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Tholouli E, Osborne W, Bachier C, Ramakrishnan A, Marzolini M, Irvine D, McSweeney P, Bartlet N, Zhang Y, Thomas S, Al-Hajj M, Pule M, Jonnaert M, Peddareddigari V, Khokhar N, Chen R, Ardesha K. 890MO Phase I Alexander study of AUTO3, the first CD19/22 dual targeting CAR.T cell, with pembrolizumab in patients with relapsed/refractory (r/r) DLBCL. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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2
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Affiliation(s)
- C. R. Frost
- Ontario Hydro, 700 University Ave., Toronto, Ontario, Canada
| | - P. Walmsley
- Ontario Hydro, Nuclear Power Demonstration Nuclear Generating Station, Rolphton, Ontario, Canada
| | - P. V. Balakrishnan
- Atomic Energy of Canada Limited, Chalk River Nuclear Laboratories, Chalk River, Ontario, Canads
| | - P. McSweeney
- Ontario Hydro, W. P. Dobson Research Laboratory, 800 Kipling Avenue, Toronto, Ontario, Canada
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Spalaris CN, Ring PJ, Wright EA, Vrijen J, van Westenbrugge JK, Wiel LVD, Rademakers PLF, Scheepens CP, Schinkel JW, Roy P, Spalaris CN, Sessions CE, Reynolds SD, Hebbar MA, Lewis JF, Kiefer JH, Sessions CE, Uber CF, Kirkland GR, Davies ER, Lambert ME, Kennett EJ, Tavassoli AA, Touron H, Weisz M, Connors HJ, Wood DS, Simpson JL, Robles MN, Spalaris CN, Moss SA, Balakrishnan PV, McSweeney P, Frost CR, Walmsley P, Van Drunen G, Cecco VS, Renshaw RH, Roy S, Bulischeck TS, van Rooyen D, Kowaka M, Nagano H, Kudo T, Okada Y, Yagi M, Takaba O, Yonezawa T, Arioka K, Wolfe CR, Esposito JN, Whyte DD, Gilkison JM, Balavage JR, Wootten MJ, Wozniak SM, Emanuelson RH, Levstek DF, Moore KE, Theus GJ, Airey GP, Vaia AR, Aspden RG, Hurst P, Cowen HC, Lewis MWJ, Campbell CS, Kirkland GR, Davies ER, Lambert ME, Satoh K, Toyoda M, Matsui S, Mori E, Shimizu S, Satoh K, Druce SG, Edwards BC, Martin JW, Talbot DEJ, Mukherjee B, Haddad MHE, Vanderglas ML, Leemans DV, Brown J, Gonzalez F, Iley D, McKay A, Vyas B, Czajkowski CJ, Weeks JR. Authors. NUCL TECHNOL 2017. [DOI: 10.13182/nt55-229] [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]
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Affiliation(s)
- P. V. Balakrishnan
- Atomic Energy of Canada Limited, Chalk River Nuclear Laboratories, Chalk River, Ontario, Canada K0J 1J0
| | - P. McSweeney
- Ontario Hydro, W. P. Dobson Research Laboratory 800 Kipling Avenue, Toronto, Ontario, Canada M8Z 5S4
| | - C. R. Frost
- Ontario Hydro, 700 University Avenue Toronto, Ontario, Canada M5G 1X6
| | - P. Walmsley
- Ontario Hydro, Nuclear Power Demonstration Nuclear Generating StationRolphton, Ontario, Canada K0J 2H0
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Laudenslager ML, Simoneau TL, Kilbourn K, Natvig C, Philips S, Spradley J, Benitez P, McSweeney P, Mikulich-Gilbertson SK. A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress. Bone Marrow Transplant 2015; 50:1110-8. [PMID: 25961767 PMCID: PMC4527944 DOI: 10.1038/bmt.2015.104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 01/20/2023]
Abstract
Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (Allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety, and depression as a result. We theorized that a stress management adapted for Allo-HSCT caregivers would reduce distress compared to treatment as usual (TAU). From 267 consecutive caregivers of Allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (n=74) or TAU (n=74). Eight 1-on-1 stress management sessions delivered across the 100 day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration, and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post-transplant (Mean=20.0, CI95=17.9-22.0) compared to TAU (Mean=23.0, CI95=21.0-25.0) with an effect size (ES) of 0.39 (p=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66 respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in Allo-HSCT caregivers.
