Algorithm for donor selection in 2011

Adverse Effects of Busulfan Plus Cyclophosphamide versus Busulfan Plus Fludarabine as Conditioning Regimens for Allogeneic Bone Marrow Transplantation

BACKGROUND

The side effects of conditioning regimens on the success rate of allogeneic transplantation around the world have been challenging. In this study, we aimed to investigate the side effect of Bu/Cy and Bu/Flu regimens on our patients who underwent allogeneic bone marrow transplantation.

METHODS

We analyzed 180 patients receiving bone marrow transplantation in Taleghani Hospital, in Tehran, Iran between April 2016 and December 2019. Patients in group A received a combination of intravenous busulfan 0.8 mg/kg QID over two hours for 4 consecutive days (12.8 mg/kg in total)(Savani et al., 2006) and cyclophosphamide 60 mg/kg per day for two consecutive days. Patients in group B received busulfan the same as the first group in combination with fludarabine equal to 40 mg/m² per day. Patients were followed up at regular intervals up to two years after transplantation.

RESULT

Various items were evaluated for patients, including cardiopulmonary function, psychological disorders, GVHD, and endocrine disorders such as hypothyroidism, fertility, or gonad dysfunction.  Primary hypothyroidism developed in 13.3% and 11.1% of the Bu/Cy and Bu/Flu groups, respectively (p=0.230). None of the patients in either group experienced infertility or gonad dysfunction. In group A versus group B, pulmonary diseases were detected in  4.4% versus 6.6% of BMT recipients, respectively (p = 0.223). In both groups, mitral and tricuspid regurgitation were observed in patients (8.9% vs. 11.1%; p = 0.189). Incidence of Psychological disorders was no significant difference between the two groups. 32.2% of group A versus 34.45%  of group B had skin and liver GVHD, respectively (p = 0.235).

CONCLUSION

The therapeutic-related adverse effects of the two conditioning regimens in patients who underwent allogeneic bone marrow transplant were almost similar. To improve quality of life and overall survival among BMT patients, careful evaluation of treatment-related complications should be part of the regular follow-up of them.

Matched-Pair Analysis of Transplant from Haploidentical, Unmanipulated Bone Marrow Donor versus HLA Identical Sibling for Patients with Hematologic Malignancies

A matched-pair analysis of transplant-related outcomes was carried out in 116 of 255 consecutive patients who received transplants from an HLA identical sibling (n = 58) or haploidentical related donor (n = 58). The 2 patient series were matched with 9 variables: period of transplant, patient and donor age, sex, diagnosis, disease phase, conditioning regimen, donor-recipient sex, and cytomegalovirus (CMV) status combinations. As graft-versus-host disease (GVHD) prophylaxis, all patients received the standard cyclosporine and methotrexate association with the addition of anti-thymocyte globulins, mycophenolate mofetil, and basiliximab in haploidentical, unmanipulated bone marrow recipients. Anti-infectious management, transfusion policy, and supportive care were identical for all patients. By comparing the 2 patient series, no statistically significant difference was observed for the cumulative incidence of advanced acute and extensive chronic GVHD, transplant-related mortality, and relapse. With a median follow-up of 3.5 years, the 5-year disease-free survival was 37% ± 6% and 36% ± 6% for HLA identical sibling and haploidentical recipients, respectively. The results of transplant from HLA identical siblings and haploidentical donors are comparable. Regardless of the HLA matching, other factors known to affect the transplant outcomes, such as donor-recipient age, sex, and CMV status combinations, might drive the search for the best donor.

Cerebellar Neurocysticercosis as Long-Term Complication of Allogeneic Haematopoietic Stem Cell Transplantation from Haploidentical Donor

Neurocysticercosis, an infection of the central nervous system with the larval stage of the cestode Taenia solium, is uncommon in developed countries. We report a case of allogeneic haematopoietic stem cell transplantation from a haploidentical donor complicated, in the long term, by T. solium infection of the central nervous system and successfully treated with empiric antiparasitic therapy with albendazole plus dexamethasone. Revised diagnostic criteria proposed by Del Brutto et al. were used for the definitive diagnosis of cerebellar neurocysticercosis.

Frequency of Finding Family Donors: A Single Center Experience

OBJECTIVES

Allogeneic hematopoietic stem cell transplant is a curative treatment option for many hematologic diseases. The existence of a fully compatible donor for recipients is the first condition for minimized transplant-related mortality and morbidity. The best donor for hematopoietic stem cell transplant is an HLA-matched sibling donor. The possibility of finding an HLA-matched sibling is less than 30% worldwide. Hematopoietic stem cell transplant is needed for an increasing number of patients every year, but the ability to find a fully compatible donor has limited its use.

MATERIALS AND METHODS

From August 2012 to May 2017, we screened 412 adult patients who required AHSCT and their families for HLA tissue groups who were seen at our center (Baskent University Adana Dr. Turgut Noyan Research and Medical Center Hematology Unit). To screen tissue groups at our center, we perform lowresolution typing for HLA-A, -B, -C, -DRB1, and -DQB. If an HLA genotype cannot be identified, verification typing is done using highresolution testing.

RESULTS

We found matched family donors in 227 (55%) of 412 patients screened at our center. The ratio of HLAmatched related donors was 83% for 279 patients who received allogeneic stem cell transplant.

CONCLUSIONS

The likelihood of finding eligible unrelated donors has been gradually increasing, in part due to the development of the National Bone Marrow Bank. However, a careful screening for related donors is still important. Our findings indicate the importance of careful examination of family genealogy and of careful family screening in our region.

