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LaPorte J, Leone K, Zhang X, Holland K, Morris L, Bashey A, Solh M, Solomon S. A unique schedule of palonosetron, ondansetron, and dexamethasone for the prevention of delayed nausea and vomiting in patients receiving myeloablative chemotherapy. J Oncol Pharm Pract 2018; 25:1336-1342. [PMID: 30058442 DOI: 10.1177/1078155218790345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myeloablative chemotherapy administered prior to autologous stem cell transplantation (auto-SCT) is associated with a significant amount of chemotherapy-induced nausea and vomiting (CINV). We conducted a phase II trial to assess the safety, efficacy, and impact on quality of life when palonosetron (PAL) 0.25 mg combined with dexamethasone were given on the final or only day of myeloablative chemotherapy for auto-SCT. The primary end point of this study was the incidence of achieving a delayed CINV complete response defined as no emetic episode and no use of rescue medications during the 24-120 h period post chemotherapy. Eighty-five patients were enrolled in the study and received PAL. A delayed CINV complete response was achieved in 15% of patients. A multivariate analysis demonstrated no associated differences between age, gender, diagnosis, or regimen. By day 5 after PAL, the mean nausea severity was 0.91 ± 2.45 vs. 0.09 ± 1.58 at baseline (p = 0.012). Quality of life measurements demonstrated similar quality of life between baseline and day 3. By day 6 however, nausea alone had a statistically significant impact on quality of life. In our study, PAL controlled nausea severity and sustained quality of life, but further strategies are needed to control delayed CINV associated with the auto-SCT process.
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Affiliation(s)
- J LaPorte
- 1 Northside Hospital, Department of Pharmacy, Atlanta, GA, USA
| | - K Leone
- 1 Northside Hospital, Department of Pharmacy, Atlanta, GA, USA
| | - X Zhang
- 2 The University of Texas School of Public Health, Houston, TX, USA
| | - K Holland
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - L Morris
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - A Bashey
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - M Solh
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
| | - S Solomon
- 3 Blood and Marrow Transplant Group of Georgia, Atlanta, GA, USA
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Davids M, Kim H, Nicotra A, Savell A, Francoeur K, Hellman J, Miskin H, Sportelli P, Bashey A, Stampleman L, Rueter J, Boruchov A, Arnason J, Jacobson C, Jacobsen E, Fisher D, Brown J. UPDATED RESULTS OF A MULTICENTER PHASE I/IB STUDY OF TGR-1202 IN COMBINATION WITH IBRUTINIB IN PATIENTS WITH RELAPSED OR REFRACTORY MCL OR CLL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_39] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M.S. Davids
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - H.T. Kim
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - A. Nicotra
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - A. Savell
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - K. Francoeur
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - J.M. Hellman
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - H. Miskin
- Drug Development; TG Therapeutics; New York USA
| | | | - A. Bashey
- Bone Marrow Transplantation Group of Georgia; Northside Hospital; Atlanta USA
| | - L. Stampleman
- Department of Medical Oncology & Hematology; Pacific Cancer Care; Monterey USA
| | - J. Rueter
- Department of Medical Oncology; Eastern Maine Medical Center; Bangor USA
| | - A. Boruchov
- Department of Medical Oncology; St. Francis Medical Center; Hartford USA
| | - J.E. Arnason
- Department of Medical Oncology; Beth Israel Deaconess Medical Center; Boston USA
| | - C.A. Jacobson
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - E.J. Jacobsen
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - D.C. Fisher
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - J.R. Brown
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
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Bashey A, Solomon SR. T-cell replete haploidentical donor transplantation using post-transplant CY: an emerging standard-of-care option for patients who lack an HLA-identical sibling donor. Bone Marrow Transplant 2014; 49:999-1008. [PMID: 24842530 DOI: 10.1038/bmt.2014.62] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/28/2014] [Indexed: 11/09/2022]
Abstract
Availability of an HLA-identical sibling (MRD) or suitably matched unrelated donor (MUD) has historically been a limiting factor in the application of allogeneic hematopoietic transplantation. Although almost all patients have an HLA-haploidentical family donor, prior attempts at transplantation from such donors using T-cell replete grafts and conventional immunosuppression were associated with unacceptable rates of GVHD, and when stringent ex vivo T-cell depletion was used to control GVHD, rates of graft rejection and post-transplant infections were prohibitive. The recent approach to HLA-haploidentical donor transplantation developed in Baltimore that uses T-cell replete grafts and post-transplant CY (Haplo-post-HCT-CY) to control post-transplant allo-reactivity appears to have overcome many of the obstacles historically associated with haploidentical donor transplantation. In particular, TRM rates of <10% are usual and rapid reconstitution of immunity leads to a low rate of post-transplant infections and no post-tranplant lymphoproliferative disorders (PTLD), consistent with the hypothesis that post-transplant CY selectively depletes proliferating alloreactive T cells responsible for GVHD and graft rejection while preserving resting memory T cells essential for post-transplant immunologic recovery. In parallel trials using similar non-myeloablative conditioning regimens, Haplo-post-HCT-CY produced similar overall survival to double umbilical cord blood transplantation(DUCBT) in adult patients (62% vs 54%), with low rates of TRM (7% vs 24%), severe acute GVHD (0% vs 21%) and chronic GVHD (13% vs 25%). Furthermore, recent non-randomized comparisons adjusted for risk factors show that Haplo-post-HCT-CY achieve at least equivalent outcomes to conventional MRD and MUD transplants. Although most experience has been obtained using BM, emerging data suggest that a G-CSF mobilized PBSC graft can also safely be used for Haplo-post-HCT-CY. Haplo-post-HCT-CY also avoids the graft acquisition costs of DUCBT and MUDs and the cost of cell selection associated with T-depleted grafts. Although randomized comparisons will be forthcoming, Haplo-post-HCT-CY can already be considered a valid standard-of-care in patients who lack conventional donors thus extending the availability of allogeneic transplants to almost all patients. This donor source may also challenge the routine preference for a MUD in patients lacking an MRD.
