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Lum SH, Albert MH, Gilbert P, Sirait T, Algeri M, Muratori R, Fournier B, Laberko A, Karakukcu M, Unal E, Ayas MF, Yadav SP, Fisgin T, Elfeky R, Fernandes JF, Faraci M, Cole T, Schulz AS, Meisel R, Zecca M, Ifversen M, Biffi A, Diana JS, Vallée TC, Giardino S, Ersoy GZ, Moshous D, Gennery AR, Balashov D, Bonfim CMS, Locatelli F, Lankester AC, Neven B, Slatter MA. Outcomes of HLA-mismatched HSCT with TCRαβ/CD19 depletion or post-HSCT cyclophosphamide for inborn errors of immunity. Blood 2024:blood.2024024038. [PMID: 38669631 DOI: 10.1182/blood.2024024038] [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] [Received: 01/22/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
HLA-mismatched transplants with either in vitro depletion of CD3+TCRαβ/CD19 (TCRαβ) cells or in vivo T-cell depletion using post-transplant cyclophosphamide (PTCY) have been increasingly used for patients with inborn errors of immunity (IEI). We performed a retrospective multicenter study via the EBMT registry on 306 children with IEI undergoing first transplant between 2010-2019 from an HLA-mismatched donor using TCRαβ (n=167) or PTCY (n=139). Median age at HSCT was 1.2 years (range, 0.03-19.6 years). The 3-year overall survival (OS) was 78% (95% confidence interval (CI), 71-84%) after TCRαβ and 66% (57-74%) after PTCY (p=0.013). Pre-HSCT morbidity score (hazard ratio (HR) 2.27, 1.07-4.80, p=0.032) and non-Busulfan/Treosulfan conditioning (HR 3.12, 1.98-4.92, p<0.001) were the only independent predictors of unfavorable OS. The 3-year event-free survival (EFS) was 58% (50-66%) after TCRαβ and 57% (48-66%) after PTCY (p=0.804). Cumulative incidence of severe acute GvHD was higher after PTCY (15%, 9-21%) than TCRαβ (6%, 2-9%, p=0.007), with no difference in chronic GvHD (PTCY, 11%, 6-17%; TCRαβ, 7%, 3-11%, p=0.173). The 3-year GvHD-free EFS was 53% (44-61%) after TCRαβ and 41% (32-50%) after PTCY (p=0.080). PTCY had significantly higher rates of veno-occlusive disease (14.4% versus TCRαβ 4.9%, p=0.009), acute kidney injury (12.7% versus 4.6%, p=0.032) and pulmonary complications (38.2% versus 24.1%, p=0.017). Adenoviraemia (18.3% versus PTCY 8.0%, p=0.015), primary graft failure (10%, versus 5%, p=0.048), and second HSCT (17.4% versus 7.9%, p=0.023) were significantly higher in TCRαβ. In conclusion, this study demonstrates that both approaches are suitable options in IEI patients, although characterized by different advantages and outcomes.
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Affiliation(s)
- Su Han Lum
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael H Albert
- Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | | | | | | | - Rafaella Muratori
- Hospital de Cli-nicas da Universidade Federal do Parana, Curitiba, Brazil
| | | | - Alexandra Laberko
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | | | - Ekrem Unal
- Erciyes University, Pediatric Hematology Oncology, Kayseri, Turkey
| | - Mouhab F Ayas
- King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Tunc Fisgin
- Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | - Reem Elfeky
- Great Ormond Street (GOS) Hospital for Children NHS Foundation Trust, University College London GOS Institute of Child Health, and NIHR GOSH BRC, London, United Kingdom
| | - Juliana Folloni Fernandes
- ITACI/Instituto da Crianca - Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Roland Meisel
- Center for Child & Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany
| | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Jean-Sebastien Diana
- Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Tanja C Vallée
- Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Gizem Zengin Ersoy
- Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey
| | | | | | - Dmitry Balashov
- Dmitriy Rogachev National Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Carmem M S Bonfim
- Hospital Pequeno Principe/Pele Pequeno Príncipe Research Institute, Curitiba, Brazil
| | - Franco Locatelli
- Bambino Gesù Children's Hospital, Catholic University of Sacred Heart, Rome, Italy
| | | | - Bénédicte Neven
- Hospital Necker-Enfants Malades, Assistance Publique-Hospitaux de Paris, INSERM, paris, France
| | - Mary A Slatter
- Newcastle upon Tyne NHS Foundation trust, Newcastle Upon Tyne, United Kingdom
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Donadel CD, Pires BG, André NC, Costa TCM, Orellana MD, Caruso SR, Seber A, Ginani VC, Gomes AA, Novis Y, Barros GMN, Vilella NC, Martinho GH, Vieira AK, Kondo AT, Hamerschlak N, Filho JS, Xavier EM, Fernandes JF, Rocha V, Covas DT, Calado RT, Guerino-Cunha RL, De Santis GC. Umbilical Cord Mesenchymal Stromal Cells for Steroid-Refractory Acute Graft-versus-Host Disease. Pharmaceuticals (Basel) 2023; 16:ph16040512. [PMID: 37111270 PMCID: PMC10144752 DOI: 10.3390/ph16040512] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Steroid-refractory acute graft-vs.-host disease (SR-aGVHD) is a complication of allogeneic hematopoietic stem cell transplantation with a dismal prognosis and for which there is no consensus-based second-line therapy. Ruxolitinib is not easily accessible in many countries. A possible therapy is the administration of mesenchymal stromal cells (MSCs). Methods: In this retrospective study, 52 patients with severe SR-aGVHD were treated with MSCs from umbilical cord (UC-MSCs) in nine institutions. Results: The median (range) age was 12.5 (0.3–65) years and the mean ± SD dose (×106/kg) was 4.73 ± 1.3 per infusion (median of four infusions). Overall (OR) and complete response (CR) rates on day 28 were 63.5% and 36.6%, respectively. Children (n = 35) had better OR (71.5% vs. 47.1%, p = 0.12), CR (48.6% vs. 11.8%, p = 0.03), overall survival (p = 0.0006), and relapse-free survival (p = 0.0014) than adults (n = 17). Acute adverse events (all of them mild or moderate) were detected in 32.7% of patients, with no significant difference in children and adult groups (p = 1.0). Conclusions: UC-MSCs are a feasible alternative therapy for SR-aGVHD, especially in children. The safety profile is favorable.
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Affiliation(s)
- Camila Derminio Donadel
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Bruno Garcia Pires
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Nathália Cristine André
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Thalita Cristina Mello Costa
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Maristela Delgado Orellana
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Sâmia Rigotto Caruso
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Adriana Seber
- Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Universidade Federal de São Paulo (UNIFESP), São Paulo 04021-001, Brazil
- Hospital Samaritano, São Paulo 01232-010, Brazil
| | - Valéria Cortez Ginani
- Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Universidade Federal de São Paulo (UNIFESP), São Paulo 04021-001, Brazil
- Hospital Samaritano, São Paulo 01232-010, Brazil
| | | | - Yana Novis
- Hospital Sírio Libanês, São Paulo 01308-050, Brazil
| | | | | | - Gláucia Helena Martinho
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil
| | - Ana Karine Vieira
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil
| | | | | | | | - Erick Menezes Xavier
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05403-010, Brazil
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Vanderson Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05403-010, Brazil
| | - Dimas Tadeu Covas
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Rodrigo Tocantins Calado
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Renato Luiz Guerino-Cunha
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
| | - Gil Cunha De Santis
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 05508-220, Brazil
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Waisbeck TM, Vogel C, Silva CC, Arcuri LJ, Ribeiro AF, Kerbauy LN, Fernandes JF, Kerbauy MN, Torres M, Kondo A, Kutner JM, Sodre Costa LS, Taba L, Savioli ML, de Sa GR, da Silva Costa C, da Silva LRR, Alves Pereira SF, Hamerschlak N. The Impact of FACT Accreditation Program in a Bone Marrow Transplantation Unit in Latin America: Improving Clinical Results. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00738-2] [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]
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4
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Duncan CN, Kühl JS, Chiesa R, Boelens JJ, Eichler F, Sevin C, Dalle JH, De Oliveira SN, Amartino HM, Kapoor N, Prasad VK, Jones S, Algeri M, Bunin NJ, Diaz-de-Heredia C, Thrasher AJ, Fernandes JF, Smith N, Shah AJ, Locatelli F, Engelen M, Lindemans CA, Dietz AC, Pan L, Sieker J, Williams DA, Orchard PJ. Comparison of Outcomes in Patients with Cerebral Adrenoleukodystrophy (CALD) Receiving Elivaldogene Autotemcel (eli-cel; Lenti-D) Gene Therapy in Clinical Trials Versus Those Receiving Allogeneic Hematopoietic Stem Cell Transplant in a Contemporaneous Comparator Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00164-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Bain V, Barrientos ACMGDA, Suzuki L, Oliveira LAND, Litvinov N, Peron KR, Fernandes JF, Marques HHDS. Radiological patterns of pulmonary fungal infection in pediatric hematology and oncology patients. Radiol Bras 2022; 55:78-83. [PMID: 35414734 PMCID: PMC8993174 DOI: 10.1590/0100-3984.2021.0055] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To describe the radiological findings in pediatric patients with hematological or oncological diseases who also have an invasive fungal infection (IFI). Materials and Methods: This was a retrospective study of all patients with IFI admitted to a pediatric hematology and oncology hospital in Brazil between 2008 and 2014. Clinical and demographic data were collected. Chest computed tomography (CT) scans of the patients were reviewed by two independent radiologists. Results: We evaluated the chest CT scans of 40 pediatric patients diagnosed with an IFI. Twenty-seven patients (67.5%) had nodules with the halo sign, seven (17.5%) had cavities, two (5.0%) had nodules without the halo sign, and seven (17.5%) had consolidation. The patients with the halo sign and cavities were older (123 vs. 77 months of age; p = 0.03) and had less severe disease (34% vs. 73%; p = 0.04). Ten patients had a proven IFI: with Aspergillus sp. (n = 4); with Candida sp. (n = 5); or with Fusarium sp. (n = 1). Conclusion: A diagnosis of IFI should be considered in children and adolescents with risk factors and abnormal CT scans, even if the imaging findings are nonspecific.
