1
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Mellgren K, Nicolajsen T, Christoforaki TP, Juan SM, Mårtensson T, Toporski J, Casswall TH, Gustafsson B. A retrospective case-control study of gastrostomy use in children undergoing hematopoietic cell transplantation. Pediatr Transplant 2023; 27:e14520. [PMID: 37087694 DOI: 10.1111/petr.14520] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/23/2023] [Accepted: 03/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Maintaining a good nutritional status during the hematopoietic cell transplantation (HCT) procedure is challenging in the pediatric population. METHODS In a multicentric retrospective study, we compared the outcome of nutritional status and HCT-related parameters in 227 pediatric patients during and after HCT between 2005 and 2015. 112 patients received a gastrostomy before the start of HCT (GS group), and 115 did not receive a gastrostomy (NGS). Data collection was performed at HCT, 3, 6, and 12 months post-HCT. RESULTS At time point of HCT the Standard Deviation Score (SDS) of weight was 0.17 in the NGS group, and 0.71 in the GS group (p = .01) Patients in the NGS group lost more weight during the first 3 months after HCT than patients in the GS group. At 12 months, patients in the NGS remained at a lower weight, while patients in the GS group slightly increased their weight. There were no differences between the groups in the incidence of acute graft-versus-host-disease (GvHD), overall survival, and non-relapse mortality. However, the number of febrile episodes requiring intravenous treatment with antibiotics, was higher in the GS group as compared to the NGS group, during the first 3 months post-HCT (p < .001). CONCLUSIONS Our results indicate that gastrostomy can be utilized in children undergoing HCT without any negative effects on mortality. Therefore, the use of a gastrostomy appears to be a safe option to maintain a good nutritional status during the HCT procedure.
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Affiliation(s)
- Karin Mellgren
- Department of Pediatric Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tom Nicolajsen
- Department of Paediatrics, NU-Sjukvården, Trollhättan, Sweden
| | | | - Sara Marin Juan
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Mårtensson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jacek Toporski
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Thomas H Casswall
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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2
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Sadeghi B, Ringdén O, Gustafsson B, Castegren M. Mesenchymal stromal cells as treatment for acute respiratory distress syndrome. Case Reports following hematopoietic cell transplantation and a review. Front Immunol 2022; 13:963445. [PMID: 36426365 PMCID: PMC9680556 DOI: 10.3389/fimmu.2022.963445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening lung disease. It may occur during the pancytopenia phase following allogeneic hematopoietic cell transplantation (HCT). ARDS is rare following HCT. Mesenchymal stromal cells (MSCs) have strong anti-inflammatory effect and first home to the lung following intravenous infusion. MSCs are safe to infuse and have almost no side effects. During the Covid-19 pandemic many patients died from ARDS. Subsequently MSCs were evaluated as a therapy for Covid-19 induced ARDS. We report three patients, who were treated with MSCs for ARDS following HCT. Two were treated with MSCs derived from the bone marrow (BM). The third patient was treated with MSCs obtained from the placenta, so-called decidua stromal cells (DSCs). In the first patient, the pulmonary infiltrates cleared after infusion of BM-MSCs, but he died from multiorgan failure. The second patient treated with BM-MSCs died of aspergillus infection. The patient treated with DSCs had a dramatic response and survived. He is alive after 7 years with a Karnofsky score of 100%. We also reviewed experimental and clinical studies using MSCs or DSCs for ARDS. Several positive reports are using MSCs for sepsis and ARDS in experimental animals. In man, two prospective randomized placebo-controlled studies used adipose and BM-MSCs, respectively. No difference in outcome was seen compared to placebo. Some pilot studies used MSCs for Covid-19 ARDS. Positive results were achieved using umbilical cord and DSCs however, optimal source of MSCs remains to be elucidated using randomized trials.
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Affiliation(s)
- Behnam Sadeghi
- Translational Cell Therapy Research (TCR), Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Behnam Sadeghi,
| | - Olle Ringdén
- Translational Cell Therapy Research (TCR), Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Markus Castegren
- Center for Clinical Research, Sörmland, Uppsala University, Uppsala, Sweden
- Department of Anesthesiology and Intensive Care, CLINTEC, Karolinska Institutet, Stockholm, Sweden
- Section of Infectious Diseases, Department of Medical Science, Uppsala University, Uppsala, Sweden
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3
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Ringdén O, Moll G, Gustafsson B, Sadeghi B. Mesenchymal Stromal Cells for Enhancing Hematopoietic Engraftment and Treatment of Graft-Versus-Host Disease, Hemorrhages and Acute Respiratory Distress Syndrome. Front Immunol 2022; 13:839844. [PMID: 35371003 PMCID: PMC8973075 DOI: 10.3389/fimmu.2022.839844] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/17/2022] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) possess profound immunomodulatory and regenerative properties that are of clinical use in numerous clinical indications with unmet medical need. Common sources of MSCs include among others, bone marrow (BM), fat, umbilical cord, and placenta-derived decidua stromal cells (DSCs). We here summarize our more than 20-years of scientific experience in the clinical use of MSCs and DSCs in different clinical settings. BM-MSCs were first explored to enhance the engraftment of autografts in hematopoietic cell transplantation (HCT) and osteogenesis imperfecta around 30 years ago. In 2004, our group reported the first anti-inflammatory use of BM-MSCs in a child with grade IV acute graft-versus-host disease (GvHD). Subsequent studies have shown that MSCs appear to be more effective in acute than chronic GvHD. Today BM-MSC-therapy is registered for acute GvHD in Japan and for GvHD in children in Canada and New Zeeland. MSCs first home to the lung following intravenous injection and exert strong local and systemic immunomodulatory effects on the host immune system. Thus, they were studied for ameliorating the cytokine storm in acute respiratory distress syndrome (ARDS). Both, MSCs and DSCs were used to treat SARS-CoV-2 coronavirus-induced disease 2019 (COVID-19)-induced ARDS. In addition, they were also used for other novel indications, such as pneumomediastinum, colon perforation, and radiculomyelopathy. MSC and DSCs trigger coagulation and were thus explored to stop hemorrhages. DSCs appear to be more effective for acute GvHD, ARDS, and hemorrhages, but randomized studies are needed to prove superiority. Stromal cell infusion is safe, well tolerated, and only gives rise to a slight fever in a limited number of patients, but no major side effects have been reported in multiple safety studies and metaanalysis. In this review we summarize current evidence from in vitro studies, animal models, and importantly our clinical experience, to support stromal cell therapy in multiple clinical indications. This encloses MSC’s effects on the immune system, coagulation, and their safety and efficacy, which are discussed in relation to prominent clinical trials within the field.
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Affiliation(s)
- Olle Ringdén
- Translational Cell Therapy Research Group, Department of Clinical Sciences, Intervention and Technology (CLNTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Olle Ringdén, ; Guido Moll, ; Britt Gustafsson, ; Behnam Sadeghi,
| | - Guido Moll
- Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT) and Berlin-Brandenburg School for Regenerative Therapies (BSRT), Berlin, Germany
- Department of Nephrology and Internal Intensive Care Medicine, All Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- *Correspondence: Olle Ringdén, ; Guido Moll, ; Britt Gustafsson, ; Behnam Sadeghi,
| | - Britt Gustafsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Olle Ringdén, ; Guido Moll, ; Britt Gustafsson, ; Behnam Sadeghi,
| | - Behnam Sadeghi
- Translational Cell Therapy Research Group, Department of Clinical Sciences, Intervention and Technology (CLNTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Olle Ringdén, ; Guido Moll, ; Britt Gustafsson, ; Behnam Sadeghi,
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4
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Leijonhufvud G, Bajalan A, Teixeira Soratto TA, Gustafsson B, Bogdanovic G, Bjerkner A, Allander T, Ljungman G, Andersson B. Better detection of Torque teno virus in children with leukemia by metagenomic sequencing than by quantitative PCR. J Med Virol 2021; 94:634-641. [PMID: 34672369 DOI: 10.1002/jmv.27409] [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: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 11/11/2022]
Abstract
Torque teno virus (TTV) is a group of chronically persisting viruses with a short circular DNA genome. TTV demonstrates a wide sequence diversity and a large majority of humans are chronically infected by one or more types of TTV. As TTV is ubiquitous, and viral replication correlates with immune status, TTV has been studied as a marker to assess global functional immune competence in transplant recipients. Most studies of the prevalence, amounts, and variation in TTV have been performed using PCR assays. We here present a comparison of the most frequently used quantitative PCR (qPCR) assay for TTV with shotgun metagenomic sequencing for detection and characterization of TTV in a cohort of pediatric cancer patients. The results show that TTV is more common than the qPCR assays indicate, and analysis of the TTV genome sequences indicate that a qPCR with primers and probe designed on a conserved region of the TTV genome may fail to detect some of the TTV strains found in this study.
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Affiliation(s)
- Gustaf Leijonhufvud
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Pediatric Hematology/Oncology, Children's University Hospital, Uppsala, Sweden
| | - Amanj Bajalan
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Tatiany Aparecida Teixeira Soratto
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Microbiology, Immunology, and Parasitology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Britt Gustafsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Gordana Bogdanovic
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Annelie Bjerkner
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Allander
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Björn Andersson
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
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5
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Rodriguez-Wallberg KA, Milenkovic M, Papaikonomou K, Keros V, Gustafsson B, Sergouniotis F, Wikander I, Perot R, Borgström B, Ljungman P, Barbany G. Successful pregnancies after transplantation of ovarian tissue retrieved and cryopreserved at time of childhood acute lymphoblastic leukemia - A case report. Haematologica 2021; 106:2783-2787. [PMID: 34233451 PMCID: PMC8485665 DOI: 10.3324/haematol.2021.278828] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm.
| | - Milan Milenkovic
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm
| | - Kiriaki Papaikonomou
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm
| | - Victoria Keros
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm
| | - Britt Gustafsson
- Department of Women's and Children's Health, Division of Pediatric Oncology, Karolinska Institutet, Stockholm
| | - Fotios Sergouniotis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm
| | - Ida Wikander
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm
| | - Ronak Perot
- Department of Gynecology, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm
| | - Birgit Borgström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm
| | - Per Ljungman
- Dept. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm
| | - Gisela Barbany
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Clinical Genetics, Laboratory Division Karolinska University Hospital, Stockholm
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6
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Mårtensson T, Szakos A, Mellgren K, Toporski J, Arvidson J, Mattsson J, Gustafsson B, Casswall TH. Diagnostic disagreement between clinical standard histopathological- and retrospective assessment of histopathology-based gastrointestinal graft-versus-host disease in children. Pediatr Transplant 2020; 24:e13824. [PMID: 33085820 DOI: 10.1111/petr.13824] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD) METHODS: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology-based GI-GVHD diagnosis by the NIH 2014. RESULTS Seventy children with 92 endoscopic occasions (including 22 re-endoscopies) were enrolled. GI-GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI-GVHD and 52% (22/42) with non-GI-GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI-GVHD solely detected in RIHA or detection of GI-GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re-endoscopy was higher in endoscopic occasions with GI-GVHD detected in RIHA but not in CSHA vs if non-GI-GVHD were detected in both readings (P = .005). CONCLUSION Our results suggest that in children with symptom-based GI-GVHD without histopathological confirmation in CSHA, a second, NIH 2014 based histopathological assessment should be considered before performing a re-endoscopy.
