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Gopalakrishnan R, Kaimal S, Wagner JE, MacMillan ML, Uppgaard RM. SPECTRUM OF ORAL PREMALIGNANT AND MALIGNANT LESIONS IN FANCONI ANEMIA PATIENTS: DIAGNOSTIC AND MANAGEMENT CHALLENGES. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.074] [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: 10/21/2022]
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2
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Turcotte LM, DeFor TE, Newell LF, Cutler CS, Verneris MR, Wu J, Howard A, MacMillan ML, Antin JH, Vercellotti GM, Slungaard A, Blazar BR, Weisdorf DJ, Panoskaltsis-Mortari A, Holtan SG. Donor and recipient plasma follistatin levels are associated with acute GvHD in Blood and Marrow Transplant Clinical Trials Network 0402. Bone Marrow Transplant 2017; 53:64-68. [PMID: 29058696 PMCID: PMC5752567 DOI: 10.1038/bmt.2017.236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/25/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022]
Abstract
Follistatin is an angiogenic factor elevated in the circulation after
allogeneic hematopoietic cell transplantation (HCT). Elevations in follistatin
plasma concentrations are associated with the onset of and poor survival after
acute graft versus host disease (aGVHD). Using data from the Blood and Marrow
Transplant Clinical Trials Network 0402 study (n=247), we sought to
further quantify the longitudinal associations between plasma follistatin levels
in transplant recipients, as well as baseline HCT donor follistatin levels, and
allogeneic HCT outcomes. Higher recipient baseline follistatin levels were
predictive of development of aGVHD (P=0.04). High donor
follistatin levels were also associated with the incidence of aGVHD
(P<0.01). Elevated follistatin levels on day 28 were
associated with the onset of grade II–IV aGVHD prior to day 28, higher
one-year non-relapse mortality, (NRM), and lower overall survival (OS). In
multivariate analyses, individuals with follistatin levels >1088 pg/mL at day
28 had a four-fold increased risk for NRM (RR=4.3, 95% CI
1.9–9.9, P<0.01) and a nearly three-fold increased
overall risk for mortality (RR=2.8, 95% CI 1.5–5.2,
P<0.01). Given the multiple roles of follistatin in
tissue inflammation and repair, and the confirmation that this biomarker is
predictive of important HCT outcomes, the pathobiology of these relationships
need further study.
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Affiliation(s)
- L M Turcotte
- Division of Pediatric Hematology/Oncology, University of Minnesota, Minneapolis, MN, USA
| | - T E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.,Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - L F Newell
- Center for Hematologic Malignancies, Oregon Health & Science University, Portland, OR, USA
| | - C S Cutler
- Hematologic Malignancy Program, Dana Farber Cancer Institute, Boston, MA, USA
| | - M R Verneris
- Pediatric BMT and Cell Therapy, University of Colorado Anschutz Medical Campus and Children's Hospital, Denver, CO, USA
| | - J Wu
- The EMMES Corporation, Rockville, MD, USA
| | - A Howard
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - M L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - J H Antin
- Hematologic Malignancy Program, Dana Farber Cancer Institute, Boston, MA, USA
| | - G M Vercellotti
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - Ane Slungaard
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - B R Blazar
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | - D J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
| | | | - S G Holtan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA
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3
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Mehta RS, Cao Q, Holtan S, MacMillan ML, Weisdorf DJ. Upper GI GVHD: similar outcomes to other grade II graft-versus-host disease. Bone Marrow Transplant 2017; 52:1180-1186. [PMID: 28504665 DOI: 10.1038/bmt.2017.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/11/2022]
Abstract
The significance of upper gastrointestinal tract (UGI) acute GVHD (aGVHD) compared with other grade II aGVHD is not clearly defined. We compared the outcomes of patients with grade II aGVHD with or without biopsy-proven UGI involvement in three groups: grade II aGVHD without UGI (n=178), grade II aGVHD with UGI and other sites (n=102) and isolated UGI aGVHD (n=32). The overall response (ORR) to steroids at day 28 differed among the three groups (76, 67 and 91%, respectively, P=0.01), but was only marginally different in direct comparison with those without or with UGI aGVHD (P=0.07) or with isolated UGI aGVHD (P=0.06). In multivariate analysis, as compared with grade II aGVHD patients without UGI involvement, those with UGI involvement and those with isolated UGI aGVHD had similar risks of chronic GVHD, relapse and non-relapse mortality and similar disease-free survival and overall survival. Our data suggest that patients with UGI aGVHD have similar outcomes as those without UGI involvement, supporting the view that UGI aGVHD should still be included as a grade II-defining event.
