1
|
Agarwal RK, Dhanya R, Sedai A, Ankita K, Parmar L, Ramprakash S, Sandeep, Trivedi D, Shah V, Bhat N, Reddy M, R N, Faulkner L. Bone Marrow Quality Index: A Predictor of Acute Graft-versus-Host Disease in Hematopoietic Stem Cell Transplantation for Thalassemia. Transplant Cell Ther 2023; 29:711.e1-711.e6. [PMID: 37481242 DOI: 10.1016/j.jtct.2023.07.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
Bone marrow (BM) continues to be the preferred source of stem cells in allogenic transplantation for nonmalignant disorders. Granulocyte colony-stimulating factor (G-CSF)-primed BM is associated with low rates of acute graft-versus-host disease (aGVHD) and allows reduced collection volumes while ensuring speedy engraftment. However, variability in BM harvest quality is a concern. This study evaluated the utility of a novel indicator, the Bone Marrow Quality Index (BMQI), to predict aGVHD. We analyzed 184 consecutive first matched related donor bone marrow transplants for thalassemia using G-CSF-primed bone marrow over 6 years from March 2017 to April 2023 across 2 centers in India. BMQI was defined as the ratio of the G-CSF-primed BM WBC count to the peripheral blood WBC count within 24 hours of harvest. European Society for Blood and Marrow Transplantation criteria were used to grade aGVHD. The log-rank test was used to assess the impact of BMQI on aGVHD. The chi-square test was used to compare categorical data, and the Wilcoxon rank-sum test was used to compare the numerical data. A Cox proportional hazards model was used to investigate the association of BMQI vis-à-vis other factors on aGVHD. Of the 184 patients studied, 19 had a BMQI <.9, 18 had a BMQI between .9 and 1, and the remaining 147 had a BMQI >1. The rate of aGVHD grade II-IV was 37% in patients with a BMQI <.9 , 22% in those with BMQI .9 to 1, and 12% in those with BMQI >1 (P = .018). Patients with BMQI <.9 had a 3.1-fold greater chance (95% confidence interval [CI], .9 to 10.6) and those with BMQI .9 to 1 had a 2-fold greater chance (95% CI, .5 to 6.6) of developing aGVHD grade II-IV. BMQI was the significant predictor associated with aGVHD hazard (P = .014). BMQI appears to be the most relevant and controllable predictor of aGVHD. It is a novel, informative, and very simple indicator that could influence aGVHD prophylaxis decision making. Our indicator is accurately measurable, inexpensive, precise, and timely; furthermore, it does not involve any sophisticated equipment and thus may be widely applicable. Prior knowledge of poor BM quality may help intensify prophylaxis and monitoring for aGVHD, as well as trigger a review of collection procedures.
Collapse
Affiliation(s)
- Rajat Kumar Agarwal
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India.
| | | | - Amit Sedai
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India
| | - Kumari Ankita
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India
| | - Lalith Parmar
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms Pvt. Ltd., Bangalore, India
| | - Stalin Ramprakash
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India
| | - Sandeep
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India
| | - Deepa Trivedi
- Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Vaibhav Shah
- Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Neema Bhat
- Sankalp-BMJH Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Mohan Reddy
- Sankalp-BMJH Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Nithya R
- Sankalp India Foundation, Bangalore, India
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India; Cure2Children Foundation, Florence, Italy
| |
Collapse
|
2
|
Verna M, Canesi M, Conter V, Faulkner L, Rovelli AM, Silvestri D, Majolino I, Biondi A, Nawfal Abdullah C, Faeq Mohammed V. A Hematopoietic Stem Cell Transplantation Startup in Iraqi Kurdistan: Results in Thalassemia Patients and Analysis of the Methodology. Transplant Cell Ther 2023; 29:329.e1-329.e7. [PMID: 36690277 DOI: 10.1016/j.jtct.2023.01.018] [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] [Received: 11/03/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
In hemoglobinopathy-prone regions, like the Middle East, thalassemia is the most prevalent noncommunicable life-threatening disorder of children and is highly curable by hematopoietic stem cell transplantation (HSCT). Moreover, transplantation is very cost-effective, and HSCT programs can be established directly in middle-income countries (MICs) at a reduced cost while maintaining quality standards and outcomes consistent with international ones. The aim of the present study was to review and verify the efficacy of the applied methodology through the analysis of 47 consecutive matched-related HSCTs in children with thalassemia. In 2016, the first HSCT unit for adults and children with both malignant and nonmalignant diseases was developed in Iraqi Kurdistan, thanks to a capacity building project funded by the Italian Agency for Development Cooperation. Data on clinical activity were obtained from a cohort of patients treated in the newly established HSCT unit. Primary endpoints were overall survival (OS) and thalassemia-free survival (TFS). Startup of the HSCT unit was completed over a 3-year period. Assessing and meeting minimum requirements were crucial for the startup; moreover, a team of international health care professionals (HCPs), all experts in the field of HSCT, conducted the education and training phase, involving all the clinical and nonclinical professionals in the program. At a median follow-up of 2.6 years, the 3-year TFS and OS were 82.8% (SE, 5.5%) and 87.1% (SE, 4.9%), respectively. TFS and graft-versus-host-disease-free composite survival was 80.6% (SE, 5.8%). At present, the HSCT service is completely autonomous, and more than 250 transplants have been done in both adults and children. The minimal essential requirements for an HSCT startup may be affordable in many MICs. Our results for thalassemia are comparable with international data. A twinning program with an international group of experts and a capacity-building approach is crucial for the success of the program, a strategy that allows for rapid development of HSCT units.
Collapse
Affiliation(s)
- Marta Verna
- Fondazione IRCCS San Gerardo dei Tintori - Pediatric Dept. University of Milano Bicocca, Monza, Italy
| | - Marta Canesi
- Fondazione IRCCS San Gerardo dei Tintori - Pediatric Dept. University of Milano Bicocca, Monza, Italy.
| | - Valentino Conter
- Fondazione IRCCS San Gerardo dei Tintori - Pediatric Dept. University of Milano Bicocca, Monza, Italy
| | | | - Attilio Maria Rovelli
- BMT Unit, Fondazione IRCCS San Gerardo dei Tintori - Pediatric Dept. University of Milano Bicocca, Monza, Italy
| | - Daniela Silvestri
- Fondazione IRCCS San Gerardo dei Tintori - Pediatric Dept. University of Milano Bicocca, Monza, Italy
| | | | - Andrea Biondi
- Fondazione IRCCS San Gerardo dei Tintori - Pediatric Dept. University of Milano Bicocca, Monza, Italy
| | | | - Vian Faeq Mohammed
- Bone Marrow Transplant Centre, Hiwa Hospital, Sulaimaniyah, Iraqi Kurdistan
| |
Collapse
|
3
|
Matthay KK, Hylton J, Penumarthy N, Khattab M, Soh SY, Nguyen HTK, Alcasabas AP, Fawzy M, Saab R, Khan MS, Ghandour K, Chantada G, Parikh NS, Faulkner L, Lam CG, Howard SC. Global Neuroblastoma Network: An international multidisciplinary neuroblastoma tumor board for resource-limited countries. Pediatr Blood Cancer 2022; 69:e29568. [PMID: 35084087 DOI: 10.1002/pbc.29568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/24/2021] [Accepted: 01/02/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tumor boards are part of standard care of patients with complex cancers, but appropriate multidisciplinary expertise and infrastructure are often not available in low- and middle-income countries (LMIC) for pediatric cancers, such as neuroblastoma. Our goal was to review results of a Global Neuroblastoma Network (GNN) tumor board accessible to LMIC. METHODS De-identified clinical cases presented via internet conference during a weekly GNN virtual tumor board from 2010 through 2020 were evaluated in a standardized format, including diagnostic imaging, pathology, therapy information, resource limitations, and questions for discussion. Information summarized included the presentations, a survey of the impact on care, and a resource questionnaire. RESULTS Registered GNN participants included 575 individuals from 77 countries, with a median of 39 participants per session. Total 412 cases were presented from 32 countries, including 351 unique neuroblastoma patients, 52 follow-up cases, and nine non-neuroblastoma diagnoses. Twenty-eight educational sessions were presented. Limited critical resources for diagnostics and staging of cases included MYCN analysis (54.7%), metaiodobenzylguanidine (MIBG) scans (38.7%), and International Neuroblastoma Pathology Classification (49%). Therapies were also limited, with markedly decreased use of radiation and autologous stem cell transplant for high-risk cases, and no availability of anti-GD2 antibody in LMIC. Limited sampling with a post-presentation survey showed that 100% found the GNN helpful, and 70% altered the care plan based on the discussion. CONCLUSION This report shows the utility of an international tumor board for LMIC focused on a challenging solid tumor where local expertise may be limited, with international multidisciplinary expert participation and educational sessions.
Collapse
Affiliation(s)
- Katherine K Matthay
- Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jennifer Hylton
- Department of Network Development, Resonance Health, Memphis, Tennessee, USA
| | - Neela Penumarthy
- Department of Pediatrics, Kaiser Permanente, Oakland, California, USA
| | - Mohammed Khattab
- Pediatric Hematology-Oncology Center, Children's Hospital, University Mohammed Vth, Rabat, Morocco
| | - Shui Yen Soh
- Pediatric Hematology-Oncology, KK Women and Children's Hospital, Singapore
| | | | - Ana Patricia Alcasabas
- Division of Pediatric Hematology Oncology, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Mohammed Fawzy
- Children's Cancer Hospital - Egypt (CCHE/57357) and National Cancer Institute, Cairo University, Cairo, Egypt
| | - Raya Saab
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center Al Madinah, Riyadh, Saudi Arabia
| | | | - Guillermo Chantada
- Fundacion Perez-Scremini-Hospital Pereira Rossell, Montevideo, Uruguay and Institute for Translational Research (IIMT) CONICET-Austral University, Pilar, Argentina
| | - Nehal S Parikh
- Department of Pediatrics, Children's Hospital of NJ and Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | | | - Catherine G Lam
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Scott C Howard
- Acute and Tertiary Care, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, USA
| |
Collapse
|
4
|
Marwah P, Ramprakash S, Prasad T R S, Gizhlaryan M, Trivedi D, Shah V, Chitaliya A, Elizabeth S, Agarwal RK, Dhanya R, Faulkner L. Is it safe and efficacious to remove central lines in pediatric bone marrow transplant patients with platelets less than 20,000/μl? eJHaem 2022; 3:154-158. [PMID: 35846206 PMCID: PMC9175805 DOI: 10.1002/jha2.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/08/2022]
Abstract
Background Patients with tunneled central venous lines (CVL) may develop bloodstream infections which at times are difficult to control without line removal. Concomitant severe thrombocytopenia with platelet transfusion refractoriness is often considered a major contraindication to any procedure involving a major blood vessel. There is very little literature on the clinical risks of tunneled central line removal in febrile pancytopenia patients. Procedure We analyzed complications and outcomes in all our patients, a total of 52, who underwent CVL removal with platelets <20,000/μl. Results CVL removal was done on a median day of 17.5 with 47 of the 52 patients never having achieved platelets engraftment prior to line removal. No bleeding episodes or unplanned transfusions could be associated with CVL removal. No other complications were also reported. All patients had time to hemostasis within 5 min of catheter removal. Removal of CVL under local anesthesia remained complication‐free even at platelet counts less than 20,000/ul. A total of 31 patients were febrile at the time of CVL removal, of which 17 became afebrile within 2 days. We found no difference in defervescence when comparing those whose antibiotic therapy was changed/escalated versus those in whom it was not. Conclusion Our findings suggest that central lines can be safely removed with platelet counts less than 20,000/ul and that this may result in enhanced bloodstream infection control. This might be particularly relevant to neutropenic patients in this day and age of multidrug‐resistant organism emergence and paucity of new effective antibiotics.