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Affiliation(s)
- Thomas Mårtensson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Attila Szakos
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Mellgren
- Department of Pediatric Oncology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jacek Toporski
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Johan Arvidson
- Department of Women´s and Children´s Health, Uppsala University Children´s Hospital, Uppsala, Sweden
| | - Jonas Mattsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Thomas H Casswall
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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7
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El-Serafi A, He R, Zheng W, Benkossou F, Oerther S, Zhao Y, Mellgren K, Gustafsson B, Heilmann C, Kanerva J, Lotfi K, Toporski J, Sundin M, Höglund M, Mattsson J, El-Serafi I, Hassan M. Vitamin D levels and busulphan kinetics in patients undergoing hematopoietic stem cell transplantation, a multicenter study. Bone Marrow Transplant 2020; 56:807-817. [PMID: 33087877 DOI: 10.1038/s41409-020-01091-y] [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] [Received: 05/14/2020] [Revised: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022]
Abstract
Vitamin D (Vit-D), an essential nutrient, interacts with different drugs including chemotherapeutic agents like busulphan, an alkylating agent used for conditioning prior to stem cell transplantation. The correlation between Vit-D plasma levels and busulphan clearance was investigated in an uncontrolled prospective study in patients and mice. Plasma 25(OH)D levels were measured and busulphan pharmacokinetics calculated in 81 patients. Adults received oral busulphan (n = 34) while children received busulphan orally (n = 19) or intravenously (n = 28). Patients received no Vit-D supplementation. To confirm our findings, pharmacokinetics after a single dose of busulphan (oral or intravenous) were evaluated in two groups of mice (n = 60) receiving high or standard-level Vit-D supplementation. Both busulphan clearance (P < 0.0001) and 25(OH)D levels (P = 0.0004) were significantly higher in adults compared to children. A significant negative correlation (P = 0.041) was found between busulphan clearance and 25(OH)D levels in children treated orally. No such correlation was observed in adults or in children receiving intravenous busulphan. In addition, no significant effect of Vit-D levels on busulphan pharmacokinetics in mice regardless of the administration route. In conclusion, 25(OH)D can affect oral busulphan pharmacokinetics in children and its level should be considered when personalizing oral busulphan treatment. Further studies are warranted to confirm the underlying mechanisms.
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Affiliation(s)
- Ahmed El-Serafi
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Rui He
- Experimental Cancer Medicine, Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Research Center and Center of Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Wenyi Zheng
- Experimental Cancer Medicine, Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Research Center and Center of Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Fadwa Benkossou
- Experimental Cancer Medicine, Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Research Center and Center of Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Sandra Oerther
- Experimental Cancer Medicine, Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Pre-clinical Laboratory, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Ying Zhao
- Experimental Cancer Medicine, Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Research Center and Center of Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Karin Mellgren
- Department of Pediatric Oncology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Britt Gustafsson
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Carsten Heilmann
- Pediatric Clinic, Rigshospitalet, National University Hospital, Copenhagen, Denmark
| | - Jukka Kanerva
- HUS Helsinki University Hospital and University of Helsinki, New Children's Hospital, Division of Hematology-Oncology and Stem Cell Transplantation, Helsinki, Finland
| | - Kourosh Lotfi
- Clinical Pharmacology, Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Hematology, Linköping University Hospital, Linköping, Sweden
| | - Jacek Toporski
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Mikael Sundin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Section of Pediatric Hematology, Immunology and HCT, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Mattsson
- Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, University of Toronto, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Ibrahim El-Serafi
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Biochemistry, Faculty of Medicine, Port-Said University, Port-Said, Egypt
| | - Moustapha Hassan
- Experimental Cancer Medicine, Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Clinical Research Center and Center of Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital Huddinge, Stockholm, Sweden.
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8
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Ringdén O, Gustafsson B, Sadeghi B. Mesenchymal Stromal Cells in Pediatric Hematopoietic Cell Transplantation a Review and a Pilot Study in Children Treated With Decidua Stromal Cells for Acute Graft-versus-Host Disease. Front Immunol 2020; 11:567210. [PMID: 33193339 PMCID: PMC7604265 DOI: 10.3389/fimmu.2020.567210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) are rare precursors in all organs of the body. MSCs have profound anti-inflammatory effects and reduce alloreactivity in vitro and in vivo. In pediatric allogeneic hematopoietic cell transplantation (HCT), MSCs have mainly been used to treat acute graft-versus-host disease (GVHD). MSCs are commercially available for this indication in Canada, Japan, and New Zeeland. More rare indications for MSCs in pediatric patients include graft failure and chronic GVHD. MSCs from bone marrow, adipose tissue, umbilical cord, Wharton's jelly, placenta tissue, and decidua have been used, but the optimal clinical stromal cell source has not been compared in clinical trials. More experimental clinical indications using MSCs, such as sepsis, acute respiratory distress syndrome, hemorrhages, pneumo-mediastinum, and neuroinflammation have primarily been explored in animal models or adult HCT patients. MSCs have almost no if any side-effects. In this pilot study we report the outcome of six children treated with decidua stromal cells (DSCs) for steroid refractory acute GVHD. At 6 months, complete response was seen in four patients and partial response in two patients. One child with high-risk ALL died from relapse and a boy with sickle cell disease died from a cerebral hemorrhage. Five-year survival was 67% and all survivors showed a Lansky score of 100%. To conclude, MSCs from various organs are well-tolerated and have shown an encouraging outcome for acute GVHD in pediatric patients.
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Affiliation(s)
- Olle Ringdén
- Translational Cell Therapy Research (TCR), Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Division of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Behnam Sadeghi
- Translational Cell Therapy Research (TCR), Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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9
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Hentati-Sundberg J, Raymond C, Sköld M, Svensson O, Gustafsson B, Bonaglia S. Fueling of a marine-terrestrial ecosystem by a major seabird colony. Sci Rep 2020; 10:15455. [PMID: 32963305 PMCID: PMC7508978 DOI: 10.1038/s41598-020-72238-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
Seabirds redistribute nutrients between different ecosystem compartments and over vast geographical areas. This nutrient transfer may impact both local ecosystems on seabird breeding islands and regional biogeochemical cycling, but these processes are seldom considered in local conservation plans or biogeochemical models. The island of Stora Karlsö in the Baltic Sea hosts the largest concentration of piscivorous seabirds in the region, and also hosts a large colony of insectivorous House martins Delichon urbicum adjacent to the breeding seabirds. We show that a previously reported unusually high insectivore abundance was explained by large amounts of chironomids—highly enriched in δ15N—that feed on seabird residues as larvae along rocky shores to eventually emerge as flying adults. Benthic ammonium and phosphate fluxes were up to 163% and 153% higher close to the colony (1,300 m distance) than further away (2,700 m) and the estimated nutrient release from the seabirds at were in the same order of magnitude as the loads from the largest waste-water treatment plants in the region. The trophic cascade impacting insectivorous passerines and the substantial redistribution of nutrients suggest that seabird nutrient transfer should be increasingly considered in local conservation plans and regional nutrient cycling models.
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Affiliation(s)
- J Hentati-Sundberg
- Department of Aquatic Resources, Institute of Marine Research, Swedish University of Agricultural Sciences, Turistgatan 5, 45330, Lysekil, Sweden.
| | - C Raymond
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
| | - M Sköld
- Department of Aquatic Resources, Institute of Marine Research, Swedish University of Agricultural Sciences, Turistgatan 5, 45330, Lysekil, Sweden
| | - O Svensson
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden
| | - B Gustafsson
- Baltic Nest Institute, Baltic Sea Centre, Stockholm University, Stockholm, Sweden.,Tvärminne Zoological Station, University of Helsinki, Hankko, Finland
| | - S Bonaglia
- Department of Ecology, Environment and Plant Sciences, Stockholm University, Stockholm, Sweden.,Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
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10
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Borgström B, Fridström M, Gustafsson B, Ljungman P, Rodriguez-Wallberg KA. A prospective study on the long-term outcome of prepubertal and pubertal boys undergoing testicular biopsy for fertility preservation prior to hematologic stem cell transplantation. Pediatr Blood Cancer 2020; 67:e28507. [PMID: 32649054 DOI: 10.1002/pbc.28507] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 12/21/2019] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Few studies have reported the long-term outcomes of prepubertal and pubertal boys undergoing testicular biopsy for fertility preservation (FP). PROCEDURE This prospective longitudinal study examined 21 boys (aged 1.5-14.5 years) who underwent testicular biopsy for FP prior to allogeneic (n = 20) or autologous (n = 1) hematological stem cell transplantation (HSCT) between 2003 and 2010. During counseling, pubertal boys were encouraged to produce a sperm sample by masturbation , while prepubertal boys were presented with surgical testicular tissue retrieval as an option for experimental FP. Clinical outcomes included postoperative complications, pubertal development, and sex-hormone levels. Survivors approaching adulthood were encouraged to provide semen samples. RESULTS Twenty boys, including 14 in prepuberty and six in early puberty (Tanner stage 2-3), underwent open testicular biopsies. Two pubertal biopsies contained mature sperms, which were cryopreserved. Testicular tissue was vitrified in the remaining 18 cases. One pubertal boy (Tanner stage 4) underwent percutaneous testicular sperm aspiration and sperms obtained were cryopreserved. Postoperative complications (hematoma or infection) were rare. Overall, 14 boys survived >5 years (mean follow-up after HSCT, 7.2 years) and 11 showed advanced puberty. Semen samples were provided by five boys and obtained sperm were cryopreserved from two. Individuals at adulthood had normal testosterone levels but subnormal testicular size, high follicle stimulating hormone, and low inhibin B and anti-Müllerian hormone levels. CONCLUSION No long-term risks were detected during continuous clinical follow-up. Experimental testicular biopsies for FP were well accepted by the patients and families, despite the absence of methods to use prepubertal tissue for fertility treatment.
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Affiliation(s)
- Birgit Borgström
- Department of Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden.,Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Fridström
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Gustafsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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11
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Mårtensson T, Mellgren K, Toporski J, Arvidson J, Szakos A, Casswall TH, Gustafsson B. Clinical relevance of endoscopy with histopathological assessment in children with suspected gastrointestinal graft-versus-host disease. Clin Transplant 2020; 34:e13867. [PMID: 32248590 DOI: 10.1111/ctr.13867] [Citation(s) in RCA: 4] [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: 01/07/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/22/2022]
Abstract
Endoscopy with histopathological assessment is an established practice to confirm gastrointestinal graft-versus-host disease (GI-GVHD). However, the clinical relevance of this approach in children is incompletely evaluated. In a retrospective cohort study, we investigated the frequency of treatment changes in response to histopathological findings in all children (<18 years) in Sweden who underwent endoscopy for suspected GI-GVHD (2000-2013) after receiving hematopoietic stem cell transplantation. Sixty-eight children with ninety-one endoscopic occasions were enrolled. At the time of endoscopy, anti-GI-GVHD treatment was ongoing in 71% (65/91). In 18% (12/65) with ongoing treatment, no histopathological evidence of GI-GVHD or another cause to justify anti-GI-GVHD treatment was found. In 48% (44/91), endoscopy with histopathological assessment led to changes in the treatment regimen. Re-endoscopy was more frequent among those with treatment changes, versus unchanged treatment, 39% (17/44) and 13% (6/47), respectively (P = .007). Histopathological findings generating treatment changes were as follows: GI-GVHD in 68% (30/44), normal histology in 25% (11/44), and an alternative diagnosis in 7% (3/44). In conclusion, this study supports that endoscopy with histopathological assessment should be considered in all children with suspected GI-GVHD.
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Affiliation(s)
- Thomas Mårtensson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karin Mellgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jacek Toporski
- Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Johan Arvidson
- Department of Women´s and Children´s Health, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Attila Szakos
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas H Casswall
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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12
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Ahmed M, Tegnebratt T, Tran T, Damberg P, Bone D, Lu L, Gistera A, Tarnawski L, Hedin U, Eriksson P, Holmin S, Gustafsson B, Caidahl K. P1217Zirconium-89 labelled probe for molecular imaging of inflammation in experimental atherosclerosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Early detection of inflamed atherosclerotic lesions by molecular imaging might improve risk assessment beyond that of vascular stenosis and plaque morphology imaging, and improve the clinical management of high-risk patients.
Purpose
To target the key features of unstable atherosclerotic lesions, we studied the feasibility of our radiotracer, based on modified human serum albumin (HSA), to identify inflamed atherosclerotic lesions by in vivo molecular imaging.
Methods
We applied a maleylated HSA (Mal-HSA) probe, recognised by scavenger receptors on macrophages, in an experimental in vivo imaging study of atherosclerosis. Mal-HSA was coupled with a positron-emittingmetal ion, Zirconium-89 (89Zr). The targeting potential of this probe was evaluated and compared with unspecific 89Zr-HSA and 18F-FDG in a mouse model of atherosclerosis (Apoe−/−, n=22) and compared with wild-type (WT) mice (C57BL/6, n=21) as controls. Radiotracer accumulation in the aortic arch was analysed in vivo by the fusion of positron emission tomography–magnetic resonance imaging (PET-MRI), radiotracer bio-distribution was measured ex vivo by gamma counter, and plaque uptake was evaluated by phosphor imaging (PI) autoradiography (ARG).
