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Fernández-Fournier M, Kerguelen A, Rodríguez de Rivera FJ, Lacruz L, Jimeno S, Losantos I, Hernández-Maraver D, Puertas I, Tallon-Barranco A, Viejo A, Frank García A, Díez-Tejedor E. Therapeutic plasma exchange for myasthenia gravis, Guillain-Barre syndrome, and other immune-mediated neurological diseases, over a 40-year experience. Expert Rev Neurother 2022; 22:897-903. [PMID: 36408604 DOI: 10.1080/14737175.2022.2147827] [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: 11/22/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) was first used in neurology in the 1980s for myasthenia gravis (MG) and Guillain-Barré syndrome (GBS). Indications have since grown. Fear of complications with this treatment modality limit its use. RESEARCH DESIGN & METHODS A study of patients undergoing TPE for neurological diseases (1981-2020) in a University Hospital in Madrid, Spain. Clinical indications, complications, procedure number, apheresis technique and replacement fluids were prospectively recorded and retrospectively analyzed. Historical trends were studied. RESULTS 159 patients (48.69 ±18.15 years, 54.3% females) underwent TPE using central-venous catheter and replacement fluid albumin. We performed 1207 procedures over 189 cycles (6.4 ±3.8 procedures/cycle). Most patients underwent TPE for category I-II indications, mainly GBS and MG (77.7%). Complication rate was low (3.9% procedures), mostly hypotensive/vasovagal reactions (55.3%) and vascular access-related complications (38.3%). Most were mild-moderate (92.9%), permitting TPE completion, and somewhat more frequent during the first procedure (38.3%) and after periods of little TPE use. GBS patients were more prone to complications than MG patients (6.5% vs. 1.2%,p<0.001) mainly hypotensive/vasovagal reactions (3.7% vs. 1.0%,p=0.008). CONCLUSIONS TPE is well-tolerated with low complication rate (<4% procedures), mainly hypotensive/vasovagal reactions. Patients with GBS seem more prone to them than MG patients. Acquaintance with this technique seems necessary.
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Affiliation(s)
- Mireya Fernández-Fournier
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | - Ana Kerguelen
- Apheresis Unit, Department of Haematology, Hospital Universitario La Paz, Spain
| | - Francisco Javier Rodríguez de Rivera
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | - Laura Lacruz
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | - Santiago Jimeno
- Apheresis Unit, Department of Haematology, Hospital Universitario La Paz, Spain
| | - Itsaso Losantos
- Biostatistics Section, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | | | - Inmaculada Puertas
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | - Antonio Tallon-Barranco
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | - Aurora Viejo
- Apheresis Unit, Department of Haematology, Hospital Universitario La Paz, Spain
| | - Ana Frank García
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
| | - Exuperio Díez-Tejedor
- Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario La Paz & Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain
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Del Río-Garma J, Bobillo S, de la Rubia J, Pascual C, García-Candel F, García-Gala JM, Gonzalez R, Abril L, Vidan J, Gomez MJ, Peña F, Arbona C, Martín-Sanchez J, Moreno G, Romón I, Viejo A, Oliva A, Linares M, Salinas R, Pérez S, Garcia-Erce JA, Pereira A. Mortality in acquired thrombotic thrombocytopenic purpura in the pre-caplacizumab era. Ann Hematol 2021; 101:59-67. [PMID: 34642787 DOI: 10.1007/s00277-021-04685-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
Despite the effectiveness of plasma exchange (PEX) and immunosuppressants in the treatment of acquired thrombotic thrombocytopenic purpura (aTTP), a number of patients still die as a result of the disease. Whether caplacizumab could rescue these patients remains still unsettled. The objective of this study was to characterise mortality patterns and prognostic factors in the first episode of aTTP.We queried the Spanish TTP Registry for patients with a diagnosis of aTTP in their presenting episode who fulfilled complete clinical and follow-up data (n = 102). The patients were diagnosed between 2004 and 2018, and all were treated with daily PEX and corticosteroids. Clinical and laboratory data were analysed at diagnosis and during the treatment course.Eight patients (7.7%) died between 12 h and 36 days after presentation, and could be classified into three patterns: death before treatment, early death driven by acute cardiac or neurologic events, and late death due to unremitted aTTP. Stupor or coma at diagnosis and platelet count < 20 × 109 /L by the 6th treatment day were independently associated with increased risk of death.Stupor or coma at diagnosis and lack of response to PEX by the 6th day in patients experiencing the first episode of aTTP are strong predictors of mortality. These patients could be rescued by novel agents aimed at halting the microvascular thrombosis until adequate immunosuppression is achieved.
