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Ducloux-Lebon B, Lebon D, Tesson JR, Fumery M, Marolleau JP, Chatelain D. [Recto-colic graft-versus-host disease (GVH). Diagnostic and prognostic criteria in a cohort of patients from Amiens university hospital]. Ann Pathol 2024:S0242-6498(24)00161-5. [PMID: 39242243 DOI: 10.1016/j.annpat.2024.08.003] [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: 09/01/2023] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Recto-colic graft-versus-host disease (GVHD) is a frequent and serious complication of hematopoietic stem cell allogeneic transplantation, which is sometimes difficult to diagnose. The aim of our study was to identify histological diagnostic and prognostic criteria for recto-colic GVH. MATERIAL AND METHOD Patients allografted at Amiens university hospital from 2012 to 2017 were retrieved. Those who had a recto-colic biopsy were included and divided into two groups (final diagnosis of GVH and non-GVH), then biopsies were reviewed by 2 pathologists. RESULTS One hundred and nineteen patients were included. Sixty-seven were allocated to the GVH group and 52 to the non-GVH group. In the GVH group, we observed a significantly greater number of apoptotic bodies (AB) on standard HES staining and with the anti-Caspase 3 immunohistochemistry, cryptolytic AB abscesses, atrophy, regenerative glands and glands lined with eosinophilic cells (P<0.001). Anti-Caspase 3 immunohistochemistry revealed more AB than standard HES staining (P<0.005). But to differentiate GVH cases from non-GVH cases, we obtained a threshold value of 3.5 AB per 10 contiguous crypts on standard HE staining and with the anti-Caspase 3 immunohistochemistry. From 4 AB per 10 contiguous crypts, on HES staining and anti-Caspase 3 immunostaining, the diagnosis of GVH became consistent. No non-GVH case had more than 6 AB per 10 contiguous crypts. GVH patients with more than 8 AB per 10 contiguous crypts had a worse prognosis (P<0.001). CONCLUSION We confirm the value of AB and their counting in the diagnosis of GVH, with a diagnostic threshold of 4 AB and a prognostic threshold of 8 AB. Glands lined with eosinophilic cells could be an additional diagnostic criterion in favor of GVH to be confirmed by further studies.
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Affiliation(s)
- Benjamin Ducloux-Lebon
- Service d'anatomie et cytologie pathologiques, CHU Amiens Nord, place Victor-Pauchet, 80000 Amiens, France.
| | - Delphine Lebon
- Service d'hématologie clinique et thérapie cellulaire, CHU Amiens Sud, 1, Rond-Point du Professeur-Christian-Cabrol, 80054 Amiens cedex, France
| | - Jean-René Tesson
- Service d'anatomie et cytologie pathologiques, CHU Amiens Nord, place Victor-Pauchet, 80000 Amiens, France
| | - Mathurin Fumery
- Service d'hépato gastro-entérologie, CHU Amiens Sud, 1, Rond-Point du Professeur-Christian-Cabrol, 80054 Amiens cedex, France
| | - Jean-Pierre Marolleau
- Service d'hématologie clinique et thérapie cellulaire, CHU Amiens Sud, 1, Rond-Point du Professeur-Christian-Cabrol, 80054 Amiens cedex, France
| | - Denis Chatelain
- Service d'anatomie et cytologie pathologiques, CHU Amiens Nord, place Victor-Pauchet, 80000 Amiens, France
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Berhan A, Damtie S, Almaw A, Legesse B, Sharew B, Getie B, Erkihun M, Solomon Y. The Role of Extracorporeal Photopheresis in the Management of Graft Versus Host Disease: Narrative Review. Immunotargets Ther 2024; 13:235-246. [PMID: 38689598 PMCID: PMC11060171 DOI: 10.2147/itt.s457366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Hematopoietic stem cell donation is a method used to treat both blood-related and non-blood-related malignancies. Graft-versus-host disease is a potentially life-threatening complication that can occur following a stem cell transplant from a donor. This happens after the transplanted grafts attack the recipient's body as foreign cells, causing significant morbidity and mortality. Clinically, this condition can be classified as acute or chronic based on onset and pathophysiology. This review aims to provide an overview of recent studies on extracorporeal photopheresis as a treatment strategy option for graft-versus-host-diseased patients. It will explain how it treats graft-versus-host disease, summarize its promising effects, and provide future recommendations for its use in treating this illness. Extracorporeal photopheresis is used to treat graft-versus-host disease by collecting and separating white blood cells from the patient. This blood is fractionated into different parts, and white blood cells undergo treatment with 8-methoxy psoralen, a photoactivable drug, before exposure to ultraviolet light A. Lastly, the cells that have been treated are reinfused into the recipient's body. It prompts the programmed cell death of lymphocytes and the engulfment of cellular debris by host antigen-presenting, leading to a subsequent rise in T regulatory cells. However, more experimental and randomized controlled studies are required to identify the best patient selection requirements, environments, and treatment regimens for graft-versus-host disease.
