1
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Potter V, Gras L, Koster L, Kroger N, Sockel K, Ganser A, Finke J, Labussiere-Wallet H, Peffault de Latour R, Koc Y, Salmenniemi U, Smidstrup Friis L, Jindra P, Schroeder T, Tischer J, Arat M, Pascual Cascon M, de Wreede LC, Hayden P, Raj K, Drozd-Sokolowska J, Scheid C, McLornan DP, Robin M, Yakoub-Agha I. Sequential vs myeloablative vs reduced intensity conditioning for patients with myelodysplastic syndromes with an excess of blasts at time of allogeneic haematopoietic cell transplantation: a retrospective study by the chronic malignancies working party of the EBMT. Bone Marrow Transplant 2024; 59:224-231. [PMID: 37993503 DOI: 10.1038/s41409-023-02111-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/27/2023] [Accepted: 09/15/2023] [Indexed: 11/24/2023]
Abstract
The optimal conditioning for patients with higher risk MDS receiving potentially curative allogeneic haematopoietic stem cell transplant(allo-HCT) remains to be defined. This is particularly the case for patients with excess of blasts at time of allo-HCT. Sequential (Seq) conditioning, whereby chemotherapy is followed rapidly by transplant conditioning, offers an opportunity to decrease disease burden, potentially improving outcomes allo-HCT outcomes. Herein we present the only analysis comparing Seq to myeloablative (MAC) and reduced intensity conditioning (RIC) specifically focussed on MDS patients with excess of blasts at allo-HCT. 303 patients were identified in the EBMT registry, receiving RIC (n = 158), Seq (n = 105), and MAC (n = 40). Median follow-up was 67.2 months and median age at allo-HCT was 59.5 years (IQR 53.5-65.6). For the entire cohort, 3 y overall survival (OS) was 50% (95% CI 45-56%) and relapse free survival (RFS) 45% (95% CI 40-51%). No significant differences in OS (log-rank p = 0.13) and RFS (log-rank p = 0.18) were observed between conditioning protocols. On multivariable analysis, lower performance status, worse IPSS-R cytogenetics, sibling donor (compared to 8/8 MUD) and ≥20% blasts at allo-HCT were associated with worse outcomes. In conclusion, the Seq protocol did little to influence the outcome in this high-risk group of patients, with outcomes mostly determined by baseline disease risk and patient characteristics such as performance status.
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Affiliation(s)
- V Potter
- Kings College Hospital NHS Foundation Trust, London, UK.
| | - L Gras
- EBMT Statistical Unit, Leiden, Netherlands
| | - L Koster
- EBMT Leiden Study Unit, Leiden, Netherlands
| | - N Kroger
- University Hospital Eppendorf, Hamburg, Germany
| | - K Sockel
- Universitaetsklinikum Dresden, Dresden, Germany
| | - A Ganser
- Hannover Medical School, Hannover, Germany
| | - J Finke
- University of Freiburg, Freiburg, Germany
| | | | | | - Y Koc
- Medicana International Hospital Istanbul, Istanbul, Turkey
| | | | | | - P Jindra
- Charles University Hospital, Pilsen, Czech Republic
| | - T Schroeder
- University Hospital Essen, Dusseldorf, Germany
| | - J Tischer
- Klinikum Grosshadern, Munich, Germany
| | - M Arat
- Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Stanbul, Turkey
| | | | - L C de Wreede
- Leiden University Medical Center, Dept of Biomedical Data Sciences, Leiden, Netherlands
| | - P Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - K Raj
- University College London Hospitals NHS Trust, London, UK
| | | | - C Scheid
- University of Cologne, Cologne, Germany
| | - D P McLornan
- University College London Hospitals NHS Trust, London, UK
| | - M Robin
- Saint-Louis Hospital, BMT Unit, Paris, France
| | - I Yakoub-Agha
- CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000, Lille, France
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2
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Spinner J, Fuentes-Baldemar A, Tu T, Robinsin P, Nicholas S, Hope K, Puri K, Denfield S, Tunuguntla H, Price J, Choudhry S, Dreyer W, Jindra P. HLA Diversity Transcends Donor-Recipient Race Matching. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1348] [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: 04/05/2023] Open
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3
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Kořen J, Steinerová K, Janíková A, Belada D, Hájková B, Krčméryová M, Hanáčková V, Vacková B, Jindra P, Osovská M, Svobodová E, Dlouhá L, Vodička P, Trněný M. MULTICENTER RETROSPECTIVE ANALYSIS OF RISK FACTORS FOR MORTALITY OF COVID‐19 INFECTION IN PATIENTS WITH LYMPHOMA. Hematol Oncol 2021. [PMCID: PMC8426804 DOI: 10.1002/hon.197_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J. Kořen
- 1st Department of Medicine Faculty of Medicine 1 Charles University General Hospital, Prague, Czech Republic haematology Prague Czech Republic
| | - K. Steinerová
- Department of Haematology and Oncology Charles University Hospital Pilsen Czech Republic, haematology anf oncology Pilsen Czech Republic
| | - A. Janíková
- 3Department of Internal Medicine Hematology and Oncology University Hospital Brno and Faculty of Medicine Masaryk University Brno Hematology and Oncology Brno Czech Republic
| | - D. Belada
- 4th Department of Internal Medicine ‐ Haematology Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic haematology Hradec Králové Czech Republic
| | - B. Hájková
- Department of Haematooncology University Hospital Ostrava, Czech Republic haematology Ostrava Czech Republic
| | - M. Krčméryová
- 1Internal Clinic of Hematology University Hospital Kralovske Vinohrady Third Faculty of Medicine Charles University in Prague, Czech Republic haematology Prague Czech Republic
| | - V. Hanáčková
- Department of Hemato‐Oncology Faculty of Medicine Palacky University and University Hospital Olomouc, Czech Republic haematology Olomouc Czech Republic
| | - B. Vacková
- 1st Department of Medicine Faculty of Medicine 1 Charles University General Hospital, Prague, Czech Republic haematology Prague Czech Republic
| | - P. Jindra
- Department of Haematology and Oncology Charles University Hospital Pilsen Czech Republic, haematology anf oncology Pilsen Czech Republic
| | - M. Osovská
- 3Department of Internal Medicine Hematology and Oncology University Hospital Brno and Faculty of Medicine Masaryk University Brno Hematology and Oncology Brno Czech Republic
| | - E. Svobodová
- 4th Department of Internal Medicine ‐ Haematology Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic haematology Hradec Králové Czech Republic
| | - L. Dlouhá
- 1st Department of Medicine Faculty of Medicine 1 Charles University General Hospital, Prague, Czech Republic haematology Prague Czech Republic
| | - P. Vodička
- 1st Department of Medicine Faculty of Medicine 1 Charles University General Hospital, Prague, Czech Republic haematology Prague Czech Republic
| | - M. Trněný
- 1st Department of Medicine Faculty of Medicine 1 Charles University General Hospital, Prague, Czech Republic haematology Prague Czech Republic
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4
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Dostalova K, Jindra P, Lysak D, Holubova M. Differences in the characteristics and functions of invariant NKT cells from healthy donors. Cytotherapy 2021. [DOI: 10.1016/s1465324921004114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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5
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Spinner J, Philogene M, Nicholas S, Jindra P, Choudhry S, Hope K, Puri K, Tunuguntla H, Price J, Denfield S, Dreyer W. AT1R-Ab: A New Player in Pediatric Heart Transplant AMR? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Kueht M, Jindra P, Stevenson HL, Galvan TN, Murthy B, Goss J, Anton J, Abbas R, Cusick MF. Intra-operative kinetics of anti-HLA antibody in simultaneous liver-kidney transplantation. Mol Genet Metab Rep 2021; 26:100705. [PMID: 33489761 PMCID: PMC7811052 DOI: 10.1016/j.ymgmr.2020.100705] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/05/2022] Open
Abstract
During simultaneous liver-kidney transplantation (SLK) in highly sensitized patients, donor specific anti-human leukocyte antigen antibodies (DSA, HLA) can be present prior to transplant leading to positive crossmatch, yet these recipients have relatively low incidences of acute rejection. The mechanisms and timing underlying immunologic changes that occur intra-operatively remain largely unknown. Therefore, we measured the intra- and peri-operative kinetics of anti-HLA antibodies in highly sensitized SLK recipients. In this study, pre- and post-operative blood samples were obtained from sensitized SLK candidates with documented DSA. Intra-operative samples were obtained from a sub-group of SLK recipients. Pretransplant anti-HLA antibody profiles were created and flow cytometry and anti-human globulin complement-dependent cytotoxic crossmatches were performed. Significant reductions in anti-HLA class I and II DSA were seen intra-operatively shortly after reperfusion of the liver allograft. This effect was most pronounced for anti-HLA class I DSA (mean change, −85%, p < 0.05); changes to anti-HLA class II DSA were less robust (mean change, −47%, p = 0.15). Importantly, non-DSA anti-HLA antibodies remained unchanged throughout the perioperative period, suggesting the mechanism(s) by which the liver lowers DSA levels are specific to the DSA. These data demonstrate the immunologic benefit of performing SLK is lasting and occurs very shortly after liver reperfusion.
