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OALib Journal期刊

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Reduced-intensity conditioning allogeneic stem cell transplantation in malignant lymphoma: current status
Le Zhang,Yi-Zhuo Zhang
Cancer Biology & Medicine , 2013, DOI: 10.7497/j.issn.2095-3941.2013.01.001
Abstract: Allogeneic stem cell transplantation (allo-SCT) is a potential cure for patients with malignant lymphoma that is based on the graft-versus-lymphoma (GVL) effect. Myeloablative conditioning allo-SCT is associated with high mortality and morbidity, particularly in patients older than 45 years, heavily pretreated patients (prior hematopoietic stem cell transplantation or more than two lines of conventional chemotherapy) or patients affected by other comorbidities. Therefore, conventional allo-SCT is restricted to younger patients (<50 to 55 years) in good physical condition. Over the last decade, allo-SCT with reduced-intensity conditioning (RIC-allo-SCT) has been increasingly used to treat patients with lymphoma. This treatment is associated with lower toxicity and substantial decrease in the incidence of transplant-related mortality, and has the potential to lead to long-term remissions. Therefore, patients who are not suitable to undergo conventional allo-SCT can benefit from the potentially curative GVL effects of allo-SCT. Although RIC-allo-SCT has improved the survival of lymphoma patients, high post-transplant relapse rates or disease progression mainly results in treatment failure. Thus, further improvement is clearly needed. The role and timing of RIC-allo-SCT in the treatment of lymphoma remains unclear. Therefore, more prospective studies should clarify the effectiveness of this method. In this article, we review the recent literature on RIC-allo-SCT as a treatment for major lymphoma subtypes. Areas that require further investigation in the context of clinical trials are also highlighted.
减低剂量预处理异基因造血干细胞移植后CMV、EBV感染情况的研究现状及进展
Research Status and Progress of CMV and EBV Infection after Allogeneic Hematopoietic Stem Cell Transplantation with Reduced Intensity Conditioning  [PDF]
郭贤哲, 江明
Advances in Clinical Medicine (ACM) , 2023, DOI: 10.12677/ACM.2023.1371579
Abstract: 随着移植模式不断完善，RIC (减低剂量预处理)移植模式的出现使许多不适合接受常规MAC (清髓性预处理)模式的老年患者和体弱的非老年患者，也能够进行造血干细胞移植。但是在RIC-allo-HSCT (减低剂量预处理异基因造血干细胞移植术)术后CMV、EBV感染是一个很棘手的问题。
With the continuous improvement of the transplantation model, the Reduced intensity conditioning (RIC) transplantation model has enabled many elderly patients and weak non-elderly patients who are not suitable for the conventional MAC (myeloablative conditioning) model to have hematopoiet-ic stem cell transplantation. However, CMV and EBV infection after RIC-allo-HSCT (reduced intensity conditioning allogeneic hematopoietic stem cell transplantation) is a thorny issue.
Optimization of the indications for allogeneic stem cell transplantation in Acute Myeloid Leukemia based on interactive diagnostic strategies
Hartwig M,Zander AR,Haferlach T,Fehse B
Cellular Therapy and Transplantation , 2008,
Abstract: The indications for allogeneic stem cell transplantation (SCT) in Acute Myeloid Leukemia (AML) represent a real challenge due to the clinical and genetic heterogeneity of the disorder. Therefore, an optimized indication for SCT in AML first requires the determination of the individual relapse risk based on diverse chromosomal and molecular prognosis-defining aberrations. A broad panel of diagnostic methods is needed to allow such subclassification and prognostic stratification: cytomorphology, cytogenetics, molecular genetics, and immunophenotyping by multiparameter flow cytometry. These methods should not be seen as isolated techniques but as parts of an integral network with hierarchies and interactions. Examples for a poor risk constellation as a clear indication for allogeneic SCT are provided by anomalies of chromosome 7, complex aberrations, or FLT3-length mutations. In contrast, the favorable reciprocal translocations such as the t(15;17)/PML-RARA or t(8;21)/AML1-ETO are not indications for SCT in first remission due to the rather good prognosis after standard therapy. Further, the indication for SCT should include the results of minimal residual disease (MRD) diagnostics by polymerase chain reaction (PCR) or flow cytometry. New aspects for a safe and fast risk stratification as basis for an optimized indication for SCT in AML might be provided by novel technologies such as microarray-based gene expression profiling.
