The controversial role of red cell transfusions for sickle cell pain
Purpose of review
Red cell transfusions are one of the most common and important therapies used for patients with sickle cell disease (SCD). For prevention of strokes, there is abundant evidence that transfusions are efficacious, whereas for other indications, such as prevention of pain, there are less data. Nonetheless, with few therapeutic options, the use of transfusion for prevention of acute pain has increased in children and adults with SCD without a clear understanding of its benefits.
Recent findings
Although it makes conceptual sense that red cell transfusions would prevent pain that arises from vaso-occlusio...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: TRANSFUSION MEDICINE AND IMMUNOHEMATOLOGY: Edited by Steven L. Spitalnik Source Type: research
Mechanisms of alloimmunization in sickle cell disease
Purpose of review
Red blood cell (RBC) transfusion is an important treatment for some complications of sickle cell disease (SCD). On the contrary, transfusion may lead to alloimmunization to RBC antigens, with such alloantibodies putting patients at risk for acute or delayed hemolysis, and increasing the difficulty of finding compatible RBCs. Patients with SCD are more susceptible to developing RBC alloantibodies than other multiply transfused patient populations, for reasons that are not completely understood. In this review, we summarize the available data about risk factors and underlying mechanisms associated with RB...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: TRANSFUSION MEDICINE AND IMMUNOHEMATOLOGY: Edited by Steven L. Spitalnik Source Type: research
Mechanisms of failure of chimeric antigen receptor T-cell therapy
Purpose of review
Although chimeric antigen receptor T (CART)-cell therapy is best recognized for its antitumor effect in relapsed/refractory B-cell hematological cancers, it is still associated with a high relapse rate.
Recent findings
We firstly analyzed internal immunological and genetic reasons of CD19+ relapse after treatment for R/R B-cell hematological cancers with CART19 cells. The reasons: murine-derived scFv may limit expansion of CART cells. Repeated antigen exposure leads to T-cell exhaustion. Activation of T cells can cause T-cell senescence and high expression of inhibitive receptors, PD-1, CTLA4, TIGIT,...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Current landscape for chimeric antigen receptor T cells in lymphomas
Purpose of review
CART cell therapy has changed the treatment landscape for relapsed/refractory aggressive lymphomas. In this article, we review the CART constructs most studied in lymphoma and their applicability.
Recent findings
Results of ZUMA-1, JULIET and TRANSCEND trials will be reviewed. Real-world data will also be reviewed.
Summary
CART cell therapy is evolving and becoming safer. Increased uptake of this modality outside of clinical trials is expected. (Source: Current Opinion in Hematology)
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Using minimal (measurable) residual disease assessments to guide decision-making for timing of allogeneic transplantation in acute myeloid leukemia
Purpose of review
The current review aims to highlight recent and important developments in the detection and value of minimal (measurable) residual disease (MRD) testing in patients with acute myeloid leukemia (AML) and the impact on the timing of allogeneic hematopoietic cell transplantation.
Recent findings
The European LeukemiaNet MRD Working Party recently published guidelines to help standardize testing, utilizing flow cytometry and molecular techniques. The timing of MRD assessments, choice of assay and cutoff of for reporting positive results are all important. Patients known to be MRD-positive pretransplantat...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Recent progress in haploidentical transplantation: is this the optimal choice for alternative donor transplantation?
This article is intended to review recent trends and improvements in haploidentical transplantation to understand its current status and future direction.
Recent findings
The noninferiority of haploidentical donors compared with other donor sources, including HLA-matched related or unrelated donors, has been demonstrated in patients with various hematological diseases. The development of graft-versus-host-disease (GVHD) prophylaxis using posttransplant cyclophosphamide has effectively reduced transplant-related mortality caused by GVHD, graft rejection, and other related complications. Novel GVHD prophylactic methods an...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Allogenic hematopoietic stem cell transplantation in sickle cell disease
Purpose of review
Discussing the currently available HSCT options for Hb SS patients highlighting advantages and disadvantages of each modality in the light of recently published data.
Recent findings
When MSD is available, myeloablative regimen is the preferred approach for otherwise healthy children whereas the nonmyeloablative (NMA) regimen is of choice for adults as well as children with SCD-associated morbidities. Mixed chimerism is common especially with NMA conditioning and is usually enough for cure. Alternative donor HSCT outcomes are progressively improving especially with posttransplant cyclophosphamide for...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Application of stem cell transplantation in autoimmune diseases
Purpose of review
Autologous hematopoietic stem cell transplantation (HSCT) is a promising therapeutic modality for severe autoimmune diseases. In this review, we will outline the immunological mechanisms and the clinical evidence and experiences for therapeutic HSCT in autoimmune diseases, with particular focus on systemic sclerosis and multiple sclerosis.
