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Biology of Blood and Marrow Transplantation

Diego Adrianzen Herrera, Noah Kornblum, Ana Acuna-Villaorduna, R Alejandro Sica, Urvi Shah, Moya Butler, Nivetha Vishnuvardhan, Nishi Shah, Lizamarie Bachier-Rodriguez, Olga Derman, Aditi Shastri, Ioannis Mantzaris, Amit K Verma, Ira Braunchweig, Murali Janakiram
In the United States (U.S.), Adult T-Cell Lymphoma-Leukemia (ATLL) carries a dismal prognosis and mainly affects immigrants from Human T-Cell Lymphotropic Virus 1 (HTLV-1) endemic areas. Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) can be effective and is recommended as an upfront treatment in the NCCN guidelines. We studied the barriers to alloHSCT in one of the largest ATLL populations in the U.S. Comprehensive chart and donor registry reviews were conducted for 88 ATLL patients treated at Montefiore Medical Center from 2003 to 2018...
February 12, 2019: Biology of Blood and Marrow Transplantation
Jiasheng Wang, Yongxian Hu, Shuye Yang, Guoqin Wei, Xin Zhao, Wenjun Wu, Yanlei Zhang, Yafei Zhang, Donghe Chen, Zhao Wu, Lei Xiao, Alex Hongsheng Chang, He Huang, Kui Zhao
BACKGROUND: CD19-targeting chimeric antigen receptor (CAR) T cell therapy has shown great efficacy in patients with relapsed/refractory non-Hodgkin lymphoma (NHL), but has been associated with serious adverse effects such as cytokine release syndrome (CRS). It has been speculated that NHL baseline disease burden might affect clinical outcome and CRS, but such assumption has not been explored in detail. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as measured by FDG PET-CT, are quantitative indicators of baseline tumor burden...
February 12, 2019: Biology of Blood and Marrow Transplantation
Tony H Truong, Jason D Pole, Henrique Bittencourt, Tal Schechter, Geoff D E Cuvelier, Kristjan Paulson, Meera Rayar, David Mitchell, Kirk R Schultz, Debbie O'Shea, Randy Barber, Donna Wall, Lillian Sung
INTRODUCTION: Access to hematopoietic stem cell transplantation (HSCT) in pediatric acute lymphoblastic leukemia (ALL) is primarily dependent on disease-related factors but may be influenced by social and economic determinants. METHODS: We included all children < 15 years old with newly diagnosed ALL in Canada between 2001 and 2018 using the Cancer in Young People in Canada (CYP-C) national registry. We examined factors potentially associated with the likelihood of receiving HSCT using univariate and multivariable logistic regression models...
February 12, 2019: Biology of Blood and Marrow Transplantation
Neeraj Y Saini, Rima M Saliba, Gabriela Rondon, Farzaneh Maadani, Uday Popat, Chitra M Hosing, Oran Betul, Qaiser Bashir, Amanda Olson, Yago Nieto, Amin Alousi, Partow Kebriaei, Samer Srour, Rohtesh Mehta, Paolo Anderlini, Elizabeth J Shpall, Muzaffar H Qazilbash, Issa F Khouri, Luis Fayad, Hun Lee, Nathan Fowler, Simrit Parmar, Jason Westin, Fredrick Hagemeister, Richard E Champlin, Stefan O Ciurea
We analyzed 186 patients with lymphoma who received allogeneic stem cell transplant (ASCT) with fludarabine-melphalan (FM) conditioning and different donors [25 haploidentical (HD), 98 matched unrelated (MUD), and 63 matched related (MRD)] at our institution between 09/2009-01/2018. Patients received fludarabine 160 mg/m2 (40 mg/m2 /day x 4 days) in combination with one dose of melphalan 140 mg/m2  (FM140) or 100 mg/m2 (FM100). Engraftment was similar between the 3 groups (92%, 89%, and 98%, respectively; p=0...
February 11, 2019: Biology of Blood and Marrow Transplantation
Colleen M Morken, Amye J Tevaarwerk, Amanda K Swiecichowski, James E Haine, Zachary T Williams, Kirsten Norslien, Natalia Arroyo, Xiao Zhang, Bethaney Campbell, Eneida A Mendonca, Mark B Juckett, Mary E Sesto
BACKGROUND: The long-term care of hematopoietic stem cell transplant (HSCT) survivors poses special challenges due to a myriad of possible chronic and/or late complications. Survivorship care plans (SCPs) have been proposed as a tool to communicate information regarding the late effects of treatment and recommended follow-up care to clinicians and survivors. Our primary objective was to determine SCP content and format as well as to assess preferred timing of SCP provision following HSCT...
