1
|
Oliveira CMCZ, Gouveia RV, Zamperlini G, Ginani VC, Matos MGAD, Monteiro CN, Domingues LDS, Soriano PAM, Pupim MV, Marques JF, Santos FVBD, Andrade CF, Paiva PM, Seber A. TRANSPLANTE ALOGÊNICO DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH) PARA TRATAMENTO DE DOENÇA FALCIFORME (DF): ESTRATÉGIAS E COMPLICAÇÕES DISTINTAS, MAS RESULTADOS SEMELHANTES COM TCTH HAPLOIDÊNTICO (HAPLO) E IRMÃO HLA-IDÊNTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
2
|
Gouveia RV, Ginani VC, Zamperlini G, Oliveira CMCZ, Breviglieri CNM, Matos MGAD, Domingues LDS, Pupim MV, Marques JF, Paiva PM, Soriano PA, Santos FVB, Andrade CF, Seber A. EXPERIÊNCIA DO RUXOLITINIB NO TRATAMENTO DE DOENÇA DO ENXERTO CONTRA O HOSPEDEIRO CRÔNICA EM CRIANÇAS SUBMETIDAS A TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH). Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
3
|
Seber A, Gomes A, Daudt LE, Fernandes JF, Darrigo-Junior LG, Siminone A, Silva CC, Hamerschlak N, Bonfim CS. OUTCOMES OF PEDIATRIC HEMATOPOIETIC STEM CELL TRANSPLANTS (HSCT) PERFORMED IN BRAZIL BETWEEN 2008 AND 2019. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
4
|
Gouveia RV, Ginani VC, Zamperlini G, Matos MGAD, Monteiro CN, Domingues LDS, Oliveira CMCZ, Soriano PAM, Marques JF, Pupim MV, Seber A, Santos FVB, Paiva PM, Andrade CF, Seber A. REVERSÃO DE QUIMERISMO MISTO COM INFUSÃO DE LEUCÓCITOS DE DOADOR EM CRIANÇAS SUBMETIDAS A TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH) HAPLOIDÊNTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
5
|
Breviglieri CNM, Gouveia RV, Ginani VC, Oliveira CMCZ, Domingues LDS, Alves MGM, Zamperlini G, Soriano PAM, Marques JF, Seber A. EXPERIÊNCIA COM REGIMES DE CONDICIONAMENTO SUGERIDOS PELO GRUPO DE ESTUDOS DE LEUCEMIA MIELÓIDE AGUDA INFANTIL (GELMAI). Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
6
|
Matos MGAD, Domingues LDS, Gouveia RV, Ginani VC, Zamperlini G, Oliveira CMCZ, Pupim MV, Soriano PA, Monteiro CN, Marques JF, Santos FVBD, Andrade CF, Seber A. O USO DE CICLOFOSFAMIDA 50 MG/KG EM REGIMES DE CONDICIONAMENTO DE TOXICIDADE REDUZIDA PROPORCIONAM ENXERTIA DE TODAS AS CRIANÇAS PORTADORAS DE APLASIA GRAVE DE MEDULA ÓSSEA SUBMETIDAS A TRANSPLANTES ALOGÊNICOS DE DOADOR NÃO APARENTADO E HAPLOIDÊNTICO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
7
|
Zamperlini G, Gouveia RV, Ginani VC, Oliveira CMCZ, Matos MGAD, Monteiro CN, Domingues LDS, Pupim MV, Soriano PAM, Marques JF, Andrade CF, Santos FVBD, Paiva PM, Seber A. RESULTADO DO TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS COM DOADORES ALTERNATIVOS APÓS BLINATUMOMAB EM CRIANÇAS COM LEUCEMIA LINFÓIDE AGUDA DE LINHAGEM B (LLA-B) RECIDIVADA OU REFRATÁRIA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
8
|
Domingues LDS, Zamperlini G, Gouveia RV, Ginani VC, Matos MGAD, Oliveira CMCZ, Monteiro CN, Pupim MV, Soriano PAM, Marques JF, Santos FVBD, Andrade CF, Paiva PM, Seber A. A ASSOCIAÇÃO DE BLINATUMOMAB (BLINA) E INOTUZUMAB (INO) PODE INDUZIR RESPOSTA COMPLETA DE LEUCEMIA LINFÓIDE AGUDA DE LINHAGEM B (LLA-B) REFRATÁRIA E PERMITIR O TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOIÉTICAS (TCTH) EM REMISSÃO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
9
|
Gouveia R, Ginani V, Zamperlini G, Zanchetta C, Lutti D, Souto E, Pereira N, Dantas M, Marques J, Seber A. TRANSPLANTES DE CÉLULAS-TRONCO HEMATOPOIÉTICAS PARA O TRATAMENTO DE ANEMIA FALCIFORME EM PEDIATRIA. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
10
|
Zamperlini G, Ginani V, Gouveia R, Domingues L, Breviglieri C, Marques J, Santos F, Andrade C, Matos M, Seber A. TRATAMENTO DE LEUCEMIA LINFÓIDE AGUDA PEDIÁTRICA RECIDIVADA APÓS TRANSPLANTE ALOGÊNICO DE CÉLULAS-TRONCO HEMATOPOIÉTICAS COM BLINATUMOMAB. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Jaimovich G, Rolon JM, Baldomero H, Rivas M, Hanesman I, Bouzas L, Bonfim C, Palma J, Kardus-Urueta A, Ubidia D, Bujan-Boza W, Gonzalez-Ramella O, Ruiz-Argüelles G, Gomez-Almaguer D, Espino G, Fanilla E, Gonzalez D, Carrasco A, Galeano S, Borelli G, Hernandez-Gimenez M, Pasquini M, Kodera Y, Gratwohl A, Gratwohl M, Nuñez J, Szer J, Gale RP, Niederwieser D, Seber A. Latin America: the next region for haematopoietic transplant progress. Bone Marrow Transplant 2017; 52:798. [PMID: 28465623 DOI: 10.1038/bmt.2017.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
12
|
DeFilipp Z, Duarte RF, Snowden JA, Majhail NS, Greenfield DM, Miranda JL, Arat M, Baker KS, Burns LJ, Duncan CN, Gilleece M, Hale GA, Hamadani M, Hamilton BK, Hogan WJ, Hsu JW, Inamoto Y, Kamble RT, Lupo-Stanghellini MT, Malone AK, McCarthy P, Mohty M, Norkin M, Paplham P, Ramanathan M, Richart JM, Salooja N, Schouten HC, Schoemans H, Seber A, Steinberg A, Wirk BM, Wood WA, Battiwalla M, Flowers MED, Savani BN, Shaw BE. Metabolic syndrome and cardiovascular disease following hematopoietic cell transplantation: screening and preventive practice recommendations from CIBMTR and EBMT. Bone Marrow Transplant 2016; 52:173-182. [PMID: 27548466 DOI: 10.1038/bmt.2016.203] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 12/12/2022]