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Affiliation(s)
- Julio Del Río-Garma
- Servicio de Hematología, Complejo Hospitalario Universitario de Ourense, Rua Ramon Puga Noguerol sn, 32005, Ourense, Spain.
| | - Sabela Bobillo
- Servicio de Hematología, Hospital Vall d´Hebron, Barcelona, Spain
| | - Javier de la Rubia
- Servicio de Hematología, Hospital Universitario Doctor Peset, Valencia, Spain
- School of Medicine, Catholic Univertity of Valencia, Valencia, Spain
| | - Cristina Pascual
- Servicio de Hematología, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Jose M García-Gala
- Servicio de Hematología, Hospital Universitario de Asturias, Oviedo, Spain
| | - Reyes Gonzalez
- Servicio de Hematología, Hospital Clínico Universitario de A Coruña, A Coruña, Spain
| | - Laura Abril
- Servicio de Hematología, Hospital Germans Trias I Pujol, Badalona, Spain
| | - Julia Vidan
- Servicio de Hematología, Hospital Universitario de León, León, Spain
| | - Maria Jesús Gomez
- Servicio de Hematología, Hospital Universitario de Móstoles, Móstoles, Spain
| | - Francisco Peña
- Servicio de Hematología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Cristina Arbona
- Servicio de Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Gemma Moreno
- Servicio de Hematología, Hospital Ramón y Cajal, Madrid, Spain
| | - Iñigo Romón
- Servicio de Hematología, Hospital Marqués de Valdecilla, Santander, Spain
| | - Aurora Viejo
- Servicio de Hematología, Hospital La Paz, Madrid, Spain
| | - Ana Oliva
- Servicio de Hematología, Hospital Universitario Virgen de La Candelaria, Tenerife, Spain
| | - Mónica Linares
- Servicio de Hematología, Hospital Vall d´Hebron, Barcelona, Spain
| | - Ramón Salinas
- Hospital del Sagrat Cor, Universitat Internacional de Catalunya and Banc de Sang I Teixits de Catalunya, Barcelona, Spain
| | - Sonia Pérez
- Servicio de Hematología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jose A Garcia-Erce
- Banco de Sangre y Tejidos de Navarra. Servicio Navarro de Salud, Pamplona, and Instituto Aragonés de Ciencias de La Salud, Pamplona, Spain
| | - Arturo Pereira
- Servicio de Hemoterapia y Hemostasia, Hospital Clínic, Barcelona, Spain
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García-Bosque I, Hernández-Maraver D, Kerguelen A, Jiménez-Yuste V, Viejo A. PLATELET TRANSFUSION REFRACTORINESS (PTR) IN A TERTIARY REFERRAL HOSPITAL. Transfus Apher Sci 2021; 60:103143. [PMID: 34219019 DOI: 10.1016/j.transci.2021.103143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | - A Viejo
- La Paz University Hospital, Spain
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4
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Pascual-Izquierdo C, Del Rio-Garma J, de la Rubia J, Viejo A, Mingot E, Cid J, Solanich X, Fernández-Sojo J, Martín-Sánchez J, Hernández L, García-Gala JM, Alonso N, González V, Oliva A, Gómez-Seguí I, Goterris R, Guerra L, García-Candel F, Fernández-Docampo M, Antelo ML, Salgado-Barreira Á, Salinas R. Incidence, diagnosis, and outcome of immune-mediated thrombotic thrombocytopenic purpura: A nationwide survey by the Spanish registry of thrombotic thrombocytopenic purpura. J Clin Apher 2021; 36:563-573. [PMID: 33780553 DOI: 10.1002/jca.21894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/01/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare disease characterized by the presence of anti-ADAMTS13 autoantibodies. Achieving accurate information on incidence and customary disease management is important to provide appropriate diagnostic and therapeutic resources. The aim of this study was to determine the incidence and outcomes of iTTP in Spain. STUDY DESIGN AND METHODS A cross-sectional survey was carried out among Spanish hospitals, focused on iTTP patients ≥16 years old attended between 2015 and 2017, and those at follow-up before that interval. Incidence, prevalence, mortality, refractoriness, exacerbations, treatment complications, relapses, and sequelae were estimated. RESULTS Forty-two hospitals covering roughly 20 million inhabitants answered the survey and reported 203 episodes (138 