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Antibody-Based Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
The US label for the use of inotuzumab ozagamicin carries an FDA black box warning concerning the risk of liver toxicity, in particular hepatic Veno-Occlusive Disease (VOD), which has proved fatal in some patients. The risk of this is higher in patients who have the ADC administered before Hematopoietic Stem Cell Transplantation (HSCT), and more patients die who have HSCT following treatment with this ADC than those who have HSCT while taking other chemotherapies. The most common serious adverse reactions in patients include infections (23%), loss of neutrophils with fever (11%), hemorrhage (5%), stomach pain, fever, VOD, and tiredness.
AI and Autoimmunity
Published in Louis J. Catania, AI for Immunology, 2021
The objective of stem cell transplantation therapy is to destroy the mature, long-lived, and auto-reactive immune cells and generate a new, properly functioning immune system. The patient’s stem cells are used in a procedure known as autologous (from “one’s self”) hematopoietic stem cell transplantation (Figure 4.1). First, patients receive injections of a growth factor, which coaxes large numbers of hematopoietic stem cells to be released from the bone marrow into the bloodstream. These cells are harvested from the blood, purified away from mature immune cells, and stored. After sufficient quantities of these cells are obtained, the patient undergoes a regimen of cytotoxic (cell-killing) drug and/or radiation therapy, which eliminates the mature immune cells. Then, the hematopoietic stem cells are returned to the patient via a blood transfusion into the circulation where they migrate to the bone marrow and begin to differentiate to become mature immune cells. The body’s immune system is then restored.53
Non-Melanoma Skin Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Irene De Francesco, Sean Whittaker, Stephen L. Morris
Reduced intensity stem cell transplantation is a possible curative option for some patients with MF and Sézary syndrome. The MD Anderson reported 19 patients with advanced disease in whom TSEB was used before conditioning with fludarabine and melphalan (and anti-thymocyte globulin for mismatched donors) and an allogeneic stem cell transplant.231 In this series, 11 patients remain in CR with a median follow-up of 19 months, and median survival has not yet been reached. A recent analysis of an EBMT cohort of 60 patients reported an OS of 46% and PFS of 32% at 5 years.232 Relapse/progression occurred in 45% at a median of 3.8 months following hematopoietic stem cell transplantation (HSCT), but many patients were rescued with donor lymphocyte infusions. Non-relapse mortality was 22%, with the latest non-relapse death occurring 14 months following HSCT. TSEB can be considered a safe and effective debulking regimen before conditioning. Long-term results of a conditioning regimen using TSEB, total lymph node irradiation, and anti-thymocyte globulin conditioning prior to stem cell transplant are awaited; early results are encouraging, with a reduced 1-year non-relapse mortality.233
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
The mean age of enrolled multiple myeloma patients was 67.0 ± 9.2 years. There were 31 (37.8%) females and 51 (62.2%) males. Besides, 33 (40.2%) patients had renal impairment, and the left 49 (59.8%) patients did not have that. Additionally, the median (interquartile range) values of serum creatinine and beta-2-microglobulin were 1.8 (1.2–2.4) mg/dL and 5.5 (3.4–8.9) mg/L, respectively. In terms of prognostic stratification, 7 (8.5%), 34 (41.5%), and 41 (50.0%) patients were classified at International Staging System stages I, II, and III, respectively. Based on the revised International Staging System stage, 4 (4.9%), 55 (67.1%), and 23 (28.0%) patients were classified at stages I, II, and III, respectively. Regarding treatment information, 21 (25.6%) patients received the combination of bortezomib, thalidomide, and dexamethasone, 61 (74.4%) patients received the combination of bortezomib, lenalidomide, and dexamethasone. In addition, 23 (28.0%) patients received autologous hematopoietic stem cell transplantation, while 59 (72.0%) patients did not receive that. The specific information is exhibited in Table 1.
Efficacy and toxicity of SEAM (semustine, etoposide, cytarabine, and melphalan) conditioning regimen followed by autologous stem cell transplantation in lymphoma
Published in Hematology, 2022
Lihong Zhang, Haifei Yang, Chongsheng Qian, Jihao Zhou, Qian Zhu, Yibin Jiang, Shuo Liu, Xiaochen Chen, Ting Xu, Changju Qu, Caixia Li, Zhengming Jin, Jianhong Chu, Xinyou Zhang, Depei Wu, Haiwen Huang
Ninety-five patients were evaluated to determine their treatment response at three months after hematopoietic stem cell transplantation (Table 3). Of these patients, 66 patients (69.5%) achieved complete remission, 14 patients (14.7%) achieved partial remission, and 15 patients (15.8%) showed no response or progressive disease. After a median follow-up time of 53.9 months, 31 patients (32.0%) showed relapse or progression over a median duration of 4.87 months (range, 1.1-40.53) after the transplantation. Of these 31, 4 patients received allogeneic transplantation, 9 patients received salvage chemotherapy, 2 patients received a second auto-SCT, 12 patients received radiation therapy, 3 patients received radiation therapy combined with salvage chemotherapy, and 1 patient received chimeric antigen receptor T cell (CAR-T) therapy after relapse. At the end of the study, 12 patients out of the 31 who relapsed or progressed were still alive either in remission (n = 9) or with evidence of disease (n = 3). In addition, the 3-year CIR was 34% (Figure 1), and the estimated PFS and OS at 3 years were 62% and 75%, respectively (Figure 2).
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].