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Fernandes JF, Loncaric F, Marciniak M, Gilbert A, Smistad E, Lovstakken L, Mcleod K, Sitges M, Lamata P. Automatic measurement of LV wall thickness from 2D cardiac echocardiography. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.150] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): PIC from European Union"s Horizon 2020 Marie Skłodowska-Curie Actions ITN
Background
The wall thickness of the left ventricle (LV) is an important parameter in the diagnosis of hypertension and more specifically in hypertrophic cardiomyopathy. A user-dependent manual assessment of distances on 2D echocardiographic images is the current clinical gold-standard.
Purpose
The automation of LV wall thickness measurements in 2D echocardiography in order to improve robustness and reduce time of clinical reports where wall thickness is required, such as hypertrophy and the presence of Basal Septal Hypertrophy (BSH)(1).
Methods
A dataset of 4-chamber (4CH) echocardiograms on 118 patients with a diagnosis of hypertension (2) is used for this study. The images were segmented automatically (3) extracting the blood pool and the myocardium. Based on the curvature of the complete myocardial contour, the valve annular regions are removed leaving the endocardial and the epicardial walls as independent structures. The wall thickness along the myocardium is calculated as the distance from each endocardial border pixel to the closest epicardial point (see Figure 1). A high pass gaussian filter was applied to remove high frequency noise. Ultimately, the basal-to-mid septal wall thickness ratio that defines BSH (ratio ≥ 1.4) was computed as the maximal of basal-septal segment divided by minimum of mid-septal segment. In order to validate the method for BSH detection, the wall thickness septal ratio was carefully measured by a clinical expert following the guidelines (2). The statistical agreement was accessed via linear correlation and Bland-Altman analysis.
Results
The automatic assessment of LV wall thickness along the myocardium is feasible in 2D echocardiography. The septal ratio showed an excellent agreement with manual measurements (R2 = 0.94, bias=-0.01, see Figure 2), leading to a detection of BSH in n = 19 vs the n = 18 detected manually (1 false-negative and 2 false-positives). In comparison to the intra and inter-observer variabilities of 12% and 42% respectively in the manual measurement (4), the automatic method had no variability for a given image acquisition.
Conclusions
The automatic measurement of myocardial wall thickness from a 2D echocardiographic images is accurate and reproducible. The implementation of the methodology in clinical practise has the potential to improve and automate the assessment of hypertrophic cardiac conditions. Abstract Figure. Pipeline for automatic measurement of WT Abstract Figure. Agreement of BSH WT ratio
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Affiliation(s)
- JF Fernandes
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - F Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - M Marciniak
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gilbert
- GE Healthcare, GE Vingmed Ultrasound, Horten, Norway
| | - E Smistad
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - L Lovstakken
- Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - K Mcleod
- GE Healthcare, GE Vingmed Ultrasound, Horten, Norway
| | - M Sitges
- Barcelona Hospital Clinic, Cardiovascular Institute, Barcelona, Spain
| | - P Lamata
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Seber A, de CastroJunior CG, Kerbauy LN, Hirayama AV, Bonfim C, Fernandes JF, Souza M, Schafell R, Nabhan S, Loggetto SR, Simões BP, Rocha V, de Lima M, Guerino-Cunha RL, Bittencourt H. Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Consensus on genetically modified cells. II: CAR-T cell therapy for patients with CD19+ acute lymphoblastic leukemia. Hematol Transfus Cell Ther 2021; 43 Suppl 2:S13-S21. [PMID: 34794791 PMCID: PMC8606700 DOI: 10.1016/j.htct.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy is a novel therapeutic modality for acute lymphoblastic leukemia (ALL) with robust outcomes in patients with refractory or relapsed disease. At the same time, CAR-T cell therapy is associated with unique and potentially fatal toxicities, such as cytokine release syndrome (CRS) and neurological toxicities (ICANS). This manuscript aims to provide a consensus of specialists in the fields of Hematology Oncology and Cellular Therapy to make recommendations on the current scenario of the use of CAR-T cells in patients with ALL.
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Affiliation(s)
- Adriana Seber
- Hospital Samaritano Higienópolis, São Paulo, SP, Brazil; Hospital Infantil Sabará, São Paulo, SP, Brazil
| | | | | | | | - Carmem Bonfim
- Hospital Pequeno Príncipe, Curitiba, PR, Brazil; Hospital de Clínicas, Universidade Federal do Paraná (HC UFPR), Curitiba, PR, Brazil
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Instituto do Tratamento do Câncer Infantil, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP), São Paulo, SP, Brazil
| | - Mair Souza
- Hospital Amaral Carvalho, Jaú, SP, Brazil
| | - Rony Schafell
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF UFRJ), Rio de Janeiro, RJ, Brazil
| | - Samir Nabhan
- Hospital de Clínicas - Universidade Federal do Paraná, (HC UFPR), Curitiba, PR, Brazil
| | - Sandra Regina Loggetto
- Hospital Infantil Sabará, São Paulo, SP, Brazil; Grupo Gestor de Serviços de Hematologia (GSH), São Paulo, SP, Brazil
| | | | - Vanderson Rocha
- Hospital das Clínicas, Universidade de São Paulo, (HC USP), São Paulo, SP, Brazil; Hospital Vila Nova Star, São Paulo, SP, Brazil
| | | | - Renato L Guerino-Cunha
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
| | - Henrique Bittencourt
- Centre Hospitalier Universitaire Sainte-Justine (CHU Sainte-Justine), Montreal, Qc, Canada; Université de Montreal, Montreal, Qc, Canada
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9
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Cirilo MVSP, Martins CA, Fernandes JF, Marques LC, Cavalcante JPR, Bariani EMMB, Bariani LCO, Bariani C, Silva AMTC. SÍNDROME DE POEMS: RELATO DE CASO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.851] [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
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10
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Martins CA, Fernandes JF, Cirilo MVSP, Marques LC, Cavalcante JPR, Bariani EMMB, Bariani LCO, Bariani C, Miranda FS, Freitas NMA. MIELOMA MÚLTIPLO COMO PRIMEIRA MANIFESTAÇÃO NEUROLÓGICA. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.344] [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
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11
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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
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12
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Fernandes JF, Martins CA, Cirilo MVSP, Marques LC, Cavalcante JPR, Bariani LCO, Silva AMTC, Bariani C, Bariani EMMB. SARCOMA DE CÉLULAS DENDRÍTICAS FOLICULARES: RELATO DE CASO. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.850] [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
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13
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Loncaric F, Fernandes JF, Sitges M, Stessel B, Dubois J, Van Halem K, Herbots L, Bijnens B. Cardiac function during COVID-19 intensive care unit hospitalisation - deformation analysis and outcomes. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC7929049 DOI: 10.1093/ehjci/jeaa356.166] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 Background Although the cardiac burden of COVID-19 has been demonstrated, follow-up imaging studies are scarce. The aim was to use speckle-tracking deformation imaging (STE) to prospectively assess cardiac function during intensive care unit (ICU) hospitalisation, comparing ventricular and atrial function of COVID-10 patients that died and those that were discharged. Methods In a single-centre, COVID-19 patients (n = 41) (71% male, aged 65 ± 11 years) were prospectively followed with echocardiography as part of ICU treatment. The left and right ventricles (LV, RV, respectively) were studied with STE in the 4-chamber cardiac view. The endpoint was defined as death or ICU discharge. Average values of the strain parameters from the first and final scans in the ICU, respectively, were calculated for the two outcome groups. Results Endpoint was not reached in 15% (n = 6) at the time of analysis. The remaining patients (n = 32) were 69% male, aged 66 (interquartile range (IQR) 60-72) years, and with an ICU mortality 26% (n = 9). The median spent in ICU was 24 (IQR 15-43) days. On average, echocardiography was performed three times during ICU hospitalisation, amounting to 103 examinations. The changes in cardiac strain are shown in Table 1. The change in LV longitudinal strain during ICU hospitalisation is shown in Figure 1. Conclusion Worsening of LV strain and lack of improvement of RV strain is linked to higher mortality in the ICU. The assessment of cardiac function might contain prognostic information in COVID-19 patients that are admitted to the ICU. | Patients discharged from thee OCU (n = 23) | Patients that died in the ICU (n = 9) | P value |
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Initial echo in the ICU | | | | LV strain, % (IQR) | 18.00 (15.6-19.95) | 14.4 (10.56-20.42) | 0.158 | RV strain, % (IQR) | 16.00 (14.70-20.05) | 15.50 (10.38-23.70) | 0.712 | Final echo before discharge | | | | LV strain, % (IQR) | 17.35 (15.13-18.98) | 13.20 (10.75-15.40) | 0.007 | RV strain, % (IQR) | 17.65 (16.83-19.60) | 15.75 (10.68-20.43) | 0.438 |
ICU - intensive care unit; IQR-inter-quartile range Abstract Figure 1 ![]()
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Affiliation(s)
- F Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - JF Fernandes
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sitges
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - B Stessel
- Jessa clinic Hasselt, Hasselt, Belgium
| | - J Dubois
- Jessa clinic Hasselt, Hasselt, Belgium
| | | | - L Herbots
- Jessa clinic Hasselt, Hasselt, Belgium
| | - B Bijnens
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
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14
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Tavares RDCB, Bonfim CS, Seber A, Pereira Lermontov S, Coulturato V, Zecchin VG, Ribeiro L, Fernandes JF, Daudt LE, Grecco CS, Darrigo-Jr LG, Villela N, Nichele S, Gouveia R, Bouzas LF, Hamerschlak N, Vigorito AC, da Silva PM, da Silva PDO, da Silva CC, de Souza Fernandez C, Flowers ME, Arcuri LJ. Hematopoietic cell transplantation in pediatric patients with acute leukemias or myelodysplastic syndrome using unrelated adult or umbilical cord blood donors in Brazil. Pediatr Transplant 2020; 24:e13789. [PMID: 32757316 DOI: 10.1111/petr.13789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
The choice of alternative donors for HCT for patients without an HLA-matched related donor depends on several factors. We compared major HCT outcomes in 212 consecutive children transplanted at 11 centers in Brazil for acute leukemia or MDS from an HLA-matched unrelated donor (MUD, n = 95), mismatched unrelated donor (MMUD, n = 47) or unrelated umbilical cord blood (UCB, n = 70). Most had ALL (61%), bone marrow (57%) as the graft source and 95% received a MAC regimen. The 3-year OS probability were 57, 55, and 37% after HCT from MUD, MMUD, and UCB, respectively (HR 1.68, 95%CI 1.07-2.63; P = .02). In comparison with MUD, OS was similar after transplantation of a ≥ 6/8 HLA-matched or a high cell dose (>5 × 107 TNC/kg) CB unit (HR 1.41, 95%CI 0.88-2.27; P = .15). NRM was higher for UCB (HR 3.90, 95%CI 1.43-10.7; P = .01) but not for MMUD (HR 1.03, 95%CI 0.53-2.00; P > .20). Advanced disease (HR 2.05, 95%CI 1.26-3.33; P < .001) and UCB with high probability of being < 6/8 HLA-matched (HR 5.34, 95%CI 2.0-13.9; P < .001) were associated with higher mortality. Relapse and acute GVHD were similar among groups, while PGF was higher among UCB transplants (P = .002) and chronic GVHD among MMUD group (HR 2.88, 95% CI 1.05-7.88; P = .04). Our results suggest that in Brazil HCT outcomes performed with MMUD and MUD donors were comparable, while with UCB units < 6/8 HLA-matched were associated with higher NRM for children with acute leukemia or MDS.
