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Pham TT, Le AH, Dang CP, Chong SY, Do DV, Peng B, Jayasinghe MK, Ong HB, Hoang DV, Louise RA, Loh Y, Hou HW, Wang J, Le MTN. Endocytosis of red blood cell extracellular vesicles by macrophages leads to cytoplasmic heme release and prevents foam cell formation in atherosclerosis. J Extracell Vesicles 2023; 12:e12354. [PMID: 37553837 PMCID: PMC10410060 DOI: 10.1002/jev2.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
Extracellular vesicles (EVs) can be produced from red blood cells (RBCs) on a large scale and used to deliver therapeutic payloads efficiently. However, not much is known about the native biological properties of RBCEVs. Here, we demonstrate that RBCEVs are primarily taken up by macrophages and monocytes. This uptake is an active process, mediated mainly by endocytosis. Incubation of CD14+ monocytes with RBCEVs induces their differentiation into macrophages with an Mheme-like phenotype, characterized by upregulation of heme oxygenase-1 (HO-1) and the ATP-binding cassette transporter ABCG1. Moreover, macrophages that take up RBCEVs exhibit a reduction in surface CD86 and decreased secretion of TNF-α under inflammatory stimulation. The upregulation of HO-1 is attributed to heme derived from haemoglobin in RBCEVs. Heme is released from internalized RBCEVs in late endosomes and lysosomes via the heme transporter, HRG1. Consequently, RBCEVs exhibit the ability to attenuate foam cell formation from oxidized low-density lipoproteins (oxLDL)-treated macrophages in vitro and reduce atherosclerotic lesions in ApoE knockout mice on a high-fat diet. In summary, our study reveals the uptake mechanism of RBCEVs and their delivery of heme to macrophages, suggesting the potential application of RBCEVs in the treatment of atherosclerosis.
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Affiliation(s)
- Thach Tuan Pham
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Anh Hong Le
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Cong Phi Dang
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Suet Yen Chong
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Cardiovascular Research Institute, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Dang Vinh Do
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Boya Peng
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Migara Kavishka Jayasinghe
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Hong Boon Ong
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Dong Van Hoang
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Roma Anne Louise
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Yuin‐Han Loh
- A*STAR Institute of Molecular and Cell BiologySingaporeSingapore
- Department of Biological SciencesNational University of SingaporeSingaporeSingapore
| | - Han Wei Hou
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Jiong‐Wei Wang
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Cardiovascular Research Institute, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Department of Physiology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Minh TN Le
- Department of Pharmacology, and Institute for Digital Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Department of Surgery, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Nanomedicine Translational Research Programme, Centre for NanoMedicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- A*STAR Institute of Molecular and Cell BiologySingaporeSingapore
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Adusumilli G, Faizy TD, Christensen S, Mlynash M, Loh Y, Albers GW, Lansberg MG, Fiehler J, Heit JJ. Comprehensive Venous Outflow Predicts Functional Outcomes in Patients with Acute Ischemic Stroke Treated by Thrombectomy. AJNR Am J Neuroradiol 2023; 44:675-680. [PMID: 37202117 PMCID: PMC10249690 DOI: 10.3174/ajnr.a7879] [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: 01/31/2023] [Accepted: 04/22/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND AND PURPOSE Cortical venous outflow has emerged as a robust measure of collateral blood flow in acute ischemic stroke. The addition of deep venous drainage to this assessment may provide valuable information to further guide the treatment of these patients. MATERIALS AND METHODS We performed a multicenter retrospective cohort study of patients with acute ischemic stroke treated by thrombectomy between January 2013 and January 2021. The internal cerebral veins were scored on a scale of 0-2. This metric was combined with existing cortical vein opacification scores to create a comprehensive venous outflow score from 0 to 8 and stratify patients as having favorable-versus-unfavorable comprehensive venous outflow. Outcome analyses were primarily conducted using the Mann-Whitney U and χ2 tests. RESULTS Six hundred seventy-eight patients met the inclusion criteria. Three hundred fifteen were stratified as having favorable comprehensive venous outflow (mean age, 73 years; range, 62-81 years; 170 men), and 363, as having unfavorable comprehensive venous outflow (mean age, 77 years; range, 67-85 years; 154 men). There were significantly higher rates of functional independence (mRS 0-2; 194/296 versus 37/352, 66% versus 11%, P < .001) and excellent reperfusion (TICI 2c/3; 166/313 versus 142/358, 53% versus 40%, P < .001) in patients with favorable comprehensive venous outflow. There was a significant increase in the association of mRS with the comprehensive venous outflow score compared with the cortical vein opacification score (-0.74 versus -0.67, P = .006). CONCLUSIONS A favorable comprehensive venous profile is strongly associated with functional independence and excellent postthrombectomy reperfusion. Future studies should focus on patients with venous outflow status that is discrepant with the eventual outcome.
