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van der Wagen L, te Boome L, Mansilla C, Lindemans C, Cuijpers M, Westinga K, Petersen E, Spierings E, Bierings M, Boelens J, Wulffraat N, Slaper-Cortenbach I, Kuball J. Treatment of steroid resistant grade II to IV acute GVHD by infusion of mesenchymal stromal cells expanded with platelet lysate - a phase I/II study. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jöris MM, Lankester AC, von dem Borne PA, Kuball J, Bierings M, Cornelissen JJ, Sijnke MEG, van der Holt B, van Rood JJ, Oudshoorn M, Claas FHJ. Translating in vitro prediction of cytotoxic T cell alloreactivity to hematopoietic stem cell transplantation outcome. Transpl Immunol 2014; 30:59-64. [PMID: 24440708 DOI: 10.1016/j.trim.2013.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 03/21/2013] [Revised: 07/24/2013] [Accepted: 08/05/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previously we developed a weighted amino acid (AA) mismatch score predictive for cytotoxic T cell (CTL) alloreactivity (in vitro CTLp assay) based on the structure of the HLA class I molecule. The aim of this study is to confirm the clinical relevance of the CTLp assay and to validate the AA mismatch score as an alternative and easy to use tool to predict permissible mismatches in hematopoietic stem cell transplantation (HSCT). METHODS We selected patients transplanted with a 9/10 single HLA class I mismatched graft (n=171) at three Dutch HSCT centers. A CTLp assay was performed in 73 donor-recipient pairs. As a control we selected 168 10/10 HLA matched pairs that were matched to the 9/10 single HLA class I mismatched pairs for HSCT year, donor type, patient age and diagnosis. RESULTS We observed that pairs with negative a CTLp assay had statistically significant decreased incidence of mortality after HSCT comparable to that of 10/10 HLA matched pairs. However, the weighted AA mismatch score did not significantly predict any HSCT end point of interest. CONCLUSION Further investigation is needed to unravel the mechanisms involved in causing the beneficial effect of a negative CTLp assay, before other alternative tools to predict HSCT outcome may be developed.
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Affiliation(s)
- M M Jöris
- Europdonor Foundation, The Netherlands; Department of Immunohematology and Blood transfusion, LUMC, The Netherlands.
| | | | | | - J Kuball
- Department of Hematology and Immunology, UMCU, The Netherlands
| | - M Bierings
- Wilhelmina Children's Hospital, UMCU, The Netherlands
| | - J J Cornelissen
- Department of Hematology, Erasmus MC-Daniel den Hoed, The Netherlands
| | | | - B van der Holt
- HOVON Data Center, Erasmus MC-Daniel den Hoed, The Netherlands
| | - J J van Rood
- Europdonor Foundation, The Netherlands; Department of Immunohematology and Blood transfusion, LUMC, The Netherlands
| | - M Oudshoorn
- Europdonor Foundation, The Netherlands; Department of Immunohematology and Blood transfusion, LUMC, The Netherlands
| | - F H J Claas
- Department of Immunohematology and Blood transfusion, LUMC, The Netherlands
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Bierings M, Van de Sande I, Van Haaren P, Hurkmans C. OC-0280: CBCT verification of heart position during breath-hold radiotherapy treatment of left-sided breast cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30385-6] [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: 11/25/2022]
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MacInnes A, Heijnen H, Van Wijk R, Van den Loosdrecht A, Bierings M, Gazda H, Wlodarski M. P-026 The role of autophagy in the etiology and malignant transformation of myeloid cells with ribosomal protein haploinsufficiencies. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70075-4] [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: 11/26/2022]
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van Haaren P, Bierings M, van Boxtel M, van der Leer J, van der Sangen M, Hurkmans C. EP-1270: Accuracy and reliability of CBCT based position verification and correction for IGRT of pancreatic cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33576-3] [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]
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Jöris MM, Lankester AC, von dem Borne PA, Kuball J, Bierings M, Cornelissen JJ, Groenendijk-Sijnke ME, van der Holt B, Haasnoot GW, van der Zanden HGM, van Walraven SM, van Rood JJ, Claas FHJ, Oudshoorn M. The impact of frequent HLA haplotypes in high linkage disequilibrium on donor search and clinical outcome after unrelated haematopoietic SCT. Bone Marrow Transplant 2012; 48:483-90. [PMID: 23064039 DOI: 10.1038/bmt.2012.189] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The MHC region on chromosome 6 contains a large number of non-HLA genes next to the HLA genes. Matching for HLA in unrelated hematopoietic SCT (HSCT) does not necessarily mean that these non-HLA genes are also matched. We selected 348 Northwest European patients transplanted with an HLA-A-, -B-, -C-, -DRB1-, -DQB1-matched unrelated donor (MUD) between 1987 