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Affiliation(s)
- A Bashey
- Blood and Marrow Transplant Program at Northside Hospital 5670 Peachtree Dunwoody Road NE Suite 1000, Atlanta, GA, USA
| | - S R Solomon
- Blood and Marrow Transplant Program at Northside Hospital 5670 Peachtree Dunwoody Road NE Suite 1000, Atlanta, GA, USA
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Leech M, LaPorte J, Mihelic R, Sanacore M, Sizemore C, Zhang X, Penland P, Holland H, Morris L, Solomon S, Bashey A. Pharmacy Driven Posaconazole Therapeutic Monitoring in a Leukemia and Bone Marrow Transplant Center. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grubbs SS, Go RS, Berger MZ, Gonzalez M, Thompson MA, Enos R, St. Germain DC, Denicoff A, Servididio C, Bearden JD, Zaren H, Wilkinson K, Krasna M, McCaskill-Stevens W, Bell M, Freeman RK, Miesfeldt S, Ravikumar TS, Nair SG, Bashey A. Early success in narrowing age, gender, and racial disparities in clinical trial accrual: Targeted screening efforts through the National Cancer Institute Community Cancer Centers Program (NCCCP). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Speckhart D, Bashey A, Morris L, Solomon S, Berry T, Holland H. Psychosocial Factors As Measured By The Transplant Evaluation Rating Scale (TERS) Predict Length Of Hospitalization And Infectious Complications Following Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sizemore C, Laporte J, Holland H, Mccollum J, Westerman J, Morris L, Bashey A, Solomon S. A Comparison Of Toxicity And Mobilization Efficacy Following Two Different Doses Of Cyclophosphamide For Mobilization Of Hematopoietic Stem Cells In Non-Hodgkin's Lymphoma Patients. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sizemore C, LaPorte J, Sanacore M, Holland H, Mccollum J, Westerman J, Morris L, Bashey A, Solomon S. A Comparison Of Toxicity And Mobilization Efficacy Following Two Different Doses Of Cyclophosphamide For Mobilization Of Hematopoietic Stem Cells In Multiple Myeloma Patients. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Solomon SR, Matthews RH, Barreras AM, Bashey A, Manion KL, McNatt K, Speckhart D, Connaghan DG, Morris LE, Holland HK. Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM. Bone Marrow Transplant 2009; 45:468-75. [PMID: 19767781 DOI: 10.1038/bmt.2009.234] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Historically, myeloablative allogeneic hematopoietic SCT (HSCT) has required prolonged in-patient hospitalization due to the effects of mucosal toxicity and prolonged cytopenias. We explored the safety and feasibility of outpatient management of these patients. A total of 100 consecutive patients underwent a matched-related donor myeloablative allogeneic HSCT for a hematologic malignancy at a single institution. Patients were hospitalized briefly for stem-cell infusion and thereafter only for complications more safely managed in the in-patient setting. The median hospital length of stay from the start of the preparative regimen to day +30 and day +100 post-transplant was 12 and 15 days, respectively. Planned hospital discharge occurred in 79 patients after stem cell infusion. Patients were readmitted to hospital at median of day +7 post transplant, with neutropenic fever being the primary cause for readmission. In total, 18 patients required no in-patient care in the first 100 days. Non-relapse mortality at day 100 and 6 months was 10 and 15%, respectively, for all patients, and 0 and 5%, respectively, for standard risk patients. In summary, outpatient myeloablative allogeneic HSCT with expectant in-patient management can be accomplished safely with low treatment-related morbidity and mortality. Clinical outcomes seem comparable to those reported for traditional in-patient management.
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Affiliation(s)
- S R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA 30342, USA.
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Speckhart D, Holland H, Solomon S, Bashey A, Morris L, Kerns L, Berry T. Relative Impact of Psychosocial Factors, Comorbidities, and Disease Risk on the Utilization of Resources and Overall Outcome in Patients Undergoing Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ueno NT, Rizzo JD, Demirer T, Cheng YC, Hegenbart U, Zhang MJ, Bregni M, Carella A, Blaise D, Bashey A, Bitran JD, Bolwell BJ, Elfenbein GJ, Fields KK, Freytes CO, Gale RP, Lazarus HM, Champlin RE, Stiff PJ, Niederwieser D. Allogeneic hematopoietic cell transplantation for metastatic breast cancer. Bone Marrow Transplant 2007; 41:537-45. [PMID: 18084340 DOI: 10.1038/sj.bmt.1705940] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We reviewed 66 women with poor-risk metastatic breast cancer from 15 centers to describe the efficacy of allogeneic hematopoietic cell transplantation (HCT). Median follow-up for survivors was 40 months (range, 3-64). A total of 39 patients (59%) received myeloablative and 27 (41%) reduced-intensity conditioning (RIC) regimens. More patients in the RIC group had poor pretransplant performance status (63 vs 26%, P=0.002). RIC group developed less chronic GVHD (8 vs 36% at 1 year, P=0.003). Treatment-related mortality rates were lower with RIC (7 vs 29% at 100 days, P=0.03). A total of 9 of 33 patients (27%) who underwent immune manipulation for persistent or progressive disease had disease control, suggesting a graft-vs-tumor (GVT) effect. Progression-free survival (PFS) at 1 year was 23% with myeloablative conditioning and 8% with RIC (P=0.09). Women who developed acute GVHD after an RIC regimen had lower risks of relapse or progression than those who did not (relative risk, 3.05: P=0.03), consistent with a GVT effect, but this did not affect PFS. These findings support the need for preclinical and clinical studies that facilitate targeted adoptive immunotherapy for breast cancer to explore the benefit of a GVT effect in breast cancer.