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Affiliation(s)
- G Adusumilli
- From the Department of Radiology (G.A.), Massachusetts General Hospital, Boston, Massachusetts
| | - T D Faizy
- Department of Neuroradiology (T.D.F., J.F.), University of Hamburg-Eppendorf, Hamburg, Germany
| | | | - M Mlynash
- Stanford Stroke Center (S.C., M.M., G.W.A., M.G.L.)
| | - Y Loh
- Comprehensive Stroke Center (Y.L.), Swedish Neuroscience Institute, Seattle, Washington
| | - G W Albers
- Stanford Stroke Center (S.C., M.M., G.W.A., M.G.L.)
| | - M G Lansberg
- Stanford Stroke Center (S.C., M.M., G.W.A., M.G.L.)
| | - J Fiehler
- Department of Neuroradiology (T.D.F., J.F.), University of Hamburg-Eppendorf, Hamburg, Germany
| | - J J Heit
- Department of Radiology (J.J.H.), Stanford University, Stanford, California
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3
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Ho G, Sheriff T, Doria-Ruiz M, Loh Y, Murrell DF. Are biosimilars for pemphigus safe? Clin Exp Dermatol 2021; 46:942-943. [PMID: 33577125 DOI: 10.1111/ced.14610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- G Ho
- Departments of, Dermatology, St George Hospital, Sydney, NSW, Australia
| | - T Sheriff
- Departments of, Dermatology, St George Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - M Doria-Ruiz
- University of New South Wales, Sydney, NSW, Australia
| | - Y Loh
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
| | - D F Murrell
- Departments of, Dermatology, St George Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, Australia
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Oh S, Lam A, Sivalingam J, Lim Z, Loh Y, Reuveny S, Malleret B. Generation of high densities of universal O-ve red blood cells from human induced pluripotent stem cells in bioreactors. Cytotherapy 2021. [DOI: 10.1016/s1465324921002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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LI Y, Chen X, Kwan T, Loh Y, Singer J, Tan J, Macia L, Chadban S, Wu H. SUN-303 DIETARY MANIPULATION OF THE GUT MICROBIOTA REDUCES DIABETIC KIDNEY INJURY IN MICE. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.709] [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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6
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Favaloro J, Chen A, Kan F, Velickovic Z, Macpherson J, Loh Y, Costa M, Marks D, Rasko J. Evaluation of human platelet lysate (HPL) as a substitute for foetal bovine serum (FBS) and recombinant proteins for the growth and maintenance of bone marrow derived mesenchymal stromal cells (BM-MSC). Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.505] [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]
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7
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Loh Y, Sturm M, Costa M, Brownrigg L, Nichols S, Marks D. Human platelet lysate is suitable for the propagation of human bone marrow derived mesenchymal stromal cells. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Bhogal P, Pederzani G, Grytsan A, Loh Y, Brouwer PA, Andersson T, Gundiah N, Robertson AM, Watton PN, Söderman M. Correction to: The unexplained success of stentplasty vasospasm treatment : Insights using Mechanistic Mathematical Modeling. Clin Neuroradiol 2019; 29:775. [PMID: 31020336 DOI: 10.1007/s00062-019-00782-4] [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: 10/26/2022]
Abstract
Correction to: Clin Neuroradiol 2019 https://doi.org/10.1007/s00062-019-00776-2 The original version of this article unfortunately contained a mistake. The Acknowledgements were missing. The correct information is given ….