Abstract
Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus and all cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with the estimated prevalence of MetS being 31-49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal of reviewing literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors.
Collapse
Affiliation(s)
- Z DeFilipp
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - R F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust and Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - N S Majhail
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - D M Greenfield
- Specialized Cancer Services, Sheffield Teaching Hospital NHS Foundation Trust, Shefflied, UK
| | - J L Miranda
- Department of Medicine, Reina Sofia University Hospital, Maimonides Institute for Biomedical Research at Cordoba (IMIBIC), University of Cordoba, CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - M Arat
- Florence Nightingale Sisli Hospital, Hematopoietic Stem Cell Transplantation Unit, Istanbul, Turkey
| | - K S Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L J Burns
- National Marrow Donor Program, University of Minnesota, Minneapolis, MN, USA
| | - C N Duncan
- Pediatric Stem Cell Transplant, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M Gilleece
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G A Hale
- All Children's Hospital, John Hopkins Medicine, St. Petersburg, FL, USA
| | - M Hamadani
- Department of Medicine, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - B K Hamilton
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - W J Hogan
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J W Hsu
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Y Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - R T Kamble
- Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - M T Lupo-Stanghellini
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | - A K Malone
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - P McCarthy
- Department of Medicine, Roswell Park Cancer Institute, BMT Program, Buffalo, NY, USA
| | - M Mohty
- University Pierre & Marie Curie, Paris, France.,Hopital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs 938, Paris, France
| | - M Norkin
- Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - P Paplham
- Department of Medicine, Roswell Park Cancer Institute, BMT Program, Buffalo, NY, USA
| | - M Ramanathan
- Department Hematology, Oncology and Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, MA, USA
| | - J M Richart
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University, St. Louis, MO, USA
| | | | - H C Schouten
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - H Schoemans
- Department of Hematology, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - A Seber
- Hospital Samaritano, Sao Paulo, Brazil.,Associação da Medula Ossea - AMEO, Sao Paulo, Brazil
| | - A Steinberg
- Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - B M Wirk
- Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - W A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M Battiwalla
- Hematology Branch, National Institutes of Health, Bethesda, MD, USA
| | - M E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - B N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - B E Shaw
- Department of Medicine, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
13
|
Gale RP, Seber A, Bonfim C, Pasquini M. Haematopoietic cell transplants in Latin America. Bone Marrow Transplant 2016; 51:898-905. [PMID: 26999468 DOI: 10.1038/bmt.2016.35] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/13/2015] [Accepted: 11/19/2015] [Indexed: 11/09/2022]
Abstract
Haematopoietic cell transplants are done by more than 1500 transplant centres in 75 countries, mostly for life-threatening haematological disorders. However, transplant technology and access are not uniformly distributed worldwide. Most transplants are done predominately in Europe, North America and some Asian countries. We review transplant activity in Latin America, a geographic region with a population of >600 million persons living in countries with diverse economic and social development levels. These data indicate a 20-40-fold lower frequency of transplants in Latin America compared with Europe and North America. We show that although economics, infrastructure and expertise are important limitations, other variables also operate. Changes in several of these variables may substantially increase transplant activity in Latin America.