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Affiliation(s)
| | | | | | | | | | | | | | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Instituto da Criança - Universidade de São Paulo, São Paulo, Brazil
| | - Liane Esteves Daudt
- Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos S Grecco
- Hospital das Clínicas da, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Luiz Guilherme Darrigo-Jr
- Hospital das Clínicas da, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Mary Evelyn Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Leonardo Javier Arcuri
- Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
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15
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Arcuri LJ, Nabhan SK, Cunha R, Nichele S, Ribeiro AAF, Fernandes JF, Daudt LE, Rodrigues ALM, Arrais-Rodrigues C, Seber A, Atta EH, de Oliveira JSR, Funke VAM, Loth G, Junior LGD, Paz A, Calixto RF, Gomes AA, Araujo CES, Colturato V, Simoes BP, Hamerschlak N, Flowers ME, Pasquini R, Rocha V, Bonfim C. Impact of CD34 Cell Dose and Conditioning Regimen on Outcomes after Haploidentical Donor Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide for Relapsed/Refractory Severe Aplastic Anemia. Biol Blood Marrow Transplant 2020; 26:2311-2317. [PMID: 32949751 DOI: 10.1016/j.bbmt.2020.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
Severe aplastic anemia (SAA) is a life-threatening disease that can be cured with allogeneic cell transplantation (HCT). Haploidentical donor transplantation with post-transplantation cyclophosphamide (haplo-PTCy) is an option for patients lacking an HLA-matched donor. We analyzed 87 patients who underwent haplo-PTCy between 2010 and 2019. The median patient age was 14 years (range, 1 to 69 years), most were heavily transfused, and all received previous immunosuppression (25% without antithymocyte globulin). Almost two-thirds (63%) received standard fludarabine (Flu)/cyclophosphamide (Cy) 29/total body irradiation (TBI) 200 cGy conditioning, and the remaining patients received an augmented conditioning: Flu/Cy29/TBI 300-400 (16%), Flu/Cy50/TBI 200 (10%), or Flu/Cy50/TBI 400 (10%). All patients received PTCy-based graft-versus-host disease (GVHD) prophylaxis. Most grafts (93%) were bone marrow (BM). The median duration of follow-up was 2 years and 2 months. The median time to neutrophil recovery was 17 days. Primary graft failure occurred in 15% of the patients, and secondary or poor graft function occurred in 5%. The incidences of grade II-IV acute GVHD was 14%, and that of chronic GVHD was 9%. Two-year overall survival and event-free survival (EFS) were 79% and 70%, respectively. EFS was higher for patients who received augmented Flu/Cy/TBI (hazard ratio [HR], .28; P = .02), and those who received higher BM CD34 cell doses (>3.2 × 10E6/kg) (HR, .29; P = .004). The presence of donor-specific antibodies before HSCT was associated with lower EFS (HR, 3.92; P = .01). Graft failure (HR, 7.20; P < .0001) was associated with an elevated risk of death. Cytomegalovirus reactivation was frequent (62%). Haploidentical HCT for SAA is a feasible procedure; outcomes are improved with augmented conditioning regimens and BM grafts with higher CD34 cell doses.
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Affiliation(s)
- Leonardo Javier Arcuri
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil.
| | - Samir Kanaan Nabhan
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Renato Cunha
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Samantha Nichele
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | | | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Liane Esteves Daudt
- Hospital das Clinicas de Porto Alegre, Bone Marrow Transplantation Unit, Porto Alegre, Brazil
| | | | | | - Adriana Seber
- Hospital Samaritano, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Elias Hallack Atta
- Instituto Nacional de Cancer, Bone Marrow Transplantation Unit, Rio de Janeiro, Brazil
| | | | | | - Gisele Loth
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Luiz Guilherme Darrigo Junior
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Alessandra Paz
- Hospital das Clinicas de Porto Alegre, Bone Marrow Transplantation Unit, Porto Alegre, Brazil
| | - Rodolfo Froes Calixto
- Real Hospital Portugues de Beneficencia em Pernambuco, Bone Marrow Transplantation Unit, Recife, Brazil
| | | | - Carlos Eduardo Sa Araujo
- Instituto de Cardiologia do Distrito Federal, Bone Marrow Transplantation Unit, Brasilia, Brazil
| | | | - Belinda Pinto Simoes
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Nelson Hamerschlak
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | | | - Ricardo Pasquini
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Vanderson Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Bone Marrow Transplantation Unit, Sao Paulo, Brazil; Rede D'or, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Carmem Bonfim
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
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16
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Zamperlini-Netto G, Fernandes JF, Garcia JL, Ribeiro AAF, Camargo LFA, de Moraes Terra C, Hamerschlak N. COVID-19 after hematopoietic stem cell transplantation: report of two children. Bone Marrow Transplant 2020; 56:713-715. [PMID: 32934304 DOI: 10.1038/s41409-020-01041-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Gabriele Zamperlini-Netto
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Julia Lopes Garcia
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | | | - Luis Fernando Aranha Camargo
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Celso de Moraes Terra
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil
| | - Nelson Hamerschlak
- Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, SP, CEP: 05652-900, Brazil.
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17
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de Melo Rodrigues AL, Bonfim C, Seber A, Colturato VAR, Zecchin VG, Nichele S, Daudt LE, Fernandes JF, Vieira AK, Darrigo Junior LG, Gomes AA, Arcuri L, Lenzi L, Picharski GL, Ribeiro RC, de Figueiredo BC. Allogeneic Hematopoietic Stem Cell Transplantation for Children and Adolescents with Acute Myeloid Leukemia in Brazil: A Multicentric Retrospective Study. Cell Transplant 2020; 29:963689720949175. [PMID: 32787568 PMCID: PMC7563924 DOI: 10.1177/0963689720949175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The survival rates of children with high-risk acute myeloid leukemia (AML)
treated with hematopoietic stem cell transplant (HSCT) range from 60% to 70% in
high-income countries. The corresponding rate for Brazilian children with AML
who undergo HSCT is unknown. We conducted a retrospective analysis of 114
children with AML who underwent HSCT between 2008 and 2012 at institutions
participating in the Brazilian Pediatric Bone Marrow Transplant Working Group.
At transplant, 38% of the children were in first complete remission (CR1), 37%
were in CR2, and 25% were in CR3+ or had persistent disease. The donors included
49 matched-related, 59 matched-unrelated, and six haploidentical donors. The
most frequent source of cells was bone marrow (69%), followed by the umbilical
cord (19%) and peripheral blood (12%). The 4-year overall survival was 47% (95%
confidence interval [CI] 30%–57%), and the 4-year progression-free survival was
40% (95% CI 30%–49%). Relapse occurred in 49 patients, at a median of 122 days
after HSCT. There were 65 deaths: 40 related to AML, 19 to infection, and six to
graft versus host disease. In conclusion, our study suggests that HSCT outcomes
for children with AML in CR1 or CR2 are acceptable and that this should be
considered in the overall treatment planning for children with AML in Brazil.
Therapeutic standardization through the adoption of multicentric protocols and
appropriate supportive care treatment will have a significant impact on the
results of HSCT for AML in Brazil and possibly in other countries with limited
resources.
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Affiliation(s)
- Ana Luiza de Melo Rodrigues
- 245143Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná,Brazil.,245067Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,176853Hospital Pequeno Príncipe, Rua Desembargador Motta, Curitiba, Paraná, Brazil
| | - Carmem Bonfim
- 176853Hospital Pequeno Príncipe, Rua Desembargador Motta, Curitiba, Paraná, Brazil.,Hospital de Clínicas da 28122Universidade Federal do Paraná, Rua General Carneiro, Curitiba, Paraná, Brazil.,417434Hospital Nossa Senhora das Graças Rua Alcídes Munhoz, Curitiba, Paraná, Brazil
| | - Adriana Seber
- 125211Hospital Samaritano, Rua Conselheiro Brotero, Higienópolis, São Paulo, Brazil
| | | | | | - Samantha Nichele
- Hospital de Clínicas da 28122Universidade Federal do Paraná, Rua General Carneiro, Curitiba, Paraná, Brazil.,417434Hospital Nossa Senhora das Graças Rua Alcídes Munhoz, Curitiba, Paraná, Brazil
| | - Liane Esteves Daudt
- 37895Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, Santa Cecilia, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Folloni Fernandes
- Instituto de Tratamento do Câncer Infantil Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Galeno de Almeida, Pinheiros, São Paulo, Brazil.,37896Hospital Israelita Albert Einstein, Jardim Leonor, São Paulo, Brazil
| | - Ana Karine Vieira
- Hospital de Clínicas da Univerdidade Federal de Minas Gerais Rua Prof. Alfredo Balena, Santa Efigenia, Belo Horizonte, Minas Gerais, Brazil
| | - Luiz Guilherme Darrigo Junior
- 54539Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo- Ribeirão Preto, Campus Universitário, Vila Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Alessandra Araujo Gomes
- Instituto de Tratamento do Câncer Infantil Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Galeno de Almeida, Pinheiros, São Paulo, Brazil.,42522Hospital Sírio Libanês, Rua Dona Adma Jafet, Bela Vista, São Paulo, Brazil
| | - Leonardo Arcuri
- Department of Oncology and Global Pediatric Medicine, 5417St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Luana Lenzi
- Departamento de Análises Clínicas, 28122Universidade Federal do Paraná, Jardim Botanico, Curitiba, Paraná, Brazil
| | | | - Raul Correa Ribeiro
- Department of Oncology and Global Pediatric Medicine, 5417St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bonald Cavalcante de Figueiredo
- 245143Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná,Brazil.,245067Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil.,Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC) at 28122Universidade Federal do Paraná, Curitiba, Paraná, Brazil.,Departamento de Saúde Coletiva, 28122Universidade Federal do Paraná, Rua Padre Camargo, Curitiba, Paraná, Brazil
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18
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Esteves I, Santos FPS, Ribeiro AAF, Seber A, Sugawara EK, Sobrinho JJDN, Barros JC, Oliveira JSR, Fernandes JF, Hamerschlak N, Andersson BS, de Lima M, Kerbauy FR. Targeted-dose of busulfan: Higher risk of sinusoidal obstructive syndrome observed with systemic exposure dose above 5000 µMol⸱min. A historically controlled clinical trial. Hematol Oncol 2020; 38:773-781. [PMID: 32779746 DOI: 10.1002/hon.2789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022]
Abstract
Busulfan is given in the conditioning regimens preceding hematopoietic stem cell transplantation (HSCT), and plasma levels can be monitored. A targeted, individualized systemic exposure (SE) dose can be achieved by calculating the area under the plasma concentration versus time curve (AUC). The objective of this study was to determine a cutoff value for safety for the AUC for busulfan plasma levels in patients undergoing HSCT. A total of 149 consecutive HSCT patients were studied. After an oral test dose of busulfan, we set target doses of 4000, 5000, or 6000 µMol⸱min/day, and analyzed the AUC of oral or intravenous Bu. These patients were compared with 53 historical control subjects who had received myeloablative conditioning regimen without busulfan pharmacokinetic monitoring. Using a test dose and the administration route had no impact on the sinusoidal obstructive syndrome (SOS) incidence, transplant-related mortality or 1-year overall survival. However, patients receiving busulfan at doses set up at AUC > 5000 had an increased risk to develop SOS after HSCT (hazard ratio 3.39, p = 0.034, 95% CI 1.09-10.52). Adjusting the busulfan dose according to SE levels target dose during conditioning is associated with lower rates of oral severe mucositis and SOS. A cutoff of 5000 µMol⸱min is safe and does not impair survival.