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Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
| | - G Pederzani
- Department of Computer Science, University of Sheffield, Sheffield, UK.,Insigneo Institue for in silico Medicine, University of Sheffield, Sheffield, UK
| | - A Grytsan
- Insigneo Institue for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Y Loh
- Uniformed Services University, University of California, Los Angeles, USA.,Swedish Neuroscience Institute, 550 17th Avenue Seattle, 98122, Washington, USA
| | - P A Brouwer
- The Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - T Andersson
- The Karolinska University Hospital, 171 76, Stockholm, Sweden.,AZ Groeninge, Kortrijk, Belgium
| | - Namrata Gundiah
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore, India
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul N Watton
- Department of Computer Science, University of Sheffield, Sheffield, UK.,Insigneo Institue for in silico Medicine, University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
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9
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Bhogal P, Pederzani G, Grytsan A, Loh Y, Brouwer PA, Andersson T, Gundiah N, Robertson AM, Watton PN, Söderman M. The unexplained success of stentplasty vasospasm treatment : Insights using Mechanistic Mathematical Modeling. Clin Neuroradiol 2019; 29:763-774. [PMID: 30915482 DOI: 10.1007/s00062-019-00776-2] [Citation(s) in RCA: 9] [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: 07/09/2018] [Accepted: 03/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral vasospasm (CVS) following subarachnoid hemorrhage occurs in up to 70% of patients. Recently, stents have been used to successfully treat CVS. This implies that the force required to expand spastic vessels and resolve vasospasm is lower than previously thought. OBJECTIVE We develop a mechanistic model of the spastic arterial wall to provide insight into CVS and predict the forces required to treat it. MATERIAL AND METHODS The arterial wall is modelled as a cylindrical membrane using a constrained mixture theory that accounts for the mechanical roles of elastin, collagen and vascular smooth muscle cells (VSMC). We model the pressure diameter curve prior to CVS and predict how it changes following CVS. We propose a stretch-based damage criterion for VSMC and evaluate if several commercially available stents are able to resolve vasospasm. RESULTS The model predicts that dilatation of VSMCs beyond a threshold of mechanical failure is sufficient to resolve CVS without damage to the underlying extracellular matrix. Consistent with recent clinical observations, our model predicts that existing stents have the potential to provide sufficient outward force to successfully treat CVS and that success will be dependent on an appropriate match between stent and vessel. CONCLUSION Mathematical models of CVS can provide insights into biological mechanisms and explore treatment approaches. Improved understanding of the underlying mechanistic processes governing CVS and its mechanical treatment may assist in the development of dedicated stents.
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Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK.
