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Medeiros GRDO, Funke VAM, Lima ACM, Mion ALV, Menezes I, Setubal DC, Sola CBDS, Tagliari G, Marchesini R, Nabhan SK, Pasquini R. The Role of Molecular or Cytogenetic Response as a Favorable Prognostic Factor Before Hematopoietic Stem Cell Transplantation for Chronic Myeloid Leukemia. Transplant Cell Ther 2024:S2666-6367(24)00293-8. [PMID: 38522578 DOI: 10.1016/j.jtct.2024.03.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have revolutionized therapy for patients with chronic myeloid leukemia (CML) over the last two decades. However, some patients still do not achieve an adequate response to these drugs, and hematopoietic stem cell transplantation (HSCT) is indicated in this scenario. We present the results of a 20-year follow-up study of 70 patients who underwent transplantation after TKI failure. The primary objective of this study was to evaluate overall survival (OS) and the secondary objective was to evaluate the outcomes of relapse-free survival (RFS), GVHD-free, relapse-free survival (GFRS) and the incidences of relapse (RI), non-relapse mortality (NRM), acute and chronic GVHD. Median survival was 11 years, with a 1-year OS of 70% (57.8 to 79.3) and a 5-year OS of 57.7% (45.1 to 68.5). The estimated 5-year OS was not different for CP1 (60%) versus advanced stages (45%); P = .60. The degree of response immediately before transplantation was directly associated with worse outcomes [HR 5.89 (1.19-29.16); P = .03] for patients with only a hematological response compared with patients with a cytogenetic or molecular response. This study corroborates the potential of HSCT in the scenario of therapeutic failure and highlights the role of molecular or cytogenetic response as a potential target to be achieved before transplantation.
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Affiliation(s)
| | - Vaneuza Araújo Moreira Funke
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Ana Lúcia Vieira Mion
- Molecular Biology in OncoHematological Diseases Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Isabela Menezes
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Daniela Carinhanha Setubal
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Caroline Bonamin Dos Santos Sola
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Gláucia Tagliari
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Rafael Marchesini
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Samir Kanaan Nabhan
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ricardo Pasquini
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Disserol CCD, Kowacs DP, Nabhan SK, Teive HAG, Kowacs PA. Case report: Successful autologous hematopoietic stem cell transplantation in a patient with GAD antibody-spectrum disorder with rapidly progressive dementia. Front Neurol 2023; 14:1254981. [PMID: 37928135 PMCID: PMC10622657 DOI: 10.3389/fneur.2023.1254981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
The prevalence of neurological syndromes associated with antibodies to glutamic acid decarboxylase is increasing. While cognitive impairment is a common feature of this condition, it seldom emerges as the primary symptom. In this study, we discuss a case of refractory dementia associated with the glutamic acid decarboxylase spectrum disorder. Interestingly, this case showed a favorable outcome following autologous hematopoietic stem cell transplantation. We also provide an in-depth review of the current literature on the use of this therapeutic approach for the treatment of this disease.
