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Chen D, Yuan Z, Guo Y, Mo W, Liu W, Liang D, Chen A, Zhang Y, Zhang N, Wei X. Prognostic Impact of Quantifying Sarcopenia and Adipopenia by Chest CT in Severe Aplastic Anemia Patients Treated With Allogeneic Hematopoietic Stem Cell Transplantation. Acad Radiol 2023; 30:1936-1945. [PMID: 36379814 DOI: 10.1016/j.acra.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/24/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the prognostic role of chest CT-defined sarcopenia and adipopenia in severe aplastic anemia (SAA) patients treated with hematopoietic stem cell transplantation (HSCT). MATERIALS AND METHODS This was a retrospective study of 123 consecutive SAA patients treated with HSCT. CT imaging was performed to quantify the pectoralis muscle (including major and minor) index (PMI) and the corresponding subcutaneous adipose tissue index (SAI). Sarcopenia and adipopenia were defined as PMI and SAI lower than the respective sex-specific medians. Correlations of the PMI and SAI with anthropometric indexes were calculated. Transplant-related outcomes were compared between the sarcopenia and adipopenia groups. Prognostic factors for overall survival (OS) and fail-free survival (FFS) were identified by Cox regression and were used to create a nomogram. The accuracy of the nomogram was evaluated by ROC curves. RESULTS PMI showed good correlation with BMI and fat-free mass index (p < 0.001). SAI correlated with BMI and fat mass index (p < 0.001). The sarcopenia group (47.2%) had a significantly worse 3-year OS (90.8% vs. 77.6%, p = 0.045) and 3-year FFS (89.2% vs. 74.1%, p = 0.035) than the nonsarcopenia group. Sarcopenia status and diagnostic category were used to construct the nomogram of OS, as these were independent prognostic factors in the multivariate analysis for OS and FFS (p < 0.05). The area under the curve of the nomogram at one year and three years was 0.801 and 0.721, respectively. CONCLUSION Sarcopenia indicates a poor prognosis in SAA patients undergoing HSCT. Intensive supportive care is suggested for SAA patients with sarcopenia before transplantation.
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Affiliation(s)
- Dandan Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China; First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
| | - Zhaohu Yuan
- Department of Blood Transfusion, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
| | - Wenjian Mo
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Weifeng Liu
- Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Dan Liang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
| | - Amei Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
| | - Yan Zhang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
| | - Nianru Zhang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1 Panfu Rd, Yuexiu District, Guangzhou, 510180, Guangdong, China; First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China.
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Peng H, Ji D, Ren S, Zou D, Li F, Huang R. Severe Anaphylaxis During Allogeneic Hematopoietic Stem Cell Transplantation in a Patient with Aplastic Anemia: Case Report of Individualized Pharmaceutical Care and Literature Review. Clin Lab 2020; 66. [PMID: 32162881 DOI: 10.7754/clin.lab.2019.190722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cyclosporine injection is usually applied in allogeneic hematopoietic stem cell transplantation (Allo-HSCT) during induction phase. Anaphylaxis to cyclosporine injection is rare and how to deal with this issue in clinical practice is intractable. METHODS We report a Chinese male patient with aplastic anemia who underwent allogeneic bone marrow transplantation (BMT) from his brother where HLA totally matched (10/10). Cyclosporine at a dose of 3 mg/kg was started by continuous infusion over 24 hours on day -1 of BMT and the patient showed sever anaphylaxis symptoms. He was then given oral capsules of cyclosporine (Sandimmun) at a conversion ratio 2:1. No further anaphylactic reaction was observed. The BM cells were successfully engrafted without causing severe GVHD. Moreover, frequent TDM monitoring as well as CYP3A4/CYP3A5/MDR1 genotyping were given so as to tailor the oral dosage of cyclosporine individually and prevent the adverse reaction between cyclosporine and posaconazole. RESULTS The patient carried CYP3A5*3 GG genotype and the concentration of cyclosporine remained steady in the period of conversion and combination of cyclosporine and posaconazole. Consequently, the patient reported no allergy after conversion to oral cyclosporine. CONCLUSIONS Polyoxyethylated castor oil that is contained in cyclosporine may be the main allergen. Changing to oral capsules that do not contain this medicinal excipient instead of cyclosporine injection would no longer cause an allergic reaction. Rational use of immunosuppressants and prophylaxis antibiotics may need close cooperation between physicians and pharmacists to avoid side effects and harmful interactions.
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Robinson C, Boyce AM, Estrada A, Kleiner DE, Mathew R, Stanton R, Frangoul H, Collins MT. Bone marrow failure and extramedullary hematopoiesis in McCune-Albright syndrome. Osteoporos Int 2018; 29:237-241. [PMID: 29071359 PMCID: PMC6983319 DOI: 10.1007/s00198-017-4217-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/05/2017] [Indexed: 01/29/2023]
Abstract
In fibrous dysplasia/McCune-Albright syndrome (FD/MAS), bone and bone marrow are, to varying degrees, replaced by fibro-osseous tissue typically devoid of hematopoietic marrow. Despite the extensive marrow replacement in severely affected patients, bone marrow failure is not commonly associated with FD/MAS. We present a 14-year-old girl with FD/MAS, who developed pancytopenia and extramedullary hematopoiesis (EMH) with no identified cause, in the setting of iatrogenic thyrotoxicosis and hyperparathyroidism. Pancytopenia, requiring monthly blood transfusions, persisted despite multiple strategies to correct these endocrinopathies. Due to worsening painful splenomegaly, likely as a result of sequestration, splenectomy was performed. Following splenectomy, pancytopenia resolved and patient has since been transfusion-independent. We report the first detailed case of bone marrow failure and EMH in FD/MAS. The etiology of marrow failure is likely multifactorial and related to the loss of marrow reserve due to extensive polyostotic FD, exacerbated by iatrogenic thyrotoxicosis and hyperparathyroidism. Mini Abstract: A patient with fibrous dysplasia developed bone marrow failure and extramedullary hematopoiesis. The etiology likely involved loss of hematopoetic marrow space and uncontrolled endocrinopathies. Splenectomy was therapeutic.
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MESH Headings
- Adolescent
- Anemia, Aplastic/etiology
- Anemia, Aplastic/pathology
- Anemia, Aplastic/surgery
- Biopsy
- Bone Marrow/pathology
- Bone Marrow Diseases/etiology
- Bone Marrow Diseases/pathology
- Bone Marrow Diseases/surgery
- Bone Marrow Failure Disorders
- Female
- Fibrous Dysplasia, Polyostotic/complications
- Fibrous Dysplasia, Polyostotic/diagnostic imaging
- Fibrous Dysplasia, Polyostotic/physiopathology
- Hematopoiesis, Extramedullary/physiology
- Hemoglobinuria, Paroxysmal/etiology
- Hemoglobinuria, Paroxysmal/pathology
- Hemoglobinuria, Paroxysmal/surgery
- Humans
- Liver/pathology
- Pancytopenia/etiology
- Pancytopenia/surgery
- Radiography
- Splenectomy
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Affiliation(s)
- C Robinson
- Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - A M Boyce
- Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
- Division of Endocrinology and Diabetes, Children's National Health System, Washington, DC, USA
- Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Health System, Washington, DC, USA
| | - A Estrada
- Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
- Division of Endocrinology and Diabetes, Children's National Health System, Washington, DC, USA
- Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Health System, Washington, DC, USA
| | - D E Kleiner
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - R Mathew
- Pediatric Hematology Oncology, The Children's Hospital at TriStar Centennial, Sarah Cannon Research Institute 330 23rd Avenue North, Suite 450, Nashville, TN, 37203, USA
| | - R Stanton
- Nemours Children's Hospital, Orlando, FL, USA
| | - H Frangoul
- Pediatric Hematology Oncology, The Children's Hospital at TriStar Centennial, Sarah Cannon Research Institute 330 23rd Avenue North, Suite 450, Nashville, TN, 37203, USA.