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Affiliation(s)
- M Kueht
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, United States of America
| | - P Jindra
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - H L Stevenson
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, United States of America
| | - T N Galvan
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - B Murthy
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - J Goss
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - J Anton
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - R Abbas
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - M F Cusick
- Department of Pathology, University of Michigan Medicine, 2800 Plymouth Rd., Building 36, Ann Arbor, MI 48109, United States of America
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7
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Loke J, Labopin M, Craddock C, Niederwieser D, Cornelissen J, Afansayev B, Jindra P, Maertens J, Blaise D, Boriskina K, Gramatzki M, Ganser A, Savani B, Mohty M, Nagler A. Impact of patient: donor HLA disparity on reduced-intensity-conditioned allogeneic stem cell transplants from HLA mismatched unrelated donors for AML: from the ALWP of the EBMT. Bone Marrow Transplant 2020; 56:614-621. [PMID: 33009514 DOI: 10.1038/s41409-020-01072-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022]
Abstract
Patients with acute myeloid leukaemia (AML) who lack a matched sibling or unrelated donor commonly undergo transplantation from a donor matched at 9/10 HLA-A, -B, -C, -DRB1, -DQB1 alleles, and it is unclear if a specific locus mismatch is preferable to any other. We therefore studied 937 patients with AML in complete remission transplanted using a reduced intensity conditioning regimen from an unrelated donor mismatched at a single allele. In a multivariate analysis, patient age, adverse karyotype and patient cytomegalovirus (CMV) seropositivity were correlated with decreased leukaemia free survival (LFS) and overall survival (OS). There was no significant difference in LFS or OS between patients transplanted from donors mismatched at HLA-A, -B, -C or -DRB1 in comparison to a HLA-DQB1 mismatched transplant. In a multivariate analysis, patients transplanted with a HLA-A mismatched donor had higher rates of acute graft-versus-host disease (GVHD) and non-relapse mortality (NRM) than patients transplanted with a HLA-DQB1 mismatched donor. Patient CMV seropositivity was associated with an increase in NRM and acute GVHD and reduced LFS and OS, regardless of donor CMV status. For CMV seropositive patients lacking a fully matched donor, alternative GVHD and CMV prophylaxis strategies should be considered.
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Affiliation(s)
- J Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - M Labopin
- Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France.,Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France
| | - C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
| | | | - J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - B Afansayev
- State Medical Pavlov University, St. Petersburg, Russia
| | - P Jindra
- Department of Haematology/Oncology, Charles University Hospital, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - J Maertens
- Department of Hematology, Acute Leukemia and Transplantation Unit, UZ Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - D Blaise
- Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France
| | - K Boriskina
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | - A Ganser
- Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, Germany
| | - B Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Mohty
- Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France.,Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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8
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Cernan M, Szotkowski T, Hisemova M, Cetkovsky P, Sramkova L, Stary J, Racil Z, Mayer J, Sramek J, Jindra P, Visek B, Zak P, Novak J, Kozak T, Furst T, Papajik T. Blastic plasmacytoid dendritic cell neoplasm: First retrospective study in the Czech Republic. Neoplasma 2020; 67:650-659. [PMID: 32064883 DOI: 10.4149/neo_2020_190507n407] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy with aggressive behavior and poor prognosis. We present the first retrospective analysis mapping its incidence and therapeutic outcomes in patients diagnosed and treated from 2000 to 2017 in the Czech Republic. The cohort comprised 14 patients (10 males, 4 females) with a median age at diagnosis of 39 years (range, 5-68 years). Initially, skin involvement was noted in 10 (71%) patients and bone marrow infiltration was present in 9 (64%). The first complete remission was achieved in 6/14 (43%) patients after acute lymphoblastic leukemia/lymphoma induction therapy and in 3/14 (21%) patients after acute myeloid leukemia regimen. Nine patients underwent allogeneic hematopoietic cell transplantation, with two patients achieving the first complete remission only after allogeneic transplantation. Patients undergoing allogeneic hematopoietic cell transplantation had longer overall survival than those treated without transplantation (the median survival over the period 16.4 vs. 8.1 months). Relapse of the disease was a significant predictor of mortality (p=0.05). Over the study period, patients' survival ranged from 3.3 to 44.2 months, with a median overall survival of 13 months. Our results revealed an effectivity of allogeneic hematopoietic cell transplantation on complete remission achievement in refractory/relapsed disease. The study aimed to present the actual data from the Czech Republic and thus contribute to a global understanding of BPDCN.
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Affiliation(s)
- M Cernan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - T Szotkowski
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - M Hisemova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - P Cetkovsky
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - L Sramkova
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J Stary
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Z Racil
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - J Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - J Sramek
- Department of Hemato-Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - P Jindra
- Department of Hemato-Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - B Visek
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - P Zak
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - J Novak
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Kozak
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Furst
- Department of Mathematical Analysis and Application of Mathematics, Faculty of Science, Palacky University Olomouc, Olomouc, Czech Republic
| | - T Papajik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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9
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Hejretová L, Čedíková M, Dolejšová M, Vlas T, Jindra P, Lysák D, Holubová M. Comparison of the immunomodulatory effect of single MSC batches versus pooled MSC products. Cell Tissue Bank 2019; 21:119-129. [PMID: 31863261 DOI: 10.1007/s10561-019-09805-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/21/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022]
Abstract
Severe corticosteroid-refractory graft-versus-host-disease (GVHD) is a major non-relapse cause of mortality and morbidity after an allogeneic hematopoietic stem cell transplantation (allo-HSCT). One of the most promising treatment options is using advanced therapy medicinal products based on mesenchymal stem cells (MSCs) immunomodulation ability. The protocols of MSC application differ in many parameters including a source of MSC, a dose, a number of doses or way of preparation of the medicinal product. The process is limited by the need for laborious and expensive manufacturing processes fraught with batch-to-batch variability. In our study, we compared the immunomodulatory effects of different MSC batches versus pooled MSC, specifically the influence on lymphocyte proliferation, the metabolic activity, and the expression of activation markers on T cells. Our goal was to determine whether the effect depends on donor-to-donor heterogeneity and if pooling of MSCs could increase their immunomodulatory ability. All tested batches showed an immunomodulatory effect, with no significant differences between the groups. Our study suggests that immunosuppressive potential is comparable in single batches and pooled products, and the use of products got from individual donors is suitable to treat corticosteroid-refractory GVHD.
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Affiliation(s)
- L Hejretová
- Department of Haematology and Oncology, University Hospital, Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M Čedíková
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M Dolejšová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - T Vlas
- Institute of Immunology and Allergology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - P Jindra
- Department of Haematology and Oncology, University Hospital, Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - D Lysák
- Department of Haematology and Oncology, University Hospital, Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - M Holubová
- Department of Haematology and Oncology, University Hospital, Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
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10
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Steinerová K, Jindra P, Lysák D, Karas M. Development of Resistant GvHD in a Patient Treated with Nivolumab for Hodgkins Lymphoma Relapse after Allogeneic Unrelated Transplantation. Klin Onkol 2019; 32:47-51. [PMID: 30764632 DOI: 10.14735/amko2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation is one of the therapeutic options for patients with relapsed or refractory classic Hodgkins lymphoma (cHL). In the case of dis-ease relapse after transplant, other treatment options are still limited (for example donor lymphocyte infusion, and chemother-apy with brentuximab, bendamustine, or other agents) with uncertain outcomes in terms of patient tolerance and long-term dis-ease remission. One way to achieve remission is administration of the PD-1 inhibitor nivolumab, a PD-1 checkpoint inhibitor. Nivolumab is also indicated for the treatment of cHL relapses after autologous hematopoietic stem cell transplantation. Since September 2018, nivolumab has been approved by the State Institute for Drug Control in the Czech Republic for treatment of cHL autologous hematopoietic stem cell transplantation relapse; however, treatment with nivolumab is accompanied by an increased risk of develop-ing fatal, acute graft-versus-host dis-ease. CASE The article describes the development of resistant acute graft-versus-host disease in a patient who had received allogeneic-unrelated transplantation and nivolumab treatment for Hodgkins lymphoma relapse. CONCLUSION Our case study, as well as the literature review, demonstrates the excellent efficacy of PD-1 inhibitors, but also cautions against the administration of these agents in patients follow-ing allogeneic hematopoietic stem cell transplantation. Administration of nivolumab to these patients should be done on a strictly individual basis in the context of known risks, and consideration should be given to other treatment options. Key words Hodgkins lymphoma -  PD-1 inhibitor -  nivolumab -  GvHD -  transplantation.