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Affiliation(s)
- N T Ueno
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lane T, Medina B, Bashey A, Holman P, Carrier E, Castro J, Ball E. 352: Clinical efficacy of cryopreserved donor lymphocytes for infusion (DLI). Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Holman PR, Demagalhaes-Silverman M, Medina BM, Corringham S, Bashey A, Castro JE, Carrier E, Lane T, Gold DP, Ball ED. Idiotype (Id) immunotherapy (IT) following high dose therapy and autologous stem cell transplant (HDT/ASCT) in mantle cell (MC) and indolent lymphoma (IL): Cellular, humoral and clinical responses. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P. R. Holman
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - M. Demagalhaes-Silverman
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - B. M. Medina
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - S. Corringham
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - A. Bashey
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - J. E. Castro
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - E. Carrier
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - T. Lane
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - D. P. Gold
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
| | - E. D. Ball
- Univ of California-San Diego, La Jolla, CA; Univ of Iowa, Iowa City, IA; Favrille Inc, San Diego, CA
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Vij R, Berenson JR, Borrello IM, Spitzer G, Bashey A, Martin T, Boccia RV, Simic A, Siegel D, Frohlich MW. A randomized phase II study of Xcellerated T Cells with or without prior fludarabine therapy in patients with multiple myeloma (MM). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Vij
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - J. R. Berenson
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - I. M. Borrello
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - G. Spitzer
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - A. Bashey
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - T. Martin
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - R. V. Boccia
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - A. Simic
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - D. Siegel
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
| | - M. W. Frohlich
- Washington Univ Sch of Medicine, St Louis, MO; Oncotherapeutics, Los Angeles, CA; Johns Hopkins Univ, Baltimore, MD; Cancer Ctr of the Carolinas, Greenville, SC; Univ of CA, San Diego, CA; Univ of CA, San Francisco, CA; Ctr for Cancer & Blood Disorders, Bethesda, MD; Oregon Health Sciences Univ, Portland, OR; Hackensack Univ, Hackensack, NJ; Xcyte Therapies, Inc., Seattle, WA
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Shu F, Bashey A, Carrier E, Castro J, Holman P, Lane T, Medina B, Corringham S, Ball E. Consolidation and mobilization of peripheral blood stem cells using high-dose cytarabine and etoposide in acute myeloid leukemia: A single institutional experience. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bashey A, Medina B, Zhong RK, Zhou JH, Carrier E, Castro J, Holman P, Lane T, Sun C, Lowy I, Corringham S, Soiffer R, Mason J, Ball E. Phase I study of a neutralizing monoclonal anti-CTLA4 antibody (MDX-010) in patients with relapse of malignancy after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2005. [DOI: 10.1016/j.bbmt.2004.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kamrava MR, Anderson EM, Kalunian K, Bashey A, Abshey A, Holman P, Medina B, Ball ED, Carrier E. T-cell depletion improves outcome after autologous stem cell transplant in patients with systemic lupus erythematosus (SLE). Bone Marrow Transplant 2004; 35:205-6. [PMID: 15543199 DOI: 10.1038/sj.bmt.1704738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Lane TA, Bashey A, Carrier E, Holman P, Castro J, Mullen M, Ward DM, Ada O, Ball ED. Improving the efficiency of PBPC collection by pre-apheresis peripheral blood and mid-apheresis product measurements of CD34 cells. Cytotherapy 2004; 6:318-27. [PMID: 16146884 DOI: 10.1080/14653240410004880] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The adequacy of HPC collection for BMT is typically assessed by the number of CD34 cells. However, during a series of leukapheresis procedures (LP) the CD34 value on the final HPC product may not be available for testing until late evening, sometimes resulting in additional, retrospectively unnecessary, LP in order to ensure an adequate HPC collection (>5x10(6) CD34/kg). We hypothesized that an estimate of the CD34 content of HPC products prior to 16:00 h on the day of LP would permit improved HPC collection planning. We therefore assessed the effectiveness of predicting the total amount of CD34 cells that would be collected in a given LP by either (a) the concentration of CD34 cells/microL in peripheral blood prior to LP (pre-CD34) or (b) the predicted total amount of CD34 cells to be collected based on sampling the LP product at the mid-point of each LP. We also compared the number of LP per patient and total HPC collected for the study group with data from the previous calendar year. METHODS Allogeneic and autologous BMT donors who completed a 20-L HPC collection between September 2002 and February 2003 were eligible. CD34 cells were measured on blood drawn prior to LP and from the HPC product at the mid-point (10 L) of LP. The CD34 content of the final LP was predicted by doubling the value of total CD34 cells at the mid-run (MRp-CD34). The MRp-CD34/kg and the cumulative CD34/kg collected were made available before 16:00 h and used to determine the need for additional LP. The true CD34 content of each HPC collection was also measured from the final product the next day (CD34-FP). RESULTS A 20-L LP was completed and data were available from 31 patients and nine allogeneic donors who underwent a total of 85 LP for diagnoses, including 11 myeloma, 10 lymphoma, seven HD, three acute leukemia and five others. The mean (range) and correlation (R2) vs. the CD34-FP were, for pre-CD34, 54 CD34/microL (0.3-232), R2=0.66 (P<0.01), and for MRp-CD34, 3.2x10(6) CD34/kg (0.04-22.48), R2=0.90 (P<0.01). The mean number of CD34/kg collected per LP in the patients/donors was 3.4x10(6) CD34/kg (0.05-18.94). The median number of CD34 cells employed for transplant in the study group vs. controls (5.7 vs. 5.6x10(6)/kg) and the time to engraftment of neutrophils (12 vs. 11 days) and platelets (12 vs. 12 days) was similar to historical controls. However, the study group had a significantly lower median number of LP (three vs. two; P<0.02) to obtain the required collection of 5x10(6) CD34 cells/kg. DISCUSSION Both the pre-CD34 and the MRp-CD34 were significantly correlated with CD34-FP. However, the CD34-FP was more reliably predicted by MRp-CD34. Early availability of mid-run CD34 values was associated with a significant reduction in the number of LP required to collect 5x10(6) CD34 cells/kg, without reduction in the number of CD34 cells for transplant or prolongation of days to neutrophil or platelet engraftment.
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Affiliation(s)
- T A Lane
- Department of Pathology, School of Medicine, University of California, San Diego, CA, USA
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19
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Wang EH, Chen YA, Corringham S, Bashey A, Holman P, Ball ED, Carrier E. High-dose CEB vs BEAM with autologous stem cell transplant in lymphoma. Bone Marrow Transplant 2004; 34:581-7. [PMID: 15273714 DOI: 10.1038/sj.bmt.1704637] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Between January 1996 and July 2002, 72 patients with non-Hodgkin's lymphoma or Hodgkin's disease underwent high-dose chemotherapy with autologous stem cell transplant conditioned with either cyclophosphamide, etoposide, carmustine (CEB) or carmustine, etoposide, cytarabine, melphalan (BEAM) at a single institution. In all, 52 patients received CEB and 20 patients received the BEAM regimen. Patient characteristics that were significantly different between the two groups are tumor grade and extranodal involvement (P = 0.0196, 0.0341, respectively). Regimen-related toxicities examined yielded only diarrhea occurring at a higher rate in the BEAM group (81 vs 51%, P = 0.0026), although cases were milder (92 vs 57%). Patients treated with CEB developed mucositis at a slightly higher rate (79%) than patients treated with BEAM (75%), but this difference did not reach statistical significance. However, the mucositis that occurred within the BEAM group was predominately mild (67%) in contrast to the predominance of moderate to severe cases in the CEB group (74%). In addition, patients treated with CEB required growth factor support for a longer time than patients treated with BEAM (P = 0.0399). Response rates were high in both groups, with trends favoring the BEAM group. Overall survival was higher after treatment with BEAM than with CEB (84 vs 60%).