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Affiliation(s)
- Ayenew Berhan
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Andargachew Almaw
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Legesse
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekele Sharew
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birhanu Getie
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulat Erkihun
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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3
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Langer R, Lelas A, Rittenschober M, Piekarska A, Sadowska-Klasa A, Sabol I, Desnica L, Greinix H, Dickinson A, Inngjerdingen M, Lawitschka A, Vrhovac R, Pulanic D, Güneş S, Klein S, Moritz Middeke J, Grube M, Edinger M, Herr W, Wolff D. Retrospective analysis of the incidence and outcome of late acute and chronic graft-versus-host disease-an analysis from transplant centers across Europe. FRONTIERS IN TRANSPLANTATION 2024; 3:1332181. [PMID: 38993773 PMCID: PMC11235324 DOI: 10.3389/frtra.2024.1332181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 07/13/2024]
Abstract
Introduction Chronic graft-versus-host disease (cGvHD) is a serious late complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods This multicenter analysis determined the cumulative incidence (CI) of cGvHD and late acute GvHD (laGvHD) and its impact on transplantation-related mortality (TRM), relapse (R), and overall survival (OS) in 317 patients [296 adults, 21 pediatrics (<12 years of age)] who underwent their first allo-HSCT in 2017. Results The CI of laGvHD was 10.5% in adults and 4.8% in pediatrics, and the CI of cGvHD was 43.0% in all adult transplant patients and 50.2% in the adult at-risk cohort at the study end. The onset of cGvHD was de novo in 42.0% of patients, quiescent in 52.1%, and progressive in 5.9%. In adults, prophylactic use of antithymocyte globulin or posttransplant cyclophosphamide was associated with a significantly lower incidence of cGvHD (28.7%) vs. standard prophylaxis with calcineurin inhibitors (30.6%) and methotrexate/mycophenolate mofetil (58.4%) (all p < 0.01). TRM was significantly higher in patients with aGvHD (31.8%) vs. cGvHD (12.6%) and no GvHD (6.3%) (all p = 0.0001). OS in the adult at-risk cohort was significantly higher in patients with cGvHD (78.9%) vs. without (66.2%; p = 0.0022; HR 0.48) due to a significantly lower relapse rate (cGvHD: 14.5%; without cGvHD: 27.2%; p = 0.00016, HR 0.41). OS was also significantly higher in patients with mild (80.0%) and moderate (79.2%) cGvHD vs. without cGvHD (66.2%), excluding severe cGvHD (72.7%) (all p = 0.0214). Discussion The negative impact of severe cGvHD on OS suggests a focus on prevention of severe forms is warranted to improve survival and quality of life.
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Affiliation(s)
- Ronja Langer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Antonela Lelas
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Agnieszka Piekarska
- Department and Clinic of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Sadowska-Klasa
- Department and Clinic of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
| | - Ivan Sabol
- Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Lana Desnica
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Anne Dickinson
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Anita Lawitschka
- St. Anna Children’s Hospital, Medical University of Vienna, Vienna, Austria
| | - Radovan Vrhovac
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Drazen Pulanic
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Sibel Güneş
- Novartis Pharmaceuticals AG, Basel, Switzerland
| | - Stefan Klein
- Department of Internal Medicine III, Hematology and Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Jan Moritz Middeke
- Medical Clinic I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Matthias Grube
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Edinger
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
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4
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Xue L, Song L, Yu X, Yang X, Xia F, Ding X, Huang C, Wu D, Miao L. Assessment of risk factors for acute graft- versus-host disease post-hematopoietic stem cell transplantation: a retrospective study based on a proportional odds model using a nonlinear mixed-effects model. Ther Adv Hematol 2023; 14:20406207231205406. [PMID: 37872970 PMCID: PMC10590544 DOI: 10.1177/20406207231205406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Background Acute graft-versus-host disease (aGVHD) is a major complication following hematopoietic stem cell transplantation (HSCT). Objective This study aimed to explore the risk factors for the incidence of aGVHD in patients post-HSCT. Design This was a retrospective study. Methods A total of 407 patients were enrolled. The patients' data were recorded from the medical records. The exposure of cyclosporine was estimated based on a population pharmacokinetics model. The occurrence of aGVHD was clinically graded and staged in severity from grades I to IV. A proportional odds model that estimated the cumulative probabilities of aGVHD was used to analyze the data using a nonlinear mixed-effects model. Then, the model parameters and plausibility were evaluated by bootstrap and visual predictive checks. Results The typical probabilities were 18.9% and 17.9% for grade II and grades III-IV, respectively. The incidence of grade II and grade III-IV aGVHD for human leukocyte antigen (HLA) haplo sibling donor patients was higher than that for HLA-matched donor patients. The incidence of grade II and grade III-IV aGVHD decreased with increasing early cyclosporine trough concentration; however, cyclosporine exposure was not associated with the incidence of aGVHD. Conclusion HLA matching and early cyclosporine trough concentration were important factors for the occurrence of aGVHD.