Collapse
Affiliation(s)
- Priya Marwah
- Department of Pediatrics Mahatma Gandhi University of Medical Sciences and Technology Jaipur India
| | - Stalin Ramprakash
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | - Sai Prasad T R
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | | | - Deepa Trivedi
- Sankalp India Foundation Bangalore India
- Sankalp‐CIMS Centre for Paediatric BMT Ahmedabad India
| | - Vaibhav Shah
- Sankalp India Foundation Bangalore India
- Sankalp‐CIMS Centre for Paediatric BMT Ahmedabad India
| | | | - Sandeep Elizabeth
- Sankalp India Foundation Bangalore India
- Sankalp‐People Tree Centre for Paediatric Bone Marrow Transplantation Bangalore India
| | - Rajat Kumar Agarwal
- Sankalp India Foundation Bangalore India
- Jagriti InnoHealth Platforms Pvt. Ltd. Bangalore India
| | | | - Lawrence Faulkner
- Sankalp India Foundation Bangalore India
- Cure2Children Foundation Florence Italy
| |
Collapse
|
5
|
Shah V, Trivedi D, Faulkner L, dhanya R, Agrawal R. Allogenic bone marrow transplantation in thalassemia major: Our experience. Pediatric Hematology Oncology Journal 2022. [DOI: 10.1016/j.phoj.2022.10.059] [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: 11/27/2022] Open
|
6
|
Dhanya R, Agarwal RK, Ramprakash S, Trivedi D, Shah V, Bhat N, Reddy M, Elizabeth S, Batool A, Khalid S, Faulkner L. Do weekly surveillance cultures contribute to antibiotic stewardship and correlate with outcome of HSCT in children - a multicentre real-world experience of 5 years from Indian subcontinent? Transplant Cell Ther 2021; 28:170.e1-170.e7. [PMID: 34936930 DOI: 10.1016/j.jtct.2021.12.008] [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: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The utility of weekly rectal swab surveillance cultures (RSSC) as a resource to identify gut colonisation with Extended Spectrum Beta-Lactamase (ESBL)-producing E Coli or Klebsiella pneumoniae carbapenemase (KPC) producing organisms, to guide empirical antibiotic therapy in HSCT patients continues to be a subject of interest. There is urgency to assess and justify modifications to empirical antibiotics based upon regional epidemiology and patient groups. OBJECTIVE To study the utility of weekly rectal swab surveillance cultures (RSSC) to guide empirical antibiotics therapy and the impact of gut colonisation on transplant outcomes. STUDY DESIGN This is a retrospective analysis of 317 successive first transplants done in three pediatric bone marrow transplant centres in Indian sub-continent, mainly for hemoglobinopathies, between April 2016 and April 2021. Transplantation, infection control and febrile neutropenia management protocols are identical among the three centres. First line antibiotics were chosen based on RCCS reports i.e. meropenem and high dose meropenem with colistin for ESBL and carbapenemase resistant colonisation respectively for first half of the study and no adjustment was made in the second half. Clinical response to antibiotics, long term outcomes, antibiotic-resistant bacteraemia and acute GVHD were analysed. Log-rank test, Chi-squared test and Wilcoxon test were used to compare data using R Statistical software. RESULTS Of all 871 weekly RSSC done, 162 were positive for ESBL- or KPC-resistant organism. RCCS were ESBL-positive in 106 patients (33%) and KPC-positive in 10 patients (3%). Within 97 ESBL-positive patients for whom antimicrobial susceptibility testing (AST) report was available, only 22 (25%) demonstrated clinical resistance of Pip-Taz. Within the 10 KPC-positive patients' clinical resistance was observed only in 4 (40%) to Pip-Taz and 3 (30%) to meropenem. For ESBL-positive RSSC where 1st line empirical antibiotics were used, 66% of the patients responded clinically. Even within the 15 who were resistant to 1st line empirical antibiotics (Pip-Taz) on RSSC reports, 67% responded to Pip-Taz clinically. Within these patients 27 (56%) never needed any carbapenems. Using Pip-Taz empirically in ESBL-positive patients did not prolong meropenem use within 100 days of transplantation (p=0.18). For KPC-positive RSSC where 1st line empirical antibiotics were used, all patients clinically responded, including 4 who were resistant to Pip-Taz and 3 patients who were meropenem resistant on RCCS. Comparing patients who were ESBL-positive, KPC-positive and neither, no statistically significant difference was seen in overall survival (p=0.95), disease free survival (p=0.45), transplant related mortality (p=0.97), rejection (p=0.68) and rate of acute GVHD grade II-IV (p=0.78). Comparing the ESBL-positive patients who did and did not get higher-level empirical antibiotics, no statistical difference was seen in overall survival (p=0.32), disease free survival (p=0.64), transplant related mortality (p=0.65), rejection (p=0.46), acute GVHD grade II-IV (p=0.26) or antibiotic resistant bacteraemia (p=0.3). CONCLUSIONS In context of transplantation for non-malignant HSCTs, empiric antibiotic choice based on rectal swab surveillance cultures is not justified, even in regions with a high prevalence of antimicrobial resistance. Antimicrobial susceptibility testing (AST) reports in surveillance cultures did not correlate with in-vivo clinical response. Colonisation reported on weekly surveillance rectal swab cultures showed no correlation with clinical outcomes.
Collapse
Affiliation(s)
| | - Rajat Kumar Agarwal
- Sankalp India Foundation, Bangalore, India; Jagriti InnoHealth Platforms, Bangalore, India.
| | - Stalin Ramprakash
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India
| | - Deepa Trivedi
- Sankalp India Foundation, Bangalore, India; Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Vaibhav Shah
- Sankalp India Foundation, Bangalore, India; Sankalp-CIMS Centre for Paediatric BMT, Ahmedabad, India
| | - Neema Bhat
- Sankalp India Foundation, Bangalore, India; BMJH-Sankalp Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Mohan Reddy
- Sankalp India Foundation, Bangalore, India; BMJH-Sankalp Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Sandeep Elizabeth
- Sankalp India Foundation, Bangalore, India; Sankalp-People Tree Centre for Paediatric Bone Marrow Transplantation, Bangalore, India; BMJH-Sankalp Centre for Pediatric Hematology Oncology and BMT, Bangalore, India
| | - Aliya Batool
- Dr Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Sadaf Khalid
- Dr Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India; Cure2Children Foundation, Florence, Italy
| |
Collapse
|
7
|
Diaz-de-Heredia C, Bresters D, Faulkner L, Yesilipek A, Strahm B, Miano M, Dalle JH, Peffault de Latour R, Corbacioglu S. Recommendations on hematopoietic stem cell transplantation for patients with Diamond-Blackfan anemia. On behalf of the Pediatric Diseases and Severe Aplastic Anemia Working Parties of the EBMT. Bone Marrow Transplant 2021; 56:2956-2963. [PMID: 34462566 DOI: 10.1038/s41409-021-01449-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022]
Abstract
Diamond Blackfan anemia (DBA) is a rare congenital syndrome presenting primarily as pure red cell aplasia with constitutional abnormalities and cancer predisposition. Established treatment options are corticosteroids, regular erythrocyte transfusions with iron chelation therapy, and hematopoietic stem cell transplantation (HSCT). To date, HSCT is the only definitive curative treatment for the hematological phenotype of DBA, but there is little experience with its use. Given the rarity of the disease and its unique features, an expert panel agreed to draw up a set of recommendations on the use of HSCT in DBA to guide clinical decision-making and practice. The recommendations address indications, pretransplant patient evaluation, donor selection, stem cell sources, conditioning regimens, prophylaxis of rejection and graft versus host disease, and post-transplant follow-up.
Collapse
Affiliation(s)
- Cristina Diaz-de-Heredia
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation. Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Akif Yesilipek
- Pediatric Stem Cell Transplantation Unit. Bahçeşehir University School of Medicine Istanbul, Medical Park Götzepe Hospital, İstanbul, Turkey
| | - Brigitte Strahm
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Maurizio Miano
- Haematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Jean-Hugues Dalle
- Hematology and Immunology Department, Robert Debré Hospital - GHU APHP Nord Université de Paris, Paris, France
| | | | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| |
Collapse
|
8
|
Mehta P, Ramprakash S, Raghuram CP, Trivedi D, Dhanya R, Agarwal RK, Faulkner L. Pre-transplant donor-type red cell transfusion is a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. Ann Hematol 2021; 100:2071-2078. [PMID: 34148110 DOI: 10.1007/s00277-021-04571-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/28/2020] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
ABO incompatibility is not a barrier to allogeneic stem cell transplant but may result in acute hemolytic reactions. As stem cell product manipulation is cumbersome, we are reporting the effectiveness and safety of donor-type red cell infusion as a method of reducing acute hemolytic reaction while using marrow as stem cell source. In major ABO-mismatched bone marrow transplants, manipulation of marrow product requires expertise and expensive equipment, which may not be readily available to transplant centers in low- and middle-income regions. The aim behind our study is to report a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants. We retrospectively analyzed 303 consecutive allogeneic bone marrow transplants (BMTs) for beta thalassemia major, between August 2015 and March 2020, with either major (n = 41) or bidirectional (n = 14) mismatches. When isohemagglutinin titers were 1:32 or higher, donor-type packed red blood cell was divided into 4 aliquots, irradiated and administered over 4 days at incremental volumes. Patients were observed for hemolytic reaction, and if no reaction, bone marrow was infused without manipulation. Out of 55 patients, 20 received donor-type blood infusion. Twelve patients showed evidence of mild hemolysis. None developed severe hemolytic or anaphylactic reaction. Titers were rechecked in 14 patients and all had reduction in titers, except for one. Our experience demonstrated that donor-type PRBC infusion is safe and effective in preventing acute hemolysis in major ABO-mismatched stem cell transplants even with bone marrow as graft source.