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Affiliation(s)
- M L Laudenslager
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - T L Simoneau
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - K Kilbourn
- Department of Psychology, Univerity of Colorado Denver, Denver, CO, USA
| | - C Natvig
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - S Philips
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - J Spradley
- 1] Presbyterian/St Luke's Medical Center, Denver, CO, USA [2] Colorado Blood Cancer Institute, Denver, CO, USA
| | - P Benitez
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - P McSweeney
- 1] Presbyterian/St Luke's Medical Center, Denver, CO, USA [2] Colorado Blood Cancer Institute, Denver, CO, USA
| | - S K Mikulich-Gilbertson
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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Ostronoff F, Milano F, Gooley T, Gutman JA, McSweeney P, Petersen FB, Sandmaier BM, Storb R, Delaney C. Double umbilical cord blood transplantation in patients with hematologic malignancies using a reduced-intensity preparative regimen without antithymocyte globulin. Bone Marrow Transplant 2012; 48:782-6. [PMID: 23241738 DOI: 10.1038/bmt.2012.243] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reduced-intensity conditioning (RIC) regimens in cord blood transplant (CBT) are increasingly utilized for older patients and those with comorbidities. However, the optimal conditioning regimen has not yet been established and remains a significant challenge of this therapeutic approach. Antithymocyte globulin (ATG) has been incorporated into conditioning regimens in order to decrease the risk of graft failure; however, use of ATG is often associated with infusion reactions and risk of post-transplant complications. We report the results of a non-ATG-containing RIC regimen, where patients received 2 Gy TBI unless they were considered to be at higher risk of graft failure, in which case they received 3 Gy of TBI. Thirty patients underwent CBT using this protocol for high-risk hematological malignancies. There was only one case of secondary and no cases of primary graft failure. At 1 year, estimates of non-relapse mortality, OS and PFS were 29%, 53% and 45%, respectively. The cumulative incidences of grade III-IV acute and chronic GVHD were 14% and 18%, respectively. In summary, the results of this study demonstrate that this non-ATG-containing conditioning regimen provides a low incidence of graft failure without increasing regimen-related toxicity.
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Affiliation(s)
- F Ostronoff
- Clinical Oncology Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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Shaughnessy P, Uberti J, Devine S, Maziarz RT, Vose J, Micallef I, Jacobsen E, McCarty J, Stiff P, Artz A, Ball ED, Berryman R, Dugan M, Joyce R, Hsu FJ, Johns D, McSweeney P. Plerixafor and G-CSF for autologous stem cell mobilization in patients with NHL, Hodgkin’s lymphoma and multiple myeloma: results from the expanded access program. Bone Marrow Transplant 2012. [DOI: 10.1038/bmt.2012.219] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sullivan K, Froshaug D, Furst D, Nash R, Mayes M, Crofford L, McSweeney P, Goldmuntz E, Keyes-Elstein L, Khanna D, Sullivan K, Woolson R, Wallace P, Sempowski G, McSweeney P, Mayes M, Crofford L, Nash R, Furst D, Storek J, Quirici N, Corti L, Scavullo C, Ferri C, Manfredi A, Giuggioli D, Lambertenghi Deliliers G, Del Papa N, Foeldvari I, Wierk A, Fargue D. S.1.1 Organ function and quality of life correlates at randomization on the SCOT (Scleroderma: Cyclophosphamide Or Transplantion) Trial. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker456] [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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Schlatter M, Gregory T, Panter E, Maris M, McSweeney P. Incidence of Hyperglycemia in Acute Allogeneic Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.386] [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: 12/01/2022]
