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Eapen M, Iype M, Saradakutty G, Jayan BB, Sreedharan M, Ahamed S, Preethi Thomas E, Habeeb A, Cherian A. Childhood Absence Epilepsy- Electroclinical Profile and Prevalence of Attention-Deficit/Hyperactivity Disorder Among a Cohort of 47 Children. Pediatr Neurol 2024; 150:65-73. [PMID: 37981446 DOI: 10.1016/j.pediatrneurol.2023.10.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/29/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND We aimed to find the proportion of attention-deficit/hyperactivity disorder (ADHD) among children with childhood absence epilepsy (CAE) and to describe their electroclinical features. METHODS Video electroencephalography (EEG) was performed on 47 children who fulfilled International League Against Epilepsy criteria for CAE. These children were also assessed for the presence of ADHD. RESULTS Of the 47 children, 27 (57%) met criteria for the diagnosis of ADHD. Majority (74%) of them had inattentive type of ADHD. Age at onset of absences ranged from three to 12 years (mean 7.2 ± 2.47). We analyzed 219 seizures (154 electroclinical and 65 electrographic). The average seizure duration was 7.1 seconds (range 1 to 38 [S.D. 5.81]). Of the 154 clinical absences, ictal discharges were less than or equal to two seconds in nine of 154 (5.8%); greater than two to less than or equal to four seconds in 33 of 154 (21.4%), and longer than 20 seconds in 11 of 154 (7%). The longest duration of ictal discharge recorded was 38 seconds, and the shortest duration was one second. The onset of ictal discharge had a "lead in" focus in 81% (177 of 219). CONCLUSIONS The proportion of ADHD among children with CAE is high. A "lead in" focus of the generalized ictal discharges was observed frequently, lending support to the theory that the origin of seizure discharges in CAE is indeed cortical. The shortest ictal discharge recorded was one second.
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Affiliation(s)
- Merin Eapen
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India.
| | - Mary Iype
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Geetha Saradakutty
- Department of Paediatrics, Government Medical College, Konni, Kerala, India
| | - Bineej B Jayan
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Mini Sreedharan
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Shahanaz Ahamed
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | | | - Azmi Habeeb
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
| | - Anchu Cherian
- Department of Paediatric Neurology, Government Medical College, Trivandrum, Kerala, India
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2
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Ramsey SD, Bansal A, Li L, O'Donnell PV, Fuchs EJ, Brunstein CG, Eapen M, Thao V, Roth JA, Steuten L. Cost-Effectiveness of Unrelated Umbilical Cord Blood vs. HLA Haploidentical Related Bone Marrow Transplant: Evidence from BMT CTN 1101. Transplant Cell Ther 2023:S2666-6367(23)01257-5. [PMID: 37120135 DOI: 10.1016/j.jtct.2023.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/07/2023] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND BMT CTN 1101 was a Phase III randomized controlled trial comparing reduced intensity conditioning followed by double unrelated umbilical cord blood (UCB) versus HLA-haploidentical related donor bone marrow (haplo-BM) transplantation for patients with high-risk hematologic malignancies. OBJECTIVE The objective of this study is to report the results of a parallel cost-effectiveness analysis. STUDY DESIGN Three hundred sixty-eight patients were randomized to unrelated UCB (n=186) or haplo-BM (n=182) transplant. We estimated healthcare utilization and costs using propensity score-matched BMT patients from the OptumLabsⓇ Data Warehouse for trial participants <65 years and Medicare claims for participants ≥65 years. Weibull models were used to estimate 20-year survival. EQ-5D surveys by trial participants were used estimate Quality-Adjusted Life Years (QALYs). RESULTS At 5-year follow-up, survival was 42% for haplo-BM versus 36% for UCB (P=.06). Over a 20-year time horizon, haplo-BM is expected to be more effective (+0.63 QALY) and more costly +$118,953) for persons under 65. For those over 65, haplo-BM is expected to be more effective and less costly. In one-way uncertainty analyses, for persons <65, the cost per QALY result was most sensitive to life years and health state utilities. For persons ≥65, life years were more influential than costs and health state utilities. CONCLUSION Compared to UCB, haplo-BM was moderately cost-effective for patients aged <65 years, and less costly and more effective for persons ≥65 years. Haplo-BM is a fair value choice for commercially insured patients with high-risk leukemia and lymphoma who require HCT. For Medicare enrollees, haplo-BM is a preferred choice when considering costs and outcomes.
