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Kwai Han Yoo - One of the best experts on this subject based on the ideXlab platform.

  • immunosuppressive therapy versus Alternative Donor hematopoietic stem cell transplantation for children with severe aplastic anemia who lack an hla matched familial Donor
    Bone Marrow Transplantation, 2017
    Co-Authors: Young Bae Choi, Ji Won Lee, K W Sung, H H Koo, Kwai Han Yoo
    Abstract:

    We compared the outcomes of immunosuppressive treatment (IST) with those of Alternative Donor hematopoietic stem cell transplantation (HSCT) in children and adolescents with severe aplastic anemia (SAA). The medical records of 42 patients with SAA who received frontline IST (N=19) or frontline HSCT with an Alternative Donor (N=23) between 1998 and 2012 were analyzed retrospectively. Six patients responded in the frontline IST group, whereas 11 underwent salvage HSCT after IST failure. Twenty-one of 23 patients who underwent frontline HSCT survived without treatment failure. The estimated failure-free survival rate of the frontline HSCT group was higher than that of the frontline IST group (91.3% vs 30.7% respectively, P<0.001). Six of 11 patients who underwent salvage HSCT experienced event-free survival (EFS). The estimated EFS of the frontline HSCT group was higher than that of the salvage HSCT group (91.3% vs 50.9% respectively, P=0.015). The outcome of Alternative Donor HSCT was better than commonly reported rates, especially in patients who underwent frontline HSCT. These results suggest that frontline Alternative Donor HSCT may be a better treatment option than IST for children and adolescents with SAA who lack a human leukocyte Ag-matched familial Donor.

  • Immunosuppressive therapy versus Alternative Donor hematopoietic stem cell transplantation for children with severe aplastic anemia who lack an HLA-matched familial Donor.
    Bone marrow transplantation, 2016
    Co-Authors: Young Bae Choi, Ji Won Lee, K W Sung, Kwai Han Yoo
    Abstract:

    We compared the outcomes of immunosuppressive treatment (IST) with those of Alternative Donor hematopoietic stem cell transplantation (HSCT) in children and adolescents with severe aplastic anemia (SAA). The medical records of 42 patients with SAA who received frontline IST (N=19) or frontline HSCT with an Alternative Donor (N=23) between 1998 and 2012 were analyzed retrospectively. Six patients responded in the frontline IST group, whereas 11 underwent salvage HSCT after IST failure. Twenty-one of 23 patients who underwent frontline HSCT survived without treatment failure. The estimated failure-free survival rate of the frontline HSCT group was higher than that of the frontline IST group (91.3% vs 30.7% respectively, P

Anna Locasciulli - One of the best experts on this subject based on the ideXlab platform.

  • Fludarabine, cyclophosphamide, antithymocyte globulin, with or without low dose total body irradiation, for Alternative Donor transplants, in acquired severe aplastic anemia: a retrospective study from the EBMT-SAA working party
    Haematologica, 2010
    Co-Authors: Andrea Bacigalupo, Simone Cesaro, E Lanino, Arcangelo Prete, Gérard Socié, Anna Locasciulli, Franco Locatelli, Avichai Shimoni, Judith C. W. Marsh, Mats Brune
    Abstract:

    Background We analyzed the outcome of 100 patients with acquired severe aplastic anemia undergoing an Alternative Donor transplant, after immune suppressive therapy had failed.Design and Methods As a conditioning regimen, patients received either a combination of fludarabine, cyclophosphamide, and antithymocyte globulin (n=52, median age 13 years) or this combination with the addition of low dose (2 Gy) total body irradiation (n=48, median age 27 years).Results With a median follow-up of 1665 and 765 days, the actuarial 5-year survival was 73% for the group that received fludarabine, cyclophosphamide, and antithymocyte globulin and 79% for the group given the conditioning regimen including total body irradiation. Acute graft-versus-host disease grade III–IV was seen in 18% and 7% of the groups, respectively. Graft failure was seen in 17 patients with an overall cumulative incidence of 17% in patients receiving conditioning with or without total body irradiation: 9 of these 17 patients survive in the long-term. The most significant predictor of survival was the interval between diagnosis and transplantation, with 5-year survival rates of 87% and 55% for patients grafted within 2 years of diagnosis and more than 2 years after diagnosis, respectively (P=0.0004). Major causes of death were graft failure (n=7), post-transplant-lymphoproliferative-disease (n=4) and graft-versus-host disease (n=4).Conclusions This study confirms positive results of Alternative Donor transplants in patients with severe aplastic anemia, the best outcomes being achieved in patients grafted within 2 years of diagnosis. Prevention of rejection and Epstein-Barr virus reactivation may further improve these results.

