Impact of stem cell source on allogeneic stem cell transplantation outcome in hematological malignancies

Stamatović, Dragana; Balint, Bela; Tukic, Ljiljana; Elez, Marija; Tarabar, Olivera; Todorović, Milena; Ostojić, Gordana; Tatomirovic, Zeljka; Ljubenov, Marika; Marjanovic, Slobodan; Malesević, M

doi:10.2298/vsp1112026s

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…This nding indicates that solely earlier recovery from neutropenia may not result in a better course of OM and other factors also in uence the course of OM. Some studies suggest more severe OM after BM-derived HSCT compared to PB-derived HSCT (22). However, in this study, NET was signi cantly faster in the PB-derived HSCT group which may account for the difference between the rates of severe OM in both groups.…”

Section: Discussioncontrasting

confidence: 68%

Association of human leukocyte antigen groups with oral mucositis in patients undergoing bone marrow transplantation

Tufan¹,

Oguz²,

Tufan³

et al. 2019

Leukemia Research

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Background: Oral mucositis (OM) after hematopoetic stem cell transplantation (HSCT) may lead to toxicity that impair quality of life. Associations between some diseases and human leukocyte antigen (HLA) groups have been long recognized. A genetic contribution as the association of HLA groups with OM after HSCT, has not been reported to date. We aimed to assess whether an association of HLA phenotype and OM after allogeneic HSCT exists. Methods: This was a prospective observational study in which OM was assessed with clinical questioning and examination. Association of OM with gender, age, HLA phenotypes, diagnosis, conditioning regimen, stem cell source, engraftment times, and complications was investigated. Results: 45 patients were enrolled. All the patients with HLA-B44 phenotype developed mild OM, while all patients with HLA-DR15 phenotype developed severe OM. HLA-A23, HLA-B21, HLA-B44, HLA-DR15, and HLA-DR11 were associated with shorter OM duration. HLA-A26 and HLA-B52 were associated with longer OM duration. Myeloablative conditioning regimen and longer duration of neutropenia were associated with longer OM duration. Regression analysis revealed HLA-B44 and HLA-DR11 as independent factors associated with milder OM. Conclusion: We identi ed that some HLA alleles correlated with OM severity and duration. These ndings may facilitate predicting risk of morbidity and may provide incorporation of individualized preventive and treatment approaches.

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Section: Discussioncontrasting

confidence: 68%

Association of human leukocyte antigen groups with oral mucositis in patients undergoing bone marrow transplantation

Tufan¹,

Oguz²,

Tufan³

et al. 2019

Leukemia Research

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“…Patients undergo pheresis, their cells are modified using zinc finger nucleases, and re-infused with the goal of establishing a CCR5-negative cell population that is resistant to HIV infection. Based on preliminary reports, this type of procedure would have lower risk and toxicity than Chemotherapy and SCT and, we assumed, lower likelihood of achieving cure [16] – [19] . Simulated patients were modeled to receive the benefit of cure one month after Gene Therapy, if effective.…”

Section: Methodsmentioning

confidence: 99%

“…SCT was assumed to have an efficacy of 70.0%, with 5.0% mortality from the procedure [35] . Patients had a 47.3% probability of acute graft-versus-host disease and 37.2% probability of chronic graft-versus-host-disease [19] . The initial cost of the transplant was assumed to be $150,000 with monthly costs of $1,000 for six months for immunosuppressive medications [36] , [37] .…”

Section: Methodsmentioning

confidence: 99%

HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?

et al. 2014

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BackgroundWe examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART).MethodsWe used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.ResultsFor patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving.ConclusionsDepending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.

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“…These significant findings, as well as data from other clinical trials, have led some to choose PBSC as a preferential graft source [2–6]. However, the 53% incidence of chronic graft-versus host disease at 2 years in the PBSC group was significantly higher when compared to 41% for the BM group, a finding confirmed by other studies [2–4,7–10]. These secondary analyses suggest that it may be important for patients who are immunosuppressed from prior chemotherapy, and have a lower risk of graft rejection, receive BM grafts, while patients with malignant diseases who have never undergone cytotoxic chemotherapy, who may be at increased risk of rejection of a BM graft, undergo transplant with a PBSC graft.…”

Section: Introductionmentioning

confidence: 54%

Infections after Transplantation of Bone Marrow or Peripheral Blood Stem Cells from Unrelated Donors

Young

Logan

et al. 2016

Biology of Blood and Marrow Transplantation

138

100

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Infection is a major complication of hematopoietic cell transplantation. Prolonged neutropenia and graft versus host disease are the two major complications with an associated risk for infection, and these complications differ according to the graft source. A phase 3, multicenter, randomized trial (BMT CTN 0201) of transplantation of bone marrow (BM) versus peripheral-blood stem cells (PBSC) from unrelated donors (URD) showed no significant differences in two-year survival between these graft sources. In an effort to provide data regarding whether bone marrow or peripheral-blood stem cells could be used as a preferential graft source for transplantation, we report a detailed analysis of the infectious complications for 2 years following transplantation from the BMT CTN 0201 trial. A total of 499 patients in this study had full audits of infection data. A total of 1347 infection episodes of moderate or greater severity were documented in 384 (77%) patients; 201/249 (81%) of the evaluable patients had received a BM graft and 183/250 (73%) had received a PBSC graft. Of 1347 infection episodes, 373 were severe and 123 were life-threatening and/or fatal; 710 (53%) of these episodes occurred on the BM arm and 637 (47%) on the PBSC arm, resulting in a two-year cumulative incidence 84.7% (95% confidence interval [CI]: 79.6–89.8) for BM vs. 79.7% (95%CI, 73.9–85.5) for PBSC, P = .013. The majority of these episodes, 810 (60%), were due to bacteria, with a two-year cumulative incidence of 72.1% and 62.9% in BM versus PBSC recipients, respectively (P = .003). The cumulative incidence of bloodstream bacterial infections during the first 100 days was 44.8% (95%CI, 38.5–51.1) for BM vs. 35.0% (95%CI, 28.9–41.1) for PBSC (P = .027). The total infection density (# infection events / 100 patient days at risk) was .67 for BM and .60 for PBSC. The overall infection density for bacterial infections was .4 in both arms; for viral infections was .2 in both arms; and for fungal/parasitic infections was .04 and .05 for BM and PBSC, respectively. The cumulative incidence of infection prior to engraftment was 47.9% (95%CI, 41.5–53.9) for BM vs. 32.8% (95%CI, 27.1–38.7) for PBSC (P = .002), possibly related to quicker neutrophil engraftment using PBSC. Infections remain frequent following URD HCT, particularly following BM grafts.

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Impact of stem cell source on allogeneic stem cell transplantation outcome in hematological malignancies

Cited by 8 publications

References 23 publications

Association of human leukocyte antigen groups with oral mucositis in patients undergoing bone marrow transplantation

Association of human leukocyte antigen groups with oral mucositis in patients undergoing bone marrow transplantation

HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?

Infections after Transplantation of Bone Marrow or Peripheral Blood Stem Cells from Unrelated Donors

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