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Affiliation(s)
- Iracema Esteves
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | | | | | - José Carlos Barros
- Transplantation, Hospital Dr. Euryclides de Jesus Zerbini, São Paulo, Brazil
| | | | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,Bone Marrow Transplantation Unit, Itaci Hospital, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Borje S Andersson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marcos de Lima
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, USA
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19
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Fernandes JF, Nichele S, Arcuri LJ, Ribeiro L, Zamperlini-Netto G, Loth G, Rodrigues ALM, Kuwahara C, Koliski A, Trennepohl J, Garcia JL, Daudt LE, Seber A, Gomes AA, Fasth A, Pasquini R, Hamerschlak N, Rocha V, Bonfim C. Outcomes after Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide in Patients with Primary Immunodeficiency Diseases. Biol Blood Marrow Transplant 2020; 26:1923-1929. [PMID: 32653621 DOI: 10.1016/j.bbmt.2020.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HCT) can cure primary immunodeficiency diseases (PID). When a HLA-matched donor is not available, a haploidentical family donor may be considered. The use of T cell-replete haploidentical HCT with post-transplantation cyclophosphamide (haplo-PTCy) in children with PID has been reported in few case series. A donor is usually readily available, and haplo-PTCy can be used in urgent cases. We studied the outcomes of 73 patients with PID who underwent haplo-PTCy, including 55 patients who did so as a first transplantation and 18 who did so as a salvage transplantation after graft failure of previous HCT. The median patient age was 1.6 years. Most of the children were male (n = 54) and had active infection at the time of transplantation (n = 50); 10 children had severe organ damage. The diagnosis was severe combined immunodeficiency (SCID) in 34 patients and non-SCID in 39 (Wiskott-Aldrich syndrome; n = 14; chronic granulomatous disease, n = 10; other PID, n = 15). The median duration of follow-up of survivors was 2 years. The cumulative incidence of neutrophil recovery was 88% in the SCID group and 84% in non-SCID group and was 81% for first transplantations and 83% after a salvage graft. At 100 days, the cumulative incidence of acute GVHD grade II-IV and III-IV was 33% and 14%, respectively. The majority of patients reached 200/μL CD4+ and 1000/μL CD3+ cell counts between 3 and 6 months. The estimated 2-year overall survival was 66%; it was 64% for SCID patients and 65% for non-SCID patients and 63% for first HCT and 77% for salvage transplantations. Twenty-five patients died, most of them due to infection early after transplantation (before 100 days). In conclusion, haplo-PTCy is a feasible procedure, can cure two-thirds of children with PID, and can be used as rescue treatment for previous graft failure. © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Juliana Folloni Fernandes
- Hematopoietic Stem Cell Transplantation unit, Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil; Hematopoietic Stem Cell Transplantation Unit, Hospital 9 de Julho, São Paulo, Brazil.
| | - Samantha Nichele
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Leonardo Javier Arcuri
- Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Lisandro Ribeiro
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Gabriele Zamperlini-Netto
- Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gisele Loth
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
| | - Ana Luiza Melo Rodrigues
- Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
| | - Cilmara Kuwahara
- Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
| | - Adriana Koliski
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Joanna Trennepohl
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Julia Lopes Garcia
- Hematopoietic Stem Cell Transplantation unit, Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Liane Esteves Daudt
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Adriana Seber
- Pediatric Hematopoietic Cell Therapy Unit, Hospital Samaritano, São Paulo, Brazil
| | - Alessandra Araujo Gomes
- Hematopoietic Stem Cell Transplantation unit, Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Hematopoietic Stem Cell Transplantation Unit, Hospital 9 de Julho, São Paulo, Brazil; Bone Marrow Transplantation Unit, Hospital Sírio Libanês, São Paulo, Brazil
| | - Anders Fasth
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ricardo Pasquini
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Nelson Hamerschlak
- Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Vanderson Rocha
- Bone Marrow Transplantation Unit, Hospital Sírio Libanês, São Paulo, Brazil; Department of Hematology, Hospital das Clínicas da Universidade de São Paulo (LIM 31), São Paulo, Brazil
| | - Carmem Bonfim
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil; Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
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Bonfim C, Arcuri LJ, Nabhan S, Seber A, Nichele S, Funke VAM, Fernandes JF, Daudt LE, Darrigo LG, Rodrigues ALM, Cunha RLG, Arrais C, Ribeiro AF, Atta E, Oliveira JSR, Paz A, Calixto RF, Gomes A, Sá Araújo CE, Colturato VA, Flowers ME, Pasquini R. Haploidentical Hematopoietic Stem Cell Transplantation with Post-Transplant Cyclophosphamide for Severe Aplastic Anemia. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.210] [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]
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Silva CC, Vogel C, Waisbeck TM, Ribeiro AF, Sodre LS, Kondo A, Torres M, Eduardo FDP, Bezinelli LM, Fernandes JF, Hamerschlak N. Data Manager in a Bone Marrow Transplant Team in Brazil: Training, Certifications, International Connections and Dissemination. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.455] [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: 10/25/2022]
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22
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Fernandes JF, Nichele S, Ribeiro L, Loth G, Netto GZ, Seber A, Daudt LE, Gomes A, Koliski A, Rodrigues ALM, Arcuri LJ, Hamerschlak N, Bonfim C. T-Cell Replete Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide (PTCy) for Pediatric Patients with Primary Immunodeficiencies (PID) - a Survey of the Pediatric Transplantation Working Group of the Brazilian Society of Bone Marrow Transplantation (SBTMO). Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.539] [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: 10/25/2022]
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Loncaric F, Marciniak M, Fernandes JF, Gilbert A, Nunno L, Mimbrero M, Tirapu L, Sanchis L, Doltra A, Fabijanovic D, Cikes M, Lamata P, Bijnens B, Sitges M. P735 Septal curvature - a novel, semi-automated parameter to aid in recognition of basal septal hypertrophy in arterial hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.404] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Horizon 2020 European Commission Project MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310).
Background and aim
Localized basal septal hypertrophy (BSH) is a known marker of increased afterload and localized deformation impairment, and can be seen in one-fifth of patients with arterial hypertension. Although there is variability in the classification, BSH is mainly defined from ratios between several wall thickness measurements. We hypothesize that the curvature of the septum is reflective of localized hypertrophy and will be significantly increased in patients with BSH. Speckle tracking endocardial delineations of the left ventricle (LV) can be used to quantify curvature, with the potential to create a novel, semi-automatized parameter for recognition of patients with an increased impact of afterload on cardiac structure and function.
Methods
An echocardiogram was performed on a total of 149 patients with a diagnosis of long-standing hypertension, treated with at least one antihypertensive drug and on 19 healthy age and sex-matched controls. The interventricular septum thickness was measured at basal and mid-level in the parasternal long axis (PLAX) and 4-chamber (4C) views. BSH was identified from a two-part criterion: both a positive visual assessment of an abrupt change in septal thickness seen in the 4C or PLAX views and a basal to mid-septal ratio ≥ 1.4. A dedicated software for speckle tracking was used to trace the endocardial border of the LV in 4C and 3C view. In post-analysis, we quantified the maximal curvature of the antero- and inferoseptal segments from the exported myocardial contour. Curvature, measured in m-1, was defined as the reciprocal value of the radius of the circle fitted into the curve defined by three subsequent neighboring points in the myocardial contour. Curvature was considered negative if the curve was convex with respect to the LV long-axis.
Results
Using septal wall thickness measurements, 19% (n = 28) of hypertensive patients were classified as having BSH, whereas all healthy controls had normal geometry. Basal antero- and inferoseptal wall thickness was significantly increased in the BSH group, which was coupled with regional deformation impairment (basal inferoseptum, controls vs. non-BSH vs. BSH: 16.1 ± 2.33 vs. 15.14 ± 2.8 vs. 13.02 ± 2.98 %, p < 0.001). The curvature of the basal inferoseptum was significantly higher in the BSH group (controls vs. non-BSH vs BSH: -23.4 (-27.2, -10.9) vs. -28.3 (-40.2, -19.3) vs. -50.5 (-66.8, -33.9) m-1, p < 0.001) (Figure 1), with the same trend seen in the basal anteroseptum. The inferoseptal curvature showed a moderately strong correlation with the inferoseptal basal-to-mid wall thickness ratio (R = 0.527, p <0.001).