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Affiliation(s)
- E H Wang
- Cancer Center, University of California, San Diego, California, USA
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20
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Martin T, Vij R, Vescio R, Borrello I, Siegel D, Bashey A, DiPersio J, Berenson J, Ferrand C, Janmohamed F, Yuan V, Bouchard L, Hami L, Berenson R, Bonyhadi M, Frohlich M. A phase I/II study of xcellerated T cells™ after autologous peripheral blood stem cell transplantation in patients with multiple myeloma. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Tanner ML, Hoh CK, Bashey A, Holman P, Sun C, Broome HE, Lane T, Ball ED, Carrier E. FLAG chemotherapy followed by allogeneic stem cell transplant using nonmyeloablative conditioning induces regression of myelofibrosis with myeloid metaplasia. Bone Marrow Transplant 2003; 32:581-5. [PMID: 12953130 DOI: 10.1038/sj.bmt.1704172] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 38-year-old woman with agnogenic myeloid metaplasia complicated by the poor prognostic factors of severe osteosclerosis, prominent hepatosplenomegaly, and profound anemia was treated with FLAG chemotherapy to decrease her organomegaly before undergoing a nonmyeloablative allogeneic stem cell transplant from a matched-sibling donor. The patient's pre- and post transplant course were complicated by an autoimmune disorder and her post transplant course was complicated by severe hepatic and gastrointestinal GVHD. A technetium-99m sulfur colloid scan 4 months post transplant and bone marrow studies 8 months post transplant demonstrated intramedullary hematopoiesis, complete resolution of marrow fibrosis, and partial resolution of osteosclerosis.
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Affiliation(s)
- M L Tanner
- University of California, San Diego School of Medicine, La Jolla, CA, USA
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22
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Bashey A, Corringham S, Gilpin E, Fields KK, Smilee RC, DeFrancisco C, Santos-Ada O, Holman P, Carrier E, Ho AD, Lane TA, Ball ED, Janssen WE, Law P. Simultaneous administration of G-CSF and GM-CSF for re-mobilization in patients with inadequate initial progenitor cell collections for autologous transplantation. Cytotherapy 2002; 2:195-200. [PMID: 12042042 DOI: 10.1080/146532400539152] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND A proportion of candidates for high-dose chemotherapy with autologous PBPC support (HDC-PBPCS) will not provide an adequate PBPC yield from their first mobilization. The value of re-mobilization and the best regimen for re-mobilization in these patients is unclear. METHODS In 23 patients who failed to provide > or = 3 x 10(6) CD34+ cells/kg after their first mobilization, PBPC were re-mobilized using a regimen of simultaneous administration of G-CSF and GM-CSF (10 microg/kg/day each) with leukaphereses (LP) starting Day 4 or 5 of CSF administration. Yields of WBC/kg, MNC/kg and CD34+ cells/kg/L of processed blood were compared between the first and second mobilization in each patient. The ability of the combined yield from the two mobilizations to achieve the desired threshold PBPC yield and the tolerability of the re-mobilization were determined. RESULTS The re-mobilization regimen was well-tolerated and no patient discontinued the regimen because of toxicity. Median collected WBC/kg/L (1.37 x 10(7) versus 2.62 x 10(7), p = 0.0065), MNC/kg/L (0.77 x 10(7) versus 1.97 x 10(7), p = 0.0003), CD34+ cells/kg/L (1.64 x 10(7) versus 4.18 x 10(7), p = 0.001) were significantly higher after the second mobilization (G-CSF/GM-CSF combination). Percentage of CD34+ cells in the leukapheresis was also significantly higher after the second mobilization (median 0.104% versus 0.195%, p = 0.036). Twelve of 22 patients achieved the target PBPC dose (> 3 x 10(6)/CD34+ cells/kg) after two mobilizations (six patients achieved the target from the second mobilization alone). A further eight underwent HDC-PBPCS without achieving the target PBPC dose. These patients experienced a significant delay in neutrophil and platelet engraftment when compared with those patients achieving the target dose. DISCUSSION This study demonstrates that the combination of G-CSF and GM-CSF is an effective and tolerable method for re-mobilization of PBPC in patients who fail to provide an adequate yield from their first mobilization.
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Affiliation(s)
- A Bashey
- Department of Blood and Marrow Transplantation, Cancer Center, University of California San Diego, La Jolla, CA 92093-0960, USA
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23
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Bashey A, Sundaram S, Corringham S, Jones V, Lancaster D, Silva-Gietzen J, Law P, Ball ED. Use of capecitabine as first-line therapy in patients with metastatic breast cancer relapsing after high-dose chemotherapy and autologous stem cell support. Clin Oncol (R Coll Radiol) 2002; 13:434-7. [PMID: 11824880 DOI: 10.1053/clon.2001.9307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
High-dose chemotherapy with autologous stem cell support (HDC-ASCS) can produce high complete remission rates in patients with metastatic breast cancer (MBC). However, the majority of those so treated will relapse within 3 years. The ability of such patients to tolerate further myelosuppressive chemotherapy may be limited and the best therapy is undefined. In this retrospective study we assessed the role of capecitabine as initial therapy after relapse. Ten patients (median age = 47 years; oestrogen receptor-positive, n = 4; visceral disease, n = 6; prior anthracycline, n = 8, prior taxanes, n = 10), whose disease progressed at a median of 246 days (range 69-480) after HDC-ASCS and who were treated with capecitabine (2500 mg/m2 per day for 2 weeks of a 3-week cycle) as initial therapy for relapse, were assessed retrospectively for response and toxicity. They received a median of eight cycles (range 4-24) of capecitabine. The toxicities encountered while receiving capecitabine were: hand-foot syndrome (grade 1, n = 3; grade 2, n = 4; grade 3, n = 1); diarrhoea (grade 1, n = 1; grade 2, n = 3); nausea (n = 2) and fatigue (n = 5). Haematological toxicity was seen in only one patient. No patient required hospitalization for toxicity. Three achieved a complete remission, four a partial remission and three disease stabilization. After a median follow-up of 183 days from commencing capecitabine (range 97-540), all patients were alive and five were in remission. Five progressed after remissions that lasted between 63 and 252 days. Oral capecitabine is an active and well-tolerated agent when used alone as first-line therapy in patients who have relapsed after HDC-ASCS for MBC.