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Affiliation(s)
- Ling Xue
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Pharmacology, Faculty of Medicine, University of the Basque Country – (UPV/EHU), Leioa, Spain
| | - Lin Song
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Xun Yu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Yang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fan Xia
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoliang Ding
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenrong Huang
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, No. 188, Shizi Street, Suzhou 215006, China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou 215006, China
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Hoefgen HR, Benoit J, Chan S, Jayasinghe Y, Lustberg M, Pohl V, Saraf A, Schmidt D, Appiah LC. Female reproductive health in pediatric, adolescent, and young adult cancer survivors. Pediatr Blood Cancer 2023; 70 Suppl 5:e29170. [PMID: 37381166 DOI: 10.1002/pbc.29170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 06/30/2023]
Abstract
An estimated 500,000 cancer survivors of reproductive age in the United States will live to experience the long-term consequences of cancer treatment. Therefore, a focused aspect of cancer care has appropriately shifted to include quality of life in survivorship. Infertility is a late effect of therapy that affects 12% of female survivors of childhood cancer receiving any cancer treatment in large cohort studies and results in a 40% decreased likelihood of pregnancy in young adults of ages 18-39 years. Nonfertility gynecologic late effects such as hypoestrogenism, radiation-induced uterine and vaginal injury, genital graft-versus-host disease after hematopoietic stem cell transplant, and sexual dysfunction also significantly affect quality of life in survivorship but are underdiagnosed and require consideration. Several articles in the special edition "Reproductive Health in Adolescent and Young Adult Cancer Survivorship" address infertility, genital graft-versus-host disease, and psychosexual functioning in survivorship. This review article focuses on other adverse gynecologic outcomes of cancer therapies including hypogonadism and hormone replacement therapy, radiation-induced uterovaginal injury, vaccination and contraception, breast and cervical cancer screening, and pregnancy considerations in survivorship.
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Affiliation(s)
- Holly R Hoefgen
- Division of Pediatric and Adolescent Gynecology, Department of Obstet Gynecol, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janie Benoit
- Gynecology & Reproductive Sciences, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Serena Chan
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology & Reproductive Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yasmin Jayasinghe
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Maryam Lustberg
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Victoria Pohl
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Amanda Saraf
- Division Pediatric Hematology Oncology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Deb Schmidt
- MACC Fund Center for Cancer and Blood Disorders, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leslie Coker Appiah
- Division of Pediatric and Adolescent Gynecology, Department of Obstet Gynecol, Children's Hospital Colorado, University of Colorado Denver, Denver, Colorado, USA
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Liu G, Chen H, Cao X, Jia L, Rui W, Zheng H, Huang D, Liu F, Liu Y, Zhao X, Lu P, Lin X. Efficacy of pp65-specific TCR-T cell therapy in treating cytomegalovirus infection after hematopoietic stem cell transplantation. Am J Hematol 2022; 97:1453-1463. [PMID: 36054234 DOI: 10.1002/ajh.26708] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 01/28/2023]
Abstract
Cytomegalovirus (CMV) infection remains a major cause of mortality after hematopoietic stem cell transplantation (HSCT). Current treatments, including antiviral drugs and adoptive cell therapy with CMV-specific cytotoxic T lymphocytes (CTLs), only show limited benefits in patients. T-cell receptor (TCR)-T cell therapy offers a promising option to treat CMV infections. Here, using tetramer-based screening and single-cell TCR cloning technologies, we identified various CMV antigen-specific TCRs from healthy donors, and generated TCR-T cells targeting multiple pp65 epitopes corresponding to three major HLA-A alleles. The TCR-T cells showed efficient cytotoxicity toward epitope-expressing target cells in vitro. After transfer into immune-deficient mice bearing pp65+ HLA+ tumor cells, TCR-T cells induced dramatic tumor regression and exhibited long-term persistence. In a phase I clinical trial (NCT04153279), CMV TCR-T cells were applied to treat patients with CMV reactivation after HSCT. Except one patient who withdrew at early treatment stage, all other six patients were well-tolerated and achieved complete response (CR), no more than grade 2 cytokine release syndrome (CRS) and other adverse events were observed. CMV TCR-T cells persisted up to 3 months. Among them, two patients have survived for more than 1 year. This study demonstrates the great potential in the treatment and prevention of CMV infection following HSCT or other organ transplantation.