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Affiliation(s)
- Caio César Diniz Disserol
- Department of Neurology, Instituto de Neurologia de Curitiba, Curitiba, Brazil
- Department of Neurology, Complexo do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Dora Pedroso Kowacs
- Department of Neurology, Instituto de Neurologia de Curitiba, Curitiba, Brazil
| | - Samir Kanaan Nabhan
- Blood and Marrow Transplantation Program, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Hélio Afonso Ghizoni Teive
- Department of Neurology, Complexo do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Pedro André Kowacs
- Department of Neurology, Instituto de Neurologia de Curitiba, Curitiba, Brazil
- Department of Neurology, Complexo do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
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Santos ES, Lima ACM, Breda GL, Tomaz APDO, Nabhan SK, Funke VAM, Loth G, Nogueira KDS. Colonization by multidrug-resistant bacteria in hematological patients undergoing hematopoietic stem cell transplantation and clinical outcomes: A single-center retrospective cohort study. Transpl Infect Dis 2023; 25:e14119. [PMID: 37561358 DOI: 10.1111/tid.14119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/05/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Bloodstream infections are a leading cause of death in patients who undergo hematopoietic stem cell transplantation (HSCT) and are more severe when caused by multidrug-resistant (MDR) bacteria. This study proposed to investigate if colonization by MDR bacteria negatively affects the clinical outcomes in hematological patients after HSCT, as well as to evaluate possible risk factors for death due to bacteremia by the same colonizing agent. METHODS A single-center retrospective cohort study was conducted with 405 hematological patients submitted to a single HSCT procedure between 2015 and 2021. Patients were classified as colonized (n = 132) or noncolonized (n = 273) based on the surveillance cultures from D-30 to D+30 of transplantation, and their relevant clinical and laboratory data were collected until D+100. RESULTS Colonization by MDR bacteria increased blood culture positivity by all micro-organisms and also specifically by MDR bacteria, with a more pronounced effect when caused by carbapenemase-producing Klebsiella pneumoniae. Patients colonized with carbapenem-resistant K. pneumoniae had increased overall mortality (HR = 4.07, 95% CI 1.85-8.91, P = .0005) and had prolonged hospital length of stay in the context of autologous transplantation. Risk factors for death due to bacteremia by the same colonizing agent were neutropenia, colonization by carbapenem-resistant K. pneumoniae and use of high-dose total body irradiation in conditioning. CONCLUSION Hematological patients colonized by MDR bacteria presented a higher incidence of bloodstream infections, and colonization by carbapenemase-producing K. pneumoniae was associated with reduced overall survival.
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Affiliation(s)
- Eduardo Sbrana Santos
- Clinical Analysis and Pathological Anatomy Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Alberto Cardoso Martins Lima
- Clinical Analysis and Pathological Anatomy Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Giovanni Luís Breda
- Infectious Diseases Division, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ana Paula de Oliveira Tomaz
- Clinical Analysis and Pathological Anatomy Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Samir Kanaan Nabhan
- Bone Marrow Transplantation Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Vaneuza Araújo Moreira Funke
- Bone Marrow Transplantation Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Keite da Silva Nogueira