Collapse
Affiliation(s)
- R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - A Seber
- Latin American Bone Marrow Transplantation Group and Hospital Samaritano, São Paulo, Brazil
| | - C Bonfim
- Federal University of Parana, Curitiba, Brazil
| | - M Pasquini
- Center for International Blood and Marrow Transplant Research and Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
14
|
Niederwieser D, Baldomero H, Szer J, Gratwohl M, Aljurf M, Atsuta Y, Bouzas LF, Confer D, Greinix H, Horowitz M, Iida M, Lipton J, Mohty M, Novitzky N, Nunez J, Passweg J, Pasquini MC, Kodera Y, Apperley J, Seber A, Gratwohl A. Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for Blood and Marrow Transplantation Group including the global survey. Bone Marrow Transplant 2016; 51:778-85. [PMID: 26901703 DOI: 10.1038/bmt.2016.18] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 12/13/2022]
Abstract
Data on 68 146 hematopoietic stem cell transplants (HSCTs) (53% autologous and 47% allogeneic) gathered by 1566 teams from 77 countries and reported through their regional transplant organizations were analyzed by main indication, donor type and stem cell source for the year 2012. With transplant rates ranging from 0.1 to 1001 per 10 million inhabitants, more HSCTs were registered from unrelated 16 433 donors than related 15 493 donors. Grafts were collected from peripheral blood (66%), bone marrow (24%; mainly non-malignant disorders) and cord blood (10%). Compared with 2006, an increase of 46% total (57% allogeneic and 38% autologous) was observed. Growth was due to an increase in reporting teams (18%) and median transplant activity/team (from 38 to 48 HSCTs/team). An increase of 167% was noted in mismatched/haploidentical family HSCT. A Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis revealed the global perspective of WBMT to be its major strength and identified potential to be the key professional body for patients and authorities. The limited data collection remains its major weakness and threat. In conclusion, global HSCT grows over the years without plateauing (allogeneic>autologous) and at different rates in the four World Health Organization regions. Major increases were observed in allogeneic, haploidentical HSCT and, to a lesser extent, in cord blood transplantation.
Collapse
Affiliation(s)
- D Niederwieser
- The Worldwide Network of Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital Basel, Basel, Switzerland.,Department of Hematology-Oncology, University Hospital, Leipzig, Germany
| | - H Baldomero
- The Worldwide Network of Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital Basel, Basel, Switzerland
| | - J Szer
- The Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Royal Melbourne Hospital, Parkville, VIC, Australia
| | - M Gratwohl
- Institute for Operations Research and Computational Finances, University of St Gallen, St Gallen, Switzerland
| | - M Aljurf
- The Eastern Mediterranean Blood and Marrow Transplant Group (EMBMT), King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Y Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - L F Bouzas
- The Latin American Blood and Marrow Transplant Group (LABMT), Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | - D Confer
- National Marrow Donor Program, Minneapolis, MN, USA
| | - H Greinix
- Medical University of Graz, Division of Hematology, Graz, Austria
| | - M Horowitz
- The Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Iida
- The Asian Pacific Blood and Marrow Transplant Group (APBMT) Data Centre, Aichi Medical University, School of Medicine, Aichi, Japan
| | - J Lipton
- The Canadian Blood and Marrow Transplant Group (CBMTG), Princess Margaret Hospital, Toronto, ON, Canada
| | - M Mohty
- The European Blood and Marrow Transplant Group (EBMT), Hôpital St Antoine, St Antoine, Paris
| | - N Novitzky
- The African Blood and Marrow Transplant Group (AFBMT), Johannesburg, South Africa
| | - J Nunez
- The World Health Organization WHO, Geneva, Switzerland
| | - J Passweg
- The Worldwide Network of Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital Basel, Basel, Switzerland
| | - M C Pasquini
- The Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Y Kodera