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Affiliation(s)
- Guangna Liu
- Department of Basic Medical Sciences and Institute for Immunology, Tsinghua University School of Medicine, Beijing, China.,School of Biomedical Sciences, Hunan University, Changsha, China
| | - Hua Chen
- Department of Basic Medical Sciences and Institute for Immunology, Tsinghua University School of Medicine, Beijing, China.,BriStar Immunotech Co, Beijing, China
| | - Xingyu Cao
- Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Lemei Jia
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Wei Rui
- BriStar Immunotech Co, Beijing, China
| | | | - Daosheng Huang
- Department of Basic Medical Sciences and Institute for Immunology, Tsinghua University School of Medicine, Beijing, China
| | - Fang Liu
- BriStar Immunotech Co, Beijing, China
| | - Yue Liu
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Xueqiang Zhao
- Department of Basic Medical Sciences and Institute for Immunology, Tsinghua University School of Medicine, Beijing, China.,BriStar Immunotech Co, Beijing, China
| | - Peihua Lu
- Hebei Yanda Lu Daopei Hospital, Langfang, China
| | - Xin Lin
- Department of Basic Medical Sciences and Institute for Immunology, Tsinghua University School of Medicine, Beijing, China
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Keshavarz Shahbaz S, Mansourabadi AH, Jafari D. Genetically engineered mesenchymal stromal cells as a new trend for treatment of severe acute graft-versus-host disease. Clin Exp Immunol 2022; 208:12-24. [PMID: 35274673 PMCID: PMC9113247 DOI: 10.1093/cei/uxac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/25/2021] [Accepted: 02/07/2022] [Indexed: 01/12/2023] Open
Abstract
Mesenchymal stem cells (MSCs) are a population of non-hematopoietic and self-renewing cells characterized by the potential to differentiate into different cell subtypes. MSCs have interesting features which have attracted a lot of attention in various clinical investigations. Some basic features of MSCs are including the weak immunogenicity (absence of MHC-II and costimulatory ligands accompanied by the low expression of MHC-I) and the potential of plasticity and multi-organ homing via expressing related surface molecules. MSCs by immunomodulatory effects could also ameliorate several immune-pathological conditions like graft-versus-host diseases (GVHD). The efficacy and potency of MSCs are the main objections of MSCs therapeutic applications. It suggested that improving the MSC immunosuppressive characteristic via genetic engineering to produce therapeutic molecules consider as one of the best options for this purpose. In this review, we explain the functions, immunologic properties, and clinical applications of MSCs to discuss the beneficial application of genetically modified MSCs in GVHD.
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Affiliation(s)
- Sanaz Keshavarz Shahbaz
- Cellular and Molecular Research Center, Research Institute for Prevention of Non-communicable Disease, Qazvin University of Medical Science, Qazvin, Iran
| | - Amir Hossein Mansourabadi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Immunogenetics Research Network (IgReN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Davood Jafari
- Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
- Immunogenetics Research Network (IgReN), Universal Scientific Education and Research Network (USERN), Zanjan, Iran
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8
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Pires de Jesus AK, Cerdeira CL, Franco FDL, Calixto GFL, Silva RDVD, Silverio ADSD. Anemia de Fanconi em paciente pediátrico. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i4.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A Anemia de Fanconi (AF) é um distúrbio genético raro, herdado de maneira autossômica recessiva, e caracterizado por uma depressão medular progressiva, alterações morfológicas, como manchas café-com-leite, ausência de quirodáctilo, atrofia de genitália, hipogonadismo, baixa estatura, susceptibilidade a eventos mielodisplásicos, dentre outros. Trata-se de um paciente de 10 anos que procurou atendimento médico para avaliação de fimose e testículo retrátil bilateral. Verificou-se ausência do primeiro quirodáctilo direito, manchas café-com-leite e de fácies sindrômica, além de plaquetopenia e dores abdominais. O teste de fragilidade cromossômica confirmou a suspeita clínica de AF. A investigação é complexa e a clínica essencial para confirmação. O tratamento mais adequado é o transplante de medula óssea, podendo acarretar a cura dos sintomas hematológicos, como foi o caso em questão.
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Nabarrete JM, Pereira AZ, Garófolo A, Seber A, Venancio AM, Grecco CES, Bonfim CMS, Nakamura CH, Fernandes D, Campos DJ, Oliveira FLC, Cousseiro FK, Rossi FFP, Gurmini J, Viani KHC, Guterres LF, Mantovani LFAL, Darrigo LG, Albuquerque MIBPE, Brumatti M, Neves MA, Duran N, Villela NC, Zecchin VG, Fernandes JF. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: children and adolescents. EINSTEIN-SAO PAULO 2021; 19:eAE5254. [PMID: 34909973 PMCID: PMC8664291 DOI: 10.31744/einstein_journal/2021ae5254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
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Affiliation(s)
- Juliana Moura Nabarrete
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Andrea Z Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Adriana Garófolo
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Adriana Seber
- Universidade Federal de São PauloSão PauloSPBrazilUniversidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Angela Mandelli Venancio
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Carlos Eduardo Setanni Grecco
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoHospital das ClínicasRibeirão PretoSPBrazilHospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Carmem Maria Sales Bonfim
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Claudia Harumi Nakamura
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Daieni Fernandes
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Denise Johnsson Campos
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Fernanda Luisa Ceragioli Oliveira
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Flávia Krüger Cousseiro
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Flávia Feijó Panico Rossi
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Jocemara Gurmini
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Karina Helena Canton Viani
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Luciana Fernandes Guterres
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Luiz Guilherme Darrigo
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoHospital das ClínicasRibeirão PretoSPBrazilHospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Maria Isabel Brandão Pires e Albuquerque
- Instituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazilInstituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | - Melina Brumatti
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Mirella Aparecida Neves
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Natália Duran
- Hospital de Câncer de BarretosBarretosSPBrazilHospital de Câncer de Barretos, Barretos, SP, Brazil.