Collapse
Affiliation(s)
- Pallavi Mehta
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India. .,Hemato-Oncology and Stem Cell Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, 110085, India.
| | - Stalin Ramprakash
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India
| | - C P Raghuram
- Sankalp-People tree Paediatric Bone Marrow Transplant Unit, People Tree Hospital, Bangalore, India
| | - Deepa Trivedi
- Care Institute of Medical Sciences, Sankalp-CIMS Centre for Pediatric BMT, Ahmedabad, India
| | | | | | | |
Collapse
|
9
|
Faulkner L, Hughes CM, Barry HE. An exploration of community pharmacists’ experience, knowledge and perspectives of frailty and medicines optimisation in frail older people: A qualitative study. International Journal of Pharmacy Practice 2021. [PMCID: PMC8083694 DOI: 10.1093/ijpp/riab016.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Frailty is a heightened state of vulnerability due to an accumulation of age-related defects in separate physiological systems (1). Frailty is becoming increasingly common, with up to 50% of older adults being diagnosed with mild, moderate or severe frailty (35%, 12% and 3% respectively) (2). Community pharmacists may often be the primary healthcare professional with whom frail older people have most frequent contact due to their convenience and accessibility. Therefore, it is hypothesised that community pharmacists could play a wider role in frailty identification and medicines optimisation for frail older people. Aim To explore community pharmacists’ knowledge of frailty and its assessment, their experiences and contact with frail older patients in the community pharmacy setting, and their perceptions of their role in optimising medicines for frail older people. Methods Two strategies were used to recruit community pharmacists registered in Northern Ireland (NI). Community pharmacists were recruited through the Pharmacy Forum NI bi-monthly newsletter and the School of Pharmacy Undergraduate Placement Network, followed by snowballing. The interview topic guide was developed based on the published literature, current frailty guidelines and through discussion within the research team; it was piloted with four pharmacists. Semi-structured interviews commenced in March 2020. Due to the Covid-19 pandemic, face-to-face interviews were logistically not possible, therefore telephone interviews were conducted at a time convenient to participants. All interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis. Results To date, 14 interviews have been conducted, lasting between 24 and 72 minutes. Apart from one interview, all were conducted over the telephone. Participant characteristics are summarised in Table 1. Analysis of interview transcripts is ongoing. Findings to date have highlighted the key role community pharmacists feel they play in assisting frail older patients with their medicines (especially during the current pandemic). Many saw themselves as a ‘point of contact’ for frail older people and highlighted the holistic approaches they used to care of such patients: “It’s easier to get in contact with us than other healthcare professionals and we tend to be the first port of call really” [CP2]. Interviews highlighted a lack of pharmacist knowledge surrounding frailty as a condition and its assessment, with participants primarily focusing on the physical aspects of frailty (e.g. weight loss, weakness) when observing or ‘informally assessing’ patients. None of the participants reported formally assessing their patients using validated frailty tools or checklists: “It’s not something that I’ve ever thought about. We don’t have any tools readily available to us that I know of and certainly nothing that would be standardised” [CP1]. Conclusion This study has highlighted that community pharmacists felt they could contribute to optimising medicines for frail older people. However, the findings emphasise the need for more formal training for community pharmacists about the clinical aspects of frailty, frailty assessment and future interventions to address the medicines-related issues they have encountered with this patient population. References 1. Shaw RL, Gwyther H, Holland C, Bujnowska M, Kurpas D, Cano A, et al. Understanding frailty: meanings and beliefs about screening and prevention across key stakeholder groups in Europe. Ageing & Society. 2018;38(6): 1223–1252. 2. Hollinghurst J, Fry R, Akbari A, Clegg A, Lyons RA, Watkins A, et al. External validation of the electronic Frailty Index using the population of Wales within the Secure Anonymised Information Linkage Databank. Age and Ageing. 2019;48(6): 922–926.
Collapse
Affiliation(s)
- L Faulkner
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - C M Hughes
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - H E Barry
- Primary Care Research Group, School of Pharmacy, Queen’s University Belfast, Belfast, UK
| |
Collapse
|
10
|
El Fakih R, Greinix H, Koh M, Shaw B, Mohty M, Al Nahedh M, Saber W, Kharfan-Dabaja MA, Perales MA, Savani BN, Majhail NS, Passweg JR, Sureda A, Ahmed SO, Gluckman E, Riches M, El-Jawahri A, Rondelli D, Srivastava A, Faulkner L, Atsuta Y, Ballen KK, Rasheed W, Okamoto S, Seber A, Chao N, Kröger N, Kodera Y, Szer J, Hashmi SK, Horowitz MM, Weisdorf D, Niederwieser D, Aljurf M. Worldwide Network for Blood and Marrow Transplantation (WBMT) Recommendations Regarding Essential Medications Required To Establish An Early Stage Hematopoietic Cell Transplantation Program. Transplant Cell Ther 2020; 27:267.e1-267.e5. [PMID: 33781535 DOI: 10.1016/j.jtct.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/30/2020] [Revised: 11/19/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Establishing a hematopoietic cell transplantation (HCT) program is complex. Planning is essential while establishing such a program to overcome the expected challenges. Authorities involved in HCT program establishment will need to coordinate the efforts between the different departments required to start up the program. One essential department is pharmacy and the medications required. To help facilitate this, the Worldwide Network for Blood and Marrow Transplantation organized a structured survey to address the essential medications required to start up an HCT program. A group of senior physicians and pharmacists prepared a list of the medications used at the different phases of transplantation. These drugs were then rated by a questionnaire using a scale of necessity based on the stage of development of the transplant program. The questionnaire was sent to 30 physicians, in different parts of the world, who have between 5 and 40 years of experience in autologous and/or allogeneic transplantation. This group of experts scored each medication on a 7-point scale, ranging from an absolute requirement (score of 1) to not required (score of 7). The results are presented here to help guide the prioritization of required medications.
Collapse
Affiliation(s)
- Riad El Fakih
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | | | - Mickey Koh
- St. George's Hospital and Medical School, London, United Kingdom; Cell Therapy Facility, Blood Services Group, Health Sciences Authority, Singapore
| | - Bronwen Shaw
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohamad Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Mohammad Al Nahedh
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Wael Saber
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Jakob R Passweg
- Hematology Division, Basel University Hospital, Basel, Switzerland
| | - Anna Sureda
- Catalan Institute of Oncology, Barcelona, Spain
| | - Syed Osman Ahmed
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Marcie Riches
- Division of Hematology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Damiano Rondelli
- University of Illinois Hospital & Health Sciences System, Chicago, Illinois
| | - Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Yoshiko Atsuta
- Center for Hematopoietic Stem Cell Transplantation, Aichi Medical University Hospital, Nagakute, Japan
| | - Karen K Ballen
- Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Walid Rasheed
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shinichiro Okamoto
- Department of Medicine, Division of Hematology, Keio University School of Medicine, Tokyo, Japan
| | - Adriana Seber
- Universidade Federal de Sao Paulo Escola Paulista de Medicina, São Paulo, Brazil
| | - Nelson Chao
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jeff Szer
- Clinical Haematology at Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mary M Horowitz
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel Weisdorf
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Dietger Niederwieser
- Division of Haematology and Medical Oncology, University of Leipzig, Leipzig, Germany
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
11
|
de la Fuente J, Gluckman E, Makani J, Telfer P, Faulkner L, Corbacioglu S. The role of haematopoietic stem cell transplantation for sickle cell disease in the era of targeted disease-modifying therapies and gene editing. Lancet Haematol 2020; 7:e902-e911. [PMID: 33242447 DOI: 10.1016/s2352-3026(20)30283-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/27/2022]
Abstract
Sickle cell disease is one of the most common, life-threatening, non-communicable diseases in the world and a major public health problem. Following the implementation of simple preventive and therapeutic modalities, infant mortality has almost been abolished in high-income countries, but only a small amount of progress has been made in improving survival in adulthood. Progressive end-organ damage, partly related to a systemic vasculopathy, is increasingly recognised. With the availability of a variety of novel disease-modifying drugs, gene addition and gene editing strategies, matched sibling donor haematopoietic stem cell transplantation (HSCT) in children (offering an overall survival rate of 95% and an event-free survival rate of 92%), and encouraging outcomes after alternative donor HSCT, the new challenge is to risk stratify patients, revise transplantation indications, and define the best therapeutic approach for each patient. The ultimate challenge will be to enable these advances in low-income and middle-income countries, where disease prevalence is highest and where innovative strategies are most needed.
Collapse
Affiliation(s)
- Josu de la Fuente
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Eliane Gluckman
- Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco
| | - Julie Makani
- Department of Haematology and Blood Transfusion, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | | | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany.
| | | |
Collapse
|
12
|
Faulkner L. How to setup a successful transplant program for hemoglobinopathies in developing countries: The Cure2Children approach. Hematol Oncol Stem Cell Ther 2020; 13:71-75. [PMID: 32201151 DOI: 10.1016/j.hemonc.2019.12.010] [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: 10/30/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) remains the only established definitive cure for severe hemoglobinopathies, such as sickle cell disease (SCD) and thalassemia-the most prevalent life-threatening non-communicable disease of childhood globally. HSCT can not only cure over 85% of children with a compatible sibling but also restore normal health-related quality of life in most cases who do not have major irreversible organ damage at transplant. In low- and middle-income countries (LMICs), particularly in sub-Saharan Africa, SCD carrier rate can be up to 30% and 1% of live births have SCD. Relatively simple and inexpensive measures such as newborn screening, early diagnosis, caregiver education, and timely institution of anti-pneumococcal prophylaxis and hydroxyurea therapy can substantially reduce SCD-related mortality and morbidity. Improved prevention and early care should proceed in parallel with the development of transplant services and hope for cure. Cure2Children, an Italian NGO, has supported the startup of several bone marrow transplantation programs in LMICs where over 500 transplants have been performed over the last 10 years, with outcomes not substantially different from high-income countries but at a fraction of the cost. This report summarizes this experience and suggests some strategies to set up new HSCT units.
Collapse
|
13
|
Marwah P, Soni R, Ramprakash S, Bhat N, Raghuram CP, Agarwal RK, Dhanya R, Sedai A, Kumari A, Parmar L, Faulkner L. Host Vs. Graft Mismatches May Impact on Rejection of Haploidentical Bone Marrow Transplants in Thalassemia Patients Using Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.115] [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: 10/27/2022]
|
14
|
Ramprakash S, Bhat N, Raghuram CP, Trivedi D, Lavana S, Marwah P, Soni R, Agarwal RK, Dhanya R, Faulkner L. Splenomegaly May Increase Rejection Rates in Matched-Related Transplants for Thalassemia, This Effect Is Mitigated by Additional Immunosuppression. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.170] [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: 10/27/2022]
|
15
|
Agarwal RK, Sedai A, Ankita K, Parmar L, Dhanya R, Dhimal S, Sriniwas R, Gowda A, Gujjal P, H P, Jain S, Ramaiah JD, Jali S, Tallur NR, Ramprakash S, Faulkner L. Information Technology-Assisted Treatment Planning and Performance Assessment for Severe Thalassemia Care in Low- and Middle-Income Countries: Observational Study. JMIR Med Inform 2019; 7:e9291. [PMID: 30672740 PMCID: PMC6364210 DOI: 10.2196/medinform.9291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 07/19/2018] [Indexed: 01/06/2023] Open
Abstract
Background Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally. Objective The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC. Methods A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed. Results Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12). Conclusions Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC.
