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3.
Bone Marrow Transplant ; 50(10): 1316-20, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26146803

ABSTRACT

We have conducted a retrospective study on 251 patients from three centers in France and Switzerland between 2004 and 2010 with the goal to evaluate the impact of HLA-DRB3/B4/B5 allele mismatching after HLA-10/10-matched unrelated allogeneic hematopoietic stem cell transplantation (HSCT). Fourteen (5.5%) patients receiving HSCT from an HLA-10/10-matched unrelated donor had a mismatched DRB4 donor, 23 (9.5%) patients had a mismatched DRB3 donor and 214 (85%) had a fully matched unrelated donor (HLA-10/10) without DRB3- or DRB4-mismatched donor. We compared the outcomes of 37 patients with a DRB3 or DRB4 mismatch with the rest of the population. The median survival for a patient without DRB3/4 mismatch was 18 months (95% confidence interval (CI), 13-29), for DRB3-mismatched patients 32 months (95% CI, 13-NR) and for DRB4-mismatched patients 7 months (95% CI, 3-NR). The multivariate analysis showed a significant impact of DRB4 mismatching on survival (Hazards ratio (HR)=2.1 (95% CI, 1.01-4.67), P=0.045), acute GvHD (HR=2.66 (95% CI, 0.99-7.09) P=0.05) and on transplant-related mortality (HR=2.8; (95% CI, 1.7-4.4) P=0.024). In the view of an impact of DRB4 locus mismatch on clinical outcome, it would be important to confirm this observation in a prospective study as it may be worth considering DRB4 in the unrelated donor selection.


Subject(s)
HLA-DRB4 Chains/immunology , Hematopoietic Stem Cell Transplantation/methods , Histocompatibility/immunology , Transplantation Conditioning/methods , Transplantation, Homologous/methods , Female , France , Histocompatibility Testing , Humans , Male , Retrospective Studies , Survival Analysis , Switzerland , Treatment Outcome , Unrelated Donors
4.
Bone Marrow Transplant ; 50(2): 253-8, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25365068

ABSTRACT

Sclerotic chronic GvHD (cGvHD) is one of the most severe complications after allo-hematopoietic stem cell transplantation (HSCT). Risk factors associated with this complication remain not very well defined. With the aim to define a pre-transplantation risk profile, we have conducted a French retrospective analysis in 705 consecutive patients between 2005 and 2010. Analyses to determine pre-transplantation risk factors included as variables: patient and donor age, kind of donor, HLA matching, ABO matching, sex-matching, diagnosis, stem cell source, gender, GvHD prophylaxis and antithymocyte globulin (ATG) in the conditioning regimen. The cumulative incidence of sclerotic cGvHD was 18% (95% CI, 16.6-19.6) 3 years after onset of cGvHD. In univariate analysis, we found a significantly lower number of sclerotic cGvHD form in patients transplanted from cord blood cells (P=0.0021), in patients with a one mismatched donor (P=0.041) and in patients who had received ATG in the conditioning regimen (P=0.002). In multivariate analysis, factors associated with an increased risk of sclerotic cGvHD were young patient age, multiple myeloma and PBSC as the stem cell source. ATG in conditioning regimen and cord blood unit as the stem cell source were associated with a lower risk.


Subject(s)
Antilymphocyte Serum/administration & dosage , Cord Blood Stem Cell Transplantation , Graft vs Host Disease/mortality , Hematopoietic Stem Cell Transplantation , Immunosuppressive Agents/administration & dosage , Transplantation Conditioning , Allografts , Chronic Disease , Female , France/epidemiology , Graft vs Host Disease/prevention & control , Hematologic Diseases/mortality , Hematologic Diseases/therapy , Humans , Male , Retrospective Studies , Risk Factors , Sclerosis
5.
Pathol Biol (Paris) ; 62(4): 226-9, 2014 Aug.
Article in French | MEDLINE | ID: mdl-24973858

ABSTRACT

The role of anti-HLA antibodies in allogeneic stem cell transplantation setting is still unclear. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. This article offers the recommendations of the group that considered the impact that have anti-HLA antibodies on outcomes in allogeneic stem cell transplantation.