February 11, 2019: Biology of Blood and Marrow Transplantation
Brian G Engelhardt, Ujjawal Savani, Dae Kwang Jung, Alvin C Powers, Madan Jagasia, Heidi Chen, Jason J Winnick, Robyn A Tamboli, James E Crowe, Naji N Abumrad
New-onset post-transplant diabetes mellitus (PTDM) occurs frequently following allogeneic hematopoietic cell transplant (HCT). Although calcineurin inhibitors and corticosteroids are assumed the cause for hyperglycemia, patients developing PTDM have elevated fasting C-peptide levels before HCT and prior to immunosuppressive medications. To determine if PTDM results from established insulin resistance present before transplant, we performed oral glucose tolerance tests (OGTT) and measured whole-body, peripheral, and hepatic insulin sensitivity with euglycemic hyperinsulinemic clamps before and 90 days after HLA-identical sibling donor HCT in 20 patients without pre-transplant diabetes...
February 6, 2019: Biology of Blood and Marrow Transplantation
José Luis Arroyo, Oscar M Pello
No abstract text is available yet for this article.
February 5, 2019: Biology of Blood and Marrow Transplantation
Vincent Bekker, Romy D Zwittink, Cornelis W Knetsch, Ingrid M J G Sanders, Dagmar Berghuis, Peter J Heidt, Jaak M J J Vossen, Willem M de Vos, Clara Belzer, Robbert G M Bredius, Peter J van 't Hof, Arjan C Lankester, Ed J Kuijper
Bloodstream infections and Graft-versus-Host disease (GvHD) are common complications after hematopoietic stem cell transplantation (HSCT) procedures, associated with the gut microbiota which acts as a reservoir for opportunistic pathogens. Selective gut decontamination (SGD) and total gut decontamination (TGD) during HSCT have been associated with a decreased risk of developing these complications after transplantation. However, since studies have shown conflicting results, the use of these treatments remain subject of debate...
February 4, 2019: Biology of Blood and Marrow Transplantation
M S Ebbesen, H Kissow, B Hartmann, K Grell, J S Gørløv, K Kielsen, J J Holst, K Müller
Autologous stem cell transplantation (ASCT) is challenged by side effects that may be propagated by chemotherapy-induced mucositis resulting in bacterial translocation and systemic inflammation. Since gastrointestinal damage appear as an early event in this cascade of reactions, we hypothesized that markers reflecting damage to the intestinal barrier could serve as early predictive markers of toxicity. Glucagon-like peptide-1 (GLP-1), a well-known regulator of blood glucose, has been found to promote intestinal growth and repair in animal studies...
February 4, 2019: Biology of Blood and Marrow Transplantation
Nicole L Prokopishyn, Brent R Logan, Deidre M Kiefer, Jennifer A Sees, Pintip Chitphakdithai, Ibrahim A Ahmed, Paolo N Anderlini, Amer M Beitinjaneh, Christopher Bredeson, Jan Cerny, Saurabh Chhabra, Andrew Daly, Miguel Angel Diaz, Nosha Farhadfar, Haydar A Frangoul, Siddhartha Ganguly, Dennis A Gastineau, Usama Gergis, Gregory A Hale, Peiman Hematti, Rammurti T Kamble, Kimberly A Kasow, Hillard M Lazarus, Jane L Liesveld, Hemant S Murthy, Maxim Norkin, Richard F Olsson, Mona Papari, Bipin N Savani, Jeffrey Szer, Edmund K Waller, Baldeep Wirk, Jean A Yared, Michael A Pulsipher, Nirali N Shah, Galen E Switzer, Paul V O'Donnell, Dennis L Confer, Bronwen E Shaw
Bone Marrow (BM) is an essential hematopoietic stem cell (HSC) source for many allogeneic hematopoietic cell transplant (HCT) recipients, including adult patients (for specific diseases and transplant strategies) and the majority of pediatric transplants. However, since the advent of Granulocyte-colony stimulating factor (G-CSF) mobilized peripheral blood stem cells (PBSC), there has been a significant decrease in utilization of BM in transplant patients, predominantly thought to be due to the increased logistical challenges around BM harvesting compared to PBSC, and generally no significant survival advantage of BM or PBSC...
