Risk-adapted graft-versus-host disease prophylaxis with post-transplantation cyclophosphamide in related, unrelated and haploidentical stem cell transplantations

Pirogova, Olga V.; Moiseev, Ivan S.; Alyanski, Alexander L.; Babenko, Elena V.; Darskaya, Elena I.; Слесарчук, О. А.; Bondarenko, Sergey N.; Afanasyev, Boris

doi:10.18620/ctt-1866-8836-2016-5-3-54-56

Cited by 3 publications

(4 citation statements)

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“…A total of 42 children with SR cGVHD were enrolled. Median age was 13 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). There were 25 (59%) males and 17 (41%) females in the study.…”

Section: Methodsmentioning

confidence: 99%

“…Non-relapse mortality (NRM) in surviving patients with cGVHD is increased within decades after allo-HSCT [ 1 ]. More recently, posttransplant cyclophosphamide (PtCy) and ruxolitinib became game changers that improved clinical outcome [ 2 , 3 , 4 , 5 ]. These innovative approaches were readily implemented into routine practice, thus resulting in lower cGVHD incidence and excellent control of cGVHD symptoms in most patients.…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Photopheresis in Children with Chronic Graft-Versus-Host Disease

et al. 2021

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Chronic graft versus host disease (cGVHD) remains a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). It significantly decreases survival and quality of life. The present study demonstrates retrospective data on extracorporeal photopheresis (ECP) in children with cGVHD. A total of 42 children with steroid-refractory cGVHD were enrolled in the study. The majority of patients had acute leukemia (n = 32, 76%). All patients received ECP as second (n = 18, 43%) or third (n = 24, 57%) line of therapy. Initial ECP schedule consisted of bimonthly regimen for two consecutive days with possibility of further tapering according to response. Any concurrent treatment administered before ECP could be continued if considered necessary. Complete response to ECP was registered in seven (17%) patients and partial response in 24 (57%). Overall response according to organ involvement was as follows: skin (n = 24, 75%), mucous membranes (n = 16, 73%), liver (n = 8, 80%), gut (n = 4, 80%), lungs (n = 2, 22%) and joints (n = 2, 67%). Five-year overall, progression-free and failure-free survival was 57%, 56% and 30%, respectively. Non-relapse mortality at 5 years was 14%. We didn’t observe any clinically significant complications in children that could be attributed to the procedure. ECP remains important and safe treatment option in children with cGVHD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extracorporeal Photopheresis in Children with Chronic Graft-Versus-Host Disease

et al. 2021

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“…Частота наблюдаемой РТПХ в целом соответствует данным у взрослых при применении посттрансплантационного циклофосфамида [22]. Клинически значимые тяжелые формы РТПХ были отмечены только у 2 из 13 пациентов, при этом один из них ранее получал ингибиторы иммунных контрольных точек, что повышает риск развития данного осложнения.…”

Section: рисунокunclassified

Allogeneic hematopoietic stem cell transplantation in children with lymphoblastic lymphoma

Kozlov

Казанцев

Юхта

et al. 2021

Voprosy gematologii/onkologii i immunopatologii v pediatrii

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Lymphoblastic lymphoma (LBL) in children is curable in most cases, but there is still a significant proportion of patients in whom standard therapy is ineffective. Thus, patients develop a relapse or a primary refractory disease in about 10% of cases (R/R). In this case, the main treatment method is allogeneic hematopoietic stem cell transplantation (allo-HSCT). The choice in favor of transplantation is predominantly based on the experience in adult patients. A small number of pediatric patients accounts for the limited data in pediatrics. The prognosis of these patients is always extremely poor. It has been shown that the survival of patients after allo-HSCT is higher only if remission is achieved prior to the transplantation. In order to provide more evidence in support of allo-HSCT, randomized clinical trials are needed. However, such studies in the field of allo-HSCT are quite difficult to conduct, and this necessitates the search for alternative methods of evidence-based medicine in this area. Probably, the achievement of high survival rates could be considered a sufficient argument in favor of this method. This study was approved by the Independent Ethics Committee and the Scientific Council of the I.P. Pavlov First Saint-Petersburg State Medical University of the Ministry of Healthcare of Russia. In this work, we summarize the experience in allo-HSCT in children with R/R LBL obtained at the R.M. Gorbacheva Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint-Petersburg State Medical University. This work is one of the few ones devoted exclusively to the role of alloHSCT in the treatment of pediatric R/R LBL. From 2006 to 2020, at the R.M. Gorbacheva Research Institute for Pediatric Oncology, Hematology and Transplantation, I.P. Pavlov First Saint-Petersburg State Medical University, allo-HSCT was performed in 13 children and adolescents with R/R LBL (2 patients underwent 2 transplantations). Repeated transplantations were performed due to progression and primary graft failure. The median number of prior lines of therapy was 2.5 (2–4). Remission prior to alloHSCT was observed in 7 cases. The graft sources were a fully HLA-matched related donor (n = 3), a fully HLA-matched unrelated donor (n = 4), and a haploidentical donor (n = 8). The following schedules were used as a conditioning regimen: fludarabine 150 mg/m2 + busulfan 8–14 mg/kg (n = 8), fludarabine 150 mg/m2 + melphalan 140 mg/m2 (n = 5), fludarabine 150 mg/m2 + treosulfan 30 mg/m2 (n = 2). In most cases, the prevention of “graft versus host” disease (GVHD) was based on post-transplant cyclophosphamide (n = 11). Cyclophosphamide alone was used in fully matched related transplantation (n = 2), in combination with tacrolimus and cellsept – in unrelated transplantation (n = 1), and in combination with sirolimus and tacrolimus – in haploidentical transplantation (n = 8). A combination of ATGAM, methotrexate and cyclosporin A was used three times in alloHSCT from an unrelated donor for the prevention of GVHD. In one allo-HSCT from a fully matched related donor, cyclosporin A alone was used for the prevention of GVHD. The graft sources were bone marrow (n = 9) and peripheral blood stem cells (n = 4). The median CD34+ cells/kg was 3.8 (1.1–10.0). At the median follow-up of 651 (106–3034) days, the 3-year event-free survival rate was 52% (95% CI: 25–74), the incidence of relapse/progression was 48% (95% CI: 26–76). Five out of thirteen patients died during the study period. The cause of death was the underlying disease in all cases. The cumulative incidence of acute and chronic GVHD was 28% (95% CI: 11–58%) and 24% (95% CI: 5–48), respectively. This work is one of the largest in terms of the number of transplanted children with R/R LBL. Our results are superior to those obtained in case of using only chemotherapy in comparison with the historical control and are comparable with the few previously published data on allo-HSCT in children. In this study, we included patients who underwent allo-HSCT. Among them, there were also children out of remission of LBL which implies that there was no selection of patients, and thus our study settings were close to the so-called real clinical settings. The drawbacks of this work include the following: the study was carried out at a single transplant center, there was no comparison group, the number of patients was low. Nevertheless, considering the complexity of conducting randomized trials in the field of allo-HSCT, the presented data serve as an important confirmation of the effectiveness of transplantation in R/R LBL.

