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Kulasekararaj A, Cavenagh J, Dokal I, Foukaneli T, Gandhi S, Garg M, Griffin M, Hillmen P, Ireland R, Killick S, Mansour S, Mufti G, Potter V, Snowden J, Stanworth S, Zuha R, Marsh J. Guidelines for the diagnosis and management of adult aplastic anaemia: A British Society for Haematology Guideline. Br J Haematol 2024; 204:784-804. [PMID: 38247114 DOI: 10.1111/bjh.19236] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
Pancytopenia with hypocellular bone marrow is the hallmark of aplastic anaemia (AA) and the diagnosis is confirmed after careful evaluation, following exclusion of alternate diagnosis including hypoplastic myelodysplastic syndromes. Emerging use of molecular cyto-genomics is helpful in delineating immune mediated AA from inherited bone marrow failures (IBMF). Camitta criteria is used to assess disease severity, which along with age and availability of human leucocyte antigen compatible donor are determinants for therapeutic decisions. Supportive care with blood and platelet transfusion support, along with anti-microbial prophylaxis and prompt management of opportunistic infections remain key throughout the disease course. The standard first-line treatment for newly diagnosed acquired severe/very severe AA patients is horse anti-thymocyte globulin and ciclosporin-based immunosuppressive therapy (IST) with eltrombopag or allogeneic haemopoietic stem cell transplant (HSCT) from a matched sibling donor. Unrelated donor HSCT in adults should be considered after lack of response to IST, and up front for young adults with severe infections and a readily available matched unrelated donor. Management of IBMF, AA in pregnancy and in elderly require special attention. In view of the rarity of AA and complexity of management, appropriate discussion in multidisciplinary meetings and involvement of expert centres is strongly recommended to improve patient outcomes.
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Affiliation(s)
- Austin Kulasekararaj
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Jamie Cavenagh
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Inderjeet Dokal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Barts Health NHS Trust, London, UK
| | - Theodora Foukaneli
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NHS Blood and Transplant, Bristol, UK
| | - Shreyans Gandhi
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Mamta Garg
- Leicester Royal Infirmary, Leicester, UK
- British Society Haematology Task Force Representative, London, UK
| | | | | | - Robin Ireland
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Sally Killick
- University Hospitals Dorset NHS Foundation Trust, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Sahar Mansour
- St George's Hospital/St George's University of London, London, UK
| | - Ghulam Mufti
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - Victoria Potter
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
| | - John Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Simon Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Roslin Zuha
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, England
| | - Judith Marsh
- King's College Hospital NHS Foundation Trust, London and King's College London, London, UK
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McLeod C, Ramsay J, Flanagan KL, Plebanski M, Marshall H, Dymock M, Marsh J, Estcourt MJ, Wadia U, Williams PCM, Tjiam MC, Blyth C, Subbarao K, Nicholson S, Faust S, Thornton RB, Mckenzie A, Snelling TL, Richmond P. Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO). Trials 2023; 24:202. [PMID: 36934272 PMCID: PMC10024280 DOI: 10.1186/s13063-023-07225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.
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Affiliation(s)
- C McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia.
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia.
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia.
| | - J Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - K L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - H Marshall
- Women's and Children's Health Network, North Adelaide, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - M Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - J Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - M J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - U Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
| | - P C M Williams
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Westmead, Australia
- School of Women and Children's Health, UNSW, Kensington, Australia
| | - M C Tjiam
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
| | - K Subbarao
- WHO Collaborating Centre for Reference and Research On Influenza, University of Melbourne, Parkville, VIC, Australia
| | - S Nicholson
- Serology Laboratory, Victorian Infectious Diseases Research Laboratory, Melbourne, Australia
| | - S Faust
- Southampton Clinical Research Facility and Biomedical Research Centre, National Institute of Health Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - A Mckenzie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - T L Snelling
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - P Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
- General Paediatrics and Immunology Departments, Perth Children's Hospital, Nedlands, Australia
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3
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Iftikhar R, Ahmad P, de Latour R, Dufour C, Risitano A, Chaudhri N, Bazarbachi A, De La Fuente J, Höchsmann B, Osman Ahmed S, Gergis U, Elhaddad A, Halkes C, Albeirouti B, Alotaibi S, Kulasekararaj A, Alzahrani H, Ben Othman T, Cesaro S, Alahmari A, Rihani R, Alshemmari S, Hamidieh AA, Bekadja MA, Passweg J, Al-Khabori M, Rasheed W, Bacigalupo A, Chaudhry QUN, Ljungman P, Marsh J, El Fakih R, Aljurf M. Correction to: Special issues related to the diagnosis and management of acquired aplastic anemia in countries with restricted resources, a report on behalf of the Eastern Mediterranean Blood and Marrow Transplantation (EMBMT) Group and Severe Aplastic Anemia Working Party of the European Society for Blood and Marrow Transplantation (SAAWP of EBMT). Bone Marrow Transplant 2021; 57:331. [PMID: 34931011 DOI: 10.1038/s41409-021-01534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
| | - Parvez Ahmad
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | | | - Carlo Dufour
- G Gaslini Children Research Hospital, Genova, Italy
| | - Antonio Risitano
- AORN Moscati, Avellino, Italy.,Federico II University, Naples, Italy
| | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Bazarbachi
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Syed Osman Ahmed
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Usama Gergis
- Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Alaa Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Bassim Albeirouti
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | | | | | - Hazzaa Alzahrani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Tarek Ben Othman
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ali Alahmari
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Walid Rasheed
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Riad El Fakih
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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4
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Iftikhar R, Ahmad P, de Latour R, Dufour C, Risitano A, Chaudhri N, Bazarbachi A, De La Fuente J, Höchsmann B, Osman Ahmed S, Gergis U, Elhaddad A, Halkes C, Albeirouti B, Alotaibi S, Kulasekararaj A, Alzahrani H, Ben Othman T, Cesaro S, Alahmari A, Rihani R, Alshemmari S, Ali Hamidieh A, Bekadja MA, Passweg J, Al-Khabori M, Rasheed W, Bacigalupo A, Chaudhry QUN, Ljungman P, Marsh J, El Fakih R, Aljurf M. Special issues related to the diagnosis and management of acquired aplastic anemia in countries with restricted resources, a report on behalf of the Eastern Mediterranean blood and marrow transplantation (EMBMT) group and severe aplastic anemia working party of the European Society for blood and marrow transplantation (SAAWP of EBMT). Bone Marrow Transplant 2021; 56:2518-2532. [PMID: 34011966 DOI: 10.1038/s41409-021-01332-8] [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: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 11/09/2022]
Abstract
Aplastic anemia is a relatively rare but potentially fatal disorder, with a reported higher incidence in developing countries in comparison to the West. There are significant variations in epidemiological as well as etiological factors of bone marrow failure syndromes in the developing countries in comparison to the developed world. Furthermore, the management of bone marrow failure syndromes in resource constraint settings has significant challenges including delayed diagnosis and referral, limited accessibility to healthcare facilities, treatment modalities as well as limitations related to patients who require allogeneic stem cell transplantation. Here we will provide a review of the available evidence related to specific issues of aplastic anemia in the developing countries and we summarize suggested recommendations from the Eastern Mediterranean blood and bone marrow transplantation (EMBMT) group and the severe aplastic anemia working party of the European Society of blood and marrow transplantation (SAAWP of EBMT) related to the diagnosis and therapeutic options in countries with restricted resources.
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Affiliation(s)
- Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
| | - Parvez Ahmad
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | | | - Carlo Dufour
- G Gaslini Children Research Hospital, Genova, Italy
| | - Antonio Risitano
- AORN Moscati, Avellino, Italy.,Federico II University, Naples, Italy
| | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Bazarbachi
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Syed Osman Ahmed
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Usama Gergis
- Sidney Kimmel Cancer Center, Philadelphia, PA, USA
| | - Alaa Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Bassim Albeirouti
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | | | | | - Hazzaa Alzahrani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Tarek Ben Othman
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ali Alahmari
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Walid Rasheed
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Division of Hematology Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Riad El Fakih
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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5
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Mehra V, Tetlow S, Choy A, de Lavallade H, Kulasekararaj A, Krishnamurthy P, Avenoso D, Marsh J, Potter V, Mufti G, Pagliuca A, Gandhi S. Early and late-onset veno-occlusive disease/sinusoidal syndrome post allogeneic stem cell transplantation - a real-world UK experience. Am J Transplant 2021; 21:864-869. [PMID: 33037770 DOI: 10.1111/ajt.16345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 01/25/2023]
Abstract
Classical veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a serious complication post allogeneic hematopoietic stem cell transplantation (HSCT). Before the recently revised EBMT criteria, the Baltimore and modified Seattle criteria failed to recognize the syndrome of late-onset VOD. We present real-world experience from a large UK transplant center reporting on VOD/SOS in consecutive HSCT adult patients (n = 530), transplanted for hematological cancers. We identified 27 patients treated with Defibrotide for VOD/SOS diagnosis, where detailed data were available for final analysis. Using standard definitions including EBMT criteria, around 30% (n = 8/27) of cases classified as late-onset VOD presenting at median of 46 (22-93) days but with D100 survival (63% vs 58%, Log-rank; P = 0.81) comparable to classical VOD. Hazard ratio for D100 mortality was 2.82 (95% CI: 1.74-4.56, P < .001, Gray test) with all VOD/SOS events. Twenty percent (n = 2/8) of late-onset VOD patients were anicteric and 42% (n = 8) classical VOD patients presented with refractory thrombocytopenia, while less than half met EBMT criteria for classical VOD in adults, highlighting gaps in real-world diagnostic limitations using EBMT criteria. However, challenges remain about underrecognition and difficulties related to early defibrotide access for treatment of late-onset VOD in current treatment guidelines. Our report strongly supports early Defibrotide for the treatment of severe VOD/SOS in adults regardless of time of onset.
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Affiliation(s)
- Varun Mehra
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK.,Cancer Studies, Kings College London, London, UK
| | - Simon Tetlow
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Adrian Choy
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Hugues de Lavallade
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Austin Kulasekararaj
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Pramila Krishnamurthy
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Daniele Avenoso
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Judith Marsh
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Victoria Potter
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Ghulam Mufti
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK.,Cancer Studies, Kings College London, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
| | - Shreyans Gandhi
- Department of Haematological Medicine, Kings College Hospital NHS Foundation Trust, London, UK
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6
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Iftikhar R, Chaudhry QUN, Anwer F, Neupane K, Rafae A, Mahmood SK, Ghafoor T, Shahbaz N, Khan MA, Khattak TA, Shamshad GU, Rehman J, Farhan M, Khan M, Ansar I, Ashraf R, Marsh J, Satti TM, Ahmed P. Allogeneic hematopoietic stem cell transplantation in aplastic anemia: current indications and transplant strategies. Blood Rev 2020; 47:100772. [PMID: 33187812 DOI: 10.1016/j.blre.2020.100772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 05/15/2020] [Revised: 09/12/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Treatment options for newly diagnosed aplastic anemia (AA) patient includes upfront allogeneic hematopoietic stem cell transplant (HSCT) or immunosuppressive therapy (IST). With recent advances in supportive care, conditioning regimens and post-transplant immunosuppression the overall survival for HSCT approaches 70-90%. Transplant eligibility needs to be assessed considering age, comorbidities, donor availability and probability of response to immunosuppressive therapy (IST). Upfront HSCT should be offered to children and young adults with matched related donor (MRD). Upfront HSCT may also be offered to children and young adults with rapidly available matched unrelated donor (MUD) who require urgent HSCT. Bone marrow (BM) graft source and cyclosporine (CsA) plus methotrexate (MTX) as graft versus host disease (GVHD) prophylaxis are preferable when using anti-thymocyte globulin (ATG) based conditioning regimens. Alemtuzumab is an acceptable alternative to ATG and is used with CsA alone and with either BM or peripheral blood stem cells (PBSC). Cyclophosphamide (CY) plus ATG conditioning is preferable for patients receiving MRD transplant, while Fludarabine (Flu) based conditioning is reserved for older adults, those with risk factors of graft failure and those receiving MUD HSCT. For haploidentical transplant, use of low dose radiotherapy and post-transplant cyclophosphamide has resulted in a marked reduction in graft failure and GVHD.