- Aichi Medical University, School of Medicine, Aichi, Japan
| | - J Apperley
- Department of Hematology, Hammersmith Hospital, London, UK
| | - A Seber
- Department of Pediatric, Hospital Samaritano, Sao Paulo, Brazil
| | - A Gratwohl
- The Worldwide Network of Blood and Marrow Transplantation (WBMT) Transplant Activity Survey Office, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
15
|
Mazzucchelli JTL, Bonfim C, Castro GG, Condino-Neto AA, Costa NMX, Cunha L, Dantas EO, Dantas VM, de Moraes-Pinto MI, Fernandes JF, Goes HC, Goudouris E, Grumach AS, Guirau LMB, Kuntze G, Mallozzi MC, Monteiro FP, Moraes LSL, Nudelman V, Pinto JA, Rizzo MCV, Porto-Neto AC, Roxo-Junior P, Ruiz M, Rullo VEV, Seber A, Takano OA, Tavares FS, Toledo E, Vilela MMS, Costa-Carvalho BT. Severe combined immunodeficiency in Brazil: management, prognosis, and BCG-associated complications. J Investig Allergol Clin Immunol 2014; 24:184-191. [PMID: 25011356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Severe combined immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency. The objectives of this study were to analyze the diagnosis, treatment, and prognosis of SCID in Brazil and to document the impact of BCG vaccine. METHODS We actively searched for cases by contacting all Brazilian referral centers. RESULTS We contacted 23 centers and 70 patients from 65 families. Patients were born between 1996 and 2011, and 49 (70%) were male. More than half (39) of the diagnoses were made after 2006. Mean age at diagnosis declined from 9.7 to 6.1 months (P = .058) before and after 2000, respectively, and mean delay in diagnosis decreased from 7.9 to 4.2 months (P = .009). Most patients (60/70) were vaccinated with BCG before the diagnosis, 39 of 60 (65%) had complications related to BCG vaccine, and the complication was disseminated in 29 of 39 (74.3%). Less than half of the patients (30, 42.9%) underwent hematopoietic stem cell transplantation (HSCT). Half of the patients died (35, 50%), and 23 of these patients had not undergone HSCT. Disseminated BCG was the cause of death, either alone or in association with other causes, in 9 of 31 cases (29%, no data for 4 cases). CONCLUSIONS In Brazil, diagnosis of SCID has improved over the last decade, both in terms of the number of cases and age at diagnosis, although a much higher number of cases had been expected. Mortality is higher than in developed countries. Complications of BCG vaccine are an important warning sign for the presence of SCID and account for significant morbidity during disease progression.
Collapse
|
16
|
Santos MVC, Paiva MG, Macedo CRDP, Petrilli AS, Azeka E, Jatene IB, Castro Junior CG, Seber A, Miachon AS, Tanaka ACS, Castro MAS, Carvalho AC, Nars CCF, Terzian CN, Santos CCL, Guerra CCS, Silva DCB, Bassi DU, Feitosa FA, Hamamoto F, Szarf G, Lederman HM, Rigon Junior HJ, Mota ICF, Perrud JÁ, Soares Junior J, Gutierrez JA, Perin JPM, Catani LH, Tsai LY, Vianna LC, Santos MJ, Ishigai MMS, Diógenes MSB, Alves MTS, Piedade MTC, Parreiras M, Cypriano M, Negrini NS, Campos Filho O, Figueiredo PA, Novaes PE, Camargo PR, Maia OS, Petrilli R, Arduini RG, Gouveia RV, Teruya SBM, Moisés VA, Morais VLL. I Diretriz Brasileira de Cardio-Oncologia Pediátrica da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2013; 100:1-68. [DOI: 10.5935/abc.2013s005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
Nucci M, Garnica M, Gloria AB, Lehugeur DS, Dias VCH, Palma LC, Cappellano P, Fertrin KY, Carlesse F, Simões B, Bergamasco MD, Cunha CA, Seber A, Ribeiro MPD, Queiroz-Telles F, Lee MLM, Chauffaille ML, Silla L, de Souza CA, Colombo AL. Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil. Clin Microbiol Infect 2012; 19:745-51. [PMID: 23009319 DOI: 10.1111/1469-0691.12002] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1 year (HCT) or end of consolidation therapy (AML/MDS). The 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p <0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. The 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p <0.001), and 5.2%, 3.8% and 0.6% (p 0.01), respectively. The 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.