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Affiliation(s)
- S D Ramsey
- Fred Hutchinson Cancer Center, Seattle, WA; University of Washington, Seattle, WA.
| | - A Bansal
- Fred Hutchinson Cancer Center, Seattle, WA; University of Washington, Seattle, WA
| | - L Li
- Fred Hutchinson Cancer Center, Seattle, WA
| | - P V O'Donnell
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - E J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - C G Brunstein
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - M Eapen
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - V Thao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; OptumLabs, Edina, MN
| | - J A Roth
- University of Washington, Seattle, WA; Pfizer, New York, NY
| | - Lmg Steuten
- Office of Health Economics, London, United Kingdom
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Iype M, Sreedharan M, Ahamed S, Thomas E, Eapen M, Sugunan S, Saradakutty G, Bindusha S. Dravet syndrome Presenting with Extrapyramidal Features, Ataxia and Basal Ganglia Hyperintensity on Brain Magnetic Resonance Imaging. Ann Indian Acad Neurol 2021; 24:839-841. [PMID: 35002176 PMCID: PMC8680914 DOI: 10.4103/aian.aian_1216_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/14/2020] [Accepted: 01/02/2021] [Indexed: 11/22/2022] Open
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4
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O'Donnell PV, Eapen M, Horowitz MM, Logan BR, DiGilio A, Brunstein C, Fuchs EJ, Flowers MED, Salit R, Raj K, Pagliuca A, Bradstock K, Granata A, Castagna L, Furst S, Blaise D. Comparable outcomes with marrow or peripheral blood as stem cell sources for hematopoietic cell transplantation from haploidentical donors after non-ablative conditioning: a matched-pair analysis. Bone Marrow Transplant 2016; 51:1599-1601. [PMID: 27526284 DOI: 10.1038/bmt.2016.215] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- P V O'Donnell
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - M Eapen
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M M Horowitz
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B R Logan
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A DiGilio
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - C Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - E J Fuchs
- Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - M E D Flowers
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R Salit
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - K Raj
- Guy's and St. Thomas' Hospitals NHS Hospitals Foundation Trusts, London, UK.,Department of Haematological Medicine, King's College Hospital, London, UK
| | - A Pagliuca
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - K Bradstock
- Department of Hematology, Westmead Hospital, Westmead, New South Wales, Australia
| | - A Granata
- Department of Hematology, Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Reserche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258, Marseille, France
| | - L Castagna
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - S Furst
- Department of Hematology, Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Reserche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258, Marseille, France
| | - D Blaise
- Department of Hematology, Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Reserche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258, Marseille, France
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Abstract
Assuming that most physicians will chose an HLA-identical sibling as the best allotransplant donor, the question arises who is the best alternative donor when an HLA-identical sibling is unavailable? The most commonly used alternative donors are HLA-identical or -mismatched unrelated donors, HLA-matched or -mismatched umbilical cord blood donor or a related, HLA-haplotype-matched related donors. Each alternative donor option has advantages and disadvantages. We discuss selected aspects of these issues based on data from randomized clinical trials and observational databases. However, because there are limited data to address specific clinical settings, quantification of expert opinion is sometimes needed.