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Affiliation(s)
- Raheel Iftikhar
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan.
| | - Qamar Un Nisa Chaudhry
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Faiz Anwer
- Department of Hematology, Medical Oncology, Tausig Cancer Center, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Karun Neupane
- Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara 33700, Nepal
| | - Abdul Rafae
- Department of Internal Medicine, McLaren Flint Michigan State University, United States
| | - Syed Kamran Mahmood
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Tariq Ghafoor
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Nighat Shahbaz
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Mehreen Ali Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Tariq Azam Khattak
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Ghassan Umair Shamshad
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Jahanzeb Rehman
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Muhammad Farhan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Maryam Khan
- Department of Hematology and Stem Cell Transplant, Armed Forces Bone Marrow Transplant Center/National Institute of Blood and Marrow Transplant, Rawalpindi 46000, Pakistan
| | - Iqraa Ansar
- Shifa College of Medicine, Islamabad 44000, Pakistan
| | - Rabia Ashraf
- King Edward Medical University, Lahore 54000, Pakistan
| | - Judith Marsh
- Department of Hematological Medicine, King's College Hospital, Denmark Hill, London SE59RS, UK
| | | | - Parvez Ahmed
- Department of Hematology Oncology and Stem Cell Transplant, Quaid-e-Azam International Hospital, Islamabad 44000, Pakistan
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7
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Mehra V, Rhone E, Widya S, Zuckerman M, Potter V, Raj K, Kulasekararaj A, McLornan D, de Lavallade H, Benson-Quarm N, Lim C, Ware S, Sudhanva M, Malik O, Nicholas R, Muraro PA, Marsh J, Mufti GJ, Silber E, Pagliuca A, Kazmi MA. Epstein-Barr Virus and Monoclonal Gammopathy of Clinical Significance in Autologous Stem Cell Transplantation for Multiple Sclerosis. Clin Infect Dis 2020; 69:1757-1763. [PMID: 30980715 DOI: 10.1093/cid/ciz047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Autologous hematopoietic stem cell transplantation (AHSCT) with anti-thymocyte globulin (ATG) conditioning as treatment of active multiple sclerosis (MS) is rapidly increasing across Europe (EBMT registry data 2017). Clinically significant Epstein-Barr virus reactivation (EBV-R) following AHSCT with ATG for severe autoimmune conditions is an underrecognized complication relative to T-cell deplete transplants performed for hematological diseases. This retrospective study reports EBV-R associated significant clinical sequelae in MS patients undergoing AHSCT with rabbit ATG. METHODS Retrospective data were analyzed for 36 consecutive MS-AHSCT patients at Kings College Hospital, London. All patients routinely underwent weekly EBV DNA polymerase chain reaction monitoring and serum electrophoresis for monoclonal gammopathy (MG or M-protein). EBV-R with rising Epstein-Barr viral load, M-protein, and associated clinical sequelae were captured from clinical records. RESULTS All patients had evidence of rising EBV DNA-emia, including 7 who were lost to long-term follow-up, with a number of them developing high EBV viral load and associated lymphoproliferative disorder (LPD). Nearly 72% (n = 18/29) developed de novo MG, some with significant neurological consequences with high M-protein and EBV-R. Six patients required anti-CD20 therapy (rituximab) with complete resolution of EBV related symptoms. Receiver operating characteristics estimated a peak EBV viremia of >500 000 DNA copies/mL correlated with high sensitivity (85.5%) and specificity (82.5%) (area under the curve: 0.87; P = .004) in predicting EBV-R related significant clinical events. CONCLUSION Symptomatic EBV reactivation increases risk of neurological sequelae and LPD in MS-AHSCT. We recommend regular monitoring for EBV and serum electrophoresis for MG in MS patients in the first 3 months post-AHSCT.
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Affiliation(s)
- Varun Mehra
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Elijah Rhone
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Stefani Widya
- GKT School of Medical Education, Kings College London University
| | - Mark Zuckerman
- Department of Virology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Victoria Potter
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Kavita Raj
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill.,Department of Hematology, Guy's and St. Thomas' NHS Foundation Trust
| | - Austin Kulasekararaj
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Donal McLornan
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill.,Department of Hematology, Guy's and St. Thomas' NHS Foundation Trust
| | - Hugues de Lavallade
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Nana Benson-Quarm
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Christina Lim
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Sarah Ware
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Malur Sudhanva
- Department of Virology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Omar Malik
- Department of Neurology, Imperial College Healthcare, United Kingdom
| | - Richard Nicholas
- Department of Neurology, Imperial College Healthcare, United Kingdom
| | - Paolo A Muraro
- Department of Neurology, Imperial College Healthcare, United Kingdom.,Department of Neuroimmunology, Imperial College London, United Kingdom
| | - Judith Marsh
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Ghulam J Mufti
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Antonio Pagliuca
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill
| | - Majid A Kazmi
- Department of Hematology, King's College Hospital NHS Foundation Trust, Denmark Hill.,Department of Hematology, Guy's and St. Thomas' NHS Foundation Trust
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8
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Shah V, Ko Ko T, Zuckerman M, Vidler J, Sharif S, Mehra V, Gandhi S, Kuhnl A, Yallop D, Avenoso D, Rice C, Sanderson R, Sarma A, Marsh J, de Lavallade H, Krishnamurthy P, Patten P, Benjamin R, Potter V, Ceesay MM, Mufti GJ, Norton S, Pagliuca A, Galloway J, Kulasekararaj AG. Poor outcome and prolonged persistence of SARS-CoV-2 RNA in COVID-19 patients with haematological malignancies; King's College Hospital experience. Br J Haematol 2020; 190:e279-e282. [PMID: 32526039 PMCID: PMC7307054 DOI: 10.1111/bjh.16935] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Vallari Shah
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Thinzar Ko Ko
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Mark Zuckerman
- South London Specialist Virology Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Jennifer Vidler
- Department of Haematological Medicine, Princess Royal University Hospital, Farnborough, UK
| | - Sobia Sharif
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Varun Mehra
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Shreyans Gandhi
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrea Kuhnl
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Deborah Yallop
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniele Avenoso
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Carmel Rice
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Robin Sanderson
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Anita Sarma
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Hugues de Lavallade
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Pramila Krishnamurthy
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Piers Patten
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Reuben Benjamin
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Victoria Potter
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - M Mansour Ceesay
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,Department of Haematological Medicine, Princess Royal University Hospital, Farnborough, UK
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Sam Norton
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Austin G Kulasekararaj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK.,King's College London, London, UK
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9
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Rio-Machin A, Vulliamy T, Hug N, Walne A, Tawana K, Cardoso S, Ellison A, Pontikos N, Wang J, Tummala H, Al Seraihi AFH, Alnajar J, Bewicke-Copley F, Armes H, Barnett M, Bloor A, Bödör C, Bowen D, Fenaux P, Green A, Hallahan A, Hjorth-Hansen H, Hossain U, Killick S, Lawson S, Layton M, Male AM, Marsh J, Mehta P, Mous R, Nomdedéu JF, Owen C, Pavlu J, Payne EM, Protheroe RE, Preudhomme C, Pujol-Moix N, Renneville A, Russell N, Saggar A, Sciuccati G, Taussig D, Toze CL, Uyttebroeck A, Vandenberghe P, Schlegelberger B, Ripperger T, Steinemann D, Wu J, Mason J, Page P, Akiki S, Reay K, Cavenagh JD, Plagnol V, Caceres JF, Fitzgibbon J, Dokal I. The complex genetic landscape of familial MDS and AML reveals pathogenic germline variants. Nat Commun 2020; 11:1044. [PMID: 32098966 PMCID: PMC7042299 DOI: 10.1038/s41467-020-14829-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
The inclusion of familial myeloid malignancies as a separate disease entity in the revised WHO classification has renewed efforts to improve the recognition and management of this group of at risk individuals. Here we report a cohort of 86 acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) families with 49 harboring germline variants in 16 previously defined loci (57%). Whole exome sequencing in a further 37 uncharacterized families (43%) allowed us to rationalize 65 new candidate loci, including genes mutated in rare hematological syndromes (ADA, GP6, IL17RA, PRF1 and SEC23B), reported in prior MDS/AML or inherited bone marrow failure series (DNAH9, NAPRT1 and SH2B3) or variants at novel loci (DHX34) that appear specific to inherited forms of myeloid malignancies. Altogether, our series of MDS/AML families offer novel insights into the etiology of myeloid malignancies and provide a framework to prioritize variants for inclusion into routine diagnostics and patient management.
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Affiliation(s)
- Ana Rio-Machin
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK.
| | - Tom Vulliamy
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK.
| | - Nele Hug
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Amanda Walne
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Kiran Tawana
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - Shirleny Cardoso
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Alicia Ellison
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Nikolas Pontikos
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Jun Wang
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Hemanth Tummala
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Ahad Fahad H Al Seraihi
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Jenna Alnajar
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Findlay Bewicke-Copley
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Hannah Armes
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Michael Barnett
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adrian Bloor
- Department of Haematology, Christie Hospital, Manchester, UK
| | - Csaba Bödör
- MTA-SE Lendulet Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - David Bowen
- Department of Haematology, St James's University Hospital, Leeds, UK
| | - Pierre Fenaux
- Service d'hématologie Séniors, Hôpital St Louis/Université Paris, Paris, France
| | - Andrew Green
- National Centre for Medical Genetics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Andrew Hallahan
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Henrik Hjorth-Hansen
- Department of Hematology, St Olavs Hospital and Institute of Cancer Research and Molecular Medicine (IKM) Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Upal Hossain
- Department of Haematology, Whipps Cross Hospital, Barts NHS Trust, London, UK
| | - Sally Killick
- Department of Haematology, The Royal Bournemouth Hospital NHS Foundation Trust, Bournemouth, UK
| | - Sarah Lawson
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - Mark Layton
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - Alison M Male
- Clinic Genetics Unit, Great Ormond Street Hospital, London, UK
| | - Judith Marsh
- Department of Haematological Medicine, Haematology Institute, King's College Hospital, London, UK
| | - Priyanka Mehta
- Bristol Haematology Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rogier Mous
- UMC Utrecht Cancer Center, Universitair Medisch Centrum Utrecht, Huispostnummer, Utrecht, Netherlands
| | - Josep F Nomdedéu
- Laboratori d´Hematologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carolyn Owen
- Division of Hematology and Hematological Malignancies, Foothills Medical Centre, Calgary, AB, Canada
| | - Jiri Pavlu
- Centre for Haematology, Imperial College London, Hammersmith Hospital, London, UK
| | - Elspeth M Payne
- Department of Haematology, UCL Cancer Institute, University College London, London, UK
| | - Rachel E Protheroe
- Bristol Haematology Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Claude Preudhomme
- Laboratory of Hematology, Biology and Pathology Center, Centre Hospitalier Regional Universitaire de Lille, Lille, France
- Jean-Pierre Aubert Research Center, INSERM, Universitaire de Lille, Lille, France
| | - Nuria Pujol-Moix
- Laboratori d´Hematologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Nigel Russell
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Anand Saggar
- Clinical Genetics, St George's Hospital Medical School, London, UK
| | - Gabriela Sciuccati
- Servicio de Hematologia y Oncologia, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Ciudad Autonoma de Buenos Aires, Argentina
| | - David Taussig
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, UK
| | - Cynthia L Toze
- The Leukemia/BMT Program of British Columbia, Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne Uyttebroeck
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Tim Ripperger
- Institut für Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Doris Steinemann
- Institut für Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | - John Wu
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Joanne Mason
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Paula Page
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Susanna Akiki
- Department of Laboratory Medicine & Pathology, Qatar Rehabilitation Institute, Hamad Bin Khalifa Medical City (HBKM), Doha, Qatar
| | - Kim Reay
- West Midlands Regional Genetics Laboratory, Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | - Jamie D Cavenagh
- Department of Haematology, St Bartholomew's Hospital, Barts NHS Trust, London, UK
| | | | - Javier F Caceres
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jude Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK.
| | - Inderjeet Dokal
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK.