Collapse
Affiliation(s)
- M Nucci
- University Hospital, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther 2012; 5:1-30. [PMID: 22446607 DOI: 10.5144/1658-3876.2012.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
Collapse
Affiliation(s)
- N S Majhail
- National Marrow Donor Program, Minneapolis, MN 55413-1753, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Souto MAA, Lalla RV, Rojz J, Gouveia RV, Seber A, Lopes NNF. Preventive action of LLLT in oral mucositis (OM) in patients undergoing hematopoetic stem cell transplantation (HSCT) - retrospectively controlled. Med Oral Patol Oral Cir Bucal 2012. [DOI: 10.4317/medoral.17643761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
20
|
Villela N, Gouveia R, Macedo C, Zecchin V, Ginani V, Marconcini J, Felix O, Barros D, Alves L, Ibanez A, Simoes P, Silva A, Petrilli A, Seber A. High Dose Carboplatin, Etoposide, Melphalan and Autologous Hematopoietic Stem Cell Rescue with for the Treatment of Relapsed Pediatric Germ Cell Tumors. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
21
|
Seber A, Ginani V, Gouveia R, Zecchin V, Barros D, Ibanez A, Marconcini J, Villela N, Felix O, Simoes P, Seixas M, Lee M, Lederman H, Caran E, Macedo C, Petrilli A. High Dose Oral Busulfan and Intravenous Melphalan as Conditioning Therapy for Autologous Hematopoietic Stem Cell Transplant (HSCT) for the Treatment of Pediatric Solid Tumors. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
22
|
Gouveia R, Bonfim C, Ginani V, Zecchin V, Carlesse F, Carvalho C, Schmitz J, Marconcini J, Porto D, Duarte A, Ribeiro L, Félix O, Simões P, Silva A, Petrilli A, Carvalho B, Pinto M, Seber A. Hematopoietic Stem Cell Transplantation For Patients With Severe Combined Immunodeficiency And Disseminated Bacillus Calmette-Guérin Infections. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
23
|
Nemecek E, Carpenter P, He W, Ellis K, Seber A, Woolfrey A, MacMillan M, Eapen M, Davies S, Frangoul H. Outcome Of Unrelated Donor Blood And Marrow Transplantation (BMT) For Children With Acute Lymphoblastic Leukemia (ALL) In Third Remission. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
24
|
Marconcini JF, Gomes CF, Delbuono E, Costa V, Pacheco CD, Seber A, Lee MM. Retrospective study of relapsed ALL in a single institution in Brazil. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.20018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
20018 Background: With contemporary protocols, 25–30% of children with ALL who achieve first complete remission (CR1) are expected to relapse. Although the majority of patients can achieve a second complete remission (CR2) with re-induction chemotherapy, only a few will maintain prolonged clinical remission. To study the pattern of ALL relapse in our institution, we performed a retrospective analysis of such events between 1994 and 2006. Methods: In the study period, 65 out of 292 (22%) patients treated at our institution for ALL suffered isolated or combined relapse. Median age was 7.2 years (range 0.4–18.2 years); 65% were male. Patients were analyzed according to immunophenotype, WBC, site of relapse and time to relapse. Kaplan-Meier life-table analyses were used to estimate survival; differences were assessed by the log-rank test. Results: Of 63 relapsed ALL that were immunophenotyped, 65% were B-cell precursors and 35% were T-cell. WBC was >50,000/mm3 in 47% of patients; 54% of them had isolated bone marrow (BM) relapse, 23% combined relapse and 23% isolated extramedullary (EM) relapse (11CNS and 4 testicular relapse); 58% had very early relapse (VER) (<18 months from CR1), 17% early relapse (ER) (18–30 months from CR1) and 25% late relapse (LR) (>30 months from CR1). The therapeutic approach was chemotherapy in 60 patients and BMT in five. CR2 was achieved in 63% of patients. Of these, 35% had a second relapse. Death rate was 66% with median follow-up of 5,3 months; 40% had cumulative survival rate = 4 years. Initial imunophenotype and WBC did not affect outcome. Patients with isolated EM relapse presented a significant superior outcome when compared with those with combined relapse (p=0.024). There was no difference in survival between isolated BM and combined relapse. As for the time to relapse, there was significant inferior outcome for patients with VER when compared with ER (p=0.0089) and LR (p=0.0041). However, there was no difference in survival between ER and LR group. Conclusions: In our casuistic, time to relapse was the main predictor of outcome. Despite continuous improvement in therapy of childhood ALL, survival rate of relapsed patients remains disappointing. No significant financial relationships to disclose.