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Affiliation(s)
- R P Gale
- Department of Medicine, Division of Experimental Medicine, Haematology Centre, Imperial College London, London, UK
| | - M Eapen
- Center for International Blood and Marrow Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Affiliation(s)
- Y S Sooraj
- Nephrology and Poisoning Services, PVS Memorial Hospital, Kaloor, Kochi, India
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7
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Kamani N, Walters M, Carter S, Brochstein J, Eapen M, Levine J, Logan B, Panepinto J, Parikh S, Pulsipher M, Schultz K, Shenoy S. Unrelated Donor Cord Blood Transplantation for Children with Severe Sickle Cell Disease: Results of a Phase II Study from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.318] [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: 11/24/2022]
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8
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Fuchs E, Wu J, Carter S, Brunstein C, Costa L, Wingard J, Jagasia M, D'Elia J, Eapen M, O'Donnell P. Phase II Trial of Non-Myeloablative Conditioning and Partially HLA-Mismatched (HLA-Haploidentical) Bone Marrow Transplantation (BMT) for Patients With Hematologic Malignancies: Results of Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Protocol 0603. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.007] [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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9
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Eapen M, Zald DH, Gatenby JC, Ding Z, Gore JC. Using high-resolution MR imaging at 7T to evaluate the anatomy of the midbrain dopaminergic system. AJNR Am J Neuroradiol 2010; 32:688-94. [PMID: 21183619 DOI: 10.3174/ajnr.a2355] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dysfunction of DA neurotransmission from the SN and VTA has been implicated in neuropsychiatric diseases, including Parkinson disease and schizophrenia. Unfortunately, these midbrain DA structures are difficult to define on clinical MR imaging. To more precisely evaluate the anatomic architecture of the DA midbrain, we scanned healthy participants with a 7T MR imaging system. Here we contrast the performance of high-resolution T2- and T2*-weighted GRASE and FFE MR imaging scans at 7T. MATERIALS AND METHODS Ten healthy participants were scanned by using GRASE and FFE sequences. CNRs were calculated among the SN, VTA, and RN, and their volumes were estimated by using a segmentation algorithm. RESULTS Both GRASE and FFE scans revealed visible contrast between midbrain DA regions. The GRASE scan showed higher CNRs compared with the FFE scan. The T2* contrast of the FFE scan further delineated substructures and microvasculature within the midbrain SN and RN. Segmentation and volume estimation of the midbrain SN, RN, and VTA showed individual differences in the size and volume of these structures across participants. CONCLUSIONS Both GRASE and FFE provide sufficient CNR to evaluate the anatomy of the midbrain DA system. The FFE in particular reveals vascular details and substructure information within the midbrain regions that could be useful for examining structural changes in midbrain pathologies.
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Affiliation(s)
- M Eapen
- Vanderbilt University Institute of Imaging Science, 1161 21st Ave South, AA 1101, Medical Center North, Nashville, TN 37232-2310, USA.
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10
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Madureira ABM, Eapen M, Locatelli F, Teira P, Zhang MJ, Davies SM, Picardi A, Woolfrey A, Chan KW, Socié G, Vora A, Bertrand Y, Sales-Bonfim CM, Gluckman E, Niemeyer C, Rocha V. Analysis of risk factors influencing outcome in children with myelodysplastic syndrome after unrelated cord blood transplantation. Leukemia 2010; 25:449-54. [PMID: 21135856 DOI: 10.1038/leu.2010.285] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [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 describe 70 children with myelodysplastic syndrome (MDS) (refractory cytopenia (n=31) and refractory anemia with excess blasts (n=30) or blasts in transformation (n=9)) who received umbilical cord blood (UCB) transplantation with a single UCB unit and a myeloablative conditioning regimen. Approximately 20% of children had secondary MDS. Median age at transplantation was 7 years and the median follow-up was 3 years. The day-60 probability of neutrophil recovery was 76%; recovery was faster after transplantation of matched or 1-locus mismatched UCB, irradiation-containing conditioning regimen, cell dose >6 × 10(7)/kg and monosomy 7. Risks of treatment failure (recurrent disease or death) were lower in patients with monosomy 7 and transplantations after 2001. The 3-year disease-free survival (DFS) was 50% for transplantations after 2001 compared with 27% for the earlier period (P=0.018). Transplantations after 2001 occurred within 6 months after diagnosis and used UCB units with higher cell dose. DFS was highest in patients with monosomy 7 (61%) compared with other karyotypes (30%), P=0.017. These data suggest that transplantation of mismatched UCB graft is an acceptable alternative for children without a matched sibling or suitably matched unrelated adult donor.