| | - M T Collins
- Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
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Nair V, Apte S. Stem Cell Transplantation in Aplastic Anaemia. J Assoc Physicians India 2015; 63:21-25. [PMID: 26529863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Tsukamoto S, Nagao Y, Yamazaki A, Sugita Y, Muto T, Sakai S, Takeda Y, Mimura N, Takeuchi M, Ohwada C, Sakaida E, Yokote K, Iseki T, Nakaseko C. Successful Allogeneic Stem Cell Transplantation for Severe Aplastic Anemia after Treatment of Lymphoproliferative Disorder Caused by Rabbit Antithymocyte Globulin. Intern Med 2015; 54:3197-200. [PMID: 26666612 DOI: 10.2169/internalmedicine.54.5090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Immunosuppressive therapy (IST) with a combination of antithymocyte globulin (ATG) and cyclosporine (CsA) is an effective therapeutic modality for patients with aplastic anemia (AA) who are not eligible for allogeneic stem cell transplantation (Allo-SCT) from a human leukocyte antigen-identical sibling donor. However, there have been reports of some patients developing lymphoproliferative disorder (LPD) after IST for AA. We herein report a case of a 26-year-old man with severe AA (SAA) complicated by LPD after a single course of IST, who was successfully treated with Allo-SCT from an unrelated donor. Two months after starting IST for SAA, he developed LPD in the stomach. CsA was reduced, however, his neutrophil counts decreased, and CsA could not be discontinued. The patient was treated with rituximab monotherapy, and LPD resulted in complete remission. However, he failed IST for SAA and underwent Allo-SCT with reduced-intensity conditioning to recover his hematopoiesis. The patient has achieved complete hematopoietic recovery without the recurrence of LPD for five years after transplantation. This is the first report of successful Allo-SCT for SAA after the treatment of LPD caused by the use of rabbit ATG. This case provides useful information for the management of SAA with the development of LPD after IST.
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Abstract
OBJECTIVES Acquired severe aplastic anaemia is a rare and potentially fatal disease. The aim of this Cochrane review was to evaluate the effectiveness and adverse events of first-line allogeneic haematopoietic stem cell transplantation of human leucocyte antigen (HLA)-matched sibling donors compared with first-line immunosuppressive therapy. SETTING Specialised stem cell transplantations units in primary care hospitals. PARTICIPANTS We included 302 participants with newly diagnosed acquired severe aplastic anaemia. The age ranged from early childhood to young adulthood. We excluded studies on participants with secondary aplastic anaemia. INTERVENTIONS We included allogeneic haematopoietic stem cell transplantation as the test intervention harvested from any source of matched sibling donor and serving as a first-line therapy. We included immunosuppressive therapy as comparator with either antithymocyte/antilymphocyte globulin or ciclosporin or a combination of the two. PRIMARY AND SECONDARY OUTCOME MEASURES PLANNED AND FINALLY MEASURED: The primary outcome was overall mortality. Secondary outcomes were treatment-related mortality, graft failure, graft-versus-host disease, no response to immunosuppressive therapy, relapse after initial successful treatment, secondary clonal disease or malignancies, health-related quality of life and performance scores. RESULTS We identified three prospective non-randomised controlled trials with a study design that was consistent with the principle of 'Mendelian randomisation' in allocating patients to treatment groups. All studies had a high risk of bias due to the study design and were conducted more than 15 years. The pooled HR for overall mortality for the donor group versus the no donor group was 0.95 (95% CI 0.43 to 2.12, p=0.90). CONCLUSIONS There are insufficient and biased data that do not allow any firm conclusions to be made about the comparative effectiveness of first-line allogeneic haematopoietic stem cell transplantation of HLA-matched sibling donors and first-line immunosuppressive therapy of patients with acquired severe aplastic anaemia.
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Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of Cologne, Cologne, Germany
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Ashizawa M, Akahoshi Y, Nakano H, Ugai T, Wada H, Yamasaki R, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako K, Kimura SI, Kikuchi M, Nakasone H, Kako S, Kanda J, Yamazaki R, Tanihara A, Nishida J, Kanda Y. A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. Int J Hematol 2014; 99:311-7. [PMID: 24488782 DOI: 10.1007/s12185-014-1501-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 11/26/2022]
Abstract
Conditioning regimens consisting of reduced-dose cyclophosphamide (CY) and fludarabine (FDR) have been investigated for use in allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with aplastic anemia to reduce the toxicities associated with CY. However, the ideal dose of CY has not been identified. In addition, little information is available regarding donor cell chimerism after allo-HSCT with these regimens. Therefore, we retrospectively analyzed 13 patients who underwent allo-HSCT with half-dose CY (100 mg/kg in total), FDR, and anti-thymocyte globulin at total doses of 2.5-10 mg/kg at our center. All the patients except one, who died due to encephalopathy on day 20, achieved neutrophil engraftment a median of 18.5 days after HSCT with complete donor-type chimerism. Two patients who received a graft from an HLA-matched donor subsequently developed mixed chimerism (MC) associated with transfusion-dependent cytopenia. One became transfusion-independent after donor lymphocyte infusion, but continues to exhibit MC. The other regained complete donor-type chimerism after the cessation of cyclosporine, but remains transfusion-dependent. These findings suggest that a conditioning regimen with half-dose CY and FDR is effective for achieving neutrophil engraftment and complete donor-type chimerism. However, subsequent MC may be observed, especially after HLA-matched HSCT.
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Affiliation(s)
- Masahiro Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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Lv M, Huang XJ. Allo-Hematopoietic Stem Cell Transplant in China: 2014 Update. Clin Transpl 2014:235-244. [PMID: 26281151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) provides powerful curative weapons for patients with certain hematological diseases. Great improvements have been made within recent years, particularly in the fields of haploidentical HSCT, allo-HSCT for aplastic anemia, and strategies to overcome relapse and graft versus host disease. This review updates the current state of allo-HSCT in China.
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Furuya A, Ishida M, Hodohara K, Yoshii M, Okuno H, Horinouchi A, Nakanishi R, Harada A, Iwai M, Yoshida K, Kagotani A, Yoshida T, Okabe H. Epstein-Barr virus-related post-transplant lymphoproliferative disorder occurring after bone marrow transplantation for aplastic anemia in Down's syndrome. Int J Clin Exp Pathol 2013; 7:438-442. [PMID: 24427369 PMCID: PMC3885503] [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] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/23/2013] [Indexed: 06/03/2023]
Abstract
It is well established that Down's syndrome exhibits a predisposition to development of leukemia, however, association between aplastic anemia and Down's syndrome is exceptional. Herein, we describe a case of aplastic anemia occurring in Down's syndrome following post-transplant lymphoproliferative disorder (PTLD) after bone marrow transplantation (BMT). A 27-year-old Japanese male with Down's syndrome presented with a headache. Laboratory tests revealed severe pancytopenia, and bone marrow biopsy demonstrated hypocellular bone marrow with decrease of trilineage cells, which led to a diagnosis of aplastic anemia. One year after diagnosis, he was incidentally found to have an anterior mediastinal tumor, which was histopathologically diagnosed as seminoma. Subsequently, he received BMT from a female donor, and engraftment was observed. Three months after transplantation, he experienced cough and high fever. Biopsy specimen from the lung revealed diffuse proliferation of large-sized lymphoid cells expressing CD20 and EBER. These lymphoid cells had XY chromosomes. Thus, a diagnosis of EBV-associated PTLD was made. This is the seventh documented case of aplastic anemia occurring in Down's syndrome. Association between aplastic anemia and Down's syndrome has not been established, therefore, additional clinicopathological studies are needed. Moreover, this is the first case to undergo BMT for aplastic anemia in Down's syndrome. Although engraftment was observed, he developed EBV-positive PTLD. The neoplastic cells of the present case were considered to be of recipient origin, although the majority of PTLD cases with BMT are of donor origin.
