Spectra-MNC and Spectra-Auto showed distinct features that should be considered on a case-by-case basis. Similar investigations should be undertaken as new collection platforms are introduced.
BackgroundCD4+CD25highFOXP3+ regulatory T (Treg) cells, which include thymus-derived and peripherally induced cells, play a central role in immune regulation, and are therefore crucial to prevent graft-versus-host disease (GVHD). The increasing use of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for elderly patients with thymus regression, and our case of allo-HSCT shortly after total thymectomy, raised questions about the activity of thymus-derived Treg cells and peripherally induced Treg cells, which are otherwise indistinguishable.ResultsWe found that despite pre-transplant thymectomy or older age, both naïve and effector Treg cells, as well as naïve and effector conventional T cells, proliferated in allo-HSCT recipients. Higher proportions of total Treg cells 1 month post allo-HSCT, and naïve Treg cells 1 year post allo-HSCT, appeared in patients achieving complete chimera without developing significant chronic GVHD, including our thymectomized patient, compared with patients who developed chronic GVHD.ConclusionsTreg cells that modulate human allogeneic immunity may arise peripherally as well as in the thymus of allo-HSCT recipients.
: From 1996 to the end of 2009, a total of 114 cases of hematopoietic stem cell transplantation were performed in the Department of Hematology, Fukushima Medical University. We report here a general overview of our results. Allogeneic hematopoietic stem cell transplantation (allo -HSCT) was performed in 37 cases of acute leukemia, 10 of myelodysplastic syndrome, 5 of aplastic anemia, and 5 others. The 5 -year survival rate with allo -HSCT was 51.1%. Autologous hematopoietic stem cell transplantation (auto -HSCT) was performed in 34 cases of malignant lymphoma, 15 of multiple myeloma, and 8 others. The 5 -year patient survival rate was 75.2% with malignant lymphoma and 46.7% with multiple myeloma. These results are comparable to those from a nationwide survey in Japan, confirming that our hospital has attained a creditable level as a transplantation center.
: Renal amyloidosis is typically characterized by nephrotic syndrome, often with massive proteinuria and refractory peripheral edema. We report the case of a patient with renal amyloidosis associated with nephrotic syndrome who maintained remission for 6 years after undergoing highdose chemotherapy followed by autologous peripheral blood stem -cell transplantation (auto -PBSCT). The patient was a man aged in his 50s who had developed nephrotic syndrome. Bone marrow aspiration and kidney biopsy determined that the cause of the nephrotic syndrome was renal amyloidosis due to multiple myeloma, and the patient was admitted to our department in July 2003. After one course of chemotherapy, auto -PBSCT was performed in March 2004. Following transplantation, serum M -protein was no longer detectable from March 2005, and the patient achieved complete hematological remission. Subsequently, proteinuria decreased, serum albumin levels normalized, and nephrotic syndrome improved. As of 6 years after transplantation, in March 2010, the patient remained in remission, meaning that auto -PBSCT proved extremely effective as a treatment for renal amyloidosis in this case.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often associated with comorbidity or mortality, due to graft-versus-host disease (GVHD), opportunistic infections, and regimen-related toxicities. Recently, several studies have shown that pre-transplant red blood cell (RBC) transfusions may increase risks of such allo-HSCT-related complications, possibly due to iron overload caused by pre-transplant RBC transfusions. However, it is unknown how post-transplant RBC and platelet (PLT) transfusions influence the long-term outcome of allo-HSCT. In this study, to clarify impact of RBC and PLT transfusions at early after engraftment of allo-HSCT, we investigated the clinical and laboratory findings and long-term outcomes of 71 recipients of allo-HSCT including 48 bone marrow transplantation and 23 peripheral blood stem cell transplantation who received leukoreduced and irradiated RBC and/or PLT from days 31 to 50, after exclusion of patients who did not achieve complete chimera (>90% donor cells) before day 30 or engraftment (neutrophil count > 0.5 x 109 /L) up to day 35; whose disease relapsed until day 60; and who did not survive until day 100. In these 71 patients, 33 (46.5%) patients received RBC and/or PLT transfusion, while 38 (53.5%) received no transfusion from days 31 to 50. Among groups of those patients who received RBC (RBC-transfused patients), PLT (PLT-transfused patients), and both (RBC/PLT-transfused patients) transfusions, pre-transplant findings, including age, sex, sources, serum ferritin (Ft) levels, conditioning regimens, and blood group and HLA compatibilities were not significantly different. However, even at day 100, significant decreases of both Hb concentrations and platelet counts, but not leukocyte counts, were observed in RBC-transfused patients, PLT-transfused patients, and RBC/PLT-transfused patients (Table 1), although vast majority of them no longer required transfusion after day 50. Moreover, serum Ft and C-reactive protein (CRP) levels were higher at day 100 in RBC-, PLT-, and RBC/PLT-transfused patients versus other patients (Table 1). Risk of clinically significant chronic GVHD (cGVHD) by transfusions of both RBC and PLT from days 31 to 50 did not reach statistical significance [hazard risk (HR) = 2.75, p = 0.06], but cumulative incidence of cGVHD was significantly greater in RBC/PLT-transfused patients compared with other patients (p = 0.03). Risk of cGVHD was also correlated with elevated CRP levels (HR = 3.28, p = 0.02) rather than serum Ft levels (HR = 1.40, p = 0.6) at day 100 in univariable analysis, although multivariable analysis did not show significant differences in CRP levels (p=0.07). Moreover, non-relapse mortality was greater in patients who received RBC transfusion compared other patients (p = 0.02), although overall survival (p=0.1) and cumulative incidence of relapse (p=0.4) were not different. In conclusion, both RBC and PLT transfusions early after engraftment of allo-HSCT may be correlated with following elevations of CRP and serum Ft levels and contribute to adverse long-term outcomes of allo-HSCT with an increase of cGVHD. Disclosures No relevant conflicts of interest to declare.
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