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11
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Steinerova K, Jindra P, Lysak D, Karas M, Trneny M, Klener P, Sykorova A, Belada D, Janikova A, Pytlik R, Prochazka V, Benesova K, Blahovcova P. EXTRANODAL NATURAL KILLER (NK)/T-CELL LYMPHOMA, NASAL TYPE - CASE REPORT AND REVIEW OF CZECH LYMPHOMA STUDY GROUP (CLSG) DATABASE. Hematol Oncol 2019. [DOI: 10.1002/hon.157_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- K. Steinerova
- Department of Hematology and Oncology; Charles University Hospital; Pilsen Czech Republic
| | - P. Jindra
- Department of Hematology and Oncology; Charles University Hospital; Pilsen Czech Republic
| | - D. Lysak
- Department of Hematology and Oncology; Charles University Hospital; Pilsen Czech Republic
| | - M. Karas
- Department of Hematology and Oncology; Charles University Hospital; Pilsen Czech Republic
| | - M. Trneny
- 1st Department of Internal Medicine-Department of Hematology; First Faculty of Medicine and General Teaching Hospital; Prague Czech Republic
| | - P. Klener
- 1st Department of Internal Medicine-Department of Hematology; First Faculty of Medicine and General Teaching Hospital; Prague Czech Republic
| | - A. Sykorova
- 4th Department of Internal Medicine-Hematology; University Hospital and Faculty of Medicine; Hradec Kralove Czech Republic
| | - D. Belada
- 4th Department of Internal Medicine-Hematology; University Hospital and Faculty of Medicine; Hradec Kralove Czech Republic
| | - A. Janikova
- Department of Hematology and Oncology; University Hospital; Brno Czech Republic
| | - R. Pytlik
- Department of Clinical Hematology; University Hospital Kralovske Vinohrady and 3rd Faculty of Medicine; Praha Czech Republic
| | - V. Prochazka
- Department of Hemato-Oncology; Faculty of Medicine; Olomouc Czech Republic
| | - K. Benesova
- 1st Department of Internal Medicine-Department of Hematology; First Faculty of Medicine and General Teaching Hospital; Prague Czech Republic
| | - P. Blahovcova
- 1st Department of Internal Medicine-Department of Hematology; First Faculty of Medicine and General Teaching Hospital; Prague Czech Republic
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12
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Durinikova A, Folta A, Culen M, Kosarova Z, Tom N, Al Tukmachi D, Cetkovsky P, Jindra P, Szotkowski T, Zak P, Mayer J, Racil Z, Jeziskova I. PF247 CONSEQUENCES OF NRAS MUTATIONS IN PATIENTS WITH ACUTE MYELOID LEUKEMIA. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000559204.24910.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Houdová L, Fetter M, Jindra P, Georgiev D. Optimal Donor Selection During Verification Process: Which Factors Are Worth Knowing? Transplant Proc 2018; 50:3082-3087. [PMID: 30577170 DOI: 10.1016/j.transproceed.2018.08.043] [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: 12/20/2017] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The selection of optimal donor is crucial for successful hematopoietic stem cell transplantation (HSCT). Thereby, it is appropriate to know, in addition to basic human leukocyte antigen (HLA) gene matches, other immunogenic or nonimmunogenic parameters predicting the outcome of transplant. OBJECTIVE A unified approach is necessary to provide a comprehensive view of the patient-donor compatibility characterization outside of standard HLA genes. The approach should be applicable as a tool for optimizing procedures for extended donor typing and/or verification typing of a donor. METHODS The study used the summary, unification, and innovation of existing practical knowledge and experience of the Czech National Marrow Donor Registry of various factors beyond HLA matching with impact on transplant outcome. RESULTS An information technology system-implemented procedure (a verification algorithm) is presented as the decision support approach for prematurely discarding less suitable donors from the transplantation process. It is intended primarily for the transplant specialist to help establish optimal procedures for verifying and determining donor critical factors. CONCLUSIONS A process defining HLAs, killer cell immunoglobulin-like receptors, and cytokine typing strategies was proposed to provide support to a transplant specialist in refining the choice of a suitable donor.
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Affiliation(s)
- L Houdová
- New Technologies for the Information Society, University of West Bohemia, Plzen, Czech Republic.
| | - M Fetter
- New Technologies for the Information Society, University of West Bohemia, Plzen, Czech Republic
| | - P Jindra
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Plzen, Czech Republic; Charles University Hospital Pilsen, Plzen, Czech Republic
| | - D Georgiev
- New Technologies for the Information Society, University of West Bohemia, Plzen, Czech Republic
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Jungova A, Vokurka S, Schutzova M, Steinerova K, Mohammadova L, Karas M, Lysak D, Jindra P. Comparison of autologous hematopoietic cell transplantation performed in tandem and in disease relapse in multiple myeloma patients. Neoplasma 2018; 65:952-957. [PMID: 29940749 DOI: 10.4149/neo_2018_170511n346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/14/2017] [Indexed: 11/08/2022]
Abstract
Multiple myeloma is a malignant hemato-oncological malignancy that affects up to 600 people in the Czech Republic every year. Treatment options are under constant improvement and the autologous hematopoietic cell transplantation (Tx) remains a part of treatment protocols. Despite modern drug administration, the autologous Tx keeps its irreplaceable position and when ensuring two autologous Tx, the studies confirm a survival time more than twice as long as in non-transplant patients. However, there are no standardized procedures specifying the period in between the transplantations in more detail. Within our group, we compared the total of 66 patients who were administered a double transplant. One group underwent both planned tandem autologous Tx within a median of six months and mostly achieved just partial remission (PR) and less after the first transplant and out of disease progression. The other group only underwent the second Tx within a median of up to 14 months during a progression period or disease relapse. Both groups were comparable as far as basic parameters are concerned (age, type of induction therapy and cytogenetic risk). A significantly better treatment free survival (TFX) and overall survival (OS) were observed in the group where tandem Tx was administered. TFS was 18 months and median OS was not reached for the group of patients who received tandem Tx, while TFS was 10 months (p=0.04) and median OS was 57 months (p=0.005) for those who received delayed second Tx. In the group of patients who received second Tx during relapse, we observed that TFS and OS were shorter in those with a higher paraprotein level, thus suggesting the potential role of paraprotein level as a prognostic marker. The TFS in the subgroup with a high initial level was 4 months vs. 11 months (p=0.0016) and OS 44 months vs. 65 months (p=0.03).
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Affiliation(s)
- A Jungova
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - S Vokurka
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - M Schutzova
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - K Steinerova
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - L Mohammadova
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - M Karas
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - D Lysak
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
| | - P Jindra
- Department of Hematology and Oncology, University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
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15
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Maluskova A, Mrazek F, Pauliskova M, Kovarova P, Koristka M, Jindra P, Cermakova Z. Association of HLA-DRB1 and HLA-DQB1 with red-blood-cell alloimmunization in the Czech population. Vox Sang 2017; 112:156-162. [PMID: 28052334 DOI: 10.1111/vox.12478] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Alloimmune antibodies against red-blood-cell (RBC) antigens induced in susceptible individuals (responders) by transfusion, pregnancy or transplantation may have serious clinical consequences. The aim of this study was to investigate association of alloimmunization against selected RBC antigens with HLA-Class II. MATERIALS AND METHODS A total of 230 responders (106 monoresponders and 124 multiresponders) were enrolled into the study. HLA-DRB1 and HLA-DQB1 variants were determined by PCR-SSO and their frequencies compared between the patients (patient subgroups) and 375 ethnically and regionally matched controls. RESULTS Development of multiple RBC antibodies was associated with HLA-DRB1*15 and HLA-DQB1*06 allelic groups in the patients, with the relationship being particularly apparent in those with anti-C+D antibodies. Furthermore, DRB1*13 and DQB1*06 were more frequent in multiresponders with anti-E+c antibodies and DRB1*03 and DQB1*02 in those with anti-E+Cw. CONCLUSION For the first time, we confirmed the association of HLA-DRB1*15 with RBC antibody multiresponder status and found HLA-Class II associations for three frequent RBC antibody combinations. Our data support the concept that HLA restriction plays an important role in the response to RBC alloantigens.