- Clinical Analysis and Pathological Anatomy Unit, Complexo do Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Lima ACM, Getz J, do Amaral GB, Loth G, Funke VAM, Nabhan SK, Petterle RR, de Marco R, Gerbase-DeLima M, Pereira NF, Bonfim C, Pasquini R. Donor-specific HLA antibodies are associated with graft failure and delayed hematologic recovery after unrelated donor hematopoietic cell transplantation. Transplant Cell Ther 2023:S2666-6367(23)01298-8. [PMID: 37220839 DOI: 10.1016/j.jtct.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/12/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Graft failure (GF) is one of the major concerns after allogeneic hematopoietic cell transplantation (allo-HCT) and remains a significant cause of morbidity and mortality. Although earlier reports have associated the presence of donor-specific HLA antibodies (DSAs) with increased risk of GF after unrelated donor allo-HCT, recent studies have failed to confirm this association. OBJECTIVE We sought to validate the presence of DSAs as a risk factor for GF and hematologic recovery in the unrelated donor allo-HCT setting. STUDY DESIGN We retrospectively evaluated 303 consecutive patients who underwent their first unrelated donor allo-HCT at our institution from January 2008 to December 2017. DSA evaluation was performed using 2 Single Antigen Beads (SAB) assays, DSA titration with 1:2, 1:8, and 1:32 dilutions, C1q-binding assay, and absorption/elution protocol to assess possible false-positive DSA reactivity. The primary endpoints were neutrophil and platelet recovery and GF, whereas the secondary endpoint was overall survival. Multivariable analyses were performed using Fine-Gray competing risks regression or Cox proportional hazards regression models. RESULTS The median patient age was 14 years (range, 0-61 years), 56.1% were male, and 52.5% were transplanted for nonmalignant diseases. Eleven patients (3.63%) were DSA-positive. Of them, 10 had preexisting DSAs, and one showed post-transplant de novo DSA. Nine patients had 1 DSA, 1 had 2 DSAs, and 1 had 3 DSAs, with a median MFI of 4334 (range, 588-20,456) and 3581 (range, 227-12,266) in LABScreen and LIFECODES SAB assays, respectively. Overall, 21 patients experienced GF. Of them, 12 had primary graft rejection, 8 had secondary graft rejection, and 1 had primary poor graft function. The cumulative incidences of GF at 28, 100, and 365 days were 4.0% (95% CI, 2.2%-6.6%), 6.6% (95% CI, 4.2%-9.8%), and 6.9% (95% CI, 4.4%-10.2%), respectively. In the multivariable analyses, DSA-positive patients had significantly delayed neutrophil (subdistribution hazard ratio [SHR] = 0.48; 95% CI, 0.29-0.81; P = .006) and platelet recovery (SHR = 0.51; 95% CI, 0.35-0.74; P = .0003) than patients without DSAs. In addition, only DSAs were significant predictors of primary GF at 28 days (SHR = 2.78; 95% CI, 1.65-4.68; P = .0001). The Fine-Gray regression also demonstrated that the presence of DSAs was strongly associated with a higher incidence of overall GF (SHR = 7.60; 95%CI, 2.61-22.14; P = .0002). DSA-positive patients with GF had significantly higher median MFI values than DSA-positive patients who achieved engraftment in LIFECODES SAB assay using neat serum (10,334 vs. 1250; P = .006) and in LABScreen SAB at 1:32 dilution (1627 vs. 61; P = .006). All 3 patients with C1q-positive DSAs failed to engraft. DSAs were not predictive of inferior survival (hazard ratio = 0.50; 95% CI, 0.20-1.26, P = .14). CONCLUSIONS Our results validate the presence of DSAs as a significant risk factor for GF and poor hematologic recovery after unrelated donor allo-HCT. Thus, careful pre-transplant DSA evaluation may optimize unrelated donor selection and improve allo-HCT outcomes.
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Affiliation(s)
- Alberto Cardoso Martins Lima
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil.
| | - Joselito Getz
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Geovana Borsato do Amaral
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Vaneuza Araújo Moreira Funke
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Samir Kanaan Nabhan
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Renato de Marco
- Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil
| | - Maria Gerbase-DeLima
- Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil
| | - Noemi Farah Pereira
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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Castro M, Nabhan SK, Sola CB, Spinelli BFB, Gonçalves MDC, Patricio FB, Gasparine AVCDS, Guedes MC, Baldanzi TDS, Pucci CM. LINFOMA CUTÂNEO DE CÉLULAS T PANICULITE SÍMILE – RELATO DE CASO. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.200] [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: 11/11/2022] Open