Collapse
Affiliation(s)
- Rajat Kumar Agarwal
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Amit Sedai
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Kumari Ankita
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | - Lalith Parmar
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India.,Sankalp India Foundation, Bangalore, India
| | | | - Sunil Dhimal
- Jagriti InnoHealth Platforms Private Ltd, Bangalore, India
| | | | - Ashwini Gowda
- Project Samraksha, Rashtrotthana Parishat, Bangalore, India
| | - Pooja Gujjal
- Indira Gandhi Institute of Child Health, Bangalore, India
| | - Pushpa H
- Sankalp India Foundation, Bangalore, India.,Indira Gandhi Institute of Child Health, Bangalore, India
| | - Suman Jain
- Thalassemia and Sickle Cell Society, Hyderabad, India
| | | | - Sujata Jali
- Jawaharlal Nehru Medical College, Belgaum, India
| | | | - Stalin Ramprakash
- Sankalp-People Tree Centre for Pediatric Bone Marrow Transplant, People Tree Hospitals, Bangalore, India
| | - Lawrence Faulkner
- Sankalp India Foundation, Bangalore, India.,Cure2Children Foundation, Florence, Italy
| |
Collapse
|
16
|
Bhat N, Ramprakash S, Faulkner L. Dengue Infection: Varying Presentations, Clinical Severity And Hlh In Thalassemia Patients Post Allogeneic Bone Marrow Transplant. Pediatric Hematology Oncology Journal 2018. [DOI: 10.1016/j.phoj.2018.11.120] [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: 11/28/2022] Open
|
17
|
Parmar L, Sedai A, Ankita K, Dhanya R, Agarwal RK, Dhimal S, Shriniwas R, Iyer HV, Gowda A, Gujjal P, Pushpa H, Jain S, Kondaveeti S, Dasaratha Ramaiah J, Raviteja, Jali S, Tallur NR, Ramprakash S, Faulkner L. Can inequity in healthcare be bridged in LMICs – Multicentre experience from thalassemia day care centres in India. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.12.006] [Citation(s) in RCA: 2] [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: 11/27/2022] Open
|
18
|
Agarwal RK, Sedai A, Ankita K, Parmar L, Dhanya R, Dhimal S, Shriniwas R, Sumithra P, Iyer HV, Gowda A, Gujjal P, Pradeep R, Pushpa H, Jain S, Kondaveeti S, Dasaratha Ramaiah J, Raviteja, Sharma H, Jali S, Viragi S, Bobati S, Tallur NR, Ramprakash S, Faulkner L. Multi-institutional, retrospective review of blood transfusion practices and outcomes in a large cohort of thalassemia patients in South India. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.12.001] [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: 10/18/2022] Open
|
19
|
Ramprakash S, Agarwal R, Dhanya R, Marwah P, Soni R, Yaqub N, Fatima I, Zhara T, Gooneratne L, Williams S, Khalid S, Sen S, Kanwar V, Faulkner L. Low-cost matched sibling bone marrow transplant for standard-risk thalassemia in a limited-resource setting. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.12.002] [Citation(s) in RCA: 2] [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: 01/19/2023] Open
|
20
|
Ramprakash S, Agarwal RK, Dhanya R, Sedai A, Kumari A, Parmar L, Srinivas R, Kakulamari VR, Marwah P, Soni R, Williams S, Rathnayake W, Sen S, Tulpule S, Faulkner L. Rejection of paternal vs maternal fully matched bone marrow grafts in children with thalassemia. Bone Marrow Transplant 2017; 52:1585-1586. [PMID: 28920948 PMCID: PMC5671933 DOI: 10.1038/bmt.2017.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Ramprakash
- Bone Marrow Transplant Unit, People Tree Hospitals, Bangalore, India
| | | | - R Dhanya
- Sankalp India Foundation, Bangalore, India
| | - A Sedai
- Sankalp India Foundation, Bangalore, India
| | - A Kumari
- Sankalp India Foundation, Bangalore, India
| | - L Parmar
- Sankalp India Foundation, Bangalore, India
| | - R Srinivas
- Sankalp India Foundation, Bangalore, India
| | | | - P Marwah
- Bone Marrow Transplant Unit, South East Asia Institute for Thalassemia, Jaipur, India
| | - R Soni
- Bone Marrow Transplant Unit, South East Asia Institute for Thalassemia, Jaipur, India
| | - S Williams
- Bone Marrow Transplant Unit, Nawaloka Hospital, Colombo, Sri Lanka
| | - W Rathnayake
- Bone Marrow Transplant Unit, Nawaloka Hospital, Colombo, Sri Lanka
| | - S Sen
- Bone Marrow Transplant Unit, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - S Tulpule
- Bone Marrow Transplant Unit, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | - L Faulkner
- Cure2Children Foundation, Florence, Italy
| |
Collapse
|
21
|
Amali MO, Sullivan A, Jenkins RE, Farrell J, Meng X, Faulkner L, Whitaker P, Peckham D, Park BK, Naisbitt DJ. Detection of drug-responsive B lymphocytes and antidrug IgG in patients with β-lactam hypersensitivity. Allergy 2017; 72:896-907. [PMID: 27861994 DOI: 10.1111/all.13087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Delayed-type β-lactam hypersensitivity develops in subset of patients. The cellular immunological processes that underlie the drug-specific response have been described; however, little is known about involvement of the humoral immune system. Thus, the aim of this study was to utilize piperacillin hypersensitivity as an exemplar to (i) develop cell culture methods for the detection of drug-specific B-cell responses, (ii) characterize drug-specific IgG subtypes and (iii) assess reactivity of IgG antibodies against proteins modified to different levels with piperacillin haptens. METHODS IgG secretion and CD19+ CD27+ expression on B cells were measured using ELISPOT and flow cytometry, respectively. A piperacillin-BSA adduct was used as an antigen in ELISA antibody binding studies. Adducts generated using different ratios of drug to protein were used to determine the degree of conjugation required to detect IgG binding. RESULTS B cells from hypersensitive patients, but not controls, were stimulated to secrete IgG and increase CD27 expression when cultured with soluble piperacillin. A piperacillin-BSA adduct with cyclized and hydrolysed forms of the hapten bound to eight lysine residues was used to detect hapten-specific IgG 1-4 subclasses in patient plasma. Hapten inhibition and the use of structurally unrelated hapten-BSA adducts confirmed antigen specificity. Antibody binding was detected with antigens generated at piperacillin/BSA ratios of 10:1 and above, which corresponded to a minimum epitope density of 1 for antibody binding. CONCLUSION These data show that antigen-specific B lymphocytes and T lymphocytes are activated in piperacillin-hypersensitive patients. Further work is needed to define the role different IgG subtypes play in regulating the iatrogenic disease.
Collapse
Affiliation(s)
- M. O. Amali
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - A. Sullivan
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - R. E. Jenkins
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - J. Farrell
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - X. Meng
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - L. Faulkner
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - P. Whitaker
- Regional Adult Cystic Fibrosis Unit; St James's University Hospital; Leeds UK
| | - D. Peckham
- Regional Adult Cystic Fibrosis Unit; St James's University Hospital; Leeds UK
| | - B. K. Park
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - D. J. Naisbitt
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| |
Collapse
|
22
|
Ramprakash S, Agarwal R, Dhanya R, Marwah P, Soni R, Yaqub N, Fatima I, Gooneratne L, Williams S, Khalid S, Sen S, Faulkner L. Role of G-CSF priming of donor marrow prior to transplant in low risk HLA matched sibling transplant in children with severe thalassemia. Pediatric Hematology Oncology Journal 2017. [DOI: 10.1016/j.phoj.2017.11.073] [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: 10/18/2022] Open
|
23
|
Abstract
Idiosyncratic drug reactions can be extremely severe and are not accounted for by the regular pharmacology of a drug. Thus, the mechanism of idiosyncratic drug–induced liver injury (iDILI), a phenomenon that occurs with many drugs including β-lactams, anti-tuberculosis drugs and non-steroidal anti-inflammatories, has been difficult to determine and remains a pressing issue for patients and drug companies. Evidence has shown that iDILI is multifactorial and multifaceted, which suggests that multiple cellular mechanisms may be involved. However, a common initiating event has been proposed to be the formation of reactive drug metabolites and covalently bound adducts. Although the fate of these metabolites are unclear, recent evidence has shown a possible link between iDILI and the adaptive immune system. This review highlights the role of reactive metabolites, the recent genetic innovations which have provided molecular targets for iDILI, and the current literature which suggests an immunological basis for iDILI.
Collapse
Affiliation(s)
- A Tailor
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, England
| | - L Faulkner
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, England
| | - DJ Naisbitt
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, England
| | - BK Park
- Department of Molecular and Clinical Pharmacology, MRC Centre for Drug Safety Science, University of Liverpool, Sherrington Building, Ashton Street, Liverpool, England
| |
Collapse
|
24
|
Parikh NS, Howard SC, Chantada G, Israels T, Khattab M, Alcasabas P, Lam CG, Faulkner L, Park JR, London WB, Matthay KK. SIOP-PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low- and middle-income settings. Pediatr Blood Cancer 2015; 62:1305-16. [PMID: 25810263 PMCID: PMC5132052 DOI: 10.1002/pbc.25501] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/30/2015] [Indexed: 12/11/2022]
Abstract
Neuroblastoma is the most common extracranial solid tumor in childhood in high-income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low- and middle- income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse.
Collapse
Affiliation(s)
- Nehal S. Parikh
- Department of PediatricsDivision of Hematology‐OncologyConnecticut Children's Medical CenterHartfordConnecticut
| | | | | | - Trijn Israels
- VU University Medical CenterAmsterdamthe Netherlands
| | - Mohammed Khattab
- Department of PaediatricsChildren's Hospital of RabatRabatMorocco
| | - Patricia Alcasabas
- University of the Philippines‐Philippine General HospitalManilaPhilippines
| | - Catherine G. Lam
- Department of Oncology and International Outreach ProgramSt. Jude Children's Research HospitalMemphisTennessee
| | | | - Julie R. Park
- Seattle Children's HospitalUniversity of Washington School of Medicine and Fred Hutchinson Cancer Research CenterSeattleWashington
| | - Wendy B. London
- Harvard Medical SchoolBoston Children's Hospital and Dana Farber Cancer InstituteBostonMaryland
| | - Katherine K. Matthay
- Department of PediatricsUCSF School of Medicine and UCSF Benioff Children's HospitalSan FranciscoCalifornia
| |
Collapse
|
25
|
Ogese MO, Saide K, Faulkner L, Whitaker P, Peckham D, Alfirevic A, Baker DM, Sette A, Pirmohamed M, Park BK, Naisbitt DJ. HLA-DQ allele-restricted activation of nitroso sulfamethoxazole-specific CD4-positive T lymphocytes from patients with cystic fibrosis. Clin Exp Allergy 2015; 45:1305-16. [DOI: 10.1111/cea.12546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/16/2015] [Accepted: 02/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. O. Ogese
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - K. Saide
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - L. Faulkner
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - P. Whitaker
- Regional Adult Cystic Fibrosis Unit; St James's Hospital; Leeds UK
| | - D. Peckham
- Regional Adult Cystic Fibrosis Unit; St James's Hospital; Leeds UK
| | - A. Alfirevic
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - D. M. Baker
- La Jolla Institute for Allergy and Immunology; La Jolla San Diego CA USA
| | - A. Sette
- La Jolla Institute for Allergy and Immunology; La Jolla San Diego CA USA
| | - M. Pirmohamed
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - B. K. Park
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| | - D. J. Naisbitt
- Department of Molecular and Clinical Pharmacology; MRC Centre for Drug Safety Science; University of Liverpool; Liverpool UK
| |
Collapse
|
26
|
Faulkner L, Dooley M, Eddie L, Vikram R. Relationships Between Mobility Test Components and Activity Performance of Older Adults. Am J Occup Ther 2015. [DOI: 10.5014/ajot.2015.69s1-po6094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/18/2015
The Timed Up and Go Components (TUGc) test may accurately illustrate activities of daily living (ADLs) participation and restriction in active community-dwelling older adults. Three mobility components were moderately correlated to three different ADLs. Age does not appear to be a factor. Testing mobility components may enhance practice.