Theoretical and practical issues of autologous versus allogeneic stem cell transplantation in multiple sclerosis
Alois Gratwohl
Cellular Therapy and Transplantation , 2011,
Abstract: Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) have some common and some clearly distinct goals. All current available information suggests that autologous HSCT should remain the standard approach to clinical HSCT for patients with severe autoimmune disorders, including multiple sclerosis. Allogeneic HSCT should be considered in rare patients with specific features that they are likely to benefit more from an allogeneic HSCT, e.g. young patients with no co-morbidities and hematological autoimmune cytopenias.
What is known about deferasirox chelation therapy in pediatric HSCT recipients: two case reports of metabolic acidosis
Antonietta Martelli,Aurelio Sonzogni,Carmen Fucile,Francesca Mattioli,Massimo Gregori,Natalia Maximova,Valeria Marini
- , 2018, DOI: 10.2147/TCRM.S170761
Abstract: To date, in pediatric field, various hematological malignancies are increasingly treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Iron overload and systemic siderosis often occur in this particular cohort of patients and are associated with poor prognosis. We describe herein the case of two allo-HSCT patients, on treatment with deferasirox; they showed histopathological elements compatible with venoocclusive disease or vanishing bile duct syndrome in ductopenic evolution before deferasirox started. The first patient developed drug-induced liver damage with metabolic acidosis and the second one a liver impairment with Fanconi syndrome. After withdrawing deferasirox treatment, both patients showed improvement. Measurements of drug plasma concentrations were performed by HPLC assay. The reduction and consequent disappearance of symptoms after the suspension of deferasirox substantiate its role in inducing hepatic damage, probably enabling the diagnosis of drug-induced liver damage. But the difficulties in diagnosing drug-related toxicity must be underlined, especially in compromised subjects. For these reasons, in patients requiring iron-chelating therapy, close and careful drug therapeutic monitoring is strongly recommended
Severe Hypoxemia in a Healthy Donor for Allogeneic Hematopoietic Stem Cell Transplantation after Only the First Administration of Granulocyte-Colony Stimulating Factor
Hisashi Sakamaki,Kazuhiko Kakihana,Kazuteru Ohashi,Keita Yamamoto,Kyoko Haraguchi,Noriko Doki,Takeshi Kobayashi,Yasushi Senoo,Yoshiki Okuyama,Yuho Najima
- , 2016, DOI: 10.1159/000446814
Abstract: Granulocyte-colony stimulating factor (G-CSF) is widely used to mobilize peripheral blood stem cells (PBSCs) in healthy donors. A few reports have shown that some healthy donors developed acute respiratory distress syndrome or capillary leak syndrome after more than several rounds of G-CSF administration or leukapheresis
Clinical Utility of Molecular Diagnosis of Blood Stream Infections in Allogeneic Hematopoietic Stem Cell Transplantation Recipients with Hematologic Malignancies  [PDF]
Atsushi Fujieda, Kazunori Nakase, Akiko Nakamura, Kohshi Ohishi, Yuka Sugimoto, Fumihiko Monma, Masahiro Masuya, Naoyuki Katayama
Advances in Microbiology (AiM) , 2019, DOI: 10.4236/aim.2019.912062
Abstract: Blood stream infections (BSIs) are a serious problem in patients with hematologic malignancies receiving allogeneic hematopoietic stem cell transplantation (ASCT). We evaluated the clinical utility of molecular diagnosis for the management of BSIs in such patients. We prospectively performed a polymerase chain reaction (PCR) analysis of microbial DNA in blood samples from 10 consecutive patients with hematological malignancies at least once a week for one month after ASCT. In total, 51 and 54 samples were analyzed by bacterial and fungal PCR assays, respectively. Bacteria were detected in 24 samples from 8 patients by PCR, but in only 2 samples from one patient by blood culture. Notably, the bacteria detected in at least half of the 24 samples were considered to have originated from the oral cavity. Fungi were detected in 5 samples from 3 patients by PCR, but not by blood culture. Most cases with positive PCR results were manageable with empirical antimicrobial therapy without disclosure of DNA data. Our DNA analyses did not directly contribute to management of BSIs, but did provide valuable microbiological evidence for the patients. Additionally, oral management appears to require a critical re-evaluation to reduce the occurrence of BSIs in ASCT recipients.