newly-diagnosed and 65 relapses), of which 193 (95.1%) were treated. Incidence was 2.67 (95% CI 1.90-3.45) patients per million inhabitants per year and prevalence 21.44 (95% CI% 19.10-23.73) patients per million inhabitants. At diagnosis, ADAMTS13 activity and anti-ADAMTS13 autoantibody were measured in 97% and 84.3% of reported episodes, respectively. Fifteen patients (7.4%) died as a direct consequence of iTTP, 6 of them before receiving any iTTP-specific treatment. Thirty-one (16.1%) of the 193 treated episodes were refractory to plasma exchange and corticosteroids, and 51 (26.4%) suffered at least one exacerbation. CONCLUSION iTTP incidence and prevalence were somewhat higher than those documented in neighboring countries. Together with data on treatments and outcomes, this information will allow us to better estimate what is needed to improve diagnosis and prognosis of iTTP patients in Spain.
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Affiliation(s)
- Cristina Pascual-Izquierdo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | | | - Eva Mingot
- Hospital Regional Universitario de Málaga, Spain
| | - Joan Cid
- Hospital Clínic de Barcelona, Spain
| | - Xavier Solanich
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | - Ana Oliva
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Luisa Guerra
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Ángel Salgado-Barreira
- Instituto de Investigación Sanitaria Galicia Sur, Complexo Hospitalario Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Ramón Salinas
- Hospital Universitari Sagrat Cor, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Banc de Sang i Teixits de Catalunya, Barcelona, Spain
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Fernández A, Navarro-Zapata A, Escudero A, Matamala N, Ruz-Caracuel B, Mirones I, Pernas A, Cobo M, Casado G, Lanzarot D, Rodríguez-Antolín C, Vela M, Ferreras C, Mestre C, Viejo A, Leivas A, Martínez J, Fernández L, Pérez-Martínez A. Optimizing the Procedure to Manufacture Clinical-Grade NK Cells for Adoptive Immunotherapy. Cancers (Basel) 2021; 13:cancers13030577. [PMID: 33540698 PMCID: PMC7867223 DOI: 10.3390/cancers13030577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 01/18/2023] Open
Abstract
Simple Summary Natural Killer cells have shown promise to treat different malignancies. Several methods have been described to obtain fully activated NK cells for clinical use. Here, we use different cell culture media and different artificial antigen presenting cells to optimize a GMP compliant manufacturing method to obtain activated and expanded NK cells suitable for clinical use. Abstract Natural killer (NK) cells represent promising tools for cancer immunotherapy. We report the optimization of an NK cell activation–expansion process and its validation on clinical-scale. Methods: RPMI-1640, stem cell growth medium (SCGM), NK MACS and TexMACS were used as culture mediums. Activated and expanded NK cells (NKAE) were obtained by coculturing total peripheral blood mononuclear cells (PBMC) or CD45RA+ cells with irradiated K562mbIL15-41BBL or K562mbIL21-41BBL. Fold increase, NK cell purity, activation status, cytotoxicity and transcriptome profile were analyzed. Clinical-grade NKAE cells were manufactured in CliniMACS Prodigy. Results: NK MACS and TexMACs achieved the highest NK cell purity and lowest T cell contamination. Obtaining NKAE cells from CD45RA+ cells was feasible although PBMC yielded higher total cell numbers and NK cell purity than CD45RA+ cells. The highest fold expansion and NK purity were achieved by using PBMC and K562mbIL21-41BBL cells. However, no differences in activation and cytotoxicity were found when using either NK cell source or activating cell line. Transcriptome profile showed to be different between basal NK cells and NKAE cells expanded with K562mbIL21-41BBL or K562mbIL15-41BBL. Clinical-grade manufactured NKAE cells complied with the specifications from the Spanish Regulatory Agency. Conclusions: GMP-grade NK cells for clinical use can be obtained by using different starting cells and aAPC.