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Affiliation(s)
- A Maluskova
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - F Mrazek
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - M Pauliskova
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - P Kovarova
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - M Koristka
- Blood Centre, University Hospital, Ostrava, Czech Republic
| | - P Jindra
- Department of Haematology and Oncology, University Hospital, Plzen, Czech Republic
| | - Z Cermakova
- Blood Centre, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
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16
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Jindra P, Raida L, Lysak D, Karas M, Papajik T, Jungova A, Mohammadová L, Houdova L. Prognostic factors to predict outcome of reduced intensity allogeneic haematopoietic cell transplantation for chronic lymphocytic leukemia. Neoplasma 2016; 63:595-600. [PMID: 27268923 DOI: 10.4149/neo_2016_413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite advances in immunochemotherapy CLL remains an incurable disease.. Allogeneic haematopoietic cell transplantation (HCT) has proven curative potential with ability to overcome adverse prognostic factors, however due to its toxicity it is generally perceived as the last option. We performed retrospective study to explore the outcomes and possible determinants of survival in the unselected consecutive cohort of 68 CLL patients (median age 59 years) receiving reduced intensity HCT as a part of salvage therapy in 2 Czech centers. The median interval from diagnosis to HCT was 69 months with median 3 of prior regimens, all patients were refractory to purine analogues. 49% of patients were transplanted with advanced (i.e. refractory or progressive disease or CR/PR>3), 38% had high risk cytogenetics. With median follow-up of 35 months the 3-year Kaplan-Meier survival probability for OS and PFS were 39% and 26%, respectively. Altogether 18 patients (26%) have relapsed or progressed. During the follow-up 41 patients died, 32 (78%) of transplant related factors (NRM), the others of relapse or disease progression.Univariate analysis failed to identify any clinical and pre- or post-transplant variables having clear prognostic significance for OS or PFS. The marginal OS advantage favoring HCT performed recently was detected (3-year OS: 31% for HCT until 2006 and 47% thereafter, p=0.0923). In multivariable hazards model only the female donors were associated with shorter OS (HR 2.278, p=0.016) whereas transplanted T-cell> 2.75x108/kg predicted inferior PFS(HR 1.957, p=0.035). No prognostic impact of donor type, age of donor and recipient, HLA mismatch, disease status pre-HCT, number of previous therapy lines, interval from dg. to HCT and number of transplanted hematopoietic cells was found. Our findings support the conclusion that alloHCT is able to overcome well known negative cytogenetic prognostic factors and that preferring male to female donors could be beneficial.
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Vokurka S, Fínek J, Svoboda T, Vojtíšek R, Votavová M, Havránek K, Salvét J, Šindelářová B, Mařan J, Sukovská E, Vasilev K, Schutzova M, Vozobulová V, Jindra P, Sýkora J. [Radiotherapy Indications in Patients with Hematological Malignancies During the Five Years Course of Modernized Center of Oncology and Radiotherapy Clinic in Pilsen]. Klin Onkol 2016; 29:313-314. [PMID: 27534789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Submitted: 27. 2. 2016.
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18
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Lysák D, Koutová L, Holubová M, Vlas T, Miklíková M, Jindra P. The Quality Control of Mesenchymal Stromal Cells by in Vitro Testing of Their Immunomodulatory Effect on Allogeneic Lymphocytes. Folia Biol (Praha) 2016; 62:120-130. [PMID: 27516191] [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: 06/06/2023]
Abstract
Mesenchymal stromal cells (MSC) represent a promising treatment of graft-versus-host disease (GVHD) in patients after allogeneic haematopoietic stem cell transplantation. We performed co-cultivation experiments with non-specifically stimulated lymphocytes to characterize the immunosuppressive activity of MSC. MSC influenced expression of some activation antigens. CD25 expression was lower with MSC and reached 55.2 % vs. 84.9 % (CD4+, P = 0.0006) and 38.8 % vs. 86.6 % (CD8+, P = 0.0003) on day +4. Conversely, CD69 antigen expression remained higher with MSC (73.3 % vs. 56.8 %, P = 0.0009; 59.5 % vs. 49.7 %, ns) and its down-regulation along with the culture time was less pronounced. MSC reduced proliferation of the stimulated lymphocytes. The cell percentages detected in daughter generations were decreased (32.82 % vs. 10.68 % in generation 4, P = 0.0004 and 29.85 % vs. 10.09 % in generation 5, P = 0.0008), resulting in a lower proliferation index with MSC (1.84 vs. 3.65, P < 0.0001). The addition of MSC affected expression of some cytokines. Production of pro-inflammatory cytokines was decreased: IL-6 (19.5 vs. 16.3 MFI; P < 0.0001 in CD3+/CD4+ and 14.5 vs. 13.2 MFI; P = 0.0128 in CD3+/CD8+), IFN-γ (13.5 vs. 12.0 MFI; P = 0.0096 in CD3+/CD4+). Expression of anti-inflammatory IL-10 was only slightly increased after the addition of MSC (ns). The analysis confirmed the immunomodulatory activity of MSC. The functional tests have proved to be an important part of the quality control of the advanced therapy cellular product intended for GVHD treatment. Future research should focus on the interaction between MSC and the patient immune environment more closely.
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Affiliation(s)
- D Lysák
- Department of Haematology and Oncology, Charles University in Prague, Faculty of Medicine in Pilsen and University Hospital in Pilsen, Pilsen, Czech Republic
| | - L Koutová
- Department of Haematology and Oncology, Charles University in Prague, Faculty of Medicine in Pilsen and University Hospital in Pilsen, Pilsen, Czech Republic
| | - M Holubová
- Department of Haematology and Oncology, Charles University in Prague, Faculty of Medicine in Pilsen and University Hospital in Pilsen, Pilsen, Czech Republic
| | - T Vlas
- Institute of Immunology and Allergology, Charles University in Prague, Faculty of Medicine in Pilsen and University Hospital in Pilsen, Pilsen, Czech Republic
| | - M Miklíková
- Biomedical Centre, Charles University in Prague, Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - P Jindra
- Czech National Marrow Donor Registry (CS-2), Pilsen, Czech Republic
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Kerman R, Jindra P, Jeewa A, Burki S, Fraser C, Adachi I. Immune Profiling Pre/Post Berlin VAD Implant and Pre/Post Transplantation of Pediatric Heart Failure Patients. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Kerman R, Melicoff E, Maddox J, Ebenbichler M, Heinle J, McKenzie D, Jindra P, Mallory G. Post Transplant De Novo Donor Specific Antibodies Correlate With the Development of Bronchiolitis Obliterans Syndrome Following Pediatric Lung Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.276] [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: 10/23/2022] Open
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21
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Baron F, Labopin M, Blaise D, Lopez-Corral L, Vigouroux S, Craddock C, Attal M, Jindra P, Goker H, Socié G, Chevallier P, Browne P, Sandstedt A, Duarte RF, Nagler A, Mohty M. Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2014; 49:389-96. [PMID: 24419525 DOI: 10.1038/bmt.2013.204] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 12/16/2022]
Abstract
The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given 6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
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Affiliation(s)
- F Baron
- Department of Hematology, University of Liège, Liège, Belgium
| | - M Labopin
- 1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France
| | - D Blaise
- Hematology, CHU de Marseille, Marseille, France
| | | | - S Vigouroux
- Hematology, CHU de Bordeaux, Bordeaux, France
| | - C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital and School of Cancer Studies, University of Birmingham, Birmingham, UK
| | - M Attal
- Hematology, CHU de Toulouse, Toulouse, France
| | - P Jindra
- Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic
| | - H Goker
- BMT Unit, Department of Hematology, Hacettepe University, Ankara, Turkey
| | - G Socié
- Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France
| | | | - P Browne
- Hope Directorate, St James's Hospital, Dublin, Ireland, UK
| | - A Sandstedt
- Department of Hematology, University Hospital, Linköping, Sweden
| | - R F Duarte
- ICO-Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain
| | - A Nagler
- Hematology Division, Sheba medical Center, Tel-Aviv University, Tel-Hashomer, Israel
| | - M Mohty
- 1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France
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22
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Vokurka S, Tupý R, Boudová L, Mraček J, Jindra P, Ferda J, Hrabětová M. [The clinical, histopathological and imaging methods characteristics of Non-Hodgkin lymphomas in patients with brain involvement]. Klin Onkol 2013; 26:348-53. [PMID: 24107158 DOI: 10.14735/amko2013348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Non- Hodgkin-lymphoma (NHL) brain infiltration carries a poor prognosis. Because of relatively rare incidence, we decided to share our experience. PATIENTS AND METHODS Retrospective analysis of patients with NHL brain infiltration dia-gnosed in 2001- 2011 at our university hospital. RESULTS Twenty -seven patients with median age of 61 (range 42- 82) years were analyzed. The primary diffuse large cell B cell lymphoma of CNS was defined in 22/ 27 (81%) patients, in the others systemic NHL was present. Median positivity of the proliferative marker Ki 67 was 80%, the number of NHL lesions 1 (1- 8), diameter 28 × 30 × 29 (11 × 16 × 20 to 85 × 76 × 65) mm. The fundamental finding in brain lymphoma MRI imaging was lesion with predominantly homogenous contrast enhancement, diffusion restriction and collateral edema. Thirteen out of 27 (48%) patients underwent lumbar puncture, and lymphoma presence in fluid was detected in only two of them. The most frequent symptoms were limb paresis or hemiparesis (55%), bradypsichysm (22%), expressive aphasia (22%), cephalea (18%). Corticosteroid therapy, as a primary treatment option, was indicated in 15% of patients with a median overall survival of one month, CNS radiotherapy in 37% with a median survival of three months, and chemotherapy in 48% patients with a median overall survival 10 (2- 45) months. CONCLUSION The brain lymphomas are rare and prognostically very unfavorable affection. When specifying brain focal lesions on MRI, it is necessary to consider this etiology and to elect imaging protocols with contrast agents and diffusion weighted sequence. Biopsy should be performed prior to start of corticosteroid therapy. Intensive chemotherapy or radiotherapy indication must be individually considered, and proposed treatment should be initiated immediately with a potential for somewhat prolonged survival.