- Barts Health NHS Trust, London, UK.
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10
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Affiliation(s)
- R. Harvey
- South West Thames Renal Transplant Team St. George's Hospital London, United Kingdom
| | - J. Marsh
- South West Thames Renal Transplant Team St. George's Hospital London, United Kingdom
| | - E.S. Chemla
- South West Thames Renal Transplant Team St. George's Hospital London, United Kingdom
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11
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Tichelli A, de Latour RP, Passweg J, Knol-Bout C, Socié G, Marsh J, Schrezenmeier H, Höchsmann B, Bacigalupo A, Samarasinghe S, Rovó A, Kulasekararaj A, Röth A, Eikema DJ, Bosman P, Bader P, Risitano A, Dufour C. Long-term outcome of a randomized controlled study in patients with newly diagnosed severe aplastic anemia treated with antithymocyte globulin and cyclosporine, with or without granulocyte colony-stimulating factor: a Severe Aplastic Anemia Working Party Trial from the European Group of Blood and Marrow Transplantation. Haematologica 2019; 105:1223-1231. [PMID: 31582549 PMCID: PMC7193468 DOI: 10.3324/haematol.2019.222562] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 03/20/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
This follow-up study of a randomized, prospective trial included 192 patients with newly diagnosed severe aplastic anemia receiving antithymoglobulin and cyclosporine, with or without granulocyte colony-stimulating factor (G-CSF). We aimed to evaluate the long-term effect of G-CSF on overall survival, event-free survival, probability of secondary myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML), clinical paroxysmal nocturnal hemoglobinuria, relapse, avascular osteonecrosis and chronic kidney disease. The median follow-up was 11.7 years (95% CI, 10.9-12.5). The overall survival rate at 15 years was 57±12% in the group given G-CSF and 63±12% in the group not given G-CSF (P=0.92); the corresponding event-free survival rates were 24±10% and 23±10%, respectively (P=0.36). In total, 9 patients developed MDS or AML, 10 only a clonal cytogenetic abnormality, 7 a solid cancer, 18 clinical paroxysmal nocturnal hemoglobinuria, 8 osteonecrosis, and 12 chronic kidney disease, without any difference between patients treated with or without G-CSF. The cumulative incidence of MDS, AML or isolated cytogenetic abnormality at 15 years was 8.5±3% for the G-CSF group and 8.2±3% for the non-G-CSF group (P=0.90). The cumulative incidence of any late event including myelodysplastic syndrome or acute myeloid leukemia, isolated cytogenetic abnormalities, solid cancer, clinical paroxysmal nocturnal hemoglobinuria, aseptic osteonecrosis, chronic kidney disease and relapse was 50±12% for the G-CSF group and 49±12% for the non-G-CSF group (P=0.65). Our results demonstrate that it is unlikely that G-CSF has an impact on the outcome of severe aplastic anemia; nevertheless, very late events are common and eventually affect the prognosis of these patients, irrespectively of their age at the time of immunosuppressive therapy (NCT01163942).
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Affiliation(s)
- André Tichelli
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Régis Peffault de Latour
- Université de Paris, and Hematology-Transplantation, Saint Louis Hospital (AP-HP), Paris, France
| | - Jakob Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Gérard Socié
- Université de Paris, INSERM U976 and Hematology-Transplantation, Saint Louis Hospital (AP-HP), Paris, France
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| | - Hubert Schrezenmeier
- Institute of Tranfusion Medicine, University of Ulm and Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, Ulm, Germany
| | - Britta Höchsmann
- Institute of Tranfusion Medicine, University of Ulm and Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen and University Hospital Ulm, Ulm, Germany
| | - Andrea Bacigalupo
- Instituto di Ematologia, Fondazione Policlinico Universitario Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Austin Kulasekararaj
- Department of Haematological Medicine, King's College Hospital, NIHR/Wellcome King's Clinical Research Facility, London, UK
| | - Alexander Röth
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Paul Bosman
- EBMT Registry Office, Leiden, the Netherlands
| | - Peter Bader
- University Children's Hospital Frankfurt, Frankfurt, Germany
| | - Antonio Risitano
- Hematology Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Carlo Dufour
- Hemato-Onco-SCT Pole, Hematology Unit. G. Gaslini Children's Research Hospital, Genova, Italy
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12
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Sheth V, Kennedy V, de Lavallade H, Mclornan D, Potter V, Engelhardt BG, Savani B, Chinratanalab W, Goodman S, Greer J, Kassim A, York S, Kenyon M, Gandhi S, Kulasekararaj A, Marsh J, Mufti G, Pagliuca A, Jagasia M, Raj K. Differential Interaction of Peripheral Blood Lymphocyte Counts (ALC) With Different in vivo Depletion Strategies in Predicting Outcomes of Allogeneic Transplant: An International 2 Center Experience. Front Oncol 2019; 9:623. [PMID: 31355140 PMCID: PMC6636242 DOI: 10.3389/fonc.2019.00623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
Dosing regimens for antithymocyte globulin (ATG) and anti-CD52 antibody (alemtuzumab) for graft vs. host disease prophylaxis (GVHD) are empiric or weight-based, and do not account for individual patient factors. Recently, it has been shown that recipient peripheral blood absolute lymphocyte count (ALC) on the day of ATG administration interacts with the dose of ATG administered to predict transplantation outcome. Similarly, we wanted to analyze if the recipient ALC interacts with alemtuzumab dosing to predict outcomes. We retrospectively compared 364 patients, 124 patients receiving ATG (anti-thymocyte globulin) for GVHD prophylaxis, and undergoing unrelated first allogeneic transplant for myeloid and lymphoid malignancies (group 1) to 240 patients receiving alemtuzumab (group 2), in similar time period. There was no difference in survival or acute and chronic GVHD between 60 and 100 mg of alemtuzumab dosing. Unlike ATG (where the pre-transplant recipient ALC interacted with ATG dose on day of its administration (day 1) to predict OS and DFS (p = 0.05), within alemtuzumab group, the recipient ALC on second day of alemtuzumab administration (day 2) and its interaction with alemtuzumab dose strongly predicted OS, DFS and relapse (p = 0.05, HR-1.81, 1.1–3.3; p = 0.002, HR-2.41, CI, 1.3–4.2; and p = 0.003, HR-2.78, CI, 1.4–5.2), respectively. ALC (day 2) of 0.08 × 109/lit or higher, had a specificity of 96% in predicting inferior DFS. Like ATG, there is definite but differential interaction between the recipient peripheral blood ALC and alemtuzumab dose to predict OS, DFS, and relapses.
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Affiliation(s)
- Vipul Sheth
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Vanessa Kennedy
- Department of Haematology and Stem Cell Transplant, Stanford University, Stanford, CA, United States
| | - Hugues de Lavallade
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Donal Mclornan
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Victoria Potter
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Brian G Engelhardt
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Bipin Savani
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Wichai Chinratanalab
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Stacey Goodman
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - John Greer
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Adetola Kassim
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Sally York
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Michelle Kenyon
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Shreyans Gandhi
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Austin Kulasekararaj
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Judith Marsh
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Ghulam Mufti
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Antonio Pagliuca
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
| | - Madan Jagasia
- Department of Haematology and Stem Cell Transplant, Vanderbilt University, Nashville, TN, United States
| | - Kavita Raj
- Department of Haematology and Stem Cell Transplantation, Kings College Hospital, London, United Kingdom
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13
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Samarasinghe S, Clesham K, Iacobelli S, Sbianchi G, Knol C, Hamladji RM, Socié G, Aljurf M, Koh M, Sengeloev H, Dalle JH, Robinson S, Van Lint MT, Halkes CJM, Beelen D, Mufti GJ, Snowden J, Blaise D, de Latour RP, Marsh J, Dufour C, Risitano AM. Impact of T-cell depletion strategies on outcomes following hematopoietic stem cell transplantation for idiopathic aplastic anemia: A study on behalf of the European blood and marrow transplant severe aplastic anemia working party. Am J Hematol 2019; 94:80-86. [PMID: 30328134 DOI: 10.1002/ajh.25314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022]
Abstract
We retrospectively analyzed the outcomes of 1837 adults and children with severe aplastic anemia (SAA) who underwent matched sibling donor (MSD) and matched unrelated donor (MUD) hemopoietic stem cell transplantation (HSCT) between 2000 and 2013. Patients were grouped by transplant conditioning containing either anti-thymocyte globulin (ATG) (n = 1283), alemtuzumab (n = 261), or no serotherapy (NS) (n = 293). The risks of chronic GvHD were significantly reduced when ATG or alemtuzumab were compared with NS (P = .021 and .003, respectively). Acute GVHD was significantly reduced in favor of alemtuzumab compared with ATG (P = .012) and NS (P < .001). By multivariate analysis, when compared with ATG, alemtuzumab was associated with a lower risk of developing acute (OR 0.262; 95% CI 0.14-0.47; P < .001) and chronic GVHD (HR 0.58; 95% CI 0.35-0.94; P = .027). OS was significantly better in ATG and alemtuzumab patients compared with NS (P = .010 and .025). Our data shows inclusion of serotherapy in MSD and MUD HSCT for patients with SAA reduces chronic GVHD and provides a survival advantage over patients not receiving serotherapy. Notably, alemtuzumab reduced the risk of acute and chronic GvHD compared with ATG and indicates that alemtuzumab might be the serotherapy of choice for MSD and MUD transplants for SAA.
