scholarly journals Thrombotic Microangiopathy after Pediatric Allogeneic Stem Cell Transplant: Potential Early Markers to Predict Individuals at High-Risk

2019 ◽  
Vol 25 (3) ◽  
pp. S45-S46
Author(s):  
Christopher E Dandoy ◽  
Audrey Stegman ◽  
Abigail R Pate ◽  
Ava Stendahl ◽  
Priscila Badia Alonso ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Thrombotic Microangiopathy ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Early Markers

A validated symptomatic BKV risk assessment score in patient post allogeneic stem cell transplant.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18536-e18536
Author(s):  
Ala Abudayyeh ◽  
Heather Y. Lin ◽  
Maen Abdelrahim ◽  
Gabriela Rondon ◽  
Borje Andersson ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Cumulative Incidence ◽  
Stem Cell Transplant ◽  
Conditioning Regimen ◽  
Large Cohort ◽  
Grading System ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Cell Immunity

e18536 Background: BKV, Polyomavirus hominis 1, is a member of the family Polyomaviridae, is a non-enveloped virion; in the 1980s, it emerged as an important pathogen in SCT recipients. In the absence of sufficient T-cell immunity, BKV reactivation can progress, leading to prolonged hospital stays and increased mortality secondary to late hemorrhagic cystitis, ureteral stenosis, and nephropathy. In our recently completed retrospective study of 2477 SCT patients, 38.1% had developed renal impairment, and BKV viruria was present in 25%. In addition, BKV was found to be an independent predictor of chronic kidney disease and shorter survival. Using the large cohort (2477) patients studied earlier (2004-2012) we have derived a grading system to identify patients with risk of symptomatic BKV. We hypothesize that the current grading system will identify the patients at risk of symptomatic BKV at day 30 post allogeneic stem cell transplant. Methods: We performed a retrospective chart review of all patients who underwent allogeneic SCT from 2012-2016. The data was extracted from the secured database at MD Anderson cancer Center. Using the three variables that were significant predictor for symptomatic BKV derived from our initial study (conditioning regimen, HLA donor status, & underlying cancer diagnosis) we performed the analysis. Predicted cumulative incidence rate of BK infection at 30 days after transplant in 1308 patients were calculated in the presence of death as a competing risk using the “BASELINE” statement in PHREG procedure in SAS. Patients were classified into low, moderate and high risk according to the distribution of the predicted cumulative incidence of BK infection 30 days after transplant. Results: We have shown that the grading system derived from allogeneic SCT population predicted accurately the high, moderate & low risk population for developing symptomatic BKV. Conclusions: We have created and validated a grading system for symptomatic BKV in a large cohort of (1308 patients) to predict risk at day 30 post allogeneic SCT. Using this grading system we would hope to identify high risk patients for BKV and intervene early with novel therapies prior to complications associated.

Use of Eculizumab in Patients With Allogeneic Stem Cell Transplant-Associated Thrombotic Microangiopathy

2015 ◽  
Vol 99 (9) ◽  
pp. 1953-1959 ◽  
Author(s):  
Flore Sicre de Fontbrune ◽  
Claire Galambrun ◽  
Anne Sirvent ◽  
Anne Huynh ◽  
Stanislas Faguer ◽  
...  
Keyword(s):  
Stem Cell ◽  
Thrombotic Microangiopathy ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant

scholarly journals Impact of Viral Load on Eradication of Cytomegalovirus (CMV) Viremia Amongst High-risk Allogeneic Stem Cell Transplant (SCT) Recipients

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Jose F. Camargo ◽  
Luis Shimose ◽  
Maria X. Bueno ◽  
Rossana Rosa ◽  
Nikeshan Jeyakumar ◽  
...  
Keyword(s):  
Stem Cell ◽  
Viral Load ◽  
High Risk ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant

scholarly journals Comparison of Cyclophosphamide/Total Body Irradiation (Cy/TBI) and Etoposide/Total Body Irradiation (Etop/TBI) Conditioned Allogeneic Stem Cell Transplant (alloHSCT) for Adult Acute Lymphoblastic Leukaemia (ALL), Data from an Australian Tertiary Care Centre