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Affiliation(s)
- A Bashey
- University of California, San Diego, USA.
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24
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Voltarelli JC, Ahmed H, Paton EJ, Stracieri AB, Holman P, Bashey A, Coutinho M, Simoes BP, Ball ED, Carrier E. Beneficial effect of intravenous lidocaine in cutaneous chronic graft-versus-host disease secondary to donor lymphocyte infusion. Bone Marrow Transplant 2001; 28:97-9. [PMID: 11498752 DOI: 10.1038/sj.bmt.1703080] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2000] [Accepted: 04/05/2001] [Indexed: 11/09/2022]
Abstract
We report two cases of refractory chronic graft-versus-host disease after donor lymphocyte infusions in which the skin lesions improved dramatically with the use of intravenous pulses of lidocaine. This form of therapy has been used successfully for the cutaneous involvement of scleroderma and may have vasodilator and anti-inflammatory effects.
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Affiliation(s)
- J C Voltarelli
- Bone Marrow Transplantation Unit, University Hospital, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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25
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Lazarus HM, Loberiza FR, Zhang MJ, Armitage JO, Ballen KK, Bashey A, Bolwell BJ, Burns LJ, Freytes CO, Gale RP, Gibson J, Herzig RH, LeMaistre CF, Marks D, Mason J, Miller AM, Milone GA, Pavlovsky S, Reece DE, Rizzo JD, van Besien K, Vose JM, Horowitz MM. Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR). Bone Marrow Transplant 2001; 27:387-96. [PMID: 11313668 DOI: 10.1038/sj.bmt.1702796] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2000] [Accepted: 11/02/2000] [Indexed: 11/08/2022]
Abstract
Although patients with relapsed Hodgkin's disease have a poor prognosis with conventional therapies, high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autotransplantation) may provide long-term progression-free survival. We reviewed data from the Autologous Blood and Marrow Transplant Registry (ABMTR) to determine relapse, disease-free survival, overall survival, and prognostic factors in this group of patients. Detailed records from the ABMTR on 414 patients with Hodgkin's disease in first relapse (n = 295) or second complete remission (CR) (n = 119) receiving an autotransplant from 1989 to 1995 were reviewed. Median age was 29 (range, 7-64) years. Median time from diagnosis to relapse was 18 (range, 6-219) months; median time from relapse to transplant was 5 (range, <1-215) months. Most patients received high-dose chemotherapy without total body irradiation for conditioning (n = 370). The most frequently used high-dose regimen was cyclophosphamide, BCNU, VP-16 (CBV) (n = 240). The graft consisted of bone marrow (n = 246), blood stem cells (n = 112), or both (n = 56). Median follow-up was 46 (range, 5-96) months. One hundred-day mortality (95% confidence interval) was 7 (5-9)%. One hundred and sixty-five of 295 patients (56%) transplanted in relapse achieved CR after autotransplantation. Of these, 61 (37%) recurred. Twenty-four of 119 patients (20%) transplanted in CR recurred. The probability of disease-free survival at 3 years was 46 (40-52)% for transplants in first relapse and 64 (53-72)% for those in second remission (P < 0.001). Overall survival at 3 years was 58 (52-64)% after transplantation in first relapse and 75 (66-83)% after transplantation in second CR (P < 0.001). In multivariate analysis, Karnofsky performance score <90% at transplant, abnormal serum LDH at transplant, and chemotherapy resistance were adverse prognostic factors for outcome. Progression of Hodgkin's disease accounted for 69% of all deaths. Autotransplantation should be considered for patients with Hodgkin's disease in first relapse or second remission. Future investigations should focus on strategies designed to decrease relapse after autotransplantation, particularly in patients at high risk for relapse.
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Affiliation(s)
- H M Lazarus
- Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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26
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Barrett AJ, Ringdén O, Zhang MJ, Bashey A, Cahn JY, Cairo MS, Gale RP, Gratwohl A, Locatelli F, Martino R, Schultz KR, Tiberghien P. Effect of nucleated marrow cell dose on relapse and survival in identical twin bone marrow transplants for leukemia. Blood 2000; 95:3323-7. [PMID: 10828011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
The impact of cell dose (number of nucleated donor cells per kilogram recipient weight) on transplantation outcome is controversial and may differ for allogeneic and identical twin (syngeneic) bone marrow transplants. We studied the association between cell dose and outcome in 100 unmanipulated identical twin bone marrow transplantations for leukemia, reported to the International Bone Marrow Transplant Registry between 1985 and 1994, using Cox proportional hazards regression for multivariate analyses. Cell doses ranged from 0.3 to 7.4 x 10(8) nucleated cells/kg (median, 3.0 x 10(8)cells/kg). Median follow-up was 75 months. Five-year cumulative incidences of transplant-related mortality with high (more than 3 x 10(8) cells/kg) versus low (less than or equal to 3 x 10(8) cells/kg) cell doses were 2% (95% confidence interval [CI], 0% to 8%) versus 10% (95% CI, 4% to 20%), respectively. Five-year probabilities of leukemia-free survival were 53% (95% CI, 39% to 67%) and 37% (95% CI, 23% to 52%), respectively. In multivariate analysis, among patients surviving in remission at least 9 months after transplantation, those receiving high cell doses were at significantly lower risk for treatment failure (relapse or death) than those receiving low cell doses (RR, 0.27; 95% CI, 0.12 to 0.6; P =.001). Lower treatment failure resulted from fewer relapses in the high cell dose group (RR for relapse, 0.28; 95% CI, 1.2 to 0.66; P =.003). These findings suggest that outcomes after syngeneic bone marrow transplantation could be improved by transplanting more than 3 x 10(8) nucleated cells per kilogram. The benefit of high cell dose on relapse may represent a delayed graft-versus-leukemia effect.