Identification of oral risk factors for chronic graft versus host disease in haematological patients who underwent allogeneic haematopoietic stem cell transplantation

OBJECTIVE

The aim of this prospective observational study was to identify local risk factors for the development of clinical manifestations of oral chronic Graft versus Host Disease (cGvHD) in a cohort of patients affected by haematological malignant diseases who underwent allogeneic haematopoietic stem cell transplantation (HSCT).

MATERIALS AND METHODS

In the context of an active collaboration between the Rome Transplant Network of the Hematology and the Oral Pathology Division at "Policlinico Tor Vergata", in Rome, 47 haematological patients were included in this trial based on a systematic dental screening and follow-up protocol. The dental checks were planned 1 month before the transplant procedure while the subsequent follow ups were scheduled on day +100, +180, +365 and + 730 after the transplant. The tool used for the dental checks was a detailed report including all the potential oral features responsible of mechanical, chemical or infective injuries, except for the drugs.

RESULTS

Overall, 64% of patients (N=30) did not perform dental hygiene during the screening pre-transplant and 53% (25/47) developed cGvHD with oral involvement. The most part of patients (84%) who experienced oral manifestations of cGvHD during the follow-up period after HSCT did not perform dental hygiene before the transplant procedure. Moreover, the comparison between the "presence" or "absence" of dental hygiene before the allogeneic HSCT showed a statistical significant increasing during the follow-up period in the occurrence of oral lesions due to the cGvHD for patients who lack pre-transplant dental care (p=0.029).On the contrary, the frequency of the other factors such as malocclusions, fractured teeth, incongruous prosthesis, food, smoke, alcol and bad habits, resulted similar between the group with or without typical oral lesions of cGvHD.

CONCLUSIONS

The prevention of oral infectious complications provided by primary and secondary dental cares can result in a great benefit for haematological patients who underwent allogeneic HSCT. The combined hematological and dental management represents a clinical need before and after allogeneic HSCT for the removal of inconvenient issues with impact on the short and long-term outcome. Poor dental hygiene seems to be a local risk factor for the development of oral lesions due to cGvHD. However, a larger cohort of patients is necessary to confirm these preliminary data and to evaluate the best preventive and therapeutic oral hygiene protocol in this specific setting.

Therapeutic efficiency of platelet gel for the treatment of oral ulcers related to chronic graft versus host disease after allogeneic haematopoietic stem cell transplantation

BACKGROUND

Platelet (PLT) gel has been successfully used in tissue regeneration of diabetic and surgical wounds through the releasing of growth factors such as basic fibroblast and PLT-derived growth factors. Based on this background, our previous clinical trial have assessed the feasibility and efficacy of PLT gel for the treatment of muco-cutaneous lesions related to graft versus host disease (GvHD) after allogeneic haematopoietic stem cell transplantion (HSCT). The promising results reported in a small series of 6 patients, of whom 1 with oral ulcers, represent the rationale of the present study.

MATERIALS AND METHODS

The aim of this study was to verify the efficacy and safety of PLT gel for treating oral ulcers due to chronic GvHD. Allogeneic hemocomponents were used to obtain PLT gel with an automated system for the on-site preparation and application of patient (autologous) or healthy blood donor (allogeneic)-derived fibrin sealant or PLT-rich fibrin (Vivostat system, Vivostat A/S). Ten patients with multiple oral lesions related to chronic GvHD underwent allogeneic PLT gel as local therapy alone or in combination with systemic therapy in half of the cases.

RESULTS

After the second PLT gel application, all patients resumed the feeding and a significant improvement of the oral pain was observed. After a median of five PLT gel applications (range, 2-15), 7 out of 10 patients showed a complete response. No side effects were documented.

CONCLUSION

These data confirm that the PLT gel may be used as a safe and effective tool, alone or in combination with systemic therapy, for the treatment of mucosal lesions of mouth related to cGvHD.

Granulocyte-mobilized bone marrow

PURPOSE OF REVIEW

In the last few years, mobilized peripheral blood has overcome bone marrow as a graft source, but, despite the evidence of a more rapid engraftment, the incidence of chronic graft-versus-host disease is significantly higher with, consequently, more transplant-related mortality on the long follow-up. Overall, the posttransplant outcome of mobilized peripheral blood recipients is similar to that of patients who are bone marrow grafted. More recently, the use of bone marrow after granulocyte colony-stimulating factor (G-CSF) donor priming has been introduced in the transplant practice. Herein, we review biological acquisitions and clinical results on the use of G-CSF-primed bone marrow as a source of hematopoietic stem cells (HSC) for allogeneic stem cell transplantation.

RECENT FINDINGS

G-CSF the increases the HSC compartment and exerts an intense immunoregulatory effect on marrow T-cells resulting in the shift from Th1 to Th2 phenotype with higher production of anti-inflammatory cytokines. The potential advantages of these biological effects have been translated in the clinical practice by using G-CSF primed unmanipulated bone marrow in the setting of transplant from human leukocyte antigen (HLA)-haploidentical donor with highly encouraging results.

SUMMARY

For patients lacking an HLA-identical sibling, the transplant of G-CSF primed unmanipulated bone marrow from a haploidentical donor combined with an intense in-vivo immunosuppression is a valid alternative achieving results that are well comparable with those reported for umbilical cord blood, HLA-matched unrelated peripheral blood/bone marrow or T-cell-depleted haploidentical transplant.