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Affiliation(s)
- R S Mehta
- Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Q Cao
- Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Holtan
- Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M L MacMillan
- Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D J Weisdorf
- Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Chen YB, Wang T, Hemmer MT, Brady C, Couriel DR, Alousi A, Pidala J, Urbano-Ispizua A, Choi SW, Nishihori T, Teshima T, Inamoto Y, Wirk B, Marks DI, Abdel-Azim H, Lehmann L, Yu L, Bitan M, Cairo MS, Qayed M, Salit R, Gale RP, Martino R, Jaglowski S, Bajel A, Savani B, Frangoul H, Lewis ID, Storek J, Askar M, Kharfan-Dabaja MA, Aljurf M, Ringden O, Reshef R, Olsson RF, Hashmi S, Seo S, Spitzer TR, MacMillan ML, Lazaryan A, Spellman SR, Arora M, Cutler CS. GvHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes. Bone Marrow Transplant 2016; 52:400-408. [PMID: 27941764 PMCID: PMC5332289 DOI: 10.1038/bmt.2016.265] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 04/12/2016] [Revised: 08/12/2016] [Accepted: 08/28/2016] [Indexed: 11/15/2022]
Abstract
Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1,404 UCBT patients [single (< 18 years) = 810, double (≥ 18 years) = 594] with acute leukemia to define the incidence of acute and chronic graft-vs.-host disease (GVHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grades II–IV aGVHD was 39% (95% CI, 36–43%), grades III–IV aGVHD was 18% (95% CI, 15–20%), and 1-year cGVHD was 27% (95% CI, 24–30%). After double UCBT, 100-day incidence of grades II–IV aGVHD was 45% (95% CI, 41%–49%), grades III–IV aGVHD was 22% (95% CI, 19–26%), and 1-year cGVHD was 26% (95% CI, 22–29%). For single UCBT, multivariate analysis showed that absence of anti-thymocyte globulin (ATG) was associated with aGVHD, whereas prior aGVHD was associated with cGVHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGVHD, while prior aGVHD predicted for cGVHD. Grades III–IV aGVHD led to worse survival whereas cGVHD had no significant effect on disease-free or overall survival. GVHD is prevalent after UCBT with severe aGVHD leading to higher mortality. Future research in UCBT should prioritize prevention of GVHD.
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Affiliation(s)
- Y-B Chen
- Massachusetts General Hospital, Boston, MA, USA
| | - T Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M T Hemmer
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - C Brady
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - D R Couriel
- Utah Blood and Marrow Transplant Program, Adults, Salt Lake City, UT, USA
| | - A Alousi
- Division of Cancer Medicine, Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Pidala
- H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A Urbano-Ispizua
- Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS and Institute of Research Josep Carreras, Barcelona, Spain
| | - S W Choi
- The University of Michigan, Ann Arbor, MI, USA
| | - T Nishihori
- Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - T Teshima
- Kyushu University Hospital, Fukuoka, Japan
| | - Y Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - B Wirk
- Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - D I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK
| | - H Abdel-Azim
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - L Lehmann
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA, USA
| | - L Yu
- Division of Hematology/Oncology and HSCT, The Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, LA, USA
| | - M Bitan
- Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - M S Cairo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - M Qayed
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, Australia
| | - R Salit
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - R P Gale
- Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - R Martino
- Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - S Jaglowski
- Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA
| | - A Bajel
- Royal Melbourne Hospital City Campus, Melbourne, Victoria, Australia
| | - B Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - H Frangoul
- Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - I D Lewis
- Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J Storek
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Askar
- Baylor University Medical Center, Dallas, TX, USA
| | - M A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H Lee Mofitt Cancer Center and Research Institute, Tampa, FL, USA
| | - M Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - O Ringden
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - R Reshef
- Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
| | - R F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden
| | - S Hashmi
- Mayo Clinic Rochester, Rochester, MN, USA
| | - S Seo
- National Cancer Research Center, East Hospital, Kashiwa, Chiba, Japan
| | - T R Spitzer
- Massachusetts General Hospital, Boston, MA, USA
| | - M L MacMillan
- University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA
| | - A Lazaryan
- University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA
| | - S R Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - M Arora
- Division of Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - C S Cutler
- Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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He F, Verneris MR, Cooley S, Blazar BR, MacMillan ML, Newell LF, Panoskaltsis-Mortari A, DeFor T, Weisdorf DJ, Holtan SG. Low day +100 serum epidermal growth factor levels are associated with acute GvHD after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2016; 52:301-303. [PMID: 27869812 DOI: 10.1038/bmt.2016.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F He
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - M R Verneris
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - S Cooley
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - B R Blazar
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - M L MacMillan
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - L F Newell
- Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR, USA
| | - A Panoskaltsis-Mortari
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - T DeFor
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - D J Weisdorf
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - S G Holtan
- Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Holtan SG, MacMillan ML. A risk-adapted approach to acute GVHD treatment: are we there yet? Bone Marrow Transplant 2015; 51:172-5. [PMID: 26551780 DOI: 10.1038/bmt.2015.261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/23/2015] [Accepted: 09/26/2015] [Indexed: 01/21/2023]
Abstract
Acute GVHD (aGVHD) is an immunologic complication of allogeneic hematopoietic cell transplantation (HCT) that can range from mild to life-threatening. Models to predict patients at risk of poor outcomes have been developed using both clinical and laboratory data, and the time to test these models in clinical trials has arrived. However, each modeling method has its potential advantages and limitations. In this mini-review, we summarize recent refinements to these models. We also suggest avenues for improving risk stratification through further studies of a patient's healing capacity and predisposition to endothelial damage, two factors that impact aGVHD outcomes but are absent from the current risk stratification models.