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Lysák D, Jindra P. [Ultra high risk chronic lymphocytic leukemia - characteristics and treatment options]. Vnitr Lek 2013; 59:887-894. [PMID: 24164366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common form adult leukemia in western world. The disease is typically cha-racterized by heterogeneous clinical behavior ranging from indolent course to rapidly progressive disease. Using clinical and bio-logical factors we can stratify patients with CLL and prospectively identify those who can be expected unfavorable course. There is a special group known as ultra highrisk chronic lymphocytic leukemia with an extremely poor prognosis. These are about 10- 15% of all patients with CLL. They do not respond to standard treatment and their survival is short with a median of 2- 3 years. For highrisk patients are considered: patients with a proven TP53 defect, refractory to purine analogues or with early relapse after chemoimmunotherapy based on fludarabine ( 24 months). While the standard 1st line treatment protocol in younger patients is chemoimmunotherapy FCR, in case of ultra highrisk CLL other methods like allogeneic hematopoietic stem cell transplantation or clinical trials testing the new drugs should be considered. In particular, allogeneic hematopoietic stem cell transplantation is a very promising treatment modality that offers longterm disease control and cure regardless of the unfavorable CLL subtype. Transplantation treatment should be therefore considered in all younger patients with ultra highrisk CLL, who should be without delay referred to a center for intensive hematological treatment.
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Jindra P, Muzik J, Indrak K, Zak P, Sabty FA, Kozak T, Cetkovsky P, Karas VKM, Raida L, Szotkowski T. The outcome of allogeneic HSCT in older AML patients is determined by disease biology and not by the donor type: an analysis of 96 allografted AML patients ≥ 50 years from the Czech acute leukaemia clinical register (alert). Neoplasma 2013; 60:576-83. [PMID: 23790178 DOI: 10.4149/neo_2013_075] [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: 11/08/2022]
Abstract
Older patients with AML have poor prognosis after chemotherapy and allo-SCT was historically limited to the young patients. In the multicentre retrospective study we analyzed 96 consecutive AML patients ≥ 50 years allografted with related (n=59) or unrelated (n=37) donor. The 2- year OS and DFS rates were 45 % and 42 % for the whole group. The corresponding figures for related patients were 48% and 42% whereas for unrelated 42% and 42%, respectively (OS p=0,721, DFS p= 0,896). The cumulative incidences of relapse (28% of all patients) and NRM mortality (26%) were low with no significant differences among related and unrelated cohorts. Multivariate analysis revealed the only major independent variables associated with an inferior OS were unfavourable cytogenetics (RR 3.36; CI 1.66-6.83; p=0.001) and advanced disease status (RR 2.30; CI 1.21-4.37; p=0.011). Unfavourable cytogenetics (RR 3.00; CI 1.50-5.99; p=0.002) and advanced disease at SCT (RR 2.27; CI 1.22-4.22; p=0.009) were also the only independent variables associated with inferior DFS. In conclusion, our analysis indicates that outcomes of allografted AML patients aged ≥ 50 years are determined by cytogenetic risk category and disease status at transplantation and not by the type of donor.
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Affiliation(s)
- P Jindra
- University Hospital, Pilsen, Czech Republic.
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25
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Pachner M, Vokurka S, Koza V, Svoboda T, Hrabětová M, Jindra P, Lysák D, Vozobulová V, Schutzova M, Karas M. [Spontaneous remission of acute myeloid leukemia - a single center case reports]. Klin Onkol 2013; 26:140-2. [PMID: 23718674 DOI: 10.14735/amko2013140] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute myeloid leukemia is a malignant disease characterized by clonal expansion of immature hematopoietic cells - myeloblasts - in the bone marrow. Intensive chemotherapy treatment in elderly patients (over 60) has disappointing results. In these patients, conservative treatment, including compensation of deficiency of red blood cells and platelets by transfusions and treatment of infectious complications is recommended. Also, relatively new treatment with hypometyl agents (azacytidine, decitabine) could be used. DESIGN The idea of this article is to present a spontaneous remission phenomenon, which has not been published in Czech literature yet. In this article, we present 2 case studies of our patients who were diagnosed with acute myeloid leukemia, were not treated with chemotherapy and spontaneously reached remission of acute myeloid leukemia. CONCLUSION The mechanisms of the spontaneous remission remain unclear, but we assume positive effect of a severe systemic infection or previous applications of blood transfusions. Antibodies in blood transfusions and a strong immune response to sepsis may have contributed to spontaneous remission.
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Affiliation(s)
- M Pachner
- Hematologicko-onkologicke oddeleni, FN Plzen.
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26
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Jindra P, Venigová P, Houdová L, Steinerová K. A novel HLA-A null allele (A*02:395N) with stop codon in exon 2 generated by single nucleotide exchange. ACTA ACUST UNITED AC 2013; 81:451-2. [PMID: 23646952 DOI: 10.1111/tan.12086] [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] [Received: 11/29/2012] [Revised: 01/14/2013] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
The new HLA-A*02:395N allele differs from A*02:01:01 at one nucleotide position in the exon 2.
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Affiliation(s)
- P Jindra
- HLA laboratory, Czech National Marrow Donors Registry, Pilsen, Czech Republic.
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27
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Lysák D, Merglová L, Navrátilová J, Svoboda T, Jindra P, Koza V. CD34⁺ cell content in unrelated allogeneic peripheral blood stem cell grafts transported internationally. Does the inter-laboratory variability affect comparability of graft quality data? Transfus Apher Sci 2012; 47:179-84. [PMID: 22842107 DOI: 10.1016/j.transci.2012.06.022] [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: 08/09/2011] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Increasing numbers of unrelated hematopoietic stem cell grafts are transported internationally and evaluated concurrently in different laboratories. The graft quality assessment using the CD34(+) enumeration could be influenced by inter-laboratory variability. METHODS We retrospectively analyzed the content of CD34(+) cells in 154 consecutive collections being performed in different transplant centers during two periods (2003-2004, 2007-2010). All samples were tested twice in our own and partner laboratories. CD34(+) percentage and absolute number were compared. RESULTS The percentage and the total CD34(+) content correlated well in both observed periods (CD34(+)%: r=0.899 and r=0.922; CD34(+)×10(8)/kg: r=0.966 and r=0.880; p<0.0001). Median CD34(+) percentages obtained in our centre in comparison with other laboratories were 0.54% vs. 0.46% in 2003-2004 and 0.69% vs. 0.70% in 2007-2010 period. The degree of laboratory compliance was affected by the laboratory identity. CD34(+) percentage reported by one laboratory and CD34(+)×10(8)/kg reported by three from twelve laboratories lacked statistically significant correlation with our own data. CONCLUSIONS The study documented that results of CD34(+) cell dose assessment of the same grafts reported by different transplant centers are comparable. The graft quality data and the CD34(+) enumeration possess a limited level of inter-laboratory variability.
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Affiliation(s)
- D Lysák
- Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic.
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Vokurka S, Koza V, Vozobulová V, Jindra P, Steinerová K, Schützová M, Boudová L. [Angioimmunoblastic T-cell lymphoma as a very poor-prognosis malignancy--a single centre experience]. Klin Onkol 2012; 25:206-211. [PMID: 22724570] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Angioimmunoblastic T-lymphoma (AITL) is a poor prognosis malignancy. Because of relatively rare incidence and lack of publications in Czech, we decided to share our experience. PATIENTS AND METHODS Retrospective analysis of newly diagnosed AITL patients treated at our institution between 1/2000-12/2010. RESULTS Twelve patients with median age of 64 (43-82) years were analysed. Two patients over 80 years were treated with corticosteroids. Ten patients were treated with 6 cycles of CHOP-21 chemotherapy resulting in: 2/10 (20%) stable disease, 5/10 (50%) partial remission and 3/10 (30%) complete remission. The median EFS and OS of chemotherapy-treated patients were 8 and 10 months, resp. The EFS and OS were both significantly longer in patients who achieved complete remission within the first line of CHOP or autologous stem cells transplantation therapy: 43 vs 6 (p = 0.0052) and 46 vs 6 months (p = 0.0023), respectively. It was not possible to perform autologous transplantation in 4/7 (57%) patients in need for further reduction of the disease because of poor performance status or early progression of lymphoma and death during salvage chemotherapy. CONCLUSION AITL is a poor prognosis malignancy with a very high risk of early relapse after CHOP induction chemotherapy. In fit patients, autologous transplantation should be performed immediately after induction chemotherapy; information about availability of stem cells donor, both in the family or any available register, should be found during the induction treatment.