and 2008. Patients' haplotypes were identified via descend. We were unable to determine the haplotypes of the donor; therefore we used frequent haplotypes (FH) in high linkage disequilibrium (LD) as a proxy for haplotype matching. Presence of a FH in a patient positively affected the probability and speed of identifying a matched unrelated donor. Competing risk survival analysis showed that patients with one or two FH have a statistically significantly decreased probability of developing ≥ grade II acute GVDH (aGVHD) without increased risk of relapse compared to patients without FH (HR (95% CI): 0.53 (0.31-0.91)). This association was strongest for those FH with the highest LD between both HLA-A and -C or -B, and HLA-C or -B and -DRB1 (HR (95% CI): 0.49 (0.26-0.92)). These results extend evidence that non-HLA allele coding regions have a significant impact on development of ≥ grade II aGVHD. We conclude that there is more to successful HSCT than matching for HLA genes.
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Affiliation(s)
- M M Jöris
- Europdonor Foundation, Leiden, The Netherlands.
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7
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Ruggeri A, Michel G, Dalle JH, Caniglia M, Locatelli F, Campos A, de Heredia CD, Mohty M, Hurtado JMP, Bierings M, Bittencourt H, Mauad M, Purtill D, Cunha R, Kabbara N, Gluckman E, Labopin M, Peters C, Rocha V. Impact of pretransplant minimal residual disease after cord blood transplantation for childhood acute lymphoblastic leukemia in remission: an Eurocord, PDWP–EBMT analysis. Leukemia 2012; 26:2455-61. [DOI: 10.1038/leu.2012.123] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Boelens J, Bartelink I, Lindemans C, Bierings M. Fludarabine + Exposure-Targeted Busulfan in Children with Malignant and Non-Malignant Diseases: An Effective and Low Toxic Regimen. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bartelink I, Flinsenberg T, Bierings M, Egberts T, Boelens J. Myelo-Ablative Exposure of Busulfan+Fludarabine in Pediatric HSCT Is a Similarly Effective Conditioning Regimen Compared to BuCy4 But Less Toxic. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.320] [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: 11/26/2022]
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10
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Boelens J, Versluys B, Lindemans C, Terhegge-Lagro S, Bierings M. Standardized Early Initiation of a “High Dose Steroid (HDS)” Treatment Protocol for Allo-Immune Lung Syndromes is Associated With Improved Survival Despite the Presence of High Viral Loads of “Common Cold Viruses”. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.527] [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]
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te Boome L, Lindemans C, Slaper-Cortebach I, Rozemuller H, Petersen E, Bierings M, Boelens J, Wulffraat N, Kuball J. Treatment of Steroid Resistant Grade II to IV Acute GVHD by Infusion of Mesenchymal Stroma Cells Expanded With Human Plasma and Platelet Lysate – a Phase I/II Study. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Strahm B, Nöllke P, Zecca M, Korthof ET, Bierings M, Furlan I, Sedlacek P, Chybicka A, Schmugge M, Bordon V, Peters C, O'Marcaigh A, de Heredia CD, Bergstraesser E, Moerloose BD, van den Heuvel-Eibrink MM, Starý J, Trebo M, Wojcik D, Niemeyer CM, Locatelli F. Hematopoietic stem cell transplantation for advanced myelodysplastic syndrome in children: results of the EWOG-MDS 98 study. Leukemia 2011; 25:455-62. [PMID: 21212791 DOI: 10.1038/leu.2010.297] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report on the outcome of children with advanced primary myelodysplastic syndrome (MDS) transplanted from an HLA-matched sibling (MSD) or an unrelated donor (UD) following a preparative regimen with busulfan, cyclophosphamide and melphalan. Ninety-seven patients with refractory anemia with excess blasts (RAEB, n=53), RAEB in transformation (RAEB-T, n=29) and myelodysplasia-related acute myeloid leukemia (MDR-AML, n=15) enrolled in the European Working Group of MDS in Childhood (EWOG-MDS) 98 study and given hematopoietic stem cell transplantation (HSCT) were analyzed. Median age at HSCT was 11.1 years (range 1.4-19.0). Thirty-nine children were transplanted from an MSD, whereas 58 were given the allograft from a UD (n=57) or alternative family donor (n=1). Stem cell source was bone marrow (n=69) or peripheral blood (n=28). With a median follow-up of 3.9 years (range 0.1-10.9), the 5-year probability of overall survival is 63%, while the 5-year cumulative incidence of transplantation-related mortality (TRM) and relapse is 21% each. Age at HSCT greater than 12 years, interval between diagnosis and HSCT longer than 4 months, and occurrence of acute or extensive chronic graft-versus-host disease were associated with increased TRM. The risk of relapse increased with more advanced disease. This study indicates that HSCT following a myeloablative preparative regimen offers a high probability of survival for children with advanced MDS.
