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Piron L, Van Eester D, Frigione D, Garzotti L, Lomas P, Lennholm M, Rimini F, Auriemma F, Baruzzo M, Carvalho P, Ferreira D, Field A, Kirov K, Stancar Z, Stuart C, Valcarcel D. Radiation control in deuterium, tritium and deuterium-tritium JET baseline plasmas – part I. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Piron L, Valcarcel D, Lennholm M, Stuart C, Carvalho I, Felton R, Ferreira D, Fontana M, Lomas P, La Luna ED, Peacock A, Pau A, Piron C, Rimini F, Sozzi C. Progress in preparing real-time control schemes for Deuterium-Tritium operation in JET. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Piron L, Challis C, Felton R, King D, Lennholm M, Lomas P, Piron C, Rimini F, Valcarcel D. The dud detector: An empirically-based real-time algorithm to save neutron and T budgets during JET DT operation. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.02.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Casanovas N, Narro F, Del Castillo P, Guma J, Pujol E, Caresia P, Garcia-Vega D, Valcarcel D, Berna L, Martinez-Rubio A. P135Pharmacologic stress SPECT. Are we properly selecting patients for invasive evaluation? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez147.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Casanovas
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - F Narro
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - P Del Castillo
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - J Guma
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - E Pujol
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - P Caresia
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Nuclear Medicine, Sabadell, Spain
| | - D Garcia-Vega
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - D Valcarcel
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
| | - L Berna
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Nuclear Medicine, Sabadell, Spain
| | - A Martinez-Rubio
- Hospital de Sabadell. Institut Universitari Parc Tauli-UAB, Cardiology, Sabadell, Spain
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Iglesias D, Bunting P, Esquembri S, Hollocombe J, Silburn S, Vitton-Mea L, Balboa I, Huber A, Matthews G, Riccardo V, Rimini F, Valcarcel D. Digital twin applications for the JET divertor. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lennholm M, Carvalho I, Cave-Ayland K, Chagnard A, Challis C, Felton R, Frigione D, Garzotti L, Goodyear A, Graves J, Guillemaut C, Harrison J, Lerche E, Lomas P, Mooney R, Rimini F, Sips A, Sozzi C, Valcarcel D, Vega J. Real time control developments at JET in preparation for deuterium-tritium operation. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cabrero M, Lopez-Corral L, de la Cruz F, Jarque I, Valcarcel D, Perez-Lopez E, Martin A, Sanchez-Guijo F, Grande C, Martin-Calvo M, Martin A, Caballero D. Results of a prospective phase II trial with ofatumumab as part of reduced intensity conditioning regimen in high-risk non-Hodgkin B lymphoma patients: A GELTAMO trial. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_96] [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: 11/11/2022]
Affiliation(s)
- M. Cabrero
- Hematology; Salamanca University Hospital; Salamanca Spain
| | | | - F. de la Cruz
- Hematology; Virgen del Rocio University Hospital; Sevilla Spain
| | - I. Jarque
- Hematology; La Fe University Hospital; Valencia Spain
| | - D. Valcarcel
- Hematology; Hospital Vall d'Hebron; Barcelona Spain
| | - E. Perez-Lopez
- Hematology; Salamanca University Hospital; Salamanca Spain
| | - A. Martin
- Hematology; Salamanca University Hospital; Salamanca Spain
| | | | - C. Grande
- Hematology; 12 de Octubre University Hospital; Madrid Spain
| | | | - A. Martin
- Hematology; Salamanca University Hospital; Salamanca Spain
| | - D. Caballero
- Hematology; Salamanca University Hospital; Salamanca Spain
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Garcia-Manero G, Sekeres MA, Egyed M, Breccia M, Graux C, Cavenagh JD, Salman H, Illes A, Fenaux P, DeAngelo DJ, Stauder R, Yee K, Zhu N, Lee JH, Valcarcel D, MacWhannell A, Borbenyi Z, Gazi L, Acharyya S, Ide S, Marker M, Ottmann OG. A phase 1b/2b multicenter study of oral panobinostat plus azacitidine in adults with MDS, CMML or AML with ⩽30% blasts. Leukemia 2017; 31:2799-2806. [PMID: 28546581 PMCID: PMC5729337 DOI: 10.1038/leu.2017.159] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/13/2017] [Accepted: 02/23/2017] [Indexed: 12/15/2022]
Abstract