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Affiliation(s)
- Aya Furuya
- Department of Hematology, Shiga University of Medical ScienceShiga, Japan
| | - Mitsuaki Ishida
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Keiko Hodohara
- Department of Hematology, Shiga University of Medical ScienceShiga, Japan
| | - Miyuki Yoshii
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Hiroko Okuno
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Akiko Horinouchi
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Ryota Nakanishi
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Ayumi Harada
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Muneo Iwai
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Keiko Yoshida
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Akiko Kagotani
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
| | - Takashi Yoshida
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
| | - Hidetoshi Okabe
- Department of Clinical Laboratory Medicine, Shiga University of Medical ScienceShiga, Japan
- Division of Diagnostic Pathology, Shiga University of Medical ScienceShiga, Japan
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Chen HR, Lou JX, Zhang Y, Liu XD, Yang K, Chen P, Liu B, He XP, Guo Z, Liu D. [Clinical analysis of haploidentical or unrelated donor hematopoietic stem cell transplantation for patients with severe aplastic anemia]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2012; 20:959-964. [PMID: 22931664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Objective of this study was to evaluate the efficacy and safety of haploidentical or unrelated donor hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA). Twenty patients with SAA received allogeneic HSCT from haploidentical or unrelated donors (14 from haploidentical donors and 6 from unrelated donors) from November 2005 to May 2011. Conditioning regimen consisted of fludarabine (FLU), cyclophosphamide (Cy) and anti-thymocyte immunoglobulin (ATG). The patients were administrated with G-CSF-primed bone marrow and mobilized peripheral blood as grafts from haploidentical donor or only mobilized peripheral blood from the unrelated donor. The results showed that the median time of neutrophil and platelet engraftment were 14 (11 - 20) d and 17 (13 - 31) d respectively. All patients who achieved engraftment had complete hematologic recovery with complete donor chimerism, except for two patients who developed graft failure in 2 months after transplantation. Four cases developed acute grade IIGVHD. The chronic GVHD occurred in 7 of the 16 evaluable cases (6 limited, 1 extensive). 14 patients got disease-free survival with follow-up to January 2012. The disease-free survival rate was 68.9%. It is concluded that the haploidentical or unrelated donor hematopoietic stem cell transplantation may become a viable therapeutic option for severe aplastic anemia patients who lack suitable human leukocyte antigen-matched donors and fail immunosuppressive therapy.
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Affiliation(s)
- Hui-Ren Chen
- Department of Hematology, General Hospital of Beijing Millitary Area, Beijing, China.
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Atta EH, de Sousa AM, Schirmer MR, Bouzas LF, Nucci M, Abdelhay E. Different outcomes between cyclophosphamide plus horse or rabbit antithymocyte globulin for HLA-identical sibling bone marrow transplant in severe aplastic anemia. Biol Blood Marrow Transplant 2012; 18:1876-82. [PMID: 22796534 DOI: 10.1016/j.bbmt.2012.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/03/2012] [Indexed: 11/18/2022]
Abstract
The standard regimen for HLA-identical sibling bone marrow transplant (BMT) in severe aplastic anemia (SAA) is cyclophosphamide (Cy) and horse antithymocyte globulin (ATG). Horse ATG has been replaced by rabbit ATG in many countries due to the unavailability of the former product. This study was designed to assess if these ATG preparations are interchangeable in the preparative regimen for matched related BMT in SAA. Forty consecutive BMTs were retrospectively analyzed: 20 received Cy plus horse ATG and 20 received Cy plus rabbit ATG as the preparative regimen. Conditioning with rabbit ATG was protective against acute graft-versus-host disease (aGVHD) grades II-IV and moderate-severe chronic GVHD (cGVHD), with incidence rates of 0% versus 35.2% (P = .009) and 0% versus 34.0% (P = .04), respectively. On day +100, the probability of proven/probable invasive fungal disease (IFD) was higher in patients conditioned with rabbit ATG, 31.2% versus 5.5%, respectively (P = .04). Earlier cytomegalovirus (CMV) reactivation (40 versus 50 days; P = .02) was observed with rabbit ATG. An inferior lymphocyte count on days +30 (0.360 versus 0.814 × 10(9)/L; P = .01) and +90 (0.744 versus 1.330 × 10(9)/L; P = .006) was noticed in recipients of rabbit ATG. The incidence of stable mixed chimerism was higher in recipients of rabbit ATG (18.2% versus 80%, respectively; P = .004). These results suggest that horse and rabbit ATG preparations have different biological and clinical properties and should not be used interchangeably in the preparative regimen for related BMT in SAA.
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Park SK, Choi JK, Yoo C, Park SJ, Lee TH, Lee JH, Kim SH. Toxoplasma encephalitis in an allogeneic hematopoietic stem cell transplant recipient in Korea. Korean J Intern Med 2012; 27:235-8. [PMID: 22707900 PMCID: PMC3372812 DOI: 10.3904/kjim.2012.27.2.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 11/25/2009] [Accepted: 02/25/2010] [Indexed: 11/27/2022] Open
Affiliation(s)
- Soo-Kyung Park
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Ki Choi
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changhoon Yoo
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Joon Park
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Hoon Lee
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je-Hwan Lee
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Han Kim
- Department of Intermal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim H, Lee JH, Joo YD, Bae SH, Hyun MS, Lee JH, Kim DY, Lee WS, Ryoo HM, Kim MK, Park JH, Lee KH. A randomized comparison of cyclophosphamide vs. reduced dose cyclophosphamide plus fludarabine for allogeneic hematopoietic cell transplantation in patients with aplastic anemia and hypoplastic myelodysplastic syndrome. Ann Hematol 2012; 91:1459-69. [PMID: 22526363 DOI: 10.1007/s00277-012-1462-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 03/26/2012] [Indexed: 11/25/2022]
Abstract
Recently, a less toxic regimen comprising reduced cyclophosphamide (Cy), fludarabine, and anti-thymocyte globulin (ATG) (Cy-Flu-ATG) was used to condition high-risk patients scheduled for allogeneic hematopoietic cell transplantation (alloHSCT) instead of standard Cy-ATG in patients with severe aplastic anemia (AA). We performed a randomized phase III study to compare the regimen-related toxicities (RRTs) of two different conditioning regimens: Cy-ATG vs. Cy-Flu-ATG. Patients in the Cy-ATG arm received Cy at 200 mg/kg. Those in the Cy-Flu-ATG arm received fludarabine (Flu) at 150 mg/m(2) and Cy at 100 mg/kg. A total of 83 patients (40 in the Cy-ATG and 43 in the Cy-Flu-ATG) were enrolled. Seventy-nine patients had AA and four had MDS. All predefined RRTs were significantly lower in patients of the Cy-Flu-ATG arm (23.3 vs. 55.0 %; p = 0.003). Infection with identified causative organism and sinusoidal obstruction syndrome, hematuria, febrile episodes, and death from any cause tended to be more frequent in Cy-ATG arm but did not differ significantly between arms. There was no difference in neutrophil engraftment failure (2.5 vs. 2.33 %; p = 0.959), acute graft-versus-host disease (GvHD) (15.0 vs. 23.3 %; p = 0.388), and chronic GvHD (16.7 vs. 16.2 %; p = 0.961) between Cy-ATG and Cy-Flu-ATG arms. The 4-year survival rate did not differ between the Cy-ATG and Cy-Flu-ATG arms. Preconditioning with Cy-Flu-ATG was superior to that afforded by Cy-ATG in terms of reducing RRT levels without increasing engraftment failure.
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Affiliation(s)
- Hawk Kim
- Division of Hematology-Oncology, Ulsan University Hospital University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Mali VP, Tan PL, Aw M, Loh LDSK, Quak SH, Madhavan K, Krishnan P. Mismatched bone marrow transplantation for severe aplastic anaemia after liver transplantation for associated acute liver failure. Ann Acad Med Singap 2011; 40:420-421. [PMID: 22065037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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15
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Eapen M, Le Rademacher J, Antin JH, Champlin RE, Carreras J, Fay J, Passweg JR, Tolar J, Horowitz MM, Marsh JCW, Deeg HJ. Effect of stem cell source on outcomes after unrelated donor transplantation in severe aplastic anemia. Blood 2011; 118:2618-21. [PMID: 21677312 PMCID: PMC3167362 DOI: 10.1182/blood-2011-05-354001] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 06/02/2011] [Indexed: 11/20/2022] Open
Abstract
Outcome after unrelated donor bone marrow (BM) transplantation for severe aplastic anemia (SAA) has improved, with survival rates now approximately 75%. Increasing use of peripheral blood stem and progenitor cells (PBPCs) instead of BM as a graft source prompted us to compare outcomes of PBPC and BM transplantation for SAA. We studied 296 patients receiving either BM (n = 225) or PBPC (n = 71) from unrelated donors matched at human leukocyte antigen-A, -B, -C, -DRB1. Hematopoietic recovery was similar after PBPC and BM transplantation. Grade 2 to 4 acute graft-versus-host disease risks were higher after transplantation of PBPC compared with BM (hazard ratio = 1.68, P = .02; 48% vs 31%). Chronic graft-versus-host disease risks were not significantly different after adjusting for age at transplantation (hazard ratio = 1.39, P = .14). Mortality risks, independent of age, were higher after PBPC compared with BM transplantation (hazard ratio = 1.62, P = .04; 76% vs 61%). These data indicate that BM is the preferred graft source for unrelated donor transplantation in SAA.
