Immune Reconstitution after Hematopoietic Stem Cell Transplantation
Richard K. Burt, Alberto M. Marmont in Stem Cell Therapy for Autoimmune Disease, 2019
Qualitative and quantitative changes occur within the immune system during aging. Normal age-related T cell alterations include a decline in CD4 + cells, loss of naïve (antigenic virgin) cells, increase in memory (antigen experienced) cells, decline in T cell proliferative responses, and narrowing of the T cell receptor repertoire. T cell age-associated alterations are secondary to increased extrathymic T cell reconstitution following post puberty thymic involution combined with peripheral antigen driven T cell maturation and expansion. Age-related B cell changes are predominately qualitative and include loss of high affinity antibodies, increase in low affinity and autoantibodies, impaired isotype switching, and hindered antibody responses to vaccination. B cell related changes appear secondary to age-related impairment of T cell function. Immune reconstitution after hematopoietic stem cell transplantation (HSCT), whether from autologous or allogeneic stem cells, initially arises by means of extrathymic reconstitution. It is, therefore, at onset dominated by changes similar to those of an aged immune system. After HSCT, it may take 1 to 2 or more years for thymic reconstitution of a T and B cell phenotype and function normal for the recipient’s age. The younger the recipient, the more rapid thymic reconstitution occurs. The health of the graft as well as patient survival appears to correlate with the rapidity of shift from extrathymic to thymic T cell reconstitution following HSCT.
Myelodysplastic Syndromes (MDS)
Dongyou Liu in Tumors and Cancers, 2017
This chapter presents a state of the art summary of myelodysplastic syndromes (MDS) to its definition, biology, epidemiology, disease mechanisms, clinical signs, diagnosis, treatment and prognosis. MDS are further divided into MDS with dysplasia, MDS with ring sideroblasts, MDS with excess blasts, MDS with isolated del, MDS unclassifiable, provisional entity—refractory cytopenia of childhood, and myeloid neoplasms with germline predisposition. Approximately 90% of MDS cases arise de novo without identifiable cause, and complex epigenetic, genetic, and immunologic mechanisms appear to underline MDS pathogenesis. MDS is a relatively common hematological malignancy, with an annual incidence of 5 per 100,000 in the general population, 30 per 100,000 in the age group of greater than 60 years, and 50 per 100,000 in the age group of greater than 80 years. Treatment options for MDS consist of hypomethylating agents, lenalidomide, and allogeneic hematopoietic stem cell transplantation.
Transplantation Immunology
Shyamasree Ghosh in Computational Immunology, 2019
Human heart valves transplanted from cadaveric donors to recipient patients are required for heart failure, and long-term anti-coagulation therapy is not required of the recipients. In last half of the century, transplantation has been successful globally although there are country-wise differences. The concept of organ transplantation owes its origin in the mythological tales of organisms with chimeric anatomy. Transplantation involves the transfer of cells, tissues or organs from their original location to new location or from one individual to another. The success of allogeneic transplantation including hematopoietic stem cell transplantation and solid organ transplantation is dependent on the properties of immune tolerance against allogeneic antigens that may decreases the risk of acute and chronic graft rejection and can improve chances of transplanted organ survival. Immune privilege enables tolerance and survival of donor tissue grafts placed in the immune-privileged site of the host for prolonged periods or permanently, but transplantation into conventional sites leads to acute immune rejection.
Short report: relationships among resilience, social support, coping style and posttraumatic growth in hematopoietic stem cell transplantation caregivers
Published in Psychology, Health & Medicine, 2020
Ru-Zhen Luo, Shuai Zhang, Yan-Hui Liu
Posttraumatic growth has become a focus of concern in cancer caregivers, but a few studies have explored relationships among resilience, social support, coping style, and posttraumatic growth, especially in hematopoietic stem cell transplantation caregivers. A descriptive cross-sectional survey was conducted. Three hundred and fourteen participants completed questionnaires consisting of demographics, Posttraumatic Growth Inventory, Perceived Social Support Scale, Connor-Davidson Resilience Scale 10 and Coping Style Questionnaire. Pearson correlation analyses revealed that posttraumatic growth was positively associated with resilience, social support, and positive coping style, while, passive coping style was negatively associated with posttraumatic growth. At the same time, structural equation modeling analyses showed that resilience mediated the relationship between positive coping style and posttraumatic growth. Positive coping style and resilience played completely intermediary role between social support and posttraumatic growth.
Complications and hospital costs during hematopoietic stem cell transplantation for non-Hodgkin lymphoma in the United States
Published in Leukemia & Lymphoma, 2019
Sang Kyu Cho, Jeffrey McCombs, Nathan Punwani, Jenny Lam
While the initial hospitalization accounts for 75% of total healthcare costs during the first 100 days following hematopoietic stem cell transplantation (HSCT), there is a lack of studies evaluating the considerable variation in cost estimates. Using the National Inpatient Sample (NIS) database from 2012–2014, we identified 1832 adult non-Hodgkin lymphoma (NHL) patients who received autologous or allogeneic HSCT and examined complications as predictors of hospital cost. Complications occurred in >70% of patients, and the presence of one or more complications was associated with an increase in mean hospital costs of 46% in autologous HSCT and 81% in allogeneic HSCT. The most common complications (∼40%) were mucositis, febrile neutropenia, and infection. Acute organ failure, acute graft-versus-host disease, and death were less frequent (∼10%) but had a greater impact on increasing hospital costs and length of stays. Despite recent advances in supportive care and pre-conditioning regimens, complications are common and costly during HSCT.
Revisiting the role of hematopoietic stem cell transplantation in chronic lymphocytic leukemia
Published in Expert Review of Anticancer Therapy, 2005
Edgardo S Santos, Mohamad Masri, Hana Safah
Since the advent of hematopoietic stem cell transplantation more than 40 years ago, numerous methods of transplantation have been developed, modified and improved upon. Although hematopoietic stem cell transplantation has been used in a variety of malignant diseases since then, its use in the treatment of chronic lymphocytic leukemia has recently started to gain interest. Patients with chronic lymphocytic leukemia are generally elderly, and because of its relatively benign course, they were not considered suitable candidates for hematopoietic stem cell transplantation. Nonetheless, there have been marked improvements in transplantation techniques, including better conditioning regimens that have decreased treatment-related morbidity and mortality. In this article, the authors review the most recent data on hematopoietic stem cell transplantation in chronic lymphocytic leukemia as well as the change in risk stratification based on newer prognostic factors and its impact on treatment decisions in chronic lymphocytic leukemia.