Collapse
|
27
|
Agarwal RK, Sedai A, Dhimal S, Ankita K, Clemente L, Siddique S, Yaqub N, Khalid S, Itrat F, Khan A, Gilani SK, Marwah P, Soni R, Missiry ME, Hussain MH, Uderzo C, Faulkner L. A prospective international cooperative information technology platform built using open-source tools for improving the access to and safety of bone marrow transplantation in low- and middle-income countries. J Am Med Inform Assoc 2014; 21:1125-8. [PMID: 24714444 PMCID: PMC4215046 DOI: 10.1136/amiajnl-2013-002594] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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] [Indexed: 11/15/2022] Open
Abstract
Jagriti Innovations developed a collaboration tool in partnership with the Cure2Children Foundation that has been used by health professionals in Italy, Pakistan, and India for the collaborative management of patients undergoing bone marrow transplantation (BMT) for thalassemia major since August 2008. This online open-access database covers data recording, analyzing, and reporting besides enabling knowledge exchange, telemedicine, capacity building, and quality assurance. As of February 2014, over 2400 patients have been registered and 112 BMTs have been performed with outcomes comparable to international standards, but at a fraction of the cost. This approach avoids medical emigration and contributes to local healthcare strengthening and competitiveness. This paper presents the experience and clinical outcomes associated with the use of this platform built using open-source tools and focusing on a locally pertinent tertiary care procedure—BMT.
Collapse
Affiliation(s)
| | - Amit Sedai
- Jagriti Innovations, Bangalore, Karnataka, India
| | - Sunil Dhimal
- Jagriti Innovations, Bangalore, Karnataka, India
| | | | | | | | - Naila Yaqub
- Children's Hospital Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Sadaf Khalid
- Children's Hospital Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Fatima Itrat
- Children's Hospital Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Anwar Khan
- Children's Hospital Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Sarah Khan Gilani
- Children's Hospital Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Priya Marwah
- South East Asia Institute for Thalassemia, Jaipur, Rajasthan, India
| | - Rajpreet Soni
- South East Asia Institute for Thalassemia, Jaipur, Rajasthan, India
| | | | | | | | | |
Collapse
|
28
|
Yaqub N, Khalid S, Itrat F, Khan A, Gilani SK, Missiry ME, Hussain MH, Uderzo C, Faulkner L. Second BMT for thalassemia major using CY post transplant. Bone Marrow Transplant 2014; 49:845-6. [PMID: 24614842 DOI: 10.1038/bmt.2014.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- N Yaqub
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - S Khalid
- Cure2Children Foundation, Florence, Italy
| | - F Itrat
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - A Khan
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - S K Gilani
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | | | | | - C Uderzo
- Cure2Children Foundation, Florence, Italy
| | - L Faulkner
- Cure2Children Foundation, Florence, Italy
| |
Collapse
|
29
|
Hussein MH, El Missiry M, Khalid S, Yaqub N, Gilani SK, Fatima I, Zara T, Marwah P, Soni R, Bernard F, Manna A, Uderzo C, Faulkner L. Bone Marrow Transplantation for Thalassemia: A Global Perspective. Thalassemia Reports 2013. [DOI: 10.4081/thal.2013.s1.e42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Even though severe thalassemia is a preventable disease, over 100,000 new cases are born yearly, particularly in the Middle East and South-East Asia. Most of these children may not reach adulthood because long-term appropriate supportive care is either inaccessible or unaffordable. Bone marrow transplantation (BMT) remains the only available definitive cure and success rates can be very high in appropriately selected patients, i.e. low-risk younger children with a matched family donor. In these circumstances BMT may be justified medically, ethically as well as financially, in fact, the cost of low-risk BMT is equivalent to that of a few years of non-curative supportive. This manuscript will briefly review the current status of bone marrow transplantation for thalassemia major with particular emphasis on a global prospective and present the experience of the Cure2Children Foundation supporting sustainable and scalable start up BMT programs in low-resource settings. The initial twelve consecutive patients managed in two start up BMT units in Pakistan (Children’s Hospital of the Pakistan Institute of Medical Sciences, Islamabad) and India (South East Asia Institute for Thalassemia, Jaipur) were included in this analysis. These initial six patients per each institution where purposely chosen as the focus of this report because they represent the steepest phase of the learning curve. The median age at transplant was 3.9 years, range 0.9 to 6.0, liver was no greater than 2 cm from costal margin, and all received matched related BMT. A structured on-site focused training program as well as ongoing intensive on-line cooperation was provided by the Cure2Children team of professionals. At a median follow-up of 7.5 months (range 3.5 to 33.5 months) both thalassemia-free and overall survival are 92%, one patient died of encephalitis-meningitis of unknown cause. No rejections where observed. Neutrophil recovery occurred at a median of 15.5 days (range 13-25) and platelet recovery at 18 days (range 12-27). Toxicities included, fever and neutropenia (10 patients), CMV reactivation (9 patients), acute GVHD grade 3 or less (4 patients), hypertension (4 patients), mild mucositis (3 patients), bacterial sepsis (1 patient). Median number of transfusions was 2 for red cells (range 0 to 7) and 5 for platelet transfusions (range 1 to 18). Median post-BMT hospital stay was 49 days (range 33 to 109). No patients developed significant chronic GVHD, one had a suspicion of malaria 8 months post-BMT and one of tuberculosis 11 months post-BMT, both where treated empirically and are doing well. The mean cost of a BMT and follow-up was around 10.164€ (8.952€ in Pakistan and 11.377€ in India), range 5.618€ to 14.604€. In low resource settings matched-related low-risk BMT for thalassemia can be performed with outcomes comparable to richer countries and with a fraction of the costs even from the very beginning of newly developed BMT units and by relatively untrained personnel provided a structured and intensive cooperation program with BMT experts is provided. This observation may have important implications to increase access to cure thalassemia major worldwide and for the startup of new BMT services in low- to middle income countries.
Collapse
|
30
|
Faulkner L, Yaqub N, Khalid SK, Zhara T, Ansari S, Farzana T, Shamsi T. Transplantation in Low Resource Countries. Thalassemia Reports 2011. [DOI: 10.4081/thal.2011.s2.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thalassemia major (TM) is the most common deadly genetic disorder, a major cause of chronic non-infectious morbidity and financial burden in many low and middle-income regions. In these settings few children reach adulthood because proper long-term supportive care is seldom available. Bone marrow transplantation (BMT) is the only available curative modality and it can be very successful and cost-effective for young children with low-risk features and a compatible related donor. However, in countries where TM is most prevalent, there is a dire shortage of BMT centers. The Cure2Children Foundation has supported a feasibility study evaluating safety, efficacy and costs of developing a new BMT center in an underserved lower-middle-income country with relatively untrained professionals within a structured collaboration and knowledge-transfer program. A total of 24 consecutive patients who underwent BMT in Pakistan between September 2008 and August 2010 are included in this prospective analysis, 17 from an established bone marrow transplant center, the National Institute for Blood Diseases in Karachi, Pakistan and the initial 7 BMTs from a start up unit in a government civil hospital, the Pakistan Institute of Medical Sciences Children’s Hospital in Islamabad. Patients were matched for age, nutritional status, growth, disease, disease status and post-BMT follow-up time. All patients had a matched-related sibling donor, were younger than 10 years of age at the time of transplantation, received the same conditioning regimen. All needy families could rely on a support program throughout the 8-month post-transplant period. The Cure2Children Foundation provided professional and financial support as well as a structured web-based data management and cooperation platform. At a median follow up of 19.6 months (range 8.7 to 31.5) actuarial thalassemia-free survival is 85.6% and 85.7% and overall survival 94.1% and 85.7% in the established and start-up center respectively with no statistically significant differences. Other outcome indices like infectious complications, engraftment parameters, transplant-related complications, and post-BMT performance scores also did not differ. The median cost of matched-related transplants in the start-up center, including pre-BMT evaluation, was 11,513 USD (range 7518 to 21,176). Within structured cooperation strategies bone marrow transplantation for thalassemia major can be performed safely, effectively, and affordably even in start-up centers in lower-middleincome countries, like Pakistan, were most thalassemia patients live. This observation may have important implications to increase access to cure for thalassemia worldwide.
Collapse
|
31
|
Corrias MV, Parodi S, Haupt R, Lacitignola L, Negri F, Sementa AR, Dau D, Scuderi F, Carlini B, Bianchi M, Casale F, Faulkner L, Garaventa A. Detection of GD2-positive cells in bone marrow samples and survival of patients with localised neuroblastoma. Br J Cancer 2008; 98:263-9. [PMID: 18182983 PMCID: PMC2361437 DOI: 10.1038/sj.bjc.6604179] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The impact of bone marrow (BM) GD2-positive cells on survival has been evaluated in 145 Italian children with localised neuroblastoma (NB) evaluated at diagnosis by anti-GD2 immunocytochemistry. Nineteen of these (13.1%) were found to be BM GD2-positive, with the number of positive cells ranging between 1 and 155 out of 1 × 106 total cells analysed. Seven/19 (38.8%) GD2-positive vs 12/126 (9.5%) GD2-negative patients relapsed. The 5-year event-free survival (EFS) and overall survival of the GD2-positive patients was significantly worse than that of the GD2-negative ones (62.2 vs 89.9%, P<0.001; and 74.9 vs 95.9%, P=0.005, respectively). GD2 positivity was not associated to other known risk factors, and in particular to Myc-N amplification and 1p deletion. Among Myc-N-negative patients, the EFS of those negative for both GD2 and 1p deletion was significantly better than in children positive for either one of these two markers (EFS=96.9 vs 66.0%, P<0.001). In conclusion, GD2 positivity may represent a prognostic marker for patients with non-metastatic NB without Myc-N amplification, and its combination with genetic alterations might help identifying patients that require a more careful follow-up.