Conclusion
Increased septal curvature is an easily quantifiable, single-value, semi-automated parameter reflective of localized thickening that could easily be incorporated into the output of the LV speckle tracking workflow, possibly aiding in the recognition of hypertensive patients in need of a closer clinical follow-up.
Abstract P735 Figure 1
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Affiliation(s)
- F Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - M Marciniak
- Kings College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - J F Fernandes
- Kings College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - A Gilbert
- GE Vingmed, Ultrasound, Oslo, Norway
| | - L Nunno
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M Mimbrero
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Tirapu
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Sanchis
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Doltra
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - D Fabijanovic
- University Hospital Centre Zagreb, Department of cardiovascular diseases, Zagreb, Croatia
| | - M Cikes
- University Hospital Centre Zagreb, Department of cardiovascular diseases, Zagreb, Croatia
| | - P Lamata
- Kings College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - B Bijnens
- Instituci?? Catalana de Recerca i Estudis Avan??ats (ICREA), Barcelona, Spain
| | - M Sitges
- Hospital Clinic de Barcelona, Barcelona, Spain
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Loncaric F, Marciniak M, Nunno L, Fernandes JF, Mimbrero M, Tirapu L, Fabijanovic D, Sanchis L, Doltra A, Cikes M, Lamata P, Bijnens B, Sitges M. 155 Myocardial work in hypertension and mitral regurgitation- insights from non-invasive assessment of left ventricular pressure-strain relations. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310)
Background and aim
Non-invasive left ventricular (LV) pressure estimates and speckle-tracking deformation curves can be used to quantify an index of myocardial work (MWI) which may offer insight into the early changes and work distribution in hypertension (HTN) and mitral regurgitation (MR) – cardiac diseases related to pressure and volume overload. The aim is to assess segmental strain and MW indices in patients with HTN, MR, and in healthy controls.
Methods
An echocardiogram was performed in 73 participants: 31 patients with a diagnosis of long-standing HTN with signs of LV hypertrophy, 22 patients with MR without hypertension, and 20 healthy age- and sex-matched controls. LV speckle-tracking was performed in 4C, 2C, and 3C apical views. MWI was calculated between mitral valve closing and opening. Average regional values of strain and MW indices were calculated by averaging the 4C, 3C, and 2C basal, mid, and apical segments, as based on the 18-segment model of the LV. Total MW per minute (MWI/min) was calculated by multiplying global MWI by the heart rate.
Results
LV ejection fraction and global longitudinal strain (GLS) were preserved and similar in all groups (GLS, controls vs. mild/moderate MR vs. severe MR vs. HTN: -21.28 ± 2.36 vs. -21.30 ± 1.49 vs. -20.93 ± 2.46 vs. -20.93 ± 2.46, p = 0.602). MR was classified as mild or moderate in 45% (n = 10) and severe in 55% (n = 12). A strong trend of higher global MWI (controls vs. mild/moderate MR vs. severe MR vs. HTN: 2098 ± 373 vs. 2036 ± 341 vs. 2237 ± 351 vs. 2297 ± 427 mmHg%, p = 0.171), as well as MWI/min could be noted in patients with hypertension and severe MR. Averaged regional deformation values showed a gradient increasing from base to apex in all groups, significantly more pronounced in the HTN patients. This deformation pattern was reflected in myocardial work distribution. In HTN, the basal region performed a lower percentage of total work, with the apex performing an increased workload. In the MR subgroups, the work was distributed similarly to the healthy controls Results are shown in Figure 1.
Conclusion
Non-invasive pressure strain relations offer additional information on cardiac function in HTN and MR with preserved LVEF and GLS. In HTN, MW is elevated and redistributed in the LV with an apex-to-base gradient signaling an apical compensation of basal impairment in the setting of increased afterload. Mild and moderate MR is associated with a compensated state of normal global MWI and work distribution, however, MWI/min in severe MR reveals an overall increase in workload - potentially predicting further LV remodeling in these patients over time.
Abstract 155 Figure 1
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Affiliation(s)
- F Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - M Marciniak
- Kings College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - L Nunno
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - J F Fernandes
- Kings College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - M Mimbrero
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Tirapu
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - D Fabijanovic
- University Hospital Centre Zagreb, Department of cardiovascular diseases , Zagreb, Croatia
| | - L Sanchis
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Doltra
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M Cikes
- University Hospital Centre Zagreb, Department of cardiovascular diseases , Zagreb, Croatia
| | - P Lamata
- Kings College London, Department of Biomedical Engineering, London, United Kingdom of Great Britain & Northern Ireland
| | - B Bijnens
- Instituci?? Catalana de Recerca i Estudis Avan??ats (ICREA), Barcelona, Spain
| | - M Sitges
- Hospital Clinic de Barcelona, Barcelona, Spain
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25
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Darrigo LG, Colturato V, de Souza MP, Loth G, Calixto R, Seber A, Zecchin VG, Esteves Daudt L, Tavares RB, Arcuri L, de Macedo AV, Vieira AK, Kuwahara C, Ribeiro L, Fernandes JF, Flowers ME, Pasquini R, Bonfim C. Allogeneic Bone Marrow Transplants for Pediatric Severe Aplastic Anemia: Real-world Data comparing Matched Related and Unrelated Donors in a Developing Country. Retrospective study on behalf of the Pediatric Hematopoietic Stem Cell Transplant Working Group of the Brazilian Bone Marrow Transplantation Society (SBTMO) and the Brazil-Seattle Consortium (Gedeco). Pediatr Transplant 2019; 23:e13552. [PMID: 31297928 DOI: 10.1111/petr.13552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/29/2019] [Accepted: 06/18/2019] [Indexed: 01/06/2023]
Abstract
In this study, we report on major MRD or URD BMT outcomes in pediatric patients with SAA in Brazil. This was a retrospective study, which included 106 patients ≤18 years old who received a first BMT for SAA. All patients received bone marrow as graft source from an MRD (n = 69) or a URD (n = 37). Conditioning regimen was non-myeloablative in 73.6% of cases, and GVHD prophylaxis comprised a calcineurin inhibitor plus methotrexate in 89.6% of patients. After a median follow-up of 4.5 years after BMT, 81 patients are alive, with a 4-year OS of 77% and no statistically significant difference between the MRD and URD groups (82% vs. 69%, respectively; P = .08). Grade III-IV aGVHD at 6 months and cGVHD at 2 years were observed in 8% and 14% of cases, respectively, and were not statistically different between the groups. Twenty-five (23%) patients died at a median of 2.9 months after BMT. Our study showed that 4-year OS after BMT was not statistically different between MRD and URD recipients. This study shows that the outcomes of pediatric patients transplanted for SAA with a URD in Brazil are approaching those of MRD transplants. In contrast, OS after MRD BMT was lower than we would expect based on previous reports. The wide range of preparatory regimens used by the study centers highlights the need for standardized protocols for these children. Our findings provide a benchmark for future studies focused on improving BMT outcomes in this setting in Brazil.
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Affiliation(s)
| | | | | | - Gisele Loth
- Universidade Federal do Paraná, Curitiba, Brazil
| | - Rodolfo Calixto
- Real Hospital Português de Beneficência, Recife - PE, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Loncaric F, Marciniak M, Fernandes JF, Nunno L, Mimbrero M, Tirapu L, Sanchis L, Doltra A, Fabijanovic D, Cikes M, Lamata P, Bijnens B, Sitges M. P3836Myocardial work distribution in hypertensive patients with basal septal hypertrophy - a non-invasive assessment with left ventricular pressure-strain relations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0677] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
Localized basal septal hypertrophy (BSH) is a known marker of hypertension. However, the underlying functional significance of this morphologic finding is not clear. Non-invasive LV pressure estimates and speckle-tracking deformation curves can be used to quantify myocardial work (MW), which may offer insights into work distribution in increased afterload leading to better understanding of the early changes in hypertensive heart disease. The aim is to assess segmental strain and MW indices in hypertensive patients with and without BSH, as well as in healthy controls.
Methods
An echocardiogram was performed on a total of 149 patients with a diagnosis of long-standing hypertension and on 19 healthy age and sex-matched controls. The septum was measured at basal and mid-level in parasternal long-axis and four-chamber views. A two-part criterion - a positive visual assessment of an abrupt change in septal thickness seen in the 4C or PLAX view and a basal to mid-septal ratio ≥1.4 - was used to identify BSH. LV speckle-tracking was performed in 4C, 2C, and 3C views. Myocardial work index was calculated between mitral valve closing and opening. Average regional values of strain and MW indices were calculated by averaging the 4C, 3C, and 2C basal, mid, and apical segments.
Results
BSH was present in 19.2% (n=28) of the hypertensive cohort. There were no differences in LV ejection fraction or global longitudinal strain between the subgroups. The basal inferoseptum and anteroseptum were thicker in the hypertensive patients, significantly more so in the BSH subgroup, which was coupled with a proportional decrease in local deformation. Averaged regional deformation values showed a gradient increasing from base to apex in all subgroups, more pronounced in the BSH patients due to significantly impaired average basal deformation (controls vs. non-BSH vs. BSH: −18.33±1.92 vs. −17.24±2.14 vs. −15.56±2.08%, p<0.001). This deformation pattern was reflected in myocardial work distribution in hypertension, showing the basal region performing a lower percentage of global work, especially so in the BSH patients, while the apical region performed a significantly higher percentage, with a trend of further increase in the BSH subgroup (Figure 1).
Figure 1
Conclusion
Localised BSH, a structural finding in one-fifth of the hypertensive population, is related to functional impairment in regional systolic deformation and a pronounced redistribution of myocardial work during the cardiac cycle. An apex-to-base gradient in myocardial work signals an apical compensation of basal impairment in the setting of increased afterload. Clinical follow-up of patients is needed in order to assess the prognostic relevance of these findings.