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Affiliation(s)
- S G Holtan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - M L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Markova M, Barker JN, Miller JS, Arora M, Wagner JE, Burns LJ, MacMillan ML, Douek D, DeFor T, Tan Y, Repka T, Blazar BR, Weisdorf DJ. Fludarabine vs cladribine plus busulfan and low-dose TBI as reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation: a prospective randomized trial. Bone Marrow Transplant 2007; 39:193-9. [PMID: 17220905 DOI: 10.1038/sj.bmt.1705556] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purine analogs are often used for conditioning preceding allogeneic hematopoietic stem cell transplantation (HCT). We prospectively tested fludarabine (Flu) 40 mg/m(2)/day x 5 days vs cladribine (Clad) 10 mg/m(2)/day x 5 days plus oral busulfan (1 mg/kg q6 h x 2 days) and total body irradiation 200 cGy in 32 recipients of matched sibling and unrelated donor (URD) HCT. Patients were similar in age (median 52 years), diagnosis, extensive pre-HCT therapy (56 vs 63%), and high-risk disease status (81 vs 93%). Neutrophil engraftment was prompt (median 11 vs 12 days), but early graft failure using Clad halted randomization. Platelet recovery was prompt (median Flu 18 vs Clad 24 days). Graft-versus-host disease (GVHD) after Flu vs Clad was similar; (acute grade II/IV 56 vs 69%, P=0.26; chronic 50 vs 31%, P=0.27). Nonrelapse mortality (Flu 25 vs Clad 38%, P=0.47) and progression-free survival at 3 years were similar as well. Multivariate analyses showed slightly, but not significantly lower relative risk (RR) of neutrophil engraftment with Clad (RR 0.6 (95% CI 0.2-1.3) P=0.16) and with URD RR 0.4 (0.2-1.0) P=0.04). Older patients with advanced hematologic malignancies achieve satisfactory outcomes using either of these reduced intensity conditioning regimens.
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Affiliation(s)
- M Markova
- Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, MN, USA
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MacMillan ML, Dostrovsky JO, Lozano AM, Hutchison WD. Involvement of Human Thalamic Neurons in Internally and Externally Generated Movements. J Neurophysiol 2004; 91:1085-90. [PMID: 14573552 DOI: 10.1152/jn.00835.2003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Several anatomical studies support the existence of recurrent neural pathways from cortical motor areas to the thalamus via basal ganglia and back to the cortex. Neuronal responses to internally and externally generated sequential movements have been studied in the motor and premotor cortex of monkeys, but the involvement of subcortical motor structures such as the thalamus have not been studied in monkeys or humans. We examined the activity of neurons during a sequential button press task in motor thalamus of parkinsonian as well as chronic pain patients undergoing implantation of deep brain stimulating electrodes. Single and dual microelectrode recordings were carried out during an internally generated task with a memorized sequence (MEM) and an externally driven task with the sequence given during task performance (follow). Average histograms of neuronal firing were constructed for each task and aligned with respect to visual cues (ready, go) or button presses (P1, P2, P3). Sequential movements were monitored with surface electromyography and hand accelerometry, and cell responses were divided into movement-defined epochs for ANOVA and post hoc means testing. Of 52 neurons tested, 31 were found to have task-related responses and 10 were task-selective with 4 responding preferentially to MEM and 7 responding preferentially to follow (1 was both). Complex responses were found including preparatory, delay period, and phase- and task-specific activity. These kinds of responses suggest a role of the thalamus in both internally and externally cued arms movement and provide some evidence for a role in sequential movements.