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Affiliation(s)
- A B M Madureira
- Eurocord Office, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
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11
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Boelens J, Aldenhoven M, Purtill D, Eapen M, DeForr T, Wynn R, Cavazanna-Calvo M, Tolar J, Prasad V, Escolar M, Gluckman E, Orchard P, Veys P, Kurtzberg J, Rocha V. Outcomes Of Transplantation Using A Various Cell Source In Children With Hurlers Syndrome After Myelo-Ablative Conditioning. An Eurocord-EBMT-CIBMTR Collaborative Study. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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12
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Nemecek E, Carpenter P, He W, Ellis K, Seber A, Woolfrey A, MacMillan M, Eapen M, Davies S, Frangoul H. Outcome Of Unrelated Donor Blood And Marrow Transplantation (BMT) For Children With Acute Lymphoblastic Leukemia (ALL) In Third Remission. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.266] [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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13
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Thiel E, Zhang MJ, Davies S, Kurtzberg J, Logan B, Ayas M, MacMillian M, Tiedemann K, Eapen M. Comparable Long-Term Leukemia-Free Survival After Matched Sibling And Unrelated Donor Transplantation For Children With Acute Lymphoblastic Leukemia In Second Complete Remission. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.338] [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: 11/16/2022]
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14
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Gale RP, Eapen M, Logan B, Zhang MJ, Lazarus HM. Erratum: Are there roles for observational database studies and structured quantification of expert opinion to answer therapy controversies in transplants? Bone Marrow Transplant 2009. [DOI: 10.1038/bmt.2009.72] [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: 11/09/2022]
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15
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Gale RP, Eapen M, Logan B, Zhang MJ, Lazarus HM. Are there roles for observational database studies and structured quantification of expert opinion to answer therapy controversies in transplants? Bone Marrow Transplant 2009; 43:435-46. [PMID: 19182830 DOI: 10.1038/bmt.2008.447] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [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
Approaches to determine whether one transplant-related therapy is better than another include: (1) using experimental data, such as those from randomized controlled trials (RCTs); (2) using observational data, such as those from observational databases (ODBs) and (3) using conclusions from the structured quantification of expert opinion based on a consideration of evidence from RCTs, ODBs and other sources. Large RCTs are widely and appropriately regarded as the gold standard of clinical investigation. However, data from large RCTs are rarely available for transplant-related therapy questions. We discuss some of the limitations of RCTs in the transplant setting often including small size and short follow-up. These limitations are only partly solved by meta-analyses of RCTs. Data from high-quality ODBs are not only often useful in this setting but also have limitations. Biases may be difficult or impossible to identify and/or adjust for. However, ODBs have large numbers of diverse subjects receiving diverse therapies and analyses that often give answers more useful to clinicians than RCTs. Side-by-side comparisons suggest analyses from high-quality ODBs often give similar conclusions to meta-analyses of high-quality RCTs. Meta-analyses combining data from RCTs and ODBs are sometimes appropriate. Quantitation of expert opinion, when of high quality, is also useful: experts rarely disagree under precisely defined circumstances and their consensus conclusions are often concordant with results of high-quality RCTs and ODBs. We suggest increased use of ODBs and expert opinion as reliable and effective ways to determine relative efficacies of new therapies in transplant settings.
