16 research outputs found
Matched Pair Analysis of Efficacy and Toxicity of Conditioning BEAM and Busilvex Based Regimen in Autologous Hematopoietic Cell Transplantation for Lymphomas: Preliminary Results
Allogeneic Hematopoietic Cell Transplantation in Patients With Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria Clones: Time for a Change
Immunogenetic Cross-Talk in Patients Transplanted for AML: CMV Reactivation Is Not a Strong Stimulus for Immune Response Against Leukemia
Low Body Mass Index Is an Independent Risk Factor for Transplant-Associated Microangiopathy following Total-Body Irradiation-Based Conditioning Regimens
Patient risk stratification and tailored clinical management of postātransplant CMVā, EBVā, and BKVāinfections by monitoring virusāspecific Tācell immunity
Abstract Background Despite routine postātransplant viral monitoring and preāemptive therapy, viral infections remain a major cause of allogeneic hematopoietic cell transplantationārelated morbidity and mortality. Objective We here aimed to prospectively assess the kinetics and the magnitude of cytomegalovirusā(CMV), Epstein Barr virusā(EBV), and BK virusā(BKV)āspecific T cell responses postātransplant and evaluate their role in guiding therapeutic decisions by patient riskāstratification. Study design The triāvirusāspecific immune recovery was assessed by Elispot, in 50 consecutively transplanted patients, on days +20, +30, +60, +100, +150, +200 postātransplant and in case of reactivation, weekly for 1 month. Results The great majority of the patients experienced at least one reactivation, while over 40% of them developed multiple reactivations from more than one of the tested viruses, especially those transplanted from matched or mismatched unrelated donors. The early reconstitution of virusāspecific immunity (day +20), favorably correlated with transplant outcomes. Īxpanding levels of CMVā, EBVā, and BKVāspecific T cells (VSTs) postāreactivation coincided with decreasing viral load and control of infection. Certain cutāoffs of absolute VST numbers or net VST cell expansion postāreactivation were determined, above which, patients with CMV or BKV reactivation hadĀ >90% probability of complete response (CR). Conclusion Immune monitoring of virusāspecific Tācell reconstitution postātransplant may allow riskāstratification of virus reactivating patients and enable patientātailored treatment. The identification of individuals with high probability of CR will minimize unnecessary overtreatment and drugāassociated toxicity while allowing candidates for preāemptive intervention with adoptive transfer of VSTs to be appropriately selected