Treatment with azacitidine (AZA), a demethylating agent, prolonged overall survival (OS) vs conventional care in patients with higher-risk myelodysplastic syndromes (MDS). As median survival with monotherapy is <2 years, novel agents are needed to improve outcomes. This phase 1b/2b trial (n=113) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of panobinostat (PAN)+AZA (phase 1b) and evaluate the early efficacy and safety of PAN+AZA vs AZA monotherapy (phase 2b) in patients with higher-risk MDS, chronic myelomonocytic leukemia or oligoblastic acute myeloid leukemia with <30% blasts. The MTD was not reached; the RP2D was PAN 30 mg plus AZA 75 mg/m2. More patients receiving PAN+AZA achieved a composite complete response ([CR)+morphologic CR with incomplete blood count+bone marrow CR (27.5% (95% CI, 14.6–43.9%)) vs AZA (14.3% (5.4–28.5%)). However, no significant difference was observed in the 1-year OS rate (PAN+AZA, 60% (50–80%); AZA, 70% (50–80%)) or time to progression (PAN+AZA, 70% (40–90%); AZA, 70% (40–80%)). More grade 3/4 adverse events (97.4 vs 81.0%) and on-treatment deaths (13.2 vs 4.8%) occurred with PAN+AZA. Further dose or schedule optimization may improve the risk/benefit profile of this regimen.
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Affiliation(s)
- G Garcia-Manero
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M A Sekeres
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - M Egyed
- Kaposi Mor County Teaching Hospital, Kasposvár, Hungary
| | | | - C Graux
- Mont-Godinne University Hospital, Yvoir, Belgium
| | | | - H Salman
- Augusta University, Augusta, GA, USA
| | - A Illes
- University of Debrecen, Debrecen, Hungary
| | - P Fenaux
- Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | | | - R Stauder
- Innsbruck Medical University, Innsbruck, Austria
| | - K Yee
- Princess Margaret Cancer Centre, Toronto, Canada
| | - N Zhu
- University of Alberta Hospital, Edmonton, Canada
| | - J-H Lee
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | | | - A MacWhannell
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - L Gazi
- Novartis Pharma AG, Basel, Switzerland
| | - S Acharyya
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Ide
- Novartis Pharmaceuticals Corporation, Cambridge, MA, USA
| | - M Marker
- Novartis Pharma S.A.S., Rueil-Malmaison, France
| | - O G Ottmann
- Department of Haematology, School of Medicine, Cardiff University, Cardiff, UK
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Merchan B, Casares V, Salamero O, Carpio C, Gallur L, Molero A, Blanco A, Montoro J, Tazon B, Valcarcel D. Characteristics and Prognosis of Patients Diagnosed with AML and MDS Who Were Excluded from Clinical Trials. A Retrospective Single-Center Analysis. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30195-9] [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]
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García-Cadenas I, Rivera I, Martino R, Esquirol A, Barba P, Novelli S, Orti G, Briones J, Brunet S, Valcarcel D, Sierra J. Patterns of infection and infection-related mortality in patients with steroid-refractory acute graft versus host disease. Bone Marrow Transplant 2016; 52:107-113. [PMID: 27595281 DOI: 10.1038/bmt.2016.225] [Citation(s) in RCA: 39] [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] [Received: 05/30/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 01/20/2023]
Abstract
This study aimed to characterize the incidence, etiology and outcome of infectious episodes in patients with steroid refractory acute GvHD (SR-GvHD). The cohort included 127 adults treated with inolimomab (77%) or etanercept (23%) owing to acute 2-4 SR-GvHD, with a response rate of 43% on day +30 and a 4-year survival of 15%. The 1-year cumulative incidences of bacterial, CMV and invasive fungal infection were 74%, 65% and 14%, respectively. A high rate (37%) of enterococcal infections was observed. Twenty patients (15.7%) developed BK virus-hemorrhagic cystitis and five percent had an EBV reactivation with only one case of PTLD. One-third of long-term survivors developed pneumonia by a community respiratory virus and/or encapsulated bacteria, mostly associated with chronic GvHD. Infections were an important cause of non-relapse mortality, with a 4-year incidence of 46%. In multivariate analysis, use of rituximab in the 6 months before SCT (hazard ratio; HR 4.2; 95% confidence interval; CI 1.1-16.3), severe infection before SR-GvHD onset (HR 5.8; 95% CI 1.3-26.3) and a baseline C-reactive protein >15 UI/mL (HR 2.9; 95% CI 1.1-8.5) were associated with infection-related mortality. High rates of opportunistic infections with remarkable mortality warrant further efforts to optimize long-term outcomes after SR-GvHD.