Collapse
Affiliation(s)
| | - C. F. Gomes
- Instituto de Oncologia Pediatrica, Sao Paulo, Brazil
| | - E. Delbuono
- Instituto de Oncologia Pediatrica, Sao Paulo, Brazil
| | - V. Costa
- Instituto de Oncologia Pediatrica, Sao Paulo, Brazil
| | - C. D. Pacheco
- Instituto de Oncologia Pediatrica, Sao Paulo, Brazil
| | - A. Seber
- Instituto de Oncologia Pediatrica, Sao Paulo, Brazil
| | - M. M. Lee
- Instituto de Oncologia Pediatrica, Sao Paulo, Brazil
| |
Collapse
|
25
|
Oliveira AL, de Souza M, Carvalho-Dias VMH, Ruiz MA, Silla L, Tanaka PY, Simões BP, Trabasso P, Seber A, Lotfi CJ, Zanichelli MA, Araujo VR, Godoy C, Maiolino A, Urakawa P, Cunha CA, de Souza CA, Pasquini R, Nucci M. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2007; 39:775-81. [PMID: 17438585 DOI: 10.1038/sj.bmt.1705677] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The incidence of Gram-negative bacteremia has increased in hematopoietic stem cell transplant (HSCT) recipients. We prospectively collected data from 13 Brazilian HSCT centers to characterize the epidemiology of bacteremia occurring early post transplant, and to identify factors associated with infection due to multi-drug-resistant (MDR) Gram-negative isolates. MDR was defined as an isolate with resistance to at least two of the following: third- or fourth-generation cephalosporins, carbapenems or piperacillin-tazobactam. Among 411 HSCT, fever occurred in 333, and 91 developed bacteremia (118 isolates): 47% owing to Gram-positive, 37% owing to Gram-negative, and 16% caused by Gram-positive and Gram-negative bacteria. Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%) and Escherichia coli (17%) accounted for the majority of Gram-negative isolates, and 37% were MDR. These isolates were recovered from 20 patients, representing 5% of all 411 HSCT and 22% of the episodes with bacteremia. By multivariate analysis, treatment with third-generation cephalosporins (odds ratio (OR) 10.65, 95% confidence interval (CI) 3.75-30.27) and being at one of the hospitals (OR 9.47, 95% CI 2.60-34.40) were associated with infection due to MDR Gram-negative isolates. These findings may have important clinical implications in the decision of giving prophylaxis and selecting the empiric antibiotic regimen.
Collapse
Affiliation(s)
- A L Oliveira
- Hospital Universitário, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bonfim C, Bitencourt M, Funke V, Setubal D, Ruiz J, Seber A, Pilonetto D, Medeiros C, Zanis-Neto J, Pasquini R. Stem cell transplantation in 40 pts with Fanconi anemia (FA): Excellent survival and low toxicity for pts with a related HLA identical donor. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
27
|
Castro C, Seber A, Mendes W, Castro H, Borsato M, Gregianin L, Ginani V, Barros J, Petrilli A, Brunetto A. Autologous stem cell transplantation for the treatment of pediatric solid tumors in Brazil. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Ginani V, Cecyn K, Carvalho M, Caram E, Macedo C, Gordan L, Gouveia R, Bastos E, Delbuono E, Lee M, Oliveira O, Vieira M, Seixas M, Petrilli A, Seber A. Large volume leukapheresis for autologous peripheral blood stem cell collection in children weighting less than 25 kg. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Oliveira O, Vieira M, Bastos E, Delbuono E, Ginani V, Gordan L, Gouveia R, Cecyn K, Carvalho M, Lee M, Petrilli A, Seber A. DMSO removal reduces stem-cell infusion-related toxicity and allows excellent engraftment of cryopreserved unrelated cord blood and autologous stem cells. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Petrilli AS, Dantas LS, Campos MC, Tanaka C, Ginani VC, Seber A. Oral ciprofloxacin vs. intravenous ceftriaxone administered in an outpatient setting for fever and neutropenia in low-risk pediatric oncology patients: randomized prospective trial. Med Pediatr Oncol 2000; 34:87-91. [PMID: 10657866 DOI: 10.1002/(sici)1096-911x(200002)34:2<87::aid-mpo2>3.0.co;2-f] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infections are one of the major complications in children undergoing chemotherapy. Monotherapy with either ciprofloxacin or ceftriaxone is safe and efficient in low-risk patients (solid tumors and stage I/II lymphomas). The same drugs may be used in an outpatient setting, decreasing costs and the risk of nosocomial infections. PROCEDURE Low-risk patients (N = 70) with episodes of fever and neutropenia (N = 116) were randomized to receive either oral ciprofloxacin or intravenous ceftriaxone as outpatients. Only one patient had a central venous catheter. RESULTS Episodes of fever and neutropenia were classified as fever of unknown origin (41% vs. 32%) or clinically documented infection (56% vs. 63%) in the ciprofloxacin and ceftriaxone groups, respectively. Most of these infections were of upper respiratory tract, skin, or gastrointestinal origin. The mean duration of neutropenia was 5 vs. 6 days. Fever persisted for 1-9 days (mean 2 vs. 3 days). Therapy was successful with no modifications in 83% vs. 75% of the episodes. Patients were admitted in 7% vs. 4% of the episodes. No bone or joint side effects were seen in either group. All patients survived. CONCLUSIONS Outpatient therapy with either oral ciprofloxacin or intravenous ceftriaxone for fever and neutropenia is effective and safe in pediatric patients with solid tumors and stage I/II non-Hodgkin lymphoma (low-risk patients).
