A retrospective comparison of allogeneic peripheral blood stem cell versus bone marrow transplantation

Bittencourt, Henrique; Lopes, Monalisa; Macedo, Antônio Vaz de; Teixeira, Elen Rose; Gomes, Gabriel Gomes Sabido; Ferreira, G. G.; Amaral, Leandro Custódio do; Soares, Priscila Gonçalves; Vieira, M.I.; Dusse, Luci Maria Sant’Ana

doi:10.1016/s1658-3876(09)50037-4

Cited by 6 publications

(9 citation statements)

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“…aGVHD is the cause of death in up to 14% of unrelated alloHSCT (7) and up to 50% of these patients will die within 2 years of aGVHD diagnosis (13). In the alloHSCT Unit of HC-UFMG, alemtuzumab given before conditioning regime effectively reduced aGVHD (grades 2–4), compared to our historical control (12) and to patients not receiving alemtuzumab. Recent studies show a decrease in aGVHD development risk in patients treated with alemtuzumab when compared to patients receiving antithymocyte globulin (ATG) or standard prophylactic drugs, such as cyclosporine/tacrolimus and MTX (6,10,14–16).…”

Section: Discussionmentioning

confidence: 61%

“…We have previously shown that, using a conventional GVHD prophylaxis with cyclosporine and methotrexate, incidence of grade 2–4 aGVHD was higher than expected in our center and resulted in lower survival (12). In order to reduce incidence of aGVHD and increase survival, we modified our GVHD prophylaxis strategy, and included alemtuzumab for patients with non-malignant diseases, for unrelated alloHSCT and for patients with a higher risk of TRM (i.e., older patients and/or with comorbidities).…”

Section: Introductionmentioning

confidence: 74%

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Alemtuzumab as graft-versus-host disease (GVHD) prophylaxis strategy in a developing country: lower rate of acute GVHD, increased risk of cytomegalovirus reactivation

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Bernardes

et al. 2017

Braz J Med Biol Res

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Acute graft-versus-host disease (aGVHD) and cytomegalovirus reactivation are important complications after allogeneic stem cell transplantation (alloHSCT). Here, we evaluated the impact of treatment with alemtuzumab on the occurrence of aGVHD, cytomegalovirus reactivation and survival after alloHSCT. This was a prospective cohort study conducted at the allo-HSCT unit of Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil, from January 2009 to December 2011. Fifty-seven patients who underwent alloHSCT were included. Forty-five (79%) patients had a malignant disease. Alemtuzumab was administered before the conditioning regimen at a dose of 1 mg/kg in children and 30 mg/day for 2 days in adults or children weighing more than 40 kg (a total dose of 60 mg) with a non-malignant disease or patients with a malignant disease and high-risk for GVHD mortality. Alemtuzumab was used in 23 (40%) patients, of whom 17 received a reduced-intensity conditioning. Eleven patients presented aGVHD (grade 2–4) and only 1 of them received alemtuzumab. Cumulative incidence of aGVHD (grade 2–4) at day 100 after transplantation (D+100) was 4 for patients receiving alemtuzumab and 29% for patients not receiving alemtuzumab. Cumulative incidence of cytomegalovirus reactivation for patients receiving or not alemtuzumab was 62 and 38%, respectively. Sixteen patients died in the first 100 days after alloHSCT, most of them due to bacterial sepsis. Only 2 patients died of aGVHD until D+100. Overall survival was 50% without any impact of alemtuzumab. Alemtuzumab effectively controlled aGVHD but increased the risk of cytomegalovirus reactivation without improving survival.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 74%

Alemtuzumab as graft-versus-host disease (GVHD) prophylaxis strategy in a developing country: lower rate of acute GVHD, increased risk of cytomegalovirus reactivation

Resende

Rezende

Bernardes

et al. 2017

Braz J Med Biol Res

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“…PBSC transplantation is associated with faster blood cell and immunity recoveries. However, PBSC transplantation has also been found to be associated with increased aGVHD incidence and severity [9]. The mobilization of the peripheral blood grafts contain more T-cells than marrow suggesting a potential for development of the GVHD [19].…”

Section: Discussionmentioning

confidence: 99%

“…These disturbances potentially can stimulate a massive release of inflammatory cytokines [3]. First, baseline circulating inflammatory cytokines, such as tumor necrosis recipient age, GVHD and cytokine production [9,10]. The purpose of this study was to investigate the impact of cytokine levels (IL-1β, IL-6, IL-10, IFN-γ and TNF-α) and HCMV load in the saliva and blood, before and after allo-HSCT, on recipient survival.…”