| | - Neysimelia Costa Villela
- Hospital de Câncer de BarretosBarretosSPBrazilHospital de Câncer de Barretos, Barretos, SP, Brazil.
| | - Victor Gottardello Zecchin
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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10
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Tan Y, Lin J, Hong X, Lu J, Lu Q. Polymyositis in a child with thalassemia after hematopoietic stem cell transplantation: A case report. Medicine (Baltimore) 2021; 100:e27388. [PMID: 34731108 PMCID: PMC8519230 DOI: 10.1097/md.0000000000027388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Polymyositis (PM) is a rare neuromuscular phenotype of chronic graft-versus-host disease (cGVHD). Although glucocorticoids have been shown to be effective in the treatment of PM, most people experience poor treatment response and poor prognosis. PATIENT CONCERNS A six-year-old boy with thalassemia received allogeneic hematopoietic stem cell transplantation (HSCT) and consequently developed sudden myasthenia of limbs 17 months after the transplant. DIAGNOSES Medical history, current symptoms, laboratory examinations, and imaging findings of the patient indicated cGVHD complicated with PM. INTERVENTIONS He was then given high-dose corticosteroid therapy, including tacrolimus, ruxolitinib, and rituximab. OUTCOMES Twenty-three months after transplantation, creatine kinase levels returned to normal range, and the MRI showed that the original muscle edema signal was significantly improved. The patient's muscle weakness continued to improve, and his overall condition was good. LESSONS This report suggests that glucocorticoids combined with immunosuppressants may be effective against polymyositis. Rituximab and ruxolitinib may be a good choice in treating polymyositis.
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11
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Blanco-Velasco G, Palos-Cuellar R, Domínguez-García MR, Solórzano-Pineda OM, Zamarripa-Mottú RA, Martínez-Camacho C, González-Bautista ML, Contreras-Serratos MM, Murcio-Pérez E, Blancas-Valencia JM, Jiménez-Ochoa MA, Hernández-Mondragón OV. Utility of capsule endoscopy in the diagnosis of gastrointestinal graft-versus-host disease. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 86:215-219. [PMID: 34210455 DOI: 10.1016/j.rgmxen.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/11/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND AIM Graft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD. MATERIALS AND METHODS A retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard. RESULTS Twenty-one patients with GvHD (7 [33%] women; 37 ± 11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55 minutes (20-113) and the median small bowel transit time was 261 minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively. CONCLUSIONS Capsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings.
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Affiliation(s)
- G Blanco-Velasco
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - R Palos-Cuellar
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - M R Domínguez-García
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - O M Solórzano-Pineda
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - R A Zamarripa-Mottú
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - C Martínez-Camacho
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - M L González-Bautista
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - M M Contreras-Serratos
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - E Murcio-Pérez
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - J M Blancas-Valencia
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - M A Jiménez-Ochoa
- Servicio de Hematología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - O V Hernández-Mondragón
- Servicio de Endoscopia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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12
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Bendahman M, Ducloux-Lebon B, Lebon D, Fumery M, Dujardin-Boisseau A, Chatelain D. [Relevance of oesophageal biopsies during graft-versus-host disease]. Ann Pathol 2021; 41:300-309. [PMID: 33926759 DOI: 10.1016/j.annpat.2020.12.011] [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: 08/06/2020] [Revised: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation. It frequently affects the digestive tract. Oesophageal damage is not part of its typical clinical picture. The objective of this study was to determine whether oesophageal lesions could be found in this condition. MATERIAL AND METHODS Cases coded as GVH at the CHU of Amiens in anatomopathology were identified from 2004 to 2019. Each patient who had an oesophageal biopsy was included. The slides were re-read by 2 pathologists to assess the lesions. RESULTS A total of 24 patients were included. A total of 79.1 % of the biopsies showed inflammatory lesions: 25 % erosions, 37.5 % a cleavage between the lamina propria and squamous epithelium, 41.7 % a lichenoid inflammatory infiltrate, 54.1 % apoptotic cells and 54.1 % epithelial vacuolations. 25 % of the biopsies were classified as Lerner's grade 4 (used in dermatopathology to assess cutaneous GVH lesions), 12.5 % as grade 3, 25 % as grade 2, 16.7 % as grade 1, and 20.8 % of the biopsies did not show oesophageal GVH lesions. None of the histological lesions observed were correlated with the prognosis, however erosions and epithelial cleavage were more frequently associated with death. CONCLUSION Lesions evocative and probably specific for acute GVH can be found in the esophagus. They could help and be part of the diagnosis. A protocol for oesophageal biopsy sampling, and the exclusion of other causes of esophagitis, should be performed in the future during suspicion of acute GVH.