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Affiliation(s)
- Adrián Fernández
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain; (A.F.); (A.L.); (J.M.); (L.F.)
| | - Alfonso Navarro-Zapata
- Translational Research Group in Paediatric Oncology Haematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, 28046 Madrid, Spain; (A.N.-Z.); (M.V.); (C.F.); (C.M.)
| | - Adela Escudero
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, 28046 Madrid, Spain;
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-Institute of Medical and Molecular Genetics (INGEMM-IdiPAZ), 28046 Madrid, Spain; (N.M.); (B.R.-C.)
| | - Nerea Matamala
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-Institute of Medical and Molecular Genetics (INGEMM-IdiPAZ), 28046 Madrid, Spain; (N.M.); (B.R.-C.)
| | - Beatriz Ruz-Caracuel
- Translational Research in Pediatric Oncology, Hematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-Institute of Medical and Molecular Genetics (INGEMM-IdiPAZ), 28046 Madrid, Spain; (N.M.); (B.R.-C.)
| | - Isabel Mirones
- Advanced Therapy Medicinal Products Production Unit Pediatric Hemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (I.M.); (A.P.); (M.C.); (G.C.)
| | - Alicia Pernas
- Advanced Therapy Medicinal Products Production Unit Pediatric Hemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (I.M.); (A.P.); (M.C.); (G.C.)
| | - Marta Cobo
- Advanced Therapy Medicinal Products Production Unit Pediatric Hemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (I.M.); (A.P.); (M.C.); (G.C.)
| | - Gema Casado
- Advanced Therapy Medicinal Products Production Unit Pediatric Hemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain; (I.M.); (A.P.); (M.C.); (G.C.)
- Advanced Therapy Medicinal Products Production Unit, Pediatric Hemato-Oncology Service and Pharmacy Service, La Paz University Hospital, 28046 Madrid, Spain
| | - Diego Lanzarot
- Applications Department Miltenyi Biotec, 28223 Madrid, Spain;
| | - Carlos Rodríguez-Antolín
- Experimental Therapies and Novel Biomarkers in Cancer, La Paz University Hospital Institute for Health Research-IdiPAZ, 28046 Madrid, Spain;
| | - María Vela
- Translational Research Group in Paediatric Oncology Haematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, 28046 Madrid, Spain; (A.N.-Z.); (M.V.); (C.F.); (C.M.)
| | - Cristina Ferreras
- Translational Research Group in Paediatric Oncology Haematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, 28046 Madrid, Spain; (A.N.-Z.); (M.V.); (C.F.); (C.M.)
| | - Carmen Mestre
- Translational Research Group in Paediatric Oncology Haematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, 28046 Madrid, Spain; (A.N.-Z.); (M.V.); (C.F.); (C.M.)
| | - Aurora Viejo
- Hematology and Hemotherapy Department, La Paz University Hospital, 28046 Madrid, Spain;
| | - Alejandra Leivas
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain; (A.F.); (A.L.); (J.M.); (L.F.)
- Hematology Department 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Joaquín Martínez
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain; (A.F.); (A.L.); (J.M.); (L.F.)
- Hematology Department 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Lucía Fernández
- Hematological Malignancies Lab-H12O Clinical Research Unit, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain; (A.F.); (A.L.); (J.M.); (L.F.)
| | - Antonio Pérez-Martínez
- Translational Research Group in Paediatric Oncology Haematopoietic Transplantation & Cell Therapy, La Paz University Hospital Institute for Health Research-IdiPAZ, 28046 Madrid, Spain; (A.N.-Z.); (M.V.); (C.F.); (C.M.)
