Post-transplant Cyclophosphamide (PT-Cy) has proved efficacy as GVHD prophylaxis regimen after HSCT. However, experiences are limited with controversial results. We herein, assess the efficacy of PT-Cy compared to Methotrexate regimen. Eighty patients with acute leukemia received a fully matched allogeneic HSCT or a Haplo-identical HSCT were analyzed. Group I (Historical group) included 40 patients received Methotrexate, Cyclosporine and MMF. They were transplanted with fully matched allogeneic transplantation. Group II included 40 patients received PT-Cy, Cyclosporine and MMF. They were subdivided to 2 subgroups. Subgroup IIA included 22 patients received fully matched allo- HSCT and subgroup IIB included 18 patients received Haplo- HSCT. Group IIA showed significantly lower incidence of cGVHD when compared to group I with an incidence of 22.7% and 67% respectively (P = 0.002). Group IIA was associated with reduced risk of extensive cGVHD compared to MTX group (P =0.003). No significant differences were found in the incidence of aGVHD, relapse rates, relapse or non-relapse related mortalities, OS and DFS data among the different groups (P>0.05). In conclusion, PT-Cy with addition of IS drugs has statistically significant difference in reducing the incidence of cGvHD in both fully matched and Haplo SCT with less hepatic and renal toxicity.

Background: The Chimeric antigen receptor T cell (CAR-T cell) is a kind of effector T cell that detects and kills cancer cells without the need for major histocompatibility complex components. The entire process of creating CAR-T cells is not well known. Acute lymphoblastic leukemia, chronic lymphocytic leukaemia, lymphoma, and multiple myeloma are among the haematological cancers for which the CAR-T cell has been employed. Objectives: Chimeric antigen receptor T cell (CAR-T cell) therapy is a novel adoptive immunotherapy where T lymphocytes are engineered with synthetic receptors known as chimeric antigen receptors (CAR). Data Sources: Electronic articles and Journal articles about role of Cart-T Cell therapy in hematological malignancy. Study Selection: This essay was containing data from many resources such as Google scholar, Elsevier, PMC, PubMed, England Journal, and Blood Journal to facilitate achieving the aim. Data Extraction: If the studies did not fulfil the inclusion criteria, they were excluded. Study quality assessment included ethical approval was gained, eligibility criteria specified, adequate information and defined assessment measures. Recent Findings: Fourth-generation CARs include the combination of second-generation CARs with an additional element, such as the tumor-killing cytokine IL-12. This type of CAR has improved tumor eradication by releasing cytokines into the tumor microenvironment and recruiting immune cells without prior conditioning. In addition, it has been used to treat virus infections, metabolic disorders and autoimmune diseases in addition to cancers. Conclusion: CAR T cell therapy has brought a new hope for the treatment of malignant hematological diseases such as acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), non-Hodgkin's lymphoma (NHL), Hodgkin's lymphoma (HL) and multiple myeloma (MM).

No abstract

Background: Acute lymphoblastic leukemia (ALL) is a rare disease in adults. Despite the novels therapies, clinical outcomes remain unsatisfactory. Bone marrow allograft still holds its place as a consolidation treatment for patients in complete remission in order to improve the prognosis and lengthen survival. Aims: We study in this work the feasibility and outcome of bone marrow allograft for adult Philadelphia chromosome negative ALL. Methods: Our study is retrospective including the cases of high-risk adult ALL (HR) diagnosed in the hematology department of Hédi Chaker Hospital of Sfax during the period from January 2004 to December 2015. These patients were treated according to protocols inspired by GRAALL 2003 and 2005. The indication of bone marrow allograft is systematic in patients whose age are < 50 years and having a compatible intrafamilial donor. For our patients we studied the allograft indication, the search for a family compatible HLA donor, the feasibility of the allograft and finally the result of this one which was carried out at the national center of bone marrow transplantation in Tunis. Results: Among the 36 cases of adult phi negative ALL treated with the GRAALL 2003 and 2005 protocols, 28 patients were in complete remission (CR) and 22 patients (79%) were classified as HR. Twenty patients had indication of bone marrow allograft (2 were> 50 years of age). Of the 20 patients who had an HLA study, 14 patients (70%) had a compatible HLA family donor. Allogeneic bone marrow allograft could only be performed for 9 patients: 64% of patients with a compatible HLA donor and 45% of patients with CR. For the 5 others the transplant could not be done for: relapsed before allograft for 2 cases and severe comorbidities for the 3 others. The median time to completion of the allograft was 15 weeks. Among the allografts, 6 patients (67%) were living in CR after a follow-up of 74 months, one patient relapsed at 6 months post-transplant and 2 patients died of acute GVH. Of the 19 non-allograft CR patients, 6 patients were living in CR (31%) and 1 died during consolidation therapy and 12 relapsed. The 5-year DFS of both allografted and non-allografted patients was 72% and 21%, respectively. Summary/Conclusion: Despite the cost-effectiveness of the intra-familial HLA study (70% donor) in our study, allografting could only be performed for a small number of patients (45%), hence the need to expand the indication of allograft for subjects over 50 years old or perform a mini allograft, do the same haplo transplant and even expand donor sources on files (pheno-identical donors). Two-thirds of the allografted patients in our series did not relapse, an interesting result and comparable to the literature.

Background: Esophageal motility changes occur in about 80% of systemic sclerosis (SSc) patients with decreasing the motility of the lower two-thirds of the esophagus and lower esophageal sphincter (LES) pressure. Aim of Study:Using high resolution manometry (HRM) to study the esophageal motility disorder in patients with systemic sclerosis to evaluate the predictive factors associated with esophageal affection. Patients and Methods: A prospective study was done on twenty female patients with SSc. Demographic data and esophageal symptoms including Gastroesophageal Reflux disease (GERD) and dysphagia were evaluated. All patients underwent HRM and High Resolution Computed Tomography (HRCT), Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Hemoglobin level (Hgb), Forced Vital Capacity (FVC).Results: High resolution manometry showed normal upper esophageal contraction in 100% of patients. Middle and lower esophageal contraction were normal in 30%, hypoperestalsis in 5%, and aperestalsis in 65% of patients. Regarding the lower esophageal sphincter pressure, it showed normal pressure in 30%, hypotensive in 65% and hypertensive in 5% of patients. The esophageal involvement was GERD in 70% and dysphagia in 45% of patients. The pulmonary involvement was dyspnea in 70% and cough in 40% of patients. All patients had skin involvement. Abnormal motility was present in 14 out of 20 patients (70%) which was significantly related to Interstitial Lung Disease (SSc-ILD) (p= 0.001), SSc subtypes (p=0.03), dyspnea (p=0.01) and FVC (p=0.046). A significant relation between GERD and ILD (p<0.05) was found. Conclusion:This study confirmed an increased prevalence of esophageal motility disorders in SSc patients with and without esophageal symptoms.