Hematopoietic Cell Transplantation Cures Adenosine Deaminase 2 Deficiency: Report on 30 Patients.

Deficiency of adenosine deaminase 2 (DADA2) is an inherited inborn error of immunity, characterized by autoinflammation (recurrent fever), vasculopathy (livedo racemosa, polyarteritis nodosa, lacunar ischemic strokes, and intracranial hemorrhages), immunodeficiency, lymphoproliferation, immune cytopenias, and bone marrow failure (BMF). Tumor necrosis factor (TNF-α) blockade is the treatment of choice for the vasculopathy, but often fails to reverse refractory cytopenia. We aimed to study the outcome of hematopoietic cell transplantation (HCT) in patients with DADA2. We conducted a retrospective study on the outcome of HCT in patients with DADA2. The primary outcome was overall survival (OS). Thirty DADA2 patients from 12 countries received a total of 38 HCTs. The indications for HCT were BMF, immune cytopenia, malignancy, or immunodeficiency. Median age at HCT was 9 years (range: 2-28 years). The conditioning regimens for the final transplants were myeloablative (n = 20), reduced intensity (n = 8), or non-myeloablative (n = 2). Donors were HLA-matched related (n = 4), HLA-matched unrelated (n = 16), HLA-haploidentical (n = 2), or HLA-mismatched unrelated (n = 8). After a median follow-up of 2 years (range: 0.5-16 years), 2-year OS was 97%, and 2-year GvHD-free relapse-free survival was 73%. The hematological and immunological phenotypes resolved, and there were no new vascular events. Plasma ADA2 enzyme activity normalized in 16/17 patients tested. Six patients required more than one HCT. HCT was an effective treatment for DADA2, successfully reversing the refractory cytopenia, as well as the vasculopathy and immunodeficiency. HCT is a definitive cure for DADA2 with > 95% survival

Hematopoietic cell transplantation cures adenosine deaminase 2 deficiency: report on 30 patients

Purpose Deficiency of adenosine deaminase 2 (DADA2) is an inherited inborn error of immunity, characterized by autoinflammation (recurrent fever), vasculopathy (livedo racemosa, polyarteritis nodosa, lacunar ischemic strokes, and intracranial hemorrhages), immunodeficiency, lymphoproliferation, immune cytopenias, and bone marrow failure (BMF). Tumor necrosis factor (TNF-alpha) blockade is the treatment of choice for the vasculopathy, but often fails to reverse refractory cytopenia. We aimed to study the outcome of hematopoietic cell transplantation (HCT) in patients with DADA2. Methods We conducted a retrospective study on the outcome of HCT in patients with DADA2. The primary outcome was overall survival (OS). Results Thirty DADA2 patients from 12 countries received a total of 38 HCTs. The indications for HCT were BMF, immune cytopenia, malignancy, or immunodeficiency. Median age at HCT was 9 years (range: 2-28 years). The conditioning regimens for the final transplants were myeloablative (n = 20), reduced intensity (n = 8), or non-myeloablative (n = 2). Donors were HLA-matched related (n = 4), HLA-matched unrelated (n = 16), HLA-haploidentical (n = 2), or HLA-mismatched unrelated (n = 8). After a median follow-up of 2 years (range: 0.5-16 years), 2-year OS was 97%, and 2-year GvHD-free relapse-free survival was 73%. The hematological and immunological phenotypes resolved, and there were no new vascular events. Plasma ADA2 enzyme activity normalized in 16/17 patients tested. Six patients required more than one HCT. Conclusion HCT was an effective treatment for DADA2, successfully reversing the refractory cytopenia, as well as the vasculopathy and immunodeficiency. Clinical Implications HCT is a definitive cure for DADA2 with > 95% survival.Transplantation and immunomodulatio

Geological features and geochemical characteristics of Late Devonian-Early Carboniferous K-bentonites from northwestern Turkey

Newly discovered K-bentonite beds, interstratified with limestones/dolomitic limestones of the Upper Devonian-Lower Carboniferous Yllanll Formation, are exposed in the northwestern Black Sea region of Turkey, around Zonguldak and Bartln. K-bentonite samples collected from four different locations: the Gavurplnarl and Yllanll Burnu quarries from the Bartln area, the Çimşir Çukurlarl quarry from the Şapça area, and the Güdüllü and Gökgöl highway tunnel section near Zonguldak city were investigated using optical microscopy,X-ray diffraction and inductively coupled plasma mass spectrometry in order to reveal their mineralogical and geochemical characteristics and understand their origin and evolution. The K-bentonites occur at different levels in the Yllanll Formation as 2-40 cm-thick, greenish to yellowish beds cropping out several hundred metres along strike. Preliminary biostratigraphic data suggest that the protoliths of the Bartln (Gavurplnarl and Yllanll Burnu) and Güdüllü K-bentonites were deposited at around the boundary between the Frasnian and Famennian, whereas those in the Şapça and Gökgöl sections are slightly younger (Devonian-Carboniferous boundary interval). The lithofacies types of the host carbonate rocks suggest an 'epeiric' shallow carbonate platform environment. Illite and mixed-layer illite-smectite were the major clay minerals in the K-bentonites. The K-bentonites from the Bartln area display a high degree of illitization and consist mainly of illite indicating high-grade diagenesis, whereas illite-smectite-rich samples from the Şapca and Gökgöl tunnel locations reflect relatively lower diagenetic conditions. According to their geochemical compositions, two groups of K-bentonites were distinguished, one with alkali basalt (Bartln area and Güdüllü locations) and one with trachyte affinities (Gökgöl tunnel and Şapça locations). Geochemical fingerprinting of K-bentonites by trace and rare earth element (REE) data suggest that tephras with alkali basalt composition have been derived by a source formed in a 'continental back-arc' setting, whereas the source of K-bentonites with trachytic precursors is related to 'continental within-plate rifting'. An evaluation of the global Late Devonian and Devonian-Carboniferous volcanism suggests that the bentonite precursors may be related to late-Variscan magmatism in Laurussia. © 2016 by Walter de Gruyter Berlin/Boston