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Pulmonary complications of bone-marrow and stem-cell transplantation
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Bekele Afessa, Andrew D Badley, Steve G Peters
Non-infectious pulmonary complications also follow a characteristic temporal pattern.7 The distinguishing features of the main non-infectious pulmonary complications are outlined in Table 17.1. Among the non-infectious pulmonary complications, pulmonary oedema, diffuse alveolar haemorrhage (DAH) and peri-engraftment respiratory distress syndrome (PERDS) usually occur during the first 30 days following transplant (see Fig. 17.1). Idiopathic pneumonia syndrome (IPS) can occur at any time following transplant.
Endothelial dysfunction and vascular complications after allogeneic hematopoietic cell transplantation: an expert analysis
Published in Expert Review of Hematology, 2021
Ioannis Eftychidis, Ioanna Sakellari, Achilles Anagnostopoulos, Eleni Gavriilaki
Better understanding of the pathophysiology of many alloHCT-related disorders has shown that endothelial injury plays a critical role [4]. Under the term endothelial injury syndromes (EIS) there are several conditions, such as veno-occlusive disease/sinusoidal obstruction syndrome (SOS/VOD), idiopathic pneumonia syndrome, diffuse alveolar hemorrhage, capillary leak syndrome, graft-versus-host-disease (GVHD), and transplant-associated thrombotic microangiopathy (TA-TMA) [4,5]. Novel cellular therapies such as CAR (chimeric antigen receptor) T cell therapy may be also associated with additional EIS [6], that will not be further discussed in this review that aims to focused on alloHCT. As precision medicine evolves across hematology and other specialties [7,8], endothelial and vascular damage post alloHCT are rapidly evolving fields in need of a personalized approach.
Allogeneic hematopoietic cell transplantation using fludarabine plus myeloablative busulfan and melphalan confers promising survival in high-risk hematopoietic neoplasms: a single-center retrospective analysis
Published in Hematology, 2021
Taro Edahiro, Takakazu Kawase, Hisao Nagoshi, Keita Fujino, Kayo Toishigawa, Takahiko Miyama, Tatsuji Mino, Tetsumi Yoshida, Takehiko Morioka, Yuji Hirata, Mitsunori Noma, Teruhisa Fujii, Masatoshi Nishizawa, Noriyasu Fukushima, Tatsuo Ichinohe
In this study, we retrospectively analyzed a consecutive series of patients with hematopoietic neoplasms who underwent allo-HCT conditioned with the combination of myeloablative FLU-BU-MEL at our center. We found that transplant outcomes using the FBM regimen were comparable to those of conventional myeloablative transplants with relatively lower NRM both in the standard-risk and the high-risk groups. Both MEL140 and MEL80 regimens conferred durable engraftment of all types of stem cell source, although further improvement is required to prevent graft dysfunction when applied to single-unit cord blood transplants. As the primary end point, 2-yr OS rate of 62% for the entire cohort is acceptable. It appears to be particularly encouraging in the high-risk group with a survival rate plateau at 44%, given that 14 (88%) of 16 patients in this group had a chemoresistant active disease at the time of transplant, although early relapse remained a significant hurdle. Although the MEL80 group appeared to have a lower survival rate compared with the MEL140 group, this was not statistically significant in multivariate analysis. We assume that this observation might reflect the higher proportion of patients with active disease in the MEL80 group. The strength of our study is that we adopted the revised CIBMTR-DRI to define the risk of primary disease in our cohort. Although there have been different ways of classifying the standard- and high-risk diseases to predict transplant outcomes, they are often neither exchangeable nor reproducible across the studies. CIBMTR-DRI is an objective risk stratification system that was validated by more than 13000 adult patients. It was proven to be a robust tool to stratify the groups with better and worse post-transplant prognosis irrespective of conditioning intensity, patient age group, and type of graft source [24]. With regard to regimen-related toxicities with the FBM regimen, mild-to-moderate grades of gastrointestinal complications were frequent but serious adverse events leading to early mortality were rare. However, it should be noted here that 3 patients with highly refractory diseases were suffered from early toxic death due to SOS/VOD and idiopathic pneumonia syndrome within 100 days after transplant, alerting the use of FBM in cases with high tumor burden.