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Affiliation(s)
| | - Katherine Clesham
- UCL Great Ormond Street Hospital for Children; London United Kingdom
| | - Simona Iacobelli
- Dipartimento di Biologia; Tor Vergata Università di Roma; Rome Italy
| | - Giulia Sbianchi
- Dipartimento di Biologia; Tor Vergata Università di Roma; Rome Italy
| | - Cora Knol
- EBMT Data Office; Leiden The Netherlands
| | | | | | - Mahmoud Aljurf
- King Faisal Hospital & Research Centre; Riyadh Saudi Arabia
| | - Mickey Koh
- St. George's Hospital; London United Kingdom
| | | | | | | | | | | | | | - Ghulam J. Mufti
- King's College Hospital/King's College London; London United Kingdom
| | - John Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield United Kingdom
| | | | | | - Judith Marsh
- King's College Hospital/King's College London; London United Kingdom
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14
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Walton DM, Marsh J. The Multidimensional Symptom Index: A new patient-reported outcome for pain phenotyping, prognosis and treatment decisions. Eur J Pain 2018; 22:1351-1361. [PMID: 29635812 DOI: 10.1002/ejp.1224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few patient-reported outcomes routinely used that capture frequency and interference of different pain-related symptoms on a single scale. The purpose of this study was to describe the development and initial validation of the new Multidimensional Symptom Index (MSI). METHODS Items were generated from patient interviews of the experience of chronic pain. Health valuations were created from rankings of 82 healthy subjects for each of 120 symptom (×10) × frequency (×3) × interference (×4) combinations using preference-based health valuations (0-100). Ranks for each symptom combination were then used in scale scoring. A sample of 300 patients with acute or chronic pain subsequently completed the MSI and a battery of other tools. Exploratory (EFA) and Confirmatory (CFA) factor analyses were triangulated with theory to arrive at the factor structure. Convergent validity was tested against established measures. RESULTS Health rankings resulted in scores of 0-12 for each of the 10 symptom types. Factor analyses revealed two factors: MSI Somatic Symptoms and MSI Non-Somatic Symptoms. The MSI also quantified number of symptoms experienced (/10), mean frequency (/3) and mean interference (/4). The indices showed appropriate associations with the established PROs. CONCLUSIONS The MSI is a new symptom-focused PRO that allows patient phenotyping and may have value for screening, prognosis and evaluating change. SIGNIFICANCE This article presents the development and psychometric properties of a new measure of pain and related symptom frequency and interference. This measure could aid clinicians in establishing clinically relevant pain phenotypes for screening, prognosis and treatment decisions.
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Affiliation(s)
- D M Walton
- School of Physical Therapy, Western University, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
| | - J Marsh
- School of Physical Therapy, Western University, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
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Sewry N, Verhagen E, Lambert M, van Mechelen W, Marsh J, Readhead C, Viljoen W, Brown J. Trends in time-loss injuries during the 2011-2016 South African Rugby Youth Weeks. Scand J Med Sci Sports 2018; 28:2066-2073. [DOI: 10.1111/sms.13087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
Affiliation(s)
- N. Sewry
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
| | - E. Verhagen
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
- Amsterdam Collaboration on Health and Safety in Sports; Department of Public and Occupational Health; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP); Federation University Australia; Ballarat Vic. Australia
| | - M. Lambert
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
- Amsterdam Collaboration on Health and Safety in Sports; Department of Public and Occupational Health; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - W. van Mechelen
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
- Amsterdam Collaboration on Health and Safety in Sports; Department of Public and Occupational Health; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
- School of Human Movement and Nutrition Sciences; Faculty of Health and Behavioural Sciences; University of Queensland; Brisbane Qld Australia
- School of Public Health, Physiotherapy and Population Sciences; University College Dublin; Dublin Ireland
| | - J. Marsh
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
| | - C. Readhead
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
- South African Rugby Union; Cape Town South Africa
| | - W. Viljoen
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
- South African Rugby Union; Cape Town South Africa
| | - J. Brown
- Division of Exercise Science and Sports Medicine; Department of Human Biology; University of Cape Town; Cape Town South Africa
- Amsterdam Collaboration on Health and Safety in Sports; Department of Public and Occupational Health; Amsterdam Public Health Research Institute; VU University Medical Center; Amsterdam The Netherlands
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Tedjaseputra A, McLornan D, McCormick J, Raj K, de Lavallade H, Potter V, Kenyon M, Pagliuca A, Marsh J, Mufti G. Anti-type M phospholipase A2 receptor antibody-positive membranous nephropathy as a part of multi-system autoimmune syndrome post-allogeneic stem cell transplantation. Intern Med J 2018; 48:481-483. [PMID: 29623981 DOI: 10.1111/imj.13762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 10/19/2017] [Accepted: 12/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Aditya Tedjaseputra
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia.,Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Donal McLornan
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Jill McCormick
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Kavita Raj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Hugues de Lavallade
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Potter
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Michelle Kenyon
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Ghulam Mufti
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
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17
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Warrington NM, Richmond R, Fenstra B, Myhre R, Gaillard R, Paternoster L, Wang CA, Beaumont RN, Das S, Murcia M, Barton SJ, Espinosa A, Thiering E, Atalay M, Pitkänen N, Ntalla I, Jonsson AE, Freathy R, Karhunen V, Tiesler CMT, Allard C, Crawford A, Ring SM, Melbye M, Magnus P, Rivadeneira F, Skotte L, Hansen T, Marsh J, Guxens M, Holloway JW, Grallert H, Jaddoe VWV, Lowe Jr WL, Roumeliotaki T, Hattersley AT, Lindi V, Pahkala K, Panoutsopoulou K, Standl M, Flexeder C, Bouchard L, Aagaard Nohr E, Marina LS, Kogevinas M, Niinikoski H, Dedoussis G, Heinrich J, Reynolds RM, Lakka T, Zeggini E, Raitakari OT, Chatzi L, Inskip HM, Bustamante M, Hivert MF, Jarvelin MR, Sørensen TIA, Pennell C, Felix JF, Jacobsson B, Geller F, Evans DM, Lawlor DA. Maternal and fetal genetic contribution to gestational weight gain. Int J Obes (Lond) 2018; 42:775-784. [PMID: 28990592 PMCID: PMC5784805 DOI: 10.1038/ijo.2017.248] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clinical recommendations to limit gestational weight gain (GWG) imply high GWG is causally related to adverse outcomes in mother or offspring, but GWG is the sum of several inter-related complex phenotypes (maternal fat deposition and vascular expansion, placenta, amniotic fluid and fetal growth). Understanding the genetic contribution to GWG could help clarify the potential effect of its different components on maternal and offspring health. Here we explore the genetic contribution to total, early and late GWG. PARTICIPANTS AND METHODS A genome-wide association study was used to identify maternal and fetal variants contributing to GWG in up to 10 543 mothers and 16 317 offspring of European origin, with replication in 10 660 mothers and 7561 offspring. Additional analyses determined the proportion of variability in GWG from maternal and fetal common genetic variants and the overlap of established genome-wide significant variants for phenotypes relevant to GWG (for example, maternal body mass index (BMI) and glucose, birth weight). RESULTS Approximately 20% of the variability in GWG was tagged by common maternal genetic variants, and the fetal genome made a surprisingly minor contribution to explain variation in GWG. Variants near the pregnancy-specific beta-1 glycoprotein 5 (PSG5) gene reached genome-wide significance (P=1.71 × 10-8) for total GWG in the offspring genome, but did not replicate. Some established variants associated with increased BMI, fasting glucose and type 2 diabetes were associated with lower early, and higher later GWG. Maternal variants related to higher systolic blood pressure were related to lower late GWG. Established maternal and fetal birth weight variants were largely unrelated to GWG. CONCLUSIONS We found a modest contribution of maternal common variants to GWG and some overlap of maternal BMI, glucose and type 2 diabetes variants with GWG. These findings suggest that associations between GWG and later offspring/maternal outcomes may be due to the relationship of maternal BMI and diabetes with GWG.
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Affiliation(s)
- N M Warrington
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - R Richmond
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - B Fenstra
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - R Myhre
- Norwegian Institute of Public Health, Oslo, Norway
| | - R Gaillard
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Paternoster
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - C A Wang
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - R N Beaumont
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
| | - S Das
- Department of Public Health and Primary Care, School of Public Health, Imperial College London, London, UK
| | - M Murcia
- Epidemiology and Environmental Health Joint Research Unit, FISABIO–Universitat Jaume I–Universitat de València, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
| | - S J Barton
- MRC Lifecourse Epidemiology Unit, Faulty of Medicine, University of Southampton, Southampton, UK
| | - A Espinosa
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - E Thiering
- Institute of Epidemiology I, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - M Atalay
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - N Pitkänen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - I Ntalla
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - A E Jonsson
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - R Freathy
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
| | - V Karhunen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - C M T Tiesler
- Institute of Epidemiology I, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - C Allard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - A Crawford
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - S M Ring
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- ALSPAC (Children of the 90s), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - M Melbye
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - P Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - F Rivadeneira
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Skotte
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - T Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Marsh
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - M Guxens
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - J W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Grallert
- Institute of Epidemiology II, Research Unit of Molecular Epidemiology, Helmholtz Zentrum München Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- Clinical Cooperation Group Nutrigenomics and Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- Technische Universität München, Freising, Germany
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W L Lowe Jr
- Department of Medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - T Roumeliotaki
- Department of Social Medicine, University of Crete, Crete, Greece
| | - A T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Royal Devon and Exeter Hospital, Exeter, UK
| | - V Lindi
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - K Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Health and Physical Activity, Turku, Finland
| | - K Panoutsopoulou
- Department of Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - M Standl
- Institute of Epidemiology I, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
| | - C Flexeder
- Institute of Epidemiology I, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
| | - L Bouchard
- Department of Biochemistry, Faculty of medicine and life sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - E Aagaard Nohr
- Public Health Division of Gipuzkoa, Basque Government, Vitoria-Gasteiz, Spain
| | - L Santa Marina
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- Health Research Institute, Biodonostia, San Sebastián, Gipuzkoa, Spain
- Health Research Institute, Biodonostia, San Sebastián, Spain
| | - M Kogevinas
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - H Niinikoski
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - G Dedoussis
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - J Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital Munich, Ludwig Maximilian University of Munich, Munich, Germany
| | - R M Reynolds
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - T Lakka
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - E Zeggini
- Department of Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - O T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - L Chatzi
- Department of Social Medicine, University of Crete, Crete, Greece
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Social Medicine, University of Crete, Crete, Greece
- Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - H M Inskip
- MRC Lifecourse Epidemiology Unit, Faulty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Bustamante
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - M-F Hivert
- Department of Population Medicine at Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - M-R Jarvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC–PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