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Miyazaki DH, Lunkes FS, Celestino JL, Silva LG, Sola CB, Nabhan SK, Setúbal DC, Marchesini R, Cerbaro JLM, Funke VAM. REATIVAÇÃO PRECOCE DO HERPESVÍRUS HUMANO TIPO 6 (HVH-6) EM PACIENTE SUBMETIDO A TRANSPLANTE AUTÓLOGO DE CÉLULAS-TRONCO ASSOCIADO A RASH CUTÂNEO E ATRASO DA PEGA DO ENXERTO. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.553] [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: 11/11/2022] Open
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Lima ACM, Bonfim C, Getz J, do Amaral GB, Petterle RR, Loth G, Nabhan SK, de Marco R, Gerbase-DeLima M, Pereira NF, Pasquini R. Untreated Donor-Specific HLA Antibodies Are Associated With Graft Failure and Poor Survival After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Pediatric Patients With Nonmalignant Disorders. Transplant Cell Ther 2022; 28:698.e1-698.e11. [DOI: 10.1016/j.jtct.2022.07.019] [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] [Received: 03/12/2022] [Revised: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
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Bonfim C, Nichele S, Loth G, Funke VAM, Nabhan SK, Pillonetto DV, Lima ACM, Pasquini R. Transplantation for Fanconi anaemia: lessons learned from Brazil. The Lancet Haematology 2022; 9:e228-e236. [DOI: 10.1016/s2352-3026(22)00032-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
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Breda G, Rossoni AMDO, Cognialli RCR, Voidaleski MF, Schneider GX, Muratori RR, Rodrigues AM, Loth G, Ronconi AC, Nabhan SK, Funke VAM, Telles FDQ. SURTO DE MUCORMICOSE CAUSADA POR RHIZOMUCOR PUSSILUS EM UMA UNIDADE DE TRANSPLANTE DE CÉLULAS TRONCO HEMATOPOIÉTICAS. Braz J Infect Dis 2022. [DOI: 10.1016/j.bjid.2021.102224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Silva LG, Menezes I, Gallucci MC, Sola CB, Setubal DC, Nabhan SK, Oliveira MM, Pasquini R, Funke VAM. ANÁLISE DOS NÍVEIS DE BCR-ABL COMO PREDITOR DE RECAÍDA APÓS TRANSPLANTE ALOGÊNICO DE CÉLULAS TRONCO HEMATOPOIÉTICAS (TCTH) EM LEUCEMIA MIELÓIDE CRÔNICA NA ERA DOS INIBIDORES DE TIROSINA-QUINASE (ITQ). Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.419] [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: 11/15/2022] Open
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Lima ACM, Bonfim C, Getz J, Dornelles LN, do Amaral GB, Petterle RR, Loth G, Nabhan SK, Pereira NF, Pasquini R. The impact of donor-specific anti-human leukocyte antigen antibodies in salvage haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide in patients with nonmalignant disorders. HLA 2021; 97:493-504. [PMID: 33886161 DOI: 10.1111/tan.14277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/10/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
The presence of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) has been recognized as a major risk factor for graft failure (GF) after haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide (haplo-PTCy). However, the role of DSAs in salvage haplo-PTCy for rescuing patients with nonmalignant disorders (NMDs) has not yet been reported. The present study retrospectively analyzed 22 patients with NMDs who underwent salvage haplo-PTCy from January 2008 to December 2017. The median age at the time of the rescue haplo-PTCy was 9 years (range, 1-26 years). Median time from the first transplant to second haplo-PTCy was 56 days (range, 37-591 days). Among all patients, six (27.3%) had DSAs, with a median DSA strength (mean fluorescence intensity [MFI]) of 5201 (range, 1412-11,543) in the first DSA testing. In addition, the median DSA MFI was 2672 (range, 832-10,498) before the bone marrow infusion. Overall, GF occurred in 5 (25%) of the 20 assessable patients. Three of four (75%) patients with DSAs experienced GF versus 2 of 16 (12.5%) DSA-negative patients (P = 0.032). The median DSA MFI for patients with GF was 6437 (range, 1412-10,498) versus 1845 (range, 832-2672) for those who engrafted or had early death (P = 0.030). One-year event-free survival was significantly lower in DSA-positive patients than in those without DSAs (16.7% vs. 62.5%, P = 0.002). DSA-negative patients had an acceptable 1-year survival of 62.5%. In conclusion, this study suggests that DSAs may be associated with deleterious outcomes after salvage haplo-PTCy in patients with NMDs.