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Affiliation(s)
- S Vokurka
- Hematologicko-onkologické oddělení, FN Plzeň.
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Jindra P, Žejšková L, Peková S, Navrátilová J, Schutzová M, Vokurka S, Koza V. [Patient with B-CLL with a history of unrelated hematopoietic cells donation--retrospective analysis of CLL development and implication for the recipient]. Klin Onkol 2012; 25:212-215. [PMID: 22724571] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Donor cell leukemia (DCL) is a relatively rare but well documented complication of hematopoietic stem cell transplantation. So far, publications described only DCL arising de novo in the recipient. OBSERVATION In this study, we describe a case of chronic lymphocytic leukemia (B-CLL) developing in a volunteer unrelated donor from the Czech National Marrow Donors Registry (CNMDR) several years after donation. From archival DNA sample, we have retrospectively found that subclinical CLL clone was already present at the time of donation but early death of recipient prevented eventual development of DCL. This case documents well the long period between detection of B-CLL clone and full development of clinical-laboratory symptomatology. The medical and ethical questions posed by an isolated case of detection of hematological malignancy present either only in the donor or only in the recipient are discussed. CONCLUSION The case demonstrates the increasing risk of development of various forms of DCL and thus highlights the need for long-term monitoring of stem cell donor, not only in terms of health of donor but also in terms of potential risks for the recipient.
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Affiliation(s)
- P Jindra
- Hematologicko-onkologické oddělení, FN Plzeň.
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Vokurka S, Koza V, Jungová A, Navrátilová J, Svoboda T, Jindra P, Steinerová K, Hrabětová M, Výrutová R, Novák L. [The incidence of malignancies and surveillance of hematopoietic stem cells donors--the results of the Haemato-Oncology Department University Hospital in Plzen (Pilsen) and Czech National Marrow Donors Registry observation]. Klin Onkol 2012; 25:42-46. [PMID: 22348219] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUNDS Granulopoesis colony-stimulating factor filgrastim is used to mobilize peripheral stem cells but there are concerns regarding an elevated risk of haematological malignancies. We analyzed the incidence of malignancies and the system of haematopoietic stem cells donor surveillance. PATIENTS AND METHODS prospective observation of sibling donors of the Haemato-Oncology Department University Hospital in Plzen (Pilsen) and of unrelated donors of the Czech National Marrow Donors Registry (CNMDR) in 2001-2010. RESULTS No malignancy was observed in a group of 344 unrelated CNMDR donors, providing 753 person-years; one case of chronic lymphocytic leukaemia manifested 6 years after bone marrow donation, with leukaemia clone retrospectively detected by DNA analysis in blood samples taken prior to the marrow donation. Acute myeloid leukaemia, non-Hodgkin lymphoma, renal and colorectal carcinoma were observed in a group of 84 peripheral stem cells sibling donors, providing 337 person-years observation. The respective incidence of the two haematologic malignancies was 593 cases and the expected incidence rate was 143 per 100,000. The sibling (related) donors age was significantly higher: 48 (16-75) vs. 31 (20-42) years, (p<0.0001). Significantly more lost-to-follow-up donors were among the related donors (32% vs. 3%, p<0.0001), even though active surveillance system was implemented. CONCLUSION The development of malignancies in hematopoietic stem cells donors can naturally be expected. Related (sibling) donors are at higher risk because of their generally older age, and higher susceptibility to haematological malignancies developed within the family. The contribution of filgrastim exposure needs to be further investigated. The follow-up cooperation with related (sibling) donors is limited.
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Affiliation(s)
- S Vokurka
- Hematologicko-onkologické oddelení, FN Plzen.
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Mociková H, Pytlík R, Raida L, Sýkorová A, Marková J, Král Z, Jindra P, Steinerová K, Válková V, Trnková M, Vacková B, Trnený M, Indrák K, Belada D, Mayer J, Koza V, Kozák T. [Treatment of patients with relapsed/refractory Hodgkin lymphoma]. Klin Onkol 2011; 24:121-125. [PMID: 21644367] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUNDS This retrospective study evaluated treatment outcomes in patients undergoing autologous stem cell transplantation (ASCT) for relapsed/refractory Hodgkin lymphoma (HL). PATIENTS AND METHODS Overall, 194 HL patients treated with ASCT between 2000 and 2009 were analyzed. Survival was calculated using Kaplan-Meier method and differences in survival between subgroups with log-rank test. RESULTS Best responses observed after ASCT: 124 complete and 35 partial remissions, 2 patients with stable disease and 33 relapses/progressions. During a median follow-up of 44 months, seventy patients after ASCT progressed/relapsed. Thirty-seven patients received salvage chemotherapy only with or without radiotherapy, 25 underwent allogeneic stem cell transplantation (SCT), 4 the second ASCT and 4 refused treatment. 5-year overall survival after ASCT was 71% and progression-free survival 54%. Median survival of the 70 patients relapsing after ASCT was 16.9 months. Median survival in patients after allogeneic SCT was 31.8 months and 12.4 months in patients treated with other modalities (p = 0.21). Overall mortality was 26.3% (51/194 patients): 13.4% progressions/relapses of HL and 12.9% non-relapse mortality. CONCLUSION Efficacy of ASCT was confirmed in 54% progression-free survivors. Median survival after ASCT failure is relatively short. There is a slightly longer overall survival after allogeneic SCT, although not statistically significant when compared to other approaches.
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Affiliation(s)
- H Mociková
- Oddelení klinické hematologie, FN Královské Vinohrady Praha.
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Jindra P, Venigová P, Lysák D, Steinerova K, Koza V. Distribution of KIR genes in the population of unrelated individuals homozygous for ancestral haplotype AH8.1 (HLA-A1B8DR3). ACTA ACUST UNITED AC 2010; 76:240-4. [PMID: 20492596 DOI: 10.1111/j.1399-0039.2010.01504.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the independent segregation of genes encoding killer immunoglobulin-like receptor (KIR) and human leukocyte antigen (HLA), there is some evidence of some kind of co-evolution. Therefore, one could expect reduced KIR diversity within the HLA restricted population. A total of 41 unrelated individuals homozygous for ancestral HLA haplotype AH8.1 (HLA-A*0101-Cw*0701-B*0801-DRB1*0301-DQB1*0201) were genotyped for KIRs. Over all, 14 different genotypes were identified. The KIR genes and genotypes repertoire generally mirror the published frequencies in Caucasians. Except for KIR2DS4, all activating genes presented frequencies below 50%. KIR2DS5 was the least frequent among activating genes (17%), whereas KIR2DL5 (37%) among inhibitory ones. The most frequent (39%) was AA genotype. Twenty-two individuals (54%) had a copy of KIR haplotypes A and B (AB genotype), whereas three (7%) were homozygous for B (BB genotype). Nine of fourteen reported genotypes occurred only in one individual. Five genotypes were reported in less than twenty individuals worldwide and one genotype was reported so far only once. Conversely, the three most frequent genotypes account for 68% of all detected genotypes. The results show the unrestricted KIR diversity in this HLA uniform group and support the fact that the driving force for KIR evolution is not exclusively a major histocompatibility complex.
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Affiliation(s)
- P Jindra
- Department of Haematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic
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Ambruzova Z, Mrazek F, Raida L, Jindra P, Vidan-Jeras B, Faber E, Pretnar J, Indrak K, Petrek M. Association of IL6 and CCL2 gene polymorphisms with the outcome of allogeneic haematopoietic stem cell transplantation. Bone Marrow Transplant 2009; 44:227-35. [PMID: 19234509 DOI: 10.1038/bmt.2009.16] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Various polymorphisms of non-HLA genes have recently been investigated as candidate risk factors in allogeneic haematopoietic SCT (aHSCT). Our study aimed at exploring possible associations of IL6 and CCL2 single nucleotide polymorphisms (SNP) with aHSCT outcome. A total of 166 HLA-identical aHSCT pairs recruited in were genotyped for IL6 -174 G/C, IL6 -597 G/A, CCL2 -2518 A/G and CCL2 -2076 A/T SNPs by PCR with sequence-specific primers (PCR-SSP). The association between IL6 -174 GG genotype and increased risk of acute GVHD was found in whole study group (P=0.03) and in the subgroup of related aHSCT (P=0.01), association between IL6 -597 GG genotype and the occurrence of acute GVHD was detected only in the related aHSCT pairs (P=0.02). Furthermore, reduction in OS was revealed among recipients possessing IL6 -174(*)G allele in the group of related aHSCT pairs (P=0.04). Presence of CCL2 -2076 TT genotype was associated with decrease of OS (P=0.04) and increase of TRM (P=0.02) in patients transplanted by related donor. These results, in the context of previous findings, suggest that IL6 gene polymorphisms may be associated with aHSCT outcome, particularly in patients transplanted from a related donor.