| | - T I A Sørensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Epidemiology (formally the Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - C Pennell
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
| | - J F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - F Geller
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
| | - D M Evans
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - D A Lawlor
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
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Griffin M, Kulasekararaj A, Gandhi S, Munir T, Richards S, Arnold L, Benson-Quarm N, Copeland N, Duggins I, Riley K, Hillmen P, Marsh J, Hill A. Concurrent treatment of aplastic anemia/paroxysmal nocturnal hemoglobinuria syndrome with immunosuppressive therapy and eculizumab: a UK experience. Haematologica 2018; 103:e345-e347. [PMID: 29545341 DOI: 10.3324/haematol.2017.183046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Morag Griffin
- Hematology department, St James University Hospital, Leeds, London, UK
| | | | - Sheyans Gandhi
- Hematology department, King's college University Hospital, London, UK
| | - Talha Munir
- Hematology department, St James University Hospital, Leeds, London, UK
| | - Stephen Richards
- Hematology department, St James University Hospital, Leeds, London, UK
| | - Louise Arnold
- Hematology department, St James University Hospital, Leeds, London, UK
| | - Nana Benson-Quarm
- Hematology department, King's college University Hospital, London, UK
| | - Nicola Copeland
- Hematology department, St James University Hospital, Leeds, London, UK
| | - Isabel Duggins
- Hematology department, King's college University Hospital, London, UK
| | - Kathryn Riley
- Hematology department, St James University Hospital, Leeds, London, UK
| | - Peter Hillmen
- Hematology department, St James University Hospital, Leeds, London, UK
| | - Judith Marsh
- Hematology department, King's college University Hospital, London, UK
| | - Anita Hill
- Hematology department, St James University Hospital, Leeds, London, UK
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Marsh J, Mijares S, Bullard BR, Weinroth M, Geornaras I, Delmore RJ, Belk KE. Comparison of Neutralizing Buffer and Sampling Sponges on Hot Beef Carcasses. Meat and Muscle Biology 2018. [DOI: 10.22175/rmc2018.161] [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: 11/03/2022] Open
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Rovó A, Kulasekararaj A, Medinger M, Chevallier P, Ribera JM, Peffault de Latour R, Knol C, Iacobelli S, Kanfer E, Bruno B, Maury S, Quarello P, Koh MBC, Schouten H, Blau IW, Tichelli A, Hill A, Risitano A, Passweg J, Marsh J, Dreger P, Dufour C. Association of aplastic anaemia and lymphoma: a report from the severe aplastic anaemia working party of the European Society of Blood and Bone Marrow Transplantation. Br J Haematol 2017; 184:294-298. [PMID: 29265360 DOI: 10.1111/bjh.15074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alicia Rovó
- University Hospital of Bern, Bern, Switzerland
| | | | | | | | - Jose M Ribera
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Jose Carreras Research Institute, Badalona, Spain
| | | | - Cora Knol
- EBMT Data Office, Leiden, the Netherlands
| | - Simona Iacobelli
- Centro Interdipartimentale di Biostatistica e Bioinformatica, Università Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | - Igor W Blau
- Charité - Campus Virchow Klinikum, Berlin, Germany
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Paquet F, Bailey MR, Leggett RW, Lipsztein J, Marsh J, Fell TP, Smith T, Nosske D, Eckerman KF, Berkovski V, Blanchardon E, Gregoratto D, Harrison JD. ICRP Publication 137: Occupational Intakes of Radionuclides: Part 3. Ann ICRP 2017; 46:1-486. [PMID: 29380630 DOI: 10.1177/0146645317734963] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The 2007 Recommendations of the International Commission on Radiological Protection (ICRP, 2007) introduced changes that affect the calculation of effective dose, and implied a revision of the dose coefficients for internal exposure, published previously in the Publication 30 series (ICRP, 1979, 1980, 1981, 1988) and Publication 68 (ICRP, 1994). In addition, new data are now available that support an update of the radionuclide-specific information given in Publications 54 and 78 (ICRP, 1988a, 1997b) for the design of monitoring programmes and retrospective assessment of occupational internal doses. Provision of new biokinetic models, dose coefficients, monitoring methods, and bioassay data was performed by Committee 2, Task Group 21 on Internal Dosimetry, and Task Group 4 on Dose Calculations. A new series, the Occupational Intakes of Radionuclides (OIR) series, will replace the Publication 30 series and Publications 54, 68, and 78. OIR Part 1 has been issued (ICRP, 2015), and describes the assessment of internal occupational exposure to radionuclides, biokinetic and dosimetric models, methods of individual and workplace monitoring, and general aspects of retrospective dose assessment. OIR Part 2 (ICRP, 2016), this current publication and upcoming publications in the OIR series (Parts 4 and 5) provide data on individual elements and their radioisotopes, including information on chemical forms encountered in the workplace; a list of principal radioisotopes and their physical half-lives and decay modes; the parameter values of the reference biokinetic model; and data on monitoring techniques for the radioisotopes encountered most commonly in workplaces. Reviews of data on inhalation, ingestion, and systemic biokinetics are also provided for most of the elements. Dosimetric data provided in the printed publications of the OIR series include tables of committed effective dose per intake (Sv Bq−1 intake) for inhalation and ingestion, tables of committed effective dose per content (Sv Bq−1 measurement) for inhalation, and graphs of retention and excretion data per Bq intake for inhalation. These data are provided for all absorption types and for the most common isotope(s) of each element. The electronic annex that accompanies the OIR series of publications contains a comprehensive set of committed effective and equivalent dose coefficients, committed effective dose per content functions, and reference bioassay functions. Data are provided for inhalation, ingestion, and direct input to blood. This third publication in the series provides the above data for the following elements: ruthenium (Ru), antimony (Sb), tellurium (Te), iodine (I), caesium (Cs), barium (Ba), iridium (Ir), lead (Pb), bismuth (Bi), polonium (Po), radon (Rn), radium (Ra), thorium (Th), and uranium (U).
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Abstract
Children's experience with stress provides a useful paradigm for the assessment of their emotional status. Such an assessment must be concerned with identifying the typical behavioral pattern a child is likely to adopt in response to stress. The Stress Response Scale has been developed to assess those response patterns. This study compared the behavior patterns of a group of children referred because of possible emotional disorders with their psychiatric diagnoses. It also examined the agreement between parents and teachers as to the type of response pattern likely to be shown by the child. The results suggested that the scale may be sensitive to selected psychiatric diagnostic categories commonly assigned to children from the Diagnostic and Statistical Manual.
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Affiliation(s)
| | - Mark D. Shermis
- Department of Educational Research Methodology, University of Pittsburgh
| | - Judith Marsh
- Western Psychiatric Institute and Clinic, University of Pittsburgh
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Hough R, Danby R, Russell N, Marks D, Veys P, Shaw B, Wynn R, Vora A, Mackinnon S, Peggs KS, Crawley C, Craddock C, Pagliuca A, Cook G, Snowden JA, Clark A, Marsh J, Querol S, Parkes G, Braund H, Rocha V. Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: an update on cord blood unit selection, donor selection algorithms and conditioning protocols. Br J Haematol 2015; 172:360-70. [PMID: 26577457 DOI: 10.1111/bjh.13802] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 06/13/2015] [Accepted: 08/31/2015] [Indexed: 01/26/2023]
Abstract
Allogeneic haemopoietic stem cell transplantation offers a potentially curative treatment option for a wide range of life-threatening malignant and non-malignant disorders of the bone marrow and immune system in patients of all ages. With rapidly emerging advances in the use of alternative donors, such as mismatched unrelated, cord blood and haploidentical donors, it is now possible to find a potential donor for almost all patients in whom an allograft is indicated. Therefore, for any specific patient, the transplant physician may be faced with a myriad of potential choices, including decisions concerning which donor to prioritize where there is more than one, the optimal selection of specific umbilical cord blood units and which conditioning and graft-versus-host disease prophylactic schedule to use. Donor choice may be further complicated by other important factors, such as urgency of transplant, the presence of alloantibodies, the disease status (homozygosity or heterozygosity) of sibling donors affected by inherited disorders and the cytomegalovirus serostatus of patient and donor. We report UK consensus guidelines on the selection of umbilical cord blood units, the hierarchy of donor selection and the preferred conditioning regimens for umbilical cord blood transplantation, with a summary of rationale supporting these recommendations.
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Affiliation(s)
| | - Robert Danby
- NHSBT, Churchill Hospital, Oxford University, Oxford, UK
| | | | - David Marks
- Adult BMT Unit, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Paul Veys
- Great Ormond Street Hospital, London, UK
| | - Bronwen Shaw
- Froedtert & the Medical College of Wisconsin, CIBMTR, Wauwatosa, WI, USA
| | - Rob Wynn
- Manchester Children's Hospital, Manchester, UK
| | - Ajay Vora
- Sheffield Children's Hospital, Sheffield, UK
| | | | | | | | | | | | | | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust & University of Sheffield, Sheffield, UK
| | - Andrew Clark
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Sergio Querol
- Anthony Nolan, London, UK.,Banc Sang i Teixits, Barcelona, Spain
| | | | | | - Vanderson Rocha
- NHSBT, Churchill Hospital, Oxford University and Eurocord, Oxford, UK
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Harris E, Hudson J, Marsh J, Marini Bettolo C, Neri M, Ferlini A, Bushby K, Lochmüller H, Straub V, Barresi R. A novel STIM1 mutation at p.340 causes tubular aggregate myopathy with miosis without additional features of Stormorken syndrome. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Cesaro S, Peffault de Latour R, Tridello G, Pillon M, Carlson K, Fagioli F, Jouet JP, Koh MBC, Panizzolo IS, Kyrcz-Krzemien S, Maertens J, Rambaldi A, Strahm B, Blaise D, Maschan A, Marsh J, Dufour C. Second allogeneic stem cell transplant for aplastic anaemia: a retrospective study by the Severe Aplastic Anaemia Working Party of the European Society for Blood and Marrow Transplantation. Br J Haematol 2015; 171:606-14. [PMID: 26304743 DOI: 10.1111/bjh.13650] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/23/2015] [Indexed: 12/15/2022]
Abstract
We analysed the outcome of a second allogeneic haematopoietic stem cell transplant (alloHSCT) in 162 patients reported to the European Society for Blood and Marrow Transplantation between 1998 and 2009. Donor origin was a sibling in 110 and an unrelated donor in 52 transplants, respectively. The stem cell source was bone marrow in 31% and peripheral blood in 69% of transplants. The same donor as for the first alloHSCT was used in 81% of transplants whereas a change in the choice of stem cell source was reported in 56% of patients, mainly from bone marrow to peripheral blood. Neutrophil and platelet engraftment occurred in 85% and 72% of patients, after a median time of 15 and 17 days, respectively. Grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD occurred in 21% and 37% of patients, respectively. Graft failure (GF) occurred in 42 patients (26%). After a median follow-up of 3·5 years, the 5-year overall survival (OS) was 60·7%. In multivariate analysis, the only factor significantly associated with a better outcome was a Karnofsky/Lansky score ≥80 (higher OS). We conclude that a second alloHSCT is feasible rescue option for GF in SAA, with a successful outcome in 60% of cases.
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Affiliation(s)
- Simone Cesaro
- Paediatric Haematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Gloria Tridello
- Paediatric Haematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marta Pillon
- Clinica di Oncoematologia Pediatrica Dipartimento di Pediatria, Padova, Italy
| | | | - Franca Fagioli
- Paediatric Haematology, Regina Margherita Hospital, Torino, Italy
| | - Jean-Pierre Jouet
- Hôpital Claude Huriez Service de Maladies du Sang, Lille Cedex, France
| | - Mickey B C Koh
- St. George's Hospital Department of Haematology, London, UK
| | - Irene Sara Panizzolo
- Paediatric Haematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Johan Maertens
- Dept. of Haematology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Brigitte Strahm
- Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany
| | - Didier Blaise
- Programme de Transplantation &Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Alexei Maschan
- Federal Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russia
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| | - Carlo Dufour
- Paediatric Haematology, Institute G. Gaslini, Genova, Italy
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Abstract
Platelet refractoriness can represent a significant clinical problem that complicates the provision of platelet transfusions, is associated with adverse clinical outcomes and increases health care costs. Although it is most frequently due to non-immune platelet consumption, immunological factors are also often involved. Human leucocyte antigen (HLA) alloimmunization is the most important immune cause. Despite the fact that systematic reviews of the clinical studies evaluating different techniques for selecting HLA compatible platelets have not been powered to demonstrate improved clinical outcomes, platelet refractoriness is currently managed by the provision of HLA-matched or cross matched platelets. This review will address a practical approach to the diagnosis and management of platelet refractoriness while highlighting on-going dilemmas and knowledge gaps.