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Affiliation(s)
- I García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Rivera
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - R Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Barba
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Orti
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Brunet
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Valcarcel
- Hematology Department, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute and IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Merchan B, Ortega M, Llamas-Poyato M, Cortés M, Arnan M, Cerveró C, Montoro J, Gimenez T, López M, Arenillas L, Valcarcel D. 271 ACQUISITION OF CYTOGENETIC ABNORMALITIES IN PATIENTS WITH IPSS LOW AND INTERMEDIATE-1 RISK. STUDY FROM THE SPANISH GROUP OF MYELODYSPLASTIC SYNDROME. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30272-1] [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]
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Garcia-Manero G, Platzbecker U, Santini V, Voso M, Garcia R, Valcarcel D, Silverman L, Almeida A, Giagounidis A, Larsen S, Kreitz S, Hoenekopp A, Skikne B. 100 INTERNATIONAL, RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF CC-486 (ORAL AZACITIDINE) IN PATIENTS WITH IPSS INTERMEDIATE-1 MYELODYSPLASTIC SYNDROMES WITH RBC-TRANSFUSION-DEPENDENT ANEMIA AND THROMBOCYTOPENIA: THE QUAZAR LOWER-RISK MDS TRIAL. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30101-6] [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]
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13
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Parody R, Lopez-Corral L, Godino OL, Cadenas IG, Martinez AP, Vazquez L, Martino R, Martinez C, Solano C, Barba P, Valcarcel D, Caballero-Velazquez T, Marquez-Malaver FJ, Sierra J, Caballero D, Perez-Simón JA. GVHD prophylaxis with sirolimus-tacrolimus may overcome the deleterious effect on survival of HLA mismatch after reduced-intensity conditioning allo-SCT. Bone Marrow Transplant 2014; 50:121-6. [PMID: 25310306 DOI: 10.1038/bmt.2014.220] [Citation(s) in RCA: 8] [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: 04/02/2014] [Revised: 08/11/2014] [Accepted: 08/15/2014] [Indexed: 02/05/2023]
Abstract
Large studies, mostly based on series of patients receiving CSA/tacrolimus (TKR) plus MTX as immunoprophylaxis, have demonstrated a deleterious effect on survival of the presence of a single mismatch out of eight loci after allogeneic hematopoietic SCT (alloHSCT). We retrospectively analyzed a series of 159 adult patients who received sirolimus(SRL)/TKR prophylaxis after alloHSCT. We compared overall outcomes according to HLA compatibility in A, B, C and DRB1 loci at the allele level: 7/8 (n=20) vs 8/8 (n=139). Donor type was unrelated in 95% vs 70% among 7/8 vs 8/8 pairs, respectively (P=0.01). No significant differences were observed in 3-year OS (68 vs 62%), 3-year EFS (53 vs 49%) and 1-year non-relapse mortality (9 vs 13%). Cumulative incidence of grades II-IV acute GVHD (aGVHD) was significantly higher in 7/8 alloHSCT (68% vs 42%, P<0.001) but no significant differences were found for III-IV aGVHD (4.5% vs 11%), overall (35% vs 53%) and extensive (20% vs 35%) chronic GHVD in 7/8 vs 8/8 subgroups, respectively. In summary, the present study indicates favorable outcomes after alloHSCT using the combination of SRL/TKR combination as GVHD prophylaxis with OS in the range of 55-70%, and non-significant differences in overall outcomes, irrespective of the presence of any mismatches at obligatory loci.
