In conclusion, despite a high rate of viral infections in the early period, present data suggest a satisfactory infectious profile after T-cell replete haplo-HSCT using post-transplant Cy. These results may help clinicians to improve both prophylactic and therapeutic antimicrobial strategies in this emerging haploidentical setting.
BACKGROUND:Alternative donors, such as unrelated umbilical cord blood (UCB) and related haploidentical (haplo) donors, are more and more frequently searched for and used for patients who are candidates for allogeneic hematopoietic stem cell transplantation but are without a suitable related or unrelated donor. The aim of the current retrospective study was to compare the outcome of patients after haplo and UCB grafts prepared using a nonmyeloablative conditioning regimen. METHODS: A total of 150 adult patients with high-risk hematologic diseases who underwent allogeneic hematopoietic stem cell transplantation from alternative donors at 2 centers (Paoli-Calmettes Institute [Marseille, France] and Humanitas Cancer Center [Milan, Italy]) were analyzed. Sixty-nine patients had haplo donors and 81 patients had UCB donors. RESULTS: The cumulative incidence of nonrecurrence mortality at 1 year was 23% in the UCB group versus 17% in the haplo group (P 5.39). The incidence of grade 2 to 4 acute graft-versus-host disease and extensive chronic graft-versus-host disease in the UCB group versus the haplo group was 52% versus 29% (P 5.05) and 12% versus 6% (P<.0001), respectively. The overall survival rate at 2 years was 45% in the UCB group (95% confidence interval [95% CI], 34%-56%) versus 69% in the haplo group (95% CI, 58%-80%) (P 5.10). The progression-free survival rate at 2 years was 36% in the UCB group (95% CI, 25%-47%) versus 65% in the haplo group (95% CI, 53%-77%) (P 5.01). CONCLUSIONS: The results of the current study suggest that for patients with high-risk hematological diseases without a related or unrelated donor, haploidentical transplants are a promising alternative option that deserves further investigation. Cancer 2015;121:1809-16. V C 2015 American Cancer Society.KEYWORDS: haploidentical donor, unrelated umbilical cord blood, allogeneic hematopoietic stem cell transplantation, nonmyeloablative conditioning regimen, high-risk hematological diseases. INTRODUCTIONAllogeneic hematopoietic stem cell transplantation (allo-HSCT) is potentially curative for patients with hematologic malignancies. 1 However, one of the most limiting factors for all patients is the unavailability of a donor. Indeed, a matched related donor is found for only 25% to 30% of patients, and a matched unrelated donor (MUD) is found for 40% to 50% of white patients. For all other patients, alternative donors who can be considered include unrelated cord blood (UCB), mismatched unrelated donor (mMUD), or a partial family matched donor (haploidentical donors; haplo). 2,3 UCB offers the advantages of easy procurement and immediate availability, the absence of risk for the donor, and a potentially reduced risk of graft-versus-host disease (GVHD) despite the absence of total human leukocyte antigen (HLA) compatibility. 4,5 Recently, the results of UCB transplants in adult patients with acute leukemia have been reported. The results with UCB transplants were similar to those obtained with MUD or mMUD for leukemia-free survival, but the nonrecur...
Over the past decade, invasive fungal infections (IFIs) have remained an important problem in patients undergoing allogeneic haematopoietic stem cell transplantation (Allo-HSCT). The optimal approach for prophylactic antifungal therapy has yet to bedetermined.We conducted a retrospective analysis, comparing the safety and efficacy of micafungin 50mg/day vs. fluconazole 400mg/day vs. itraconazole 200mg/day as prophylaxis for adult patients with various haematological diseases receiving haploidentical hematopoietic stem cell transplantation (haplo-HSCT) followed by high-dose cyclophosphamide (PT-Cy).Overall, 99 patients were identified: 30 patients received micafungin, 50 and 19 patients received itraconazole and fluconazole, respectively. After a median follow-up of 12 months (range: 1–51), proven or probable IFIs were reported in 3 patients (10%) in the micafungin, 5 patients in the itraconazole (10%) and 2 patients (11%) in the fluconazole group (p=0.998). Fewer patients in the micafungin group had invasive aspergillosis (1 [3%] vs. 3 [6%] in the itraconazole vs. 2 [11%] in the fluconazole group, p=0.589). Four patients (13%) in the micafungin group vs 13 (26%) patients in the itraconazole group and 10 (53%) patients in the fluconazole received empirical antifungal therapy (P = 0.19).No serious adverse events related to treatment were reported by patients, and there was no treatment discontinuation because of drug-related adverse events in both groups.The present analysis shows that micafungin did better than fluconazole in preventing invasive aspergillosis after transplant in these high-risk hematological diseases, as expected. In addition, micafungin was more effective than itraconazole in preventing all IFI episodes when also considering possible fungal infections. Future prospective studies would shed light on this issue, concerning this increasingly used transplant platform.