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Affiliation(s)
- Mary Eapen
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, USA.
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Wang XJ, Chen L, Sai Y. [Allogeneic hematopoietic stem cell transplantation for paroxysmal nocturnal hemoglobinuria-aplastic anemia syndrome: a case report]. Zhonghua Xue Ye Xue Za Zhi 2011; 32:563. [PMID: 22338185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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17
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Donnini I, Scappini B, Guidi S, Longo G, Bosi A. Acquired severe aplastic anemia after H1N1 influenza virus vaccination successfully treated with allogeneic bone marrow transplantation. Ann Hematol 2011; 91:475-6. [PMID: 21681390 DOI: 10.1007/s00277-011-1278-0] [Citation(s) in RCA: 7] [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] [Received: 10/09/2010] [Accepted: 06/07/2011] [Indexed: 11/25/2022]
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18
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Han W, Huang XJ, Liu KY, Xu LP, Liu DH, Chen H, Zhang XH, Chen YH, Wang FR, Wang Y. [The efficacy and safety of mismatched hematopoietic stem cell transplantation for treatment of severe aplastic anemia]. Zhonghua Nei Ke Za Zhi 2011; 50:287-290. [PMID: 21600145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To study the efficacy and safety of human leukocyte antigen (HLA) mismatched hematopoietic stem cell transplantation (HSCT) on severe aplastic anemia (SAA). METHODS From January 2006 to May 2010, 17 patients received mismatched HSCT. HLA antigens were 3-loci-mismatched in 9 patients, 2-loci-mismatched in 8. All patients received recombinant human granulocyte colony-stimulating factor (rhG-CSF) primed bone marrow cells plus peripheral blood stem cells after modified busulfan/cyclophosphamide + antithymocyte immunoglobulin (BU/CY + ATG) conditioning regimen. RESULTS All patients achieved full donor type engraftment. Grade III-IV graft versus host disease (GVHD) occurred in 3 patients and extensive chronic GVHD in 1. With a median following-up time of 285 (60 - 1670) d, 11 patients were alive, 9 of them had normal blood counts and the other 2 were blood transfusion independent. Six patients died of transplant-related complications. CONCLUSION Mismatched HSCT is a feasible and safe option for SAA patients without sibling identical donors.
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Affiliation(s)
- Wei Han
- Institute of Hematology, People's Hospital, Peking University, Beijing 100044, China
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19
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Novichkova GA, Maschan MA, Shipitsyna IP, Skvortsova IV, Persiantseva MI, Lebedeva LL, Bobrynina VO, Baĭdil'dina DD, Goronkova OV, Solopova GG, Khachatrian LA, Petrova UN, Suntsova EV, Kalinina II, Sinitsyna VV, Skorobogatova EV, Balashov DN, Dyshlevaia ZM, Shelikhova LN, Kurnikova EE, Trakhtman PE, Maschan AA. [Transplantation of the bone marrow from a HLA-compatible unrelated donor after immunoablative conditioning in children with acquired aplastic anemia unresponsive to combined immunosuppressive therapy: preliminary results]. TERAPEVT ARKH 2010; 82:41-47. [PMID: 20853608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM To analyze the efficiency of transplantation of the bone marrow from a HLA-compatible unrelated donor and continued immunosuppressive therapy (IST) in children with aplastic anemia (AA) unresponsive to 2 courses of IST. SUBJECTS AND METHODS The study enrolled 14 children aged 2-16 years (median 9 years). A control group comprised 26 patients in whom IST was continued. The median interval between the diagnosis of AA and transplantation was 26 months (9-156 months). The conditioning regimen consisted of thoracoabdominal irradiation in a dose of 2 Gy, fludarabin (Flu) 100-150 mg/m2, cyclophosphamide (Cy) 100-200 mg/kg, antithymocyte globulin (ATG) in 11 patients and Flu, Cy, and ATG in 3. A graft-versus-host reaction was prevented with mycophenolate mefetil in all the patients, tacrolimus in 11, and cyclosporin A in 3. Donors were compatible for high-resolution typing of 10/10 and 9/10 alleles in 8 and 6 patients, respectively; the source of a transplant was bone marrow in 13 patients and granulocyte colony-stimulating factor-mobilized peripheral blood precursors in one case. RESULTS Thirteen patients achieved primary engraftment after single transplantation; one patient did after repeat transplantation. Grades I to II graft-versus-host reaction (GVHR) developed in 9 patients; postengraftment life-threatening infections in 3, extensive chronic GVHR in 2, circumscribed GVHR in 7. All fourteen hemopoietic cell transplant recipients followed for a median 17.5 months (range 1-71 months) were survivors. CONCLUSION The likelihood of good survival after unrelated transplantations in AA is much higher than that after continued IST: 100% versus 15 +/- 11%.
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Ganapiev AA, Golubovskaia IK, Zalialov IR, Estrina MA, Afanas'ev BV. [The use of allogeneic bone marrow transplantation and immunosuppressive therapy in the treatment of patients with acquired aplastic anemia]. TERAPEVT ARKH 2010; 82:48-52. [PMID: 20853609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM To evaluate the efficiency of related and unrelated allogeneic bone marrow transplantation (alloBMT) versus immunosuppressive therapy (IST) in patients with aplastic anemia (AA) having no HLA-compatible bone marrow donor. SUBJECTS AND METHODS The study covered 61 patients (34 men and 27 women) diagnosed as having acquired AA. Of them, 51 patients were diagnosed as having severe AA, 5 had supersevere AA, and 5 had non-severe AA. Combined IST (antithymocyte globulin (ATG) + cyclosporin A (CsA)) was used in 43 patients; allo-BMT was performed in 18. The basic types of ATG (ATGAM (Pfizer), thymoglobulin (Genzim), ATG (Fresenius), and goat antilymphocyte globulin (ALG) (Research Institute of Gerontology, Ministry of Health of the Russian Federation) were administered. CsA was given in a dose of 5 mg/kg/day. The standard conditioning regimen (ATGAM + cyclophosphanum) and fludarabine-containing (fludarabine + cyclophosphanum + ATG; busulfan + fludarabine + ATG) programs were used in the allo-BMT group. A combination of CsA and metothrexate was given to prevent a graft-versus-host reaction. RESULTS Among the IST-receiving patients, overall survival (OS) was 71%. After the first course of IST by follow-up month 6, the response rate was 74%. The second course of IST was performed in 7 patients unresponsive after the first-line IST and in 8 patients with recurrent AA. After the second course of IST, the response rate was 46.7%. Four patients who failed to achieve remission after 2 courses of IST received its third course. A complete response was obtained in 3 patients. In 18 patients following allo-BMT (related and unrelated), OS was 86%; event-free survival was 65. In 12 patients after related allo-BMT, OS was 91.7%. CONCLUSION Related allo-BMT is the method of choice if there is a HLA-compatible sibling. If there are contraindications to it or no related donor, IST with ATG + CsA is indicated. Ineffective IST is an indication for unrelated allo-BMT that may be recommended as life-saving therapy for young patients under 40 years of age.
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Abstract
We describe 3 cases of fatal but clinically unsuspected anerobic bacteremia amongst hematopoietic stem cell transplant (HSCT) recipients treated empirically for fever and neutropenia with third or fourth generation cephalosporins. All patients had diarrhea but none had classical findings of neutropenic enterocolitis. HSCT recipients with fever, neutropenia and gastrointestinal tract symptoms such as abdominal pain or diarrhea or with septic shock despite broad spectrum antibiotics should receive an antimicrobial agent with anerobic activity.
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Affiliation(s)
- Monica A Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia.
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Marr H, McDonald EJ, Merriman E, Smith M, Mangos H, Stoddart C, Ganly P. Successful treatment of transplant-associated microangiopathy with rituximab. N Z Med J 2009; 122:72-74. [PMID: 19448776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The microangiopathic anaemia with thrombocytopenia--which can occur after haematopoietic stem cell transplant--resembles thrombotic thrombocytopenic purpura but has different pathophysiology and does not respond to plasma exchange. We describe a patient with severe manifestations of this disorder who recovered promptly following treatment with rituximab, an anti-CD20 antibody.