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Franke G, Hegenbart U, Niederwieser D, Sandmaier B, Maris M, Shizuru J, Stuart M, Greinix H, Cordonnier C, Rio B, Gratwohl A, Lange T, Poenisch W, Grommisch L, Al-Ali H, Storer B, Maloney D, Petersdorf E, McSweeney P, Chauncey T, Agura E, Epner E, Maziarz R, Petersen F, Bruno B, Storb R. Treatment for acute myelogenous leukemia by low dose Total Body Irradiation (TBI) based conditioning and hematopoietic cell transplantation from related and unrelated donors. Biol Blood Marrow Transplant 2006. [DOI: 10.1016/j.bbmt.2005.11.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sorror M, Maris M, Sandmaier B, Jain-Stuart M, Storer B, Hegenbart U, McSweeney P, Chauncey T, Bruno B, Wade J, Agura E, Pulsipher M, Leis J, Little MT, Niederwieser D, Blume K, Storb R, Maloney D. Treatment of patients (pts) with chemotherapy-refractory chronic lymphocytic leukemia (CLL) with nonmyeloablative (NM) conditioning and hematopoietic cell transplantation (HCT) from HLA-matched related (MRD) or unrelated donors (URD). Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2003.12.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Miller CB, Waller EK, Klingemann HG, Dignani MC, Anaissie EJ, Cagnoni PJ, McSweeney P, Fleck PR, Fruchtman SM, McGuirk J, Chao NJ. Lipid formulations of amphotericin B preserve and stabilize renal function in HSCT recipients. Bone Marrow Transplant 2004; 33:543-8. [PMID: 14730342 DOI: 10.1038/sj.bmt.1704408] [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: 11/08/2022]
Abstract
The current study assessed renal function based on medical records in adult hematopoietic stem cell transplant (HSCT) recipients with proven or probable invasive fungal infection (IFI) transplanted between 1995 and 2000. We confirm that amphotericin B deoxycholate (AmB-d) is nephrotoxic in a large percentage of HSCT recipients. Due to nephrotoxicity, defined as serum creatinine (SCr) >2.5 mg/dl or a 100% increase in SCr from baseline, 88% of patients treated with AmB-d were switched to a lipid formulation of amphotericin B (LFAB). In total, 53% of patients initiated on AmB-d were switched within the first week of therapy. Significantly more patients (70.6%) treated with AmB-d experienced a 100% increase in SCr from baseline compared to patients treated with either AmBisome (44.4%) or Abelcet (41.2%). A Cox Proportional Hazards Model revealed that, compared to patients initiated on AmBisome or Abelcet, the risk of nephrotoxicity (RR=1.5 vs AmBisome; RR=1.7 vs Abelcet), dialysis (RR=2.4 vs AmBisome; RR=1.4 vs Abelcet), and death (RR=2.0 vs AmBisome; RR=1.1 vs Abelcet) were all increased for patients initiated on AmB-d. Study results suggest that renal function improves and mortality declines when an LFAB is given to HSCT patients as initial therapy rather than as second-line therapy, the current practice.
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Parikh C, McSweeney P, Schrier R. 39 Acute renal failure following non-myeloablative hematopoietic stem cell transplantation — a multicenter study. Biol Blood Marrow Transplant 2003. [DOI: 10.1016/s1083-8791(03)80040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McSweeney P. Nonmyeloablative allogeneic hematopoietic cell transplants: any role for rheumatoid arthritis? J Rheumatol Suppl 2001; 64:49-54. [PMID: 11642505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Recent studies have suggested limited efficacy of high dose cyclophosphamide and autologous stem cell transplant as a treatment for severe rheumatoid arthritis. Preclinical data and anecdotal evidence from human transplants suggest that greater efficacy and possible cures might be achieved through use of allogeneic transplants. Newer less intensive methods of allogeneic transplantation have been introduced that reduce morbidity and mortality of the procedure. This article reviews the possible role of the so-called nonmyeloablative transplants in the treatnent of RA.
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Affiliation(s)
- P McSweeney
- Bone Marrow Transplant Program, University of Colorado Health Sciences Center, Denver 80262, USA
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Binks M, Passweg JR, Furst D, McSweeney P, Sullivan K, Besenthal C, Finke J, Peter HH, van Laar J, Breedveld FC, Fibbe WE, Farge D, Gluckman E, Locatelli F, Martini A, van den Hoogen F, van de Putte L, Schattenberg AV, Arnold R, Bacon PA, Emery P, Espigado I, Hertenstein B, Hiepe F, Kashyap A, Kötter I, Marmont A, Martinez A, Pascual MJ, Gratwohl A, Prentice HG, Black C, Tyndall A. Phase I/II trial of autologous stem cell transplantation in systemic sclerosis: procedure related mortality and impact on skin disease. Ann Rheum Dis 2001; 60:577-84. [PMID: 11350846 PMCID: PMC1753658 DOI: 10.1136/ard.60.6.577] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc, scleroderma) in either its diffuse or limited skin forms has a high mortality when vital organs are affected. No treatment has been shown to influence the outcome or significantly affect the skin score, though many forms of immunosuppression have been tried. Recent developments in haemopoietic stem cell transplantation (HSCT) have allowed the application of profound immunosuppression followed by HSCT, or rescue, to autoimmune diseases such as SSc. METHODS Results for 41 patients included in continuing multicentre open phase I/II studies using HSCT in the treatment of poor prognosis