February 1, 2019: Biology of Blood and Marrow Transplantation
Sara Singer, Robert Dean, Qiuhong Zhao, Nidhi Sharma, Donna Abounader, Patrick Elder, Craig C Hofmeister, Don M Benson, Ashley Rosko, Sam Penza, Leslie Andritsos, Sumithira Vasu, Samantha Jaglowski, Basem M William, Brian Bolwell, Brad Pohlman, Matt Kalaycio, Deepa Jagadeesh, Brian Hill, Ronald Sobecks, Steven M Devine, Navneet S Majhail, Yvonne A Efebera
High-dose chemotherapy followed by autologous hematopoietic stem cell transplant (AHSCT) is a standard of care for patients with relapsed Hodgkin's lymphoma (HL). Different conditioning regimen prior to AHSCT have been used with the two most common being BEAM (carmustine, etoposide, cytarabine, and melphalan) and BUCYVP16 (busulfan, cyclophosphamide, and etoposide). We retrospectively compared the outcomes of patients treated with BEAM (N=128) or BUCYVP16 (N=105) followed by AHSCT. After a median follow up of 4...
February 1, 2019: Biology of Blood and Marrow Transplantation
Jason P Cooper, Rafic J Farah, Philip A Stevenson, Ted A Gooley, Rainer Storb, Bart L Scott
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired clonal hematopoietic cell disease characterized by destruction of hematopoietic cells through the activation of the complement system with manifestations that can be life threatening including hemolysis, thrombosis, and marrow failure. Allogeneic hematopoietic cell transplantation (HCT) remains the only cure for PNH, but eculizumab, a terminal complement inhibitor of C5, has been used to prevent complement mediated hemolysis in PNH since its FDA approval in 2007...
January 31, 2019: Biology of Blood and Marrow Transplantation
Erica Stohs, Victor A Chow, Catherine Liu, Lori Bourassa, Arianna Miles-Jay, Julie Knight, Ania Sweet, Barry E Storer, Marco Mielcarek, Steven A Pergam
BACKGROUND: Steroids used to treat acute graft-versus-host-disease (GVHD) are thought to blunt clinical symptoms of infection. We aimed to assess the value of weekly surveillance blood cultures (SBCs) drawn in an outpatient setting from hematopoietic cell transplant (HCT) patients receiving high-dose steroids. We hypothesized that most positive outpatient surveillance cultures would be low-pathogenicity gram positive organisms and would lead to excess vancomycin therapy. METHODS: We conducted a retrospective review of blood cultures collected from a cohort of adult HCT patients enrolled in a clinical trial of acute GVHD therapy with high-dose steroids (prednisone-equivalent doses ≥ 0...
January 31, 2019: Biology of Blood and Marrow Transplantation
Johan Törlén, Ahmed Gaballa, Mats Remberger, Lisa-Mari Mörk, Berit Sundberg, Jonas Mattsson, Michael Uhlin
Lymphocyte reconstitution is pivotal for successful long-term outcome after allogeneic hematopoietic stem cell transplantation (HSCT), and conditioning and post-transplant immunosuppression constitute risk factors for prolonged immunodeficiency. Nevertheless, the effect of different immunosuppressive protocols on lymphocyte output and replicative capacity has not been investigated. Here, we assessed T-cell receptor excision circles (TREC), kappa-deleting recombination excision circles (KREC), and T-cell telomere length (TL) as proxy markers for immune reconstitution in patients in a prospective randomized trial comparing graft-versus-host disease (GVHD) prophylaxis after transplantation (cyclosporine/methotrexate vs...
January 30, 2019: Biology of Blood and Marrow Transplantation
John Magenau, Thomas Braun, Erin Gatza, Tracey Churay, Amanda Mazzoli, Grant Chappell, Joseph Brisson, Lyndsey Runaas, Sarah Anand, Monalisa Ghosh, Mary Riwes, Attaphol Pawarode, Gregory Yanik, Pavan Reddy, Sung Won Choi
The overall composite of GVHD-free, relapse-free survival (GRFS), defined as survival free of grade III-IV acute GVHD, chronic GVHD requiring systemic immunosuppressive therapy (IST), or relapse has emerged as a useful composite in clinical trials and to capture clinically meaningful events that impact quantity and quality of survival after allogeneic hematopoietic cell transplantation (HCT). We reviewed 565 consecutive patients aged ≥18 years undergoing HCT for hematologic malignancy to analyze how baseline incidence, specifics of clinical definitions, and proposed reductions in any one individual event may dynamically alter the overall performance of the composite To determine the relative impact of each GRFS event (excluding death), we accounted for competing risks using Fine and Gray methods, and correlated each event with overall survival using Kaplan-Meier methods...