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MESH Headings
- Adult
- Anemia, Aplastic/diagnosis
- Anemia, Aplastic/surgery
- Anemia, Hemolytic/drug therapy
- Anemia, Hemolytic/etiology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Bone Marrow Transplantation/adverse effects
- Bone Marrow Transplantation/methods
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Female
- Follow-Up Studies
- Humans
- Purpura, Thrombotic Thrombocytopenic/drug therapy
- Purpura, Thrombotic Thrombocytopenic/etiology
- Risk Assessment
- Rituximab
- Severity of Illness Index
- Transplantation, Homologous
- Treatment Outcome
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Ogawa E, Okuyama R, Niizuma H, Tagami H, Tsuchiya S, Aiba S. Eosinophilic pustular folliculitis occurring after bone marrow transplantation in a child with aplastic anaemia. Acta Derm Venereol 2009; 89:200-1. [PMID: 19326017 DOI: 10.2340/00015555-0588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rojas A G, González G N, Venables G C, Araos H D. [Gran versus host disease with oral involvement: report of one case]. Rev Med Chil 2008; 136:1570-1573. [PMID: 19350175] [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: 05/27/2023]
Abstract
Gran versus Host Disease (GVHD) is a common complication in allogenic bone marrow transplants and in some cases, it involves the oral mucosa. Therefore, the appropriate diagnosis and timely treatment is essential to prevent local complications which interfere with normal oral functions and facilitate infection spread. We report a 17 years old woman with GVHD associated to lichenoid and ulcerative lesion in the oral mucosa, which responded to the topical administration of a 0.1% tacrolimus ointment.
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Affiliation(s)
- Gonzalo Rojas A
- Facultad de Odontología, Universidad de Chile, Santiago, Chile.
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Abstract
We report a series of three patients in whom the diagnoses of aplastic anaemia (AA) and coeliac disease were made concurrently. Haematological manifestations of coeliac disease are well described but this is the first report to suggest an association with aplastic anaemia. 'Silent/atypical coeliac disease', in the absence of gastrointestinal symptoms, is increasingly recognised and patients may present with generalised symptoms, such as malaise and fatigue, which are easily attributable to AA. Immunosuppressive therapy for AA could modulate the course of celiac disease. We recommend clinicians should be vigilant for signs of coeliac disease in patients with AA.
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Affiliation(s)
- E Grey-Davies
- Department of Haematology, St George's Hospital, London, UK.
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Nishio M, Endo T, Nakao S, Sato N, Koike T. Reversible cardiomyopathy due to secondary hemochromatosis with multitransfusions for severe aplastic anemia after successful non-myeloablative stem cell transplantation. Int J Cardiol 2008; 127:400-1. [PMID: 17582528 DOI: 10.1016/j.ijcard.2007.04.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
A 30-year-old Japanese woman with acquired severe aplastic anemia (SAA), diagnosed 20 years ago, was referred to our institution for allogeneic stem cell transplantation (SCT). As an unusual case of long-standing SAA, the patient was complicated with moderate heart failure due to secondary hemochromatosis. After successful SCT using a non-myeloablative conditioning regimen, she needed no transfusion. Five years after SCT, echocardiography showed a dramatic improvement of her cardiac function. This case indicates that the cardiac function in secondary hemochromatosis could be reversed once iron overload from multitransfusions is stopped.
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Abstract
Using the Seattle protocol with minor modifications, 23 patients with severe aplastic anaemia received allogeneic bone marrow transplants from HLA/mixed leucocyte culture matched sibs in three London centres between 1973 and 1977. Ten patients (43.5%) are alive 6 months to 5 years after transplantation, and are well with full haemopoietic reconstitution, two with autologous bone marrow recovery following the graft procedure. A failure of the marrow graft to take, or take followed by rejection occurred in 12 patients (52%). Failure of marrow recovery was associated with a high early mortality from bacterial or fungal infection. The only survivors amongst those who rejected the first graft were four patients in whom a subsequent graft from the same donor was successful, and two in whom autologous recovery occurred. Graft versus host disease (GVHD) occurred in seven patients, and was fatal in one case. The most frequent complication after successful engraftment was varicella-zoster infection which occurred in five patients and was fatal in one patient. The overall results compare favourably with those from other transplant centres, but the high rate of graft rejection and low incidence of GVHD differ from other series. The results should encourage further referral of patients with severe AA for bone marrow transplantation.
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Petrova TV, Nifontova IN, Svinareva DA, Vinogradova MA, Mikhaĭlova EA, Drize NI. [Impaired expression of genes regulating homeostasis of stem hemopoietic cells in stromal cells of patients with aplastic anemia]. TERAPEVT ARKH 2008; 80:61-65. [PMID: 18326231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM To evaluate expression of genes participating in regulation of hemopoietic stem cells (HSC) in the cells of stromal sublayer of bone marrow long-term cultures in patients with aplastic anemia (AA); to determine effects of parathyroid hormone (PTH) on stromal microenvironment and on its ability to maintain HSC homeostasis. MATERIAL AND METHODS Gene expression in the sublayer of the adherent cells (SAC) was examined with RT-PCt. SAC was for a long time treated with PTH, then their ability to secure survival of early hemopoietic precursors was tested. Changes in the function of stromal cells and expression of some genes were compared in 9 AA patients and 14 donors. RESULTS Stromal sublayer of AA patients is characterized by low expression of Ang-1 and VCAM-1 genes and high VEGF expression compared to mean level of healthy donors. PTH stimulates expression of different genes participating in HSC regulation in stromal cells of some patients and improves survival of early hemopoietic hemopoietic precursors on such sublayers. CONCLUSION AA patients have severe defects in SAC interaction with stroma. In some cases the defects can be partially compensated with application of PTH.
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Focosi D, Kast RE, Benedetti E, Papineschi F, Galimberti S, Petrini M. Phenobarbital-associated bone marrow aplasia: a case report and review of the literature. Acta Haematol 2008; 119:18-21. [PMID: 18230962 DOI: 10.1159/000114096] [Citation(s) in RCA: 9] [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] [Received: 09/27/2007] [Accepted: 11/06/2007] [Indexed: 11/19/2022]
Abstract
We report on a 22-year-old female who developed aplastic anemia after administration of phenobarbital for 6 years. Being refractory to steroid and anti-lymphocyte serum, the patient received allogeneic stem cell transplantation, achieving complete remission. We discuss here the potential mechanisms by which phenobarbital and other anti-epileptic drugs can cause aplastic anemia and review the literature for previous case reports and epidemiological studies.
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Affiliation(s)
- Daniele Focosi
- Division of Hematology, Azienda Ospedaliera Universitaria Santa Chiara, Pisa, Italy.
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Unal S, Cetin M, Tavil B, Calişkan N, Yetgin S, Uçkan D. Favorable outcome with allogeneic hematopoietic stem cell transplantation in pediatric acquired aplastic anemia patients. Pediatr Transplant 2007; 11:788-91. [PMID: 17910658 DOI: 10.1111/j.1399-3046.2007.00771.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The data of allogeneic HSCT in nine children with acquired AA between June 1998 and July 2006 were analyzed retrospectively. The median duration of time to neutrophil and platelet engraftment was 18 and 25 days, respectively. None of the patients had primary graft failure. Two (22.2%) patients developed acute GVHD and of these, one (11.1%) was Grade 1, and the other (11.1%) was Grade 3. Although the study group was composed of higher risk patients, including six of nine resistant to previous immunosuppressive treatment, eight had multiple not irradiated or filtered transfusion histories and one of the cases was only 5/6 HLA-compatible with his donor, the five-yr overall and EFS was 100%, and all recipients are alive without any graft failure. This may be attributed to the dose adjusted use of ATG according to individual transfusion history and gradual tapering of CsA and cessation at least nine months after allogeneic HSCT.
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Affiliation(s)
- Sule Unal
- Department of Pediatrics, Division of Pediatric Hematology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
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Abstract
Major surgery in a patient with pancytopenia might be associated with increased surgical risks, especially for bleeding and infection. A 66-yr-old man was admitted to the hospital due to shortness of breath. His dyspnea was classified by the New York Heart Association (NYHA) as functional class III. Prior to admission, he had a 5-yr history of medical management for idiopathic aplastic anemia. The severity of aplastic anemia of the patient was graded as non-severe aplastic anemia. Echocardiography revealed reduced left ventricular function and severe aortic valve regurgitation (grade IV) with left ventricular end diastolic dimension measuring 87 mm. Because of dyspnea and echocardiographically documented aortic valve insufficiency, the patient underwent elective aortic valve replacement. Although extracorporeal circulation for valve operations might be associated with aggravation of impaired blood cell function, the patient recovered from surgery uneventfully. Here, we report a successful cardiac surgery with extracorporeal cardiopulmonary bypass in a patient with severe aortic valve insufficiency and concomitant idiopathic aplastic anemia.
