Assuntos
Alemtuzumab/uso terapêutico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Terapia de Salvação/métodos , Doença Aguda , Adulto , Idoso , Alemtuzumab/imunologia , Alemtuzumab/farmacocinética , Feminino , Humanos , Depleção Linfocítica , Masculino , Pessoa de Meia-Idade , Esteroides/farmacologia , Resultado do TratamentoRESUMO
Opportunistic infection remains the principal cause of mortality in allogeneic stem cell transplant recipients with active extensive chronic graft-versus-host disease. Human cytomegalovirus (HCMV) represents an important cause of disease in this setting and the toxicity of protracted and recurrent antiviral treatment together with eventual drug resistance represents a significant limitation to therapy. Although the expansion and adoptive transfer of HCMV-specific T cells from the healthy original donor can be an effective strategy to control viral replication, this is not possible when donors are seronegative or are subsequently inaccessible. Here we demonstrate for the first time, the successful expansion of HCMV-specific T cells from a seropositive transplant recipient of a seronegative graft with active HCMV disease and the long-term reconstitution of protective antiviral immunity following their adoptive transfer back into the patient.
Assuntos
Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/terapia , Citomegalovirus/imunologia , Imunoterapia Adotiva/métodos , Transplante de Células-Tronco/efeitos adversos , Linfócitos T/imunologia , Linfócitos T/virologia , Adulto , Sequência de Aminoácidos , Antígenos Virais/administração & dosagem , Antígenos Virais/genética , Sequência de Bases , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/etiologia , Primers do DNA/genética , Humanos , Masculino , Reação em Cadeia da Polimerase , Transplante Homólogo , Carga Viral , Proteínas Virais/administração & dosagem , Proteínas Virais/genética , Proteínas Virais/imunologiaRESUMO
The in vitro growth of erythroid colonies in the absence of erythropoietin, known as endogenous erythroid colonies (EEC) forms part of the diagnostic criteria for polycythaemia vera (PV). The availability of EEC culture in routine laboratory setting is limited as culture methods are technically demanding, difficult to standardize, expensive and laborious. In this study, we assessed the performance characteristics of a simplified method using ammonium chloride red cell lysis followed by culture on commercially available, batch-tested, methylcellulose media. Seventy-six patients were included; four were secondarily excluded on the basis of culture failure. Of the 14 patients with PV, 13 (93%) were positive for EEC on at least one occasion: 90% (nine of 10) of bone marrow and 67% (six of nine) of peripheral blood specimens were positive. All 30 patients with secondary polycythaemia (n = 12) or apparent polycythaemia (n = 18) were negative for EEC. The incidence of EEC in idiopathic erythrocytosis was 40% (eight of 28); 50% (five of 10) in those who met one of the minor criteria for PV and 17% (three of 18) in those who did not. We conclude that our EEC assay yield results comparable with that of more elaborate methods.