Collapse
Affiliation(s)
- M V Corrias
- Department of Experimental and Laboratory Medicine, Laboratory of Oncology, Gaslini Institute, Largo Gaslini, 5, Genoa 16147, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Iannalfi A, Bambi F, Tintori V, Lacitignola L, Bernini G, Mariani MP, Sanvito MC, Pagliai F, Brandigi F, Muscarella E, Tapinassi F, Faulkner L. Peripheral blood progenitor uncontrolled-rate freezing: a single pediatric center experience. Transfusion 2007; 47:2202-6. [PMID: 17714421 DOI: 10.1111/j.1537-2995.2007.01447.x] [Citation(s) in RCA: 5] [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: 11/29/2022]
Abstract
BACKGROUND Controlled-rate freezing (CRF) followed by storage in liquid nitrogen is employed by most centers as the standard procedure for peripheral blood progenitor cell (PBPC) cryopreservation. Uncontrolled-rate freezing (URF) at -80 degrees C is more simple, time-saving, less expensive, and, possibly, as effective as CRF. The aim of this retrospective analysis was to compare CRF and URF in childhood transplantation. STUDY DESIGN AND METHODS A total of 54 PBPC transplants performed in 39 children aged 3 to 16 years (median, 9.5 years) were analyzed: 23 transplants in 16 children with CRF versus 31 transplants performed in 23 children with -80 degrees C URF. All grafts contained at least 2 x 10(6) per kg unselected CD34+ cells, enumerated before freezing. Nucleated cells infused ranged from 1.32 x 10(8) to 4.3 x 10(8) per mL with a median of 3.1 x 10(8) per mL. Cryoprotectant solution consisted of a final dimethyl sulfoxide (DMSO) concentration of 10 percent DMSO with autologous plasma. RESULTS The two study groups did not differ in terms of timing of neutrophil and platelet recovery or transfusion requirements. Adverse events related to graft infusion, severe complications, and transplant-related mortality were not significantly different between CRF and URF groups. In both groups only mild adverse events were observed during graft administration. URF procedures, however, were simpler and less expensive. At a median follow-up of 72 months, no secondary myelodysplasia was observed in either group. CONCLUSION Our analysis suggests that URF is safe and effective in the pediatric population.
Collapse
Affiliation(s)
- Alberto Iannalfi
- Stem Cell Transplantation Unit, Department of Hematology-Oncology, A. Meyer Pediatric Hospital, University of Florence, Florence, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Jayne D, Passweg J, Marmont A, Farge D, Zhao X, Arnold R, Hiepe F, Lisukov I, Musso M, Ou-Yang J, Marsh J, Wulffraat N, Besalduch J, Bingham SJ, Emery P, Brune M, Fassas A, Faulkner L, Ferster A, Fiehn C, Fouillard L, Geromin A, Greinix H, Rabusin M, Saccardi R, Schneider P, Zintl F, Gratwohl A, Tyndall A. Autologous stem cell transplantation for systemic lupus erythematosus. Lupus 2004; 13:168-76. [PMID: 15119545 DOI: 10.1191/0961203304lu525oa] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.1] [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: 12/11/2022]
Abstract
Systemic lupus erythematosus (SLE) is responsive to treatment with immunosuppressives and steroids, but often pursues a relapsing or refractory course resulting in increasing incapacity and reduced survival. Autologous stem cell transplantation (ASCT) following immunoablative chemotherapy is a newer therapy for autoimmune disease of potential use in severe SLE. A retrospective registry survey was carried out by the European Blood and Marrow Transplant and European League Against Rheumatism (EBMT/EULAR) registry. Data was collected from 53 patients with SLE treated by ASCT in 23 centres. Disease duration before ASCT was 59 (2-155) months (median, range), 44 (83%) were female, and median age was 29 (9-52) years. At the time of ASCT a median of seven American College of Rheumatology (ACR) diagnostic criteria for SLE were present (range 2-10) and 33 (62%) had nephritis. Peripheral blood stem cells were mobilized with cyclophosphamide and granulocyte colony stimulating factor in 93% of cases. Ex vivo CD34 stem cell selection was performed in 42% of patients. Conditioning regimens employed cyclophosphamide in 84%, anti-thymocyte globulin in 76% and lymphoid irradiation in 22%. The mean duration of follow-up after ASCT was 26 (0-78) months. Remission of disease activity (SLEDAI < 3) was seen in 33/50 (66%; 95%CI 52-80) evaluable patients by six months, of which 10/31 (32%; 95%CI 15-50) subsequently relapsed after six (3-40) months. Relapse was associated with negative anti-double stranded DNA (anti-dsDNA) antibodies before ASCT (P = 0.007). There were 12 deaths after 1.5 (0-48) months, of which seven (12%; 95%CI 3-21) were related to the procedure. Mortality was associated with a longer disease course before ASCT (P = 0.036). In conclusion, this registry study demonstrates the efficacy of ASCT for remission induction of refractory SLE, although mortality appeared high. The safety of this procedure is likely to be improved by patient selection and choice of conditioning regimen. The return of disease activity in one-third of patients might be reduced by long-term immunosuppressive therapy post-ASCT.
Collapse
Affiliation(s)
- David Jayne
- Department of Medicine, Addenbrooke's Hospital, Cambridge, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Humphray SJ, Oliver K, Hunt AR, Plumb RW, Loveland JE, Howe KL, Andrews TD, Searle S, Hunt SE, Scott CE, Jones MC, Ainscough R, Almeida JP, Ambrose KD, Ashwell RIS, Babbage AK, Babbage S, Bagguley CL, Bailey J, Banerjee R, Barker DJ, Barlow KF, Bates K, Beasley H, Beasley O, Bird CP, Bray-Allen S, Brown AJ, Brown JY, Burford D, Burrill W, Burton J, Carder C, Carter NP, Chapman JC, Chen Y, Clarke G, Clark SY, Clee CM, Clegg S, Collier RE, Corby N, Crosier M, Cummings AT, Davies J, Dhami P, Dunn M, Dutta I, Dyer LW, Earthrowl ME, Faulkner L, Fleming CJ, Frankish A, Frankland JA, French L, Fricker DG, Garner P, Garnett J, Ghori J, Gilbert JGR, Glison C, Grafham DV, Gribble S, Griffiths C, Griffiths-Jones S, Grocock R, Guy J, Hall RE, Hammond S, Harley JL, Harrison ESI, Hart EA, Heath PD, Henderson CD, Hopkins BL, Howard PJ, Howden PJ, Huckle E, Johnson C, Johnson D, Joy AA, Kay M, Keenan S, Kershaw JK, Kimberley AM, King A, Knights A, Laird GK, Langford C, Lawlor S, Leongamornlert DA, Leversha M, Lloyd C, Lloyd DM, Lovell J, Martin S, Mashreghi-Mohammadi M, Matthews L, McLaren S, McLay KE, McMurray A, Milne S, Nickerson T, Nisbett J, Nordsiek G, Pearce AV, Peck AI, Porter KM, Pandian R, Pelan S, Phillimore B, Povey S, Ramsey Y, Rand V, Scharfe M, Sehra HK, Shownkeen R, Sims SK, Skuce CD, Smith M, Steward CA, Swarbreck D, Sycamore N, Tester J, Thorpe A, Tracey A, Tromans A, Thomas DW, Wall M, Wallis JM, West AP, Whitehead SL, Willey DL, Williams SA, Wilming L, Wray PW, Young L, Ashurst JL, Coulson A, Blöcker H, Durbin R, Sulston JE, Hubbard T, Jackson MJ, Bentley DR, Beck S, Rogers J, Dunham I. DNA sequence and analysis of human chromosome 9. Nature 2004; 429:369-74. [PMID: 15164053 PMCID: PMC2734081 DOI: 10.1038/nature02465] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [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: 12/22/2003] [Accepted: 03/08/2004] [Indexed: 11/09/2022]
Abstract
Chromosome 9 is highly structurally polymorphic. It contains the largest autosomal block of heterochromatin, which is heteromorphic in 6-8% of humans, whereas pericentric inversions occur in more than 1% of the population. The finished euchromatic sequence of chromosome 9 comprises 109,044,351 base pairs and represents >99.6% of the region. Analysis of the sequence reveals many intra- and interchromosomal duplications, including segmental duplications adjacent to both the centromere and the large heterochromatic block. We have annotated 1,149 genes, including genes implicated in male-to-female sex reversal, cancer and neurodegenerative disease, and 426 pseudogenes. The chromosome contains the largest interferon gene cluster in the human genome. There is also a region of exceptionally high gene and G + C content including genes paralogous to those in the major histocompatibility complex. We have also detected recently duplicated genes that exhibit different rates of sequence divergence, presumably reflecting natural selection.
Collapse
Affiliation(s)
- S J Humphray
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Deloukas P, Earthrowl ME, Grafham DV, Rubenfield M, French L, Steward CA, Sims SK, Jones MC, Searle S, Scott C, Howe K, Hunt SE, Andrews TD, Gilbert JGR, Swarbreck D, Ashurst JL, Taylor A, Battles J, Bird CP, Ainscough R, Almeida JP, Ashwell RIS, Ambrose KD, Babbage AK, Bagguley CL, Bailey J, Banerjee R, Bates K, Beasley H, Bray-Allen S, Brown AJ, Brown JY, Burford DC, Burrill W, Burton J, Cahill P, Camire D, Carter NP, Chapman JC, Clark SY, Clarke G, Clee CM, Clegg S, Corby N, Coulson A, Dhami P, Dutta I, Dunn M, Faulkner L, Frankish A, Frankland JA, Garner P, Garnett J, Gribble S, Griffiths C, Grocock R, Gustafson E, Hammond S, Harley JL, Hart E, Heath PD, Ho TP, Hopkins B, Horne J, Howden PJ, Huckle E, Hynds C, Johnson C, Johnson D, Kana A, Kay M, Kimberley AM, Kershaw JK, Kokkinaki M, Laird GK, Lawlor S, Lee HM, Leongamornlert DA, Laird G, Lloyd C, Lloyd DM, Loveland J, Lovell J, McLaren S, McLay KE, McMurray A, Mashreghi-Mohammadi M, Matthews L, Milne S, Nickerson T, Nguyen M, Overton-Larty E, Palmer SA, Pearce AV, Peck AI, Pelan S, Phillimore B, Porter K, Rice CM, Rogosin A, Ross MT, Sarafidou T, Sehra HK, Shownkeen R, Skuce CD, Smith M, Standring L, Sycamore N, Tester J, Thorpe A, Torcasso W, Tracey A, Tromans A, Tsolas J, Wall M, Walsh J, Wang H, Weinstock K, West AP, Willey DL, Whitehead SL, Wilming L, Wray PW, Young L, Chen Y, Lovering RC, Moschonas NK, Siebert R, Fechtel K, Bentley D, Durbin R, Hubbard T, Doucette-Stamm L, Beck S, Smith DR, Rogers J. The DNA sequence and comparative analysis of human chromosome 10. Nature 2004; 429:375-81. [PMID: 15164054 DOI: 10.1038/nature02462] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [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: 12/17/2003] [Accepted: 03/09/2004] [Indexed: 11/08/2022]
Abstract
The finished sequence of human chromosome 10 comprises a total of 131,666,441 base pairs. It represents 99.4% of the euchromatic DNA and includes one megabase of heterochromatic sequence within the pericentromeric region of the short and long arm of the chromosome. Sequence annotation revealed 1,357 genes, of which 816 are protein coding, and 430 are pseudogenes. We observed widespread occurrence of overlapping coding genes (either strand) and identified 67 antisense transcripts. Our analysis suggests that both inter- and intrachromosomal segmental duplications have impacted on the gene count on chromosome 10. Multispecies comparative analysis indicated that we can readily annotate the protein-coding genes with current resources. We estimate that over 95% of all coding exons were identified in this study. Assessment of single base changes between the human chromosome 10 and chimpanzee sequence revealed nonsense mutations in only 21 coding genes with respect to the human sequence.
