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...
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.
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.
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