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Affiliation(s)
- Mickael Bendahman
- Service d'anatomie pathologique-tumorothèque de Picardie, université de Picardie-Jules-Verne, CHU d'Amiens Site Nord, place Victor-Pauchet, 80000 Amiens cedex 1, France.
| | - Benjamin Ducloux-Lebon
- Service d'anatomie pathologique-tumorothèque de Picardie, université de Picardie-Jules-Verne, CHU d'Amiens Site Nord, place Victor-Pauchet, 80000 Amiens cedex 1, France
| | - Delphine Lebon
- Service d'hématologie clinique et thérapie cellulaire, université de Picardie-Jules-Verne, CHU d'Amiens Site Sud, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - Mathurin Fumery
- Service d'hépato-gastro-entérologie, université de Picardie-Jules-Verne, CHU d'Amiens, CHU d'Amiens Site Sud, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - Adèle Dujardin-Boisseau
- Service d'hématologie clinique et thérapie cellulaire, université de Picardie-Jules-Verne, CHU d'Amiens Site Sud, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - Denis Chatelain
- Service d'anatomie pathologique-tumorothèque de Picardie, université de Picardie-Jules-Verne, CHU d'Amiens Site Nord, place Victor-Pauchet, 80000 Amiens cedex 1, France
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13
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Ramos GDA, Moreira MCR, Costa AMDD, Antunes HS. Photobiomodulation Therapy and Dexamethasone in the Management of Oral Acute Graft-Versus-Host Disease: Case Report. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:683-686. [PMID: 33095112 DOI: 10.1089/photob.2020.4878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Acute graft-versus-host disease (GVHD) in the oral cavity is a rare complication of hematopoietic stem cell transplantation (HSCT) and treatment has a varying length of time for wound healing. Objective: This case report present a 63-year-old female patient with a diagnosis of acute lymphoid leukemia, submitted a related allogeneic HSCT, which after 6 months evolved with oral acute GVHD, presenting odynophagia, dysphagia, and difficulty of hygiene. Methods: We started the mouthwash dexamethasone and nystatin oral suspension and five sessions of photobiomodulation therapy (PBMT) (660 nm, 100 mW, 0.028 cm2, 2 J, 70 J/cm2, 20 sec/point) has been used with daily applications in the oral cavity (at the lesion sites and in healthy areas). Results: Complete healing of the oral lesions was observed in 5 days although the patient had acute skin and gastrointestinal GVHD. Conclusions: The treatment of oral acute GVHD with PBMT is still rare in the literature, but due to a good result in wound healing with PBMT, we have used this therapeutic option in combination with dexamethasone and have been successful in healing and reducing pain.
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14
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Allogenic stem cell transplant-associated acute graft versus host disease: a computational drug discovery text mining approach using oral and gut microbiome signatures. Support Care Cancer 2020; 29:1765-1779. [PMID: 33094358 DOI: 10.1007/s00520-020-05821-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Acute graft versus host disease (aGVHD) is a major cause of non-relapse morbidity and mortality post-allogenic hematopoietic stem cell transplant (HSCT). Using conventional literature search and computational approaches, our objective was to identify oral and gut bacterial species associated with aGVHD, potentially affecting drug treatment via lipopolysaccharide (LPS) pathways. METHODS Medline, PubMed, PubMed Central, and Google Scholar were searched using MeSH terms. The top 100 hits per database were curated, and 25 research articles were selected to examine oral and gut microbiomes associated with health, HSCT, and aGVHD. Literature search validation, aGVHD drug targets, and microbial metabolic pathway identification were completed using BioReader, MACADAM, KEGG, and STRING programs. RESULTS Our review determined that (1) oral genera Rothia, Solobacterium, and Veillonella were identified in HSCT patients' stool and associated with aGVHD; (2) shifts in gut enterococci profiles were determined in HSCT-associated aGVHD; (3) gut microbiome dysbiosis prior or during HSCT and lower Shannon diversity index at time of HSCT were also associated with increased risk of aGVHD and transplant related death; and (4) Coriobacteriaceae family was negatively correlated with gut aGVHD, whereas Eubacterium limosum was associated with decreased risk of chronic GVHD relapse. Additionally, we identified molecular pathways related to TLR4/ LPS, including candidate aGVHD drug targets, impacted by oral and gut bacterial taxa. CONCLUSION Reduced microbial diversity reflects higher severity and mortality rate in HSCT patients with aGVHD. Multi-omics approaches to decipher oral and gut microbiome associations will be critical for developing aGVHD preventive therapies.
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15
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Leuci S, Coppola N, Blasi A, Ruoppo E, Bizzoca ME, Lo Muzio L, Marano L, Risitano AM, Mignogna MD. Oral Dysplastic Complications after HSCT: Single Case Series of Multidisciplinary Evaluation of 80 Patients. Life (Basel) 2020; 10:life10100236. [PMID: 33050268 PMCID: PMC7600275 DOI: 10.3390/life10100236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is the most common secondary solid malignancy after hematopoietic stem-cell transplantation (HSCT). OSCC following HSCT is frequently preceded by chronic graft-versus-host disease (cGVHD). The aim of this study was to describe a cohort of post-HSCT patients and to evaluate the onset of oral epithelial dysplasia and/or OSCC over time. In this retrospective cohort study, we present a cohort of hematological patients that underwent HSCT. Demographic variables, clinical hematological data, data regarding acute graft-versus-host disease (aGVHD) and cGVHD, and oral clinical features were analyzed. We focused on clinicopathological features of a subgroup of 22 patients with oral cGVHD and OSCC after HSCT. Among 80 included patients, 46 patients (57.5%) developed aGVHD and 39 patients (48.7%) developed cGVHD. Oral mucosa was involved in 17 patients with aGVHD (36.9%) and in 22 patients (56.4%) with cGVHD. Out of a total of 22 oral biopsies, roughly 40% revealed mild to moderate dysplasia, and 32% were OSCC. In the absence of international agreement on the best timing of oral follow-up after HSCT, it is mandatory to establish a close multidisciplinary evaluation in order to prevent the onset of HSCT-related OSCC and to reduce post-transplant mortality due to secondary tumors.