SSc are reported. Thirty seven patients had a predominantly diffuse skin form of the disease and four the limited form, with some clinical overlap. Median age was 41 years with a 5:1 female to male ratio. The skin score was >50% of maximum in 20/33 (61%) patients, with some lung disease attributable to SSc in 28/37 (76%), the forced vital capacity being <70% of the predicted value in 18/36 (50%). Pulmonary hypertension was described in 7/37 (19%) patients and renal disease in 5/37 (14%). The Scl-70 antibody was positive in 18/32 (56%) and the anticentromere antibody in 10% of evaluable patients. Peripheral blood stem cell mobilisation was performed with cyclophosphamide or granulocyte colony stimulating factor, alone or in combination. Thirty eight patients had ex vivo CD34 stem cell selection, with additional T cell depletion in seven. Seven conditioning regimens were used, but six of these used haemoimmunoablative doses of cyclophosphamide +/- anti-thymocyte globulin +/- total body irradiation. The median duration of follow up was 12 months (3-55). RESULTS An improvement in skin score of >25% after transplantation occurred in 20/29 (69%) evaluable patients, and deterioration in 2/29 (7%). Lung function did not change significantly after transplantation. One of five renal cases deteriorated but with no new occurrences of renal disease after HSCT, and the pulmonary hypertension did not progress in the evaluable cases. Disease progression was seen in 7/37 (19%) patients after HSCT with a median period of 67 (range 49-255) days. Eleven (27%) patients had died at census and seven (17%) deaths were considered to be related to the procedure (direct organ toxicity in four, haemorrhage in two, and infection/neutropenic fever in one). The cumulative probability of survival at one year was 73% (95% CI 58 to 88) by Kaplan-Meier analysis. CONCLUSION Despite a higher procedure related mortality rate from HSCT in SSc compared with patients with breast cancer and non-Hodgkin's lymphoma, the marked impact on skin score, a surrogate marker of mortality, the trend towards stabilisation of lung involvement, and lack of other treatment alternatives justify further carefully designed studies. If future trials incorporate inclusion and exclusion criteria based on this preliminary experience, the predicted procedure related mortality should be around 10%.
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Carnevale-Schianca F, Martin P, Sullivan K, Flowers M, Gooley T, Anasetti C, Deeg J, Furlong T, McSweeney P, Storb R, Nash RA. Changing from cyclosporine to tacrolimus as salvage therapy for chronic graft-versus-host disease. Biol Blood Marrow Transplant 2001; 6:613-20. [PMID: 11128811 DOI: 10.1016/s1083-8791(00)70026-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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: 11/19/2022]
Abstract
Chronic graft-versus-host disease (GVHD) is the principal cause of transplantation-related morbidity and nonrelapse mortality late after allogeneic hematopoietic stem cell transplantation. The safety and potential efficacy of tacrolimus for the salvage treatment of chronic GVHD was evaluated in a single-arm, open-label phase 2 study. A total of 39 evaluable patients with chronic GVHD who failed previous immunosuppressive therapy with cyclosporine and prednisone were treated with tacrolimus starting at a median of 20 months (range, 3-68 months) after transplantation. At 3 years after the start of treatment, 5 patients (13%) had discontinued tacrolimus and were in complete remission, and 3 were considered clinically stable but not able to discontinue tacrolimus. A total of 31 patients (79%) experienced treatment failure; 22 (56%) who failed therapy had a change in immunosuppressive regimen because of progression (n = 18) or toxicity (n = 4). Nine patients (23%) died during continued treatment with tacrolimus. Two patients were lost to follow-up, at 11 and 19 months. The median duration of treatment with tacrolimus was 9 months (range, 1-29 months). Infections (144 episodes) were the most frequent adverse event. Nephrotoxicity occurred in 16 patients (41%); tacrolimus was discontinued in only 2 patients because of progressive deterioration in renal function. The Kaplan-Meier estimate of survival was 64% (95% confidence interval, 49%-79%) at 3 years posttransplantation. Seven patients had discontinued all immunosuppression at last contact, leading to an estimated 29% probability of stopping all immunosuppression by 3 years posttransplantation. Four patients died after relapse of malignancy. The response rate is consistent with previous reports of salvage treatment for chronic GVHD, indicating that a small group of patients failing cyclosporine may respond or stabilize with tacrolimus.