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Affiliation(s)
- B Strahm
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany.
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Rubin J, Vettenranta K, Vettenranta J, Bierings M, Abrahamsson J, Békássy AN, Håkansson Y, Frost BM, Arvidson J, Spendilow C, Winiarski J, Gustafsson B. Use of intrathecal chemoprophylaxis in children after SCT and the risk of central nervous system relapse. Bone Marrow Transplant 2010; 46:372-8. [DOI: 10.1038/bmt.2010.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Flinsenberg T, Bartelink I, Ververs T, Bierings M, Boelens J. Busulfan+Fludarabine, An Effective And Low Toxic Regimen In Children With Malignant And Non-Malignant Diseases. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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de Pagter P, Lindemans C, Keukens L, Belitser S, de Weger R, van der Weide P, Baeten E, de Gouw A, Bierings M, Van Baarle D, Bloem A, Boelens J. Fast B- And NK-, Reconstitution Early After Unrelated Cord Blood Transplantation Compared To (UN)Related Bone Marrow Transplantation In Children. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.073] [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: 11/28/2022]
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16
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De Vries A, Bredius R, Lankester A, Bierings M, Trebo M, Sedlacek P, Niemeyer C, Zecca M, Locatelli F, van den Heuvel-Eibrink M. C029 HLA-identical umbilical cord blood transplantation from a sibling donor in juvenile myelomonocytic leukemia. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70067-0] [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: 11/26/2022]
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17
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Bartelink I, Bredius R, Bierings M, Egeler M, Lankester A, Egberts T, Zwaveling J, Boelens J. Targeting to an Optimal AUC of Intravenous Busulfan Prevents Graft Failure In Transplantation In Children With Non-Malignant Diseases. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Boelens J, Bierings M, Wynn R, O’Meara A, Veys P, Bertrand Y, Wraith E, Cavazzana-Calvo M, Wulffraat N, Gluckman E, Rocha V. 157: Outcomes of cord blood transplantation for Hurler’s syndrome. An EUROCORD-working party inborn errors EBMT survey. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Yoshimi A, Mohamed M, Bierings M, Urban C, Korthof E, Zecca M, Sykora KW, Duffner U, Trebo M, Matthes-Martin S, Sedlacek P, Klingebiel T, Lang P, Führer M, Claviez A, Wössmann W, Pession A, Arvidson J, O'Marcaigh AS, van den Heuvel-Eibrink MM, Starý J, Hasle H, Nöllke P, Locatelli F, Niemeyer CM. Second allogeneic hematopoietic stem cell transplantation (HSCT) results in outcome similar to that of first HSCT for patients with juvenile myelomonocytic leukemia. Leukemia 2007; 21:556-60. [PMID: 17268527 DOI: 10.1038/sj.leu.2404537] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Versluys B, Rossen J, Bierings M, Schuurman R, van Ewijk B, Boelens J. 286: Role of respiratory viral infection in the development of allo-reactive lung disease. Biol Blood Marrow Transplant 2007. [DOI: 10.1016/j.bbmt.2006.12.291] [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: 10/23/2022]
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21
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Reimann C, Arola M, Bierings M, Karow A, van den Heuvel-Eibrink MM, Hasle H, Niemeyer CM, Kratz CP. A novel somatic K-Ras mutation in juvenile myelomonocytic leukemia. Leukemia 2006; 20:1637-8. [PMID: 16826224 DOI: 10.1038/sj.leu.2404303] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sharon RF, Bierings M, Vrielink H, Versluys B, Boelens JJ. Pre-emptive granulocyte transfusions enable allogeneic hematopoietic stem cell transplantation in pediatric patients with chronic infections. Bone Marrow Transplant 2006; 37:331-3. [PMID: 16314849 DOI: 10.1038/sj.bmt.1705233] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Rossen J, Versluys B, Bierings M, van Ewijk B, Wolfs T, van Loon A, Boelens J. The role of respiratory viruses in developing bronchiolitis obliterans and IPS in pediatric HCT patients. J Clin