Recent findings
Approximately 3000 patients with autoimmune diseases worldwide have been treated with HSCT. HSCT in systemic sclerosis has been shown in three randomized controlled trials to be associated with significant long-term event-free survival despite some ...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Is autologous stem cell transplantation still relevant for multiple myeloma?
Purpose of review
Autologous stem cell transplantation has been the standard of care in myeloma treatment for many years, but the availability of newer antimyeloma drugs and the emerging data from chimeric antigen receptor (CAR) T-cell clinical studies make us question the relevance of it. The purpose of this review is to go over recent data and to reassess the current status of autologous stem cell transplantation as a standard of care.
Recent findings
Autologous stem cell transplantation can be safely performed for elderly patients and there is no absolute age limit. Recent data on BEAM (Carmustine, Etoposide, Cytar...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
MICROtransplant to refractory acute myeloid leukemia in Egyptian population
Purpose of review
The purpose of this review is to outline Egyptian experience of nonengraftment haploidentical cellular therapy [microtransplantation (MST)] for patients with refractory acute myeloid leukemia.
Recent findings
The use of granulocyte colony-stimulating factor primed halo-identical MST appears to be a biologically active therapy in patients with refractory acute myeloid leukemia (AML), especially in patients received less than four previous chemotherapy lines, fludarabine-free previous chemotherapy, response naïve and young age patients.
Summary
Refractory AML is still challenging. MST is promising,...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Current state of nonengrafting donor leukocyte infusion (focus on microtransplantation for acute myeloid leukemia)
Purpose of review
Microtransplantation (or micro-stem cell transplantation, MST) is one permutation of alloreactive immunotherapy increasingly studied in clinical trials. It is most commonly applied to patients with myeloid malignancies who are not suitable candidates for allogeneic hematopoietic cell transplantation. This review highlights the past 2 years of work on stem/progenitor cell products in the field of nonengrafting donor leukocyte infusion (NE-DLI), with a focus on applications of MST in acute myeloid leukemia (AML).
Recent findings
Assessing the utility of MST is hampered by lack of randomized controlled ...
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: HEMATOPOIETIC STEM CELL TRANSPLANTATION: Edited by David Rizzieri Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Hematology)
Source: Current Opinion in Hematology - October 4, 2019 Category: Hematology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Antiphospholipid syndrome in pediatric patients
Purpose of review
The purpose of this review is to summarize the diagnosis and management of the antiphospholipid syndrome (APS) in children.
Recent findings
APS is a rare, acquired autoimmune systemic disease that can result in significant morbidity in children related to vascular thrombosis. The diagnosis and management of APS in children can be challenging due to a lack of validated diagnostic criteria and the rarity of the disease. In addition, many healthy children have transient circulating antiphospholipid antibodies without thrombotic complications. Nevertheless, epidemiological studies suggest that APS repres...
Source: Current Opinion in Hematology - August 2, 2019 Category: Hematology Tags: HEMOSTASIS AND THROMBOSIS: Edited by Alvin H. Schmaier Source Type: research
CD36 and ERK5 link dyslipidemia to apoptotic-like platelet procoagulant function
Purpose of review
Metabolic diseases, including dyslipidemia, diabetes mellitus, and chronic inflammation are risk factors for clinically significant thrombotic events. Thrombosis in these settings is multifaceted with coordinated mechanisms between platelet activation and the hemostatic pathways. This review focuses on recent advances in platelet procoagulant and apoptotic signaling with emphasis on the pathophysiologic mechanisms induced by platelet CD36 in dyslipidemia, and the key unaddressed questions relating to the field.
Recent findings
CD36 promotes platelet activation and increases the risk for thrombosis th...
Source: Current Opinion in Hematology - August 2, 2019 Category: Hematology Tags: HEMOSTASIS AND THROMBOSIS: Edited by Alvin H. Schmaier Source Type: research
Cancer cell-derived tissue factor-positive extracellular vesicles: biomarkers of thrombosis and survival
Purpose of review
Tissue factor (TF) is released from cancer cells and tumors in the form of extracellular vesicles (EVs). This review summarizes our current knowledge of the mechanisms of release of TF-positive EVs (TF+EVs) from cancer cells and the effect of these TF+EVs on cultured endothelial cells. In addition, we will summarize the contribution of TF+EVs to thrombosis in mice, and the association between plasma EVTF activity and venous thrombosis as well as survival of cancer patients.
Recent findings
The release of TF+EVs from cancer cells is regulated by multiple factors, including hypoxia, epithelial–mesenc...
Source: Current Opinion in Hematology - August 2, 2019 Category: Hematology Tags: HEMOSTASIS AND THROMBOSIS: Edited by Alvin H. Schmaier Source Type: research