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Affiliation(s)
- F Carnevale-Schianca
- Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington Schools of -Medicine, Seattle, 98109-1024, USA
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Sandmaier BM, Maloney DG, McSweeney P, Niederwieser D, Shizuru J, Chauncey T, Gooley T, Molina A, Radich J, Blume K, Storb R. Nonmyeloablative conditioning for stem cell allografts with low-dose tbi. Exp Hematol 2000. [DOI: 10.1016/s0301-472x(00)00276-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shpall E, Quinones R, Jones R, Bearman S, Cagnoni P, Giller R, Nieto Y, McSweeney P, McNiece I. Transplantation of adult and pediatric cancer patients with ex vivo expanded cord blood. Exp Hematol 2000. [DOI: 10.1016/s0301-472x(00)00361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Openshaw H, Stuve O, Antel JP, Nash R, Lund BT, Weiner LP, Kashyap A, McSweeney P, Forman S. Multiple sclerosis flares associated with recombinant granulocyte colony-stimulating factor. Neurology 2000; 54:2147-50. [PMID: 10851379 DOI: 10.1212/wnl.54.11.2147] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [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: 12/28/2022] Open
Abstract
Four of 10 patients who were enrolled on protocols of high-dose immunosuppression with peripheral blood stem cell rescue for MS experienced neurologic worsening while receiving recombinant human granulocyte colony-stimulating factor. There was improvement when methylprednisolone was given to three of the patients, but one patient died of respiratory failure. The mechanism of the neurologic worsening is uncertain.
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Affiliation(s)
- H Openshaw
- Department of Neurology, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Sandmaier BM, McSweeney P, Yu C, Storb R. Nonmyeloablative transplants: preclinical and clinical results. Semin Oncol 2000; 27:78-81. [PMID: 10877058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Conditioning regimens have been intensified to a level at which organ toxicties are dose-limiting, which restricts the application of hematopoietic stem cell transplants to relatively young patients in otherwise good clinical condition. Studies done in a canine model have demonstrated that stable allogeneic mixed donor/host hematopoietic chimerism can be established by the administration of a sublethal dose of 2.0 Gy total body irradiation followed by immunosuppression with mycophenolate mofetil and cyclosporine after major histocompatibility complex-identical marrow transplantation. Both host-versus-graft and graft-versus-host reactions are controlled with mycophenolate mofetil and cyclosporine, which results in a stable state of graft/host tolerance manifested by stable mixed donor/ host hematopoietic chimerism. Current efforts are directed at replacing pretransplant radiation by anti-T-cell reagents, such as antibodies to T cells, or by purine antagonists, such as pentostatin (Nipent; SuperGen, San Ramon, CA). Given the minimal toxicity of this approach in dogs, a clinical study was initiated that uses an almost identical conditioning regimen. Thus far, 26 patients have been treated. Results to date indicate that this is a well-tolerated procedure that can be performed entirely in an outpatient setting. All patients have shown primary engraftment with persistence of mixed or full donor chimerism present through at least 2 months after transplant. Three patients experienced nonfatal graft rejection between 2 and 3 months after transplant, with a return to baseline peripheral counts over the subsequent 1 to 2 months. Acute graft-versus-host disease developed in 10 of 24 evaluable patients, occurring only after discontinuation of mycophenolate mofetil, and was controlled with additional immunosuppression in all cases. Overall, this novel nonmyeloablative conditioning regimen has been well tolerated and has encouraged us to investigate these transplants in other clinical settings, including using HLA-matched unrelated donors.
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Affiliation(s)
- B M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Abstract
Conventional allogeneic stem cell transplantation is a valuable approach to therapy for many hematologic malignancies. However, high-dose conditioning regimens designed both to control the malignancy and to prevent graft rejection are associated with a high incidence of acute and long-term side-effects. This has largely precluded the use of allografting for patients older than 55 years or for younger patients with certain pre-existing organ damage. In order to manage the side-effects, transplants have traditionally been delivered in highly specialized hospital wards or intensive care settings. Thus, an important goal is to develop safer allografting procedures that can be extended to older patients or patients with pre-existing organ dysfunction who are currently excluded from consideration for transplant. Recent observations have shown that donor lymphocyte infusions (DLI) can eradicate some malignancies that relapse after conventional allografting. These observations confirmed earlier evidence in favor of a graft-versus-leukemia effect based on the association of graft-versus-host disease (GVHD) with a lower likelihood of relapse of malignancy after allografting. Given the potential efficacy of DLI as the sole modality for eradication of malignancy, new strategies for allografting can incorporate the concept of less intensive conditioning therapy which is given with the sole aim of facilitating allogeneic engraftment. Recent pre-clinical studies in a canine model have shown that conditioning regimens for allografting can be markedly reduced in intensity yet still achieve the goal of engraftment. This review briefly summarizes the initial translational clinical studies, using a minimally myelosuppressive-conditioning regimen based on low dose total body irradiation (TBI) or fludarabine alone or in combination with other drugs followed by a short course of immunosuppression with post-grafting cyclosporine and methotrexate or mycophenolate mofetil.