Virol 2006. [PMCID: PMC7129530 DOI: 10.1016/s1386-6532(06)80722-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ljungman P, Ribaud P, Eyrich M, Matthes-Martin S, Einsele H, Bleakley M, Machaczka M, Bierings M, Bosi A, Gratecos N, Cordonnier C. Cidofovir for adenovirus infections after allogeneic hematopoietic stem cell transplantation: a survey by the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2003; 31:481-6. [PMID: 12665844 DOI: 10.1038/sj.bmt.1703798] [Citation(s) in RCA: 222] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Adenovirus is an important cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation and there is no established therapy. Cidofovir has in vitro efficacy against adenovirus. We performed a retrospective analysis of 45 patients treated with cidofovir for adenovirus from 10 centers. In total, 16 patients had definite adenovirus disease, 13 probable disease, and 16 asymptomatic infections. A total of 31 (69%) patients were successfully treated with cidofovir, 10 failed, and four were not evaluable owing to early death from other causes. Cidofovir therapy was successful in 10 patients with adenovirus disease, 10 patients with probable disease, and in 10 patients with asymptomatic infections. The overall survival at 28 days and 6 months after initiation of cidofovir therapy was 76 and 46%, respectively. Of the patients, 18 developed toxicity associated with cidofovir: 14 developed renal toxicity and four other types of toxicities. We conclude that cidofovir may be useful against adenovirus after allogeneic hematopoietic stem cell transplantation but additional studies are needed.
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Affiliation(s)
- P Ljungman
- Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
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Bierings M, Szczepański T, van Wering ER, Willemse MJ, Langerak AW, Révész T, van Dongen JJ. Two consecutive immunophenotypic switches in a child with immunogenotypically stable acute leukaemia. Br J Haematol 2001; 113:757-62. [PMID: 11380467 DOI: 10.1046/j.1365-2141.2001.02772.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 12-year-old girl presented with a CD33+ precursor B-acute lymphoblastic leukaemia (ALL) and seemed to respond well to ALL treatment. However, 2 weeks after diagnosis her leucocyte count rose rapidly with a predominance of myeloid blasts with M5b morphology and CD19+ myeloid immunophenotype. Acute myeloid leukaemia (AML) treatment was started and remission was achieved after one course of chemotherapy; the AML treatment was continued for 6 months. Two months after cessation of chemotherapy, the patient developed a bone marrow relapse, this time with an undifferentiated blast morphology and a precursor B immunophenotype. Molecular analysis of the immunoglobulin and T-cell receptor genes showed several clonal gene rearrangements at diagnosis: two IGH, two IGK and two TCRD gene rearrangements. All rearrangements were also detected during the AML phase of the disease, suggesting a phenotypic shift of the same leukaemia. At relapse, 8 months later, all rearrangements were preserved except for one TCRD (Vdelta2-Ddelta3) rearrangement. The first phenotypic shift in the genotypically stable leukaemia was remarkably fast. The most probable explanation for our observations is an oncogenic event in an undifferentiated haematopoietic progenitor clone, with a highly versatile phenotype.
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MESH Headings
- Acute Disease
- Antigens, CD
- Antigens, Differentiation, Myelomonocytic
- Blotting, Southern
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/immunology
- Child
- Female
- Gene Rearrangement
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Gene Rearrangement, B-Lymphocyte, Light Chain
- Gene Rearrangement, delta-Chain T-Cell Antigen Receptor
- Humans
- Immunophenotyping
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/immunology
- Sialic Acid Binding Ig-like Lectin 3
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Affiliation(s)
- M Bierings
- Department of Haematology and Stem Cell Transplantation, University Medical Centre, Het Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands.