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Affiliation(s)
- Stefania Leuci
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
- Correspondence: ; Tel.: +39-3392602615
| | - Andrea Blasi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
| | - Elvira Ruoppo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
| | - Maria Eleonora Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.E.B.); (L.L.M.)
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.E.B.); (L.L.M.)
| | - Luana Marano
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80138 Naples, Italy;
| | | | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Oral Medicine Unit, Federico II University of Naples, 80138 Naples, Italy; (S.L.); (A.B.); (E.R.); (M.D.M.)
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16
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Pereira AZ, Vigorito AC, Almeida ADM, Candolo ADA, Silva ACL, Brandão-Anjos AEDP, Sá BLD, Souza CLSD, Castro Junior CGD, Oliveira JSRD, Barban JB, Mancilha EMB, Todaro J, Lopes LP, Macedo MCMDA, Rodrigues M, Ribeiro PC, Silva RLD, Roberto TS, Rodrigues TDCR, Colturato VAR, Paton EJDA, Barros GMN, Almeida RDS, Moreira MCR, Flowers ME. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease. EINSTEIN-SAO PAULO 2020; 18:eAE4799. [PMID: 32215466 PMCID: PMC7069734 DOI: 10.31744/einstein_journal/2020ae4799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/27/2019] [Indexed: 02/02/2023] Open
Abstract
The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Juliana Todaro
- Hospital Israelita Albert Einstein , São Paulo , SP , Brazil
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17
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Dal Collo G, Adamo A, Gatti A, Tamellini E, Bazzoni R, Takam Kamga P, Tecchio C, Quaglia FM, Krampera M. Functional dosing of mesenchymal stromal cell-derived extracellular vesicles for the prevention of acute graft-versus-host-disease. Stem Cells 2020; 38:698-711. [PMID: 32064745 DOI: 10.1002/stem.3160] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 02/06/2023]
Abstract
Graft-vs-host-disease (GvHD) is currently the main complication of allogeneic hematopoietic stem cell transplantation. Mortality and morbidity rates are particularly high, especially in steroid-refractory acute GvHD (aGvHD). Immune regulatory human bone marrow mesenchymal stromal cells (hMB-MSCs) represent a therapeutic approach to address this issue. Unfortunately, their effect is hardly predictable in vivo due to several variables, that is, MSC tissue origin, concentration, dose number, administration route and timing, and inflammatory status of the recipient. Interestingly, human bone marrow MSC-derived extracellular vesicles (hBM-MSC-EVs) display many of the hBM-MSC immunoregulatory properties due to their content in paracrine factors that greatly varies according to the collection method. In this study, we focused on the immunological characterization of hBM-MSC-EVs on their capability of inducing regulatory T-cells (T-regs) both in vitro and in a xenograft mouse model of aGvHD. We correlated these data with the aGvHD incidence and degree following hBM-MSC-EV intravenous administration. Thus, we first quantified the EV immunomodulation in vitro in terms of EV immunomodulatory functional unit (EV-IFU), that is, the lowest concentration of EVs leading in vitro to at least threefold increase of the T-regs compared with controls. Second, we established the EV therapeutic dose in vivo (EV-TD) corresponding to 10-fold the in vitro EV-IFU. According to this approach, we observed a significant improvement of both mouse survival and control of aGvHD onset and progression. This study confirms that EVs may represent an alternative to whole MSCs for aGvHD prevention, once the effective dose is reproducibly identified according to EV-IFU and EV-TD definition.