Collapse
Affiliation(s)
- P Deloukas
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Dunham A, Matthews LH, Burton J, Ashurst JL, Howe KL, Ashcroft KJ, Beare DM, Burford DC, Hunt SE, Griffiths-Jones S, Jones MC, Keenan SJ, Oliver K, Scott CE, Ainscough R, Almeida JP, Ambrose KD, Andrews DT, Ashwell RIS, Babbage AK, Bagguley CL, Bailey J, Bannerjee R, Barlow KF, Bates K, Beasley H, Bird CP, Bray-Allen S, Brown AJ, Brown JY, Burrill W, Carder C, Carter NP, Chapman JC, Clamp ME, Clark SY, Clarke G, Clee CM, Clegg SCM, Cobley V, Collins JE, Corby N, Coville GJ, Deloukas P, Dhami P, Dunham I, Dunn M, Earthrowl ME, Ellington AG, Faulkner L, Frankish AG, Frankland J, French L, Garner P, Garnett J, Gilbert JGR, Gilson CJ, Ghori J, Grafham DV, Gribble SM, Griffiths C, Hall RE, Hammond S, Harley JL, Hart EA, Heath PD, Howden PJ, Huckle EJ, Hunt PJ, Hunt AR, Johnson C, Johnson D, Kay M, Kimberley AM, King A, Laird GK, Langford CJ, Lawlor S, Leongamornlert DA, Lloyd DM, Lloyd C, Loveland JE, Lovell J, Martin S, Mashreghi-Mohammadi M, McLaren SJ, McMurray A, Milne S, Moore MJF, Nickerson T, Palmer SA, Pearce AV, Peck AI, Pelan S, Phillimore B, Porter KM, Rice CM, Searle S, Sehra HK, Shownkeen R, Skuce CD, Smith M, Steward CA, Sycamore N, Tester J, Thomas DW, Tracey A, Tromans A, Tubby B, Wall M, Wallis JM, West AP, Whitehead SL, Willey DL, Wilming L, Wray PW, Wright MW, Young L, Coulson A, Durbin R, Hubbard T, Sulston JE, Beck S, Bentley DR, Rogers J, Ross MT. The DNA sequence and analysis of human chromosome 13. Nature 2004; 428:522-8. [PMID: 15057823 PMCID: PMC2665288 DOI: 10.1038/nature02379] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Accepted: 01/27/2004] [Indexed: 12/14/2022]
Abstract
Chromosome 13 is the largest acrocentric human chromosome. It carries genes involved in cancer including the breast cancer type 2 (BRCA2) and retinoblastoma (RB1) genes, is frequently rearranged in B-cell chronic lymphocytic leukaemia, and contains the DAOA locus associated with bipolar disorder and schizophrenia. We describe completion and analysis of 95.5 megabases (Mb) of sequence from chromosome 13, which contains 633 genes and 296 pseudogenes. We estimate that more than 95.4% of the protein-coding genes of this chromosome have been identified, on the basis of comparison with other vertebrate genome sequences. Additionally, 105 putative non-coding RNA genes were found. Chromosome 13 has one of the lowest gene densities (6.5 genes per Mb) among human chromosomes, and contains a central region of 38 Mb where the gene density drops to only 3.1 genes per Mb.
Collapse
Affiliation(s)
- A Dunham
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, CB10 1SA, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Forster R, Faulkner L. Correction. Electrochemistry of Spontaneously Adsorbed Monolayers. Equilibrium Properties and Fundamental Electron Transfer Characteristics. J Am Chem Soc 2004. [DOI: 10.1021/ja00099a602] [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: 11/28/2022]
|
38
|
Mungall AJ, Palmer SA, Sims SK, Edwards CA, Ashurst JL, Wilming L, Jones MC, Horton R, Hunt SE, Scott CE, Gilbert JGR, Clamp ME, Bethel G, Milne S, Ainscough R, Almeida JP, Ambrose KD, Andrews TD, Ashwell RIS, Babbage AK, Bagguley CL, Bailey J, Banerjee R, Barker DJ, Barlow KF, Bates K, Beare DM, Beasley H, Beasley O, Bird CP, Blakey S, Bray-Allen S, Brook J, Brown AJ, Brown JY, Burford DC, Burrill W, Burton J, Carder C, Carter NP, Chapman JC, Clark SY, Clark G, Clee CM, Clegg S, Cobley V, Collier RE, Collins JE, Colman LK, Corby NR, Coville GJ, Culley KM, Dhami P, Davies J, Dunn M, Earthrowl ME, Ellington AE, Evans KA, Faulkner L, Francis MD, Frankish A, Frankland J, French L, Garner P, Garnett J, Ghori MJR, Gilby LM, Gillson CJ, Glithero RJ, Grafham DV, Grant M, Gribble S, Griffiths C, Griffiths M, Hall R, Halls KS, Hammond S, Harley JL, Hart EA, Heath PD, Heathcott R, Holmes SJ, Howden PJ, Howe KL, Howell GR, Huckle E, Humphray SJ, Humphries MD, Hunt AR, Johnson CM, Joy AA, Kay M, Keenan SJ, Kimberley AM, King A, Laird GK, Langford C, Lawlor S, Leongamornlert DA, Leversha M, Lloyd CR, Lloyd DM, Loveland JE, Lovell J, Martin S, Mashreghi-Mohammadi M, Maslen GL, Matthews L, McCann OT, McLaren SJ, McLay K, McMurray A, Moore MJF, Mullikin JC, Niblett D, Nickerson T, Novik KL, Oliver K, Overton-Larty EK, Parker A, Patel R, Pearce AV, Peck AI, Phillimore B, Phillips S, Plumb RW, Porter KM, Ramsey Y, Ranby SA, Rice CM, Ross MT, Searle SM, Sehra HK, Sheridan E, Skuce CD, Smith S, Smith M, Spraggon L, Squares SL, Steward CA, Sycamore N, Tamlyn-Hall G, Tester J, Theaker AJ, Thomas DW, Thorpe A, Tracey A, Tromans A, Tubby B, Wall M, Wallis JM, West AP, White SS, Whitehead SL, Whittaker H, Wild A, Willey DJ, Wilmer TE, Wood JM, Wray PW, Wyatt JC, Young L, Younger RM, Bentley DR, Coulson A, Durbin R, Hubbard T, Sulston JE, Dunham I, Rogers J, Beck S. The DNA sequence and analysis of human chromosome 6. Nature 2003; 425:805-11. [PMID: 14574404 DOI: 10.1038/nature02055] [Citation(s) in RCA: 235] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2003] [Accepted: 09/11/2003] [Indexed: 01/17/2023]
Abstract
Chromosome 6 is a metacentric chromosome that constitutes about 6% of the human genome. The finished sequence comprises 166,880,988 base pairs, representing the largest chromosome sequenced so far. The entire sequence has been subjected to high-quality manual annotation, resulting in the evidence-supported identification of 1,557 genes and 633 pseudogenes. Here we report that at least 96% of the protein-coding genes have been identified, as assessed by multi-species comparative sequence analysis, and provide evidence for the presence of further, otherwise unsupported exons/genes. Among these are genes directly implicated in cancer, schizophrenia, autoimmunity and many other diseases. Chromosome 6 harbours the largest transfer RNA gene cluster in the genome; we show that this cluster co-localizes with a region of high transcriptional activity. Within the essential immune loci of the major histocompatibility complex, we find HLA-B to be the most polymorphic gene on chromosome 6 and in the human genome.
Collapse
Affiliation(s)
- A J Mungall
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Faulkner L, Buchan G, Slobbe L, Lockhart E, Wales J, Wilson M, Baird M. Influenza hemagglutinin peptides fused to interferon gamma and encapsulated in liposomes protects mice against influenza infection. Vaccine 2003; 21:932-9. [PMID: 12547605 DOI: 10.1016/s0264-410x(02)00543-1] [Citation(s) in RCA: 17] [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: 10/27/2022]
Abstract
The immunogenicity of a peptide vaccine may be improved by fusing antigen to a cytokine and administering this chimeric protein in a particulate delivery system. We have investigated this using a vaccine comprising an immunodominant T cell epitope and a B cell epitope from influenza haemagglutinin (HATB) fused to interferon gamma and encapsulated in liposomes (HATB/IFN-gamma/lipo). Controls comprised groups receiving HATB/IFN-gamma mixed with liposomes, HATB incorporated in liposomes or heat inactivated PR8 influenza virus (HI PR8). IFN-gamma production in mice treated with HATB/IFN-gamma/lipo was significantly higher than in mice inoculated with either HATB/IFN-gamma mixed with liposomes or HATB incorporated in liposomes but less than HI PR8. Lung viral titres were significantly lower in mice treated with HATB/IFN-gamma/lipo compared with those treated with HATB/IFN-gamma mixed with liposomes. HI PR8-treated mice recorded a nil viral titre. There was no correlation between the level of antibody production and clearance of virus from the lungs. These data suggest that particulate delivery systems may be useful adjuncts to improve immune responses to chimeric proteins and to induce protection against disease.
Collapse
Affiliation(s)
- L Faulkner
- Department of Microbiology, University of Otago, PO Box 56, Dunedin, New Zealand
| | | | | | | | | | | | | |
Collapse
|
40
|
Girvan A, Aldwell FE, Buchan GS, Faulkner L, Baird MA. Transfer of macrophage-derived mycobacterial antigens to dendritic cells can induce naïve T-cell activation. Scand J Immunol 2003; 57:107-14. [PMID: 12588656 DOI: 10.1046/j.1365-3083.2003.01191.x] [Citation(s) in RCA: 15] [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: 11/20/2022]
Abstract
Mycobacteria are capable of surviving and replicating in host macrophages, where they can release antigenic material into the environment. However, unlike dendritic cells (DCs), macrophages do not appear to be capable of activating naïve T cells. Therefore, this work investigated antigen transfer between macrophages and DCs. We generated culture supernatants from bacille Calmette-Guérin (BCG)-infected and uninfected macrophages and then determined whether DCs could present these extracellular mycobacterial antigens to T cells. Here, we show that DCs pulsed with antigens released from BCG-infected macrophages can stimulate primed T cells in vitro and initiate naïve T-cell responses in vivo. These results suggest that antigen transfer can occur between macrophages and DCs.
Collapse
Affiliation(s)
- A Girvan
- Department of Microbiology, University of Otago, Dunedin, New Zealand
| | | | | | | | | |
Collapse
|
41
|
Sardi I, Tintori V, Marchi C, Veltroni M, Lippi A, Tucci F, Tamburini A, Bernini G, Faulkner L. Molecular profiling of high-risk neuroblastoma by cDNA array. Int J Mol Med 2002; 9:541-5. [PMID: 11956663] [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: 02/24/2023] Open
Abstract
The aim of this study was to investigate gene expression changes in disseminated neuroblastoma by cDNA array technique. Three stage IV neuroblastomas and one neuroblastoma cell line (SK-N-FI) were analyzed. Expression profiles were confirmed by semiquantitative RT-PCR and in some instances by Northern blotting. Comparison of expression profiles identified several genes which were highly expressed as well as some which were down-regulated in tumor samples relatively to SK-N-FI cells. The tumors studied lacked N-myc overexpression, while showing up-regulation of basic transcription factors, growth factors and receptors such as NSEP, c-myc binding protein MM1, thymosin beta10 (TMSB10), TNF-R superfamily member 10A (TNFRSF10A) and FZ9. These results suggest that cDNA array technology is a powerful tool to identify a set of genes involved in neuroblastoma genesis and progression. Thus, the sensitive cDNA array may provide new insight into many aspects of pediatric tumors and play crucial role in the administration of adjuvant therapy of patients with neuroblastoma.