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Affiliation(s)
- Kyung Jin Lee
- Department of Cardiology, College of Medicine, Eulji University, Daejeon, Korea
| | - Jun Wan Lee
- Department of Thoracic & Cardiovascular Surgery, College of Medicine, Cheju National University, Jeju, Korea
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Trakhtman P, Balashov D, Shipicina I, Skvortsova Y, Shelikhova L, Filimonov A, Novichkova G, Skorobogatova E, Maschan M, Maschan A. Alkylator-free conditioning regimen for patients with acquired aplastic anemia, transplanted from genetically identical twins. Pediatr Transplant 2007; 11:572-4. [PMID: 17631032 DOI: 10.1111/j.1399-3046.2007.00677.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Allogeneic stem cell transplantation remains the best option for young patients with SAA. With genetically identical twin as an ideal donor, the majority of SAA patients require appropriate immunosuppression before and after stem cell transplantation to obtain long-term hematopoietic reconstitution. Alkylating agents, used during conditioning, are associated with short- and long-term toxic effects that lead to poor compliance of treatment and could compromise the quality of future life. Three SAA patients, transplanted from genetically identical twins without using alkylating agents during conditioning, showed rapid and sustained hematological reconstitution without any evidence of conditioning-related toxicity.
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Affiliation(s)
- P Trakhtman
- Bone Marrow Transplantation Unit, Russian Institute for Pediatric Hematology, Oncology and Immunology, 117513 Moscow, Russia.
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Abstract
A major limitation in hematopoietic stem cell transplantation (HSCT) is the availability of a genetically matched donor, particularly with respect to the human leukocyte antigens (HLA)-linked immune response genes located on chromosome 6 in humans. During the last 5 years, a total of 688 patients requiring HSCT underwent HLA testing in our department to identify a matched donor from their families. The sibship size ranged from 1 to > or =5 in all disease categories, except thalassemia major where the majority of patients had only 1 sibling. Family genotype analysis revealed that 39.3% of the total number of patients had an HLA-matched sibling and that families with sibship size of > or =4 had a higher probability (68.8%) compared with those with sibship size of < or =3 (29.7%). Because the Indian population is characterized by the presence of novel HLA alleles and unique haplotypes (HLA-A*0211, B*2707, A*26-B*08-DRB1*03), patients with rare HLA alleles have much less probability of finding an unrelated optimally matched donor than those with common HLA phenotypes. Smaller family size and unique HLA profile are limitations that can be overcome by developing unrelated volunteer marrow donor registries. The Asian Indian Donor Marrow Registry at our institute is regularly providing services to such patients.
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Affiliation(s)
- U Kanga
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
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Maury S, Balère-Appert ML, Chir Z, Boiron JM, Galambrun C, Yakouben K, Bordigoni P, Marie-Cardine A, Milpied N, Kanold J, Maillard N, Socié G. Unrelated stem cell transplantation for severe acquired aplastic anemia: improved outcome in the era of high-resolution HLA matching between donor and recipient. Haematologica 2007; 92:589-96. [PMID: 17488681 DOI: 10.3324/haematol.10899] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [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: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Severe acquired aplastic anemia (SAA) is a potentially fatal bone marrow failure syndrome occurring mainly in children and young adults. Immunosuppressive regimens and hematopoietic stem cell transplantation (HSCT) are the only two available curative treatments. Patients who lack an HLA-identical sibling donor may receive HSCT from an unrelated donor, a strategy historically associated with high mortality rates. Thus, for patients refractory to immunosuppressive regimens, the decision to transplant stem cells from unrelated donors is weighed against supportive care and often represents a dilemma for physicians. We aimed to determine whether outcome after unrelated HSCT has improved in recent years and, if so, to determine the factors responsible for the improvement. DESIGN AND METHODS We analyzed the outcome of 89 patients (median age 17 years, range 0-52) with acquired SAA undergoing HSCT from an unrelated donor between 1989 and 2004. Cases were consecutively reported to the French Registry (SFGM-TC) by 25 centers. RESULTS Patients transplanted during two successive time-periods (1989-1998 and 1999-2004) had different 5-year survival probabilities (+/-95% confidence interval): 29%+/-7% and 50%+/-7%, respectively (p<0.01). The main difference between the two cohorts concerned HLA matching between donors and recipients at the allelic level for the ten HLA-A, -B, -C, -DRB1 and -DQB1 antigens, which was more frequent in 1999-2004 than in the former period (p=0.0004). In multivariate analysis, the only two factors affecting survival were HLA allelic matching (p<0.01) and younger age of recipient (17 pounds sterling years, p<0.0001). Survival reached 78%+/-11% at 5 years for the younger, fully HLA-matched patients. INTERPRETATION AND CONCLUSIONS Survival after unrelated HSCT for SAA has improved significantly over the past 15 years, mainly due to better HLA matching. Results for young patients who are fully HLA-matched at the allelic level with their donor are comparable to those observed after HSCT from a related donor.
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Affiliation(s)
- Sébastien Maury
- Service d'Hématologie, Hôpital Henri Mondor, Créteil, France.
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Fernandes J, Rocha V, Robin M, de Latour RP, Traineau R, Devergie A, Ribaud P, Réa D, Larghero J, Gluckman E, Socié G. Second transplant with two unrelated cord blood units for early graft failure after haematopoietic stem cell transplantation. Br J Haematol 2007; 137:248-51. [PMID: 17408466 DOI: 10.1111/j.1365-2141.2007.06562.x] [Citation(s) in RCA: 37] [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: 11/27/2022]
Abstract
Graft failure (GF) can be a fatal complication following haematopoietic stem cell transplantation (HSCT). We report four patients who developed early GF after unrelated HSCT and who subsequently received a double unrelated cord blood transplant (dUCBT) after reduced-intensity conditioning, at a median 15 d after the decision to perform a second transplant. Neutrophil recovery was observed in all four patients between day +15 and +31 with full donor chimaerism of one unit. Acute GVHD grades II-IV was observed in three patients. Three are alive, between 12 and 25 months after dUCBT. In conclusion, dUCBT is a promising procedure to treat early GF.
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Affiliation(s)
- Juliana Fernandes
- Haematology Department and Bone Marrow Transplant Unit, Hôpital Saint Louis, Paris, France
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Lee KH, Park SS, Kim I, Kim JH, Ra EK, Yoon SS, Hong YC, Park S, Kim BK. P2X7 receptor polymorphism and clinical outcomes in HLA-matched sibling allogeneic hematopoietic stem cell transplantation. Haematologica 2007; 92:651-7. [PMID: 17488689 DOI: 10.3324/haematol.10810] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The P2X7 receptor (P2X7 R) is a key player in the processing and release of interleukin (IL)-1. To evaluate whether the A1513C polymorphism of the P2X7 R gene is related to allogeneic stem cell transplantation outcome, we performed an association analysis between this polymorphism and clinical outcomes in patients treated with an HLA-matched sibling stem cell transplant. DESIGN AND METHODS Patients (n=152) with a malignancy or aplastic anemia underwent allogeneic stem cell transplantation at a single institute. Peripheral blood DNA of these 152 patients and their 152 donors was genotyped. Genotypes of 145 recipients and 150 donors were obtained and analyzed for the polymorphism. RESULTS The frequencies of the A and C alleles in all 295 study subjects were 72% and 28%, respectively. The genotypes in patients were AA in 75, AC in 58, and CC in 12; the genotypes in donors were AA in 74, AC in 70, and CC in 6. Overall survival was significantly shorter for recipients with the CC genotype than for those with the AA or AC genotype (92 days for 1513CC vs. 821 days for 1513AA or 1513AC, p=0.012), and for recipients from donors with the CC genotype than for recipients from donors with the AA or AC genotype (63 days for 1513CC vs. 702 days for 1513AA or 1513AC, p=0.024). Multivariate analyses, which included sex, age, transplant method (reduced intensity conditioning vs. conventional conditioning), stem cell source, risk group, and P2X7R recipient and donor genotypes, as parameters, identified high-risk group (hazard ratio 3.25, 95% confidence interval 1.83~5.77) and a donor 1513CC genotype (hazard ratio 2.66, 95% confidence interval 1.02~6.91) as risk factors for a shorter survival. Microbiologically documented bacteremia occurred in 66.7% of recipients with the CC donor genotype and in 17.6% of recipients of transplants of AA or AC genotype (p=0.014). INTERPRETATION AND CONCLUSIONS We conclude that the A1513C polymorphism in the P2X7R gene is related to the occurrence of infections and survival after allogeneic stem cell transplantation. Thus, the determination of this polymorphism may be helpful for the optimal selection of patients and donors.