  • pre emptive treatment of acute gvhd a randomized multicenter trial of rabbit anti thymocyte globulin given on day 7 after Alternative Donor transplants
    Bone Marrow Transplantation, 2010
    Co-Authors: Andrea Bacigalupo, Jacopo Peccatori, Ignazio Majolino, Maria Pia Sormani, Teresa Lamparelli, Anna Locasciulli, Fabio Ciceri, Giuseppe Milone, P Di Bartolomeo, F. Mazza
    Abstract:

    We have previously shown that hemopoietic stem cell transplant (HSCT) recipients can be stratified on day+7 as having low, intermediate or a high risk of transplant-related mortality (TRM). With the aim of reducing TRM and GVHD, intermediate and high-risk patients (n=170) were randomized to receive anti-thymocyte globulin (ATG, thymoglobuline) on day+7 (n=84) or no treatment (n=86) (controls). There was a reduction of TRM from 35% in controls to 29% in ATG patients (P=0.3), of acute GVHD III-IV from 15 to 5% (P=0.02) and of chronic GVHD from 26 to 11% (P=0.03); survival was comparable. The predictive value of the day+7 score on TRM was confirmed for controls (19 vs 42% for intermediate vs high risk, respectively, P=0.03), whereas ATG abrogated this predictive effect (29 vs 29%). ATG reduced GVHD (P=0.006) in high-risk patients, but not in patients with an intermediate risk. In conclusion, we confirm that TRM can be predicted on the basis of day+7 laboratory values, after Alternative Donor HSCT; in high-, but not intermediate-risk patients, the administration of ATG on day+7 reduces GVHD. These results may represent a platform for risk-adapted post transplant immune modulation.

  • Pre-emptive treatment of acute GVHD: a randomized multicenter trial of rabbit anti-thymocyte globulin, given on day+7 after Alternative Donor transplants.
    Bone Marrow Transplantation, 2009
    Co-Authors: Andrea Bacigalupo, Jacopo Peccatori, Ignazio Majolino, Maria Pia Sormani, Teresa Lamparelli, Paolo Di Bartolomeo, Anna Locasciulli, Fabio Ciceri, Giuseppe Milone, F. Mazza
    Abstract:

    Pre-emptive treatment of acute GVHD: a randomized multicenter trial of rabbit anti-thymocyte globulin, given on day+7 after Alternative Donor transplants

  • fludarabine cyclophosphamide and anti thymocyte globulin for Alternative Donor transplants in acquired severe aplastic anemia a report from the ebmt saa working party
    Bone Marrow Transplantation, 2005
    Co-Authors: Andrea Bacigalupo, Simone Cesaro, E Lanino, J C W Marsh, Sebastien Maury, Arcangelo Prete, Gérard Socié, Anna Locasciulli, F Locatelli, Jakob Passweg
    Abstract:

    Fludarabine, cyclophosphamide and anti-thymocyte globulin for Alternative Donor transplants in acquired severe aplastic anemia: a report from the EBMT-SAA Working Party

Teresa Lamparelli - One of the best experts on this subject based on the ideXlab platform.

  • improved outcome of Alternative Donor transplantations in patients with myelofibrosis from unrelated to haploidentical family Donors
    Biology of Blood and Marrow Transplantation, 2016
    Co-Authors: Stefania Bregante, Teresa Lamparelli, Anna Maria Raiola, Francesca Gualandi, Carmen Di Grazia, Alida Dominietto, Anna Ghiso, Riccardo Varaldo, Silvia Luchetti, Simona Geroldi
    Abstract:

    Abstract This is a retrospective analysis of 95 patients with myelofibrosis who were allografted between 2001 and 2014. The aims of the study were to assess whether the outcome of Alternative Donor grafts has improved with time and how this compares with the outcome of identical sibling grafts. Patients were studied in 2 time intervals: 2000 to 2010 (n = 58) and 2011 to 2014 (n = 37). The Dynamic International Prognostic Scoring System score was comparable in the 2 time periods, but differences in the most recent group included older age (58 versus 53 years, P = .004), more family haploidentical Donors (54% versus 5%, P