Subject(s)
HLA Antigens/immunology , Isoantibodies/adverse effects , Stem Cell Transplantation , Transplantation, Homologous , Treatment Outcome , France , Histocompatibility Testing , Humans , Isoantibodies/analysis , Tissue Donors
6.
Bone Marrow Transplant ; 49(5): 664-70, 2014 May.
Article in English | MEDLINE | ID: mdl-24488049

ABSTRACT

BK virus (BKV) reactivation has been increasingly associated with the occurrence of late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic SCT (allo-HSCT) resulting in morbidity and sometimes mortality. We investigated the incidence, risk factors and outcome of BKV-HC in 323 consecutive adult patients undergoing allo-HSCT over a 5-year period. BK viremia values for HC staging were evaluated, as well as the medico-economic impact of the complication. Forty-three patients developed BKV-HC. In univariate analysis, young age (P=0.028), unrelated donor (P=0.0178), stem cell source (P=0.0001), HLA mismatching (P=0.0022) and BU in conditioning regimen (P=0.01) were associated with a higher risk of developing BKV-HC. In multivariate analysis, patients receiving cord blood units (CBUs) (P=0.0005) and peripheral blood stem cells (P=0.011) represented high-risk subgroups for developing BKV-HC. BK viremia was directly correlated to HC severity (P=0.011) with a 3 to 6-log peak being likely associated with grades 3 or 4 HC. No correlation was found between BKV-HC and acute graft versus host disease or mortality rate. Patients with BKV-HC required a significantly longer duration of hospitalization (P<0.0001), more RBC (P=0.0003) and platelet transfusions (P<0.0001). Over the 5-year study period, the financial cost of the complication was evaluated at \[euro]2 376 076 ($3 088 899). Strategies to prevent the occurrence of late-onset BKV-HC after allo-HSCT are urgently needed, especially in CBU and peripheral blood stem cell recipients. BK viremia correlates with the severity of the disease. Prospective studies are required to test prophylactic approaches.


Subject(s)
BK Virus , Cystitis/virology , Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Polyomavirus Infections/epidemiology , Tumor Virus Infections/epidemiology , Adolescent , Adult , Aged , Antiviral Agents/therapeutic use , Cidofovir , Cystitis/economics , Cystitis/epidemiology , Cytosine/analogs & derivatives , Cytosine/therapeutic use , Female , Graft vs Host Disease/economics , Graft vs Host Disease/epidemiology , Health Care Costs , Hematologic Neoplasms/economics , Hematologic Neoplasms/epidemiology , Hematopoietic Stem Cell Transplantation/economics , Hospital Costs , Humans , Incidence , Male , Middle Aged , Organophosphonates/therapeutic use , Polyomavirus Infections/drug therapy , Polyomavirus Infections/economics , Risk Factors , Transplantation, Homologous , Tumor Virus Infections/drug therapy , Tumor Virus Infections/economics , Viremia/complications , Viremia/drug therapy , Viremia/immunology , Young Adult
7.
Pathol Biol (Paris) ; 61(4): 147-8, 2013 Aug.
Article in French | MEDLINE | ID: mdl-24011969

ABSTRACT

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the choice of optimal unrelated cord blood unit in terms of cell dose, HLA-matching and other characteristics.


Subject(s)
Cord Blood Stem Cell Transplantation/standards , Fetal Blood/transplantation , Hematopoietic Stem Cell Transplantation/standards , Unrelated Donors , Blood Volume , Choice Behavior , Cord Blood Stem Cell Transplantation/methods , France , Hematopoietic Stem Cell Transplantation/methods , Histocompatibility , Humans , Transplantation, Homologous
10.
Int J Infect Dis ; 12(6): e7-10, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18539494

ABSTRACT

INTRODUCTION: We report here two cases of Agrobacterium radiobacter bacteremia. These cases were observed at the same institution over a short time period (3 months). CASE REPORTS: The first patient was a female cancer patient receiving third-line chemotherapy for ovarian carcinoma. When she developed bacteremia, she was neutropenic and had an indwelling catheter that was removed as part of the treatment. The second case was a geriatric patient admitted from home with bacteremia, clinical signs of septic shock, and concomitant acute cholecystitis. OUTCOME: Both patients responded promptly and completely to antibiotherapy. No recurrence was observed.