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5543-5543 ◽  
Author(s):  
Anish Puliyayil Nair ◽  
Shaun Fleming ◽  
Sharon Avery ◽  
David J. Curtis ◽  
Sushrut S. Patil ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Board Of Directors ◽  
Total Body Irradiation ◽  
Research Funding ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Advisory Committees ◽  
Total Body

Abstract Background/Aim: Despite recent advances in the management of ALL, alloHSCT remains standard of care for younger adults with high-risk features. The optimum conditioning regimen for adults is not yet established. There is evidence for usage of Etoposide or higher-dose TBI in advanced disease transplants for ALL in a mixture of adult and paediatric patients (Marks et al, Biol BMT, 2006) We undertook a retrospective analysis of adult ALL patients who underwent allogeneic stem cell transplantation at our centre to find out factors influencing outcome and early treatment related complications. We also compared between Cyclophosphosphamide and Total Body Irradiation (Cy/TBI) and Etoposide and Total Body Irradiation (Etop/TBI). Method: Patients were identified from a transplant database search from January 2000 to May 2015 at the Alfred Hospital Melbourne, Australia. Decision to transplant the patients were based on high risk factors such as adverse cytogenetics (Ph+, MLL, complex karyotype), high presenting WBC count, delayed blast clearance with induction treatment and relapsed and refractory disease. Patients were compared based on transplant conditioning, disease factors and analysed for disease outcomes and complications. We also stratified the patients based on EBMT risk score and investigated the applicability of the score to predict outcome. High EBMT score was defined as >3. Results: 69 patients identified (34 Cy/TBI, 35 Etop/TBI) with median age of 33 years (range 17 - 59 years). Age was comparable for each group (Cy/TBI 35 years, Etop/TBI 31 years, p=0.84). 52 patients were males. The diagnoses were B ALL(49),T ALL(15), Bilineage Leukemia(1) and ambiguous lineage leukemia(1). 27 sibling and 42 non-sibling transplants, similar proportion for each conditioning (p=0.14). T-cell depletion with antithymocytic globulin used in 43 cases (all non-sibling and 1 sibling). High EBMT scores seen in 22 patients, with significantly higher numbers in Cy/TBI group (47% vs. 17%, p=0.01). 43 transplants done in CR1, 8 in CR2 and 18 in active-disease. There were significantly higher non-CR transplants in the Cy/TBI group (55% vs. 20%,p=0.003). Stem cell source was bone marrow in 10 patients (6 in CyTBI, 4 in Etop/TBI, p=0.5). 18 patients developed grade 3-4 acute GVHD and 13 of them were from Etop/TBI group (p=0.09). 28 patients developed extensive chronic GVHD and 20 of them received Etop/TBI conditioning(p=0.006). TRM was similar in both groups (38% vs. 31%, p=0.62). TRM was lower in patients transplanted in CR1 versus non-CR1 (25% vs. 50%, p=0.04). Median overall survival (OS) was 263 days in the Cy/TBI group versus not reached in the Etop/TBI group (p=0.08). In patients transplanted in CR1, OS was similar (NR, p=0.59) with a predicted 3-year OS of 77% and 62% in Cy/TBI and Etop/TBI groups respectively. OS was superior in CR1 transplants compared to the rest (NR vs 174 days, p<0.001). There was no difference in outcome between sibling and matched unrelated transplants (p=0.12). Patients with a high EBMT score had inferior OS (99 days vs NR, p<0.001) and TRM (63% vs 21%, p<0.001). Discussion: Outcomes for allogeneic stem cell transplant are similar for Cy/TBI and Etop/TBI for transplants performed in first remission, with equivalent outcomes for sibling and unrelated donor transplants. The rates of chronic graft vs. host disease are higher in Etop/TBI conditioned transplants. The EBMT score was highly predictive of outcome in ALL transplants, with high transplant related and disease related mortality. While long-term survivors are seen with Etop/TBI conditioning in non-CR1 transplants, the outcome in this patient group are very poor, highlighting the need for better prediction of relapse risk to aid appropriate patient selection for allografts in CR1. Figure 1. Figure 1. Figure 2. Figure 2. Figure 3. Figure 3. Disclosures Wei: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Membership on an entity's Board of Directors or advisory committees, Research Funding; Agios: Membership on an entity's Board of Directors or advisory committees; Astra Zeneca: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees.

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