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Bisschop MM, Révész T, Bierings M, van Weerden JF, van Wering ER, Hählen K, van der Does-van den Berg A. Extramedullary infiltrates at diagnosis have no prognostic significance in children with acute myeloid leukaemia. Leukemia 2001; 15:46-9. [PMID: 11243398 DOI: 10.1038/sj.leu.2401971] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [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: 11/09/2022]
Abstract
This retrospective study was designed to review the relative frequency and prognostic significance of extramedullary infiltrates in children with acute myeloid leukaemia (AML). The registration data and initial discharge summaries were reviewed for all children diagnosed with AML, and registered by the Dutch Childhood Leukaemia Study Group (DCLSG). Between 1972 and 1998, 477 children were diagnosed with AML. Of these patients, 120 (25.1%) had extramedullary leukaemia (EML) at diagnosis. Four categories of EML were found: skin, soft tissue or bone, gingival infiltration and central nervous system (CNS) involvement. Patients who presented with gingival infiltrates, were older than those without EML or those in the other EML subgroups, had a high initial WBC count and a high proportion of M4/M5 morphological variants. This type of presentation could indicate a special biological entity. Univariate analysis of prognostic factors in patients treated after 1985 with intensive protocols showed that initial WBC count and the presence of favourable cytogenetic findings were significant. The presence of EML at diagnosis had no significant effect on event-free survival. In a stepwise multiple regression analysis only favourable cytogenetic findings remained significant.
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Affiliation(s)
- M M Bisschop
- Department of Paediatric Haematology-Oncology, University Medical Centre, Utrecht, The Netherlands
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de Vries DS, Bruin MC, Bierings M, Révész T. [Congenital amegakaryocytic thrombocytopenia: indication for allogeneic stem cell transplantation]. Ned Tijdschr Geneeskd 2000; 144:1596-8. [PMID: 10965369] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In two neonates, girls, persistent thrombocytopenia was found, which afterwards proved to be caused by a megakaryocytosis. Congenital amegakaryocytic thrombocytopenia is a rare bone marrow failure in young children that is defined as thrombocytopenia with absent or markedly decreased megakaryocytes in the bone marrow. Untreated, amegakaryocytic thrombocytopenia progresses to marrow failure with pancytopenia. Allogeneic stem cell transplantation offers the only possibility for cure, and is successful in approximately half of the patients. Both patients were treated by stem cell transplantation, the one with a matched unrelated donor, the second with stem cells from her HLA-identical sister. The first patient died, the second recovered with a normal number of circulating thrombocytes of donor origin.
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Affiliation(s)
- D S de Vries
- Wilhelmina Kinderziekenhuis, afd. Hematologie en Stamceltransplantatie, AB Utrecht
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Lackner A, Basu O, Bierings M, Lassay L, Schaefer UW, Révész T, Havers W, Kremens B. Haematopoietic stem cell transplantation for amegakaryocytic thrombocytopenia. Br J Haematol 2000; 109:773-5. [PMID: 10929028 DOI: 10.1046/j.1365-2141.2000.02099.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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: 11/20/2022]
Abstract
Congenital amegakaryocytic thrombocytopenia (CAT), a rare syndrome with failure of megakaryopoiesis, cannot be cured by immunoglobulins, steroids or cyclosporin, but only by allogeneic bone marrow transplantation (BMT). We report on eight patients with CAT, all of whom were dependent at the time of BMT on platelet transfusion. Sources of haematopoietic progenitor cells were bone marrow (n = 5), peripheral stem cells (n = 2) and cord blood (n = 1). Seven patients engrafted. Both patients with matched unrelated donor transplants died, six patients are well with stable platelet counts 3-27 months after transplantation. BMT represents a curative option for CAT. The benefit of using alternative marrow donors should be carefully evaluated.
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Affiliation(s)
- A Lackner
- Department of Paediatrics, University of Essen Medical School, Essen, Germany
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Affiliation(s)
- T Révész
- Department of Hematology-Oncology, Wilhelmina Children's Hospital, University of Utrecht, Utrecht, The Netherlands.