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Holmberg LA, Boeckh M, Hooper H, Leisenring W, Rowley S, Heimfeld S, Press O, Maloney DG, McSweeney P, Corey L, Maziarz RT, Appelbaum FR, Bensinger W. Increased incidence of cytomegalovirus disease after autologous CD34-selected peripheral blood stem cell transplantation. Blood 1999; 94:4029-35. [PMID: 10590046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
High-dose therapy with autologous peripheral blood stem cell (PBSC) rescue is widely used for the treatment of malignant disease. CD34 selection of PBSC has been applied as a means of reducing contamination of the graft. Although CD34 selection results in a 2 to 3 log reduction in contaminating tumor cells without significantly delaying engraftment, many other types of cells are depleted from the CD34-enriched grafts and immune reconstitution may be impaired. In the present study, 31 cytomegalovirus (CMV)-seropositive patients who received myeloablative therapy followed by the infusion of CD34-selected autologous PBSC were assessed for the development of CMV disease in the first 100 days posttransplant. Seven patients (22.6%) developed CMV disease and 4 patients (12.9%) died from complications of their infection. In a contemporaneous group of 237 CMV-seropositive patients receiving unselected, autologous PBSC, only 10 patients (4.2%) developed CMV disease, with 5 deaths (2.1%). In a multivariate logistic regression analysis, the use of CD34-selected autologous PBSC after high-dose therapy was associated with a marked increase in the incidence of CMV disease and CMV-associated deaths.
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Affiliation(s)
- L A Holmberg
- Clinical Division, Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Tyndall A, Fassas A, Passweg J, Ruiz de Elvira C, Attal M, Brooks P, Black C, Durez P, Finke J, Forman S, Fouillard L, Furst D, Holmes J, Joske D, Jouet J, Kötter I, Locatelli F, Prentice H, Marmont AM, McSweeney P, Musso M, Peter HH, Snowden JA, Sullivan K, Gratwohl A. Autologous haematopoietic stem cell transplants for autoimmune disease--feasibility and transplant-related mortality. Autoimmune Disease and Lymphoma Working Parties of the European Group for Blood and Marrow Transplantation, the European League Against Rheumatism and the International Stem Cell Project for Autoimmune Disease. Bone Marrow Transplant 1999; 24:729-34. [PMID: 10516675 DOI: 10.1038/sj.bmt.1701987] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [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: 11/09/2022]
Abstract
This ongoing multicentre prospective phase I/II trial enrolled 74 consecutive patients from 22 centres worldwide with severe autoimmune disease, 35 with rheumatological disorders, 31 with neurological, five with haematological and three with vasculitides. They were treated with autologous peripheral blood or bone marrow transplants according to predetermined criteria. Two patients died after mobilisation before transplant. Seventy-two patients were given 73 transplants, seven bone marrow, and 66 mobilised peripheral blood stem cell transplants. The graft was manipulated to remove T and/or B cells in 43 cases. All 73 transplants engrafted. Five patients died of transplant-related complications: two from bleeding, three from infections. Two patients died of progressive disease. The transplant-related mortality at 1 year of 9% (1-17%; 95% CI) is comparable to the transplant-related mortality of 6% (3-9%; 95% CI) in patients transplanted during the same period in Europe for non-Hodgkin's lymphoma in sensitive relapse (P = 0.39). Sixty patients are evaluable for response, 40 patients (65%) showed some improvement in their disease. Haematopoietic stem cell transplants are feasible for patients with severe refractory autoimmune disease. Transplant-related mortality is comparable to results in patients with non-Hodgkin's lymphoma in responsive relapse. Two-thirds of the patients show at least some response. These preliminary data are promising. Although associated with considerable risk, randomised trials comparing autologous stem cell transplants to conventional therapy are warranted.