Results
PET-MRI, gamma counter measurements, and PI-ARG showed the accumulation of 89Zr-Mal-HSA in the atherosclerotic lesions of Apoe−/− mice. The maximum standardised uptake value (SUVmax) for 89Zr-Mal-HSA at 16 and 20 weeks were 26% and 20% higher (P<0.05) in Apoe−/− mice than control WT mice, whereas no difference in SUVmax was found for 18F-FDG in the same animals. 89Zr-Mal-HSA uptake in the aorta as evaluated by gamma counter 48 h post-injection was 32% higher (P<0.01) for Apoe−/− mice compared to WT mice, and the aorta-to-blood ratio was 10-fold higher (P<0.001) for 89Zr-Mal-HSA compared with unspecific 89Zr-HSA. HSA probes were mainly distributed to the liver, spleen, kidneys, bone and lymph nodes. The PI-ARG results corroborated the PET and gamma counter measurements, showing higher accumulation of 89Zr-Mal-HSA in the aortas of Apoe−/− mice compared to WT mice; 9.4±1.4 vs 0.8±0.3% (P<0.001).
Conclusions
The modified HSA-based radiotracer showed in vivo targeting of inflamed atherosclerotic lesions of mouse aorta, which could also be verified ex vivo. 89Zr-Mal-HSA seems to be a promising diagnostic tool for the identification of vascular inflammation. Further methodological studies are needed to verify its applicability for detecting rupture-prone plaques.
Acknowledgement/Funding
Swedish Research Council (22036); the Swedish HLF (20150423, 20170669); ALF (20150517, 447561, 726481); Söderberg Foundations, VINNOVA and KI
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Affiliation(s)
- M Ahmed
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - T Tegnebratt
- Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden
| | - T Tran
- Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden
| | - P Damberg
- Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden
| | - D Bone
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - L Lu
- Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden
| | - A Gistera
- Karolinska Institute, Department of Medicine Solna, Stockholm, Sweden
| | - L Tarnawski
- Karolinska Institute, Department of Medicine Solna, Stockholm, Sweden
| | - U Hedin
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - P Eriksson
- Karolinska Institute, Department of Medicine Solna, Stockholm, Sweden
| | - S Holmin
- Karolinska Institute, Department of Clinical Neuroscience, Stockholm, Sweden
| | - B Gustafsson
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - K Caidahl
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
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13
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Sadeghi B, Remberger M, Gustafsson B, Winiarski J, Moretti G, Khoein B, Klingspor L, Westgren M, Mattsson J, Ringdén O. Long-Term Follow-Up of a Pilot Study Using Placenta-Derived Decidua Stromal Cells for Severe Acute Graft-versus-Host Disease. Biol Blood Marrow Transplant 2019; 25:1965-1969. [PMID: 31173898 DOI: 10.1016/j.bbmt.2019.05.034] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/26/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023]
Abstract
There is a need for effective therapy with few side effects for severe acute graft-versus-host disease (GVHD). The placenta protects the fetus from the mother's haploidentical immune system during pregnancy. We found that maternal stromal cells from the fetal membrane, so-called decidua stromal cells (DSCs), are more immunosuppressive than other sources of stromal cells. We prospectively treated 21 patients (median age, 49 years; range, 1.6 to 72 years) for grade II-IV acute GVHD. All 21 patients had biopsy-proven gastrointestinal GVHD. The majority of patients were either steroid-refractory or had progressive GVHD, 11 patients after >7 days or with progression after 3 days, and 10 were refractory to steroids after >3 days. We used an improved protocol in which DSCs were thawed and infused in a buffer with 5% human albumin. DSCs were given at a median dose of 1.2 (range, 0.9 to 2.9) × 106 cells/kg body weight with a median of 2 (range, 1 to 6) doses, given 1 week apart. The median viability of thawed DSCs was 93% (range, 69% to 100%), and the median cell passage number was 4 (range, 2 to 4). Complete resolution of GVHD was seen in 11 patients, with a partial response in the other 10. The cumulative incidence of chronic GVHD was 52%. GVHD was mild in 6 patients, moderate in 4 patients, and severe in 1 patient based on National Institutes of Health chronic GVHD severity scoring. Nine patients died, including 3 from relapse and 1 each from acute GVHD and septicemia, Zygomycetes infection, liver insufficiency, cerebral hemorrhage, multiple organ failure, and chronic GVHD with obstructive bronchiolitis. Four-year transplantation-related mortality was 28.6%, and overall survival was 57%. Survival was similar (P = .33) to that for all 293 patients who underwent allogeneic hematopoietic cell transplantation during the same period (2012 to 2015), with 66% overall survival. DSC infusion is a novel therapy for acute GVHD grade II-IV, and a randomized trial is currently underway (ClinicalTrials.gov NCT02172937).
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Affiliation(s)
- Behnam Sadeghi
- Translational Cell Therapy Research, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Huddinge, Sweden.
| | - Mats Remberger
- Kliniska Forsknings- och Utvecklingsenheten, Verksamhetsområde Blod- och Tumörsjukdomar, Uppsala University Hospital, and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Britt Gustafsson
- Division of Pediatrics, CLINTEC, Karolinska Institute, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge, Sweden
| | - Jacek Winiarski
- Division of Pediatrics, CLINTEC, Karolinska Institute, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge, Sweden
| | - Gianluca Moretti
- Translational Cell Therapy Research, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Huddinge, Sweden
| | - Bita Khoein
- Translational Cell Therapy Research, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Huddinge, Sweden
| | - Lena Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Magnus Westgren
- Division of Obstetrics and Gynecology, CLINTEC, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden; Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Olle Ringdén
- Translational Cell Therapy Research, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Huddinge, Sweden
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14
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Sadeghi B, Remberger M, Gustafsson B, Winiarski J, Moretti G, Khoein B, Kingspor L, Westgren M, Mattsson J, Ringden O. Long-term follow up of a pilot study using placenta derived decidua stromal cells for severe acute graft versus host diseases. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.472] [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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15
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Ringden O, Remberger M, Gustafsson B, Winiarski J, Khoein B, Klingspor L, Westgren M, Mattsson J, Sadeghi B. Long Term Follow-up of a Pilot Study Using Placenta-Derived Decidua Stromal Cells for Severe Acute Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.246] [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]
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16
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Pou C, Barrientos-Somarribas M, Marin-Juan S, Bogdanovic G, Bjerkner A, Allander T, Gustafsson B, Andersson B. Virome definition in cerebrospinal fluid of patients with neurological complications after hematopoietic stem cell transplantation. J Clin Virol 2018; 108:112-120. [DOI: 10.1016/j.jcv.2018.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 01/16/2023]
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17
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Uggla L, Bonde LO, Hammar U, Wrangsjö B, Gustafsson B. Music therapy supported the health-related quality of life for children undergoing haematopoietic stem cell transplants. Acta Paediatr 2018; 107:1986-1994. [PMID: 30043415 PMCID: PMC6220970 DOI: 10.1111/apa.14515] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/17/2018] [Accepted: 07/23/2018] [Indexed: 01/11/2023]
Abstract
Aim Paediatric haematopoietic stem cell transplantation (HSCT) is a stressful treatment with an impact on health‐related quality of life (HRQoL), and supportive interventions are needed. This study evaluated the effects of music therapy during and after HSCT. Methods This was a randomised clinical pilot study of 29 patients aged 0–17 years who underwent HSCT at Karolinska University Hospital in Huddinge, Stockholm, Sweden, between February 2013 and May 2017. The music therapy group comprised 14 children who received the music therapy during hospitalisation. Fifteen children in the control group received the intervention after discharge. Music therapy was offered twice a week for four to six weeks. The patients’ HRQoL, pain and mood were evaluated at admission, discharge and after six months. The instruments for HRQoL included the Pediatric Quality of Life Inventory 4.0 generic core scales. Results The scales showed that the music therapy group had a higher estimated physical function (adjusted p = 0.04) at the time of discharge, and the control group showed improved results after the intervention in all domains (p = 0.015). Conclusion Despite the small sample, we found improved HRQoL after music therapy, which suggests that it could be a complementary intervention during and after paediatric HSCT.
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Affiliation(s)
- L Uggla
- Astrid Lindgren Children`s Hospital; Karolinska University Hospital-Huddinge; Stockholm Sweden
- Cell Therapy and Allogeneic Stem Cell Transplantation; Karolinska University Hospital-Huddinge; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology; CLINTEC; Karolinska Institutet; Stockholm Sweden
| | - L-O Bonde
- Department of Communication and Psychology; The Faculty of Humanities; Aalborg University; Aalborg Denmark
| | - U Hammar
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | | | - B Gustafsson
- Department of Clinical Science, Intervention and Technology; CLINTEC; Karolinska Institutet; Stockholm Sweden
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18
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Ringden O, Baygan A, Remberger M, Gustafsson B, Winiarski J, Khoein B, Moll G, Klingspor L, Westgren M, Sadeghi B. Placenta-Derived Decidua Stromal Cells for Treatment of Severe Acute Graft-Versus-Host Disease. Stem Cells Transl Med 2018. [PMID: 29533533 PMCID: PMC5866941 DOI: 10.1002/sctm.17-0167] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Severe acute graft‐versus‐host disease (GVHD) is a life‐threatening complication after allogeneic hematopoietic stem cell transplantation (HSCT). The placenta protects the fetus from the mother's immune system. We evaluated placenta‐derived decidua stromal cells (DSCs), which differ from bone marrow mesenchymal stromal cells (BM‐MSCs), as a treatment for severe acute GVHD. DSCs were obtained from term placentas. The DSCs were given to 38 patients with severe acute GVHD; 25 were steroid refractory (SR). DSCs were thawed and infused in buffer supplemented with either 10% AB plasma (group 1, n = 17), or 5% albumin (group 2, n = 21). The viability of cells was higher when thawed in albumin rather than AB plasma (p < .001). Group 1 received a higher cell dose (p < .001), cells of lower passage number (p < .001), and fewer infusions (p = .002) than group 2. The GVHD response (no/partial/complete) was 7/5/5 in group 1 and 0/10/11 in group 2 (p = .01). One‐year survival in the two groups was 47% (95% confidence interval [CI] 23–68) and 76% (95% CI 51–89), respectively (p = .016). For the SR patients, 1‐year survival was 73% (95% CI 37–90) in SR group 2 (n = 11), which was better than 31% (95% CI 11–54) in SR group 1 (n = 13; p = .02), 20% (95% CI 5–42) in BM‐MSC treated (n = 15; p = .0015), and 3% (95% CI 0–14) in historic controls (n = 32; p < .001). DSCs are a promising new treatment for severe acute GVHD. Prospective randomized trials are needed for evaluation of efficacy. (Clinical trial NCT‐02172937.) stemcellstranslationalmedicine2018;7:325–332
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Affiliation(s)
- Olle Ringden
- Translational Cell Therapy Research (TCR), Department of Laboratory Medicine
| | - Arjang Baygan
- Translational Cell Therapy Research (TCR), Department of Laboratory Medicine
| | - Mats Remberger
- Center for Allogeneic Stem Cell Transplantation, Department of Oncology and Pathology
| | - Britt Gustafsson
- Division of Pediatrics, Department of Clinical Intervention and Technology, CLINTEC
| | - Jacek Winiarski
- Division of Pediatrics, Department of Clinical Intervention and Technology, CLINTEC
| | - Bita Khoein
- Translational Cell Therapy Research (TCR), Department of Laboratory Medicine
| | - Guido Moll
- Berlin-Brandenburg Center and School for Regenerative Therapies (BCRT/BSRT), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Lena Klingspor
- Division of Clinical Microbiology, Department of Laboratory Medicine, CLINTEC, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Magnus Westgren
- Division of Obstetrics and Gynaecology, Department of Clinical Intervention and Technology, CLINTEC, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Behnam Sadeghi
- Translational Cell Therapy Research (TCR), Department of Laboratory Medicine
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19
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Uggla L, Svahn BM, Wrangsjö B, Gustafsson B. Music Therapy Effect Health Related Quality of Life in Children Undergoing Hsct; A Randomized Clinical Study. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.702] [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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20
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Gustafsson B, Frisk P, Szakos A, Sadeghi B, Ringdén O, Frost BM. Successful treatment with placenta-derived decidual stromal cells in a pediatric patient with life-threatening acute gastrointestinal graft-versus-host disease. Pediatr Transplant 2017; 21. [PMID: 28612364 DOI: 10.1111/petr.12990] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 12/14/2022]
Abstract
Severe aGvHD is a life-threatening complication after allogeneic HSCT. The GI tract is considered to play a key role in aGvHD, where the disease process can start and is one of the major target organs. Here, we present a case of a one-year-old child with a life-threatening GI-aGvHD stage IV, post-HSCT, resistant to steroids and MMF for 4 weeks. He was successfully treated with placenta-derived DSC.