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Affiliation(s)
- Simon J Stanworth
- Department of Haematology, NHS Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford, UK.,International Collaboration for Transfusion Medicine Guidelines (ICTMG), Oxford, UK
| | - Cristina Navarrete
- Histocompatibility & Immunogenetics, NHSBT/Division of Infection & Immunity, University College London, London, UK
| | - Lise Estcourt
- Department of Haematology, NHS Blood and Transplant, Oxford, UK
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
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Mäkelä MJ, Eriksson C, Kotaniemi-Syrjänen A, Palosuo K, Marsh J, Borres M, Kuitunen M, Pelkonen AS. Wheat allergy in children - new tools for diagnostics. Clin Exp Allergy 2015; 44:1420-30. [PMID: 25146380 DOI: 10.1111/cea.12393] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 08/07/2014] [Accepted: 08/14/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND The detection of wheat-specific IgE in children often leads to a suspicion of wheat allergy, but little information is available on the most reliable wheat allergens for predicting clinical reactivity. OBJECTIVE To evaluate the role of allergenic components of wheat in wheat allergy diagnostics. METHODS One hundred and eight children (median age 1.5 years; range 0.6-17.3 years) with suspected wheat allergy underwent open or double-blinded, placebo-controlled oral wheat challenges. Responsiveness to different allergenic components of wheat was studied by skin prick tests and by determination of serum IgE antibodies using a semi-quantitative microarray assay. RESULTS Thirty (28%) children reacted with immediate symptoms, and 27 (25%) with delayed symptoms to ingested wheat, whereas 51 (47%) children exhibited no reactions in oral wheat challenges. Positive IgE responses to any of the 12 allergenic components of wheat was seen in 93%, 41%, and 43% of those with immediate, delayed or no reactions to ingested wheat, respectively (P < 0.001 to P < 0.05 in every comparisons between those with immediate reactions and those with no reactions). Positive IgE responses to ≥5 different allergenic components improved significantly the diagnostic accuracy (with a positive likelihood ratio (LR+) of 5.10). Alpha-amylase inhibitors (AAI), in particular dimeric AAI 0.19 (LR+ 6.12), alpha-, beta-, and gamma-gliadins (LR+ from 3.57 to 4.53), and high-molecular-weight (HMW) glutenin subunits (LR+ 4.37) were the single allergenic components of wheat differentiating most effectively those with immediate symptoms from those who did not exhibit any reactions. CONCLUSIONS AND CLINICAL RELEVANCE Wheat allergy diagnostics is difficult, even using sophisticated component methods. Our results confirm earlier findings about gliadins and identify the dimeric AAI 0.19, as a relevant allergen in clinically reactive patients when compared to non-reactive subjects. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several components of wheat.
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Affiliation(s)
- M J Mäkelä
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Samarasinghe S, Marsh J, Dufour C. Immune suppression for childhood acquired aplastic anemia and myelodysplastic syndrome: where next? Haematologica 2015; 99:597-9. [PMID: 24688105 DOI: 10.3324/haematol.2014.105569] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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30
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Basak GW, Wiktor-Jedrzejczak W, Labopin M, Schoemans H, Ljungman P, Kobbe G, Beguin Y, Lang P, Koenecke C, Sykora KW, Te Boome L, van Biezen A, van der Werf S, Mohty M, de Witte T, Marsh J, Dreger P, Kröger N, Duarte R, Ruutu T. Allogeneic hematopoietic stem cell transplantation in solid organ transplant recipients: a retrospective, multicenter study of the EBMT. Am J Transplant 2015; 15:705-14. [PMID: 25648262 DOI: 10.1111/ajt.13017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/11/2014] [Revised: 08/21/2014] [Accepted: 09/11/2014] [Indexed: 01/25/2023]
Abstract
We conducted a questionnaire survey of the 565 European Society for Blood and Marrow Transplantation centers to analyze the outcome of allogeneic hematopoietic stem cell transplantation (alloSCT) in recipients of solid organ transplantation (SOT). We investigated 28 patients with malignant (N = 22) or nonmalignant diseases (N = 6), who underwent 31 alloSCT procedures: 12 after kidney, 13 after liver and 3 after heart transplantation. The incidence of solid organ graft failure at 60 months after first alloSCT was 33% (95% confidence interval [CI], 16-51%) for all patients, 15% (95% CI, 2-40%) for liver recipients and 50% (95% CI, 19-75%) for kidney recipients (p = 0.06). The relapse rate after alloSCT (22%) was low following transplantation for malignant disorders, despite advanced stages of malignancy. Overall survival at 60 months after first alloSCT was 40% (95% CI, 19-60%) for all patients, 51% (95% CI, 16-86%) for liver recipients and 42% (95% CI, 14-70%) for kidney recipients (p = 0.39). In summary, we show that selected SOT recipients suffering from hematologic disorders may benefit from alloSCT and experience enhanced long-term survival without loss of organ function.
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Affiliation(s)
- G W Basak
- The Medical University of Warsaw, Warsaw, Poland
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Dufour C, Pillon M, Sociè G, Rovò A, Carraro E, Bacigalupo A, Oneto R, Passweg J, Risitano A, Tichelli A, Peffault de Latour R, Schrezenmeier H, Hocshmann B, Peters C, Kulasekararaj A, Van Biezen A, Samarasinghe S, Hussein AA, Ayas M, Aljurf M, Marsh J. Outcome of aplastic anaemia in children. A study by the severe aplastic anaemia and paediatric disease working parties of the European group blood and bone marrow transplant. Br J Haematol 2015; 169:565-73. [PMID: 25683884 DOI: 10.1111/bjh.13297] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022]
Abstract
This study analysed the outcome of 563 Aplastic Anaemia (AA) children aged 0-12 years reported to the Severe Aplastic Anaemia Working Party database of the European Society for Blood and Marrow Transplantation, according to treatment received. Overall survival (OS) after upfront human leucocyte antigen-matched family donor (MFD) haematopoietic stem cell transplantation (HSCT) or immunosuppressive treatment (IST) was 91% vs. 87% (P 0·18). Event-free survival (EFS) after upfront MFD HSCT or IST was 87% vs. 33% (P 0·001). Ninety-one of 167 patients (55%) failed front-line IST and underwent rescue HSCT. The OS of this rescue group was 83% compared with 91% for upfront MFD HSCT patients and 97% for those who did not fail IST up-front (P 0·017). Rejection was 2% for MFD HSCT and HSCT post-IST failure (P 0·73). Acute graft-versus-host disease (GVHD) grade II-IV was 8% in MFD graft vs. 25% for HSCT post-IST failure (P < 0·0001). Chronic GVHD was 6% in MFD HSCT vs. 20% in HSCT post-IST failure (P < 0·0001). MFD HSCT is an excellent therapy for children with AA. IST has a high failure rate, but remains a reasonable first-line choice if MFD HSCT is not available because high OS enables access to HSCT, which is a very good rescue option.
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Affiliation(s)
- Carlo Dufour
- Clinical and Experimental Haematology Unit, G Gaslini Childrens' Hospital, Genova, Italy
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Marsh J, Ziel G, Diaz A, Byrne R. SC-18 * DOES INVOLVEMENT OF THE NEURAL STEM CELL COMPARTMENT INFLUENCE OUTCOMES IN ADULT LOW GRADE GLIOMAS? A RETROSPECTIVE REVIEW OF 95 CASES. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou275.18] [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: 11/12/2022] Open
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33
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Lenox S, Marsh J, Amen D, Willeumier K, Taylor D, Golden C. C-10 * The Activation of the Right Inferior Orbitofrontal Cortex in Individuals with Eating Disorders during Administration of Conners' Continuous Performance Task. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.191] [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: 11/13/2022] Open
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34
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Dufour C, Pillon M, Passweg J, Socié G, Bacigalupo A, Franceschetto G, Carraro E, Oneto R, Risitano AM, Peffault de Latour R, Tichelli A, Rovo A, Peters C, Hoechsmann B, Samarasinghe S, Kulasekararaj AG, Schrezenmeier H, Aljurf M, Marsh J. Outcome of aplastic anemia in adolescence: a survey of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2014; 99:1574-81. [PMID: 25085353 DOI: 10.3324/haematol.2014.106096] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We analyzed the outcome of 537 adolescents (age 12-18 years) with idiopathic aplastic anemia included in the database of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation comparing: i) matched family donor hematopoietic stem cell transplantation performed as first-line treatment with ii) front-line immunosuppressive therapy not followed by subsequent transplant given for failure and with iii) hematopoietic stem cell transplantation performed after failed front-line immunosuppressive therapy. Overall survival was 86% in the matched family donor hematopoietic stem cell transplantation group, 90% in patients given front-line immunosuppressive alone (those who did not fail this treatment and who did not receive subsequent rescue with hematopoietic stem cell transplantation) and 78% in subjects who underwent hematopoietic stem cell transplantation post failed front-line immunosuppressive therapy (P=0.14). Event-free survival in the same groups was respectively 83%, 64% and 71% (P=0.04). Cumulative incidence of rejection was 8% in matched family donor hematopoietic stem cell transplantation and 9% in transplants post failed front-line immunosuppression (P=0.62). Cumulative incidence of acute graft-versus-host disease was 12% in matched family donor transplants and 18% in transplants post failed immunosuppression (P=0.18). Chronic graft-versus-host disease was higher in matched family donor hematopoietic stem cell transplantation (8%) than in transplants post failed immunosuppressive therapy (20%) (P=0.0009). Cumulative incidence of post-therapy malignancies was 0.7% in matched family donor transplantations, 7% in transplantations post failed immunosuppression and 21% after front-line immunosuppression (P=0.0017). In the whole cohort, under multivariate analysis, the diagnosis to treatment interval of two months or under positively affected overall survival whereas up-front immunosuppression alone (with no subsequent rescue transplants) negatively affected event-free survival. In transplanted patients an interval from diagnosis to treatment of 2 months or under, bone marrow as source of cells and first-line matched family donor transplants provided a significant advantage in overall and event-free survival. Aplastic anemia in adolescents has a very good outcome. If a matched family donor is available, hematopoietic stem cell transplantation using bone marrow cells is the first choice treatment. If such a donor is not available, immunosuppressive treatment may still be an acceptable second choice, also because, in case of failure, hematopoietic stem cell transplantation is a very good rescue option.