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MESH Headings
- Adolescent
- Adult
- Bone Marrow Cells/cytology
- Bone Marrow Transplantation
- Cell Nucleus/ultrastructure
- Child
- Child, Preschool
- Disease-Free Survival
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Proportional Hazards Models
- Recurrence
- Registries
- Regression Analysis
- Retrospective Studies
- Survival Analysis
- Tissue Donors
- Transplantation, Isogeneic/physiology
- Twins, Monozygotic
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Affiliation(s)
- A J Barrett
- International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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27
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Bashey A, Corringham S, Garrett J, Lane TA, Gilpin EA, Corringham RE, Law P, Ho AD. A phase II study of two cycles of high-dose chemotherapy with autologous stem cell support in patients with metastatic breast cancer who meet eligibility criteria for a single cycle. Bone Marrow Transplant 2000; 25:519-24. [PMID: 10713629 DOI: 10.1038/sj.bmt.1702172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multi-cycle high-dose chemotherapy with autologous stem cell support (HDC-ASCS) may improve the results obtained with single-cycle HDC-ASCS in metastatic breast cancer (MBC). However, the tolerability and efficacy of additional cycles of HDC-ASCS in patients selected using standard eligibility criteria for single cycle HDC-ASCS is uncertain. Twenty-nine patients with MBC and a CR or PR to induction chemotherapy were selected by standard institutional eligibility criteria for single-cycle HDC-ASCS. Cycle 1 HDC-ASCS (cyclophosphamide 6 g/m2; mitoxantrone 70 mg/m2; carboplatin 800 mg/m2) was followed by a planned second cycle (etoposide 1.6 g/m2; thiotepa 800 mg/m2; carboplatin 800 mg/m2 modulated by tamoxifen 120 mg/m2/day x 5 days) with a median interval of 3.2 months. CR rate was 20% after induction chemotherapy and 33% and 54% after HDC cycles I and II, respectively. Sixteen patients (55%) failed to complete HDC cycle II within 200 days because of disease progression, toxicity, inadequate stem cell collection, insurance denials or patient choice. Median progression-free survival (PFS) for all 29 patients entered is 301 days from date of HDC cycle I and actuarial PFS at 2 years is 35%. For the 13 patients who received the two cycles of HDC-ASCS, actuarial PFS at 2 years was 54% (P = NS compared to those receiving only one cycle). These data show that a second cycle of full-dose intensity HDC-ASCS may increase the proportion of patients with MBC that achieve CR and may increase PFS. However, a large proportion of patients that complete HDC-ASCS cycle I may fail to proceed to cycle II in a timely fashion. Bone Marrow Transplantation (2000) 25, 519-524.
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Affiliation(s)
- A Bashey
- Blood and Marrow Transplantation Program, University of California, San Diego, La Jolla, CA 92093-7621, USA
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28
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Huang S, Chen Z, Yu JF, Young D, Bashey A, Ho AD, Law P. Correlation between IL-3 receptor expression and growth potential of human CD34+ hematopoietic cells from different tissues. Stem Cells 1999; 17:265-72. [PMID: 10527461 DOI: 10.1002/stem.170265] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
CD123 (alpha-subunit of IL-3 receptor) expression on primitive and committed human hematopoietic cells was studied by multicolor sorting and single-cell culture. The sources of cells included fetal liver (FLV), fetal bone marrow, umbilical cord blood, adult bone marrow and mobilized peripheral blood. Three subsets of CD34+ cells were defined by the levels of surface CD123: CD123negative, CD123low, and CD123bright. Coexpression of lineage markers showed that a majority of CD34+CD123bright cells were myeloid and B-lymphoid progenitors, while erythroid progenitors were mainly in the CD34+CD123negative subset. The CD34+CD123low subset contained a heterogeneous distribution of early and committed progenitor cells. Single CD34+ cells from the CD123 subsets were cultured in a cytokine cocktail of stem cell factor, interleukin 3 (IL-3), IL-6, GM-CSF, erythropoietin, insulin-like growth factor-1, and basic fibroblast growth factor. After 14 days of incubation, a higher cloning efficiency (CE) was observed in the CD34+CD123negative and CD34+CD123low fractions (37+/-23% and 44+/-23%, respectively) than in the CD34+CD123bright fraction (15+/-21%). Using previously published criteria that colonies containing dispersed, translucent cells (dispersed growth pattern, DGP) were derived from primitive cells and that colonies composed solely of clusters were from committed cells, early precursors were distributed evenly in the CD34+CD123negative and CD34+CD123low subsets. When CD38 and CD90 (Thy-1) were used for further characterization of CD34+ cells from FLV, CE increased from 37+/-23% in CD123negative to 70+/-19% in CD123negativeCD38- and from 44+/-23% in CD123low to 66+/-19% in CD123lowCD38-. No significant increase in CE or DGP progenitors was observed when CD34+ cells were sorted by CD90 and CD123. We concluded that: A) high levels of CD123 were expressed on B-lymphoid and myeloid progenitors; B) early erythroid progenitors had little or no surface CD123, and C) primitive hematopoietic cells are characterized by CD123negative/low expression.