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Affiliation(s)
- R P Gale
- Center for International Blood and Marrow Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
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16
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Verneris M, Burke M, He W, Davies S, Eapen M, Wagner J. Impact Of Reduced Intensity Conditioning (RIC) in Pediatric Acute Lymphoblastic Leukemia (ALL): A Report From the CIBMTR. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.083] [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: 11/24/2022]
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Horwitz M, Tunes da Silva G, Eapen M, Horwitz E. Survival Following Allogeneic Stem Cell Transplantation for Congenital Immunodeficiency and Metabolic Disorders. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.240] [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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18
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Eapen M. Response to Dr Gilman. Bone Marrow Transplant 2008. [DOI: 10.1038/bmt.2008.241] [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: 11/09/2022]
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Cohen Y, Scaradavou A, Stevens C, Rubinstein P, Gluckman E, Pacheco D, Eapen M, Horowitz M, Shpall E, Laughlin M, Nagler A, Daniely Y, Barishev R, Olmer L, Freedman L. 8: Factors Affecting 100-Day and 1-Year Mortality Following Myeloablative Single-Unit Cord Blood Transplantation in Adults and Adolescents: A Comprehensive Meta-Analysis of CIBMTR, NCBP and Eurocord. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.016] [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: 10/22/2022]
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20
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Hale G, He V, Termuhlen A, Davies S, Camitta B, Cairo M, Eapen M, Gross T. 60: Outcomes After Hematopoietic Stem Cell Transplant (HSCT) for Non-Hodgkin Lymphoma (NHL) in Children and Adolescents. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.068] [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: 10/22/2022]
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Eapen M, Zhang MJ, Devidas M, Raetz E, Barredo JC, Ritchey AK, Godder K, Grupp S, Lewis VA, Malloy K, Carroll WL, Davies SM, Camitta BM. Outcomes after HLA-matched sibling transplantation or chemotherapy in children with acute lymphoblastic leukemia in a second remission after an isolated central nervous system relapse: a collaborative study of the Children's Oncology Group and the Center for International Blood and Marrow Transplant Research. Leukemia 2007; 22:281-6. [PMID: 18033318 DOI: 10.1038/sj.leu.2405037] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In children with acute lymphoblastic leukemia (ALL) with isolated central nervous system (CNS) relapse and a human leucocyte antigen (HLA)-matched sibling, the optimal treatment after attaining second remission is unknown. We compared outcomes in 149 patients enrolled on chemotherapy trials and 60 HLA-matched sibling transplants, treated in 1990-2000. All patients achieved a second complete remission. Groups were similar, except the chemotherapy recipients were younger at diagnosis, less likely to have T-cell ALL and had longer duration (> or = 18 months) first remission. To adjust for time-to-transplant bias, left-truncated Cox's regression models were constructed. Relapse rates were similar after chemotherapy and transplantation. In both treatment groups, relapse rates were higher in older children (11-17 years; RR 2.81, P=0.002) and shorter first remission (< 18 months; RR 3.89, P<0.001). Treatment-related mortality rates were higher after transplantation (RR 4.28, P=0.001). The 8-year probabilities of leukemia-free survival adjusted for age and duration of first remission were similar after chemotherapy with irradiation and transplantation (66 and 58%, respectively). In the absence of an advantage for one treatment option over another, the data support use of either intensive chemotherapy with irradiation or HLA-matched sibling transplantation with total body irradiation containing conditioning regimen for children with ALL in second remission after an isolated CNS relapse.
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Affiliation(s)
- M Eapen
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Eapen M, DeLaat CA, Baker KS, Cairo MS, Cowan MJ, Kurtzberg J, Steward CG, Veys PA, Filipovich AH. Hematopoietic cell transplantation for Chediak-Higashi syndrome. Bone Marrow Transplant 2007; 39:411-5. [PMID: 17293882 DOI: 10.1038/sj.bmt.1705600] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We reviewed outcomes after allogeneic hematopoietic cell transplantation (HCT) in 35 children with Chediak-Higashi syndrome (CHS). Twenty-two patients had a history of the life-threatening accelerated phase of CHS before HCT and 11 were in accelerated phase at transplantation. Thirteen patients received their allograft from an human leukocyte antigen (HLA)-matched sibling, 10 from an alternative related donor and 12 from an unrelated donor. Eleven recipients of HLA-matched sibling donor, three recipients of alternative related donor and eight recipients of unrelated donor HCT are alive. With a median follow-up of 6.5 years, the 5-year probability of overall survival is 62%. Mortality was highest in those with accelerated phase disease at transplantation and after alternative related donor HCT. Only four of 11 patients with active disease at transplantation are alive. Seven recipients of alternative related donor HCT had active disease at transplantation and this may have influenced the poor outcome in this group. Although numbers are limited, HCT appears to be effective therapy for correcting and preventing hematologic and immunologic complications of CHS, and an unrelated donor may be a suitable alternative for patients without an HLA-matched sibling. Early referral and transplantation in remission after accelerated phase disease may improve disease-free survival.