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Affiliation(s)
- Carlo Dufour
- Clinical and Experimental Hematology Unit. G Gaslini Childrens' Hospital, Genova, Italy
| | - Marta Pillon
- Pediatric Hemato-Oncology Clinic, University of Padova, Italy
| | | | - Gerard Socié
- Department of Hematology, Hospital St Louis, Paris, France
| | | | | | - Elisa Carraro
- Pediatric Hemato-Oncology Clinic, University of Padova, Italy
| | - Rosi Oneto
- Second Division of Hematology, San Martino Hospital, Genova, Italy
| | - Antonio Maria Risitano
- Hematology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Italy
| | | | | | | | - Christina Peters
- Pediatric Hematopoietic Stem Cell Transplantation, St Anna Kinderspital, Vienna, Austria
| | - Britta Hoechsmann
- Institut for Clinical Transfusion Medicine and Immunogenetics, and Department of Transfusion Medicine University of Ulm, Germany
| | - Sujith Samarasinghe
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS. Current address: Great Ormond Street Children's Hospital, London UK
| | - Austin G Kulasekararaj
- Department of Haematological Medicine, King's College Hospital/King's College London, UK
| | - Hubert Schrezenmeier
- Institut for Clinical Transfusion Medicine and Immunogenetics, and Department of Transfusion Medicine University of Ulm, Germany
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Saudi Arabia
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, UK
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Kelly T, Prah M, Jogal S, Maheshwari M, Lew S, Schmainda K, Kannan G, Khatua S, Zaky W, Ketonen L, Drogosiewicz M, Dembowska-Baginska B, Jurkiewicz E, Nowak K, Perek D, Hirpara D, Bhatt M, Scheinemann K, Shimizu Y, Kondo A, Miyajima M, Arai H, Dvir R, Shiran S, Sira LB, Roth J, Tabori U, Bouffet E, Durno C, Aronson M, Constantini S, Elhasid R, Fangusaro J, Marsh J, Bregman C, Diaz A, Byrne R, Ziel E, Goldman S, Calmon R, Grevent D, Blauwblomme T, Puget S, Sainte-Rose C, Varlet P, Dufour C, Grill J, Saitovich A, Zilbovicius M, Brunelle F, Boddaert N, Wei L, Tan AM, Tang PH, Orphanidou-Vlachou E, Vlachos N, Davies N, Arvanitis T, Grundy R, Peet A, Withey S, Novak J, MacPherson L, Peet A, Avula S, Kumar R, Pizer B, Pettorini B, Garlick D, Mallucci C, Reddick W, Guo J, Glass J, Pryweller J, Gajjar A, Thust S, Blanco E, Mankad K, Michalski A. RADIOLOGY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou064] [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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Clancy C, Shelton M, Shields R, Marsh J, Harrison L, Bermudez C, Pilewski J, Crespo M, Nguyen M. Clinical and Molecular Epidemiologic Characterization of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Occurring Early After Lung Transplant. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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37
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Raj K, Pagliuca A, Bradstock K, Noriega V, Potter V, Streetly M, McLornan D, Kazmi M, Marsh J, Kwan J, Huang G, Getzendaner L, Lee S, Guthrie KA, Mufti GJ, O'Donnell P. Peripheral blood hematopoietic stem cells for transplantation of hematological diseases from related, haploidentical donors after reduced-intensity conditioning. Biol Blood Marrow Transplant 2014; 20:890-5. [PMID: 24650678 DOI: 10.1016/j.bbmt.2014.03.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/01/2014] [Indexed: 12/20/2022]
Abstract
In a multicenter collaboration, we carried out T cell-replete, peripheral blood stem cell (PBSC) transplantations from related, HLA-haploidentical donors with reduced-intensity conditioning (RIC) and post-transplantation cyclophosphamide (Cy) as graft-versus-host disease (GVHD) prophylaxis in 55 patients with high-risk hematologic disorders. Patients received 2 doses of Cy 50 mg/kg i.v. on days 3 and 4 after infusion of PBSC (mean, 6.4 × 10(6)/kg CD34(+) cells; mean, 2.0 × 10(8)/kg CD3(+) cells). The median times to neutrophil (500/μL) and platelet (>20,000/μL) recovery were 17 and 21 days respectively. All but 2 of the patients achieved full engraftment. The 1-year cumulative incidences of grade II and grade III acute GVHD were 53% and 8%, respectively. There were no cases of grade IV GVHD. The 2-year cumulative incidence of chronic GHVD was 18%. With a median follow-up of 509 days, overall survival and event-free survival at 2 years were 48% and 51%, respectively. The 2-year cumulative incidences of nonrelapse mortality and relapse were 23% and 28%, respectively. Our results suggest that PBSC can be substituted safely and effectively for bone marrow as the graft source for haploidentical transplantation after RIC.
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Affiliation(s)
- Kavita Raj
- Guy's and St Thomas' NHS Hospitals Foundation Trusts, London, United Kingdom; Department of Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Antonio Pagliuca
- Guy's and St Thomas' NHS Hospitals Foundation Trusts, London, United Kingdom; Department of Haematological Medicine, King's College Hospital, London, United Kingdom; King's College London, United Kingdom
| | | | - Victor Noriega
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Victoria Potter
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Matthew Streetly
- Guy's and St Thomas' NHS Hospitals Foundation Trusts, London, United Kingdom; Department of Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Donal McLornan
- Guy's and St Thomas' NHS Hospitals Foundation Trusts, London, United Kingdom; Department of Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Majid Kazmi
- Guy's and St Thomas' NHS Hospitals Foundation Trusts, London, United Kingdom; Department of Haematological Medicine, King's College Hospital, London, United Kingdom
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom; King's College London, United Kingdom
| | - John Kwan
- Westmead Hospital, Sydney, NSW, Australia
| | | | | | - Stephanie Lee
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle
| | | | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom; King's College London, United Kingdom
| | - Paul O'Donnell
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle.
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38
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Affiliation(s)
- Nana Benson-Quarm
- Department of Hematological MedicineKing's College Hospital, London SE5 9RS, UK
| | - Shreyans Gandhi
- Department of Hematological MedicineKing's College Hospital, London SE5 9RS, UK
| | | | - Judith Marsh
- Department of Hematological MedicineKing's College Hospital, London SE5 9RS, UK
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Maury S, Balère-Appert ML, Pollichieni S, Oneto R, Yakoub-Agha I, Locatelli F, Dalle JH, Lanino E, Fischer A, Pession A, Huynh A, Barberi W, Mohty M, Risitano A, Milpied N, Socié G, Bacigalupo A, Marsh J, Passweg JR. Outcome of patients activating an unrelated donor search for severe acquired aplastic anemia. Am J Hematol 2013; 88:868-73. [PMID: 23804195 DOI: 10.1002/ajh.23522] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 11/12/2022]
Abstract
Patients with severe aplastic anemia (SAA) without a sibling donor receive immunosuppressive treatment (IST) with anti-thymocyte globulin (ATG). In the case of no response to IST, a voluntary unrelated donor (VUD) search is usually started. This study analyzes the outcome of ATG-refractory SAA patients activating a VUD search. Of 179 patients, 68 had at least one HLA-A, -B, and -DR matched donor identified and underwent HSCT while 50 also with a donor were not transplanted because of early death (8), late response to IST (34), transplant refusal (1), or other (7). Conversely, 61 had no matched donor, 13 of those ultimately received a mismatched HSCT. All but one received marrow stem cells. Among patients aged <17 years, those with at least one matched donor had a significant higher 4-year survival as compared to others (79% ± 6% versus 53% ± 10%, P = 0.01). There was also a survival advantage independent of recipient age when the donor search was initiated in the recent 2000-2005 study-period (74% ± 6% versus 47% ± 10%, P < 0.05). In multivariate analysis, the identification of a matched VUD tended to impact favourably on survival in patients with a recent donor search (P = 0.07). This study provides evidence for the use of unrelated donor HSCT in children and adults with IST-refractory SAA.
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Passweg JR, Baldomero H, Bregni M, Cesaro S, Dreger P, Duarte RF, Falkenburg JHF, Kröger N, Farge-Bancel D, Bobby Gaspar H, Marsh J, Mohty M, Peters C, Sureda A, Velardi A, Ruiz de Elvira C, Madrigal A. Hematopoietic SCT in Europe: data and trends in 2011. Bone Marrow Transplant 2013; 48:1161-7. [PMID: 23584439 PMCID: PMC3763517 DOI: 10.1038/bmt.2013.51] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/01/2013] [Accepted: 03/08/2013] [Indexed: 11/20/2022]
Abstract
In all, 651 from 680 centers in 48 countries reported 35 660 hematopoietic SCT (HSCT) in 32 075 patients (13 470 allogeneic (42%), 18 605 autologous (58%)) to the 2011 survey. Main indications were: leukemias; 10 113 (32%; 94% allogeneic); lymphoid neoplasias; non-Hodgkin's lymphoma, Hodgkin's lymphoma, plasma cell disorders; 18 433 (57%; 12% allogeneic); solid tumours; 1573 (5%; 5% allogeneic); and non-malignant disorders; 1830 (6%; 92% allogeneic). There were more unrelated donors than HLA identical sibling donors (54% versus 39%); proportion of peripheral blood as stem cell source was 99% for autologous and 73% for allogeneic HSCT. Cord blood was only used in allogeneic transplants (6% of total). In the past 10 years, the overall number of transplants has increased by 53%. Allogeneic HSCT have doubled (from 7272 to 14 549) while, autologous have increased by 32% and continue to increase by about 1100 HSCT per year since 2001. In the past 2 years, an increase of >2000 HSCT per year was seen. Transplant activity is shown by team size. For allogeneic HSCT, we show use of reduced-intensity conditioning versus myeloablative conditioning across Europe and use of post-transplant donor lymphocyte infusions with considerable variation across different countries.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - H Baldomero
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - M Bregni
- Department of Oncology, Scientific Institute San Raffaele, Milan, Italy
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | - R F Duarte
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | | | - N Kröger
- University Hospital Eppendorf, Hamburg, Germany
| | - D Farge-Bancel
- Service de Médecine Interne, Hopital St Louis, Paris, France
| | - H Bobby Gaspar
- Molecular Immunology Unit, UCL Institute of Child Health, London, UK
| | - J Marsh
- GKT School of Medicine, Department of Haematological Medicine, King's Denmark Hill Campus, London, UK
| | - M Mohty
- Universite Pierre and Maris Curie, INSERM UMRs 938, Hôpital Saint Antoine, Paris, France
| | - C Peters
- St Anna Kinderspital, BMT Unit, Vienna, Austria
| | - A Sureda
- Addenbrookes Hospital, Cambridge, UK
| | - A Velardi
- Ospedale Santa Maria della Misericordia - Sezione di Ematologia, Localitá Sant Andrea delle Fratte, Perugia, Italy
| | | | - A Madrigal
- Anthony Nolan Research Institute Royal Free Hospital, London, UK
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Chowdhury FU, Vaidyanathan S, Bould M, Marsh J, Trickett C, Dodds K, Clark TPR, Sapsford RJ, Dickinson CJ, Patel CN, Thorley PJ. Rapid-acquisition myocardial perfusion scintigraphy (MPS) on a novel gamma camera using multipinhole collimation and miniaturized cadmium-zinc-telluride (CZT) detectors: prognostic value and diagnostic accuracy in a 'real-world' nuclear cardiology service. Eur Heart J Cardiovasc Imaging 2013; 15:275-83. [DOI: 10.1093/ehjci/jet149] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Gerull S, Stern M, Apperley J, Beelen D, Brinch L, Bunjes D, Butler A, Ganser A, Ghavamzadeh A, Koh MB, Komarnicki M, Kröger N, Maertens J, Maschan A, Peters C, Rovira M, Sengeløv H, Socié G, Tischer J, Oneto R, Passweg J, Marsh J. Syngeneic transplantation in aplastic anemia: pre-transplant conditioning and peripheral blood are associated with improved engraftment: an observational study on behalf of the Severe Aplastic Anemia and Pediatric Diseases Working Parties of the European Group for Blood and Marrow Transplantation. Haematologica 2013; 98:1804-9. [PMID: 23894010 DOI: 10.3324/haematol.2013.091074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aplastic anemia is usually treated with immunosuppression or allogeneic transplant, depending on patient and disease characteristics. Syngeneic transplant offers a rare treatment opportunity with minimal transplant-related mortality, and offers an insight into disease mechanisms. We present here a retrospective analysis of all syngeneic transplants for aplastic anemia reported to the European Group for Blood and Marrow Transplantation. Between 1976 and 2009, 88 patients received 113 transplants. Most transplants (n=85) were preceded by a conditioning regimen, 22 of these including anti-thymocyte globulin. About half of transplants with data available (39 of 86) were followed by posttransplant immunosuppression. Graft source was bone marrow in the majority of cases (n=77). Transplant practice changed over time with more transplants with conditioning and anti-thymocyte globulin as well as peripheral blood stem cells performed in later years. Ten year overall survival was 93% with 5 transplant-related deaths. Graft failure occurred in 32% of transplants. Risk of graft failure was significantly increased in transplants without conditioning, and with bone marrow as graft source. Lack of posttransplant immunosuppression also showed a trend towards increased risk of graft failure, while anti-thymocyte globulin did not have an influence. In summary, syngeneic transplant is associated with a significant risk of graft failure when no conditioning is given, but has an excellent long-term outcome. Furthermore, our comparatively large series enables us to recommend the use of pre-transplant conditioning rather than not and possibly to prefer peripheral blood as a stem cell source.