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Affiliation(s)
- Britt Gustafsson
- Department of Clinical Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Pediatric Oncology, Children's University Hospital, Uppsala, Sweden
| | - Per Frisk
- Department of Women's and Children's Health, Pediatric Oncology, Children's University Hospital, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Attilla Szakos
- Department of Pathology and Cytologi, Karolinska University Hospital, Stockholm, Sweden
| | - Behnam Sadeghi
- Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ringdén
- Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Britt-Marie Frost
- Department of Women's and Children's Health, Pediatric Oncology, Children's University Hospital, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
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21
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Baygan A, Aronsson-Kurttila W, Moretti G, Tibert B, Dahllöf G, Klingspor L, Gustafsson B, Khoein B, Moll G, Hausmann C, Svahn BM, Westgren M, Remberger M, Sadeghi B, Ringden O. Safety and Side Effects of Using Placenta-Derived Decidual Stromal Cells for Graft-versus-Host Disease and Hemorrhagic Cystitis. Front Immunol 2017; 8:795. [PMID: 28744284 PMCID: PMC5504152 DOI: 10.3389/fimmu.2017.00795] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/22/2017] [Indexed: 11/13/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) are increasingly used in regenerate medicine. Placenta-derived decidual stromal cells (DSCs) are a novel therapy for acute graft-versus-host-disease (GVHD) and hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT). DSCs are more immunosuppressive than MSCs. We assessed adverse events and safety using DSCs among 44 treated patients and 40 controls. The median dose of infused cells was 1.5 (range 0.9–2.9) × 106 DSCs/kg. The patients were given 2 (1–5) doses, with a total of 82 infusions. Monitoring ended 3 months after the last DSC infusion. Three patients had transient reactions during DSC infusion. Laboratory values, hemorrhages, and transfusions were similar in the two groups. The frequency of leukemic relapse (2/2, DSC/controls) and invasive fungal infections (6/6) were the same in the two groups. Causes of death were those seen in HSCT patients: infections (5/3), respiratory failure (1/1), circulatory failure (3/1), thromboembolism (1/0), multiorgan failure (0/1), and GVHD and others (2/7). One-year survival for the DSC patients with GVHD was 67%, which was significantly better than achieved previously at our center. One-year survival was 90% in the DSC-treated HC group. DSC infusions appear safe. Randomized studies are required to prove efficacy.
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Affiliation(s)
- Arjang Baygan
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Wictor Aronsson-Kurttila
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Gianluca Moretti
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Babylonia Tibert
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Göran Dahllöf
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Klingspor
- Department of Microbiology, Uppsala University Hospital, Uppsala, Sweden
| | - Britt Gustafsson
- Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden
| | - Bita Khoein
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Guido Moll
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden.,Charité Universitätsmedizin, Berlin, Germany
| | - Charlotta Hausmann
- Center for Allogeneic Stem Cell Transplantation, Department of Pathology/Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Britt-Marie Svahn
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Remberger
- Center for Allogeneic Stem Cell Transplantation, Department of Pathology/Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Behnam Sadeghi
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ringden
- Translational Cell Therapy Research Group (TCR), Division of Therapeutic Immunology, Department of LabMed, Karolinska Institutet, Stockholm, Sweden
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22
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Uggla L, Bonde LO, Svahn BM, Remberger M, Wrangsjö B, Gustafsson B. Music therapy can lower the heart rates of severely sick children. Acta Paediatr 2016; 105:1225-30. [PMID: 27129139 DOI: 10.1111/apa.13452] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/30/2015] [Revised: 03/04/2016] [Accepted: 04/27/2016] [Indexed: 12/18/2022]
Abstract
AIM Paediatric recipients of haematopoietic stem cell transplants (HSCT) are at increased risk of developing post-traumatic stress disorder (PTSD), and there is a need to identify interventions that can alleviate stress in this group. The aim of this study was to examine the previously unexplored effect of music therapy on children undergoing HSCT, by analysing physiological parameters and comparing them with a control group. METHODS We performed a randomised clinical pilot study of 24 patients up to the age of 16 undergoing HSCT at Karolinska University Hospital, Huddinge, Sweden. Music therapy, including expressive and receptive elements, was performed twice a week in the treatment group and compared to standard care in the control group. Physiological parameters were evaluated according to the hospital's protocols. RESULTS The music therapy group had significantly reduced evening heart rates compared to the control group (p < 0.001), and the effect was sustainable for four to eight hours after the intervention. There were no significant differences in saturation or blood pressure observed between the groups. CONCLUSION Music therapy significantly lowered the heart rate of children undergoing HSCT for at least four to eight hours, indicating reduced stress levels and potentially lowering the risk of developing PTSD.
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Affiliation(s)
- L Uggla
- Astrid Lindgren Children's Hospital; Karolinska University Hospital-Huddinge; Stockholm Sweden
- Center for Allogeneic Stem Cell Transplantation; Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology; CLINTEC; Karolinska Institutet; Stockholm Sweden
| | - LO Bonde
- Department of Communication and Psychology; The Faculty of Humanities; Aalborgs University; Aalborg Denmark
| | - BM Svahn
- Karolinska University Hospital; Stockholm Sweden
| | - M Remberger
- Center for Allogeneic Stem Cell Transplantation; Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Oncology-Pathology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | | | - B Gustafsson
- Center for Allogeneic Stem Cell Transplantation; Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Clinical Science, Intervention and Technology; CLINTEC; Karolinska Institutet; Stockholm Sweden
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23
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Svenberg P, Remberger M, Uzunel M, Mattsson J, Gustafsson B, Fjaertoft G, Sundin M, Winiarski J, Ringdén O. Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation - A comparison of the last two decades. Pediatr Transplant 2016; 20:667-74. [PMID: 27251184 DOI: 10.1111/petr.12723] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] [Accepted: 04/26/2016] [Indexed: 01/06/2023]
Abstract
Pediatric protocols for allogeneic hematopoietic SCT have been altered during the last two decades. To compare the outcomes in children (<18 yr old), who underwent SCT at our center during 1992-2002 (P1) and 2003-2013 (P2). We retrospectively analyzed 188 patients in P1 and 201 patients in P2. The most significant protocol changes during P2 compared with P1 were a decrease in MAC protocols, particularly those containing TBI, an increase in RIC protocols, and altered GvHD prophylaxis. In addition, P2 had more patients with nonmalignant diagnoses (p = 0.002), more mismatched (MM) donors (p = 0.01), and more umbilical CB grafts (p = 0.03). Mesenchymal or DSCs were used for severe acute GvHD during P2. Three-yr OS in P1 was 58%, and in P2, it was 78% (p < 0.001). Improved OS was seen in both malignant disorders (51% vs. 68%; p = 0.05) and nonmalignant disorders (77% vs. 87%; p = 0.04). Multivariate analysis showed that SCT during P2 was associated with reduced mortality (HR = 0.57; p = 0.005), reduced TRM (HR = 0.57; p = 0.03), unchanged relapse rate, similar rate of GF, less chronic GvHD (HR = 0.49; p = 0.01), and more acute GvHD (HR = 1.77, p = 0.007). During recent years, OS has improved at our center, possibly reflecting the introduction of less toxic conditioning regimens and a number of other methodological developments in SCT.
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Affiliation(s)
- Petter Svenberg
- Oncology/Coagulation Section, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Remberger
- Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden.,Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Mehmet Uzunel
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden.,Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Britt Gustafsson
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.,Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Gustav Fjaertoft
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Sundin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Hematology/Immunology Section, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jacek Winiarski
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Hematology/Immunology Section, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Olle Ringdén
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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24
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Wattier RL, Dvorak CC, Hoffman JA, Brozovich AA, Bin-Hussain I, Groll AH, Castagnola E, Knapp KM, Zaoutis TE, Gustafsson B, Sung L, Berman D, Halasa NB, Abzug MJ, Velegraki A, Sharma TS, Fisher BT, Steinbach WJ. A Prospective, International Cohort Study of Invasive Mold Infections in Children. J Pediatric Infect Dis Soc 2015; 4:313-22. [PMID: 26582870 PMCID: PMC4681382 DOI: 10.1093/jpids/piu074] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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: 03/28/2014] [Accepted: 06/14/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Invasive mold infections (IMIs) are a leading cause of mortality in immunocompromised children, yet there has never been an international epidemiologic investigation of pediatric IMIs. METHODS This international, prospective cohort study was performed to characterize the epidemiology, antifungal therapy, and outcomes of pediatric IMIs. Children (≤18 years) with proven or probable IMIs were enrolled between August 2007 and May 2011 at 22 sites. Risk factors, underlying diagnoses, and treatments were recorded. Outcomes were assessed at 12 weeks after diagnosis using European Organization for Research and Treatment of Cancer/Mycoses Study Group response criteria. RESULTS One hundred thirty-one pediatric patients with IMIs were enrolled; the most common IMI was invasive aspergillosis ([IA] 75%). Children with IA and those with other types of IMIs had similar underlying risk factors, except that children with IMIs caused by non-Aspergillus species were more likely to have received mold-active antifungal agents preceding diagnosis. The most commonly used antifungal classes after diagnosis were triazoles (82%) and polyenes (63%). Combination therapy was used in 53% of patients. Use of combination therapy was associated with an increased risk of adverse events (risk ratio, 1.98; 95% confidence interval, 1.06-3.68; P = .031), although there was no detectable difference in outcome. CONCLUSIONS Although risk factors for IMIs are similar across specific subtypes, preceding antifungal therapy may be an important modifier. Combination antifungal therapy requires further study to determine its true risks and benefits.
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Affiliation(s)
| | | | - Jill A. Hoffman
- Department of Pediatrics, University of Southern California School of Medicine, Los Angeles
| | - Ava A. Brozovich
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Ibrahim Bin-Hussain
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Andreas H. Groll
- Department of Pediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Katherine M. Knapp
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Theoklis E. Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - Britt Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lillian Sung
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Berman
- Department of Pediatrics, All Children's Hospital, St. Petersburg, Florida
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mark J. Abzug
- Department of Pediatrics, Children's Hospital Colorado, Aurora
| | | | - Tanvi S. Sharma
- Division of Infectious Diseases, Boston Children's Hospital, Massachusetts
| | - Brian T. Fisher
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania
| | - William J. Steinbach
- Department of Pediatrics, Duke University, Durham, North Carolina,Department of Molecular Genetics & Microbiology, Duke University, Durham, North Carolina
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25
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Mattsson K, Honkaniemi E, Barbany G, Gustafsson B. Increased p53 protein expression as a potential predictor of early relapse after hematopoietic stem cell transplantation in children with acute myelogenous leukemia. Pediatr Transplant 2015; 19:767-75. [PMID: 26432780 DOI: 10.1111/petr.12585] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 01/17/2023]
Abstract
Dysregulation of genes involved in the cell cycle such as TP53, P21, P16, and PTEN plays a key role in oncogenesis. We have earlier reported increased expression of the TP53 encoded protein p53, in bone marrow samples from pediatric patients with more aggressive, rare chronic myeloid malignancies. The aim of this study was to investigate protein expression of p53, p21, p16, and PTEN before and after HSCT in pediatric patients with AML and evaluate whether any potential alterations could predict relapse after HSCT. Paraffin-embedded bone marrow samples from 34 pediatric patients with AML were collected retrospectively from time of diagnosis as well as pre- and post-HSCT. IHC was performed on tissue microarrays with antibodies against p53, p21, p16, and PTEN. Study material was analyzed by independent t-tests and nonlinear regression. t-Tests showed a statistical significant difference in p53 (p = 0.010) with overexpression in the group of patients who relapsed compared to the relapse-free patients at >3-6 months post-HSCT. Analysis of p53 protein expression by IHC may be a potential predictor for relapse after HSCT in children with AML.