| | - G Pederzani
- Department of Computer Science, University of Sheffield, Sheffield, UK.,Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - A Grytsan
- Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Y Loh
- Uniformed Services University, University of California, Los Angeles, USA.,Swedish Neuroscience Institute, 550 17th Avenue Seattle, 98122, Washington, USA
| | - P A Brouwer
- The Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - T Andersson
- The Karolinska University Hospital, 171 76, Stockholm, Sweden.,AZ Groeninge, Kortrijk, Belgium
| | - Namrata Gundiah
- Department of Mechanical Engineering, Indian Institute of Science, Bangalore, India
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Paul N Watton
- Department of Computer Science, University of Sheffield, Sheffield, UK.,Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK.,Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
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Wang J, Yong L, Chan W, So G, Loh Y, Peh K. THE ROLE OF PARA-COUNSELLOR IN THE PROVISION OF INTEGRATED PSYCHO-EMOTIONAL CARE FOR OLDER PERSONS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4357] [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: 11/12/2022] Open
Affiliation(s)
- J. Wang
- Tsao Foundation, Singapore, Singapore
| | - L. Yong
- Tsao Foundation, Singapore, Singapore
| | - W. Chan
- Tsao Foundation, Singapore, Singapore
| | - G. So
- Tsao Foundation, Singapore, Singapore
| | - Y. Loh
- Tsao Foundation, Singapore, Singapore
| | - K. Peh
- Tsao Foundation, Singapore, Singapore
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11
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Lam A, Sivalingam J, Chen A, Reuveny S, Loh Y, Oh S. Microcarrier-based platforms for derivation, expansion and differentiation of induced pluripotent stem cells. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.356] [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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12
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Tan D, Diong CP, Loh Y, Goh YT. Histone deacetylase (HDAC) inhibitors when combined with a proteasome inhibitor are safe and effective in patients with extranodal natural killer/T-cell lymphoma (ENKTL). Ann Oncol 2016; 27:1811-2. [PMID: 27287208 DOI: 10.1093/annonc/mdw231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Tan
- Raffles Cancer Centre, Raffles Hospital, Singapore
| | - C P Diong
- Department of Haematology, Singapore General Hospital, Singapore, Republic of Singapore
| | - Y Loh
- Raffles Cancer Centre, Raffles Hospital, Singapore
| | - Y T Goh
- Department of Haematology, Singapore General Hospital, Singapore, Republic of Singapore
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13
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Phipps C, Ng HY, Appan P, Loh Y, Koh M, Ho AYL, Lee JJ, Linn YC, Tan BH, Goh YT, Hwang W. BK-virus prophylaxis: still no answer. Bone Marrow Transplant 2013. [PMID: 23645168 DOI: 10.1013/bmt.2013.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- C Phipps
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
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14
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Linn YC, Niam M, Chu S, Choong A, Yong HX, Heng KK, Hwang W, Loh Y, Goh YT, Suck G, Chan M, Koh M. The anti-tumour activity of allogeneic cytokine-induced killer cells in patients who relapse after allogeneic transplant for haematological malignancies. Bone Marrow Transplant 2011; 47:957-66. [PMID: 21986635 DOI: 10.1038/bmt.2011.202] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We performed a Phase I/II clinical trial to study the feasibility, toxicity and efficacy of allogeneic cytokine-induced killer (CIK) cell expansion, and treatment for patients with haematological malignancies who relapsed after allogeneic haemopoietic SCT (allo-HSCT). Allogeneic CIK cells were successfully generated for a total of 24 patients, including those from patients' own leukapheresis products in 5 patients who had no access to further donor cells. The median CD3(+) T-cell expansion was 9.33 (1.3-38.97) fold, and CD3(+)CD56(+) natural killer (NK)-like T-cell expansion was 27.77 (2.59-438.93) fold. A total of 55 infusions were done for 16 patients who had either failed or progressed after initial response to various individualized chemotherapy regimens and donor lymphocyte infusion (DLI), at doses ranging from 10 to 200 million CD3(+) cells/kg. Response attributable to CIK cell infusion was observed in five patients. These included two with ALL, two with Hodgkin's disease (HD) and one with AML, and two of whom had a response sustained for more than 2 years. Acute GVHD occurred in three and was easily treatable. This study provides some evidence suggestive of the efficacy of allogeneic CIK cells even after failure of DLI in some cases.
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Affiliation(s)
- Y-C Linn
- Department of Haematology, Singapore General Hospital, Outram Road, Singapore.
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15
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Loh Y. Teaching Neuro Images: Another CC fistula. Neurology 2011. [DOI: 10.1212/wnl.0b013e318219fa89] [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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16
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Loh Y, Shi Z. The endovascular management of ischemic stroke. J Neurosurg Sci 2011; 55:7-26. [PMID: 21464806] [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: 05/30/2023]
Abstract
Endovascular techniques are showing promise as both alternative as well as primary therapies for ischemic strokes. These procedures are continuously evolving as the patient population and clinical expectations increase while materials and imaging technology advances to match those demands. Many of these techniques have yet to demonstrate the rigorous proof of benefit gained only through a randomized controlled trial, in part due to the emergent nature and devastating natural history of some ischemic strokes. Multi-disciplinary neurovascular centers are spearheading the rapid accumulation of both data and experience, which will one day hopefully validate the application of some if not all of these techniques. This review is aimed at summarizing the major categories of available techniques, the existing evidence leading to and supporting their employment, and the ongoing data collection intended to eventually establish them as standards in clinical practice.