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Murray RL, Leonardi-Bee J, Marsh J, Jayes L, Li J, Parrott S, Britton J. Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial. BMJ 2013; 347:f4004. [PMID: 23836616 PMCID: PMC3704182 DOI: 10.1136/bmj.f4004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care. DESIGN Open, cluster randomised controlled trial. SETTING Acute medical wards in one large teaching hospital in the United Kingdom. PARTICIPANTS 264 patients randomised to intervention and 229 to usual care; primary outcome data were available at four weeks for 260 and 224 patients, respectively. All adult smokers and recent ex-smokers able to give informed consent were eligible for entry into the study. INTERVENTIONS The intervention comprised systematic smoking ascertainment and default provision of behavioural support and cessation pharmacotherapy for the duration of the hospital stay for all smokers and recent ex-smokers, with follow-up and referral to community services after discharge. Usual care comprised cessation support delivered at the initiative and discretion of clinical staff. All staff and patients were aware of group assignment. MAIN OUTCOME MEASURES Smoking cessation at four weeks, validated by measuring exhaled carbon monoxide. Secondary outcomes were uptake of inpatient behavioural support, use of cessation pharmacotherapy, referral to and uptake of community support after discharge, and validated smoking cessation at six months. Participants lost to follow-up were assumed to have reverted to smoking. RESULTS All patients in the intervention group received at least brief advice to quit smoking, compared to 106 (46%) patients in the usual care group. Cessation at four weeks was achieved by 38% (n=98) of intervention patients and 17% (n=37) of usual care patients (adjusted odds ratio 2.10 (95% confidence interval 0.96 to 4.61), P=0.06, number of patients needed to treat 8). Uptake of inpatient behavioural support, use of pharmacotherapy, and referral to and uptake of community support after discharge were all substantially and statistically significantly higher in the intervention group than in the usual care group. Cessation at six months was achieved by 19% (n=47) of intervention and 9% (n=19) of usual care patients, although this difference was not significant (adjusted odds ratio 1.53 (95% confidence interval 0.60 to 3.91); P=0.37). CONCLUSIONS Substantial improvements in smoking cessation among smokers admitted to hospital can be achieved by systematic ascertainment and delivery of cessation support in secondary care. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN25441641.
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Affiliation(s)
- R L Murray
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, UK.
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Datema MR, Zuidmeer L, Garino C, Marsh J, Lovegrove A, Clausen M, Gislason D, Dubakiene R, Reig I, Barreales L, Knulst AC, Le TM, Kowalski ML, Jedvzejczak M, Lidholm J, Kralimarkova T, Popov T, Asero R, Seneviratne S, Sinaniotis N, Papadopoulos N, Purohit A, de Blay F, Bures P, Vieths S, Fernández-Rivas M, Hoffmann-Sommergruber K, van Ree R, Ballmer-Weber B. Component resolved diagnosis in relation to severity of hazelnut allergy across Europe. Clin Transl Allergy 2013. [PMCID: PMC3723535 DOI: 10.1186/2045-7022-3-s3-p39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tirmarche M, Harrison J, Laurier D, Blanchardon E, Paquet F, Marsh J. Risk of lung cancer from radon exposure: contribution of recently published studies of uranium miners. Ann ICRP 2012; 41:368-77. [PMID: 23089036 DOI: 10.1016/j.icrp.2012.06.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The International Commission on Radiological Protection (ICRP) recently estimated the risk of lung cancer associated with radon exposure, and a statement was issued in ICRP Publication 115. This was based on recent epidemiological studies and the results from a joint analysis of cohorts of Czech, French, and German uranium miners, and indicated that the excess relative risk of lung cancer per unit of exposure should be expressed with consideration of chronic exposure over more than 10 years, by modelling time since median exposure, age attained or age at exposure, and taking in account, if possible, interaction between radon and tobacco. The lifetime excess absolute risk (LEAR) calculated from occupational exposure studies is close to 5 × 10(-4) per working level month (WLM) (14 × 10(-5) per hmJ/m(3)). LEAR values estimated using risk models derived from both miners and domestic exposure studies are in good agreement after accounting for factors such as sex, attained age, and exposure scenario. A sensitivity analysis highlighted the high dependence of background mortality rates on LEAR estimates. Using lung cancer rates among Euro-American males instead of the ICRP reference rates (males and females, and Euro-American and Asian populations), the estimated LEAR is close to 7 × 10(-4) per WLM (20 × 10(-5) per hm J/m(3)).
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Affiliation(s)
- M Tirmarche
- Institut de Radioprotection et de Sûreté Nucléaire, P.O. Box 17, 92262 Fontenay-aux-roses, Cedex, France.
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Passweg JR, Baldomero H, Gratwohl A, Bregni M, Cesaro S, Dreger P, de Witte T, Farge-Bancel D, Gaspar B, Marsh J, Mohty M, Peters C, Tichelli A, Velardi A, de Elvira CR, Falkenburg F, Sureda A, Madrigal A. The EBMT activity survey: 1990-2010. Bone Marrow Transplant 2012; 47:906-23. [PMID: 22543746 DOI: 10.1038/bmt.2012.66] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A total of 654 centers from 48 countries were contacted for the 2010 survey. In all, 634 centers reported a total of 33 362 hematopoietic SCT (HSCT) with 30 012 patients receiving their first transplant (12 276 allogeneic (41%) and 17 736 autologous (59%)). Main indications were leukemias: 9355 (31%; 93% allogeneic), lymphoid neoplasias specifically Non Hodgkin's lymphoma, Hodgkin's lymphoma and plasma cell disorders: 17 362 (58%; 12% allogeneic), solid tumors: 1585 (5%; 6% allogeneic) and non-malignant disorders: 1609 (6%; 88% allogeneic). There were more unrelated donors than HLA-identical sibling donors (53% versus 41%); the proportion of peripheral blood as stem cell source was 99% for autologous and 71% for allogeneic HSCT. Cord blood was primarily used in allogeneic transplants (6% of total) with three autologous cord blood HSCT being reported. The number of transplants has increased by 19% since 2005 (allogeneic 37% and autologous 9%) and continued to increase by about 1100 HSCT per year since 2000. Patterns of increase were distinct and different. The data show the development of transplantation in Europe since 1990, with the number of patients receiving a HSCT increasing from 4200 to over 30 000 annually. The most impressive trend seen is the steady increase of unrelated donor transplantation, in parallel to the availability of unrelated donors through donor registries.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Department of Medicine, Division of Hematology, University Hospital Basel, Basel, Switzerland.
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47
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Affiliation(s)
| | - Angela Giorgini
- Department of Haematological Medicine; King's College Hospital; London; UK
| | - Dupe Elebute
- Department of Haematological Medicine; King's College Hospital; London; UK
| | - Judith Marsh
- Department of Haematological Medicine; King's College Hospital; London; UK
| | - Robin Ireland
- Department of Haematological Medicine; King's College Hospital; London; UK
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Henderson M, Hudson J, Marsh J, Charlton R, Straub V, Lochmüller H, Bushby K, Vissing J, Barresi R. P70 A single in-frame deletion in the CAPN3 gene is linked to muscular dystrophy with a dominant pattern of inheritance. Neuromuscul Disord 2012. [DOI: 10.1016/s0960-8966(12)70078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Hospital admission provides an opportunity to promote smoking cessation. Clinical guidelines recommend ascertainment of smoking status and delivery of cessation interventions in all consultations. In this article, smoking ascertainment and intervention among all patients admitted to medical wards in a UK hospital over a four-week period in 2010 were audited. Medical records of 767 patients were screened; 96 (13%) were current smokers, 243 (32%) ex-smokers and 233 (30%) non-smokers. There was no record of smoking status in 243 (25%) individuals and this proportion varied between specialties. Of the 96 current smokers, only 23 received documented cessation advice or pharmacological support. Four weeks after discharge, 31% reported that they were abstinent from smoking, representing 50% of those who received support and 20% of those who did not. Ascertainment of smoking status and delivery of cessation support to patients admitted to medical wards was low, suggesting that there is room for improvement in the management of smoking among inpatients.
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Affiliation(s)
- R Murray
- Division of Epidemiology and Public Health and UK Centre for Tobacco Control Studies, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital.
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50
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Skavland J, Shewry PR, Marsh J, Geisner B, Marcusson JA. In vitro screening for putative psoriasis-specific antigens among wheat proteins and peptides. Br J Dermatol 2011; 166:67-73. [PMID: 21910707 DOI: 10.1111/j.1365-2133.2011.10608.x] [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: 01/20/2023]
Abstract
BACKGROUND Patients with psoriasis who had raised IgG and/or IgA antigliadin antibodies showed clinical improvement in a trial with a gluten-free diet. The selection of patients for the diet treatment was based on the presence of specific antibodies, i.e. the result of humoral immunity. OBJECTIVES As psoriasis is now considered to be a T cell-mediated disease we decided to challenge peripheral blood mononuclear cells (PBMCs) in vitro from randomly selected patients with well-defined wheat proteins/peptides to explore the possibility of identifying a specific antigen with T cell activating properties in a subgroup of patients. METHODS PBMCs from 37 patients (20 female and 17 male; mean age 49years) and 37 healthy controls (12 female and 25 male; mean age 57years) were included. Not all patients participated in all experiments. The PBMCs were exposed in vitro with the following wheat proteins/peptides in various concentrations: total albumins, 0·28 α-amylase inhibitor and the synthetic peptides, p31-43, p57-68 and p62-75, based on coeliac-active sequences of α-gliadin. The proliferative response was measured as counts per minute after the cells had been pulsed with methyl-(3) H-thymidine. RESULTS Albumin, α-amylase inhibitor, p31-43 and p57-68 elicited a significant response in both patients and controls but showed no differences between the groups. The response induced by the α-amylase inhibitor was higher than that induced by the albumin fraction and the p31-43 and p57-68 peptides. At a concentration of 25μgmL(-1) , five of 36 patients with psoriasis responded positively to the p62-75 peptide and none of the 33 controls, using a stimulation index of 2·4 as the cut-off level (P<0·05). These five patients did not show clinical features that differed from the remaining patients. Among the responding patients the relative number of CD4+ cells increased in some but not all after in vitro challenge with the albumins, 0·28 α-amylase inhibitor, and p62-75. These antigens could also induce in vitro the expression of the homing antigen cutaneous lymphocyte antigen (CLA) in a few patients and controls. CONCLUSIONS The wheat protein antigens, especially the p62-75 peptide, might be of interest in a subgroup of patients with psoriasis.
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Affiliation(s)
- J Skavland
- Section of Dermatovenereology, Institute of Medicine, University of Bergen and Haukeland University Hospital, Bergen, Norway
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