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Affiliation(s)
- Kristin Mattsson
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Emma Honkaniemi
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Södertälje Hospital, Stockholm, Sweden
| | - Gisela Barbany
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
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26
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Erkers T, Kaipe H, Nava S, Molldén P, Gustafsson B, Axelsson R, Ringdén O. Treatment of severe chronic graft-versus-host disease with decidual stromal cells and tracing with (111)indium radiolabeling. Stem Cells Dev 2015; 24:253-63. [PMID: 25162829 DOI: 10.1089/scd.2014.0265] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Decidual stromal cells (DSCs) isolated from fetal membranes of term placentas are easily expanded and are highly immunosuppressive in vitro. These cells express high levels of integrins that are of importance in homing to inflamed tissues. In this study, we investigated DSCs as a cellular therapy for chronic graft-versus-host disease (cGvHD), a severe complication after allogeneic hematopoietic stem cell transplantation. Subsequent to transplantation, three patients developed severe extensive cGvHD and were treated with DSCs (1-2.8 × 10(6) cells/kg). One-third of the DSCs administered to two patients were labeled with (111)Indium, and the in vivo distribution was tracked for 48 h. The (111)In-labeled DSCs were initially located in the lungs, followed by dissemination to the liver and spleen. The DSCs induced a partial response in two of the patients. Blood samples from the patients were extensively evaluated by flow cytometry, luminex, and enzyme-linked immunosorbent assay. The nonresponder had the highest proportion of T-cells with Th17 and Th2 phenotypes and the highest median plasma concentrations of IL-17 and IL-4. The same patient also had high frequencies of HLA-DR(+) T-cells and regulatory T-cells. To conclude, DSCs are safe to infuse with no adverse effects. We determined how stromal cells are distributed in vivo after infusion in a cGvHD setting. The methods established for analysis of blood samples will be useful in determining the effect of DSCs in a study comprising a larger patient material. This pilot study may provide a basis for further controlled investigations with DSCs in a clinical setting.
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Affiliation(s)
- Tom Erkers
- 1 Division of Therapeutic Immunology, Department of Laboratory Medicine, Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet and Karolinska University Hospital , Stockholm, Sweden
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27
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Kaipe H, Carlson LM, Erkers T, Nava S, Molldén P, Gustafsson B, Qian H, Li X, Hashimoto T, Sadeghi B, Alheim M, Ringdén O. Immunogenicity of decidual stromal cells in an epidermolysis bullosa patient and in allogeneic hematopoietic stem cell transplantation patients. Stem Cells Dev 2015; 24:1471-82. [PMID: 25658253 PMCID: PMC4485366 DOI: 10.1089/scd.2014.0568] [Citation(s) in RCA: 17] [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] [Received: 12/08/2014] [Accepted: 02/06/2015] [Indexed: 12/17/2022] Open
Abstract
Allogeneic mesenchymal stromal cells (MSCs) are widely used in regenerative medicine, but little is known about their immunogenicity. In this study, we monitored the therapeutic and immunogenic effects of decidual stromal cells (DSCs) from term placentas when used as a therapy for generalized severe junctional epidermolysis bullosa (JEB) (previously termed Herlitz JEB), a lethal condition caused by the lack of functional laminin-332. An 11-month-old JEB patient was treated with five infusions of allogeneic DSCs within a 3-month period. Amniotic membranes (AMs) were applied to severe wounds. After the treatment, wounds started to heal in the middle of the blisters, but the improvements were transient. After two infusions of DSCs, the JEB patient had developed multispecific anti-HLA class-I antibodies. No antibodies to laminin-332 were detected, but the patient had high levels of anti-bovine serum albumin antibodies, which could bind to DSCs. Peripheral blood mononuclear cells (PBMCs) from the patient had a higher proliferative response to DSCs than to third-party PBMCs, which contrasts with the pattern observed in healthy donors. Human DSCs and MSCs induced similar xenoreactivity in mice. Two of 16 allogeneic stem cell-transplanted patients, treated with DSCs for graft-versus-host disease or hemorrhagic cystitis, showed a positive flow cytometric crossmatch test. One patient had anti-HLA antibodies before DSC infusion, whereas the other had no anti-HLA antibodies at any time. AM and DSC infusions may have improved the healing process in the JEB patient, but DSCs appeared to induce anti-HLA antibodies. The risk of alloimmunization by DSCs seems to be low in immunocompromised patients.
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Affiliation(s)
- Helen Kaipe
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lena-Maria Carlson
- Hematology/Immunology/HSCT Section, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Tom Erkers
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Silvia Nava
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pia Molldén
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Britt Gustafsson
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Hua Qian
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Xiaoguang Li
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Behnam Sadeghi
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Alheim
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olle Ringdén
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
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28
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Erkers T, Kaipe H, Nava S, Molldén P, Gustafsson B, Axelsson R, Ringden O. Immunological Effects of Decidual Stromal Cell Treatment in Patients with Severe Chronic Graft-Versus-Host Disease. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.206] [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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29
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Wilhelmsson M, Vatanen A, Borgström B, Gustafsson B, Taskinen M, Saarinen-Pihkala UM, Winiarski J, Jahnukainen K. Adult testicular volume predicts spermatogenetic recovery after allogeneic HSCT in childhood and adolescence. Pediatr Blood Cancer 2014; 61:1094-100. [PMID: 24851267 DOI: 10.1002/pbc.24970] [Citation(s) in RCA: 26] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Testicular dysfunction and infertility are of major concern in long-term survivors after allogeneic hematopoietic stem cell transplantation (HSCT). This study assesses predictive factors for very long-term testicular recovery after allogeneic HSCT in childhood and adolescence. PROCEDURE Testicular volume, sperm production and long-term need of testosterone substitution were evaluated among 106 male survivors transplanted at Huddinge and Helsinki University Hospitals from 1978 through 2000, at a mean age of 8 ± 4.6 years (range 1-17). A mean ± SD of 13 ± 4.8 years (range 4-28) had elapsed since their HSCT and the mean age of the participants was 22 ± 6.0 years (range 12-42). An adult testicular volume was recorded in 74 patients at a mean age of 19 ± 3.3 years (range 14-36). RESULTS Recipients conditioned with busulfan-based regimens or regimens containing only cyclophosphamide had significantly larger adult testicular volumes (mean volume 18 ml and 16 ml vs. 9 ml, P < 0.00001, respectively) and lower serum levels of FSH (mean 9 IU and 5 IU vs. 19 IU, P < 0.01 and 0.001, respectively) compared to those conditioned with total body irradiation (TBI). Multivariate analysis demonstrated that a non-leukemia diagnosis (P < 0.01) and adult testicular volume ≥ 15 ml (P < 0.03) positively impacted spermatogenetic recovery. CONCLUSIONS A larger adult testicular volume, normal serum levels of FSH and spermatozoa detected in a majority of seminal fluids after busulfan-based or cyclophosphamide conditionings suggest very long-term recovery of spermatogenesis after chemotherapy-based regimens. A simple measurement of adult testicular volume may help predict spermatogenetic potential among pediatric HSCT survivors.
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Affiliation(s)
- Mari Wilhelmsson
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Department of Pediatrics; Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge; Stockholm Sweden
| | - Anu Vatanen
- Division of Haematology-Oncology and Stem Cell Transplantation; Children's Hospital, University of Helsinki, Helsinki University Central Hospital; Helsinki Finland
| | - Birgit Borgström
- Department of Pediatrics; Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Clinical Science; Intervention, and Technology, Karolinska Institutet; Stockholm Sweden
| | - Britt Gustafsson
- Department of Pediatrics; Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Clinical Science; Intervention, and Technology, Karolinska Institutet; Stockholm Sweden
| | - Mervi Taskinen
- Division of Haematology-Oncology and Stem Cell Transplantation; Children's Hospital, University of Helsinki, Helsinki University Central Hospital; Helsinki Finland
| | - Ulla M. Saarinen-Pihkala
- Division of Haematology-Oncology and Stem Cell Transplantation; Children's Hospital, University of Helsinki, Helsinki University Central Hospital; Helsinki Finland
| | - Jacek Winiarski
- Department of Pediatrics; Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge; Stockholm Sweden
- Department of Clinical Science; Intervention, and Technology, Karolinska Institutet; Stockholm Sweden
| | - Kirsi Jahnukainen
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Division of Haematology-Oncology and Stem Cell Transplantation; Children's Hospital, University of Helsinki, Helsinki University Central Hospital; Helsinki Finland
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30
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31