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Affiliation(s)
- Y Loh
- Madigan Army Medical Center, Tacoma, Washington, DC, USA.
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17
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Loh Y, How G, Hwang W, Linn Y, Goh Y, Diong C, Wong G, Lim L. Improved Survival of Patients With Acute Myeloid Leukemia With Normal Cytogenetics and FLT3-ITD Mutation After Allogeneic Hematopoietic Cell Transplant: Concurrent NPM1 Mutation Not Associated With Better Outcomes. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Loh Y, Liebeskind DS, Shi ZS, Jahan R, Gonzalez NR, Tateshima S, Vespa PM, Starkman S, Saver JL, Viñuela F, Duckwiler GR. Partial recanalization of concomitant internal carotid-middle cerebral arterial occlusions promotes distal recanalization of residual thrombus within 24 h. J Neurointerv Surg 2010; 3:38-42. [PMID: 21990786 DOI: 10.1136/jnis.2009.002097] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Acute, simultaneous, concomitant internal carotid artery (ICA) and middle cerebral arteries (MCA) occlusions almost invariably lead to significant neurological disability if left untreated. Endovascular therapy is frequently the method of treatment in such situations but there remains a chance of incomplete recanalization. Successful recanalization of the proximal aspect of the occlusion may allow for endogenous thrombolysis and facilitate further endogenous recanalization of any residual MCA occlusion. METHODS Consecutive patients with acute ischemic stroke undergoing endovascular therapy for tandem extracranial ICA-MCA or contiguous intracranial ICA-MCA occlusions were retrospectively analyzed. Rates of facilitated endogenous recanalization at 24 h (FER(24)) were compared by imaging within the immediate post-intervention 5-24 h period in those with proximal recanalization and in those without. RESULTS 17 patients were included in the analysis. 12 patients had good initial proximal recanalization but a residual partial or total occlusion of the MCA while five patients failed any recanalization. Seven patients (58.3%) in the first group and none in the second had FER(24) on interval imaging after intervention (p=0.04). The probability of death and disability at discharge was less in patients with FER(24) than those without (p=0.05). CONCLUSIONS More than half of all patients who present with both ICA and MCA occlusions who are only partially recanalized will undergo facilitated endogenous recanalization within the subsequent 24 h following intervention.
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Affiliation(s)
- Y Loh
- Division of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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Loh Y, McArthur DL, Vespa P, Shi ZS, Liebeskind DS, Jahan R, Gonzalez NR, Starkman S, Saver JL, Tateshima S, Duckwiler GR, Viñuela F. The risk of acute radiocontrast-mediated kidney injury following endovascular therapy for acute ischemic stroke is low. AJNR Am J Neuroradiol 2010; 31:1584-7. [PMID: 20522566 DOI: 10.3174/ajnr.a2136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy is an alternative for the treatment of AIS resulting from large intracranial arterial occlusions that depends on the use of iodinated RCM. The risk of RCM-mediated AKI following endovascular therapy for AIS may be different from that following coronary interventions because patients may not have identical risk factors. MATERIALS AND METHODS All consecutive patients with large-vessel AIS undergoing endovascular therapy were prospectively recorded. We recorded the baseline kidney function, and RCM-AKI was assessed according to the AKIN criteria at 48 hours after RCM administration. We compared the rate of RCM-AKI 48 hours after the procedure and sought to determine whether any preexisting factors increased the risk of RCM-AKI. RESULTS We identified 99 patients meeting inclusion criteria. The average volume of contrast was 189 ± 71 mL, and the average creatinine change was -4.6% at 48 hours postangiography. There were 3 patients with RCM-AKI. Although all 3 patients died as a result of their strokes, return to baseline creatinine levels occurred before death. There was a trend toward higher rates of premorbid diabetes mellitus, chronic renal insufficiency, preadmission statin and NSAID use, and a higher serum creatinine level on admission for the RCM-AKI group. The volume of procedural contrast was similar between groups (those with and those without RCM-AKI) (P = .5). CONCLUSIONS In this small study, the rate of RCM-AKI following endovascular intervention for AIS was very low. A much larger study is required to determine its true incidence.
