scholarly journals Differential impact of inhibitory and activating Killer Ig-Like Receptors (KIR) on high-risk patients with myeloid and lymphoid malignancies undergoing reduced intensity transplantation from haploidentical related donors

2011 ◽  
Vol 47 (6) ◽  
pp. 817-823 ◽  
Author(s):  
D-F Chen ◽  
V K Prasad ◽  
G Broadwater ◽  
N L Reinsmoen ◽  
A DeOliveira ◽  
...  
Keyword(s):  
High Risk ◽  
Differential Impact ◽  
High Risk Patients ◽  
Lymphoid Malignancies ◽  
Risk Patients ◽  
Reduced Intensity

Grade 2–4 Acute Graft-Versus-Host Disease and Extensive Chronic Graft-Versus-Host Disease Are Associated with Significantly Decreased Survival Following Reduced Intensity Allogeneic Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1246-1246
Author(s):  
Geoffrey W. Chan ◽  
Andreas K. Klein ◽  
Kellie A. Sprague ◽  
Kenneth B. Miller ◽  
Francine M. Foss
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
High Risk ◽  
Graft Versus Host Disease ◽  
Host Disease ◽  
Graft Versus Host ◽  
High Risk Patients ◽  
Risk Patients ◽  
Grade 3 ◽  
Reduced Intensity

Abstract Grade 2–4 acute graft versus host disease (aGVHD) is associated with decreased overall survival following conventional allogeneic stem cell transplantation but its impact on reduced intensity transplantation remains controversial. We evaluated the impact of grade 2–4 aGVHD on survival in a retrospective review of 112 high-risk patients, median age 50 (range 18 to 70), with AML (n=29), MDS (n=19), CML (n=9), CLL (n=5), ALL (n=3), HD (n=10), NHL (n=16), MM (n=9), MMM (n=7), PNH (n=2), or renal cell carcinoma (n=3), who underwent a reduced intensity preparative regimen of extracorporeal photopheresis day −7, −6, pentostatin 8mg/m2 by continuous intravenous infusion day −5 thru −4, and total body irradiation in three 200cGy fractions day −3, −2, followed by allogeneic bone marrow stem cell infusion from a 6/6 HLA matched related (n=70), 5/6 HLA matched related (n=10), or matched unrelated (n=32) donor. All patients were high-risk, including 30 patients with a prior autologous stem cell transplant and 5 patients with a prior allogeneic stem cell transplant. Full donor chimerism at the time of neutrophil engraftment was achieved in 89% of patients. The median time to neutrophil and platelet engraftment were 19 and 21 days respectively. Day 100 transplant related mortality(TRM) was 20%. Disease relapse occurred in 22% of patients. Grade 0 or 1 aGVHD occurred in 27 patients (27%) and 54 patients (54%) respectively. Grade 2, 3 or 4 aGVHD occurred in 7 patients (7%), 6 patients (6%), and 7 patients (7%) respectively. The one-year overall survival (OS) by aGVHD grade was 70% for grade 0, 69% for grade 1, 29% for grade 2, 17% for grade 3, and 0% for grade 4. Grade 2–4 aGVHD was associated with a significantly increased day 100 TRM (37% vs 14%: p=0.03), decreased median failure-free survival (5 months vs 35 months: p=0.001), and decreased median OS (5 months vs “not reached”: p=0.001). The decrease in median OS among patients with grade 2–4 aGVHD was significant among matched related donor transplants (5 months vs “not reached”: p=0.002) and among mismatched related or matched unrelated donor transplants (6 months vs 35 months: p=0.0004). There was no significant difference in median OS between patients with grade 2 aGVHD and patients with grade 3–4 aGVHD (6 months vs 3 months: p=0.24). Patients with limited or no chronic GVHD (cGVHD) had similar one-year OS (90% vs 79%) but patients who developed extensive chronic GVHD had a significantly worse median OS (56% vs “not reached”: p=0.001). In conclusion, high-risk patients who undergo reduced intensity transplantation and develop grade 2–4 aGVHD or extensive cGVHD have a significantly decreased overall survival. Patients with grade 2 aGVHD have similarly poor OS as patients with grade 3–4 aGVHD. High-risk patients tolerate GVHD poorly with a significantly decreased overall survival. To improve survival, reduced intensity transplantation regimens that decrease the incidence of grade 2–4 aGVHD or extensive cGVHD need to be developed. Figure Figure