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Affiliation(s)
- Giada Dal Collo
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Annalisa Adamo
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Gatti
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Edoardo Tamellini
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Riccardo Bazzoni
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Paul Takam Kamga
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy.,EA4340-BCOH, Biomarker in Cancerology and Onco-Haematology, UVSQ, Université Paris Saclay, Boulogne-Billancourt, France
| | - Cristina Tecchio
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Maria Quaglia
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Krampera
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
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18
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Seo HJ, Baek YG, Cho BS, Kim TS, Um YH, Chae JH. Anxiety and Depression of the Patients with Hematological Malignancies during Hospitalization for Hematopoietic Stem Cell Transplantation. Psychiatry Investig 2019; 16:751-758. [PMID: 31558690 PMCID: PMC6801322 DOI: 10.30773/pi.2019.07.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/12/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE This study aimed to assess the anxiety and depression in patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS Eighty-seven adult patients with various hematologic diseases, who were scheduled to receive autologous or allogeneic HSCT, were enrolled. The M.D. Anderson Symptom Inventory and the Hospital Anxiety Depression Scale were applied prospectively at hospital admission (D-14), on the day of transplantation (D day), and at 7 (D7) and 14 days (D14) after transplantation. RESULTS The severity of both anxiety and depressive symptoms increased over time, with a peak at D7, and then showed a downturn at D14. Physical distresses also started with mild intensity at base line, which were continuously aggravated until D7, and then a partial recovery afterwards. Approximately, 52% of the participants had significantly high anxiety or depression before the start of HSCT. The occurrence of aggravation of pain, nausea, shortness of breath, and lack of appetite was associated with the development of anxiety during isolation period. The patients with significant baseline anxiety had higher scores on fatigue and shortness of breath items at D7 compared to those without. CONCLUSION Our finding suggests the importance of psychiatric approaches, including preventive measures, for the patients undergoing HSCT.
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Affiliation(s)
- Ho-Jun Seo
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Young-Gun Baek
- Seoul Metropolitan Office of Education, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Suk Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zamani M, Yaghoubi Y, Movassaghpour A, Shakouri K, Mehdizadeh A, Pishgahi A, Yousefi M. Novel therapeutic approaches in utilizing platelet lysate in regenerative medicine: Are we ready for clinical use? J Cell Physiol 2019; 234:17172-17186. [PMID: 30912141 DOI: 10.1002/jcp.28496] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/13/2022]
Abstract
Hemoderivative materials are used to treat different diseases. These derivatives include platelet-rich plasma, serum, platelet gel, and platelet lysate (PL). Among them, PL contains more growth factors than the others and its production is inexpensive and easy. PL is one of the proper sources of platelet release factors. It is used in cells growth and proliferation and is a good alternative to fetal bovine serum. In recent years, the clinical use of PL has gained more appeal by scientists. PL is a solution saturated by growth factors, proteins, cytokines, and chemokines and is administered to treat different diseases such as wound healing, bone regeneration, alopecia, oral mucositis, radicular pain, osteoarthritis, and ocular diseases. In addition, it can be used in cell culture for cell therapy and tissue transplantation purposes. Platelet-derived growth factor, fibroblast growth factor, insulin-like growth factor, transforming growth factor β, and vascular endothelial growth factor are key PL growth factors playing a major role in cell proliferation, wound healing, and angiogenesis. In this paper, we scrutinized recent advances in using PL and PL-derived growth factors to treat diseases and in regenerative medicine, and the ability to replace PL with other hemoderivative materials.
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Affiliation(s)
- Majid Zamani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yoda Yaghoubi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aliakbar Movassaghpour
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Hematology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kazem Shakouri
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Mehdizadeh
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Pishgahi
- Department of Hematology, Tabriz University of Medical Sciences, Tabriz, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
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Marinho-Dias J, Baldaque I, Pinho-Vaz C, Leite L, Branca R, Campilho F, Campos A, Medeiros R, Sousa H. Association of Epstein‑Barr virus infection with allogeneic hematopoietic stem cell transplantation in patients in Portugal. Mol Med Rep 2018; 19:1435-1442. [PMID: 30592278 PMCID: PMC6390016 DOI: 10.3892/mmr.2018.9794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 07/05/2018] [Indexed: 11/17/2022] Open
Abstract
The identification of patients at higher risk of developing Epstein-Barr virus (EBV) infection in hematopoietic stem cell transplants (HSCT) is useful for the prevention of EBV-associated diseases A prospective observational study was developed that included 40 patients (27 male and 13 females, with mean age of 32.2±1.5 years old) undergoing allogeneic-HSCT between January and December 2015. EBV was examined in whole blood samples collected during routine procedures at day (D)+30, D +60, +90, D+120, D+150 and D+180 post-transplant. EBV was detected, at least once during the follow-up period in 70.0% of our patients. Results indicated that patients with unrelated donors had increased risk of developing EBV infection at D+60 and D+150 (OR=3.9, P=0.058; OR=8.0, P=0.043; respectively). Moreover, myeloablative conditioning (OR=4.3, P=0.052), anti-thymocyte globulin use (OR=12.0, P=0.030) and graft-vs.-host disease (OR=6.7, P=0.032) were associated with EBV infection at D+60, D+150 and D+90, respectively. In our series, none of these patients developed post-transplant lymphoproliferative disease. To the best of our knowledge, the present study is the first study to report EBV infection in patients undergoing aHSCT from Portugal. The study revealed that EBV infection is associated with different factors. These findings provide evidence towards the identification of high-risk patients for EBV-infection and associated disease.
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Affiliation(s)
- Joana Marinho-Dias
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Inês Baldaque
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Carlos Pinho-Vaz
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Luís Leite
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Rosa Branca
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Fernando Campilho
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - António Campos
- Bone Marrow Transplantation Unit, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Rui Medeiros
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
| | - Hugo Sousa
- Virology Service, Portuguese Oncology Institute of Porto, 4200‑072 Porto, Portugal
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