The Presence of a CMV Immunodominant Allele in the Recipient Is Associated With Increased Survival in CMV Positive Patients Undergoing Haploidentical Hematopoietic Stem Cell Transplantation

Specific major histocompatibility (MHC) class I alleles dominate anti-CMV responses in a hierarchal manner. These CMV immunodominant (IMD) alleles are associated with a higher magnitude and frequency of cytotoxic lymphocyte responses as compared to other human leukocyte antigen (HLA) alleles. CMV reactivation has been associated with an increased incidence of graft-vs.-host disease and non-relapse mortality, as well as protection from relapse in HLA-matched HSCT settings. Less is known about the impact of CMV reactivation on these major outcomes after haploidentical (HI) HSCT, an increasingly applied therapeutic option. In HI HSCT, the efficiency of the immune response is decreased due to the immune suppression required to cross the MHC barrier as well as MHC mismatch between presenting and responding cells. We hypothesized that the presence of a CMV IMD allele would increase the efficiency of CMV responses after HI HSCT potentially impacting CMV-related outcomes. In this retrospective, multivariable review of 216 HI HSCT patients, we found that CMV+ recipients possessing at least 1 of 5 identified CMV IMD alleles had a lower hazard of death (HR = 0.40, p = 0.003) compared to CMV+ recipients not possessing a CMV IMD allele, and an overall survival rate similar to their CMV– counterparts. The analysis delineated subgroups within the CMV+ population at greater risk for death due to CMV reactivation.
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research

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Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
Allogeneic hematopoietic stem cell transplantation (HSCT) is the standard of care in children with very high-risk acute leukemia.1-3 Through advances in donor selection and supportive care strategies, cure rates in patients with high-risk acute lymphoblastic leukemia (ALL) are approaching 70% in large multi-institutional trials.4 However, this success comes at the cost of complications and sequelae from chemotherapy and HSCT with negative impact on quality of life (QoL).
Source: Biology of Blood and Marrow Transplantation - Category: Hematology Authors: Tags: Review article Source Type: research
Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective and curative treatment option for patients with aplastic anemia (AA). High-dose cyclophosphamide (CY) (200 mg/kg) combined with anti-thymocyte globulin (ATG) is frequently used as a conditioning regimen, and shows excellent outcomes especially in HSCT from a human leukocyte antigen (HLA)-matched sibling [1]. However, the cardiotoxicity of high-dose CY is a major problem [2], since patients with AA often have cardiac dysfunction due to long-term anemia and iron overload associated with massive transfusion.
Source: Biology of Blood and Marrow Transplantation - Category: Hematology Authors: Source Type: research
Post-remission therapy with allogeneic hematopoietic stem cell transplantation (allo-HSCT) is generally recommended for adult patients with intermediate or high-risk AML in first complete remission (CR1) or more advanced disease stage [1 –12]. However, NRM and GVHD remain the main causes of post-transplant morbidity and mortality, particularly in older patients, and have limited its widespread use. Though use of reduced intensity regimens has expanded applicability of allogeneic HSCT to older patient populations, the lower risk of NRM has been countered with a higher incidence of relapse [13].
Source: Biology of Blood and Marrow Transplantation - Category: Hematology Authors: Source Type: research
Conclusions: PICU mortality of pediatric cancer and hematopoietic stem cell transplant patients requiring continuous renal replacement therapy is sadly high. Fluid overload at the initiation of continuous renal replacement therapy is the most important and earliest predictor of PICU mortality. Our results suggest that the most commonly used criteria of acute kidney injury, that is, serum creatinine and urine production, are not useful as a trigger to initiate continuous renal replacement therapy. This highlights the urgent need for prospective studies to generate recommendations for effective therapeutic interventions at...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
Publication date: Available online 11 October 2019Source: Hematology/Oncology and Stem Cell TherapyAuthor(s): Jennifer C. Zhao, Justin R. Arnall, Allison L. Martin, Saad Usmani, Shebli Atrash
Source: Hematology Oncology and Stem Cell Therapy - Category: Cancer & Oncology Source Type: research
ConclusionWe confirmed that myeloablative Bu/Flu conditioning has comparable clinical and QOL outcomes to Bu/Cy.
Source: Hematology Oncology and Stem Cell Therapy - Category: Cancer & Oncology Source Type: research
Publication date: Available online 10 October 2019Source: Stem Cell ReportsAuthor(s): Stephanie Smith-Berdan, Alyssa Bercasio, Smrithi Rajendiran, E. Camilla ForsbergSummaryHematopoietic stem cell (HSC) transplantation is a curative treatment for a variety of blood and immune disorders. Currently available methods to obtain donor HSCs are suboptimal, and the limited supply of donor HSCs hampers the success and availability of HSC transplantation therapies. We recently showed that manipulation of vascular integrity can be employed to induce HSC mobilization from the bone marrow to the blood stream, facilitating non-invasive...
Source: Stem Cell Reports - Category: Stem Cells Source Type: research
Authors: Merz AMA, Merz M, Hillengass J, Holstein SA, McCarthy P Abstract Introduction: Maintenance therapy after autologous transplantation is a standard of care in newly diagnosed myeloma. However, there is no universal answer to the question of which maintenance strategy should be pursued after ASCT? Areas covered: We conducted a MEDLINE search using the medical subject headings 'multiple myeloma', 'autologous transplantation' and 'maintenance' to identify available data from clinical trials on the role of different maintenance strategies after autologous transplantation for the newly diagnosed disease. Expert o...
Source: Expert Review of Anticancer Therapy - Category: Cancer & Oncology Tags: Expert Rev Anticancer Ther Source Type: research
Conclusions: All phenotypes of X-linked adrenoleukodystrophy, except for myelopathy in women, were presented in the studied population, which mainly consisted of children and adolescents. Prevalent signs and symptoms registered in the literature were observed. Most of the patients with cerebral demyelinating inflammatory adrenoleukodystrophy were not diagnosed in time for hematopoietic stem cell transplantation.RESUMO Objetivo: Descrever pacientes com diferentes formas de adrenoleucodistrofia ligada ao X: pr é-sintomática, adrenoleucodistrofia inflamatória desmielinizante cerebral, adrenomieloneuropati...
Source: Revista Paulista de Pediatria - Category: Pediatrics Source Type: research
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