Risk factors and outcome of graft failure after HLA matched and mismatched unrelated donor hematopoietic stem cell transplantation: a study on behalf of SFGM-TC and SFHI.

Graft failure remains a severe complication of hematopoietic stem cell transplantation (HSCT). Several risk factors have already been published. In this study, we re-evaluated them in a large cohort who had the benefit of the recent experience in HSCT (2006-2012). Data from 4684 unrelated donor HSCT from 2006 to 2012 were retrospectively collected from centers belonging to the French Society for Stem Cell Transplantation. Among the 2716 patients for whom HLA typing was available, 103 did not engraft leading to a low rate of no engraftment at 3.8%. In univariate analysis, only type of disease and status of disease at transplant for malignant diseases remained significant risk factors (P=0.04 and P<0.0001, respectively). In multivariate analysis, only status of disease was a significant risk factor (P<0.0001). Among the 61 patients who did not engraft and who were mismatched for 1 HLA class I and/or HLA-DP, 5 donor-specific antibodies (DSAs) were detected but only 1 was clearly involved in graft failure, for the others their role was more questionable. Second HSCT exhibited a protective although not statistically significant effect on OS (hazard ratio=0.57 [0.32-1.02]). In conclusion, only one parameter (disease status before graft) remains risk factor for graft failure in this recent cohort.

[Post-transfusional anti-HLA hyperimmunization: importance of erythropoietin]. / Hyperimmunisation anti-HLA post-transfusionnelle: intérêt de l'érythropoïétine.

The use of erythropoietin (Epo) in chronic renal failure patients improves anemia and avoids iterative transfusions. As a consequence, a significant decrease of anti-HLA antibodies might be observed. From 31.12.1985 to 30.07.1991, among the 61 highly sensitized patients (pts) waiting for renal transplantation at our institution, 23 (7 men, 16 women, mean age 43.3 +/- 2.3 years) were treated with Epo during 21.4 +/- 1.7 months. After introduction of Epo, the mean number of transfusions significantly decreased from 35 +/- 8 to 0.5 +/- 0.4 (p < 0.0001) and the Panel Reactive Antibodies decreased from 88.1 +/- 1.7 to 18.8 +/- 5.6% (p < 0.0001). HLA antibodies totally disappeared in 12 patients, decreased more than 30% in 9 patients and remained stable in the 3 others. Renal transplantation was performed in 9 patients; 4 with a negative cross-match in both historical and current sera and 5 with a negative current cross-match but with a positive historical cross-match. 6/9 patients are doing well with a good graft function; 2 patients returned to hemodialysis for rejection and 1 patient died with a functioning kidney. Since Epo permits the transfusion withdrawal, its introduction in chronic renal failure treatment suppresses both the main factor of immunisation and one of the most important mechanisms of persistence of antibodies.

[Prevention of septicemia caused by gastrointestinal tract organisms in patients with granulopenia. Comparison of three gastrointestinal tract decontamination treatments]. / Prévention des septicémies d'origine digestive chez les granulopéniques: comparaison de trois traitements de décontamination digestive.

Three gastrointestinal tract decontamination regimens were tested in patients with granulopenia: vancomycin 250 mg, tobramycin 75 mg, and colistin 1 million international units (regimen A); vancomycin 125 mg, tobramycin 75 mg, and colistin 1 million IU (regimen B); and colistin 1 million IU (regimen C); nystatin was added to all three regimens. Effectiveness was evaluated by stool organism counts and blood cultures to detect bacterial translocation (passage of bacteria from the intestinal tract to the bloodstream). Regimen C proved insufficiently effective. Regimen A was found to be poorly tolerated by the digestive mucosa. Regimen B was the best treatment since the low dosage of vancomycin proved effective. Nystatin satisfactorily eliminated yeasts.

[Importance of anti-idiotype antibodies in candidates for a renal graft]. / Importance des anticorps anti-idiotypes chez les candidats à une greffe rénale.

Anti-idiotypes antibodies neutralize, some T lymphocytes clones, others cytotoxic antibodies carrying corresponding idiotypes. Anti-idiotypes antibodies are found in about 45% of patients with chronic renal failure which have received blood transfusions. Some antibodies favourize the kidney graft tolerance, others at the contrary augment the rejection reaction. It is possible to detect antibodies which protect graft by relatively simple and rapid technics. This research merits to be added to the classic cross match. When donor and recipient study reveals a positive cross match with an ancient serum and a negative cross match with an actual serum, the absence of protective antibodies is a contra-indication for kidney graft, but their presence authorize the transplantation.