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Affiliation(s)
- M L MacMillan
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, USA
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Burns LJ, Miller W, Kandaswamy C, DeFor TE, MacMillan ML, Van Burik JA, Weisdorf DJ. Randomized clinical trial of ganciclovir vs acyclovir for prevention of cytomegalovirus antigenemia after allogeneic transplantation. Bone Marrow Transplant 2002; 30:945-51. [PMID: 12476289 DOI: 10.1038/sj.bmt.1703770] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2002] [Accepted: 09/16/2002] [Indexed: 11/08/2022]
Abstract
Cytomegalovirus (CMV) disease remains a major cause of morbidity following allogeneic stem cell transplantation (SCT). In a prospective randomized trial, we tested prophylactic therapy with ganciclovir or acyclovir for patients at high risk of disease. Ninety-one CMV seropositive recipients of related (n = 53) and unrelated (n = 38) donor transplants were enrolled. All patients received intravenous (i.v.) ganciclovir 5 mg/kg every 12 h days -7 to -2, followed by acyclovir 10 mg/kg i.v. every 8 h from day -1 until neutrophil engraftment. Patients were then randomly assigned to either ganciclovir (n = 45) or acyclovir (n = 46) until day 100 post transplant. Any degree of antigenemia was treated with ganciclovir 5 mg/kg i.v. twice a day for 2 weeks, followed by 5 mg/kg i.v. each weekday for 6 weeks. At day 100, the cumulative incidence of antigenemia was 31% (95% CI 17-45%) for ganciclovir and 41% (95% CI 26-56%) (P = 0.22) for acyclovir prophylaxis, respectively. The assigned prophylaxis cohort did not predict for CMV antigenemia. The cumulative incidence of CMV disease at 12 months was 13% (95% CI 3-23%) and 17% (95% CI 6-28%) (P = 0.59) for the ganciclovir- and acyclovir-treated groups, respectively. An absolute neutrophil count (ANC) <or=1500 x 10(6)/l at randomization (P < 0.01) and grade II-IV acute graft-versus-host-disease (P = 0.01), but not the assigned prophylaxis cohort (P = 0.62), were independent risk factors for CMV disease. The incidence of fungal infections and renal insufficiency was similar across treatment groups; however, bacterial infections and secondary neutropenia occurred more frequently in the ganciclovir group. With our study powered to detect a 60% reduction in antigenemia with ganciclovir prophylaxis, we did not find a statistically significant difference between ganciclovir and acyclovir when used as part of an overall strategy for prevention of CMV antigenemia and disease in SCT, although fewer side-effects occurred with acyclovir treatment.
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Affiliation(s)
- L J Burns
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
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10
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MacMillan ML, Auerbach AD, Davies SM, Defor TE, Gillio A, Giller R, Harris R, Cairo M, Dusenbery K, Hirsch B, Ramsay NK, Weisdorf DJ, Wagner JE. Haematopoietic cell transplantation in patients with Fanconi anaemia using alternate donors: results of a total body irradiation dose escalation trial. Br J Haematol 2000; 109:121-9. [PMID: 10848791 DOI: 10.1046/j.1365-2141.2000.01955.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Allogeneic haematopoietic cell transplantation (HCT) is the only therapeutic modality capable of correcting the haematologic manifestations of Fanconi anaemia (FA). However, HCT from alternative donors has been associated with poor survival. Between June 1993 and July 1998, 29 FA patients (median age 12.1 years; range 3.7-48.5 years) were enrolled in a prospective phase I-II dose escalation study. All patients were treated with cyclophosphamide 40 mg/kg, total body irradiation (TBI) 450 cGy or 600 cGy and antithymocyte globulin (ATG), followed by HCT from an alternative donor. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A for 6 months, short course methylprednisolone (2 mg/kg/day) between days +5 and +19 and marrow T-cell depletion by counterflow elutriation. The probability of developing grade III-IV toxicity was 17% (95% CI 3-31%). For the 25 marrow recipients, the probability of neutrophil engraftment (ANC 0.5 x 109/l by day 45) was 63% (95% CI 42-82%). Probabilities of grade II-IV acute GVHD and chronic GVHD were 32% (95%CI 10-54%) and 0% respectively. With a median follow-up of 18 months, the probability of survival for the entire cohort at 1 year was 34% (95% CI 17-51%). The presence of lymphocyte somatic mosaicism [i.e. the presence of diepoxybutane (DEB)-insensitive cells] was associated with a significantly increased risk of graft failure. Disappointingly, the use of higher dose TBI and post-transplant ATG did not improve engraftment. More effective peritransplant immunosuppression, especially in FA patients with somatic mosaicism, was required to overcome the barrier of graft rejection. New conditioning regimens adapted to each individual's alkylator sensitivity are needed to improve the outcome of alternative donor HCT for FA.
