BACKGROUND: Donor-specific human leukocyte antigen (HLA) antibodies are a significant risk factor for graft failure in cord blood transplantation (CBT). Although there are several treatments to decrease HLA antibodies, such as platelet transfusion, plasma exchange, rituximab, and bortezomib, their effectiveness has not been established.
STUDY DESIGN AND METHODS:We herein report the case of a primary myelofibrosis (PMF) patient with broad HLA antibodies who underwent CBT from an HLAhomozygous donor in which the alleles were matched only in the host-versus-graft direction (homo-tohetero CBT).
RESULTS:The cord blood was killer cell immunoglobulin-like receptor (KIR) ligand matched. She received a reduced-intensity conditioning regimen. We used tacrolimus and mycophenolate mofetil as prophylaxis against graft-versus-host disease (GVHD). The neutrophils engrafted on Day 31. A chimerism analysis with fluorescence in situ hybridization of peripheral blood cells showed 99.9% donor type on Day 33. She developed only mild acute skin GVHD and chronic skin GVHD.
CONCLUSION: This case indicates the usefulness ofhomo-to-hetero CBT in a patient with broad HLA antibodies with a strong mean fluorescence intensity, which is a significant risk factor for graft failure. Further studies are necessary to determine the risk of GVHD and to elucidate the association between KIR ligand incompatibility and graft failure in homo-to-hetero CBT. ABBREVIATIONS: CBT = cord blood transplantation; HCT = hematopoietic cell transplantation; KIR = killer cell immunoglobulin-like receptor; PMF = primary myelofibrosis; TAC = tacrolimus.From the
Immunization of health care personnel (HCP) is critically important to reduce healthcare-associated influenza infections substantially. During 2009During -2010 of all HCP at Kitano Hospital, Osaka, Japan, including 94% of pediatricians, received the monovalent unadjuvanted influenza A (H1N1) pdm09 vaccine.We evaluated the vaccine's immunogenicity. Sixteen pediatricians received 15 mg hemagglutinin antigen subcutaneously. Antibody titer assays were conducted using hemagglutination-inhibition antibody assay on days 0 and 21 and at 5 mo after vaccination. Seroprotection rates, seroconversion rates, and geometric mean titer folds at 21 d were, respectively, 43.8%, 43.8% and 5.4 in all subjects, 70.0%, 70.0% and 8.0 in subjects aged 27-34 y, and 0.0%, 0.0% and 8.0 in subjects aged $ 35 y. None of the latter group met the European Medicines Agency criteria.We hope to adopt intradermal routes and further the development of the influenza vaccine using new technology to improve immunogenicity in Japan.
A 64-year-old woman with lymphoma-associated demyelinating neuropathy was treated by 6 cycles of R-CHOP with intravenous immunoglobulin in the first 2 cycles. We noted substantial improvement in the findings of a nerve conduction study (NCS) after the first cycle, followed by more protracted improvement during the second to sixth cycles. The improvement of the neurological symptoms paralleled the findings of the NCS. Our case provides important information for understanding the etiology and optimization of treatments for lymphoma-associated demyelinating neuropathy.
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