Subject(s)
Bacteremia/microbiology , Gram-Negative Bacterial Infections/microbiology , Rhizobium , Adult , Aged, 80 and over , Carcinoma/complications , Catheters, Indwelling , Female , Humans , Immunocompromised Host , Male , Ovarian Neoplasms/complications , Rhizobium/classification , Rhizobium/isolation & purification , Rhizobium/pathogenicity
11.
Haemophilia ; 13(5): 588-92, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17880448

ABSTRACT

Prior to the introduction of virally inactivated clotting factor concentrates, the majority of patients with haemophilia became infected with the hepatitis C virus. Although transjugular liver biopsy can be safely performed in these patients, the procedure is associated with a significant financial burden mainly related to replacement therapy with clotting factor. The purpose of this study was to evaluate the feasibility and safety of transjugular liver biopsy in patients with haemophilia substituted with clotting factor concentrates for major surgical procedures. Over the last 5 years, transjugular liver biopsy was performed in nine patients with haemophilia within 1-10 days after orthopaedic (7), thoracic (1) or abdominal surgery (1). All patients had abnormal liver function tests and persistent hepatitis C viraemia. At the time of the biopsy, patients received recombinant factor VIII delivered by dose-adjusted continuous infusion through a central catheter inserted preoperatively in the left internal jugular (n = 8) or in an ante-cubital vein (n = 1). Before the biopsy, basal FVIII levels were raised to 80-100% by a bolus infusion and maintained above 80% for 24 h. The biopsy was informative in all cases. Only one patient developed an episode of supraventricular dysrhythmia. No bleeding or infectious complications were observed. When compared with elective liver biopsy performed outside the postsurgical period, the cost-savings per biopsy were 19 875 +/- 2660 euro. This study shows that intensive replacement therapy required by surgical procedures provides a safe and cost-effective opportunity for transjugular liver biopsy in patients with haemophilia and active hepatitis C.


Subject(s)
Hemophilia A/virology , Hepatitis C, Chronic/complications , Liver/pathology , Adult , Biopsy/economics , Biopsy/methods , Costs and Cost Analysis , Feasibility Studies , Female , Hemophilia A/complications , Hemophilia A/economics , Hepacivirus , Hepatitis C, Chronic/economics , Hospitalization/economics , Humans , Jugular Veins , Male , Middle Aged , Treatment Outcome
12.
J Immunol ; 162(8): 4966-74, 1999 Apr 15.
Article in English | MEDLINE | ID: mdl-10202044

ABSTRACT

In previous studies we have transferred thyroiditis to naive BALB/c and NOD mice with human thyrotropin (TSH) receptor (TSHR)-primed splenocytes. Because the TSHR has been implicated in the pathogenesis of thyroid eye disease (TED) we have examined the orbits of recipients of TSHR-primed T cells, generated using a TSHR fusion protein or by genetic immunization. In the NOD mice, 25 of 26 animals treated with TSHR-primed T cells developed thyroiditis with considerable follicular destruction, numerous activated and CD8+ T cells, and immunoreactivity for IFN-gamma. Thyroxine levels were reduced. Thyroiditis was not induced in controls. None of the NOD animals developed any orbital pathology. Thirty-five BALB/c mice received TSHR-primed spleen cells. Thyroiditis was induced in 60-100% and comprised activated T cells, B cells, and immunoreactivity for IL-4 and IL-10. Autoantibodies to the receptor were induced, including TSH binding inhibiting Igs. A total of 17 of 25 BALB/c orbits displayed changes consisting of accumulation of adipose tissue, edema caused by periodic acid Schiff-positive material, dissociation of the muscle fibers, the presence of TSHR immunoreactivity, and infiltration by lymphocytes and mast cells. No orbital changes or thyroiditis were observed in control BALB/c mice. We have induced orbital pathology having many parallels with human TED, only in BALB/c mice, suggesting that a Th2 autoimmune response to the TSHR may be a prerequisite for the development of TED.


Subject(s)
Eye Diseases/immunology , Eye Diseases/pathology , Thyroiditis, Autoimmune/immunology , Thyroiditis, Autoimmune/pathology , Animals , Binding Sites, Antibody , Carrier Proteins/genetics , Disease Models, Animal , Eye Diseases/etiology , Female , Humans , Immunoglobulins, Thyroid-Stimulating/blood , Lymphocyte Transfusion , Maltose-Binding Proteins , Mice , Mice, Inbred BALB C , Mice, Inbred NOD , Orbit/pathology , Receptors, Thyrotropin/genetics , Receptors, Thyrotropin/immunology , T-Lymphocytes/transplantation , Thyroid Gland/pathology , Thyroid Hormones/blood , Thyroiditis, Autoimmune/etiology
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