  • In vivo B-cell depletion with rituximab for Alternative Donor hemopoietic SCT.
    Bone marrow transplantation, 2011
    Co-Authors: A Dominietto, Teresa Lamparelli, E. Tedone, Barbara Galano, M. Soracco, M. T. Van Lint, A M Raiola, Simona Geroldi, Bénédicte Bruno, F. Gualandi
    Abstract:

    We retrospectively analyzed 55 patients given a fixed dose of rituximab (200 mg) on day+5 after an Alternative Donor transplant, to prevent EBV DNA-emia; 68 Alternative transplants who did not receive prophylactic rituximab served as controls. The two groups were comparable for Donor type, and all patients received anti-thymocyte globulin in the conditioning regimen. Rituximab patients had a significantly lower rate of EBV DNA-emia 56 vs 85% (P=0.0004), a lower number of maximum median EBV copies (91 vs 1321/105 cells, P=0.003) and a significantly lower risk of exceeding 1000 EBV copies per 105cells (14 vs 49%, P=0.0001). Leukocyte and lymphocyte counts were lower on day +50 and+100 in rituximab patients, whereas Ig levels were comparable. The cumulative incidence of grade II–IV acute GvHD was significantly reduced in rituximab patients (20 vs 38%, P=0.02). Chronic GvHD was comparable. There was a trend for a survival advantage for patients receiving rituximab (46 vs 40%, P=0.1), mainly because of lower transplant mortality (25 vs 37%, P=0.1). Despite the drawback of a retrospective study, these data suggest that a fixed dose of rituximab on day +5 reduces the risk of a high EBV load, and also reduces acute GvHD.

  • Rituximab Treatment for Epstein-Barr Virus DNAemia after Alternative-Donor Hematopoietic Stem Cell Transplantation
    Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2010
    Co-Authors: Stefania Coppoletta, Teresa Lamparelli, E. Tedone, Barbara Galano, M. Soracco, Anna Maria Raiola, Francesca Gualandi, Stefania Bregante, Adalberto Ibatici, Carmen Di Grazia
    Abstract:

    We report 55 patients undergoing an Alternative-Donor hematopoietic stem cell transplantation (HSCT) who developed Epstein-Barr virus (EBV) DNAemia, with >1000 EBV copies/105 peripheral blood mononuclear cells (PBMCs), and were treated with rituximab (375 mg/m2). The median patient age was 47 years (range, 20-65 years), and graft sources were mismatched family members (n = 4), unrelated Donors (n = 46), and unrelated cord blood (n = 5). The conditioning regimen included antithymocyte globulin (ATG) in all patients. The median time to development of EBV DNAemia was day 27 post-HSCT (range, day 5 to day 242), with a median of 60 EBV copies/105 PBMCs (range, 1-5770 copies/105 PBMCs). The number of EBV copies was reduced to

  • pre emptive treatment of acute gvhd a randomized multicenter trial of rabbit anti thymocyte globulin given on day 7 after Alternative Donor transplants
    Bone Marrow Transplantation, 2010
    Co-Authors: Andrea Bacigalupo, Jacopo Peccatori, Ignazio Majolino, Maria Pia Sormani, Teresa Lamparelli, Anna Locasciulli, Fabio Ciceri, Giuseppe Milone, P Di Bartolomeo, F. Mazza
    Abstract:

    We have previously shown that hemopoietic stem cell transplant (HSCT) recipients can be stratified on day+7 as having low, intermediate or a high risk of transplant-related mortality (TRM). With the aim of reducing TRM and GVHD, intermediate and high-risk patients (n=170) were randomized to receive anti-thymocyte globulin (ATG, thymoglobuline) on day+7 (n=84) or no treatment (n=86) (controls). There was a reduction of TRM from 35% in controls to 29% in ATG patients (P=0.3), of acute GVHD III-IV from 15 to 5% (P=0.02) and of chronic GVHD from 26 to 11% (P=0.03); survival was comparable. The predictive value of the day+7 score on TRM was confirmed for controls (19 vs 42% for intermediate vs high risk, respectively, P=0.03), whereas ATG abrogated this predictive effect (29 vs 29%). ATG reduced GVHD (P=0.006) in high-risk patients, but not in patients with an intermediate risk. In conclusion, we confirm that TRM can be predicted on the basis of day+7 laboratory values, after Alternative Donor HSCT; in high-, but not intermediate-risk patients, the administration of ATG on day+7 reduces GVHD. These results may represent a platform for risk-adapted post transplant immune modulation.