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Affiliation(s)
- Y Loh
- Division of Neurosurgery, David Geffen School of Medicine at the University of California at Los Angeles, CA, USA.
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Burt RK, Abinun M, Farge-Bancel D, Fassas A, Hiepe F, Havrdova E, Ikehara S, Loh Y, Marmont du Haut Champ A, Voltarelli JC, Snowden J, Slavin S. Risks of Immune System Treatments. Science 2010; 328:825-6. [DOI: 10.1126/science.328.5980.825-e] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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21
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Loh Y, Jahan R, McArthur DL, Shi ZS, Gonzalez NR, Duckwiler GR, Vespa PM, Starkman S, Saver JL, Tateshima S, Liebeskind DS, Viñuela F. Recanalization rates decrease with increasing thrombectomy attempts. AJNR Am J Neuroradiol 2010; 31:935-9. [PMID: 20075091 DOI: 10.3174/ajnr.a1958] [Citation(s) in RCA: 41] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Use of the Merci retriever is increasing as a means to reopen large intracranial arterial occlusions. We sought to determine whether there is an optimum number of retrieval attempts that yields the highest recanalization rates and after which the probability of success decreases. MATERIALS AND METHODS All consecutive patients undergoing Merci retrieval for large cerebral artery occlusions were prospectively tracked at a comprehensive stroke center. We analyzed ICA, M1 segment of the MCA, and vertebrobasilar occlusions. We compared the revascularization of the primary AOL with the number of documented retrieval attempts used to achieve that AOL score. For tandem lesions, each target lesion was compared separately on the basis of where the device was deployed. RESULTS We identified a total of 97 patients with 115 arterial occlusions. The median number of attempts per target vessel was 3, while the median final AOL score was 2. Up to 3 retrieval attempts correlated with good revascularization (AOL 2 or 3). When >or=4 attempts were performed, the end result was more often failed revascularization (AOL 0 or 1) and procedural complications (P = .006). CONCLUSIONS In our experience, 3 may be the optimum number of Merci retrieval attempts per target vessel occlusion. Four or more attempts may not improve the chances of recanalization, while increasing the risk of complications.
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Affiliation(s)
- Y Loh
- Division of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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22
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Linn YC, Phang CY, Lim TJ, Chong SF, Heng KK, Lee JJ, Loh Y, Hwang W, Goh YT, Koh M. Effect of missing killer-immunoglobulin-like receptor ligand in recipients undergoing HLA full matched, non-T-depleted sibling donor transplantation: a single institution experience of 151 Asian patients. Bone Marrow Transplant 2009; 45:1031-7. [DOI: 10.1038/bmt.2009.303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Koh MBC, Goh YT, Tan PHC, Koh LP, Hwang WYK, Loh Y, Tan D, Ng HJ, Chuah C, Lim TJ, Niam M, Suck G, Chan M, Phang CY, Lee JJ, Wee V, Ng HY, Lim CH, Yiu R, Kam G, Ang A, Linn YC. Stem cell transplantation programme at Singapore General Hospital. Bone Marrow Transplant 2008; 42 Suppl 1:S121-S124. [DOI: 10.1038/bmt.2008.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Oyama Y, Sufit R, Loh Y, Statkute L, Yaung K, Quigley K, Gonda E, Spahovic D, Bronesky D, Burt RK. Nonmyeloablative autologous hematopoietic stem celltransplantation for refractory CIDP. Neurology 2007; 69:1802-3. [PMID: 17967996 DOI: 10.1212/01.wnl.0000277266.53449.8b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Y Oyama
- Department of Medicine, Division of Immunotherapy, Feinberg School of Medicine, Northwestern University, 750 N. Lakeshore Dr. 649, Chicago, IL 60611, USA