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Affiliation(s)
- M Eapen
- Department of Medicine, Statistical Center, Center for International Blood and Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee, WI, USA
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Passweg JR, Pérez WS, Eapen M, Camitta BM, Gluckman E, Hinterberger W, Hows JM, Marsh JCW, Pasquini R, Schrezenmeier H, Socié G, Zhang MJ, Bredeson C. Bone marrow transplants from mismatched related and unrelated donors for severe aplastic anemia. Bone Marrow Transplant 2006; 37:641-9. [PMID: 16489361 DOI: 10.1038/sj.bmt.1705299] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For patients with acquired severe aplastic anemia without a matched sibling donor and not responding to immunosuppressive treatment, bone marrow transplantation from a suitable alternative donor is often attempted. We examined risks of graft failure, graft-versus-host disease and overall survival after 318 alternative donor transplants between 1988 and 1998. Sixty-six patients received allografts from 1-antigen and 20 from >1-antigen mismatched related donors; 181 from matched and 51 from mismatched unrelated donors. Most patients were young, had had multiple red blood cell transfusions and poor performance score at transplantation. We did not observe differences in risks of graft failure and overall mortality by donor type. The probabilities of graft failure at 100 days after 1-antigen mismatched related donor, >1-antigen mismatched related donor, matched unrelated donor and mismatched unrelated donor transplants were 21, 25, 15 and 18%, respectively. Corresponding probabilities of overall survival at 5 years were 49, 30, 39 and 36%, respectively. Although alternative donor transplantation results in long-term survival, mortality rates are high. Poor performance score and older age adversely affect outcomes after transplantation. Therefore, early referral for transplantation should be encouraged for patients who fail immunosuppressive therapy and have a suitable alternative donor.
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Affiliation(s)
- J R Passweg
- Department Innere Medizin, Kantonsspital, Basel, Switzerland.
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Abstract
AIMS To formulate evidence based histopathological criteria for the diagnosis of acquired toxoplasmic lymphadenitis, in an area of high tuberculosis prevalence. METHODS Multiple histopathological parameters were assessed in a consecutive sample of biopsies from 68 patients presenting with lymphadenopathy with a duration of less than six months. Serum IgM enzyme linked immunosorbent assay was used as the standard reference test for the diagnosis of toxoplasmic lymphadenitis. The sensitivity, specificity, and likelihood ratios of various histological parameters were estimated. RESULTS The presence of microgranulomas (p < 0.0001), paracortical widening (p = 0.006), paracortical hyperplasia (p = 0.02), monocytoid B cells in sinuses (p = 0.007), lower than grade 2 macrogranuloma (p = 0.002), and the absence of giant cells (p = 0.05) were found to discriminate between IgM positive cases and IgM negative controls. Using a composite criterion-(1) presence of microgranulomas, (2) lower than grade 2 macrogranuloma, (3) absence of giant cells, and (4) follicular hyperplasia-toxoplasmic lymphadenitis can be diagnosed with a high degree of sensitivity (100%), specificity (96.6%), and positive likelihood ratio (29). CONCLUSION Toxoplasma lymphadenitis can be diagnosed with a high degree of confidence using the specific histopathological criteria identified here.