Graft-versus-host disease following allogeneic transplantation from HLA-identical sibling with antithymocyte globulin–based reduced-intensity preparative regimen

Blood ◽  
2003 ◽  
Vol 102 (2) ◽  
pp. 470-476 ◽  
Author(s):  
Mohamad Mohty ◽  
Jacques-Olivier Bay ◽  
Catherine Faucher ◽  
Bachra Choufi ◽  
Karin Bilger ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Graft Versus Host Disease ◽  
Cumulative Incidence ◽  
Antithymocyte Globulin ◽  
Host Disease ◽  
Graft Versus Host ◽  
High Risk Patients ◽  
Risk Patients ◽  
Reduced Intensity

AbstractReduced-intensity conditioning (RIC) regimens are increasingly used for allogeneic stem cell transplantation (allo-SCT). RIC has been shown to allow engraftment with minimal early transplantation-related mortality (TRM). However, in the context of RIC, predictive factors for acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively) and their effect on outcome remain unknown. In this report, we analyzed the outcome of 101 high-risk patients (70 hematologic and 31 nonhematologic malignancies) who received an HLA-identical sibling allo-SCT after RIC, including fludarabine, busulfan, and antithymocyte globulin (ATG). The cumulative incidence of grade II-IV aGVHD was 36% (95% confidence interval [CI], 27%-45%), whereas the cumulative incidence of cGVHD at 2 years was 43% (95% CI, 33%-53%). In multivariate analysis, the incidence of aGVHD was significantly associated with the ATG dose infused during conditioning (P = .0005), whereas peripheral blood as stem cell source was the only predictive factor for the development of cGVHD (P = .0007). The 1-year cumulative incidences of disease progression or relapse in patients with (n = 69) and without (n = 31) GVHD (whatever its form or grade) were 30% (95% CI, 19%-41%) and 55% (95% CI, 37%-72%), respectively (P = .02), suggesting that a potent graft-versus-tumor (GVT) effect can be achieved in high-risk patients following RIC. Moreover, the GVT effect was closely associated with GVHD without an increased risk of TRM (cumulative incidence of TRM, 18% [95% CI, 10%-25%]). Collectively, these results provide a framework for the refinement of RIC approaches designed to enhance the GVT effect with an acceptable risk of GVHD.

Combination of norfloxacin and cisapride in prevention of SBP in high risk patients: A new approach

2001 ◽  
Vol 120 (5) ◽  
pp. A376-A376
Author(s):  
B JEETSANDHU ◽  
R JAIN ◽  
J SINGH ◽  
M JAIN ◽  
J SHARMA ◽  
...  
Keyword(s):  
High Risk ◽  
New Approach ◽  
High Risk Patients ◽  
Risk Patients

1610: High-Risk Patients Undergoing Radical Prostatectomy Today are Less High-Risk than in the Past

2005 ◽  
Vol 173 (4S) ◽  
pp. 436-436
Author(s):  
Christopher J. Kane ◽  
Martha K. Terris ◽  
William J. Aronson ◽  
Joseph C. Presti ◽  
Christopher L. Amling ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
High Risk Patients ◽  
The Past ◽  
Risk Patients

995: Immunohistochemical Analysis of Tumor Polyamines Discriminates High Risk Patients Undergoing Nephrectomy for Renal Cell Carcinoma

2004 ◽  
Vol 171 (4S) ◽  
pp. 263-263
Author(s):  
Nathalie Rioux-Leclercq ◽  
Florence Jouan ◽  
Pascale Bellaud ◽  
Jacques-Philippe Moulinoux ◽  
Karim Bensalah ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
High Risk ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Immunohistochemical Analysis ◽  
High Risk Patients ◽  
Risk Patients
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