Hematopoietic Stem Cell Transplantation in Iran: 1991 through 2010
Ardeshir Ghavamzadeh,Kamran Alimogaddam,Mohammad Jahani,Amirali Hamidieh
International Journal of Hematology-Oncology and Stem Cell Research , 2010,
Abstract: "nIntroduction: This review reports the current results of hematopoietic stem cell transplantation (HSCT) in patients who had received transplantation in the Hematology-Oncology and SCT Research Center, Tehran, Iran. "nMethods: In Iran, from 1991 through 2010, a total of 3170 hematopoietic stem cell transplantation have been carried out. The male/female patient ratio was 1909/1261 with a median age of 23 years (range: 4 months-71 years). The most common transplanted disorders were acute myelogenous leukemia (799 patients; 25.2%), thalassemia major (500 patients; 15.8%) and acute lymphoblastic leukemia (447 patients; 14.1%). The donor types for 2147 allogeneic HSCT patients were 2007 (93.5%) human leukocyte antigen (HLA) matched-identical siblings, 66 (3.1%) HLA matched (other relatives), 52 (2.4%) HLA mismatched sibling/other relatives and 22 (1%) unrelated donors; also 16 (0.5%) of transplanted patients had syngeneic twins as donor. "nResults: There were 2147 cases which had received allogeneic HSCT and 1007 cases which had received autologous HSCT. The number of allogeneic and autologous HSCT patients had increased during that time, but the allogeneic to autologous ratio remained constant. Out of 2147 allogeneic HSCT cases, there were 1730 (80.6%) cases of peripheral blood, 370 (17.2%) cases of bone marrow, and 13 (0.6%) combined peripheral blood and bone marrow cases and 34 (1.6%) cord blood cases as product types. Of the 1007 autologous patients with the first HSCT, 937 (93%) received peripheral blood, 65 (6.5%) bone marrow and 5 (0.5%) mixed bone marrow and peripheral blood as stem cell sources. "nConclusion: Hematopoietic stem cell transplantation is a choice treatment for many malignant, nonmalignant and genetic diseases. In Iran, HSCT has been successfully adapted in routine clinical care. Recently, new methods have been used, for example double cord blood and haploidentical transplantation.
EBV-Associated Post-Transplantation B-Cell Lymphoproliferative Disorder in Patient after Allogenic Stem Cell Transplantation  [PDF]
Li Tang, Yu Li
Journal of Biosciences and Medicines (JBM) , 2019, DOI: 10.4236/jbm.2019.75003
Abstract:
Epstein-Barr virus (EBV)-associated B-cell post-transplantation lymphoproliferative disorder (PTLD) is a severe complication following solid-organ transplantation (SOT) and allogeneic hematopoietic stem cell transplantation (HSCT). We present a case of a 15-year-old male developing a monomorphic B-cell PTLD after receiving an allogenic stem cell transplant for acute acute myeloid leukemia. A diagnostic lymph node biopsy revealed monomorphic type, B cell phenotype, associated with Epstein-Barr virus, consistent with post-transplant lymphoproliferative disorder (PTLD). The morbidity and mortality of PTLD are high, and there is no standard protocol for treatment of PTLD. To prevent the occurrence of PTLD and early intervention are important for the prognosis of patients.
A comparison of flow cytometry detection of minimal residual disease and chimerism kinetics in chronic lymphocytic leukemia patients after allogeneic hematopoietic stem cell transplantation  [PDF]
Adriana Plesa, Xavier Thomas, Quoc Hung Le, Anne-Sophie Michallet, Valérie Dubois, Charles Dumontet, Mauricette Michallet
Journal of Biomedical Science and Engineering (JBiSE) , 2011, DOI: 10.4236/jbise.2011.43024
Abstract: Determination of minimal residual disease (MRD) remains crucial for the follow-up after therapy in chronic lymphocytic leukemia (CLL) patients. Chimerism was assessed by short tandem repeat (STR)-PCR and single nucleotide polymorphisms (SNP)-PCR, and MRD by a multicolor flow cytometric approach in 12 consecutive patients with CLL after they received allogeneic stem cell transplantation (SCT). Overall, 11 patients achieved MRD flow negativity [10 had full donor chimerism (FDC) and one had mixed chimerism (MC)]. Only one patient remained with MRD flow positivity and displayed MC. Fifty-six samples were concomitantly studied by both chimerism and MRD flow. A significant correlation was observed between MRD flow data and chimerism in both PB and BM by using a mixed effect linear regression (p < 0.001). Flow cytometry approach of MRD can be easily combined with chimerism during the follow-up post-allogeneic SCT. Both techniques appeared complementary for guiding post-transplant immunomodulation.
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