Acknowledgement/Funding
Spanish Ministry of Economy and Competitiveness (TIN2014-52923-R), Fundacio La Maratό de TV3 (040310), H2020-MSCA-ITN-2016 (764738)
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Affiliation(s)
- F Loncaric
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - M Marciniak
- Kings College London, Department of Biomedical Engineering, London, United Kingdom
| | - J F Fernandes
- Kings College London, Department of Biomedical Engineering, London, United Kingdom
| | - L Nunno
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - M Mimbrero
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Tirapu
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - L Sanchis
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Doltra
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - D Fabijanovic
- University Hospital Centre Zagreb, Department of Cardiovascular Diseases, Zagreb, Croatia
| | - M Cikes
- University Hospital Centre Zagreb, Department of Cardiovascular Diseases, Zagreb, Croatia
| | - P Lamata
- Kings College London, Department of Biomedical Engineering, London, United Kingdom
| | - B Bijnens
- Instituciό Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - M Sitges
- Hospital Clinic de Barcelona, Barcelona, Spain
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Kerbauy MN, Kerbauy LN, Esteves I, Rocha JD, Stanzione RL, Rodrigues M, Fernandes JF, Kutner JM, Sobrinho JJ, Mantovani LFAL, Kerbauy FR, Ribeiro AF, Hamerschlak N. Hospital Length of Stay and Impact of Readmission in the First 100 Days of Allogeneic Stem Cell Transplantation: Comparison among Alternative Donor in Pediatric and Adult Population. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bonfim C, Franco S, Colturato VA, Fernandes JF, Zecchin V, Seber A, Darrigo LG, Daudt LE, Arcuri LJ, Flowers ME. Outcomes after Hematopoietic Cell Transplantation (HCT) in Brazil for Children and Adolescents with Non-Malignant Diseases: A Multicenter Study on Behalf on the Brazil-Seattle Consortium Study Group. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.529] [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]
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Fernandes JF, Bonfim C, Kerbauy FR, Rodrigues M, Esteves I, Silva NH, Azambuja AP, Mantovani LF, Kutner JM, Loth G, Kuwahara CC, Bueno C, Kondo AT, Ribeiro AAF, Kok F, Hamerschlak N. Haploidentical bone marrow transplantation with post transplant cyclophosphamide for patients with X-linked adrenoleukodystrophy: a suitable choice in an urgent situation. Bone Marrow Transplant 2018; 53:392-399. [DOI: 10.1038/s41409-017-0015-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/23/2017] [Accepted: 04/15/2017] [Indexed: 02/03/2023]
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Barzaghi F, Amaya Hernandez LC, Neven B, Ricci S, Kucuk ZY, Bleesing JJ, Nademi Z, Slatter MA, Ulloa ER, Shcherbina A, Roppelt A, Worth A, Silva J, Aiuti A, Murguia-Favela L, Speckmann C, Carneiro-Sampaio M, Fernandes JF, Baris S, Ozen A, Karakoc-Aydiner E, Kiykim A, Schulz A, Steinmann S, Notarangelo LD, Gambineri E, Lionetti P, Shearer WT, Forbes LR, Martinez C, Moshous D, Blanche S, Fisher A, Ruemmele FM, Tissandier C, Ouachee-Chardin M, Rieux-Laucat F, Cavazzana M, Qasim W, Lucarelli B, Albert MH, Kobayashi I, Alonso L, Diaz De Heredia C, Kanegane H, Lawitschka A, Seo JJ, Gonzalez-Vicent M, Diaz MA, Goyal RK, Sauer MG, Yesilipek A, Kim M, Yilmaz-Demirdag Y, Bhatia M, Khlevner J, Richmond Padilla EJ, Martino S, Montin D, Neth O, Molinos-Quintana A, Valverde-Fernandez J, Broides A, Pinsk V, Ballauf A, Haerynck F, Bordon V, Dhooge C, Garcia-Lloret ML, Bredius RG, Kałwak K, Haddad E, Seidel MG, Duckers G, Pai SY, Dvorak CC, Ehl S, Locatelli F, Goldman F, Gennery AR, Cowan MJ, Roncarolo MG, Bacchetta R. Long-term follow-up of IPEX syndrome patients after different therapeutic strategies: An international multicenter retrospective study. J Allergy Clin Immunol 2017; 141:1036-1049.e5. [PMID: 29241729 PMCID: PMC6050203 DOI: 10.1016/j.jaci.2017.10.041] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 01/15/2023]
Abstract
Background Immunodysregulation polyendocrinopathy enteropathy x-linked(IPEX) syndromeis a monogenic autoimmune disease caused by FOXP3 mutations. Because it is a rare disease, the natural history and response to treatments, including allogeneic hematopoietic stem cell transplantation (HSCT) and immunosuppression (IS), have not been thoroughly examined. Objective This analysis sought to evaluate disease onset, progression, and long-term outcome of the 2 main treatments in long-term IPEX survivors. Methods Clinical histories of 96 patients with a genetically proven IPEX syndrome were collected from 38 institutions worldwide and retrospectively analyzed. To investigate possible factors suitable to predict the outcome, an organ involvement (OI) scoring system was developed. Results We confirm neonatal onset with enteropathy, type 1 diabetes, and eczema. In addition, we found less common manifestations in delayed onset patients or during disease evolution. There is no correlation between the site of mutation and the disease course or outcome, and the same genotype can present with variable phenotypes. HSCT patients (n = 58) had a median follow-up of 2.7 years (range, 1 week-15 years). Patients receiving chronic IS (n = 34) had a median follow-up of 4 years (range, 2 months-25 years). The overall survival after HSCT was 73.2% (95% CI, 59.4-83.0) and after IS was 65.1% (95% CI, 62.8-95.8). The pretreatment OI score was the only significant predictor of overall survival after transplant (P = .035) but not under IS. Conclusions Patients receiving chronic IS were hampered by disease recurrence or complications, impacting long-term disease-free survival. When performed in patients with a low OI score, HSCT resulted in disease resolution with better quality of life, independent of age, donor source, or conditioning regimen.
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MESH Headings
- Adolescent
- Adult
- Allografts
- Child
- Child, Preschool
- Diabetes Mellitus, Type 1/congenital
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 1/therapy
- Diarrhea/genetics
- Diarrhea/immunology
- Diarrhea/mortality
- Diarrhea/therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Forkhead Transcription Factors/genetics
- Forkhead Transcription Factors/immunology
- Genetic Diseases, X-Linked/genetics
- Genetic Diseases, X-Linked/immunology
- Genetic Diseases, X-Linked/mortality
- Genetic Diseases, X-Linked/therapy
- Hematopoietic Stem Cell Transplantation
- Humans
- Immune System Diseases/congenital
- Immune System Diseases/genetics
- Immune System Diseases/immunology
- Immune System Diseases/mortality
- Immune System Diseases/therapy
- Immunosuppression Therapy
- Infant
- Male
- Mutation
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy, Pediatric Immunohematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Laura Cristina Amaya Hernandez
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Benedicte Neven
- Paediatric Immunology, Haematology and Rheumatology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes-Université Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Silvia Ricci
- Pediatric Immunology, "Anna Meyer" Children's Hospital, Florence, Italy
| | - Zeynep Yesim Kucuk
- Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jack J Bleesing
- Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Zohreh Nademi
- Institute of Cellular Medicine, Newcastle University and Children's Bone Marrow Transplant Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Mary Anne Slatter
- Institute of Cellular Medicine, Newcastle University and Children's Bone Marrow Transplant Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | | | - Anna Shcherbina
- Department of Immunology, Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Anna Roppelt
- Department of Immunology, Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Austen Worth
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital, London, United Kingdom
| | - Juliana Silva
- Department of Stem Cell Transplantation, Great Ormond Street Hospital, London, United Kingdom
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy, Pediatric Immunohematology and Bone Marrow Transplantation Unit, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luis Murguia-Favela
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carsten Speckmann
- Department of Pediatrics and Adolescent Medicine, University of Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Magda Carneiro-Sampaio
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo and Hospital Albert Einstein, São Paulo, Brazil
| | - Juliana Folloni Fernandes
- Stem Cell Transplantation Unit, Instituto da Criança, Faculdade de Medicina da Universidade de São Paulo and Hospital Albert Einstein, São Paulo, Brazil
| | - Safa Baris
- Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Ahmet Ozen
- Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | | | - Ayca Kiykim
- Pediatric Allergy and Immunology, Marmara University, Istanbul, Turkey
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center, Ulm, Germany
| | - Sandra Steinmann
- Department of Pediatrics, University Medical Center, Ulm, Germany
| | - Lucia Dora Notarangelo
- Pediatric Onco-Hematology and Bone Marrow Transplant (BMT) Unit, Children's Hospital, Spedali Civili, Brescia, Italy
| | - Eleonora Gambineri
- Department of Hematology-Oncology: Bone Marrow Transplant (BMT) Unit, "Anna Meyer" Children's Hospital, Florence, Italy
| | - Paolo Lionetti
- Gastroenterology Unit, University of Florence, Department of "NEUROFARBA": Section of Child's Health, "Anna Meyer" Children's Hospital, Florence, Italy
| | - William Thomas Shearer
- Department of Pediatrics, Section of Immunology Allergy Rheumatology, Baylor College of Medicine Texas Children's Hospital, Houston, Tex
| | - Lisa R Forbes
- Department of Pediatrics, Section of Immunology Allergy Rheumatology, Baylor College of Medicine Texas Children's Hospital, Houston, Tex
| | - Caridad Martinez
- Department of Pediatric Hematology and Oncology, Baylor College of Medicine Texas Children's Hospital, Houston, Tex
| | - Despina Moshous
- Paediatric Immunology, Haematology and Rheumatology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes-Université Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Stephane Blanche
- Paediatric Immunology, Haematology and Rheumatology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes-Université Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Alain Fisher
- Paediatric Immunology, Haematology and Rheumatology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes-Université Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Frank M Ruemmele
- Pediatric Gastroenterology unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes-Université Sorbonne Paris Cité, Paris, France
| | - Come Tissandier
- Pediatric Gastroenterology unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes-Université Sorbonne Paris Cité, Paris, France
| | - Marie Ouachee-Chardin
- Hematology Unit, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Rieux-Laucat
- Institut national de la santé et de la recherche médicale (INSERM) UMR 1163, Laboratory of Immunogenetics of Pediatric Autoimmune Disease, Paris, France
| | - Marina Cavazzana
- Biotherapy Department, Necker-Enfants Malades University Hospital, Paris Descartes -Université Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Waseem Qasim
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Barbarella Lucarelli
- Department of Pediatric Hematology-Oncology, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michael H Albert