Collapse
Affiliation(s)
- A S Petrilli
- Pediatric Oncology Institute, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
Hemorrhagic cystitis (HC) is a common toxicity of preparative regimens for bone marrow transplantation (BMT). Severe HC often requires prolonged and expensive hospitalization, and occasionally can result in death. To investigate the risk factors for severe HC, we conducted a retrospective study among 1908 patients who received BMTs at the University of Minnesota during 1974 to 1993. A previous report from our institution reported on 977 of these patients. We identified all patients with genitourinary complication within 100 days post-BMT from the BMT database. Medical charts for these patients were reviewed to determine whether the patient had HC and also the grade of HC. A total of 208 HC cases were identified during the study period. Of them, 92 patients had severe HC, an incidence of 5% (95% CI = 4-6%). We found that grade II-IV graft-versus-host disease (RR = 2.56; 95% CI = 1.43-4.56), use of busulfan (RR = 2.69; 95% CI = 1.35-5.35), and age at transplant (RR = 2.20; 95% CI = 1.27-3.81, for age of 10-30 compared to age of 0-9) were related to an increased risk of HC. In contrast, transplant year was inversely associated with the risk of HC (trend test, P < 0.01). We did not find any significant difference in HC with the use of prophylactic Mesna.
Collapse
Affiliation(s)
- A Seber
- Pediatric Department, Universidade Federal de Sao Paulo, Brazil
| | | | | | | | | |
Collapse
|
32
|
O'Donnell PV, Jones RJ, Vogelsang GB, Seber A, Ambinder RF, Flinn I, Miller C, Marcellus DC, Griffin C, Abrams R, Braine HG, Grever M, Hess AD, Piantadosi S, Noga SJ. CD34+ stem cell augmentation of elutriated allogeneic bone marrow grafts: results of a phase II clinical trial of engraftment and graft-versus-host disease prophylaxis in high-risk hematologic malignancies. Bone Marrow Transplant 1998; 22:947-55. [PMID: 9849691 DOI: 10.1038/sj.bmt.1701476] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although T cell depletion of allografts used in BMT has reduced GVHD, it has been associated with inferior engraftment and an increased risk of relapse. We have found that T cell depletion by counterflow centrifugal elutriation (CCE) also results in depletion of CD34+ stem cells. In order to determine if the discarded CD34+ cells would improve engraftment, we undertook a phase II trial of allogeneic BMT in which 110 patients (median age 43) with a variety of hematologic malignancies received CD34+ stem cell augmented, elutriated marrow grafts. The T cell-depleted grafts were tightly controlled and contained a mean of 4.3 x 10(7) mononuclear cells/kg, 3.3 x 10(6) CD34+ cells/kg, 1.5 x 10(5) CFU-GM/kg and 5.5 x 10(5) CD3+ T cells/kg. Median time to engraftment of granulocytes (>500/microl) was 16 days and of platelets (>50000/microl) was 25 days, comparable to that seen with unmanipulated marrow. No mixed hematopoietic chimerism was observed that was not associated with disease relapse. The four patients (3.6%) who failed to engraft were all at high risk because of prior donor transfusions or underlying marrow disorders. The incidence of GVHD was dependent on the duration of cyclosporin A (CsA) immunosuppression. In patients who received CsA for > or = 80 days, the incidence of clinically significant acute GVHD (>stage 1) and extensive, chronic GVHD was 5% and 11%, respectively. Peritransplant (< or = 100 day post-BMT) mortality for this group of patients was 15%. Event-free survival in selected subsets of patients compared favorably to previous studies in which patients received unmanipulated marrow allografts.