- Pediatric Hemato-Oncology Department, La Paz University Hospital, 28046 Madrid, Spain
- Correspondence: ; Tel.: +34-912071408 (ext. 41408)
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Hernández-Maraver D, Viejo A, Kerguelén AE, Jiménez-Yuste V. Transfusion medicine during COVID-19 outbreak in the hotspot of Spain. Transfusion 2020; 60:2762-2764. [PMID: 32815162 PMCID: PMC7461430 DOI: 10.1111/trf.16038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/28/2023]
Affiliation(s)
| | - Aurora Viejo
- Transfusion Medicine, Hematology Service, La Paz University Hospital, Madrid, Spain
| | - Ana Esther Kerguelén
- Transfusion Medicine, Hematology Service, La Paz University Hospital, Madrid, Spain
| | - Victor Jiménez-Yuste
- Hematology Service, La Paz University Hospital-IdiPAZ, Autonomous University, Madrid, Spain
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7
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Oarbeascoa G, Lozano ML, Guerra LM, Amunarriz C, Saavedra CA, Garcia-Gala JM, Viejo A, Revilla N, Acosta Fleitas C, Arroyo JL, Martinez Revuelta E, Galego A, Hernandez-Maraver D, Kwon M, Diez-Martin JL, Pascual C. Retrospective Multicenter Study of Extracorporeal Photopheresis in Steroid-Refractory Acute and Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2020; 26:651-658. [PMID: 31917270 DOI: 10.1016/j.bbmt.2019.12.769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 01/09/2023]
Abstract
Extracorporeal photopheresis (ECP) is an established treatment strategy in steroid-refractory graft-versus-host disease (GVHD). This study's main objective was to analyze the clinical response and impact of ECP therapy in steroid dose reduction. A retrospective observational series of 113 patients from 7 transplantation centers was analyzed. Sixty-five patients (58%) had acute GVHD (aGVHD), and 48 (42%) had chronic GVHD (cGVHD). All ECP procedures were performed with the off-line system. The median number of procedures until achievement of initial response was 3 for both patients with aGVHD and those with cGVHD. ECP was the second-line therapy in 48% of the aGVHD cases and in 50% of the cGVHD cases. 71% of the cases of aGVHD were grade III-IV, and 69% of the cases of cGVHD were severe. The overall response rate on day 28 was 53% (complete response [CR] rate, 45%) in the patients with aGVHD and 67% (CR, 23%) in those with cGVHD. Skin was the most frequently involved organ, with a response rate of 58% (CR, 49%) in the patients with aGVHD and 69% (CR 29%) in those with cGVHD. At the end of ECP treatment, 60% of patients treated for aGVHD who responded were able to stop steroid therapy, with a median dose reduction of 100%. Significant differences in overall survival were observed for patients responding to ECP with aGVHD (hazard ratio [HR], 4.3; P < .001) and with cGVHD (HR, 4.8; P = .003). Our data indicate that ECP is a valid therapeutic alternative in patients with steroid-refractory aGVHD and cGVHD, permitting significant steroid dosage reductions.
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Affiliation(s)
- Gillen Oarbeascoa
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Maria Luisa Lozano
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain; Centro Regional de Hemodonación, Murcia, Spain; School of Medicine, University of Murcia, Murcia, Spain; Instituto Murciano de Investigación Biomédica-Arrixaca, Murcia, Spain
| | - Luisa Maria Guerra
- Department of Hematology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Cristina Amunarriz
- Banco de Sangre y Tejidos de Cantabria-Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Jose Maria Garcia-Gala
- Department of Hematology and Hemotherapy, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Aurora Viejo
- Department of Hematology, Hospital Universitario La Paz, Madrid, Spain
| | - Nuria Revilla
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain; Centro Regional de Hemodonación, Murcia, Spain; School of Medicine, University of Murcia, Murcia, Spain; Instituto Murciano de Investigación Biomédica-Arrixaca, Murcia, Spain
| | - Cynthia Acosta Fleitas
- Department of Hematology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Spain
| | - Jose Luis Arroyo
- Banco de Sangre y Tejidos de Cantabria-Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eva Martinez Revuelta
- Department of Hematology and Hemotherapy, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Andrea Galego
- Department of Hematology, Complexo Hospitalario Universitario, A Coruña, Spain
| | | | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Jose Luis Diez-Martin
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain; School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Cristina Pascual
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.