  • Pre-emptive treatment of acute GVHD: a randomized multicenter trial of rabbit anti-thymocyte globulin, given on day+7 after Alternative Donor transplants.
    Bone Marrow Transplantation, 2009
    Co-Authors: Andrea Bacigalupo, Jacopo Peccatori, Ignazio Majolino, Maria Pia Sormani, Teresa Lamparelli, Paolo Di Bartolomeo, Anna Locasciulli, Fabio Ciceri, Giuseppe Milone, F. Mazza
    Abstract:

    Pre-emptive treatment of acute GVHD: a randomized multicenter trial of rabbit anti-thymocyte globulin, given on day+7 after Alternative Donor transplants

Andrea Bacigalupo - One of the best experts on this subject based on the ideXlab platform.

Jakob Passweg - One of the best experts on this subject based on the ideXlab platform.

  • fludarabine cyclophosphamide and anti thymocyte globulin for Alternative Donor transplants in acquired severe aplastic anemia a report from the ebmt saa working party
    Bone Marrow Transplantation, 2005
    Co-Authors: Andrea Bacigalupo, Simone Cesaro, E Lanino, J C W Marsh, Sebastien Maury, Arcangelo Prete, Gérard Socié, Anna Locasciulli, F Locatelli, Jakob Passweg
    Abstract:

    Fludarabine, cyclophosphamide and anti-thymocyte globulin for Alternative Donor transplants in acquired severe aplastic anemia: a report from the EBMT-SAA Working Party

  • Association of Donor-derived host-reactive cytolytic and helper T cells with outcome following Alternative Donor T cell-depleted bone marrow transplantation.
    Bone marrow transplantation, 1997
    Co-Authors: Carolyn A. Keever-taylor, Jakob Passweg, James T. Casper, Y Kawanishi, Neal Flomenberg, La Baxter-lowe
    Abstract:

    Recipients of marrow from Alternative Donors (unrelated or HLA-mismatched related Donors) have a higher incidence of post-transplant complications compared to recipients of marrow from HLA-identical siblings. HLA disparity undetected by routine typing techniques has been suggested as one cause for the increased complications observed. Limiting dilution analysis (LDA) of Donor-derived, host-reactive T cell precursor frequency prior to transplant has been proposed as a surrogate indicator of underlying HLA disparity which might be used to predict transplant outcome and aid in Donor selection. We compared results of LDA of host-reactive IL-2 producing helper T lymphocytes (HTLp) and/or cytolytic T lymphocytes (CTLp) in 77 Alternative marrow Donor/recipient pairs with transplant outcome using univariate and multivariate analysis. All Donor grafts were depleted ex vivo of mature T cells. Median patient age was 15 years (1-53). Donor selection was based on serologic typing for HLA class I and high resolution oligotyping for HLA-DRB1-DRB5, and HLA-DQB1. HLA-A and HLA-B locus antigens were retrospectively defined by one dimensional isoelectric focusing (IEF). Cox proportional hazards regression models were used to assess the impact of frequency and estimated cell dose of CTLp and HTLp on outcome. The CTLp assay was most sensitive to HLA-A and HLA-B locus disparity detected by serology or IEF. The HTLp assay detected class I disparity but was most strongly reactive in the presence of HLA-DRB1 disparity. Univariate analysis indicated a significant association of CTLp frequency and dose with severe (grades 3-4) acute graft-versus-host disease (GVHD), and of CTLp dose with chronic GVHD. Both assays were associated with survival and neither assay was associated with relapse. After adjustment for other significant covariables including known HLA disparity, the association of CTLp with acute GVHD was lost, however, CTLp frequency and CTLp dose remained associated with survival and HTLp frequency was associated with chronic GVHD. These data support the hypothesis that post-BMT complications may be influenced not only by T cell dose but by the alloreactive potential of the cells infused. LDA of alloreactive potential was useful in detecting disparity and in predicting survival or chronic GVHD in recipients of Alternative Donor TCD marrow grafts.