January 30, 2019: Biology of Blood and Marrow Transplantation
Cai Yuan, Angela M Boyd, Jan Nelson, Rushang D Patel, Juan C Varela, Steven C Goldstein, Sarfraz Ahmad, Xiang Zhu, Shahram Mori
Thrombocytopenia after Allogeneic hematopoietic stem cell transplantation (Allo-SCT) can pose significant problems in management of patients. Eltrombopag is a small molecule, thrombopoietin receptor agonist (TPO-R) which has been approved for use in immune thrombocytopenia purpura (ITP) and aplastic anemia; but its use after the Allo-SCT is limited. We treated 13 patients with Eltrombopag for poor platelet engraftment without evidence of relapse at the time of initiation between 2014-2017. Six patient had primary platelet engraftment failure and seven patients had secondary platelet engraftment failure...
January 30, 2019: Biology of Blood and Marrow Transplantation
Stephanie J M van Leeuwen, Dr Carin M J Potting, Prof Dr Marie-Charlotte D N J M Huysmans, Prof Dr Nicole M A Blijlevens
Severe oral problems including oral mucositis (OM) and xerostomia often occur after conditioning therapy for hematopoietic stem cell transplantation (HSCT). Saliva plays a major role in protecting the oral mucosa and teeth. Alterations in salivary flow rate or salivary components resulting in decreased salivary defence mechanisms may affect oral/mucosal health and may influence the severity of OM. To assess current scientific knowledge on changes in salivary function and composition before and after HSCT a systematic review was conducted...
January 30, 2019: Biology of Blood and Marrow Transplantation
Rui Ma, Xiao-Jun Huang, Lan-Ping Xu, Kai-Yan Liu, Xiao-Hui Zhang, Chen-Hua Yan, Wei Han, Feng-Rong Wang, Yu-Hong Chen, Huan Chen, Yao Chen, Jing-Zhi Wang, Yu Wang
Haploidentical transplantations have achieved comparable survival as HLA fully matched unrelated donors. When choosing the best donor for HLA-haploidentical transplantations, most institutions prioritize using young male donors over mother donors. In a retrospective study we compared outcomes in mother donor and unrelated donor transplantations. We found that both 2-year overall survival and 2-year leukemia-free survival were comparable between mother donor group and unrelated donor group (74.8% versus 72.9%, p=0...
January 29, 2019: Biology of Blood and Marrow Transplantation
Mariam T Nawas, Charalambos Andreadis, Thomas G Martin, Jeffrey L Wolf, Weiyun Z Ai, Lawrence D Kaplan, Gabriel N Mannis, Aaron C Logan, Lloyd E Damon, Chiung-Yu Huang, Rebecca L Olin
BACKGROUND: While use of geriatric assessment in the allogeneic hematopoietic cell transplantation setting has been reported, few studies have evaluated the impact of patient reported function on autologous transplant outcomes. METHODS: Geriatric assessment including the quality of life tool FACT-BMT was administered to 184 patients ≥50 years old (median 61, range 50-75) prior to autologous transplant. Associations between geriatric assessment, quality of life metrics and post-transplant outcomes were evaluated using Cox regressions...
January 29, 2019: Biology of Blood and Marrow Transplantation
Matthew Mei, Rohan Gupta, Margaret O'Donnell, Monzr M Al Malki, Ibrahim Aldoss, Haris Ali, Leonardo Farol, David Snyder, Stephen J Forman, Ryotaro Nakamura, Samer Khaled
Paroxysmal nocturnal hemoglobinuria (PNH) is frequently seen in the context of other aplastic anemia and myelodysplastic syndrome and is associated with hemolysis and increased thromboembolic events. Allogeneic hematopoietic stem cell transplantation (alloHCT) is the only curative treatment but is associated with significant morbidity. The terminal complement inhibitor eculizumab reduces hemolysis and thromboembolic events and is the only FDA-approved therapy for PNH. Prophylactic administration of this agent in the early post-transplant setting to prevent hemolysis and thrombosis has not been described in the literature...
January 29, 2019: Biology of Blood and Marrow Transplantation
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