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“…2021;20(3):20-26. https://doi.org /10.18692/1810-4800-2021-3-20-26 Трансплантация гемопоэтических стволовых клеток (ТСГК) является методом лечения гематологических, онкологических и некоторых наследственных заболеваний детей и взрослых [1][2][3]. Ежегодно количество трансплантаций ГСК увеличивается и в настоящее время достигает 100 000 случаев в год, при этом количество аллогенных трансплантаций превалирует над аутологичными и составляет 60-70% от их общего числа [4][5][6]. Факторами риска инфекционных осложнений при трансплантации гемопоэтических стволовых клеток являются: токсичность высокодозной химиотерапии, проводимой перед ТГСК; период агранулоцитоза, возникающий после трансплантации; длительная иммуносупрессивная терапия; развитие реакции трансплантат против хозяина и другие [7][8][9][10].…”

Section: Rossiiskaya Otorinolaringologiyaunclassified

Prevalence of acute inflammatory otorhinolaryngological diseases in hematopoietic stem cell transplant recipients

Dolgov¹,

Karpishchenko²,

Rodneva³

et al. 2021

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The article presents the results of a study of the prevalence of acute (exacerbation of chronic) otorhinolaryngological pathology at the stages of hematopoietic stem cell transplantation (HSCT). The frequency of the studied pathology was assessed at the stage of pre-transplant screening, at the stage before graft engraftment and at the stage after graft engraftment up to 180 days. The study included 1129 cases of HSCT performed at the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation from January 2017 to December 2019. The median age of the patients was 27 years (min – 0,36, max – 73,22). Allogeneic HSCT was performed in 784 (69,4%) cases, autologous HSCT in 345 (30,6%) cases. The power of the study was 0,95. A comparative analysis using the Pearson χ2 criterion revealed that infectious complications were significantly more frequent with allo-HSCT than with auto-HSCT, both at the stage before engraftment (χ2 = 21.8 at p <0.0001) and at the stage after graft engraftment (χ2 = 224,78 at p < 0.0001). It was also shown that acute symptoms of rhinosinusitis prevailed at all stages of HSCT, reaching 5,3% (95% CI 5.0% – 5,6%) at the stage before transplantation, 3,01% (95% CI 2, 8% – 3,2%) at the stage before engraftment, and 8,13% (95% CI 7,67% – 8,60%) at the stage after engraftment. At the stage before engraftment, rhinosinusitis competed with the diagnosis of acute pharyngitis, with a frequency of 34 (36,17%) and 33 (35,11%), respectively. Acute rhinosinusitis, acute rhinitis, and strep throat were the most common diagnoses at all three stages assessed. The rest of the acute inflammatory otorhinolaryngological diagnoses were observed in less than 2% of cases each. Establishing the frequency of acute otorhinolaryngological pathology at the stages of HSCT; understanding the most relevant nosologies. This allows us to focus on further study of the factors of their development, prevention and treatment.

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Risk-adapted graft-versus-host disease prophylaxis with post-transplantation cyclophosphamide in related, unrelated and haploidentical stem cell transplantations

Cited by 3 publications

References 0 publications

Extracorporeal Photopheresis in Children with Chronic Graft-Versus-Host Disease

Extracorporeal Photopheresis in Children with Chronic Graft-Versus-Host Disease

Allogeneic hematopoietic stem cell transplantation in children with lymphoblastic lymphoma

Prevalence of acute inflammatory otorhinolaryngological diseases in hematopoietic stem cell transplant recipients

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