Recruiting refugees and migrants as potential hematopoietic stem cell donors to serve patients of comparable ethnicities with rare human leucocyte antigen patterns - The BluStar.NRW project in North Western Germany.

Currently, approximately 19 million people with a migration background live in Germany. The majority of those descend from regions where the population has a genetically different distribution of HLA antigens when compared to the HLA frequencies usually found in North Western Europe. In case of severe haematological disorders of these individuals, allogeneic stem cell transplantation may be the treatment of choice. However, finding appropriate histocompatible hematopoietic stem cell donors continues to be a major challenge. If no matching sibling donors are available, there are only few suitable donors with a similar genetic background available in international blood stem cell donor registries. The "BluStar.NRW" project aimed to recruit new blood and hematopoietic stem cell donors with a migration background and to noticeably increase the number of suitable donors for patients within this group. Since December 2017, a total number of 9100 blood and stem cell donors with a migration background were recruited and typed for this project. HLA typing for HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 was performed by Next Generation Sequencing. We assessed the proportion of rare alleles according to HLA frequency tables, as defined by a frequency of <1:1000. The rare HLA allele frequencies according to HLA frequency tables of the BluStar.NRW cohort were compared with a matched control donor cohort: Rare HLA-A, -B, -C, -DRB1 and -DQB1 alleles occurred three times more frequent than in the control group, but rare HLA-DPB1 alleles occurred more frequently in the control cohort. This difference was highly significant for all HLA alleles (p < 0.0001 for HLA-A, -B, -C, -DRB1, -DPB1; p = 0.0002 for HLA-DQB1). In addition, the distribution of rare alleles differed between the two groups. To date, 29 work-ups were initiated, 12 PBSC, one BM and three DLI were collected so far out of the BluStar.NRW cohort. The apheresis probability is twofold higher (0.18% vs. 0.07%) compared to the control group which clearly shows a serious medical need. However, 13 work-ups were cancelled in the BluStar.NRW donor cohort which represents an almost twice as higher cancellation rate (45% vs. 25%). This single registry analysis with a large sample cohort clearly indicates that hematopoietic stem cell donors with a migration background represent an adequate donor pool to serve patients of comparable ethnicity.

[Selective adsorption of cryoglobulins from plasma of three patients with mixed type II cryoglobulinemia]. / Selektive Adsorption von Kryoglobulinen aus dem Plasma von drei Patienten mit gemischter Typ-II-Kryoglobulinämie.

A new immunoadsorption column using Sepharose CL 4B as carrier material and IgG as covalently bound ligand was applied for the treatment of three patients with mixed type II kryoglobulinaemia. The titers of rheumatoid factors and cryoglobulins could be significantly decreased during each treatment. The removal of both correlated with the clinical improvement. Skin ulcers, refractory to conventional therapy and arthropathical complaints decreased considerably or disappeared. Further studies evaluating the pathomechanisms and the predictivity of the results must be performed.

Plasma exchange and selective adsorption in Guillain-Barré syndrome--a comparison of therapies by clinical course and side effects.

Selective adsorption is a new method of treating Guillain-Barré syndrome. Its therapeutic effects and its concomitant side effects were compared between plasma exchange and symptomatic treatment only. The clinical study of three groups of 10 Guillain-Barré patients, each matched for age and maximal disability, was analyzed. Selective adsorption compared favorably with plasma exchange in shortening the time to first improvement and duration of in-hospital treatment. Side effects were similar in both groups. Symptomatic arteriosclerosis should be considered a relative contraindication for selective adsorption.