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Affiliation(s)
- R Parody
- Servicio de Hematología, Hospital Universitario / Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain
| | | | - O L Godino
- Hospital Clínico de Salamanca, Salamanca, Spain
| | - I G Cadenas
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - L Vazquez
- Hospital Clínico de Salamanca, Salamanca, Spain
| | - R Martino
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - C Martinez
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - C Solano
- Hospital Clínico de Valencia, Valencia, Spain
| | - P Barba
- Hospital Vall d'Hebron, Barcelona, Spain
| | | | - T Caballero-Velazquez
- Servicio de Hematología, Hospital Universitario / Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain
| | - F J Marquez-Malaver
- Servicio de Hematología, Hospital Universitario / Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain
| | - J Sierra
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - D Caballero
- Hospital Clínico de Salamanca, Salamanca, Spain
| | - J A Perez-Simón
- Servicio de Hematología, Hospital Universitario / Instituto de Biomedicina (IBIS)/CSIC, Seville, Spain
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Hron M, Janky F, Pipek J, Sousa J, Carvalho B, Fernandes H, Vondracek P, Cahyna P, Urban J, Paprok R, Mikulín O, Aftanas M, Panek R, Havlicek J, Fortunato J, Batista A, Santos B, Duarte A, Pereira T, Valcarcel D. Overview of the COMPASS CODAC system. Fusion Engineering and Design 2014. [DOI: 10.1016/j.fusengdes.2013.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sanchez-Garcia J, Del Cañizo C, Such E, Nomdedeu B, Luño E, De Paz R, Xicoy B, Valcarcel D, Sierra A, Marco V, Garcia M, Osorio S, Tormo M, Bailen A, Cervero C, Torres-Gomez A, Ramos F, Diez-Campelo M, Belkaid M, Arrizabalaga B, Azaceta G, Bargay J, Arilla M, Caballero M, Falantes J, Sanz G. 64 A retrospective time-dependent comparative analysis of the impact of lenalidomide on outcomes in lower risk MDS with chromosome 5q deletion. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70066-2] [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: 10/18/2022]
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Halter J, Schüpbach W, Casali C, Elhasid R, Fay K, Hammans S, Illa I, Kappeler L, Krähenbühl S, Lehmann T, Mandel H, Marti R, Mattle H, Orchard K, Savage D, Sue CM, Valcarcel D, Gratwohl A, Hirano M. Allogeneic hematopoietic SCT as treatment option for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): a consensus conference proposal for a standardized approach. Bone Marrow Transplant 2010; 46:330-337. [PMID: 20436523 PMCID: PMC4578692 DOI: 10.1038/bmt.2010.100] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic hematopoietic SCT (HSCT) has been proposed as a treatment for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). HSCT has been performed in nine patients using different protocols with varying success. Based on this preliminary experience, participants of the first consensus conference propose a common approach to allogeneic HSCT in MNGIE. Standardization of the transplant protocol and the clinical and biochemical assessments will allow evaluation of the safety and efficacy of HSCT as well as optimization of therapy for patients with MNGIE.
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Affiliation(s)
- J Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Wmm Schüpbach
- Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux & INSERM UMR 679, Pitié-Salpxêtrière Group, Paris, France.,Department of Neurology, University Hospital-Inselspital Bern, Bern, Switzerland
| | - C Casali
- Neurology, La Sapienza University, University Hospital, Rome, Italy
| | - R Elhasid
- Pediatric-Oncology, Rambam Medical Centre, Haifa, Israel
| | - K Fay
- Department of Hematology, St Vincent's Hospital, Darlinghurst, Sydney, Australia
| | - S Hammans
- Wessex Neurological Centre, Southampton University Hospital Trust, Southampton, UK
| | - I Illa
- Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Kappeler
- Department of Neurology, University Hospital-Inselspital Bern, Bern, Switzerland
| | - S Krähenbühl
- Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland
| | - T Lehmann
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - H Mandel
- Pediatrics, Rambam Medical Centre, Haifa, Israel
| | - R Marti
- Institut de Recerca, University Hospital Vall d'Hebron and CIBERER, Barcelona, Spain
| | - H Mattle
- Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux & INSERM UMR 679, Pitié-Salpxêtrière Group, Paris, France.,Department of Neurology, University Hospital-Inselspital Bern, Bern, Switzerland
| | - K Orchard
- Department of Haematology, University of Southampton, Southampton, UK