The Pavia University History Museum, which houses historic items mainly connected to the physics and medicine fields, has focused in the past years on new ways to involve its public and to attract new audiences. Among different approaches, digital technologies have proven important to both external and internal communication. Lately, an Augmented Reality application has been made available to visitors, offering in one tool multimedia material of a historical-scientific nature: stories, 3D animations, images and user-generated video storytelling (developed mainly by University students, one of our least present demographics before the App, and younger students, who typically participate in the annual co-creative project). The App was designed to be as non-intrusive and discreet as possible, to preserve the historic ambiance of the museum, to unite social and educational aspects, to register user behaviour and to make the museum experience more vibrant and active and therefore captivating.
Introduction a major limitation of hematopoietic stem cell transplantation (HSCT) from haploidentical donor is the impaired immune reconstitution due to extensive immunosuppression necessary to overcome HLA disparity. Recently, a platform for T-cell repleted HSCT from haploidentical donor (haplo-HSCT) using post-transplant cyclophosphamide (CTX) has been reported, with low TRM and high reproducibility. However, little has been reported so far about immune reconstitution and, in particular, incidence of infections after this type of transplantation. Aims of the study to describe infectious complications after T-cell replete haplo-HSCT after NMA conditioning performed at our center and to compare them with HLA-identical transplantations performed at the same center. Patients and Methods data on patients with hematological malignancies who underwent haplo-HSCT were collected and compared with RIC/NMA-HSCT from HLA-identical donors. Transplants included were those performed up to 31st December 2012. Infections were classified as FUO, bacterial, micotic or viral and prevalence over five post-transplant intervals was estimated: days 0-30, 31-100, 101-180, 181-365, >365. Prevalence for each time period was defined as the number of infectious events/patients at risk. Results we identified a total of 72 and 40 patients transplanted from HLA-identical or haploidentical donor respectively. Median follow-up was longer in HLA-identical vs. haploidentical (34 vs. 15 months, p<0.0001). Among 38 out of 40 haplo-HSCT patients, a total of 96 infectious events occurred, with a median of 3 events/patient (range: 0-6). Etiologies were as follows: 39 bacterial, 6 fungal and 51 viral. Bacterial infections occurred mostly between day 0 and +30, whereas viral infections/reactivations between +30 and +100 (see Figure 1a). In the HLA-identical cohort, 166 events occurred among 64 out of 72 patients, with a median of 2 events/patient (range: 0-8); etiologies were: 84 bacterial, 9 fungal and 73 viral. FUO events were 19 and 34 among haplo- and HLA-identical transplants respectively. Prevalence of infections was lower in HLA-identical compared with haplo-HSCT group, but subdistribution of etiologies was similar overtime (see Figure 1b), with bacterial and FUO mostly before day+30 and viral events mostly between +30 and +100. Importantly, no fungal infections occurred beyond day +180 in haplo group, probably due to the low incidence of chronic GVH. Conversely, higher prevalence of bacterial events observed in HLA-identical group may be due to chronic GVH. Deaths due infection were 25% in haplo group (10/40, occuring between +13 and +152) and 11% (8/75) among HLA-identical transplants. Conclusion RIC haplo-SCT with post-transplant CTX shows a slightly higher rate of infectious complications compared with HLA-identical ones. Subdistribution of etiologies is similar, with the highest prevalence of viral infections between +30 and +100 and no fungal events after +180. Thus, in haplo-SCT, immunological recovery appears to be satisfactory after +180. Future comparisons with other alternative stem cell sources (i.e. cord blood) are warranted. Disclosures: No relevant conflicts of interest to declare.
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