- Pediatric Hematology-Oncology, Dr. von Hauner Children's hospital, Ludwig-Maximilians Universität, Munich, Germany
| | - Ichiro Kobayashi
- Center for Pediatric Allergy and Rheumatology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Laura Alonso
- Paediatric Haematology and Oncology, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | | | - Hirokazu Kanegane
- Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Anita Lawitschka
- St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Jong Jin Seo
- Pediatrics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Marta Gonzalez-Vicent
- Hematopoietic Stem Cell Transplantation Unit, Pediatric Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Miguel Angel Diaz
- Hematopoietic Stem Cell Transplantation Unit, Pediatric Department, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Rakesh Kumar Goyal
- Division of Blood and Marrow Transplantation and Cellular Therapies, Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Martin G Sauer
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Akif Yesilipek
- Pediatric Stem Cell Transplantation Unit, Medicalpark Hospital Goztepe and Antalya Hospitals, Antalya, Turkey
| | - Minsoo Kim
- Pediatric Allergy, Immunology and Rheumatology, Columbia Medical Center, New York, NY
| | - Yesim Yilmaz-Demirdag
- Pediatric Allergy, Immunology and Rheumatology, Columbia Medical Center, New York, NY
| | - Monica Bhatia
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia Medical Center, New York, NY
| | - Julie Khlevner
- Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia Medical Center, New York, NY
| | | | - Silvana Martino
- Division of Immunology and Rheumatology, Department of Paediatric Infectious Diseases, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Davide Montin
- Division of Immunology and Rheumatology, Department of Paediatric Infectious Diseases, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Olaf Neth
- Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Instituto de Biomedicina de Sevilla/CSIC/Universidad de Sevilla, Seville, Spain
| | - Agueda Molinos-Quintana
- Department of Pediatric Hematology, Instituto de Biomedicina de Sevilla/CSIC/Universidad de Sevilla, Seville, Spain
| | - Justo Valverde-Fernandez
- Department of Paediatirc Gastroenterology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla/Unite Mixte de Recherche (UMR) or Mixed Unit of Research Consejo Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Seville, Spain
| | - Arnon Broides
- Pediatric Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Vered Pinsk
- Pediatric Ambulatory Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Antje Ballauf
- Department of Pediatrics, Helios Children's Hospital, Krefeld, Germany
| | - Filomeen Haerynck
- Department of Pediatrics, Center for Primary Immunodeficiencies, Ghent University Hospital, Ghent, Belgium
| | - Victoria Bordon
- Department of Pediatrics, Center for Primary Immunodeficiencies, Ghent University Hospital, Ghent, Belgium
| | - Catharina Dhooge
- Department of Pediatrics, Center for Primary Immunodeficiencies, Ghent University Hospital, Ghent, Belgium
| | - Maria Laura Garcia-Lloret
- Division of Pediatric Allergy, Immunology and Rheumatology, University of California-Los Angeles School of Medicine, Los Angeles, Calif
| | - Robbert G Bredius
- Pediatric Immunology, Infections and Stem Cell Transplantation (SCT), Leiden University Medical Center, Leiden, The Netherlands
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant (BMT) Unit, Wroclaw Medical University, Wroclaw, Poland
| | - Elie Haddad
- Department of Pediatrics, Saint Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Markus Gerhard Seidel
- Division of Pediatric Hematology-Oncology, Research Unit Pediatric Hematology and Immunology, Medical University Graz, Graz, Austria
| | - Gregor Duckers
- Department of Pediatrics, Helios Children's Hospital, Krefeld, Germany
| | - Sung-Yun Pai
- Pediatrics, Boston Children's Hospital, Boston, Mass; Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass
| | - Christopher C Dvorak
- Pediatric Allergy, Immunology and Bone Marrow Transplant, University of California-San Francisco Benioff Children's Hospital, San Francisco, Calif
| | - Stephan Ehl
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franco Locatelli
- Department of Pediatric Hematology-Oncology, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Andrew Richard Gennery
- Institute of Cellular Medicine, Newcastle University and Children's Bone Marrow Transplant Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Mort J Cowan
- Pediatric Allergy, Immunology and Bone Marrow Transplant, University of California-San Francisco Benioff Children's Hospital, San Francisco, Calif
| | - Maria-Grazia Roncarolo
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Rosa Bacchetta
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
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Campregher PV, Halley NDS, Vieira GA, Fernandes JF, Velloso EDRP, Ali S, Mughal T, Miller V, Mangueira CLP, Odone V, Hamerschlak N. Identification of a novel fusion TBL1XR1-PDGFRB in a patient with acute myeloid leukemia harboring the DEK-NUP214 fusion and clinical response to dasatinib. Leuk Lymphoma 2017; 58:2969-2972. [PMID: 28509585 DOI: 10.1080/10428194.2017.1318437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
MESH Headings
- Adolescent
- Antineoplastic Agents/therapeutic use
- Biopsy
- Bone Marrow/pathology
- Chromosomal Proteins, Non-Histone/genetics
- Chromosome Banding
- Dasatinib/therapeutic use
- Humans
- Immunohistochemistry
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Male
- Nuclear Pore Complex Proteins/genetics
- Nuclear Proteins/genetics
- Oncogene Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Poly-ADP-Ribose Binding Proteins/genetics
- Protein Kinase Inhibitors/therapeutic use
- Receptor, Platelet-Derived Growth Factor beta/genetics
- Receptors, Cytoplasmic and Nuclear/genetics
- Repressor Proteins/genetics
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- Paulo Vidal Campregher
- a Department of Hematology and Clinical Pathology , Research Institute, Hospital Israelita Albert Einstein , São Paulo , Brazil
- b Foundation Medicine , Cambridge , MT
- c Department of Hematology, University of Campinas (Hemocentro - Unicamp) , Campinas , São Paulo , Brazil
| | | | - Gabriela Amaral Vieira
- a Department of Hematology and Clinical Pathology , Research Institute, Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Juliana Folloni Fernandes
- e Hematology and Bone Marrow Transplantation Program , Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Elvira Deolinda Rodrigues Pereira Velloso
- f Hematology Service , Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
- g Cytogenetics Laboratories , Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Siraj Ali
- b Foundation Medicine , Cambridge , MT
| | - Tariq Mughal
- h Tufts University Cancer Center , Boston , MA , USA
| | | | | | - Vicente Odone
- i Department of Pediatric Oncology , Hospital Israelita Albert Einstein , São Paulo , Brazil
| | - Nelson Hamerschlak
- j Department of Hematology , Hospital Israelita Albert Einstein , São Paulo , Brazil
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32
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Fernandes JF, Mantovani LFAL, Venancio AM, Dorna M, Pastorino AC, Vasconcelos D, Neto AC, Moura ACA, Collassanti MD, Zanichelli MA, Carneiro-Sampaio M, Rocha VG, Filho VO. Hematopoietic Stem Cell Transplantation for Chronic Granulomatous Disease in a Single Institution in Brazil. Reproducing Good Results with a Reduced Toxicity Regimen. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.456] [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]
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33
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Ribeiro AF, Fernandes JF, da Silva CC, Sobrinho JJ, Kutner JM, Rodrigues M, Esteves I, Kerbauy FR, Kerbauy MN, Kerbauy LN, Hamerschlak N. Unmanipulated Haploidentical Transplants Using Post-Transplant Cyclophosphamide CAN Safely Extend Hematopoietic STEM CELL Transplantation for Patients Without an HLA Matched DONOR: Preliminary Results in Brazil. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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34
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e Moura de Souza CL, Bub CB, Torres MA, Velloso EDRP, Silveira PAA, Correia RP, Bacal NS, Mangueira CLP, Fernandes JF, Odone Filho V, Hamerschlak N, Campregher PV. Eosinophil chimerism in the differential diagnosis between DEK-NUP214-positive acute myeloid leukaemia relapse and chronic graft-versus-host disease. J Clin Pathol 2015; 68:950-2. [PMID: 26193901 DOI: 10.1136/jclinpath-2015-203013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/18/2015] [Indexed: 11/04/2022]
MESH Headings
- Adolescent
- Chromosomal Proteins, Non-Histone/genetics
- Diagnosis, Differential
- Eosinophilia/etiology
- Eosinophils
- Graft vs Host Disease/diagnosis
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/surgery
- Male
- Neoplasm Recurrence, Local/diagnosis
- Nuclear Pore Complex Proteins/genetics
- Oncogene Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Poly-ADP-Ribose Binding Proteins
- Transplantation Chimera
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Affiliation(s)
| | - Carolina Bonet Bub
- Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Vicente Odone Filho
- Department of Pediatric Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nelson Hamerschlak
- Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Vidal Campregher
- Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil Hematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
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35
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Eduardo FDP, Bezinelli LM, de Carvalho DLC, Lopes RMDG, Fernandes JF, Brumatti M, Vince CSC, de Azambuja AMP, Vogel C, Hamerschlak N, Correa L. Oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: clinical outcomes in a context of specialized oral care using low-level laser therapy. Pediatr Transplant 2015; 19:316-25. [PMID: 25677170 DOI: 10.1111/petr.12440] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 01/27/2023]
Abstract
OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff.
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36
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Fernandes JF, Seber A, Daudt LE, Ribeiro L, Zecchin V, Mauad MA, Darrigo LG, Vieira AK, Gregianin L, Sousa AM, Santini A, Tavares R, Nichele S, Koliski A, Bouzas LFS, Hamerschlak N, Bonfim C. Hematopoietic Stem Cell Transplantation in Primary Immunodeficiencies in Brazil-a Survey of the Working Group on Paediatric Transplantation of the Brazilian Society of Bone Marrow Transplantation. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.118] [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]
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37
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Zago CA, Jacob CMA, de Albuquerque Diniz EM, Lovisolo SM, Zerbini MCN, Dorna M, Watanabe L, Fernandes JF, Rocha V, Oliveira JB, Carneiro-Sampaio M. Autoimmune manifestations in SCID due to IL7R mutations: Omenn syndrome and cytopenias. Hum Immunol 2014; 75:662-6. [DOI: 10.1016/j.humimm.2014.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/22/2014] [Accepted: 04/06/2014] [Indexed: 11/26/2022]
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38
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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.