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Statkute L, Oyama Y, Barr WG, Sufit R, Ho S, Verda L, Loh Y, Yaung K, Quigley K, Burt RK. Autologous non-myeloablative haematopoietic stem cell transplantation for refractory systemic vasculitis. Ann Rheum Dis 2007; 67:991-7. [PMID: 17947303 DOI: 10.1136/ard.2007.070227] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE For patients with systemic vasculitis (SV) refractory to conventional therapy, new treatment strategies aimed at aggressive induction of remission and relapse prevention are being sought. We herein report our single-centre experience in treating four patients with refractory SV employing non-myeloablative autologous haematopoietic stem cell transplantation (HSCT). METHODS Four patients with refractory SV (two with neurovascular Behcet disease, one with neurovascular Sjögren syndrome, and one with Wegener granulomatosis) were involved in an Institutional Review Board (IRB) and US Food and Drug Administration (FDA) approved phase I clinical trial of high dose chemotherapy and autologous HSCT. Peripheral blood stem cells were mobilised with cyclophosphamide (Cy) and granulocyte-colony stimulating factor (G-CSF). Conditioning regimen consisted of Cy 200 mg/kg and rabbit anti-thymocyte globulin 5.5 mg/kg intravenously (iv). RESULTS All four patients tolerated HSCT well without transplant related mortality or any significant toxicity. At median follow-up of 28 (range 22-36) months all patients were alive. Three patients (one with Behcet disease, one with Sjögren syndrome, and one with Wegener granulomatosis) entered a sustained remission at 6, 6 and 24 months, respectively, after transplant. They had significant decrease in disease activity and disease or treatment related damage, as measured by the Birmingham Vasculitis Activity Score and Vasculitis Damage Index, respectively. All three patients who achieved remission discontinued immunosuppressive therapy at the time of transplant and have not required treatment since. One patient with Behcet disease and positive for human leukocyte antigen (HLA)-B51 has not improved after HSCT. CONCLUSION We suggest non-myeloablative autologous HSCT is an alternative therapy for select patients with SV refractory to conventional immunosuppressive therapies.
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Affiliation(s)
- L Statkute
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, Suite 649, Chicago, Illinois 60611, USA
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26
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Loh Y, Oyama Y, Statkute L, Traynor A, Satkus J, Quigley K, Yaung K, Barr W, Bucha J, Gheorghiade M, Burt RK. Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus patients with cardiac dysfunction: feasibility and reversibility of ventricular and valvular dysfunction with transplant-induced remission. Bone Marrow Transplant 2007; 40:47-53. [PMID: 17483845 DOI: 10.1038/sj.bmt.1705698] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with cardiac dysfunction may be at increased risk of cardiac toxicity when undergoing hematopoietic stem cell transplantation (HSCT), which may preclude them from receiving this therapy. Cardiac dysfunction is, however, common in systemic lupus erythematosus (SLE) patients. While autologous HSCT (auto-HSCT) has been performed increasingly for SLE, its impact on cardiac function has not previously been evaluated. We, therefore, performed a retrospective analysis of SLE patients who had undergone auto-HSCT in our center to determine the prevalence of significant cardiac involvement, and the impact of transplantation on this. The records of 55 patients were reviewed, of which 13 were found to have abnormal cardiac findings on pre-transplant two-dimensional echocardiography or multi-gated acquisition scan: impaired left ventricular ejection fraction (LVEF) (n = 6), pulmonary hypertension (n = 5), mitral valve dysfunction (n = 3) and large pericardial effusion (n = 1). At a median follow-up of 24 months (8-105 months), there were no transplant-related or cardiac deaths. With transplant-induced disease remission, all patients with impaired LVEF remained stable or improved; while three with symptomatic mitral valve disease similarly improved. Elevated pulmonary pressures paralleled activity of underlying lupus. These data suggest that auto-HSCT is feasible in selected patients with lupus-related cardiac dysfunction, and with control of disease activity, may improve.