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Affiliation(s)
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Joselito Getz
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Luciana Nasser Dornelles
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Geovana Borsato do Amaral
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Gisele Loth
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Samir Kanaan Nabhan
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Noemi Farah Pereira
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Arcuri LJ, Nabhan SK, Cunha R, Nichele S, Ribeiro AAF, Fernandes JF, Daudt LE, Rodrigues ALM, Arrais-Rodrigues C, Seber A, Atta EH, de Oliveira JSR, Funke VAM, Loth G, Junior LGD, Paz A, Calixto RF, Gomes AA, Araujo CES, Colturato V, Simoes BP, Hamerschlak N, Flowers ME, Pasquini R, Rocha V, Bonfim C. Impact of CD34 Cell Dose and Conditioning Regimen on Outcomes after Haploidentical Donor Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide for Relapsed/Refractory Severe Aplastic Anemia. Biol Blood Marrow Transplant 2020; 26:2311-2317. [PMID: 32949751 DOI: 10.1016/j.bbmt.2020.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
Severe aplastic anemia (SAA) is a life-threatening disease that can be cured with allogeneic cell transplantation (HCT). Haploidentical donor transplantation with post-transplantation cyclophosphamide (haplo-PTCy) is an option for patients lacking an HLA-matched donor. We analyzed 87 patients who underwent haplo-PTCy between 2010 and 2019. The median patient age was 14 years (range, 1 to 69 years), most were heavily transfused, and all received previous immunosuppression (25% without antithymocyte globulin). Almost two-thirds (63%) received standard fludarabine (Flu)/cyclophosphamide (Cy) 29/total body irradiation (TBI) 200 cGy conditioning, and the remaining patients received an augmented conditioning: Flu/Cy29/TBI 300-400 (16%), Flu/Cy50/TBI 200 (10%), or Flu/Cy50/TBI 400 (10%). All patients received PTCy-based graft-versus-host disease (GVHD) prophylaxis. Most grafts (93%) were bone marrow (BM). The median duration of follow-up was 2 years and 2 months. The median time to neutrophil recovery was 17 days. Primary graft failure occurred in 15% of the patients, and secondary or poor graft function occurred in 5%. The incidences of grade II-IV acute GVHD was 14%, and that of chronic GVHD was 9%. Two-year overall survival and event-free survival (EFS) were 79% and 70%, respectively. EFS was higher for patients who received augmented Flu/Cy/TBI (hazard ratio [HR], .28; P = .02), and those who received higher BM CD34 cell doses (>3.2 × 10E6/kg) (HR, .29; P = .004). The presence of donor-specific antibodies before HSCT was associated with lower EFS (HR, 3.92; P = .01). Graft failure (HR, 7.20; P < .0001) was associated with an elevated risk of death. Cytomegalovirus reactivation was frequent (62%). Haploidentical HCT for SAA is a feasible procedure; outcomes are improved with augmented conditioning regimens and BM grafts with higher CD34 cell doses.
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Affiliation(s)
- Leonardo Javier Arcuri
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil.
| | - Samir Kanaan Nabhan
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Renato Cunha
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Samantha Nichele
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | | | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Liane Esteves Daudt
- Hospital das Clinicas de Porto Alegre, Bone Marrow Transplantation Unit, Porto Alegre, Brazil
| | | | | | - Adriana Seber
- Hospital Samaritano, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Elias Hallack Atta
- Instituto Nacional de Cancer, Bone Marrow Transplantation Unit, Rio de Janeiro, Brazil
| | | | | | - Gisele Loth
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Luiz Guilherme Darrigo Junior
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Alessandra Paz
- Hospital das Clinicas de Porto Alegre, Bone Marrow Transplantation Unit, Porto Alegre, Brazil
| | - Rodolfo Froes Calixto
- Real Hospital Portugues de Beneficencia em Pernambuco, Bone Marrow Transplantation Unit, Recife, Brazil
| | | | - Carlos Eduardo Sa Araujo
- Instituto de Cardiologia do Distrito Federal, Bone Marrow Transplantation Unit, Brasilia, Brazil
| | | | - Belinda Pinto Simoes
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Nelson Hamerschlak
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | | | - Ricardo Pasquini
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Vanderson Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Bone Marrow Transplantation Unit, Sao Paulo, Brazil; Rede D'or, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Carmem Bonfim
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
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13
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Arcuri LJ, Nabhan SK, Loth G, Atta EH, Oliveira M, Nichele S, Araujo RDC, Bonfim C. A Case Series of Post-Transplantation Cyclophosphamide in Unrelated Donor Hematopoietic Cell Transplantation for Aplastic Anemia. Biol Blood Marrow Transplant 2020; 26:e222-e226. [DOI: 10.1016/j.bbmt.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 11/26/2022]
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14
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Padilha PH, Borges G, Santana BA, Medeiros LA, Nabhan SK, Pasquini R, Donaires FS, Calado RT. THPO gene variants in patients with acquired aplastic anemia. Hematol Transfus Cell Ther 2018. [PMCID: PMC6738484 DOI: 10.1016/j.htct.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Pedro Henrique Padilha
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Gustavo Borges
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Barbara Amélia Santana
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | | | | | | | - Flavia Sacilotto Donaires
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Rodrigo Tocantins Calado
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
- Corresponding author at: Faculdade de Medicina de Ribeirão Preto da USP, Laboratório de Hematologia, bloco G, subsolo, HCRP, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900, Brazil.