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Affiliation(s)
- M Eapen
- Medical College, Calicut 673008, India
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25
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Talano JM, Casper JT, Camitta BM, Keever-Taylor CA, Murray KJ, Eapen M, Pierce KL, Margolis DA. Alternative donor bone marrow transplant for children with Philadelphia chromosome ALL. Bone Marrow Transplant 2005; 37:135-41. [PMID: 16273115 DOI: 10.1038/sj.bmt.1705200] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Children with Philadelphia chromosome positive (Ph+) acute lymphocytic leukemia (ALL) have only a 20% event-free survival when treated with chemotherapy alone. Bone marrow transplant (BMT) for patients with matched siblings has been associated with significantly better long-term survival. We asked whether children who lack a matched sibling donor would do as well if an alternative donor was utilized. Between 1987 and 2002, we transplanted 29 children and adolescents using either an unrelated donor (23) or a mismatched family member (six). The conditioning regimen included cytosine-arabinoside, cyclophosphamide and total body irradiation. Graft-versus-host disease (GVHD) prophylaxis consisted of T-cell depletion (antibody T10B9 or OKT3 and complement) with post transplant cyclosporine (CSA). All patients engrafted. Four developed grades III-IV acute GVHD. Three of 24 evaluable patients developed extensive chronic GVHD. Two patients died of relapse (7%). Two long-term survivors (>6 years) died of malignant glioblastoma multiforme. Event-free survival at 3, 5, and 10 years is 56, 51, and 46%, respectively. Five of six patients in >CR2 or relapse at the time of transplant died. Our data should encourage the use of alternative donor transplants early in the course of disease for children with Ph+ ALL.
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Affiliation(s)
- J M Talano
- Department of Pediatric Hematology, Oncology, Bone Marrow Transplant, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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26
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Eapen M, Giralt SA, Horowitz MM, Klein JP, Wagner JE, Zhang MJ, Tallman MS, Marks DI, Camitta BM, Champlin RE, Ringdén O, Bredeson CN, Martino R, Gale RP, Cairo MS, Litzow MR, deLima M. Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant. Bone Marrow Transplant 2004; 34:721-7. [PMID: 15322568 DOI: 10.1038/sj.bmt.1704645] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36-48)% and 30 (24-36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23-34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (< or =20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.
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Affiliation(s)
- M Eapen
- Statistical Center, International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, 8701 Watertown Plank Road, PO Box 26509, Milwaukee, WI 53226, USA.
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27
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Schwake CJ, Eapen M, Horowitz MM, Loberiza FR. Differences in characteristics of United States hematopoietic stem cell transplant (HSCT) centers by proportion of ethnic minorities. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. J. Schwake
- Medical College of Wisconsin, Milwaukee, WI; International Bone Marrow Transplant Registry, Milwaukee, WI
| | - M. Eapen
- Medical College of Wisconsin, Milwaukee, WI; International Bone Marrow Transplant Registry, Milwaukee, WI
| | - M. M. Horowitz
- Medical College of Wisconsin, Milwaukee, WI; International Bone Marrow Transplant Registry, Milwaukee, WI
| | - F. R. Loberiza
- Medical College of Wisconsin, Milwaukee, WI; International Bone Marrow Transplant Registry, Milwaukee, WI
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28
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Loberiza FR, Zhang M, Rizzo JD, Lee SJ, Klein JP, Logan BR, Eapen M, Serna DS, Lemaistre CF, Horowitz MM. Patient and transplant center factors associated with 100D mortality after receiving allogeneic hematopoietic stem cell transplantation (HSCT). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. R. Loberiza
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - M. Zhang
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - J. D. Rizzo
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - S. J. Lee
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - J. P. Klein
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - B. R. Logan
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - M. Eapen
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - D. S. Serna
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - C. F. Lemaistre
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
| | - M. M. Horowitz
- International Bone Marrow Transplant Registry, Milwaukee, WI; Dana-Farber Cancer Institute, Boston, MA; Texas Transplant Institute, San Antonio, TX
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29
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Eapen M, Ramsay NK, Mertens AC, Robison LL, DeFor T, Davies SM. Late outcomes after bone marrow transplant for aplastic anaemia. Br J Haematol 2000; 111:754-60. [PMID: 11122134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Allogeneic transplantation is effective in reconstituting haemopoiesis in severe aplastic anaemia (SAA). We report long-term health-related outcomes in 37 children and young adults with SAA transplanted between 1975 and 1996. The median length of follow-up was 17 years (range, 4-25 years). Using a case-control design, late social and medical outcomes in transplant recipients were compared with 146 control subjects matched for gender and age. The majority of patients received an irradiation-containing preparative regimen. There were no significant differences in the self-rating of health status between transplant recipients and controls (P = 0.8), with 71% reporting their health status as excellent and 29% as good compared with 74% and 26% of controls. They demonstrate the same normal psychosexual function as their peers and have similar educational achievements and employment history. Transplant recipients and controls are equally likely to have held a job or be currently employed and there are no significant differences in their personal income (OR = 0.60, 95% CI = 0.11-3.37). Although transplant recipients have had problems related to health insurance policies, the majority have adequate health insurance coverage. There were no differences in chronic health problems between transplant recipients and control subjects, except for expected increases in cataracts, short stature in men, hypothyroidism and gonadal dysfunction. Using self-assessment, these transplant recipients indicated an excellent level of satisfaction and social integration, showing transplantation to be an effective long-term therapy for SAA.