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Vaidyanathan G, Gururangan S, Bigner D, Zalutsky M, Morfouace M, Shelat A, Megan J, Freeman BB, Robinson S, Throm S, Olson JM, Li XN, Guy KR, Robinson G, Stewart C, Gajjar A, Roussel M, Sirachainan N, Pakakasama S, Anurathapan U, Hansasuta A, Dhanachai M, Khongkhatithum C, Hongeng S, Feroze A, Lee KS, Gholamin S, Wu Z, Lu B, Mitra S, Cheshier S, Northcott P, Lee C, Zichner T, Lichter P, Korbel J, Wechsler-Reya R, Pfister S, Project IPT, Li KKW, Xia T, Ma FMT, Zhang R, Zhou L, Lau KM, Ng HK, Lafay-Cousin L, Chi S, Madden J, Smith A, Wells E, Owens E, Strother D, Foreman N, Packer R, Bouffet E, Wataya T, Peacock J, Taylor MD, Ivanov D, Garnett M, Parker T, Alexander C, Meijer L, Grundy R, Gellert P, Ashford M, Walker D, Brent J, Cader FZ, Ford D, Kay A, Walsh R, Solanki G, Peet A, English M, Shalaby T, Fiaschetti G, Baulande S, Gerber N, Baumgartner M, Grotzer M, Hayase T, Kawahara Y, Yagi M, Minami T, Kanai N, Yamaguchi T, Gomi A, Morimoto A, Hill R, Kuijper S, Lindsey J, Schwalbe E, Barker K, Boult J, Williamson D, Ahmad Z, Hallsworth A, Ryan S, Poon E, Robinson S, Ruddle R, Raynaud F, Howell L, Kwok C, Joshi A, Nicholson SL, Crosier S, Wharton S, Robson K, Michalski A, Hargrave D, Jacques T, Pizer B, Bailey S, Swartling F, Petrie K, Weiss W, Chesler L, Clifford S, Kitanovski L, Prelog T, Kotnik BF, Debeljak M, Fiaschetti G, Shalaby T, Baumgartner M, Grotzer MA, Gevorgian A, Morozova E, Kazantsev I, Iukhta T, Safonova S, Kumirova E, Punanov Y, Afanasyev B, Zheludkova O, Grajkowska W, Pronicki M, Cukrowska B, Dembowska-Baginska B, Lastowska M, Murase A, Nobusawa S, Gemma Y, Yamazaki F, Masuzawa A, Uno T, Osumi T, Shioda Y, Kiyotani C, Mori T, Matsumoto K, Ogiwara H, Morota N, Hirato J, Nakazawa A, Terashima K, Fay-McClymont T, Walsh K, Mabbott D, Smith A, Wells E, Madden J, Chi S, Owens E, Strother D, Packer R, Foreman N, Bouffet E, Lafay-Cousin L, Sturm D, Northcott PA, Jones DTW, Korshunov A, Lichter P, Pfister SM, Kool M, Hooper C, Hawes S, Kees U, Gottardo N, Dallas P, Siegfried A, Bertozzi AI, Sevely A, Loukh N, Munzer C, Miquel C, Bourdeaut F, Pietsch T, Dufour C, Delisle MB, Kawauchi D, Rehg J, Finkelstein D, Zindy F, Phoenix T, Gilbertson R, Pfister S, Roussel M, Trubicka J, Borucka-Mankiewicz M, Ciara E, Chrzanowska K, Perek-Polnik M, Abramczuk-Piekutowska D, Grajkowska W, Jurkiewicz D, Luczak S, Kowalski P, Krajewska-Walasek M, Lastowska M, Sheila C, Lee S, Foster C, Manoranjan B, Pambit M, Berns R, Fotovati A, Venugopal C, O'Halloran K, Narendran A, Hawkins C, Ramaswamy V, Bouffet E, Taylor M, Singhal A, Hukin J, Rassekh R, Yip S, Northcott P, Singh S, Duhman C, Dunn S, Chen T, Rush S, Fuji H, Ishida Y, Onoe T, Kanda T, Kase Y, Yamashita H, Murayama S, Nakasu Y, Kurimoto T, Kondo A, Sakaguchi S, Fujimura J, Saito M, Arakawa T, Arai H, Shimizu T, Lastowska M, Jurkiewicz E, Daszkiewicz P, Drogosiewicz M, Trubicka J, Grajkowska W, Pronicki M, Kool M, Sturm D, Jones DTW, Hovestadt V, Buchhalter I, Jager NN, Stuetz A, Johann P, Schmidt C, Ryzhova M, Landgraf P, Hasselblatt M, Schuller U, Yaspo ML, von Deimling A, Korbel J, Eils R, Lichter P, Korshunov A, Pfister S, Modi A, Patel M, Berk M, Wang LX, Plautz G, Camara-Costa H, Resch A, Lalande C, Kieffer V, Poggi G, Kennedy C, Bull K, Calaminus G, Grill J, Doz F, Rutkowski S, Massimino M, Kortmann RD, Lannering B, Dellatolas G, Chevignard M, Lindsey J, Kawauchi D, Schwalbe E, Solecki D, McKinnon P, Olson J, Hayden J, Grundy R, Ellison D, Williamson D, Bailey S, Roussel M, Clifford S, Buss M, Remke M, Lee J, Caspary T, Taylor M, Castellino R, Lannering B, Sabel M, Gustafsson G, Fleischhack G, Benesch M, Doz F, Kortmann RD, Massimino M, Navajas A, Reddingius R, Rutkowski S, Miquel C, Delisle MB, Dufour C, Lafon D, Sevenet N, Pierron G, Delattre O, Bourdeaut F, Ecker J, Oehme I, Mazitschek R, Korshunov A, Kool M, Lodrini M, Deubzer HE, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T, Phoenix T, Patmore D, Boulos N, Wright K, Boop S, Gilbertson R, Janicki T, Burzynski S, Burzynski G, Marszalek A, Triscott J, Green M, Foster C, Fotovati A, Berns R, O'Halloran K, Singhal A, Hukin J, Rassekh SR, Yip S, Toyota B, Dunham C, Dunn SE, Liu KW, Pei Y, Wechsler-Reya R, Genovesi L, Ji P, Davis M, Ng CG, Remke M, Taylor M, Cho YJ, Jenkins N, Copeland N, Wainwright B, Tang Y, Schubert S, Nguyen B, Masoud S, Gholamin S, Lee A, Willardson M, Bandopadhayay P, Bergthold G, Atwood S, Whitson R, Cheshier S, Qi J, Beroukhim R, Tang J, Wechsler-Reya R, Oro A, Link B, Bradner J, Cho YJ, Vallero SG, Bertin D, Basso ME, Milanaccio C, Peretta P, Cama A, Mussano A, Barra S, Morana G, Morra I, Nozza P, Fagioli F, Garre ML, Darabi A, Sanden E, Visse E, Stahl N, Siesjo P, Cho YJ, Vaka D, Schubert S, Vasquez F, Weir B, Cowley G, Keller C, Hahn W, Gibbs IC, Partap S, Yeom K, Martinez M, Vogel H, Donaldson SS, Fisher P, Perreault S, Cho YJ, Guerrini-Rousseau L, Dufour C, Pujet S, Kieffer-Renaux V, Raquin MA, Varlet P, Longaud A, Sainte-Rose C, Valteau-Couanet D, Grill J, Staal J, Lau LS, Zhang H, Ingram WJ, Cho YJ, Hathout Y, Brown K, Rood BR, Sanden E, Visse E, Stahl N, Siesjo P, Darabi A, Handler M, Hankinson T, Madden J, Kleinschmidt-Demasters BK, Foreman N, Hutter S, Northcott PA, Kool M, Pfister S, Kawauchi D, Jones DT, Kagawa N, Hirayama R, Kijima N, Chiba Y, Kinoshita M, Takano K, Eino D, Fukuya S, Yamamoto F, Nakanishi K, Hashimoto N, Hashii Y, Hara J, Taylor MD, Yoshimine T, Wang J, Guo C, Yang Q, Chen Z, Perek-Polnik M, Lastowska M, Drogosiewicz M, Dembowska-Baginska B, Grajkowska W, Filipek I, Swieszkowska E, Tarasinska M, Perek D, Kebudi R, Koc B, Gorgun O, Agaoglu FY, Wolff J, Darendeliler E, Schmidt C, Kerl K, Gronych J, Kawauchi D, Lichter P, Schuller U, Pfister S, Kool M, McGlade J, Endersby R, Hii H, Johns T, Gottardo N, Sastry J, Murphy D, Ronghe M, Cunningham C, Cowie F, Jones R, Sastry J, Calisto A, Sangra M, Mathieson C, Brown J, Phuakpet K, Larouche V, Hawkins C, Bartels U, Bouffet E, Ishida T, Hasegawa D, Miyata K, Ochi S, Saito A, Kozaki A, Yanai T, Kawasaki K, Yamamoto K, Kawamura A, Nagashima T, Akasaka Y, Soejima T, Yoshida M, Kosaka Y, Rutkowski S, von Bueren A, Goschzik T, Kortmann R, von Hoff K, Friedrich C, Muehlen AZ, Gerber N, Warmuth-Metz M, Soerensen N, Deinlein F, Benesch M, Zwiener I, Faldum A, Kuehl J, Pietsch T, KRAMER K, -Taskar NP, Zanzonico P, Humm JL, Wolden SL, Cheung NKV, Venkataraman S, Alimova I, Harris P, Birks D, Balakrishnan I, Griesinger A, Remke M, Taylor MD, Handler M, Foreman NK, Vibhakar R, Margol A, Robison N, Gnanachandran J, Hung L, Kennedy R, Vali M, Dhall G, Finlay J, Erdrich-Epstein A, Krieger M, Drissi R, Fouladi M, Gilles F, Judkins A, Sposto R, Asgharzadeh S, Peyrl A, Chocholous M, Holm S, Grillner P, Blomgren K, Azizi A, Czech T, Gustafsson B, Dieckmann K, Leiss U, Slavc I, Babelyan S, Dolgopolov I, Pimenov R, Mentkevich G, Gorelishev S, Laskov M, Friedrich C, Warmuth-Metz M, von Bueren AO, Nowak J, von Hoff K, Pietsch T, Kortmann RD, Rutkowski S, Mynarek M, von Hoff K, Muller K, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Pietsch T, Warmuth-Metz M, Ottensmeier H, Kwiecien R, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Mynarek M, von Hoff K, Muller K, Friedrich C, von Bueren AO, Gerber NU, Benesch M, Pietsch T, Warmuth-Metz M, Ottensmeier H, Kwiecien R, Faldum A, Kuehl J, Kortmann RD, Rutkowski S, Yankelevich M, Laskov M, Boyarshinov V, Glekov I, Pimenov R, Ozerov S, Gorelyshev S, Popa A, Dolgopolov I, Subbotina N, Mentkevich G, Martin AM, Nirschl C, Polanczyk M, Bell R, Martinez D, Sullivan LM, Santi M, Burger PC, Taube JM, Drake CG, Pardoll DM, Lim M, Li L, Wang WG, Pu JX, Sun HD, Remke M, Taylor MD, Ruggieri R, Symons MH, Vanan MI, Bandopadhayay P, Bergthold G, Nguyen B, Schubert S, Gholamin S, Tang Y, Bolin S, Schumacher S, Zeid R, Masoud S, Yu F, Vue N, Gibson W, Paolella B, Mitra S, Cheshier S, Qi J, Liu KW, Wechsler-Reya R, Weiss W, Swartling FJ, Kieran MW, Bradner JE, Beroukhim R, Cho YJ, Maher O, Khatua S, Tarek N, Zaky W, Gupta T, Mohanty S, Kannan S, Jalali R, Kapitza E, Denkhaus D, Muhlen AZ, Rutkowski S, Pietsch T, von Hoff K, Pizer B, Dufour C, van Vuurden DG, Garami M, Massimino M, Fangusaro J, Davidson TB, da Costa MJG, Sterba J, Benesch M, Gerber NU, Mynarek M, Kwiecien R, Clifford SC, Kool M, Pietsch T, Finlay JL, Rutkowski S, Pietsch T, Schmidt R, Remke M, Korshunov A, Hovestadt V, Jones DT, Felsberg J, Goschzik T, Kool M, Northcott PA, von Hoff K, von Bueren A, Skladny H, Taylor M, Cremer F, Lichter P, Faldum A, Reifenberger G, Rutkowski S, Pfister S, Kunder R, Jalali R, Sridhar E, Moiyadi AA, Goel A, Goel N, Shirsat N, Othman R, Storer L, Korshunov A, Pfister SM, Kerr I, Coyle B, Law N, Smith ML, Greenberg M, Bouffet E, Taylor MD, Laughlin S, Malkin D, Liu F, Moxon-Emre I, Scantlebury N, Mabbott D, Nasir A, Othman R, Storer L, Onion D, Lourdusamy A, Grabowska A, Coyle B, Cai Y, Othman R, Bradshaw T, Coyle B, de Medeiros RSS, Beaugrand A, Soares S, Epelman S, Jones DTW, Hovestadt V, Wang W, Northcott PA, Kool M, Sultan M, Landgraf P, Reifenberger G, Eils R, Yaspo ML, Wechsler-Reya RJ, Korshunov A, Zapatka M, Radlwimmer B, Pfister SM, Lichter P, Alderete D, Baroni L, Lubinieki F, Auad F, Gonzalez ML, Puya W, Pacheco P, Aurtenetxe O, Gaffar A, Gros L, Cruz O, Calvo C, Navajas A, Shinojima N, Nakamura H, Kuratsu JI, Hanaford A, Eberhart C, Archer T, Tamayo P, Pomeroy S, Raabe E, De Braganca K, Gilheeney S, Khakoo Y, Kramer K, Wolden S, Dunkel I, Lulla RR, Laskowski J, Fangusaro J, Goldman S, Gopalakrishnan V, Ramaswamy V, Remke M, Shih D, Wang X, Northcott P, Faria C, Raybaud C, Tabori U, Hawkins C, Rutka J, Taylor M, Bouffet E, Jacobs S, De Vathaire F, Diallo I, Llanas D, Verez C, Diop F, Kahlouche A, Grill J, Puget S, Valteau-Couanet D, Dufour C, Ramaswamy V, Thompson E, Taylor M, Pomeroy S, Archer T, Northcott P, Tamayo P, Prince E, Amani V, Griesinger A, Foreman N, Vibhakar R, Sin-Chan P, Lu M, Kleinman C, Spence T, Picard D, Ho KC, Chan J, Hawkins C, Majewski J, Jabado N, Dirks P, Huang A, Madden JR, Foreman NK, Donson AM, Mirsky DM, Wang X, Dubuc A, Korshunov A, Ramaswamy V, Remke M, Mack S, Gendoo D, Peacock J, Luu B, Cho YJ, Eberhart C, MacDonald T, Li XN, Van Meter T, Northcott P, Croul S, Bouffet E, Pfister S, Taylor M, Laureano A, Brugmann W, Denman C, Singh H, Huls H, Moyes J, Khatua S, Sandberg D, Silla L, Cooper L, Lee D, Gopalakrishnan V. MEDULLOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou074] [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: 11/14/2022] Open
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Honkaniemi E, Mattsson K, Barbany G, Sander B, Gustafsson B. Elevated p53 protein expression; a predictor of relapse in rare chronic myeloid malignancies in children? Pediatr Hematol Oncol 2014; 31:327-39. [PMID: 24761810 DOI: 10.3109/08880018.2014.898723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alterations in the tumor suppressor gene TP53 have been associated with poor outcome in adult hematological malignancies. We have earlier reported an increased expression of the TP53 encoded protein p53, in bone marrow samples from pediatric patients with aggressive leukemia. Our aim was now to evaluate p53 protein expression at different time points before and after hematopoietic stem cell transplantation (HSCT) as a predictor of relapse in a group of children diagnosed with MDS, JMML and CML, and also investigate if potential alterations in expression could be correlated to mutations in TP53. PROCEDURE Paraffin embedded bone marrow samples from 33 pediatric patients diagnosed with MDS, JMML and CML between 1997 and 2010 were collected retrospectively from time of diagnosis and pre and post HSCT. Immunohistochemistry (IHC) was performed on tissue microarrays (TMA) with antibodies to p53 and p21. DNA sequencing of exon 2-11 of TP53 was performed in 7 patients with JMML and 5 patients with MDS. RESULTS Elevated p53 protein expression at diagnosis predicted for relapse, odds ratio (OR) 1.19 (95% CI: 1.02-1.40, p = .028). Sequencing of TP53 did not reveal any mutations in the 12 patients analyzed and p53 expression correlated positively to p21 expression indicating a functional p53/p21 protein pathway. CONCLUSION Elevated p53 protein expression at diagnosis may be an indicator of relapse in children with MDS, JMML and CML.