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Affiliation(s)
- Y Loh
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Loh Y, Oyama Y, Statkute L, Verda L, Quigley K, Yaung K, Barr W, Jovanovic B, Burt RK. Non-myeloablative allogeneic hematopoietic stem cell transplantation for severe systemic sclerosis: graft-versus-autoimmunity without graft-versus-host disease? Bone Marrow Transplant 2007; 39:435-7. [PMID: 17310133 DOI: 10.1038/sj.bmt.1705611] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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28
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Statkute L, Verda L, Oyama Y, Traynor A, Villa M, Shook T, Clifton R, Jovanovic B, Satkus J, Loh Y, Quigley K, Yaung K, Gonda E, Krosnjar N, Spahovic D, Burt RK. Mobilization, harvesting and selection of peripheral blood stem cells in patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 39:317-29. [PMID: 17277794 DOI: 10.1038/sj.bmt.1705579] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral blood stem cells (PBSC) were mobilized in 130 patients with autoimmune diseases undergoing autologous hematopoietic stem cell transplantation using cyclophosphamide 2 g/m(2) and either granulocyte colony-stimulating factor (G-CSF) 5 mcg/kg/day (for systemic lupus erythematosus (SLE) and secondary progressive multiple sclerosis, SPMS) or G-CSF 10 mcg/kg/day (for relapsing remitting multiple sclerosis (RRMS), Crohn's disease (CD), systemic sclerosis (SSc), and other immune-mediated disorders). Mobilization-related mortality was 0.8% (one of 130) secondary to infection. Circulating peripheral blood (PB) CD34(+) cells/microl differed significantly by disease. Collected CD34(+) cells/kg/apheresis and overall collection efficiency was significantly better using Spectra apheresis device compared to the Fenwall CS3000 instrument. Patients with SLE and RRMS achieved the lowest and the highest CD34(+) cell yields, respectively. Ex vivo CD34(+) cell selection employing Isolex 300iv2.5 apparatus was significantly more efficient compared to CEPRATE CS device. Circulating PB CD34(+) cells/microl correlated positively with initial CD34(+) cells/kg/apheresis and enriched product CD34(+) cells/kg. Mean WBC and platelet engraftment (ANC>0.5 x 10(9)/l and platelet count >20 x 10(9)/l) occurred on days 9 and 11, respectively. Infused CD34(+) cell/kg dose showed significant direct correlation with faster white blood cell (WBC) and platelet engraftment. When adjusted for CD34(+) cell/kg dose, patients treated with a myeloablative regimen had significantly slower WBC and platelet recovery compared to non-myeloablative regimens.
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Affiliation(s)
- L Statkute
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Tan D, Wong GC, Koh LP, Hwang W, Loh Y, Linn YC, Goh YT. Successful treatment of primary granulocytic sarcoma by non-myeloablative stem cell transplant. Leuk Lymphoma 2006; 47:159-62. [PMID: 16321843 DOI: 10.1080/10428190500301140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pre-leukemic granulocytic sarcoma (GS) may pose an initial diagnostic problem and its therapeutic approach has never been formally established. To our knowledge, non-myeloablative stem cell transplantation has been reported in cases of leukemic GS, but not in primary GS. We report a case of primary GS with extensive and aggressive presenting features and successfully treated with intensive chemotherapy followed by non-myeloablative allogeneic stem cell transplant. This resulted in complete remission with minimal complications. Our case demonstrates the potential of graft-vs.-tumour effect in the treatment of GS and suggests that non-myeloablative allogeneic stem cell transplant may be a feasible therapeutic approach for primary GS.
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Affiliation(s)
- D Tan
- Department of Hematology, Singapore General Hospital, Singapore.
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