HLA-Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplant Cyclophosphamide after Busulfan-Containing Reduced-Intensity Conditioning

AbstractAllogeneic hematopoietic stem cell transplantation (allo-SCT) using post-transplant cyclophosphamide (PTCy) is increasingly performed. We conducted a multicenter phase II study to evaluate the safety and efficacy of PTCy-based HLA-haploidentical peripheral blood stem cell transplantation (PTCy-haploPBSCT) after busulfan-containing reduced-intensity conditioning. Thirty-one patients were enrolled; 61% patients were not in remission and 42% patients had a history of prior allo-SCT. Neutrophil engraftment was achieved in 87% patients with a median of 19 days. The cumulative incidence of grades II to IV and III to IV acute graft-versus-host disease (GVHD) and chronic GVHD at 1 year were 23%, 3%, and 15%, respectively. No patients developed severe chronic GVHD. Day 100 nonrelapse mortality (NRM) rate was 19.4%. Overall survival, relapse, and disease-free survival rates were 45%, 45%, and 34%, respectively, at 1 year. Subgroup analysis showed that patients who had a history of prior allo-SCT had lower engraftment, higher NRM, and lower overall survival than those not receiving a prior allo-SCT. Our results suggest that PTCy-haploPBSCT after busulfan-containing reduced-intensity conditioning achieved low incidences of acute and chronic GVHD and NRM and stable donor engraftment and low NRM, particularly in patients without a history of prior allo-SCT

Ruxolitinib for Glucocorticoid-Refractory Acute Graft-versus-Host Disease

BACKGROUND: Acute graft-versus-host disease (GVHD) remains a major limitation of allogeneic stem-cell transplantation; not all patients have a response to standard glucocorticoid treatment. In a phase 2 trial, ruxolitinib, a selective Janus kinase (JAK1 and JAK2) inhibitor, showed potential efficacy in patients with glucocorticoid-refractory acute GVHD. METHODS: We conducted a multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitinib (10 mg twice daily) with the investigator's choice of therapy from a list of nine commonly used options (control) in patients 12 years of age or older who had glucocorticoid-refractory acute GVHD after allogeneic stem-cell transplantation. The primary end point was overall response (complete response or partial response) at day 28. The key secondary end point was durable overall response at day 56. RESULTS: A total of 309 patients underwent randomization; 154 patients were assigned to the ruxolitinib group and 155 to the control group. Overall response at day 28 was higher in the ruxolitinib group than in the control group (62% [96 patients] vs. 39% [61]; odds ratio, 2.64; 95% confidence interval [CI], 1.65 to 4.22; P<0.001). Durable overall response at day 56 was higher in the ruxolitinib group than in the control group (40% [61 patients] vs. 22% [34]; odds ratio, 2.38; 95% CI, 1.43 to 3.94; P<0.001). The estimated cumulative incidence of loss of response at 6 months was 10% in the ruxolitinib group and 39% in the control group. The median failure-free survival was considerably longer with ruxolitinib than with control (5.0 months vs. 1.0 month; hazard ratio for relapse or progression of hematologic disease, non-relapse-related death, or addition of new systemic therapy for acute GVHD, 0.46; 95% CI, 0.35 to 0.60). The median overall survival was 11.1 months in the ruxolitinib group and 6.5 months in the control group (hazard ratio for death, 0.83; 95% CI, 0.60 to 1.15). The most common adverse events up to day 28 were thrombocytopenia (in 50 of 152 patients [33%] in the ruxolitinib group and 27 of 150 [18%] in the control group), anemia (in 46 [30%] and 42 [28%], respectively), and cytomegalovirus infection (in 39 [26%] and 31 [21%]). CONCLUSIONS: Ruxolitinib therapy led to significant improvements in efficacy outcomes, with a higher incidence of thrombocytopenia, the most frequent toxic effect, than that observed with control therapy

Electronic Structure Calculation of Cr³⁺ and Fe³⁺ in Phosphor Host Materials Based on Relaxed Structures by Molecular Dynamics Simulation

The electronic structures of the luminescent center ions Cr3+ and Fe3+ in the deep red phosphors LiAl5O8:Cr3+, α-Al2O3:Cr3+, and γ-LiAlO2:Fe3+ were calculated by the DV-Xα method, in which the local distortion induced by the replacement of Al3+ sites in the host crystals by the luminescent center ions was reproduced by classical molecular dynamics (MD) simulation. The MD simulations based on classical dynamics allowed for the handling of more than 1000 atoms for the lattice relaxation calculations, which was advantageous to simulate situations in which a small number of foreign atoms (ions) were dispersed in the host lattice as in phosphors, even when typical periodic boundary conditions were applied. The relaxed lattices obtained after MD indicated that the coordination polyhedra around Cr3+ and Fe3+ expanded in accordance with the size difference between the luminescent center ions and Al3+ in the host crystals. The overall profiles of the partial density of states (p-DOSs) of the isolated Cr3+ and Fe3+ 3d orbitals were not significantly affected by the lattice relaxation, whereas the widths of the energy splitting of the 3d orbitals were reduced. The electronic structure calculations for Fe–Fe pairs in γ-LiAlO2 showed that the antiferromagnetic interactions with antiparallel electron spins between the Fe3+ ions were preferred, especially when the Fe–Fe pair was on the first-nearest neighboring cation sites

Cobalt Oxide Nanoclusters on Rutile Titania as Bifunctional Units for Water Oxidation Catalysis and Visible Light Absorption: Understanding the Structure–Activity Relationship

The structure of cobalt oxide (CoO_<i>x</i>) nanoparticles dispersed on rutile TiO₂ (R-TiO₂) was characterized by X-ray diffraction, UV–vis–NIR diffuse reflectance spectroscopy, high-resolution transmission electron microscopy, X-ray absorption fine-structure spectroscopy, and X-ray photoelectron spectroscopy. The CoO_<i>x</i> nanoparticles were loaded onto R-TiO₂ by an impregnation method from an aqueous solution containing Co­(NO₃)₂·6H₂O followed by heating in air. Modification of the R-TiO₂ with 2.0 wt % Co followed by heating at 423 K for 1 h resulted in the highest photocatalytic activity with good reproducibility. Structural analyses revealed that the activity of this photocatalyst depended strongly on the generation of Co₃O₄ nanoclusters with an optimal distribution. These nanoclusters are thought to interact with the R-TiO₂ surface, resulting in visible light absorption and active sites for water oxidation

Central nervous system infection following allogeneic hematopoietic stem cell transplantation

Objective/background: Here, we described the clinical characteristics and outcomes of central nervous system (CNS) infections occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a single institution over the previous 6 years. Methods: Charts of 353 consecutive allogeneic transplant recipients were retrospectively reviewed for CNS infection. Results: A total of 17 cases of CNS infection were identified at a median of 38 days (range, 10–1028 days) after allo-HSCT. Causative pathogens were human herpesvirus-6 (n = 6), enterococcus (n = 2), staphylococcus (n = 2), streptococcus (n = 2), varicella zoster virus (n = 1), cytomegalovirus (n = 1), John Cunningham virus (n = 1), adenovirus (n = 1), and Toxoplasma gondii (n = 1). The cumulative incidence of CNS infection was 4.1% at 1 year and 5.5% at 5 years. Conclusion: Multivariate analysis revealed that high-risk disease status was a risk factor for developing CNS infection (p = .02), and that overall survival at 3 years after allo-HSCT was 33% in patients with CNS infection and 53% in those without CNS infection (p = .04). Keywords: Allogeneic hematopoietic stem cell transplantation, Central nervous system infections, Human herpesvirus