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39
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Riccetto AGL, Buzolin M, Fernandes JF, Traina F, Barjas-de-Castro MLR, Silva MTN, Oliveira JB, Vilela MM. Compound heterozygous RAG2 mutations mimicking hyper IgM syndrome. J Clin Immunol 2013; 34:7-9. [PMID: 24174341 DOI: 10.1007/s10875-013-9956-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A G L Riccetto
- Department of Pediatrics, Center for Investigation in Pediatrics-CIPED, University of Campinas Medical School -Unicamp, Rua Tessalia Vieira de Camargo 126, Campinas, São Paulo, Brazil, CEP 13083-887
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40
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Carneiro Borba C, de Lourdes Chauffaille M, Saeed Sanabani S, Saeed Sanabnai S, Folloni Fernandes J, Aiko Kumeda C, Rodrigues Pereira Velloso ED, Jarandilha dos Santos K, Puato Vieira Pupim M, Hamerschlak N, Odone Filho V, Bendit I. Simultaneous occurrence of biphenotypic T cell/myeloid lesions involving t(12;13)(p13;q14) in a pediatric patient. Acta Haematol 2012; 127:165-9. [PMID: 22301888 DOI: 10.1159/000334881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/31/2011] [Indexed: 11/19/2022]
Abstract
This paper chronicles a 2-year-old girl who presented with acute leukemia/lymphoma syndrome of the T cell immunophenotype. At this time, the cytogenetic analysis of her bone marrow cells showed a reciprocal translocation between the short arm of chromosome 12 and the long arm of chromosome 13, t(12;13)(p13;q14). The immunophenotyping of bone marrow blast cells by flow cytometry revealed a population of cells positive for CD56, CD117, CD45, partial CD33, partial HLA-DR, CD13, CD7, CD2 and CD5. Therefore, a diagnosis of acute leukemia with a mixed T cell/myeloid phenotype was made. The patient had a poor response to classic T cell acute lymphocytic leukemia/lymphoma therapy; thus, her treatment was changed to a myeloid leukemia protocol, which produced a good response. She underwent a successful cord blood transplantation from an unrelated HLA partially matched donor. The coexistence of these two phenotypes prompts questions about the existence of clonal instability, which might influence the choice of therapy. The rarity of the t(12;13)(p13;q14) and the coexistence of T cell/myeloid markers suggest a nonrandom association. To the best of our knowledge, this is the first reported case in which a cell clone bearing a t(12;13)(p13;q14) translocation in a mixed T cell/myeloid lesion was detected.
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MESH Headings
- Acute Disease
- Antigens, CD/analysis
- Child, Preschool
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 13/genetics
- Female
- HLA-DR Antigens/analysis
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Myeloid/diagnosis
- Leukemia, Myeloid/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Proto-Oncogene Proteins c-ets/genetics
- Receptors, Antigen, T-Cell/genetics
- Repressor Proteins/genetics
- Translocation, Genetic
- ETS Translocation Variant 6 Protein
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41
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Perini GF, Kerbauy FR, Fernandes JF, Santos FPS, Torres MA, Ribeiro AAF, Hamerschlak N. Haploidentical non-myeloablative stem cell transplantation as salvage for graft failure in a patient with juvenile myelomonocytic leukemia. Pediatr Blood Cancer 2011; 57:1084. [PMID: 21748848 DOI: 10.1002/pbc.23163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 03/23/2011] [Indexed: 11/08/2022]
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42
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Fernandes JF, Kerbauy FR, Ribeiro AAF, Kutner JM, Camargo LFA, Stape A, Troster EJ, Zamperlini-Netto G, Azambuja AMPD, Carvalho B, Dorna MDB, Vilela MDS, Jacob CMA, Costa-Carvalho BT, Cunha JM, Carneiro-Sampaio MM, Hamerschlak N. Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience. Einstein (Sao Paulo) 2011; 9:140-4. [PMID: 26760806 DOI: 10.1590/s1679-45082011ao2007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. METHODS Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. RESULTS Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood: n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftment due to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. CONCLUSION Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.
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Affiliation(s)
| | | | | | - Jose Mauro Kutner
- Blood Bank, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | - Adalberto Stape
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | | | | | | | - Bruna Carvalho
- Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR
| | - Mayra de Barros Dorna
- Children's Institute, Hospital da Clínicas of Medial College, Unversidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Cristina Miuki Abe Jacob
- Children's Institute, Hospital da Clínicas of Medial College, Unversidade de São Paulo - USP, São Paulo, SP, BR
| | | | - Jose Marcos Cunha
- Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, BR
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43
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Rocha V, Porcher R, Fernandes JF, Filion A, Bittencourt H, Silva W, Vilela G, Zanette DL, Ferry C, Larghero J, Devergie A, Ribaud P, Skvortsova Y, Tamouza R, Gluckman E, Socie G, Zago MA. Association of drug metabolism gene polymorphisms with toxicities, graft-versus-host disease and survival after HLA-identical sibling hematopoietic stem cell transplantation for patients with leukemia. Leukemia 2008; 23:545-56. [DOI: 10.1038/leu.2008.323] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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44
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Fernandes JF, Pedro LM, Freire JP, Evangelista A, Granate MM, Cachita M, Pinto FJ, Sousa P, Lopes A, Dias NV, Fernandes RF. [Endovascular treatment of aneurysms of the descending thoracic aorta--a new therapeutic perspective]. Rev Port Cardiol 2000; 19:1029-35. [PMID: 11126106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Endovascular treatment of aneurysmal disease of descending thoracic aorta and infra-renal abdominal aorta, has become an accepted technique, in selected cases due to the reduction of neurological morbidity, paraparesis or paraplegic and renal ischemia, associated with conventional surgery. The authors describe the first case performed in Portugal of a 75-year-old female with an expanding thoracic aneurysm managed by endovascular exclusion of the aneurysm with an EXCLUDER endoprosthesis, without any complications or evidence of endoleak, achieving complete exclusion of the aneurysm.
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Affiliation(s)
- J F Fernandes
- Instituto Cardiovascular de Lisboa, Complexo Hospitalar das Torres de Lisboa, Lisboa, Portugal
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45
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Hendrickx J, Coucke P, Dams E, Lee P, Odièvre M, Corbeel L, Fernandes JF, Willems PJ. Mutations in the phosphorylase kinase gene PHKA2 are responsible for X-linked liver glycogen storage disease. Hum Mol Genet 1995; 4:77-83. [PMID: 7711737 DOI: 10.1093/hmg/4.1.77] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [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: 01/26/2023] Open
Abstract
Phosphorylase kinase (PHK) is a key enzyme in the control of glycogen breakdown. Several types of PHK deficiency have been described of which X-linked liver glycogenosis type I (XLG I) is the most common. Since the XLG I locus and the gene encoding the liver alpha-subunit gene of PHK (PHKA2) have both been localized to Xp22, PHKA2 was a candidate gene for XLG I. In this study we identified four point mutations in four unrelated XLG I patients: three mutations introduce a premature stop codon, whereas the fourth mutation abolishes a splice site consensus sequence leading to exon skipping. These findings indicate that PHKA2 is the XLG I gene.
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Affiliation(s)
- J Hendrickx
- Department of Medical Genetics, University of Antwerp, Belgium
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46
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Affiliation(s)
- J F Fernandes
- Department of Vascular Surgery, Faculty of Medicine, Hospital Santa Maria, Lisbon, Portugal
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47
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Fernandes JF, Pedro LM, Freire JP, Correia A, Pedro MM, Damião A, Pereira R, Alves JP, Martins C. [Prevalence of extracranial carotid occlusive disease. Non-invasive study]. ACTA MEDICA PORT 1992; 5:5-10. [PMID: 1570756] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cerebrovascular disease is the most important cause of mortality and morbility in some European Countries, but the prevalence of carotid occlusive disease has not been adequately assessed. From 1985 to 1987, 1,143 patients were consecutively evaluated in the Vascular Laboratory in order to determine the presence of extracranial carotid occlusive disease. 638 (55.8%) were males and 505 (44.2%) females and mean age was 58 years (16-87). 509 had previously focal brain ischemia, ocular and/or hemispheric (Group I), 78 had assymptomatic cervical bruit (Group II), 55 non-hemispheric neurologic dysfunction (Group III) and 501 had atypical symptoms for cerebrovascular disease (Group IV). Diagnostic criteria for carotid disease: were peak frequency greater than 4.0 KHz; spectral broadening greater than 40% and late sysstolic turbulence. Global prevalence of carotid disease was 31.8% and the results in each group were: Gr. I-37.2%; Gr. II-57.7%; Gr. III-43.6%; Gr. IV-21.2%. 49% of the patients had hypertension, 22.8% dyslipidemia, 22.4% evidence of coronary disease and 13.6% had diabetes. Hypertension, diabetes, coronary disease and the coexistence of two risk factors were significantly more prevalent in the group of patients with carotid disease. These results confirm a high prevalence of carotid disease in this population, which is comparable to the one is northern european populations.
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48
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Burger E, Lay WH, Hypolito LV, Fernandes JF. Trypanosoma cruzi: the fate of bloodstream trypomastigote, amastigote, metacyclic trypomastigote and epimastigote forms in the peritoneal macrophages of immune and non-immune mice in vivo. Acta Trop 1982; 39:111-22. [PMID: 6126093] [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: 01/18/2023]
Abstract
Experiments were done in vivo in order to compare the ability of Trypanosoma cruzi bloodstream trypomastigotes (BTr), amastigotes (Am), metacyclic trypomastigotes (MTr) and epimastigotes (Ep) to proliferate in the peritoneal macrophages of the following groups of A/Sn mice: actively immunized with increasing doses of living BTr (AIM); mice passively immunized with homologous immune serum (ISTM); mice passively transfused with normal homologous serum (NSTM) and normal mice (NM). Parasite load was evaluated by counting the number of infected peritoneal macrophages harvested on the 4th day after i.p. challenge with one of the forms. All four parasite stages infected NM. AIM seldom showed parasitized macrophages after challenge with any of the forms. ISTM always harboured numerous parasitized macrophages. The only form susceptible to humoral immunity was the Am.
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49
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Abstract
Ambulatory calf volume plethysmography has been used to study venous insufficiency in 50 lower limbs. The results demonstrate that it is possible to determine the presence of venous insufficiency and differentiate between normal limbs, limbs with superficial venous insufficiency only, limbs with deep venous insufficiency and limbs with deep venous insufficiency and occlusion by determining the ambulatory volume change and maximum venous outflow or venous volume.
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50
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Kimura E, Lay WH, Fernandes JF. Extracellular "in vitro" evolution of metacyclic trypomastigotes isolated from Trypanosoma cruzi cultures. Rev Inst Med Trop Sao Paulo 1978; 20:133-8. [PMID: 356159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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