; Little Rock; Arkansas; USA
| | - Z. Shahid
- The Myeloma Institute; University of Arkansas for Medical Sciences; Little Rock; Arkansas; USA
| | - A. Restrepo
- The Myeloma Institute; University of Arkansas for Medical Sciences; Little Rock; Arkansas; USA
| | - J. Muzaffar
- The Myeloma Institute; University of Arkansas for Medical Sciences; Little Rock; Arkansas; USA
| | - D. Alapat
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock; Arkansas; USA
| | - E. Anaissie
- Division of Hematology and Oncology; University of Cincinnati; Cincinnati; Ohio; USA
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12
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Calvet L, Cabrespine A, Boiret-Dupré N, Merlin E, Paillard C, Berger M, Bay JO, Tournilhac O, Halle P. Hematologic, immunologic reconstitution, and outcome of 342 autologous peripheral blood stem cell transplantations after cryopreservation in a -80°C mechanical freezer and preserved less than 6 months. Transfusion 2012; 53:570-8. [PMID: 22804351 DOI: 10.1111/j.1537-2995.2012.03768.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Controlled-rate freezing and storage in nitrogen is the standard technique for cryopreservation of peripheral hematopoietic progenitor cells (PHPCs) but presents high cost and dimethyl sulfoxide (DMSO) toxicity. Cryopreservation at -80°C, by uncontrolled rate freezing with only 3.5% DMSO, preserves the functional capacities of PHPCs, produces successful engraftment, and reduces toxicity during infusion. STUDY DESIGN AND METHODS Long-term hematopoietic and immunologic reconstitution for 342 autografts (311 adults, 31 children) after PHPCs were cryopreserved at -80°C was studied at 3, 6, and 12 months. The median (range) storage time of PHPCs cryopreserved was 1.7 (0.1-5.99) months. RESULTS Hemoglobin (Hb), white blood cells, and platelets (PLTs) reach normal values to trilineage at 12 months for 39% patients. Multivariate analysis shows a significant impact on CD34+ infused and on conditioning regimen for PLTs. Hb was influenced by growth factor administration at 3 months. Long-term recovery is also highly dependent on blood counts (Hb, PLT, and neutrophil) at start of high-dose chemotherapy. Only 43% of patients had reached normal lymphocyte values at 12 months after transplant, and a profound CD4+ T-lymphocyte deficit remained, as others reported. CONCLUSION Transplantation with PHPCs cryopreserved at -80°C for no more than 6 months is satisfactory for long-term hematopoietic and immunologic reconstitution, even if a profound CD4+ T lymphocyte deficit persists at 1 year. This easier and cheaper cryopreservation method also leads to successful engraftment.
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Affiliation(s)
- Laure Calvet
- Department of Clinical Hematology and Cell Therapy, EA3846, CIC 501, Auvergne University, France
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13
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Nouér SA, Nucci M, Kumar NS, Grazziutti M, Restrepo A, Anaissie E. Baseline platelet count and creatinine clearance rate predict the outcome of neutropenia-related invasive aspergillosis. Clin Infect Dis 2012; 54:e173-83. [PMID: 22423136 DOI: 10.1093/cid/cis298] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a life-threatening infection for immunocompromised patients. Improvement in IA outcome has been hampered by lack of early prognostic factors, namely, those available before starting chemotherapy (baseline) or early in the course of IA (nonbaseline). We hypothesized that prognostic factors can be identified before chemotherapy, ≤7 days from the first positive serum Aspergillus galactomannan index (s-GMI). METHODS We analyzed 98 patients with multiple myeloma who developed neutropenia-related IA and had a positive s-GMI. Three response criteria were used: kinetics of s-GMI, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions, and 6-week survival. Baseline and nonbaseline variables were analyzed separately. RESULTS Independent response predictors at baseline were a platelet count ≥65,000 platelets/mm(3) (odds ratio [OR], 1.009; 95% confidence interval [CI], 1.001-1.017; P = .03) by s-GMI kinetics, and a platelet count ≥65,000 platelets/mm(3) (OR, 1.009; 95% CI, 1.002-1.017; P = .01) and a creatinine clearance rate ≥53 mL/min (OR, 1.024; 95% CI, 1.006-1.042; P = .009) by EORTC/MSG criteria, with response rates of 83% and 28% when both variables were above or below these cutoffs, respectively (P < .001). Only baseline creatinine clearance rate ≥53 mL/min predicted 6-week survival (P = .003). Normalization of the s-GMI ≤7 days after the first positive s-GMI and neutrophil recovery were the nonbaseline factors associated with positive outcomes. CONCLUSIONS Two simple, inexpensive to measure, widely available, and routinely collected prechemotherapy values, platelet count and creatinine clearance rate, predict IA outcome and stratify patients into low-, intermediate-, and high-risk categories, while early evaluation of s-GMI allows timely treatment modification. These findings may improve patient outcomes by optimizing management strategies for this serious infection and may prove valuable in designing clinical trials of interventions to improve IA outcomes.