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15
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Nuernberg MAA, Rodrigues SC, Perdoncini NN, Funke VAM, Bonfim CMS, Nabhan SK, Torres-Pereira CC. Periodontal status of candidates for allogeneic hematopoietic stem cell transplantation. Spec Care Dentist 2017; 37:187-193. [DOI: 10.1111/scd.12229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Samir Kanaan Nabhan
- Avenida Prefeito Lothário Meissner; 632, Jardim Botânico Curitiba Paraná Brazil, 80210-170
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16
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Nuernberg MAA, Nabhan SK, Bonfim CMS, Funke VAM, Torres-Pereira CC. Access to oral care before hematopoietic stem cell transplantation: understand to improve. Support Care Cancer 2016; 24:3307-13. [DOI: 10.1007/s00520-016-3142-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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17
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Calefi KAC, Rocha VD, Nabhan SK, Maftum MA, Kalinke LP, Mantovani MDF. The quality of life of patients with hematological neoplasia undergoing chemotherapy. Reme: Revista Mineira de Enfermagem 2014. [DOI: 10.5935/1415-2762.20140004] [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: 11/20/2022] Open
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Morando J, Mauad MA, Fortier SC, Piazera FZ, Souza MPD, Oliveira C, Machado C, Matos E, Azevedo WM, Ribeiro LL, Nunes EC, Bitencourt MA, Setúbal DC, Funke VM, Oliveira MMD, Medeiros LA, Nabhan SK, Loth G, Sola CBS, Koliski A, Pasquini R, Zanis Neto J, Colturato VAR, Bonfim CMS. Transplante de células-tronco hematopoéticas em crianças e adolescentes com leucemia aguda: experiência de duas instituições Brasileiras. Rev Bras Hematol Hemoter 2010. [DOI: 10.1590/s1516-84842010000500006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Morando J, Mauad MA, Fortier SC, Piazera FZ, Souza MPD, Oliveira C, Machado C, Matos E, Azevedo WM, Ribeiro LL, Nunes EC, Bitencourt MA, Setúbal DC, Funke VM, Oliveira MMD, Medeiros LA, Nabhan SK, Loth G, Sola CBS, Koliski A, Pasquini R, Zanis Neto J, Colturato VAR, Bonfim CMS. Transplante de células-tronco hematopoéticas em crianças e adolescentes com leucemia aguda: experiência de duas instituições brasileiras. Rev Bras Hematol Hemoter 2010. [DOI: 10.1590/s1516-84842010005000093] [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: 11/22/2022] Open
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20
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de Almeida SM, Teive HAG, Brandi I, Nabhan SK, Werneck LC, Bittencourt MA, Medeiros CR, Pasquini R, de Mello HH. Fatal Bacillus cereus meningitis without inflammatory reaction in cerebral spinal fluid after bone marrow transplantation. Transplantation 2004; 76:1533-4. [PMID: 14657704 DOI: 10.1097/01.tp.0000079251.82361.99] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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