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Affiliation(s)
- Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Weber-Mzell D, Urban C, Benesch M, Rojacher T, Zois B, Höfler G, Schwinger W. Durable remission following a third allogeneic stem cell transplantation in a patient with repeatedly relapsing SAA. The importance of stroma cells for sustained engraftment? Pediatr Transplant 2007; 11:332-5. [PMID: 17430493 DOI: 10.1111/j.1399-3046.2006.00638.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diagnosis of acquired AATP which finally progressed to SAA was established in an eight-yr-old boy. PBSCT from an HLA-identical unrelated donor using high numbers of CD34+ selected stem cells was performed and resulted in complete remission for almost two yr. However, SAA reoccurred with 100% donor hematopoiesis and was reversed by a second CD 34+ selected PBSCT from the same donor. Declining blood cell counts after an interval of two yr indicated second relapse. Chimerism analysis in PB and BM aspirates revealed a small autologous cell population of 4-12% and 2-11%, respectively. Finally, a third transplantation with unmanipulated BM from the same donor resulted in sustained remission with 100% donor hematopoiesis. The patient is in complete remission for more than five yr following the third SCT. Late graft failure or late graft rejection known to occur after transplantation of highly purified CD34+ cells, or even graft exhaustion caused by stromal dysfunction due to the underlying disease necessitated a third transplantation. Regardless of the cause of relapse, transplantation of unmanipulated BM instead of highly purified PBSCTs led to a permanent and stable engraftment in a third attempt after two previous PBSCTs.
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Affiliation(s)
- Daniela Weber-Mzell
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Wolf T, Rickerts V, Staszewski S, Kriener S, Wassmann B, Bug G, Bickel M, Gute P, Brodt HR, Martin H. First case of successful allogeneic stem cell transplantation in an HIV-patient who acquired severe Aplastic Anemia. Haematologica 2007; 92:e56-8. [PMID: 17562594 DOI: 10.3324/haematol.11394] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 11/09/2022] Open
Abstract
We report on the first successful allogeneic stem cell transplantation (SCT) in an HIV-infected patient with severe aplastic anemia (SAA) per- formed at a tertiary care institution. Highly active antiretroviral therapy (HAART) was administered until transplantation and restarted 34 days later with sustained virological response. The patient did however develop a rapid rise in HIV load during the interruption of HAART associated with an acute febrile illness. Due to the extended period between the onset of SAA until SCT, the posttransplant course was complicated by bacterial infections. Stage two skin GvHD, but no AIDS-defining opportunistic diseases were experienced. Neutrophils recovered to >0.5/nL on day +18 and the CD4 count reached 250/microL on day +71 and >500/microL on day +182. The patient is in good condition with an ECOG score of 0 twelve months after transplantation. This report demonstrates the feasibility of allogeneic stem cell transplantation in the HIV setting.
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Affiliation(s)
- T Wolf
- Department of Infectious Diseases, Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany.
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Agbalika F, Larghero J, Esperou H, Marais D, Robin M, Foïs E, de Latour RP, Gluckman E, Rocha V, Benbunan M, Socié G, Marolleau JP. Epstein-Barr virus early-antigen antibodies before allogeneic haematopoietic stem cell transplantation as a marker of risk of post-transplant lymphoproliferative disorders. Br J Haematol 2007; 136:305-8. [PMID: 17278263 DOI: 10.1111/j.1365-2141.2006.06420.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The occurrence of post-transplant lymphoproliferative disorders (PTLDs) after allogeneic haematopoietic stem cell transplantation (allo-HSCT) represents a clinical problem. Pretransplant Epstein-Barr virus serological status and viral load was determined in 21 recipients and 28 control transplanted patients, with (+) and without (-) PTLD, respectively. Early-antigen immunoglobulin G (EA-IgG) was detected in 12/21 PTLD+ patients, but only 2/28 PTLD patients (P = 0.00023, Odds ratio = 17.42). High viral load was detected in peripheral blood mononuclear cells at PTLD diagnosis, independently of deleted LMP1. Detection of EA-IgG in allo-HSCT recipients pretransplantation might be considered as risk factor for PTLD development.
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Affiliation(s)
- Felix Agbalika
- Department of Microbiology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Affiliation(s)
- Murat O Arcasoy
- Duke University Medical Center, Hematology-Medical Oncology Durham, NC, USA.
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Inagaki J, Nagatoshi Y, Kawano Y, Saito Y, Takahashi D, Nagayama J, Shinkoda Y, Hirata H, Okamura J. Bone marrow transplantation in children with severe aplastic anemia using a conditioning regimen containing 3 Gy of total body irradiation, cyclophosphamide with or without antithymocyte globulin. Pediatr Transplant 2007; 11:180-6. [PMID: 17300498 DOI: 10.1111/j.1399-3046.2006.00640.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We have employed the 3 Gy total body irradiation (TBI) containing conditioning regimen to bone marrow transplantation (BMT) for severe aplastic anemia (SAA) in pediatric patients irrespective of donor type since March 1986. The outcome of BMT for 17 SAA patients is favorable. Eight patients received BMT from human leukocyte antigen matched-related donors (MRD) and nine received BMT from alternative donors. The conditioning regimen consisted of 3-Gy TBI and cyclophosphamide of 200 mg/kg in the BMT from MRD. In the case of BMT from alternative donor, antithymocyte globulin 10 mg/kg was added to the regimen. Fifteen of 17 patients (88%) engrafted on median of day 18 (range, 11-26) and all 13 evaluable patients showed complete donor chimerism by median 30 (range, 13-47) days after BMT. Fourteen patients have survived with a median follow-up of 67 (range, 2-228) months and the probability of survival was 81.9% (95% CI, 63.3-100%). No late complications including second malignancies caused by TBI have been observed and all three female patients have regular menstruation. In conclusion, TBI of 3 Gy appears to be an appropriate dose regarding to ensure engraftment and avoid the risk of late adverse event for SAA patients.
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Affiliation(s)
- Jiro Inagaki
- Section of Pediatrics, National Kyusyu Cancer Center, Notame, Fukuoka, Japan.
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Kaplan FS, Glaser DL, Shore EM, Pignolo RJ, Xu M, Zhang Y, Senitzer D, Forman SJ, Emerson SG. Hematopoietic stem-cell contribution to ectopic skeletogenesis. J Bone Joint Surg Am 2007; 89:347-57. [PMID: 17272450 DOI: 10.2106/jbjs.f.00472] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fibrodysplasia ossificans progressiva is a rare genetic disorder of ectopic skeletogenesis associated with dysregulation of bone morphogenetic protein (BMP) signaling. Hematopoietic cells have been implicated in the ectopic skeletogenesis of fibrodysplasia ossificans progressiva, and their replacement has been postulated as a possible cure. However, the definitive contribution of hematopoietic cells to the pathogenesis of ectopic skeletogenesis remains obscure. METHODS We employed both careful clinical observation and in vivo murine transplantation studies to more precisely determine the contribution of hematopoietic cells to ectopic skeletogenesis. We identified a patient with fibrodysplasia ossificans progressiva who had undergone bone marrow transplantation for the treatment of intercurrent aplastic anemia twenty-five years earlier and investigated whether the clinical course of the fibrodysplasia ossificans progressiva had been influenced by bone marrow replacement or immunosuppression, or both. In complementary studies, we transplanted hematopoietic stem cells from constitutively expressing LacZ transgenic mice to identify the contribution of hematopoietic cells to BMP4-induced heterotopic ossification, a histopathologic model of fibrodysplasia ossificans progressiva. RESULTS We found that replacement of hematopoietic cells was not sufficient to prevent ectopic skeletogenesis in the patient with fibrodysplasia ossificans progressiva but pharmacologic suppression of the apparently normal donor immune system following transplantation in the new host modulated the activity of the fibrodysplasia ossificans progressiva and diminished the expression of skeletal ectopia. In complementary murine transplantation studies, we found that cells of hematopoietic origin contributed to the early inflammatory and late marrow-repopulating stages of BMP4-induced heterotopic ossification but were not represented in the fibroproliferative, chondrogenic, or osteogenic stages of heterotopic ossification. Interestingly, both recombinant human BMP4 induction in an animal model and the dysregulated BMP signaling pathway in a patient with fibrodysplasia ossificans progressiva were sufficient to recruit at least two populations of cells, one of hematopoietic origin and at least one of non-hematopoietic origin, that contribute to the formation of an ectopic skeleton. CONCLUSIONS Taken together, these findings demonstrate that bone marrow transplantation did not cure fibrodysplasia ossificans progressiva in the patient in this study, most likely because the hematopoietic cell population is not the site, or at least not the dominant site, of the intrinsic dysregulation of the BMP signaling pathway in fibrodysplasia ossificans progressiva. However, following transplantation of bone marrow from a presumably normal donor, immunosuppression of the immune system appeared to ameliorate activation of ectopic skeletogenesis in a genetically susceptible host. Thus, cells of hematopoietic origin may contribute to the formation of an ectopic skeleton, although they are not sufficient to initiate the process alone.