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8
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Luczkowiak J, Arribas JR, Gómez S, Jiménez-Yuste V, de la Calle F, Viejo A, Delgado R. Specific neutralizing response in plasma from convalescent patients of Ebola Virus Disease against the West Africa Makona variant of Ebola virus. Virus Res 2015; 213:224-229. [PMID: 26739425 DOI: 10.1016/j.virusres.2015.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The current outbreak of Ebola Virus Disease in West Africa is caused by a new variant of Ebola virus (EBOV) named Makona 2014, whose sequence differs 3% from isolates from Central Africa such as Mayinga 1976 EBOV. The specificity and kinetics of the neutralizing antibody response induced by the circulating Makona EBOV has not been thoroughly studied. METHODS We have used a lentiviral EBOV-glycoprotein (GP)-pseudotyped infection assay to measure Makona-GP and Mayinga-GP specific neutralizing activity of plasma from three convalescent Ebola Virus Disease patients from the current EBOV outbreak at 2, 3, 4 and 9 months post-infection. Total anti-EBOV GP IgG was measured by a commercial ELISA assay. FINDINGS In convalescent Ebola Virus Disease patients, Makona-GP-specific neutralizing titers increased from 2 months (mean IC50 1/59), 3 months (IC50 1/212), 4 months (IC50 1/239) and up to 9 months (IC50 1/268) post-infection. Neutralizing activity of plasma from the three convalescent Ebola Virus Disease patients was more vigorous against the current Makona-GP pseudotyped EBOV variant than against Mayinga-GP pseudotyped EBOV and this difference was observed at each time point tested: Mayinga vs Makona mean IC50 fold=4.92 at 2 months post-infection, 2.89 fold at 3 months post-infection, 2.23 at 4 months post-infection and 2.98 at 9 months post-infection (all differences p<0.01). Total level of IgG against EBOV-GP did not evolve significantly during the follow up. DISCUSSION In convalescent Ebola Virus Disease patients, EBOV-GP specific neutralizing activity increases over time, at least up to 9 months post-infection, which suggests that active affinity maturation of antibodies takes place long after clinical recovery. EBOV-GP specific neutralizing response is significantly higher against Makona EBOV circulating in West Africa than against the variants included in the currently approved vaccines. Correlates of protection for EBOV vaccines have not been completely established and the relevance of a lower neutralizing activity in convalescent plasma from the current outbreak against one of the EBOV-GPs contained in the vaccines in terms of its potential efficacy does not necessarily preclude its efficacy. However, this observation highlights the concern regarding the natural diversity of EBOV and its subsequent challenge for diagnosis, therapy and vaccine design. EBOV-GP neutralizing activity varies considerably over time in convalescent Ebola Virus Disease patients. Titering of convalescent blood products would be desirable to standardize and evaluate their potential therapeutic value.
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Affiliation(s)
- Joanna Luczkowiak
- Department of Microbiology, Instituto de Investigación Hospital 12 de Octubre (imas12), CAA, Avenida de Córdoba sn, 28041 Madrid, Spain.
| | - José R Arribas
- Infectious Diseases Unit, Department of Internal Medicine, Instituto de Investigación Hospital La Paz (IdiPAZ), Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Sara Gómez
- Department of Microbiology, Instituto de Investigación Hospital 12 de Octubre (imas12), CAA, Avenida de Córdoba sn, 28041 Madrid, Spain.
| | - Víctor Jiménez-Yuste
- Department of Hematology, Instituto de Investigación Hospital La Paz (IdiPAZ), Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Fernando de la Calle
- Tropical Diseases Unit, Department of Internal Medicine, Instituto de Investigación Hospital La Paz (IdiPAZ), Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Aurora Viejo
- Department of Hematology, Instituto de Investigación Hospital La Paz (IdiPAZ), Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Rafael Delgado
- Department of Microbiology, Instituto de Investigación Hospital 12 de Octubre (imas12), CAA, Avenida de Córdoba sn, 28041 Madrid, Spain.