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Affiliation(s)
- Emma Honkaniemi
- 1Department of Pediatrics, Astrid Lindgren Children`s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Vatanen A, Wilhelmsson M, Borgström B, Gustafsson B, Taskinen M, Saarinen-Pihkala UM, Winiarski J, Jahnukainen K. Ovarian function after allogeneic hematopoietic stem cell transplantation in childhood and adolescence. Eur J Endocrinol 2014; 170:211-8. [PMID: 24179099 DOI: 10.1530/eje-13-0694] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate long-term ovarian function after allogeneic hematopoietic stem cell transplantation (HSCT) in childhood and adolescence. SUBJECTS AND METHODS Predictive factors for ovarian function were evaluated among 92 adult or pubertal female survivors transplanted at Huddinge and Helsinki University Hospital during 1978-2000, at a mean age of 9±4.3 years (range 1-19). At the time of the study a mean±s.d. of 13±5.5 years (range 6-27) had elapsed since the HSCT and the mean age of the participants was 22±6.3 years (range 9-41). RESULTS Spontaneous puberty based on breast development occurred in 40 and menarche in 30 of the 70 girls who were prepubertal at transplantation. Six out of 20 girls who received HSCT after initiation of pubertal development recovered their ovarian function. Younger age at HSCT, conditioning without total body irradiation (TBI), and a non-leukemia diagnosis predicted the spontaneous menarche. The incidence of menarche was higher after fractioned vs single fraction TBI (P<0.05), cyclophosphamide (Cy) vs busulfan (Bu)-based conditioning (P<0.05), and among leukemia patients transplanted at first remission vs later remissions (P<0.01) and with no cranial irradiation (cranial radiotherapy, CRT) vs given CRT (14-24 Gy) (P<0.01). The majority of recipients conditioned with only Cy vs TBI (P<0.001) or vs Bu-based regimens (P<0.01) showed preserved ovarian function and required no estrogen replacement at their latest follow-up visit at a mean age of 23±6.3 years (range 15-41). Ten women became pregnant. CONCLUSIONS Patients conditioned with TBI or Bu-based regimes are at high risk of ovarian failure. Intensive anti-leukemia therapy before HSCT including CRT especially among relapsed patients may further decrease the possibility of spontaneous menarche.
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Affiliation(s)
- A Vatanen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, FIN-00029 HUS Helsinki, Finland
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Gustafsson B, Priftakis P, Rubin J, Giraud G, Ramqvist T, Dalianis T. Human polyomaviruses were not detected in cerebrospinal fluid of patients with neurological complications after hematopoietic stem cell transplantation. Future Virol 2013. [DOI: 10.2217/fvl.13.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Neurological complications after allogeneic hematopoietic stem cell transplantation (HSCT) are associated with increased mortality. Reactivation of JC virus, a well-known human polyomavirus (HPyV), can be associated with progressive multifocal leukoencephalopathy after HSCT. Aim: To investigate whether reactivation of the newly discovered HPyVs KIPyV, WUPyV, Merkel cell polyomavirus, HPyV6, HPyV7, trichodysplasia spinulosa polyomavirus, HPyV9 or HPyV10 (MWPyV) is associated with neurological complications after HSCT. Materials & methods: Cerebrospinal fluid from 32 HSCT patients with neurological symptoms was analyzed for the presence of the above HPyVs, including BK virus and JC virus, as well as the primate polyomaviruses lymphotropic polyomavirus and simian virus 40. Results & conclusion: No HPyV DNA was detected or associated with the neurological symptoms the patients showed post-HSCT.
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Affiliation(s)
- Britt Gustafsson
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Peter Priftakis
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Rubin
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital-Huddinge, Department of Clinical Science, Intervention & Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Geraldine Giraud
- Mälarsjukhuset, Eskilstuna, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology–Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology–Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Mårtensson T, Priftakis P, Casswall T, Ringdén O, Mattsson J, Remberger M, Hassan M, Gustafsson B. Increased risk of gastrointestinal acute GVHD following the addition of melphalan to busulfan/cyclophosphamide conditioning. Pediatr Transplant 2013; 17:285-93. [PMID: 23489519 DOI: 10.1111/petr.12061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Abstract
Risk factors associated with the development of aGVHD in the gastrointestinal tract have not been studied in depth. We retrospectively assessed 25 pediatric patients with MDS and JMML and compared the treatment outcome of two different conditioning regimens. Seventeen children (68%) underwent conditioning with busulfan (Bu), cyclophosphamide (Cy), and melphalan (Mel) and eight children (32%) with Bu and Cy. Gastrointestinal aGVHD stages II-IV (day 0-100) were observed in 47% (eight of 17) of the patients in the BuCyMel group and in none (0 of 8) in the BuCy group (p < 0.05). In patients who developed gastrointestinal aGVHD stages III-IV, a 24-h variation in the Bu concentration with a nighttime peak was noted. HC and liver aGVHD stages II-IV were observed in 47% (eight of 17) and 35% (six of 17) after BuCyMel conditioning and in 0% (0 of 17) and 12.5% (one of eight) after BuCy conditioning. The overall survival rate was 53% (nine of 17) in the BuCyMel group and 62.5% (five of eight) in the BuCy group. In conclusion, the addition of melphalan to the BuCy conditioning regimen resulted in severe gastrointestinal complications and did not improve overall survival.
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Affiliation(s)
- T Mårtensson
- Astrid Lindgren Children's Hospital and Karolinska University Hospital-Huddinge, Stockholm, Sweden.
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Barbany G, Gauffin F, Öfverholm I, Karlsson H, Thörn I, Arvidson J, Heyman M, Gustafsson B, Nordgren A. TheETV6/RUNX1fusion transcript is not detected in RNA isolated from neonatal dried blood spots from children later diagnosed with the corresponding leukemia. Leuk Lymphoma 2013; 54:2742-4. [DOI: 10.3109/10428194.2013.786068] [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: 11/13/2022]
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Lundgren A, Leach S, Tobias J, Carlin N, Gustafsson B, Jertborn M, Bourgeois L, Walker R, Holmgren J, Svennerholm AM. Clinical trial to evaluate safety and immunogenicity of an oral inactivated enterotoxigenic Escherichia coli prototype vaccine containing CFA/I overexpressing bacteria and recombinantly produced LTB/CTB hybrid protein. Vaccine 2013; 31:1163-70. [DOI: 10.1016/j.vaccine.2012.12.063] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/18/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
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Wareham NE, Heilmann C, Abrahamsson J, Forestier E, Gustafsson B, Ha SY, Heldrup J, Jahnukainen K, Jónsson ÓG, Lausen B, Palle J, Zeller B, Hasle H. Outcome of poor response paediatric AML using early SCT. Eur J Haematol 2013; 90:187-94. [DOI: 10.1111/ejh.12051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 01/24/2023]
Affiliation(s)
- Neval E. Wareham
- Department of Paediatrics; The University Hospital Rigshospitalet; Copenhagen; Denmark
| | - Carsten Heilmann
- Department of Paediatrics; The University Hospital Rigshospitalet; Copenhagen; Denmark
| | - Jonas Abrahamsson
- Department of Paediatrics; The Queen Silvia Children's Hospital; Sahlgrenska University Hospital; Gothenburg; Sweden
| | | | - Britt Gustafsson
- Department of Clinical Science; Intervention and Technology; Karolinska Institutet, Karolinska University Hospital; Huddinge; Sweden
| | - Shau-Yin Ha
- Department of Paediatrics; Queen Mary Hospital and Hong Kong Paediatric Haematology & Oncology Study Group (HKPHOSG); Hong Kong; China
| | - Jesper Heldrup
- Department of Paediatrics; University Hospital Lund; Lund; Sweden
| | - Kirsi Jahnukainen
- Division of Haematology-Oncology and Stem Cell Transplantation; Children's Hospital; University of Helsinki; Helsinki University Central Hospital; Helsinki; Finland
| | - Ólafur G. Jónsson
- Children's Hospital Iceland; Landspítali - University Hospital; Reykjavík; Iceland
| | - Birgitte Lausen
- Department of Paediatrics; The University Hospital Rigshospitalet; Copenhagen; Denmark
| | - Josefine Palle
- Department of Women's and Children's Health; University Children's Hospital; Uppsala; Sweden
| | - Bernward Zeller
- Department of Paediatrics; Oslo University Hospital Rikshospitalet; Oslo; Norway
| | - Henrik Hasle
- Department of Paediatrics; Aarhus University Hospital Skejby; Aarhus; Denmark
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Machaczka M, Klimkowska M, Chiang SCC, Meeths M, Müller ML, Gustafsson B, Henter JI, Bryceson YT. Development of classical Hodgkin's lymphoma in an adult with biallelic STXBP2 mutations. Haematologica 2012; 98:760-4. [PMID: 23100279 DOI: 10.3324/haematol.2012.073098] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Experimental model systems have delineated an important role for cytotoxic lymphocytes in the immunosurveillance of cancer. In humans, perforin-deficiency has been associated with occurrence of hematologic malignancies. Here, we describe an Epstein-Barr virus-positive classical Hodgkin's lymphoma in a patient harboring biallelic mutations in STXBP2, a gene required for exocytosis of perforin-containing lytic granules and associated with familial hemophagocytic lymphohistocytosis. Cytotoxic T lymphocytes were found infiltrating the tumor, and a high frequency of Epstein-Barr virus-specific cytotoxic T lymphocytes were detected in peripheral blood. However, lytic granule exocytosis and cytotoxicity by cytotoxic T lymphocytes, as well as natural killer cells, were severely impaired in the patient. Thus, the data suggest a link between defective lymphocyte exocytosis and development of lymphoma in STXBP2-deficient patients. Therefore, with regards to treatment of familial hemophagocytic lymphohistocytosis patients with mutations in genes required for lymphocyte exocytosis, it is important to consider both the risks of hemophagocytic lymphohistocytosis and malignancy.