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Affiliation(s)
- Z Ambruzova
- Department of Immunology, Palacky University and University Hospital, Olomouc, Czech Republic
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Reischig T, Nemcova J, Vanecek T, Jindra P, Hes O, Bouda M, Treska V. PREEMPTIVE VALGANCICLOVIR THERAPY IS NOT ASSOCIATED WITH INCREASE IN CYTOMEGALOVIRUS (CMV) DNA IN RENAL ALLOGRAFT BIOPSY SPECIMENS COMPARED WITH VALACYCLOVIR PROPHYLAXIS. Transplantation 2008. [DOI: 10.1097/01.tp.0000332482.73775.a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reischig T, Jindra P, Hes O, Svecová M, Klaboch J, Treska V. Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation. Am J Transplant 2008; 8:69-77. [PMID: 17973956 DOI: 10.1111/j.1600-6143.2007.02031.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Both preemptive therapy and universal prophylaxis are used to prevent cytomegalovirus (CMV) disease after transplantation. Randomized trials comparing both strategies are sparse. Renal transplant recipients at risk for CMV (D+/R-, D+/R+, D-/R+) were randomized to 3-month prophylaxis with valacyclovir (2 g q.i.d., n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia (>/=2000 copies/mL by quantitative PCR in whole blood) assessed weekly for 16 weeks and at 5, 6, 9 and 12 months. The 12-month incidence of CMV DNAemia was higher in the preemptive group (92% vs. 59%, p < 0.001) while the incidence of CMV disease was not different (6% vs. 9%, p = 0.567). The onset of CMV DNAemia was delayed in the valacyclovir group (37 +/- 22 vs. 187 +/- 110 days, p < 0.001). Significantly higher rate of biopsy-proven acute rejection during 12 months was observed in the preemptive group (36% vs. 15%, p = 0.034). The average CMV-associated costs per patient were $5525 and $2629 in preemptive therapy and valacyclovir, respectively (p < 0.001). However, assuming the cost of $60 per PCR test, there was no difference in overall costs. In conclusion, preemptive valganciclovir therapy and valacyclovir prophylaxis are equally effective in the prevention of CMV disease after renal transplantation.
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Affiliation(s)
- T Reischig
- Department of Internal Medicine I, Charles Medical School and Teaching Hospital, Pilsen, Czech Republic.
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Karvunidis T, Jindra P, Fischer G, Venigova P, Dorner A, Koza V. Identification of a novel HLA-DRB1*14 allele, HLA-DRB1*1458, by sequence-based typing. ACTA ACUST UNITED AC 2007; 70:348-9. [PMID: 17767565 DOI: 10.1111/j.1399-0039.2007.00897.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 12/01/2022]
Abstract
Identification of a novel HLA-DRB1*1458 allele within a Caucasian individual using sequence-based typing.
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Affiliation(s)
- T Karvunidis
- Department of Hematology and Oncology, University Hospital Pilsen, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
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Little AM, Jindra P, Raffoux C. Strategies for new donor typing based on donor HLA type or donor characteristics. Tissue Antigens 2007; 69 Suppl 1:8-9. [PMID: 17445153 DOI: 10.1111/j.1399-0039.2006.758_4.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Registries of volunteer unrelated haematopoietic stem cell donors must make decisions on the procedures used to human leukocyte antigen type new donors based on various factors including available finances and donor diversity. This manuscript describes a comparison of new donor typing strategies for three European registries which was presented for discussion at the 14th International Histocompatibility Workshop.
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Lysak D, Koza V, Steinerova K, Jindra P, Vozobulova V, Schutzova M. Mobilization of peripheral blood stem cells in CLL patients after front-line fludarabine treatment. Ann Hematol 2005; 84:456-61. [PMID: 15770494 DOI: 10.1007/s00277-005-1008-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 10/25/2004] [Accepted: 01/17/2005] [Indexed: 10/25/2022]
Abstract
Autologous peripheral blood stem cell transplantation is performed in an increasing number of chronic lymphocytic leukaemia (CLL) patients who are in the first remission following fludarabine treatment. There are contradictory data about the adverse impact of fludarabine on stem cell harvest. We analysed retrospectively mobilization results in 56 poor-risk CLL patients (median age: 56 years) who underwent first-line treatment with fludarabine and cyclophosphamide. The mobilization, consisting of cyclophosphamide 3 g/m(2) and granulocyte colony-stimulating factor (G-CSF) 10 microg/kg per day, was performed with a median of 77 days following the last fludarabine course. The target yield was >or=2.0x10(6) CD34+ cells/kg. The procedure was successful in 23 (41%) patients. A median of 3.3x10(6) CD34+ cells/kg was collected per patient. The successful mobilization was associated with a longer interval from the last chemotherapy (>2 months). The mobilization result was not influenced by the number of fludarabine cycles. No correlation was found in other parameters such as disease stage at diagnosis, disease status at stimulation or age. The poorly mobilized patients had significantly lower prestimulation blood counts (platelets, WBC and haemoglobin). Our data show that fludarabine does not generally prevent the stem cell mobilization; nevertheless, mechanisms related to the impact of fludarabine on stem cell harvest must be further investigated.
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Affiliation(s)
- D Lysak
- Department of Haematology and Oncology, Charles University Hospital, Alej Svobody 80, 304 60, Plzen, Czech Republic.
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Jindra P, Koza V, Lysák D, Vozobulová V, Steinerová K. Inefficiency of high-dose G-CSF alone as second mobilization regimen in fludarabin-cyclophosphamide-treated CLL patients who failed to mobilize after chemotherapy and G-CSF. Bone Marrow Transplant 2005; 35:729-30. [PMID: 15785772 DOI: 10.1038/sj.bmt.1704864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
We have tried to make use of the opportunity of repeated observations through the analysis of the recorded movements of the phonating vocal folds by means of the phonating vocal folds through indirect videolaryngostroboscopic technique. The results of our investigation correspond, among others, with Hála and Sovák's diagrammatic description of continual and gradual changes in the vibration of the vocal folds in an uninterrupted sequence of tones of the human voice. In the initial chapter mention has been made of Hála and Honty's works and of Pressmann's work dealing with the described behaviour of the glottis when phonating high-pitched tones. The conclusions analogous to our findings have also been described by means of stereoscopically measuring the length of the phonating vocal folds. In conclusion, by measuring the distances between the anterior commissure and the junction between the membranous part of the vocal fold and vocal process of the arytenoid and the anterior commissure to the posterior nodal point of the vibrating part of the vocal folds we have verified the correctness of the findings published by Czermak, Hála and Honty, Pressmann, and Sovák, who pointed out the phenomenon of the shortening of the front vibrating part of the vocal folds in phonating high-pitched tones of the human voice.
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Affiliation(s)
- J Pesák
- Department of the Biophysics of the Medical Faculty, Palacký University, Olomouc, Czech Republic.
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Jindra P, Koza V, Boudová L, Vozobulová V, Cerná K, Karas M, Lysák D, Svojgrová M. Epstein-Barr virus-associated B-cell lymphoproliferative disorder in CLL patients after treatment with fludarabine and cyclophosphamide followed by high-dose chemotherapy with autologous stem cell transplantation. Bone Marrow Transplant 2003; 31:951-2. [PMID: 12748677 DOI: 10.1038/sj.bmt.1704026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Simková P, Jindra P, Koza V, Cerná K. [Detection of cytomegalovirus infection with the polymerase chain reaction and antigenemia after allogenic bone marrow transplantation]. Vnitr Lek 2002; 48:120-4. [PMID: 11949219] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
UNLABELLED The objective of the work was to evaluate the frequency and time of incidence of cytomegaloviral (CMV) infection and disease in patients after allogeneic bone marrow transplantation (BMT). One hundred patients were followed up (70 with a related and 30 with an unrelated donor), who had transplantations during the period between XI/1996-XI/2000. METHODS USED nested-PCR (MIE-gene) and antigenaemia (antigen pp65). Active CMV infection was proved in antigenaemia > or = 5 positive cells or in two consecutive positive PCR. The CMV syndrome was assessed in confirmed CMV infection and otherwise inexplicable febrile conditions and/or a drop of haemogram values. For the diagnosis of CMV pneumonia the clinical picture was needed, evidence of active CMV infection and on the X-ray of the lungs interstitial pneumonia. In 33 patients both methods were used, in 67 only PCR. The first positive test appeared 6-321 days after BMT (median +/- 49 days). CMV infection was proved in 44% cases, CMV syndrome in 30% and CMV pneumonia in 4%. In patients with a related donor CMV infection was found in 34.3%, CMV syndrome in 22.9%, CMV pneumonia in 1.4%. After unrelated donor BMT CMV infection was recorded in 66.7%, CMV syndrome in 46.7% and CMV pneumonia in 10% patients. Two patients died from CMV pneumonia. CMV pneumonia was diagnosed 57-115 days after BMT (median +/- 68 days. The risk of CMV infection is high in both groups of patients, in particular in patients after unrelated donor BMT (66.7%). As far as the development of CMV pneumonia was concerned, the mortality in the authors' group was 50%.