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Martínez-Sánchez N, Robles-Marhuenda Á, Álvarez-Doforno R, Viejo A, Antolín-Alvarado E, Deirós-Bronte L, Bartha JL. The effect of a triple therapy on maternal anti-Ro/SS-A levels associated to fetal cardiac manifestations. Autoimmun Rev 2015; 14:423-8. [DOI: 10.1016/j.autrev.2015.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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10
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del Río-Garma J, Alvarez-Larrán A, Martínez C, Muncunill J, Castellà D, de la Rubia J, Zamora C, Corral M, Viejo A, Peña F, Rodríguez-Vicente P, Contreras E, Arbona C, Ramírez C, Garcia-Erce JA, Alegre A, Mateo J, Pereira A. Methylene blue-photoinactivated plasmaversusquarantine fresh frozen plasma in thrombotic thrombocytopenic purpura: a multicentric, prospective cohort study. Br J Haematol 2008; 143:39-45. [DOI: 10.1111/j.1365-2141.2008.07292.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [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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11
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Castro-Guardiola A, Armengou A, García D, Viejo A, Obón M, García-Bragado F. [Prospective study of 198 community acquired pneumonias in a general hospital]. Enferm Infecc Microbiol Clin 1999; 17:213-8. [PMID: 10396084] [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: 02/13/2023]
Abstract
BACKGROUND Pneumonia is a common medical problem with a significant mortality and morbidity. It is the leading infectious disease in hospital admissions. We conducted a one year prospective study of the patients over 14 years of age that had been diagnosed of community-acquired pneumonia in our institution. The objective was to determinate the clinical characteristics and the aetiological agents of pneumonia in our geographic area and to know which factors are related with the evolution and prognosis of this disease. PATIENTS AND METHODS A medical team evaluated and followed-up all the patients diagnosed of community-acquired pneumonia. Epidemiological, clinical, radiological and laboratory data were recorded. An attempt to obtain an aetiological diagnosis was done by means of sputum, blood cultures and serologic studies at admission and between third and fourth week later. In individualized patients invasive techniques were performed. We classified the patients in five groups according to previous criteria defined in the guidelines of our hospital based in age, the presence of an underlying disease and the severity in the initial presentation. RESULTS 274 patients received an initial diagnosis of pneumonia, in 76 (28%) this initial diagnosis was not confirmed. The mean age of the remaining 198 was 55 years. 62% were men. 40% had an identifiable microbiological etiology. The main causal microorganism was Streptococcus pneumoniae followed by Mycoplasma pneumoniae. Gram stain and sputum culture were the most useful laboratory tests for the aetiological diagnosis. Blood cultures and serological test had a lower efficiency. There was no relationship between the clinical presentation, typical or atypical pneumonia, and the causal microorganism. Complications developed in 11% of the patients and the mortality rate was of 3%. CONCLUSIONS There was a high rate of initial erroneous diagnoses of pneumonia. The epidemiological, clinical and roentgenographic characteristics were similar to other studies conducted in our country with a lower number of microbiological agents identified. Patients who were admitted at hospital only because their age or the presence of chronic disease had a good evolution. In this series patients with severe presentation also had a good prognosis. It would be interesting to investigate about which parameters could be useful as indicators of prognosis and evolution at initial presentation of pneumonia.
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Affiliation(s)
- A Castro-Guardiola
- Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta
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García Pérez A, Viejo A, Pérez Solaz A, Ena J. [Is chloroquine useful in the the treatment of sideroblastic refractory anemia?]. Sangre (Barc) 1996; 41:162. [PMID: 9045362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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García Pérez A, Viejo A, Salinas M, Almenar MV. [Inappropriate use of emergency coagulation tests in a regional hospital]. Sangre (Barc) 1994; 39:495. [PMID: 7855702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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14
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Carbonell C, Viejo A, Varona C, Vilar A. [Eosinophilia-myalgia syndrome associated with L-tryptophan use. The first reported case in Spain]. Med Clin (Barc) 1991; 96:716. [PMID: 2072782] [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: 12/30/2022]
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