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Affiliation(s)
- Maciej Machaczka
- Division of Hematology, Department of Medicine, Karolinska Institutet, and Hematology Center Karolinska, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Forslöw U, Blennow O, LeBlanc K, Ringdén O, Gustafsson B, Mattsson J, Remberger M. Treatment with mesenchymal stromal cells is a risk factor for pneumonia-related death after allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2012; 89:220-7. [PMID: 22765507 DOI: 10.1111/j.1600-0609.2012.01824.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We performed a retrospective cohort study to find out whether the use of reduced-intensity conditioning (RIC) might reduce the risk of early death from pneumonia. Pneumonia-associated deaths were evaluated in 691 hematopoietic stem cell transplantation (HSCT) patients. The majority had a hematological malignancy (n = 504) and an HLA-matched donor (n = 584). RIC was given to 336 patients and myeloablative conditioning (MAC) to 355. Data concerning radiology, culture and autopsy results were evaluated together with risk factors for death related to pneumonia within or after 100 d after HSCT (early and overall pneumonia). In 60 patients, pneumonia contributed to death (early n = 17). The cumulative incidence of early pneumonia-related death was 2.8% and 2.1% in MAC and RIC patients, respectively. The cumulative incidence of overall pneumonia-related death was 8.2% and 10.5%, respectively. In 40 patients, (67%) an etiology could be established, with 19 patients having proven or probable mold infection. In the multivariate analyses, acute graft-versus-host disease (GVHD) grades II-IV, cytomegalovirus (CMV) infection and having received mesenchymal stromal cells (MSCs) were factors associated with overall pneumonia-related death. Bacteremia and a previous HSCT were associated with early pneumonia-related death. RIC did not reduce the incidence of early death associated with pneumonia. Acute GVHD II-IV, CMV infection and MSC treatment were factors associated with pneumonia-related death. Mold infection was the most common contributor to pneumonia-related death in HSCT patients.
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Affiliation(s)
- Ulrica Forslöw
- Division of Respiratory Medicine and Allergology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden.
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Mjörnstedt L, Sørensen SS, von Zur Mühlen B, Jespersen B, Hansen JM, Bistrup C, Andersson H, Gustafsson B, Undset LH, Fagertun H, Solbu D, Holdaas H. Improved renal function after early conversion from a calcineurin inhibitor to everolimus: a randomized trial in kidney transplantation. Am J Transplant 2012; 12:2744-53. [PMID: 22812414 DOI: 10.1111/j.1600-6143.2012.04162.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In an open-label, multicenter trial, de novo kidney transplant recipients at low to medium immunological risk were randomized at week 7 posttransplant to remain on CsA (n = 100, controls) or convert to everolimus (n = 102), both with enteric-coated mycophenolate sodium and corticosteroids. The primary endpoint, change in measured GFR (mGFR) from week 7 to month 12, was significantly greater with everolimus than controls: 4.9 (11.8) mL/min versus 0.0 (12.9) mL/min (p = 0.012; analysis of covariance [ANCOVA]). Per protocol analysis demonstrated a more marked difference: an increase of 8.7 (11.2) mL/min with everolimus versus a decrease of 0.4 (12.0) mL/min in controls (p < 0.001; ANCOVA). There were no differences in graft or patient survival. The 12-month incidence of biopsy-proven acute rejection (BPAR) was 27.5% (n = 28) with everolimus and 11.0% (n = 11) in controls (p = 0.004). All but two episodes of BPAR in each group were mild. Adverse events occurred in 95.1% of everolimus patients and 90.0% controls (p = 0.19), with serious adverse events in 53.9% and 38.0%, respectively (p = 0.025). Discontinuation because of adverse events was more frequent with everolimus (25.5%) than controls (3.0%; p = 0.030). In conclusion, conversion from CsA to everolimus at week 7 after kidney transplantation was associated with a greater improvement in mGFR at month 12 versus CNI-treated controls but discontinuations and BPAR were more frequent.
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Affiliation(s)
- L Mjörnstedt
- Transplant Institute, Sahlgrenska University Hospital, Göteborg, Sweden.
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Gustafsson B, Moell J, Leblanc K, Barbany G, Söderhäll S, Winiarski J. Donor cell-derived acute myeloid leukemia after second allogenic cord blood transplantation in a patient with Fanconi anemia. Pediatr Transplant 2012; 16:E241-5. [PMID: 22081947 DOI: 10.1111/j.1399-3046.2011.01584.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
DCL following hematopoietic stem cell transplantation has been reported in approximately 5% of all leukemic relapses. There have been several reports on DCL, mainly AML after umbilical cord blood transplantation. In this case study, we present a young boy diagnosed with Fanconi anemia who underwent an umbilical cord blood transplantation. Because of the graft failure, he was retransplanted one month later, also with a cord blood transplant. Two years after the second transplant, he developed AML, where 100% of the cells were of female donor origin. The donor, a now 14-yr-old female, was recently reported healthy.
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Affiliation(s)
- Britt Gustafsson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital-Huddinge, Sweden.
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Wareham N, Heilmann C, Abrahamsson J, Forestier E, Gustafsson B, Ha SY, Heldrup J, Jahnukainen K, Jónsson Ó, Lausen B, Palle J, Zeller B, Hasle H. Outcome of Poor Response Paediatric AML Using Early SCT. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.094] [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: 10/14/2022]
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Rubin J, Giraud G, Priftakis P, Wide K, Gustafsson B, Ramqvist T, Dalianis T. No detection of BK virus, JC virus, KI, WU and Merkel cell polyomaviruses in cerebrospinal fluid of patients with neurological complications after hematopoetic stem cell transplantation. Anticancer Res 2011; 31:3489-3492. [PMID: 21965766] [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: 05/31/2023]
Abstract
Neurological complications, often due to viral reactivation, after allogeneic hematopoetic stem cell transplantation (HSCT) are associated with increased mortality. Here, cerebrospinal fluid from 20 HSCT patients with neurological symptoms were analyzed and found to be negative by PCR for BK virus, JC virus, KI, WU and Merkel cell polyomavirus DNA.
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Affiliation(s)
- J Rubin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital Huddinge, Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden
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Soeria-Atmadja S, Oskarsson T, Celci G, Sander B, Berg U, Gustafsson B. Maintenance of remission with cyclosporine in paediatric patients with Kimura's disease - two case reports. Acta Paediatr 2011; 100:e186-9. [PMID: 21388449 DOI: 10.1111/j.1651-2227.2011.02259.x] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Here we report two paediatric cases of Kimura's disease, which is a rare, chronic inflammatory disorder with undetermined aetiology. The first patient was a 17-year-old boy presenting with a swelling behind his right ear and a nephrotic syndrome. The second patient was a 9-year-old boy presenting with a left-sided preauricular swelling. Both displayed peripheral blood eosinophilia, raised levels of serum IgE and typical histological findings. Initial response to prednisolone was excellent but both relapsed as medication was tapered or discontinued. Adding cyclosporine to the regimen resulted in prolonged remission in both patients. CONCLUSION We support the use of cyclosporine for maintaining remission in paediatric patients with Kimura's disease.
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Affiliation(s)
- Sandra Soeria-Atmadja
- Department of Hematology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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von Bahr L, Sundberg B, Lönnies L, Sander B, Karbach H, Hägglund H, Ljungman P, Gustafsson B, Karlsson H, Le Blanc K, Ringdén O. Long-term complications, immunologic effects, and role of passage for outcome in mesenchymal stromal cell therapy. Biol Blood Marrow Transplant 2011; 18:557-64. [PMID: 21820393 DOI: 10.1016/j.bbmt.2011.07.023] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 07/27/2011] [Indexed: 02/07/2023]
Abstract
Thirty-one patients treated with mesenchymal stromal cells (MSCs) for acute graft-versus-host disease (aGVHD) or hemorrhagic cystitis between 2002 and 2007 were followed to investigate predictors of outcome, immunologic effects in vivo, and long-term survival. There was no correlation between in vitro suppression by MSCs in mixed lymphocyte cultures and outcome. Soluble IL-2 receptors were measured in blood before and after MSC infusion and declined significantly during the first week after MSC infusion (P = .03). Levels of interleukin-6 and HLA-G were unaffected. Infectious complications occurred several years after recovery from aGVHD. Cytomegalovirus viral load was high, and cytomegalovirus disease was common. Among patients recovering from aGVHD, 54% died of late infections, between 4 months and 2 years after MSC treatment. No increase in leukemia relapse or graft rejection was found. Children had a better survival rate than adults (P = .005). In GVHD patients, 1-year survival was 75% in patients who received early-passage MSCs (from passages 1-2) in contrast to 21% using later passage MSCs (from passages 3-4) (P < .01). We conclude that treatment with early-passage MSCs improved survival in patients with therapy-resistant GVHD. Death from infection was common in MSC-treated patients, but there was no increase in leukemia relapse.
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Affiliation(s)
- Lena von Bahr
- Haematology Centre, Department of Clinical Immunology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Remberger M, Ackefors M, Berglund S, Blennow O, Dahllöf G, Dlugosz A, Garming-Legert K, Gertow J, Gustafsson B, Hassan M, Hassan Z, Hauzenberger D, Hägglund H, Karlsson H, Klingspor L, Kumlien G, Le Blanc K, Ljungman P, Machaczka M, Malmberg KJ, Marschall HU, Mattsson J, Olsson R, Omazic B, Sairafi D, Schaffer M, Svahn BM, Svenberg P, Swartling L, Szakos A, Uhlin M, Uzunel M, Watz E, Wernerson A, Wikman A, Wikström AC, Winiarski J, Ringdén O. Improved survival after allogeneic hematopoietic stem cell transplantation in recent years. A single-center study. Biol Blood Marrow Transplant 2011; 17:1688-97. [PMID: 21620989 DOI: 10.1016/j.bbmt.2011.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
We analyzed the outcome of allogeneic hematopoietic stem cell transplantation (HSCT) over the past 2 decades. Between 1992 and 2009, 953 patients were treated with HSCT, mainly for a hematologic malignancy. They were divided according to 4 different time periods of treatment: 1992 to 1995, 1996 to 2000, 2001 to 2005, and 2006 to 2009. Over the years, many factors have changed considerably regarding patient age, diagnosis, disease stage, type of donor, stem cell source, genomic HLA typing, cell dose, type of conditioning, treatment of infections, use of granulocyte-colony stimulating factor (G-CSF), use of mesenchymal stem cells, use of cytotoxic T cells, and home care. When we compared the last period (2006-2009) with earlier periods, we found slower neutrophil engraftment, a higher incidence of acute graft-versus-host disease (aGVHD) of grades II-IV, and less chronic GVHD (cGHVD). The incidence of relapse was unchanged over the 4 periods (22%-25%). Overall survival (OS) and transplant-related mortality (TRM) improved significantly in the more recent periods, with the best results during the last period (2006-2009) and a 100-day TRM of 5.5%. This improvement was also apparent in a multivariate analysis. When correcting for differences between the 4 groups, the hazard ratio for mortality in the last period was 0.59 (95% confidence interval [CI]: 0.44-0.79; P < .001) and for TRM it was 0.63 (CI: 0.43-0.92; P = .02). This study shows that the combined efforts to improve outcome after HSCT have been very effective. Even though we now treat older patients with more advanced disease and use more alternative HLA nonidentical donors, OS and TRM have improved. The problem of relapse still has to be remedied. Thus, several different developments together have resulted in significantly lower TRM and improved survival after HSCT over the last few years.
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Affiliation(s)
- Mats Remberger
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Zachariadis V, Gauffin F, Kuchinskaya E, Heyman M, Schoumans J, Blennow E, Gustafsson B, Barbany G, Golovleva I, Ehrencrona H, Cavelier L, Palmqvist L, Lönnerholm G, Nordenskjöld M, Johansson B, Forestier E, Nordgren A. The frequency and prognostic impact of dic(9;20)(p13.2;q11.2) in childhood B-cell precursor acute lymphoblastic leukemia: results from the NOPHO ALL-2000 trial. Leukemia 2011; 25:622-8. [DOI: 10.1038/leu.2010.318] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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50
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Friman S, Nordén G, Lennerling A, Fehrman-Ekholm I, Felldin M, Hansson S, Rydberg L, Holgersson J, Rizell M, Kvarnström N, Gustafsson B, Gäbel M, Olausson M, Mjörnstedt L. Kidney transplantation--a 46-year experience from the Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden. Clin Transpl 2011:119-125. [PMID: 22755408] [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: 06/01/2023]
Abstract
The limiting factor in organ transplantation is the availability of organs. Ongoing work to improve donation rates both at the public and the organizational level in donating hospitals is essential. We also think that encouragement of live donation is important, and the possibility of ABO incompatible transplantation has increased the number of LD transplantations. The one-year graft survival rate is excellent and focus has shifted towards achieving long-term results to reduce the attrition rate. There is also an increasing interest in studying and working to reduce comorbidities on a long-term basis and thus, improve survival rates and recipient quality of life.
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Affiliation(s)
- S Friman
- Sahlgrenska University Hospital, Gothenburg, Sweden.
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