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Affiliation(s)
- M Bierings
- University Hospital Het Wilhelmina Kinderziekenhuis', Department of Haematology-Bone Marrow Transplantation, Utrecht, The Netherlands
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31
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Abstract
BACKGROUND Autologous haemopoietic stem-cell transplantation (AHSCT) had been described as a possible treatment for severe autoimmune disease refractory to conventional treatment. We report the first four children with severe forms of juvenile chronic arthritis (JCA) treated with AHSCT. METHODS We studied three children with systemic JCA and one child with polyarticular JCA. Unprimed bone marrow was taken 1 month before AHSCT. T-cell depletion of the graft was done with CD2 and CD3 antibodies. We used a preparative regimen of antithymocyte globulin (20 mg/kg), cyclophosphamide (200 mg/kg) and low-dose total body irradiation (4 Gy). Methotrexate and cyclosporin were stopped before AHCST, prednisone was tapered after 2 months. FINDINGS Our patients showed a drug-free follow-up of 6-18 months with a marked decrease in joint swelling, pain, and morning stiffness. Erythrocyte sedimentation rate, C-reactive protein, and haemoglobin returned to almost normal values within 6 weeks. Despite T-cell depletion there was a rapid immune reconstitution in three out of four children. Two patients developed a limited varicella zoster virus eruption, which was treated by aciclovir. INTERPRETATION AHSCT for severe JCA was well tolerated and induced a remission of disease in four children with JCA that was resistant to conventional treatment. Prolonged prednisone-free growth catch-up and general well-being is a major therapeutic gain in such children. The actual follow-up is too short, however, for us to conclude that these children are completely cured of their disease.
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Affiliation(s)
- N Wulffraat
- Department of Pediatric Immunology and Haematology, University Hospital for Children Het Wilhelmina kinderziekenhuis, Utrecht, The Netherlands.
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Révész T, Arets B, Bierings M, van den Bos C, Duval E. Recombinant factor VIIa in severe uremic bleeding. Thromb Haemost 1998; 80:353. [PMID: 9716175] [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: 02/08/2023]
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Schlegel PG, Haber HP, Beck J, Krümpelmann S, Handgretinger R, Bader P, Bierings M, Niethammer D, Klingebiel T. Hepatic veno-occlusive disease in pediatric stem cell recipients: successful treatment with continuous infusion of prostaglandin E1 and low-dose heparin. Ann Hematol 1998; 76:37-41. [PMID: 9486923 DOI: 10.1007/s002770050358] [Citation(s) in RCA: 17] [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: 02/06/2023]
Abstract
Limited data exist on therapeutic options for established hepatic veno-occlusive disease (VOD) in pediatric patients after stem cell transplantation (SCT). In this report, we present data on the successful treatment of VOD in three children following allogeneic SCT and report the duplex ultrasound criteria for the confirmation of the diagnosis and for the evaluation of the treatment progress. All patients were <2 years at the time of transplantation and had received preparative regimens containing busulfan and cyclophosphamide. There were no known pretransplant risk factors for VOD. Allogeneic stem cell transplantation was performed from a sibling donor for CMML and from unrelated donors for Wiskott-Aldrich syndrome and familial hemophagocytic lymphohistiocytosis (FHL). The onset of first clinical symptoms of VOD (as defined by the Seattle and Baltimore criteria) was relatively late in all three patients (days +19, +20, and +25, respectively). Time from onset of first symptoms until confirmation of diagnosis by serial duplex ultrasound examination was 4-11 days. Duplex ultrasound criteria are as follows: complete change of direction of blood flow in the portal vein, decrease of flow in the hepatic veins, and development of collateral circulation. Treatment was initiated upon confirmation of VOD by continuous infusion of prostaglandin E1 (initial dose 0.075 microg/kg/h) in addition to low-dose heparin (100 units/kg/d). Treatment was continued at the maximum tolerated dose of 0.3-0.5 microg/kg/h of PGE1. After 9, 14, and 25 days of treatment respectively, normal portal vein flow was restored and treatment could be discontinued. All three patients are alive and well without apparent sequelae.
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Affiliation(s)
- P G Schlegel
- University Children's Hospital, Department of Pediatric Hematology/Oncology, Tübingen, Germany
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