| | - D Savage
- Department of Haematology, Columbia University Medical Centre, New York, NY, USA
| | - C M Sue
- Department of Neurogenetics, University of Sydney Kolling Institute for Medical Research, Kolling Institute for Medical Research, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - D Valcarcel
- Department of Hematology, Santa Creu i San Pau Hospital, Barcelona, Spain
| | - A Gratwohl
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - M Hirano
- Department of Neurology, Columbia University Medical Centre, New York, NY, USA
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Delgado J, Marco A, Moreno E, Piñana J, Valcarcel D, Martino R, Briones J, Sureda A, Brunet S, Sierra J. Reduced-intensity conditioning allogeneic hematopoietic cell transplantation using oral fludarabine as part of the conditioning regimen. Cytotherapy 2009; 11:356-61. [PMID: 19148841 DOI: 10.1080/14653240802582109] [Citation(s) in RCA: 4] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND In 2003, oral fludarabine was introduced for the treatment of patients with hematologic malignancies as an alternative to its intravenous (i.v.) formulation. In an attempt to simplify the management of patients undergoing reduced intensity allogeneic hematopoietic transplantation, we have incorporated oral fludarabine in the conditioning regimen. METHODS We present a non-randomized retrospective analysis of 37 patients conditioned with oral fludarabine compared with 144 patients conditioned with the i.v. formulation. In addition to fludarabine, the conditioning regimens also included melphalan or busulfan depending on the underlying disease. Donors were HLA-matched siblings in 75% of cases and unrelated donors in the remaining 25%. RESULTS Eight patients (22%) receiving oral fludarabine were switched to the i.v. route because of gastrointestinal toxicity (three patients), patient preference (two patients) and physician preference (three patients). There were no statistical differences in terms of hospital admission (P=0.16), time to neutrophil engraftment (P=0.35), time to platelet engraftment (P=0.38), acute graft versus host disease rate (P=0.71) and non-relapse mortality at days +30 (P=1.0) and +100 (P=0.43). DISCUSSION This preliminary analysis confirms that oral fludarabine can replace its i.v. formulation as part of reduced-intensity conditioning regimens with no deleterious effect on any of the early transplantation outcomes. In addition, oral fludarabine can be more convenient for patients and caregivers, facilitating its implementation.
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Affiliation(s)
- J Delgado
- Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Martino R, Piñana JL, Parody R, Valcarcel D, Sureda A, Brunet S, Briones J, Delgado J, Sánchez F, Rabella N, Sierra J. Lower respiratory tract respiratory virus infections increase the risk of invasive aspergillosis after a reduced-intensity allogeneic hematopoietic SCT. Bone Marrow Transplant 2009; 44:749-56. [PMID: 19398963 PMCID: PMC7091792 DOI: 10.1038/bmt.2009.78] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We have analyzed the incidence and risk factors for the occurrence of invasive aspergillosis (IA) among 219 consecutive recipients of an allogeneic hematopoietic SCT after a reduced-intensity conditioning regimen (Allo-RIC). Twenty-seven patients developed an IA at a median of 218 days (range 24–2051) post-Allo-RIC, for a 4-year incidence of 13% (95% confidence interval 4–24%). In multivariate analysis, risk factors for developing IA were steroid therapy for moderate-to-severe graft vs host disease (GVHD) (Hazard Ratio (HR) 2.9, P=0.03), occurrence of a lower respiratory tract infection (LRTI) by a respiratory virus (RV) (HR 4.3, P<0.01) and CMV disease (HR 2.8, P=0.03). Variables that decreased survival after Allo-RIC were advanced disease phase (HR 1.9, P=0.02), steroid therapy for moderate-to-severe GVHD (HR 2.2, P<0.01), not developing chronic GVHD (HR 4.3, P<0.01), occurrence of LRTI by an RV (HR 3.4, P<0.01) and CMV disease (HR 2, P=0.01), whereas occurrence of IA had no effect on survival (P=0.5). Our results show that IA is a common infectious complication after an Allo-RIC, which occurs late post-transplant and may not have a strong effect on survival. An important observation is the possible role of LRTI by conventional RVs as risk factors for IA.
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Affiliation(s)
- R Martino
- Division of Clinical Hematology, Hospital de la Sant Creu i Sant Pau, Autonomous University of Barcelona, Sant Antoni Maria Claret 167, Barcelona, Catalunya, Spain.
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