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Affiliation(s)
- Frederick S Kaplan
- Center for Research in Fibrodyplasia Ossificans Progressiva and Related Disorders, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6081, USA.
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Abstract
This review highlights some of the contributions that have appeared in the literature in the past decade on the pathogenesis and treatment of aplastic anemia (AA). This summary is brief because the field is vast, spaning from stem cell biology to stem cell disorders, from autoimmunity to transplantation, from graft-versus-host disease to late effects. The immune pathogenesis of AA is now based on several lines of evidence and will be discussed. Immunosuppressive therapy (IST) remains an important option for AA patients who are not candidates for transplantation. Favorable prognostic indicators for IST are young age and a short interval from diagnosis; the neutrophil count seems to have lost its predictive value with current antithymocyte globulin-cyclsoporin combination therapy. The outcome of allogeneic bone marrow transplantations has significantly improved in the past decade, particularly in the unrelated donor setting, to such an extent that treatment strategies may be affected. A short interval between diagnosis and treatment will also improve results for bone marrow transplantation; these rare patients should be referred to an experienced center immediately.
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Saito AM, Chiba S, Ogawa S, Kanda Y, Hirai H, Kurokawa M. Long-term sustained mixed chimerism after allogeneic stem cell transplantation in a patient with severe aplastic anemia. Intern Med 2007; 46:1923-6. [PMID: 18057766 DOI: 10.2169/internalmedicine.46.0249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mixed chimerism in a post-transplant patient with severe aplastic anemia (SAA) is generally considered to be a status preceding donor-cell rejection and bone marrow failure. Here, we report on a rare, prolonged mixed chimerism in a patient with SAA who showed a full recovery in hematological and immunological status after transplantation. The analysis in this patient showed about 20% and 80% recipient-type cells of total blood cells and T cells, respectively, at two years post-transplantation, and 14% and 25% of total blood cells and T cells, respectively, at four years post-transplantation. This report describes the most comprehensive case study known to date.
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Affiliation(s)
- Akiko M Saito
- Department of Hematology/Oncology, Graduate School of Medicine and Department of Cell Therapy/Transplantation Medicine, University of Tokyo Hospital, University of Tokyo, Tokyo.
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Kennedy-Nasser AA, Leung KS, Mahajan A, Weiss HL, Arce JA, Gottschalk S, Carrum G, Khan SP, Heslop HE, Brenner MK, Bollard CM, Krance RA. Comparable Outcomes of Matched-Related and Alternative Donor Stem Cell Transplantation for Pediatric Severe Aplastic Anemia. Biol Blood Marrow Transplant 2006; 12:1277-84. [PMID: 17162209 DOI: 10.1016/j.bbmt.2006.07.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 07/20/2006] [Indexed: 10/23/2022]
Abstract
Matched sibling donor (MSD) bone marrow transplantation is the treatment of choice for pediatric patients with severe aplastic anemia (SAA); however, only about 33% of patients will have an HLA-identical sibling. Alternative donor (AD) transplants may be an option for these patients, but such therapies have been associated with greater incidence of graft failure and graft-versus-host disease (GVHD). We retrospectively analyzed 36 pediatric patients who received 38 bone marrow or peripheral blood stem cell transplants (15 MSD and 23 AD) for SAA at our institution from April 1997 to October 2005. Nineteen AD recipients received reduced intensity conditioning with cyclophosphamide, low-dose total body irradiation, and antithymocyte globulin (ATG) or Campath. The 4-year overall survival for MSD recipients was 93% versus 89% for AD recipients treated with reduced intensity conditioning regimens at a median follow-up of 52 months (range, 6-99 months). No patient receiving Campath, compared with 3 of 9 patients receiving ATG, developed extensive, chronic GVHD. We conclude that, for children with SAA, AD transplantation is as effective as MSD transplantation. Further, compared with ATG, preparatory regimens containing Campath may be associated with a lower incidence of extensive, chronic GHVD.
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Affiliation(s)
- Alana A Kennedy-Nasser
- Center for Cell and Gene Therapy, Baylor College of Medicine, The Methodist Hospital and Texas Children's Hospital, Houston, Texas 77030, USA.
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Solaro C, Mantegazza R, Bacigalupo A, Uccelli A. Intractable myoclonus associated with anti-GluR3 antibodies after allogeneic bone marrow transplantation. Haematologica 2006; 91:ECR62. [PMID: 17194668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- Claudio Solaro
- Department of Neurology ASL3 genovese Genoa, Via Oliva 22 16154-Genoa, Italy.
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Okumura H, Yamaguchi M, Kotani T, Sugimori N, Sugimori C, Ozaki J, Kondo Y, Yamazaki H, Chuhjo T, Takami A, Ueda M, Ohtake S, Nakao S. Graft rejection and hyperacute graft-versus-host disease in stem cell transplantation from non-inherited maternal antigen complementary HLA-mismatched siblings. Eur J Haematol 2006; 78:157-60. [PMID: 17313562 DOI: 10.1111/j.1600-0609.2006.00797.x] [Citation(s) in RCA: 10] [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: 11/28/2022]
Abstract
Human leukocyte antigen (HLA)-mismatched stem cell transplantation from non-inherited maternal antigen (NIMA)-complementary donors is known to produce stable engraftment without inducing severe graft-versus-host disease (GVHD). We treated two patients with acute myeloid leukemia (AML) and one patient with severe aplastic anemia (SAA) with HLA-mismatched stem cell transplantation (SCT) from NIMA-complementary donors (NIMA-mismatched SCT). The presence of donor and recipient-derived blood cells in the peripheral blood of recipient (donor microchimerism) and donor was documented respectively by amplifying NIMA-derived DNA in two of the three patients. Graft rejection occurred in the SAA patient who was conditioned with a fludarabine-based regimen. Grade III and grade IV acute GVHD developed in patients with AML on day 8 and day 11 respectively, and became a direct cause of death in one patient. The findings suggest that intensive conditioning and immunosuppression after stem cell transplantation are needed in NIMA-mismatched SCT even if donor and recipient microchimerisms is detectable in the donor and recipient before SCT.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Anemia, Aplastic/immunology
- Anemia, Aplastic/pathology
- Anemia, Aplastic/surgery
- Blast Crisis/immunology
- Blast Crisis/pathology
- Blast Crisis/surgery
- Chimera/genetics
- Chimera/immunology
- Cord Blood Stem Cell Transplantation
- Disease Progression
- Fatal Outcome
- Female
- Graft Rejection/genetics
- Graft Rejection/immunology
- Graft vs Host Disease/genetics
- Graft vs Host Disease/immunology
- Graft vs Host Disease/prevention & control
- HLA Antigens/genetics
- HLA Antigens/immunology
- Histocompatibility
- Humans
- Immunity, Maternally-Acquired
- Isoantigens/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/pathology
- Male
- Peripheral Blood Stem Cell Transplantation/adverse effects
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/surgery
- Remission Induction
- Siblings
- Tissue Donors
- Transplantation Conditioning/methods
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- Hirokazu Okumura
- Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
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Urban C, Lackner H, Benesch M, Sovinz P, Dornbusch HJ, Moser A, Schwinger W. Comments on 'Skin transplantation to monitor clinical donor-related tolerance in mixed hematopoietic chimerism' by Mache et al. (Pediatr Transplant 2006;10:128-131). Pediatr Transplant 2006; 10:749-50; author reply 751-2. [PMID: 16911503 DOI: 10.1111/j.1399-3046.2006.00548.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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