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Affiliation(s)
- A Tyndall
- University Rheumatology Clinic, Felix Platter Hospital, Basel, Switzerland
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Storb R, Yu C, Barnett T, Wagner JL, Deeg HJ, Nash RA, Kiem HP, McSweeney P, Seidel K, Georges G, Zaucha JM. Stable mixed hematopoietic chimerism in dog leukocyte antigen-identical littermate dogs given lymph node irradiation before and pharmacologic immunosuppression after marrow transplantation. Blood 1999; 94:1131-6. [PMID: 10419907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
Stable mixed donor/host hematopoietic chimerism can be accomplished in dog leukocyte antigen (DLA)-identical littermate dogs given sublethal (200 cGy) total-body irradiation (TBI) before and immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP) after transplant (Blood 89:3048, 1997). Studies were based on the hypothesis that drugs that prevent graft-versus-host disease (GVHD) after transplant also suppress host-versus-graft (HVG) reactions and thereby enhance engraftment. Here, we asked whether pretransplant TBI provided marrow space for the graft to home or caused host immunosuppression. To address the questions, recipients were given pretransplant irradiation to cervical, thoracic, and abdominal lymph nodes (except pelvis), DLA-identical littermate marrow grafts, and MMF/CSP posttransplant. Six dogs that received 450 cGy irradiation showed initial engraftment. Two rejected their grafts after 8 and 18 weeks, 1 died with GVHD and engraftment, and 3 are alive as mixed chimeras after 57 to 97 weeks. Four dogs given 200 cGy irradiation also showed initial engraftment, but rejected their grafts after 10 to 18 weeks. Mixed chimerism was present in nonirradiated marrow and lymph node spaces and involved granulocytes, T cells, and monocytes. While other explanations are possible, results seem consistent with the hypothesis that pretransplant radiation provides host immunosuppression, and grafts can create their own marrow space. These data set the stage for the development of novel transplant regimens that substitute immunosuppressive for cytotoxic agents.
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Affiliation(s)
- R Storb
- Clinical Research Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington, Seattle, WA, USA
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Affiliation(s)
- R Storb
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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Rowley SD, Loken M, Radich J, Kunkle LA, Mills BJ, Gooley T, Holmberg L, McSweeney P, Beach K, MacLeod B, Appelbaum F, Bensinger WI. Isolation of CD34+ cells from blood stem cell components using the Baxter Isolex system. Bone Marrow Transplant 1998; 21:1253-62. [PMID: 9674860 DOI: 10.1038/sj.bmt.1701257] [Citation(s) in RCA: 56] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The CD34 antigen is expressed by human hematopoietic progenitor and stem cells. These cells are capable of reconstituting marrow function after marrow-ablative chemo-radiotherapy. Several different technologies have been developed for the separation of CD34+ cells from bone marrow or peripheral blood stem cell (PBSC) components. We used an immunomagnetic separation technique to enrich CD34+ cells from PBSC components in anticipation of autologous transplantation for patients with B lymphoid malignancies. Twenty-nine patients enrolled on this study and received mobilization chemotherapy followed by G-CSF. Of these, 21 achieved a peripheral blood CD34+ cell level of at least 2.0 x 10(4)/l required by protocol for separation of the stem cell components. A median of three components per patient was collected for processing. The average CD34+ cell concentration in the components after apheresis was 1.0 +/- 1.2%. After the CD34+ cell selection, the enriched components contained 0.6 +/- 0.6% of the starting nucleated cells. The recovery of CD34+ cells, however, averaged 58.4 +/- 19.2% of the starting cell number, with a purity of 90.8 +/- 6.5%. Overall depletion of CD34- cells was 99.96 +/- 0.06%. Nineteen patients were treated with marrow-ablative conditioning regimens and received an average of 6.2 +/- 2.0 x 10(6) CD34+ cells/kg body weight. These patients recovered to an ANC >0.5 x 10(9)/l at a median of 11 days (range 8-14), and platelet transfusion independence at a median of 9 days (range 5-13). Four patients died of transplant-related complications or relapse before 100 days after transplantation. No patient required infusion of unseparated cells because of failure of sustained bone marrow function. These data demonstrate that peripheral blood-derived CD34+ cells enriched by use of an immunomagnetic separation technique are capable of rapid engraftment after autologous transplantation.