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Affiliation(s)
- M Eapen
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
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30
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Abstract
Late graft rejection following allogeneic bone marrow transplantation (BMT) for aplastic anaemia is a significant clinical problem and is associated with a high risk of mortality. We report two children with severe aplastic anaemia (SAA) who developed very late graft rejection 2 years and 4 months and 10 years respectively after allogeneic BMT from HLA-identical siblings. Following a second BMT from their initial donors, engraftment has been sustained in both cases. The patients are alive with full donor chimaerism, 18 and 19 years from initial transplant. These cases illustrate that graft failure can be an extremely late event after allogeneic BMT for SAA, and that long-term sustained engraftment can be achieved in these patients with second BMT from the original donors.
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Affiliation(s)
- M Eapen
- Department of Pediatrics and Blood and Marrow Transplant Program, University of Minnesota, Minneapolis 55455, USA
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31
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Eapen M, Hostetter M, Neglia JP. Massive splenomegaly and Epstein-Barr virus-associated infectious mononucleosis in a patient with Gaucher disease. J Pediatr Hematol Oncol 1999; 21:47-9. [PMID: 10029812] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE Gaucher disease should be considered in the differential diagnosis of a patient with Epstein-Barr virus (EBV) infection who has unexplained or disproportionate splenomegaly. PATIENTS AND METHODS A previously asymptomatic adolescent with EBV-associated infectious mononucleosis and massive splenomegaly is described. He was found to have Gaucher disease on bone marrow biopsy, which was performed to exclude a hematologic malignancy. The diagnosis was confirmed by assay of beta-glucosidase enzyme activity. RESULTS Regression of splenomegaly and improving hematologic indices. CONCLUSION Patients with infectious mononucleosis and disproportionate organomegaly should be investigated to exclude a hematologic malignancy or an underlying storage disorder such as Gaucher disease.
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Affiliation(s)
- M Eapen
- Department of Hematology/Oncology, University of Minnesota, Minneapolis, USA
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Abstract
Infantile osteopetrosis is a lethal disorder resulting from a severe defect in the ability of osteoclasts to resorb bone. The only therapy shown to be capable of providing lasting benefit is allogeneic hematopoietic stem cell transplantation (HCT). We report the outcome of 10 patients with infantile malignant osteopetrosis treated with HCT from an HLA A, B, DRB1 matched (n=6) or A or B locus mismatched (n=4) family member or unrelated donor at the University of Minnesota between 1978 and 1997. Eight of 10 patients achieved primary engraftment; secondary graft failure was seen in two patients. Five of 10 patients survive; three with full or partial donor chimerism and two with autologous hematological recovery. Transient or partial donor chimerism can be sufficient to correct the hematological manifestations of osteopetrosis. We recommend early referral for consideration of HCT with a related or unrelated donor as neurosensory manifestations of osteopetrosis are generally not reversible. Donor engraftment may be easier to achieve early in the course of the disease.
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Affiliation(s)
- M Eapen
- Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA
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Koshi G, Eapen M, Singh G. Brucellosis--an oft forgotten clinical entity. Indian J Med Sci 1971; 25:324-8. [PMID: 5559180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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