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Affiliation(s)
- Simone Aranha Nouér
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Brazil
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14
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Rellick SL, O'Leary H, Piktel D, Walton C, Fortney JE, Akers SM, Martin KH, Denvir J, Boskovic G, Primerano DA, Vos J, Bailey N, Gencheva M, Gibson LF. Bone marrow osteoblast damage by chemotherapeutic agents. PLoS One 2012; 7:e30758. [PMID: 22363485 PMCID: PMC3281873 DOI: 10.1371/journal.pone.0030758] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 12/28/2011] [Indexed: 11/19/2022] Open
Abstract
Hematopoietic reconstitution, following bone marrow or stem cell transplantation, requires a microenvironment niche capable of supporting both immature progenitors and stem cells with the capacity to differentiate and expand. Osteoblasts comprise one important component of this niche. We determined that treatment of human primary osteoblasts (HOB) with melphalan or VP-16 resulted in increased phospho-Smad2, consistent with increased TGF-β1 activity. This increase was coincident with reduced HOB capacity to support immature B lineage cell chemotaxis and adherence. The supportive deficit was not limited to committed progenitor cells, as human embryonic stem cells (hESC) or human CD34+ bone marrow cells co-cultured with HOB pre-exposed to melphalan, VP-16 or rTGF-β1 had profiles distinct from the same populations co-cultured with untreated HOB. Functional support deficits were downstream of changes in HOB gene expression profiles following chemotherapy exposure. Melphalan and VP-16 induced damage of HOB suggests vulnerability of this critical niche to therapeutic agents frequently utilized in pre-transplant regimens and suggests that dose escalated chemotherapy may contribute to post-transplantation hematopoietic deficits by damaging structural components of this supportive niche.
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Affiliation(s)
- Stephanie L. Rellick
- Cancer Cell Biology Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Heather O'Leary
- Cancer Cell Biology Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Debbie Piktel
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Cheryl Walton
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - James E. Fortney
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Stephen M. Akers
- Cancer Cell Biology Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Karen H. Martin
- Department of Neurobiology and Anatomy, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - James Denvir
- Department of Statistics, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Goran Boskovic
- Microarray Core Facility, Marshall University, Huntington, West Virginia, United States of America
| | - Donald A. Primerano
- Microarray Core Facility, Marshall University, Huntington, West Virginia, United States of America
| | - Jeffrey Vos
- West Virginia University Department of Pathology, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America,
| | - Nathanael Bailey
- West Virginia University Department of Pathology, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America,
| | - Marieta Gencheva
- Cancer Cell Biology Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Laura F. Gibson
- Cancer Cell Biology Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- Alexander B. Osborn Hematopoietic Malignancy and Transplantation Program, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
- Department of Microbiology, Immunology and Cell Biology, School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
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Jantunen E, Fruehauf S. Importance of blood graft characteristics in auto-SCT: implications for optimizing mobilization regimens. Bone Marrow Transplant 2011; 46:627-35. [DOI: 10.1038/bmt.2010.320] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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16
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Derdouch S, Gay W, Nègre D, Prost S, Le Dantec M, Delache B, Auregan G, Andrieu T, Leplat JJ, Cosset FL, Le Grand R. Reconstitution of the myeloid and lymphoid compartments after the transplantation of autologous and genetically modified CD34+ bone marrow cells, following gamma irradiation in cynomolgus macaques. Retrovirology 2008; 5:50. [PMID: 18565229 PMCID: PMC2464606 DOI: 10.1186/1742-4690-5-50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 06/19/2008] [Indexed: 01/08/2023] Open
Abstract
Background Prolonged, altered hematopoietic reconstitution is commonly observed in patients undergoing myeloablative conditioning and bone marrow and/or mobilized peripheral blood-derived stem cell transplantation. We studied the reconstitution of myeloid and lymphoid compartments after the transplantation of autologous CD34+ bone marrow cells following gamma irradiation in cynomolgus macaques. Results The bone marrow cells were first transduced ex vivo with a lentiviral vector encoding eGFP, with a mean efficiency of 72% ± 4%. The vector used was derived from the simian immunodeficiency lentivirus SIVmac251, VSV-g pseudotyped and encoded eGFP under the control of the phosphoglycerate kinase promoter. After myeloid differentiation, GFP was detected in colony-forming cells (37% ± 10%). A previous study showed that transduction rates did not differ significantly between colony-forming cells and immature cells capable of initiating long-term cultures, indicating that progenitor cells and highly immature hematopoietic cells were transduced with similar efficiency. Blood cells producingeGFP were detected as early as three days after transplantation, and eGFP-producing granulocyte and mononuclear cells persisted for more than one year in the periphery. Conclusion The transplantation of CD34+ bone marrow cells had beneficial effects for the ex vivo proliferation and differentiation of hematopoietic progenitors, favoring reconstitution of the T- and B-lymphocyte, thrombocyte and red blood cell compartments.
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Affiliation(s)
- Sonia Derdouch
- CEA, service d'Immuno-Virologie, Institut des Maladies Emergentes et Thérapies Innovantes, Direction des Sciences du Vivant, Fontenay aux Roses, France.
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Current Awareness in Hematological Oncology. Hematol Oncol 2005. [DOI: 10.1002/hon.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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