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Affiliation(s)
- S D Rowley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA
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McSweeney P. The politics of quality. Nurs Manag (Harrow) 1996; 3:12-13. [PMID: 8716639 DOI: 10.7748/nm.3.2.12.s15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Bensinger WI, Rowley SD, Demirer T, Lilleby K, Schiffman K, Clift RA, Appelbaum FR, Fefer A, Barnett T, Storb R, Chauncey T, Maziarz RT, Klarnet J, McSweeney P, Holmberg L, Maloney DG, Weaver CH, Buckner CD. High-dose therapy followed by autologous hematopoietic stem-cell infusion for patients with multiple myeloma. J Clin Oncol 1996; 14:1447-56. [PMID: 8622058 DOI: 10.1200/jco.1996.14.5.1447] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [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: 01/31/2023] Open
Abstract
PURPOSE To evaluate the outcome of patients with multiple myeloma (MM) who received high-dose therapy followed by autologous bone marrow (BM) or peripheral-blood stem-cell (PBSC) infusion. PATIENTS AND METHODS Sixty-three consecutive patients with MM received autologous BM (n = 13) or PBSC with or without BM (n = 50) following regimens that contained busulfan (Bu) and cyclophosphamide (Cy) (n = 18), modified total-body irradiation (TBI) followed by Bu and Cy (n = 36), or Bu, melphalan, and thiotepa (n = 9). Two thirds of the patients had resistant disease and 69% had received more than 6 months of previous chemotherapy. RESULTS AND CONCLUSION Recovery of peripheral-blood cell counts was more rapid in patients who received PBSC with or without BM than in patients who received BM alone. Sixteen of 63 patients (25%) died of complications of treatment within 100 days. Nineteen (40%) of 48 assessable patients achieved a complete response (CR), 23 (48%) had a partial response (PR), and six (12%) had no response. The probabilities of survival and survival without relapse or progression for all 63 patients at 3.0 years were .43 and .21, respectively. The probability of relapse or progression at 3 years was .69, and 17 patients (27%) have died of progressive MM. The probabilities of survival and relapse-free survival at 3 years for the 19 patients who achieved a CR were .42 and .17, respectively. In the multivariate analysis, beta2-microglobulin levels more than 2.5 micrograms/mL, more than two regimens of prior therapy and eight cycles of treatment, time to transplant longer than 3 years from diagnosis, and prior radiation were associated with adverse outcomes. Additional strategies, such as intervention earlier in the disease course, improved treatment regimens, sequential high-dose treatments, and posttransplant therapies may improve outcome of selected patients with MM.
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Affiliation(s)
- W I Bensinger
- Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA
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McSweeney P. So you'd like an award for quality.... Nurs Manag (Harrow) 1996; 2:8-9. [PMID: 8696688 DOI: 10.7748/nm.2.9.8.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Wagner LA, Kiem HP, McSweeney P, Schuening FG, Storb R, Ostrander EA. Development of a clonality assay for canine hematopoietic stem cells. Blood 1995; 86:3265-7. [PMID: 7579426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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McSweeney P. Get it right first time. Nurs Stand 1995; 9:22-3. [PMID: 7619707 DOI: 10.7748/ns.9.42.22.s33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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39
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McSweeney P. One-stop to quality. Nurs Manag (Harrow) 1995; 2:8-9. [PMID: 7600006 DOI: 10.7748/nm.2.3.8.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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McSweeney P. Ready-made winning ways. Nurs Manag (Harrow) 1995; 2:22-23. [PMID: 7767627 DOI: 10.7748/nm.2.2.22.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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41
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McSweeney P. Quality assurance: overnight sensation. Nurs Stand 1995; 9:20-1. [PMID: 7766517 DOI: 10.7748/ns.9.30.20.s34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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McSweeney P. Chains for the better. Nurs Manag (Harrow) 1994; 1:19-20. [PMID: 7987604 DOI: 10.7748/nm.1.6.19.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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McSweeney P. Assessing the cost of pressure sores. Nurs Stand 1994; 8:25-26. [PMID: 7993735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Nash R, McSweeney P, Zambello R, Semenzato G, Loughran TP. Clonal studies of CD3- lymphoproliferative disease of granular lymphocytes. Blood 1993; 81:2363-8. [PMID: 8097633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The lymphoproliferative disease of granular lymphocytes (LDGL) results from chronic proliferation of either CD3- or CD3+ large granular lymphocytes (LGLs). Most CD3+ LGLs have been well characterized as clonal LGL proliferations (LGL leukemia). In contrast, the clonal nature and clinical features of patients with CD3- LDGL have not been defined. In this study, we analyzed seven female patients with CD3- LDGL who were heterozygous at certain X-linked gene loci. Neutrophils and CD3- granular lymphocytes were isolated from peripheral blood. Clonal analysis was performed on genomic DNA from these cell fractions on six patients by conventional Southern techniques using probes to the X-linked genes, PGK and DXS255 (M27 beta). In four patients, three of whom were already studied by Southern analyses of genomic DNA and one in whom there were insufficient amounts of DNA, polymerase chain reaction (PCR)-based clonal analysis was performed with primer pairs flanking the BstXI polymorphism on the PGK gene. In six patients, a polyclonal expansion of CD3- granular lymphocytes was demonstrated and in one the result was indeterminate. In contrast to patients with CD3+ LDGL (LGL leukemia), a clonal disease could not be demonstrated with X-linked markers in patients with CD3- LDGL, suggesting a reactive rather than a neoplastic origin of the lymphocytes in these cases.
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Affiliation(s)
- R Nash
- Fred Hutchinson Cancer Research Center, Seattle, WA
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50
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McSweeney P. Does TMQ have anything to offer nurse education? Sr Nurse 1992; 12:30-2, 37. [PMID: 1299902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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