Collapse
Affiliation(s)
- P V O'Donnell
- The Johns Hopkins Oncology Center, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Fuchs EJ, Seber A, Altomonte V, Braine HG, Humphrey RL, Jones RJ, Noga SJ, Schepers K, Wright SK, Vogelsang GB. Chemotherapy does not nullify the ability of donor lymphocyte infusions to mediate graft-versus-host reactions. Bone Marrow Transplant 1998; 22:303-5. [PMID: 9720749 DOI: 10.1038/sj.bmt.1701323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two patients with multiple myeloma in relapse after allogeneic BMT received donor lymphocyte infusions (DLI) but later required chemotherapy for treatment of myeloma-related complications. In both patients, recovery from chemotherapy-induced aplasia was accompanied by manifestations of graft-versus-host reactions. The first patient developed grade II acute GVHD and a complete remission which has lasted >22 months. The second patient developed grade III acute GVHD but died with co-existing GVHD and extensive extramedullary myeloma. These results demonstrate that chemotherapy does not nullify the ability of donor lymphocytes to mediate graft-versus-host reactions.
Collapse
Affiliation(s)
- E J Fuchs
- Division of Hematologic Malignancies, Johns Hopkins Oncology Center, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Noga SJ, Seber A, Davis JM, Berenson RJ, Vogelsang GB, Braine HG, Hess AD, Marcellus D, Miller CA, Sharkis SJ, Goodman SN, Santos GW, Jones RJ. CD34 augmentation improves allogeneic T cell-depleted bone marrow engraftment. J Hematother 1998; 7:151-7. [PMID: 9597572 DOI: 10.1089/scd.1.1998.7.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
T cell depletion (TCD) performed by elutriation has decreased the incidence of acute and chronic graft-versus-host disease (GvHD) following bone marrow transplantation (BMT). However, as with all forms of TCD, patients may experience graft failure (10%), delayed engraftment, and mixed chimerism. Because 66%-75% of the CD34+ cells coseparate with the small lymphocytes, which are removed by elutriation, we designed a phase I trial in HLA-identical siblings to determine if the readdition of these previously lost small CD34+ cells would improve elutriation's engraftment kinetics. CD34+ cells were isolated from the small cell fraction of 10 consecutive donor grafts and infused into the recipients along with the TCD graft. The positively selected product had a mean T cell content of 1.2 x 10(5)/kg and was 80% CD34+, doubling the CD34+ content of the graft. All patients engrafted promptly with a median time to 500 neutrophils/mm3, untransfused 50,000 platelets/mm3, and discharge from the hospital of 19 (range 10-25), 24 (14-52), and 24 (18-29) days, respectively. Acute GvHD occurred in 2 patients, and no patient had chronic GvHD. Augmenting stem cell dose may be an efficient and safe alternative for overcoming TCD-associated delayed engraftment and graft failure, rather than increasing immunosuppression.
Collapse
Affiliation(s)
- S J Noga
- Johns Hopkins Oncology Center, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Noga SJ, Vogelsang GB, Seber A, Davis JM, Schepers K, Hess AD, Jones RJ. CD34+ stem cell augmentation of allogeneic, elutriated marrow grafts improves engraftment but cyclosporine A is still required to reduce GVHD and morbidity. Transplant Proc 1997; 29:728-32. [PMID: 9123500 DOI: 10.1016/s0041-1345(96)00442-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S J Noga
- Johns Hopkins Bone Marrow Transplantation Unit, Baltimore, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Seber A, Khan SP, Kersey JH. Unexplained effusions: association with allogeneic bone marrow transplantation and acute or chronic graft-versus-host disease. Bone Marrow Transplant 1996; 17:207-11. [PMID: 8640168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We evaluated patients presenting with large and recurrent sterile serosal effusions following bone marrow transplants. From a review of the Minnesota BMT Database from 1974 to 1993, seven patients with unexplained multiple effusions involving two or more of the pleural, pericardial or peritoneal cavities were identified. Patients with veno-occlusive disease (VOD), infections, cardiac insufficiency, tumor relapse and GM-CSF toxicity were excluded. All had onset following engraftment and six occurred before day 100. Unexplained multiple effusions were observed in recipients of allogeneic transplants but not autologous transplants and were found only in patients with acute and/or chronic GVHD. Five of seven patients also had cytomegalovirus (CMV) disease. Multiple effusions appear to be part of the presentation of severe acute or chronic GVHD, often in association with CMV disease in patients who receive allogeneic donor marrow.
Collapse
Affiliation(s)
- A Seber
- Bone Marrow Transplantation Program, University of Minnesota, Minneapolis 55455, USA
| | | | | |
Collapse
|
37
|
|