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Affiliation(s)
- S Huang
- University of California San Diego, Division of Blood & Marrow Transplantation, La Jolla 92037-7621, USA
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29
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Lane TA, Ho AD, Bashey A, Peterson S, Young D, Law P. Mobilization of blood-derived stem and progenitor cells in normal subjects by granulocyte-macrophage- and granulocyte-colony-stimulating factors. Transfusion 1999; 39:39-47. [PMID: 9920165 DOI: 10.1046/j.1537-2995.1999.39199116893.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It was previously reported that the combination of granulocyte-macrophage-colony-stimulating factor (GM-CSF) and granulocyte-CSF (G-CSF) for 4 days mobilized more primitive CD34+ subsets than did either G-CSF or GM-CSF alone. STUDY DESIGN AND METHODS The studies determine the optimal number of days of growth factor dosing for mobilization and collection of peripheral blood progenitor cells, by increasing the days of administration of GM-CSF and/or G-CSF or employing the sequential administration of GM-CSF followed by G-CSF. Sixty normal subjects were given injections of G-CSF or GM-CSF alone; GM-CSF and G-CSF concurrently for 4, 5, or 6 days; or a sequential regimen of GM-CSF for 3 or 4 days followed by G-CSF for 2 or 3 days. A 10-L apheresis was performed 24 hours after the last dose. RESULTS The three most efficacious mobilization regimens consisted of sequential GM-CSF for 3 days followed by G-CSF for either 2 or 3 days and G-CSF alone for 5 days. Each of these regimens resulted in the collection of significantly greater numbers of CD34+ cells by apheresis than any of the 4-day dosing regimens with G-CSF and/or GM-CSF (sequential GM-CSF/G-CSF: 3 days/2 days = 3.58 +/- 0.53 x 106 CD34+ cells/kg; GM-CSF/G-CSF: 3 days/3 days = 4.45 +/- 1.08 x 10(6) CD34+ cells/kg; G-CSF: 5 days = 3.58 +/- 0.97 x 10(6) CD34+ cells/kg; all p<0.05 vs. G-CSF and/or GM-CSF for 4 days). Clonogenic assays generally paralleled the level of CD34+ cells. Regimens containing GM-CSF resulted in a higher percentage of the cells from primitive CD34+/CD38-/HLA-DR+ subset than G-CSF alone. CONCLUSION Compared with 4-day dosing regimens with G-CSF and/or GM-CSF, mobilization of CD34+ cells in normal subjects using sequential GM-CSF for 3 days followed by G-CSF for 2 or 3 days or using G-CSF alone for 5 days increased the number CD34+ cells that can be collected by a single 10-L apheresis 24 hours after the last dose of cytokine.
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Affiliation(s)
- T A Lane
- Blood and Marrow Transplant Program, Department of Medicine, University of California, San Diego, School of Medicine, USA
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30
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Bashey A, Shepherd S, Frankel W, Wang-Rodriguez J, Cahill T, Chamberlain M, Mason JR, Ho AD, Corringham RE. Induction of molecular remission by donor peripheral blood leukocyte therapy in patients relapsing with extramedullary blastic phase chronic myeloid leukemia after allogeneic bone marrow transplantation. Oncol Rep 1998; 5:281-5. [PMID: 9458334 DOI: 10.3892/or.5.1.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Two patients with chronic myeloid leukemia (CML) who relapsed in blastic transformation after allogeneic bone marrow transplantation (BMT) were treated with infusions of leukapheresed peripheral blood mononuclear cells from their original donor. At relapse, their disease was characterized by symptomatic extramedullary deposits of leukemia with minimal (PCR positive, cytologically negative) involvement of bone marrow. Treatment with donor cell infusions was associated with clinical remission, return of full donor chimerism and loss of the BCR-ABL transcript detectable in bone marrow before donor leukocyte infusion (molecular remission). Donor leukocyte infusions should be considered for therapy of relapsed blastic phase CML after allogeneic BMT, especially when the relapse is primarily extramedullary and responsive to local and systemic cytoreductive therapy. However, severe GVHD and CNS relapse remain obstacles to achieving a successful long-term outcome.
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Affiliation(s)
- A Bashey
- Division of Bone Marrow Transplantation, University of California, San Diego, La Jolla 92093-0987, USA 92093-0987, USA
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31
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32
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Price CM, Marshall CJ, Bashey A. Sequential acquisition of trisomy 8 and N-ras mutation in acute myeloid leukaemia demonstrated by analysis of isolated leukaemic colonies. Br J Haematol 1994; 88:338-42. [PMID: 7803279 DOI: 10.1111/j.1365-2141.1994.tb05028.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Specific chromosomal aberrations and point mutations of the N-ras proto-oncogene are characteristic genetic alterations in acute leukaemias. However, the relationships between these two different genetic changes are unclear. Here we have determined the order of genetic events in a patient with acute myeloid leukaemia characterized by trisomy 8 and a point mutation of N-ras at codon 12 (N12-cys) and codon 61 (N61-his). 30 colonies obtained by in vitro clonogenic assay of leukaemic cells from a patient with AML were individually analysed for the presence of trisomy 8 and each of two different N-ras mutations by fluorescence in situ hybridization (FISH) and the polymerase chain reaction (PCR). Trisomy 8 was detected in 25/26 evaluable colonies. 19/26 colonies contained the N12-cys mutation. The N61-his mutation was not detected in any of the colonies obtained. All the colonies with the N12 cys mutation were also trisomic from chromosome 8, whereas 6/25 colonies with trisomy 8 had no N-ras mutation. These data suggest that trisomy 8 was acquired before N12 cys mutation in the pathogenesis of this leukaemia and that two genetic events can co-operate within a single subclone.
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Affiliation(s)
- C M Price
- Centre of Cell and Molecular Biology, Chester Beatty Laboratories, Institute of Cancer Research, London
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33
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Bashey A, Healy L, Marshall CJ. Proliferative but not nonproliferative responses to granulocyte colony-stimulating factor are associated with rapid activation of the p21ras/MAP kinase signalling pathway. Blood 1994; 83:949-57. [PMID: 7509213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) can elicit responses that include proliferation, granulocytic differentiation, and activation of cellular functions in target cells. The biochemical pathways responsible for transduction of these signals from the G-CSF receptor (G-CSFR) have not been defined. In this report, we show that, in murine (NFS-60) and human (OCI-AML 1) myeloid leukemia cell lines and in murine pro-B-lymphocytic cells, BAF/B03, transfected with the murine G-CSFR, proliferative responses to G-CSF are associated with rapid activation of p42 and p44 MAP kinases and p21ras. Truncation of the cytoplasmic portion of the murine G-CSFR at residue 646 but not at residue 739 abolished G-CSF-induced stimulation of cellular proliferation as well as activation of MAP kinase and p21ras in transfected BAF/B03 cells. G-CSF-induced granulocytic differentiation of the murine leukemic cell line 32DC13(G) occurred in the absence of detectable activation of p42 MAP kinase. Nonproliferative responses to G-CSF in the human promyelocytic cell line HL-60 and in human neutrophils were similarly associated with no MAP kinase activation. These results imply that differing cellular effects of G-CSF may be involve the recruitment of differing signal transduction pathways with the p21ras/MAP kinase pathway being limited to proliferative responses.
