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Inflammatory Disorders of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Finally, autologous hematopoietic stem cell transplantation (AHSCT) aims to “reboot” the immune system.23 It causes a 90% reduction in RR, but it carries a significant morbidity and small mortality, currently restricting its use to patients with severe relapsing MS.
Autologous Stem Cell Transplantation for Refractory Juvenile Idiopathic Arthritis (JIA)
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Autologous hematopoietic stem cell transplantation (HSCT) has been described recently as a possible treatment for patients with severe autoimmune disease such as Systemic Scleroderma, Rheumatoid Arthritis (RA), Multiple Sclerosis (MS) and Systemic Lupus Erythematosus (SLE) refractory to conventional treatment.6-9 The first 4 children with severe JIA treated with HSCT were published earlier.10 We report here an extension of this study, which at present includes 18 children with JIA, treated in the Netherlands, and 13 children from other European pediatric centers, with a follow up of 5 to 51 months.
Minimal Residual Disease
Published in Gertjan J. L. Kaspers, Bertrand Coiffier, Michael C. Heinrich, Elihu Estey, Innovative Leukemia and Lymphoma Therapy, 2019
Jacques J. M. van Dongen, Tomasz Szczepański, Vincent H. J. van der Velden
Current cytotoxic treatment protocols induce complete remission (CR) in most acute leukemia patients [both acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML)], in some patients with chronic lymphocytic leukemia (CLL), and in most non-Hodgkin’s lymphoma (NHL) and chronic myeloid leukemia (CML) patients. Introduction of allogeneic and autologous hematopoietic stem cell transplantation (HSCT) in treatment protocols has further increased the remission rates in ALL, AML, CML, and NHL. Nevertheless, many of these patients ultimately relapse. Apparently, the treatment protocols are not capable of killing all clonogenic malignant cells in these patients, even though they reached CR according to cytomorphological criteria. The detection limit of cytomorphological techniques is not lower than 1% to 5% of malignant cells, implying that these techniques can provide only superficial information about the effectiveness of the treatment. More sensitive techniques are required for the detection of low frequencies of malignant cells during and after treatment, i.e., detection of minimal residual disease (MRD). MRD techniques should reach sensitivities of at least 10−3 (one malignant cell within thousand normal cells), but sensitivities of 10−4 to 10−6 are preferred. Such sensitivities allow “true” MRD detection and thereby evaluation of the effectiveness of the total treatment and assessment of the contribution of each treatment phase.
Cell division cycle 37 change after bortezomib-based induction therapy helps to predict clinical response and prognosis in multiple myeloma patients
Published in Hematology, 2023
Wuqiang Lin, Xiuli Chen, Heyong Zheng, Zhenjie Cai
In terms of overall survival, univariate regression analysis suggested that only CDC37 after induction treatment (high vs. low) (hazard ratio = 4.165, P = 0.011) was related to worse overall survival; however, CDC37 at baseline was not linked to that (hazard ratio = 2.013, P = 0.132). In addition, a higher revised International Staging System stage (hazard ratio = 2.424, P = 0.030) was also linked to shorter overall survival in multiple myeloma patients. Whereas autologous hematopoietic stem cell transplantation (yes vs. no) was related to prolonged overall survival (hazard ratio = 0.097, P = 0.023). It should be noticed that treatment (bortezomib, thalidomide, and dexamethasone vs. bortezomib, lenalidomide, and dexamethasone) (hazard ratio = 1.007, P = 0.988) and cytogenetics (t (4; 14), t (14; 16), or Del (17p) vs. no) (hazard ratio = 1.762, P = 0.210) were not correlated with overall survival. Further forward-multivariate regression analysis revealed that CDC37 after induction treatment (high vs. low) (hazard ratio = 3.580, P = 0.022) independently predicted worse overall survival in multiple myeloma patients; nevertheless, CDC37 at baseline could not independently estimate that. Besides, autologous hematopoietic stem cell transplantation (yes vs. no) independently predicted longer overall survival in multiple myeloma patients (hazard ratio = 0.113, P = 0.034) (Table 4).
A model based on machine learning for the prediction of cyclosporin A trough concentration in Chinese allo-HSCT patients
Published in Expert Review of Clinical Pharmacology, 2023
Lin Song, Chen-Rong Huang, Shi-Zheng Pan, Jian-Guo Zhu, Zong-Qi Cheng, Xun Yu, Ling Xue, Fan Xia, Jin-Yuan Zhang, De-Pei Wu, Li-Yan Miao
We enrolled inpatients who underwent HSCT at the First Affiliated Hospital of Soochow University from January 2015 to June 2020. The inclusion criteria were as follows: (i) patients who underwent allo-HSCT, (ii) patients who were treated with CsA as a component of prophylactic immunosuppression therapy to prevent GVHD and (iii) patients with two or more TDM data for CsA after HSCT. The exclusion criteria were as follows: (i) patients whose data were incomplete, including the lack of more than 50% blood biochemical and blood routine result, the lack of demographic characteritic and diagnosis record and the lack of source of donor; (ii) CsA TDM data with concentration >1000 ng mL−1 or <30 ng mL−1; (iii) patients who underwent autologous hematopoietic stem cell transplantation (auto-HSCT); (iv) the CsA TDM data when patients were on oral CsA; and (v) patients with less than two CsA TDM data after HSCT. The flow chart of patient inclusion is shown in Figure 1. All kinds of diseases were collected in this research and classified as acute lymphoblastic leukemia, acute myelocytic leukemia, chronic myeloid leukemia, myelodysplastic syndrome, aplastic anemia, malignant lymphoma, other nonmalignant hematological diseases, and other diseases that cannot be classified.
Fusariosis: an update on therapeutic options for management
Published in Expert Opinion on Orphan Drugs, 2021
Laila S Al Yazidi, Abdullah M. S. Al-Hatmi
Risk factors for acquiring localized fusariosis include direct inoculation and loss of skin integrity secondary to trauma or foreign body entrance [2]. Prolonged profound neutropenia and severe T-cell immunodeficiency are the main risk factors for invasive fusariosis. The latter type of disease is limited to patients with hematological malignancy, hematopoietic stem cells, or solid organ transplant [3,9,10]. Nucci et al. reported that 56% of 84 patients with disseminated fusariosis had hematological malignancies, and 83% of them were neutropenic [9,14]. Allogenic hematopoietic stem cell transplant (HSCT) recipients are also at increased risk. The overall incidence among populations with malignancies is about six cases per 1000. The lowest risk is among autologous hematopoietic stem cell transplantation (HSCT) (1.5/1000) and the highest among mismatched related allogeneic HSCT recipients (20/1000) [9,15]. The first peak of infection is during the early pre-engraftment post-transplant period, when the patients are neutropenic. A second peak is observed among patients developing acute graft-versus-host disease (GVHD), about 70 days post-transplantation. An eventual third peak mostly involves patients with chronic extensive graft-versus-host disease (GVHD) under prolonged steroid administration, >1 year post-HSCT [9,15]. Organ transplant recipients show higher frequencies of locally invasive fusariosis compared to HSCT recipients [9,16].