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Affiliation(s)
- P Simková
- Hematologicko-onkologické oddĕlení FN, Plzen
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Boudová L, Fakan F, Michal M, Dusek J, Curík R, Husek K, Voska L, Kolník P, Mukensnabl P, Hes O, Jindra P. [Lymphoproliferative disease after transplantation]. Cesk Patol 2002; 38:24-32. [PMID: 11933458] [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] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Herein we describe 7 cases of posttransplantation lymphoproliferative disease (PTLD), 5 in men and 2 in women (aged from 25 to 62 years), occurring from 4 months to 12 years (mean, 7 years) after transplantation. Our patients were recipients of kidney, kidney and pancreas, heart, and autologous peripheral haematopoetic stem cells. Four cases were diagnosed as monomorphic and three as polymorphic type of PTLD according to the WHO classification. Monoclonal immunoglobuline heavy chain gene rearrangement was detected in two monomorphic lesions and one polymorphic lesion by polymerase chain reaction (PCR). In the two cases of polymorphic and the one case of monomorphic PTLD, the presence of EBV was visualised by immunohistochemical staining of some transformed lymphoid cells for latent membrane protein (LMP) of EBV. The presence of type A EBV was demonstrated by PCR. The patients were treated by reduction or discontinuation of immunosuppression and by chemotherapy. In 2 cases, a part of the organ affected by lymphoma (sigmoid colon and pancreas) was surgically resected. Four patients died of causes related to PTLD (2 to 15 months after the diagnosis), mainly of infectious complications. Two other patients who achieved remission died of unrelated causes. Only the youngest man is alive and in the complete remission 10 months after the diagnosis of PTLD.
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Affiliation(s)
- L Boudová
- Siklův patologicko-anatomický útav, Lékarská fakulta Univerzity Karlovy a Fakultní nemocnice, Plzen.
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Karas M, Cerná K, Koza V, Jindra P, Vozobulová V, Schützová M. [Allogenic transplantation of bone marrow in patients with chronic myeloid leukemia 1991-1995 and 1996-1998. Experience at the Hematology-Oncology Clinic of the University Hospital in Plzen]. Vnitr Lek 2001; 47 Suppl 1:34-9. [PMID: 11693060] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The authors compare the results of allogenic bone marrow transplantations of relatives in patients with chronic myeloid leukaemia during the initial years of the transplantation programme 1991-1995 (group 1, 15 patients) with results achieved in 1996-1998 (group 2, 30 patients) and evaluate the effect of changes concerning supportive treatment and new diagnostic methods. The age median of group 1 was 35 years, the median age of group 2 46 years. In other parameters the groups were comparable. In 1991-1995 a high transplantation mortality by the 100th day was recorded (40% as compared with 17%) and a higher incidence of stage III and IV of the acute reaction of the graft against the host (GVHD) in group 1 (20% vs. 6%). In group 2 there was a higher transplantation mortality after day 100 associated with a more frequent chronic GVHD (0% vs. 16.5%). The total survival is insignificantly better in group 2 (60% in group 1 survive with a median of 58 months follow up and 67% of group 2 with a median follow up of 33 months). Group 2 comprises however older patients. In the improved early transplantation mortality participated new methods, a change of the posttransplantation immunosuppression, experience with care of transplanted patients and better collaboration with other medical disciplines. The authors did not observe a substantial effect of changes in the basic supportive treatment on results of transplantation. Late transplantation mortality associated in particular with a higher incidence of chronic GVHD could be in the authors' opinion reduced by longer administration of immunosuppression after transplantation, in particular in older patients.
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Affiliation(s)
- M Karas
- Hematologicko-onkologické oddĕlení Fakultní nemocnice, Plzen
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46
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Lysák D, Koza V, Jindra P, Vozobulová V, Schutzová M, Fiser J, Cerná K, Karas M, Skopek P, Svojgrová M, Vokurka S. Allogeneic BMT in patients above 45 years of age: a single center experience. Bone Marrow Transplant 2001; 27:723-6. [PMID: 11360112 DOI: 10.1038/sj.bmt.1702851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2000] [Accepted: 01/04/2001] [Indexed: 11/09/2022]
Abstract
Increasing age has been reported to be associated with worse outcome and higher occurrence of complication after allogeneic bone marrow transplantation. We analysed a cohort of 39 patients between the ages of 45 and 57 (median 49 years) with different hematologic malignancies who had undergone BMT in our institution over the preceding 4 years. Pretransplant conditioning consisted of Bu/CY2, GVHD prophylaxis of a combination of cyclosporine and "short" methotrexate. At present 54% of patients remain alive (with a median follow-up 44 months), the probability of survival at 5 years is 53% (5-year DFS 78%). The 5-year survival probability in the control group of younger patients is 53% (P = 0.8003). Main causes of death were GVHD (4 patients, 10%), relapse (5 patients, 13%) and infection (6 patients, 15%). The incidence of acute GVHD grade II-IV was 51% (grade III-IV 0% patients), the incidence of chronic GVHD 49% (limited 18% and extensive 31% patients). Our results suggest that allogeneic BMT can be performed in patients above the age of 45 years with acceptable morbidity and mortality, especially if a family HLA matched donor is available.
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Affiliation(s)
- D Lysák
- Department of Haematology and Oncology, Charles University Hospital Pilsen, Alej Svovody 80, 304 60 Pilsen, Czech Republic
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47
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Rokyta R, Novak I, Matejovic M, Sramek V, Hora P, Jindra P. Author’s reply. Intensive Care Med 2001. [DOI: 10.1007/s001340100924] [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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48
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Jindra P, Koza V, Svojgrová M, Skopek P, Vozobulová V, Schützová M. Frontline transplantation of autologous CD34+ selected blood cells for advanced mantle cell lymphoma: no evidence of long-term cure: a single centre experience. Bone Marrow Transplant 2000; 26:1138-9. [PMID: 11108321 DOI: 10.1038/sj.bmt.1702673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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49
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Pesák J, Jindra P, Grosman Z. [An unknown role of the ligament layer of the conus elasticus during phonation?]. Sb Lek 2000; 99:471-81. [PMID: 10803290] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The investigation of the intoning vocal folds with the help of Cermák's mirror in as early as the 19th century and also their ensuring records by means of a stroboscopic film have discovered the fact that the front vibrating part of the vocal folds becomes shortened in high frequencies. This information has been ignored since about the 60ies of the 20th century. The aim of the present paper is to verify the shortening of the front vibrating part of the vocal folds and to recall this fact. Approximately in two octaves we have measured the virtual images of a video stroboscopic record. Our results are comparable with similar measurement resulting from stroboscopic investigation and confirm the hypothetic role of the ligament layer conus elasticus.
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Affiliation(s)
- J Pesák
- Ustav lékarské biofyziky Lékarské fakulty Univerzity Palackého v Olomouci, Czech Republic
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Affiliation(s)
- R. Rokyta
- />Intensive Care Unit, Department of Internal Medicine I, Charles University Hospital Plzen, Alej Svobody 80, Lochotin, 304 60 Plzen, Czech Republic, Czech Republic
| | - I. Novak
- />Intensive Care Unit, Department of Internal Medicine I, Charles University Hospital Plzen, Alej Svobody 80, Lochotin, 304 60 Plzen, Czech Republic, Czech Republic
| | - M. Matejovic
- />Intensive Care Unit, Department of Internal Medicine I, Charles University Hospital Plzen, Alej Svobody 80, Lochotin, 304 60 Plzen, Czech Republic, Czech Republic
| | - V. Sramek
- />Intensive Care Unit, Department of Internal Medicine I, Charles University Hospital Plzen, Alej Svobody 80, Lochotin, 304 60 Plzen, Czech Republic, Czech Republic
| | - P. Hora
- />Intensive Care Unit, Department of Internal Medicine I, Charles University Hospital Plzen, Alej Svobody 80, Lochotin, 304 60 Plzen, Czech Republic, Czech Republic
| | - P. Jindra
- />Department of Hematology and Oncology, Charles University Hospital, Plzen, Czech Republic, Czech Republic
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