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Affiliation(s)
- A Bashey
- Section of Cell and Molecular Biology, Chester Beatty Laboratories, Institute of Cancer Research, London, UK
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Bashey A, Gill R, Levi S, Farr CJ, Clutterbuck R, Millar JL, Pragnell IB, Marshall CJ. Mutational activation of the N-ras oncogene assessed in primary clonogenic culture of acute myeloid leukemia (AML): implications for the role of N-ras mutation in AML pathogenesis. Blood 1992; 79:981-9. [PMID: 1737106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The number of steps involved in the pathogenesis of acute myeloid leukemia (AML) is unclear. The initiating event would be expected to exist in all leukemic cells, but subsequent events may be subclonal. If several genetic events occur, they may cooperate within the same cell or be alternatively acquired by different subclones. These possibilities cannot be adequately analyzed in DNA prepared directly from patient specimens. In this study, N-ras mutations demonstrable in DNA prepared from peripheral blood of 10 patients with AML were examined in primary in vitro colonies (AML-colony-forming units [CFU]) grown from these patients. Both colonies containing the mutant gene and colonies containing normal allele only were obtained from each patient. The proportion of colonies containing no mutant allele varied among patients (5% to 57%). A subset of mutation containing colonies appeared to have lost the normal allele in nine of 10 AML cases analyzed. In the four cases with two N-ras mutations, the two mutations were found to exist in different subclones. In these cases, macroscopic colonies (AML-MCFU) were also obtained using an assay system designed to select for earlier clonogenic cells than in the AML-CFU assay. The N12cys mutation in AML10 was found in the CFU, but not in the MCFU, and the N12asp mutation in AML43 was found in the MCFU, but not in the CFU. These results suggest that N-ras mutation is a postinitiation event in AML that contributes to the outgrowth of more malignant subclones. Where two mutations are found in a case of AML, they appear to have been acquired by separate subclones, which may show different degrees of differentiation.
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Affiliation(s)
- A Bashey
- Section of Cell and Molecular Biology, Institute of Cancer Research, Chester Beatty Laboratories, London, UK
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Bashey A, Vulliamy T, Cai BS, Schwarer AP, Goldman JM. Non-lymphoid blast crisis of CML with rearrangement of immunoglobulin and T-cell receptor delta genes. Eur J Haematol 1991; 47:36-41. [PMID: 1907927 DOI: 10.1111/j.1600-0609.1991.tb00558.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report a patient with chronic myeloid leukaemia (Philadelphia-positive with M-BCR rearrangement) in transformation whose blast cells had myelomonocytic morphology, absent terminal deoxynucleotidyl transferase expression and non-lymphoid cell surface markers (CD10-, CD19-, CD33+, CD14+, CD11+). Leukaemia cell DNA showed rearrangement of both immunoglobulin heavy chain and T-cell receptor delta genes. Such rearrangements may be a feature of a small proportion of patients with non-lymphoid transformation of CML as they are in a minority of cases of de novo acute non-lymphoblastic leukaemia.
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Affiliation(s)
- A Bashey
- Department of Haematology, Royal Postgraduate Medical School, London, U.K
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Bashey A, Owen I, Lucas GF, Amphlett NW, Jones MM, Lawal A, McMullin MF, Mahendra P, Tyfield LA, Hows JM. Late onset immune pancytopenia following bone marrow transplantation. Br J Haematol 1991; 78:268-74. [PMID: 2064966 DOI: 10.1111/j.1365-2141.1991.tb04427.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 17-year-old boy developed autoimmune pancytopenia in the absence of chronic graft-versus-host disease 170 d after allogeneic bone marrow transplantation (BMT) from his HLA identical brother. The anaemia and thrombocytopenia responded to conventional immunosuppressive treatment, but the neutropenia was refractory to this and to splenectomy and subsequent removal of splenic remnant. Following total lymphoid irradiation the neutrophil count rose to low normal levels but thrombocytopenia and anaemia secondary to marrow hypoplasia required transfusion support. Bone marrow function was finally normalized by an additional transfusion of donor marrow without prior immunosuppressive therapy. We conclude that late onset immune pancytopenia post BMT caused by antibodies of probable donor origin may be life threatening in the absence of chronic graft-versus-host disease.
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Affiliation(s)
- A Bashey
- Department of Haematology, Royal Postgraduate Medical School, London
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Bashey A, McMullin MF, Hows JM. Pneumocystis prophylaxis after bone marrow transplantation for severe aplastic anaemia. Bone Marrow Transplant 1990; 5:285. [PMID: 2337740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Dokal IS, Amos A, Bashey A, Goldman JM. Recurrent bone marrow necrosis and extramedullary myeloid deposits in Philadelphia negative chronic myeloid leukaemia. Haematologica 1988; 73:513-5. [PMID: 3148515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Affiliation(s)
- A Bashey
- Department of Respiratory Medicine, City Hospital, Edinburgh
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Kerr MA, Falconer JS, Bashey A, Beck JS. The effect of C3 levels on yeast opsonization by normal and pathological sera: identification of a complement independent opsonin. Clin Exp Immunol 1983; 54:793-800. [PMID: 6652976 PMCID: PMC1536141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The ability of 150 normal and pathological sera to opsonize yeast for uptake by isolated human polymorphonuclear leucocytes has been studied. Phagocytosis was measured by an assay depending on electronic particle counting to measure yeast uptake and by a new fluorometric assay which is able to distinguish particle adherence from true phagocytosis. The opsonic activity of normal human serum was heat labile and depended markedly on C3 levels. The sera of 6% of healthy young adults (three from 45) and 8% of healthy donors aged 65-88 (four from 57) showed defective opsonization in spite of normal C3 and CH50 levels. Thirty-eight pathological sera with low C3 levels showed defective opsonization. However, three sera with low C3 levels showed apparently normal opsonic activity. The opsonin from two of these sera was characterized. It was heat stable, had apparent mol.wt of 400,000 and was active in serum free media. The opsonin was absorbed by immobilized Staphylococcus aureus and by gelatin-Sepharose, suggesting that it is related to fibronectin. Fibronectin from normal human sera prepared by affinity chromatography on gelatin-Sepharose was not opsonic in this system.
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