Section: Introductionmentioning

confidence: 99%

Cytokine Production and Human Cytomegalovirus Load in Allogeneic Hematopoietic Stem Cell Transplantation Outcome

TA¹

2016

Int J Immunother Cancer Res

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Objective: To investigate the impact of cytokine levels (IL-1β, IL-6, IL-10, IFN-γ and TNF-α) and Human cytomegalovirus (HCMV) load in the saliva and blood on the survival of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients.Study Design: Samples were obtained from 63 patients 7 days before and 21 days after allo-HSCT. Cytokine levels were assessed by ELISA, and HCMV load was determined by real-time PCR. Results:The increase of IL-6 in the saliva and the reduction of IFN-γ in the blood before allo-HSCT were associated with increased risk of death. Moreover, the increase of IL-6 in the blood and of HCMV in the saliva after allo-HSCT were also associated with increased risk of death. Conclusions:Cytokine levels and HCMV load were associated with the increased risk of death. The findings suggest a potential function of these biomarkers in the determination of allo-HSCT survival.factor-α (TNF-α) and interleukin-1 (IL-1), could be increased as a result of disease, therapy, comorbidities or ongoing infections that occur before allo-HSCT. Second, immediately after allo-HSCT, the immune dysfunction caused by the conditioning regimen, which may produce tissue injury and consequently the production of inflammatory cytokines, may affect the reconstitution of white blood cells. Third, after allo-HSCT, activated, mature donor T-cells can set off a cytokine response that in turn stimulates host T-cell responses related to the onset of acute graft-versus-host disease (aGVHD) [3,4]. Immune dysfunction following allo-HSCT involves activated T-cells secreting interferon (IFN)-γ as well as other cytokines, which activate monocytes and dendritic cells. This process appears to be associated with the induction of aGVHD, resulting in significant morbidity and mortality. In addition, a prolonged immune deficiency characterized by lymphopenia and susceptibility to infection can occur [2]. Deregulation of inflammatory cytokines is also associated with multiple symptoms (pain, sleep disturbance and depression) during neutropenia after allo-HSCT [3]. Interleukin-6 (IL-6) is an important pro-inflammatory cytokine involved in immune-mediated complications after allo-HSCT [5].Human cytomegalovirus (HCMV) infection remains one of the most important causes of morbidity and mortality among allo-HSCT recipients [6,7]. Infection by HCMV may result not only in HCMV disease, but is also associated with other adverse effects due to its immunomodulatory actions; this might result in increased risk of bacterial, fungal and viral infections, and also of aGVHD [8].Allo-HSCT outcomes could be affected by factors such as HCMV infection, recipient/donor histocompatibility, patient/donor gender,

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“…Continued efforts have been made to prevent the occurrence of severe GVHD by eliminating or suppressing donor-derived effector T cells. Conventional immunosuppression does not adequately prevent GVHD, especially in mismatched transplants (26,27). Unfortunately, elimination of donor-derived T cells impairs stem cell engraftment and delays immunologic reconstitution, rendering the recipient susceptible to posttransplantation infections and disease relapse with potentially lethal consequences.…”

Section: Discussionmentioning

confidence: 99%

Mouse Flk-1+Sca-1- Mesenchymal Stem Cells

Zhu

et al. 2014

Transplantation

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A retrospective comparison of allogeneic peripheral blood stem cell versus bone marrow transplantation

Abstract: Although allogeneic PBSC transplant results in a faster hematopoietic engraftment, there was an increase in acute GVHD. There was no clear benefit in relapse rate and no evidence that transplantation with PBSC benefits patient survival in our institution.

Cited by 6 publications

References 34 publications

Alemtuzumab as graft-versus-host disease (GVHD) prophylaxis strategy in a developing country: lower rate of acute GVHD, increased risk of cytomegalovirus reactivation

Alemtuzumab as graft-versus-host disease (GVHD) prophylaxis strategy in a developing country: lower rate of acute GVHD, increased risk of cytomegalovirus reactivation

Cytokine Production and Human Cytomegalovirus Load in Allogeneic Hematopoietic Stem Cell Transplantation Outcome

Mouse Flk-1+Sca-1- Mesenchymal Stem Cells

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