Collapse
Affiliation(s)
- Iacopo Sardi
- Unita di Oncoematologia, Ospedale Pediatrico A. Meyer, via L. Giordano 13, 50132 Florence, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Sardi I, Tintori V, Marchi C, Veltroni M, Lippi A, Tucci F, Tamburini A, Bernini G, Faulkner L. Molecular profiling of high-risk neuroblastoma by cDNA array. Int J Mol Med 2002. [DOI: 10.3892/ijmm.9.5.541] [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: 11/05/2022] Open
|
43
|
Faulkner L, Buchan G, Lockhart E, Slobbe L, Wilson M, Baird M. IL-2 linked to a peptide from influenza hemagglutinin enhances T cell activation by affecting the antigen-presentation function of bone marrow-derived dendritic cells. Int Immunol 2001; 13:713-21. [PMID: 11369698 DOI: 10.1093/intimm/13.6.713] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/13/2022] Open
Abstract
Chimeric proteins containing antigen linked to cytokines have shown some promise as vaccine candidates but little is known of their mechanism of action, particularly at the level of the antigen-presenting cell. We have investigated this using a chimeric protein in which an immunodominant T cell epitope from influenza hemagglutinin peptide (HA), recognized in the context of I-E(d), was fused to IL-2. Immature murine dendritic cells (DC) derived from bone marrow (BMDC) were used to present the chimeric protein to a T cell hybridoma with TCR specific for the HA peptide (A5 cell line). HA-IL-2 was found to induce significantly higher T cell activation than HA alone. Although the inclusion of IL-2 and HA separately did increase the response of A5 cells compared to HA alone, they were not as effective as the HA-IL-2 chimeric protein. When an antibody known to block IL-2 receptor alpha chain (CD25) was included, A5 activation was reduced, suggesting a role for the receptor in this process. Expression of CD25 on A5 cells was low during activation, implying that the effect was mediated by CD25(+) BMDC. Antigen uptake and processing of HA-IL-2 by BMDC was required since fixing BMDC, prior to antigen exposure, greatly reduced their ability to activate A5 cells. The function of CD25 on DC is currently unknown. Our results suggest this receptor may play a role in antigen uptake and subsequent T cell activation by receptor-mediated endocytosis of antigen attached to IL-2. This finding that may have implications for the development of a new generation of vaccines.
Collapse
Affiliation(s)
- L Faulkner
- Department of Microbiology, University of Otago, PO Box 56, Dunedin, New Zealand
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
The Geminiviridae is an extensive family of plant viruses responsible for economically devastating diseases in crops worldwide. Geminiviruses package circular, single-stranded DNA (ssDNA) genomes. The characteristic twinned or "geminate" particles, which consist of two joined, incomplete T = 1 icosahedra, are unique among viruses. We have determined the first structure of a geminivirus particle, the Nigerian strain of Maize streak virus (MSV-N), using cryo-electron microscopy and three-dimensional image reconstruction methods. The particle, of dimensions 220 x 380 A, has an overall 52-point-group symmetry, in which each half particle "head" consists of the coat protein (CP) arranged with quasi-icosahedral symmetry. We have modeled the MSV-N CP as an eight-stranded, antiparallel beta-barrel motif (a structural motif common to all known ssDNA viruses) with an N-terminal alpha-helix. This has produced a model of the geminate particle in which 110 copies of the CP nicely fit into the reconstructed density map. The reconstructed density map and MSV-N pseudo-atomic model demonstrate that the geminate particle has a stable, defined structure.
Collapse
Affiliation(s)
- W Zhang
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana 47907-1392, USA
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Live, attenuated vaccines currently offer the best protection against virulent pathogens. Recent advances in Immunology and Molecular Biology provide an opportunity to design vaccines that will be more effective and safer than existing ones. Immunologists are rapidly developing the capacity to identify and construct the minimal immunogenic units from pathogens. The molecular signals required to fully activate antigen presenting cells (APCs) and responder T cells are becoming apparent. Improved vaccine delivery systems are being designed which will mimic the actions of pathogens in vivo. These vaccines will incorporate protective epitopes fused to immunoregulatory cytokines in chimeric proteins. They will be encapsulated in formulations which allow for the slow release of these chimeric proteins thereby inducing the memory T cells required for long-lived immunity. These vaccine formulations will target receptors present on the most active APCs. Here we discuss how these advances will allow us to rationally construct "virtual pathogens" which will provide improved protection against new and old microbial foes.
Collapse
Affiliation(s)
- G S Buchan
- Department of Microbiology, University of Otago School of Medical Sciences, P.O. Box 56, Dunedin, New Zealand.
| | | | | | | | | | | | | |
Collapse
|
46
|
Faulkner L, Buchan G, Baird M. Interleukin-10 does not affect phagocytosis of particulate antigen by bone marrow-derived dendritic cells but does impair antigen presentation. Immunology 2000; 99:523-31. [PMID: 10792499 PMCID: PMC2327185 DOI: 10.1046/j.1365-2567.2000.00018.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [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: 11/20/2022] Open
Abstract
Dendritic cells (DC) are important initiators of an immune response so understanding the factors controlling antigen acquisition and presentation has important consequences for the use of these cells in vaccines and other forms of immunotherapy. We investigated the factors that influence phagocytosis by immature bone marrow-derived DC (BMDC) and the effect of interleukin-10 (IL-10) on this process. Two sizes of fluorescent particles and recombinant bacillus Calmette-Guèrin expressing the green fluorescent protein (rBCG) were used as particulate antigens. The percentage of cells taking up the antigen was found to be dependent on the size and dose of the particles, and the length of exposure to them. BMDC exposed to IL-10 at various concentrations for different periods exhibited no distinguishable change in antigen uptake. However, if BMDC treated with IL-10 and rBCG were then exposed to a second dose of particulate antigen, uptake was increased compared with those BMDC not treated with IL-10. The expression of major histocompatibility complex class II, CD80, CD86 and CD11c by BMDC after phagocytosing rBCG or inert beads, was inhibited when the BMDC were pretreated with IL-10. In contrast, the expression of CD25 was increased. BMDC that had taken up BCG or purified protein derivative (PPD) were able to stimulate primed T-cell proliferation but this was severely inhibited if the BMDC were cultured with IL-10 before exposure to the antigen. This work suggests that although IL-10 does not affect the phagocytic capacity of BMDC, it does inhibit maturation of the cells and consequently, T-cell activation.
Collapse
Affiliation(s)
- L Faulkner
- Department of Microbiology, University of Otago, PO Box 56, Dunedin, New Zealand
| | | | | |
Collapse
|
47
|
Faulkner L. Acting on health. Nurs Stand 1999; 13:20. [PMID: 10687637] [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: 02/15/2023]
|
48
|
Abstract
HLA class I transgenic mice are a powerful research tool which have been used as models for human immune responses. This review describes the generation of the different HLA class I transgenic mice, the techniques used to improve expression of the transgene and use of the transgene product in immune responses. It also illustrates how HLA class I transgenic mice have provided insights into the nature of the allogeneic and xenogeneic response, the generation of CTL responses, the development of autoimmune diseases, and their use for the generation of anti-HLA class I antibodies. Despite these advances, the use of available HLA class I transgenic mice as models for human disease and immune responses has been limited. The development of new transgenic strains incorporating multiple human transgenes may allow the potential of HLA class I transgenic mice to be realised.
Collapse
Affiliation(s)
- L Faulkner
- Department of Medicine, University of Wales College of Medicine, Heath Park, Cardiff, UK.
| | | | | |
Collapse
|
49
|
Faulkner L, Patel M, Brickell PM, Katz DR. The role of the Fgr tyrosine kinase in the control of the adhesive properties of U937 monoblastoid cells and their derivatives. Immunology 1997; 92:519-26. [PMID: 9497494 PMCID: PMC1364158 DOI: 10.1046/j.1365-2567.1997.00367.x] [Citation(s) in RCA: 9] [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: 02/06/2023] Open
Abstract
In humans, expression of the cellular proto-oncogene c-fgr is normally restricted to mature cells of the myeloid lineage, mantle zone B cells and various myeloid and B-cell lines. Previous studies of the monoblastoid cell line, U937, showed that c-fgr expression increased following differentiation, but its role in monocytes and related cells has not been defined in functional terms. We therefore investigated the role of c-fgr in U937 cells transfected with the c-fgr gene such that its expression could be manipulated independent of differentiation. Induction of the transfected c-fgr gene by cadmium ions did not affect cell proliferation, responses to phorbol 12-myristate 13-acetate (PMA), dihydroxycholecalciferol (DHCC), tumour necrosis factor-alpha (TNF-alpha) or retinoic acid, or phagocytosis of antibody-coated sheep red blood cells. However, there was increased surface expression of CD54 (intracellular adhesion molecule-1; ICAM-1) and CD102 (ICAM-2) and decreased surface expression of CD50 (ICAM-3) compared with cells that had been transfected with plasmid only and treated in the same way. These findings suggest that the product of the c-fgr gene may be important in control of relative adhesive properties of mature monocytic cells.
Collapse
Affiliation(s)
- L Faulkner
- Department of Immunology, University College London Medical School, UK
| | | | | | | |
Collapse
|
50
|
Rayment NB, Moss E, Faulkner L, Brickell PM, Davies MJ, Woolf N, Katz DR. Synthesis of TNF alpha and TGF beta mRNA in the different micro-environments within atheromatous plaques. Cardiovasc Res 1996; 32:1123-30. [PMID: 9015415 DOI: 10.1016/s0008-6363(96)00145-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To examine localisation of tumour necrosis factor (TNF alpha) and transforming growth factor beta (TGF beta) mRNA synthesis in human coronary artery atheromatous plaques, to explore how synthesis of these cytokines relates to distribution of macrophages and smooth muscle cells, and to correlate this with plaque micro-environments. METHOD In situ hybridisation with digoxigenin-labelled sense and anti-sense riboprobes was used, combined with immunohistochemistry to detect TNF alpha protein, macrophage, lymphocyte and smooth muscle cell markers. RESULTS In the intimal plaque TNF alpha mRNA is synthesised by monocytes/macrophages as well as by smooth muscle cells. Both TNF alpha and TGF beta mRNAs were present at the margins of the lesions and in reactive areas, where there was little lipid and fibrosis. Focal aggregates of macrophages in the adventitia expressed both TNF alpha mRNA and protein and TGF beta mRNA. CONCLUSION Synthesis of these two cytokines by macrophages as well as smooth muscle cells contributes to the pathobiology of the plaque and that this is part of the 'reaction to injury', rather than a feature of a specific cell, or a specific layer, within the vessel wall.
Collapse
Affiliation(s)
- N B Rayment
- British Heart Foundation Atherosclerosis Research Group, University College London Medical School, UK
| | | | | | | | | | | | | |
Collapse
|