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Affiliation(s)
- M L MacMillan
- Department of Paediatrics, Laboratory Medicine and Pathology, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis 55455, USA
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Abstract
Seven children, 11 months to 5.9 years of age, with juvenile myelomonocytic leukaemia (JMML) underwent allogeneic haemopoietic cell transplantation (HCT) using related or unrelated donor bone marrow or umbilical cord blood. All patients had active disease at time of transplant despite chemotherapy in five patients and chemotherapy and splenectomy in one patient prior to HCT conditioning. All patients received cyclophosphamide and TBI, with the addition of busulphan in two cases. Engraftment was documented in all cases. Notably, six of seven patients relapsed after allogeneic HCT with one achieving a return to full donor chimaerism after cyclosporin A (CSA) withdrawal. Two patients are alive in remission, 23+ and 30+ months after transplant. The role of allogeneic HCT in patients with JMML is discussed. A cooperative multicentre trial is needed to establish the optimal therapy for these patients.
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Affiliation(s)
- M L MacMillan
- Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA
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12
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Affiliation(s)
- M L MacMillan
- McMaster University Medical Centre, Hamilton, Ontario, Canada
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13
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Affiliation(s)
- M L MacMillan
- The Hospital for Sick Children, and the Department of Pediatrics, University of Toronto, Faculty of Medicine, Ontario, Canada
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MacMillan ML, Davies SM, Wagner JE, Ramsay NK. Engraftment of unrelated donor stem cells in children with familial amegakaryocytic thrombocytopenia. Bone Marrow Transplant 1998; 21:735-7. [PMID: 9578317 DOI: 10.1038/sj.bmt.1701147] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Congenital amegakaryocytic thrombocytopenia is an extremely rare disorder for which bone marrow transplantation offers the only possibility for cure. The pathophysiology is unclear. Two children with familial amegakaryocytic thrombocytopenia underwent unrelated donor transplantation (bone marrow in one, umbilical cord blood in the second) after a preparative regimen of cyclophosphamide and total body irradiation. Both patients failed initial engraftment, required further donor stem cell infusions and are currently well with sustained engraftment, 16 months and 7 months after transplantation, respectively. The difficulty in achieving engraftment of unrelated donor stem cells in these children suggests that in future cases additional measures to achieve engraftment may be necessary, for example, a more aggressive preparative regimen or an increased stem cell dose.
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Affiliation(s)
- M L MacMillan
- Department of Pediatrics and the Bone Marrow Transplant Program, University of Minnesota, Minneapolis 55455, USA
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Abstract
Two studies investigated the effects of peripheral (IP) administration of the dietary indispensible amino acid tryptophan, on food intake and macronutrient selection in rats adapted to a 12 hr nocturnal feeding period and a choice of 10% and 60% casein diets. In a dose-response study (35, 55, 75, 95, 115 mg/kg), the threshold dose of 75 mg/kg produced a significant reduction in total food intake (3.6 to 2.3 g, p less than 0.05) during the first hour of feeding. The reduction in carbohydrate intake (2.1 vs. 1.2 g, p less than 0.05) was greater than that for protein intake (1.6 vs. 1.1 g, p less than 0.05). Twelve hr total food intake was also decreased (20.9 to 19.5 g, p less than 0.05) and this was attributable to decreased carbohydrate intake (13.2 to 11.8 g, p less than 0.05). In a second study designed to determine if tryptophan's effects were mediated by the central nervous system, brain tryptophan uptake was blocked by co-injecting valine with tryptophan. The significant reduction in first hour total food intake by tryptophan was not prevented by co-injection of an equal quantity of valine (3.5 to 1.8 g, p less than 0.05). Again the suppression of carbohydrate intake (2.0 to 0.9 g p less than 0.05) was greater than that for protein intake (1.5 to 0.9 g, p less than 0.05). This dose of valine significantly reduced brain tryptophan uptake by 16% (21.3 to 17.8 micrograms/g, p less than 0.05) and when administered alone did not affect first hour total food intake (3.1 vs 3.2 g).(ABSTRACT TRUNCATED AT 250 WORDS)
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