Graft-versus-host disease in recipients of male unrelated donor compared with parous female sibling donor transplants

Optimal donor selection is critical for successful allogeneic hematopoietic cell transplantation (HCT). Donor sex and parity are well-established risk factors for graft-versus-host disease (GVHD), with male donors typically associated with lower rates of GVHD. Well-matched unrelated donors (URDs) have also been associated with increased risks of GVHD as compared with matched sibling donors. These observations raise the question of whether male URDs would lead to more (or less) favorable transplant outcomes as compared with parous female sibling donors. We used the Center for International Blood and Marrow Transplant Research registry to complete a retrospective cohort study in adults with acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome, who underwent T-cell replete HCT from these 2 donor types (parous female sibling or male URD) between 2000 and 2012. Primary outcomes included grade 2 to 4 acute GVHD (aGVHD), chronic GVHD (cGVHD), and overall survival. Secondary outcomes included disease-free survival, transplant-related mortality, and relapse. In 2813 recipients, patients receiving male URD transplants (n = 1921) had 1.6 times higher risk of grade 2 to 4 aGVHD (P \u3c .0001). For cGVHD, recipient sex was a significant factor, so donor/recipient pairs were evaluated. Female recipients of male URD grafts had a higher risk of cGVHD than those receiving parous female sibling grafts (relative risk [RR] = 1.43, P \u3c .0001), whereas male recipients had similar rates of cGVHD regardless of donor type (RR = 1.09, P = .23). Donor type did not significantly affect any other end point. We conclude that when available, parous female siblings are preferred over male URDs

Association between the choice of the conditioning regimen and outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis

Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, the optimal conditioning regimen either with reduced intensity conditioning (RIC) or myeloablative conditioning (MAC) is not well known. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged ≥18 years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MAC cohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (Fludarabine/busulfan=166, Fludarabine/melphalan=327) and 379 using MAC (Fludarabine/busulfan=247, Busulfan/cyclophosphamide=132). In multivariable analysis with RIC, Fludarabine/melphalan was associated with inferior overall survival (HR 1.80, 95% CI 1.15-2.81, p=0.009), higher early non-relapse mortality (HR 1.81, 95% CI 1.12-2.91, p=0.01) and higher acute graft versus host disease (GVHD) (grade II-IV- HR 1.45, 95% CI 1.03-2.03, p=0.03; grade III-IV HR 2.21, 95%CI 1.28-3.83, p=0.004) compared to Fludarabine/busulfan. In the MAC setting, Busulfan/cyclophosphamide was associated with a higher acute GVHD (grade II-IV HR 2.33, 95% CI 1.67-3.25, p\u3c0.001; grade III-IV HR 2.31, 95% CI 1.52-3.52, p\u3c0.001) and inferior GVHD-free relapse-free survival (GRFS) (HR 1.94, 95% CI 1.49-2.53, p\u3c0.001) as compared to Fludarabine/busulfan. Hence, our study suggests that Fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lower early non-relapse mortality, lower acute GVHD) and MAC (lower acute GVHD and better GRFS) in myelofibrosis

Donor Types and Outcomes of Transplantation in Myelofibrosis: a CIBMTR Study

We evaluate the impact of donor types on outcomes of hematopoietic cell transplantation (HCT) in myelofibrosis, using the Center for International Blood and Marrow Transplant Research registry data for HCTs done between 2013 and 2019. In all 1597 patients, the use of haploidentical donors increased from 3% in 2013 to 19% in 2019. In study-eligible 1032 patients who received peripheral blood grafts for chronic-phase myelofibrosis, 38% of recipients of haploidentical HCT were non-White/Caucasian. Matched sibling donor (MSD)-HCTs were associated with superior overall survival (OS) in the first 3 months (haploidentical hazard ratio [HR], 5.80 [95% confidence interval (CI), 2.52-13.35]; matched unrelated (MUD) HR, 4.50 [95% CI, 2.24-9.03]; mismatched unrelated HR, 5.13 [95% CI, 1.44-18.31]; P \u3c .001). This difference in OS aligns with lower graft failure with MSD (haploidentical HR, 6.11 [95% CI, 2.98-12.54]; matched unrelated HR, 2.33 [95% CI, 1.20-4.51]; mismatched unrelated HR, 1.82 [95% CI, 0.58-5.72]). There was no significant difference in OS among haploidentical, MUD, and mismatched unrelated donor HCTs in the first 3 months. Donor type was not associated with differences in OS beyond 3 months after HCT, relapse, disease-free survival, or OS among patients who underwent HCT within 24 months of diagnosis. Patients who experienced graft failure had more advanced disease and commonly used nonmyeloablative conditioning. Although MSD-HCTs were superior, there is no significant difference in HCT outcomes from haploidentical and MUDs. These results establish haploidentical HCT with posttransplantation cyclophosphamide as a viable option in myelofibrosis, especially for ethnic minorities underrepresented in the donor registries

Grievance with the Disputes Unit in accordance with the Public Procurement Law

هدفت هذه الدراسة الى إلقاء الضوء على التظلم الإداري الذي يقدمه صاحب المصلحة إلى جهة الإدارة بوصفها سلطة عامة لغايات تحقيق المصلحة العامة، إلا انها قد تنحرف جهة الادارة عن ذلك وبناء عليه يتم إلغاء القرار الإداري غير المشروع أو سحبه، وتم تسليط الضوء من خلال هذا البحث على التظلم كإجراء ودي لإنهاء المنازعات الإدارية من قبل جهة الإدارة الأمر الذي يُجنب الشخص المتضرر بطء إجراءات التقاضي الإدارية ولذلك يهدف هذا البحث إلى دراسة التظلم الإداري كإجراء ودي لتسوية منازعات العقود الإدارية الذي بدوره قد يأخذ شكل الإجراء الإجباري أو الاختياري بحسب الجهة الإدارية المصدرة له بناء على النص القانوني الذي ينظمه، وألقت الدراسة الضوء حول التَظلُم الإدَاري مِن حيث الجِهة التي يُقدم إليهَا التظلُم من خلال الإشارة إلى جهة أخرى يُقدم التظلم اليها يطلق عليها التظلم إلى لجنة إدارية خاصة حيث انه وعند عدم انصاف المتضرر لديها يتم اللجوء إلى طريق التقاضي لتسوية منازعاته العقدية. تناولت الدراسة إجراءات التظلم الإداري أمام وحدة مراجعة المنازعات المشكلة بموجب القرار بقانون رقم (8) لعام 2014م للشراء العام، والتطرق إلى تكوين هذه الوحدة واختصاصاتها وإجراءات التظلم أمامها. وتناولت كيفية تشكيل وحدة لمراجعة النزاعات وذلك وفق نص المادة (57) من القرار بقانون رقم (8) لسنة 2014 بشأن الشراء العام، وتناولت الواقع العملي للتظلم لدى وحدة مراجعة المنازعات من خلال عرض بعض الأمثلة المنشورة على بوابة الشراء العام وتناولت هذه الدراسة منازعات العقود الإدارية من خلال بيان القرارات التي تصدر في العقود الإدارية وكيفية التظلم من هذه القرارات في مرحلة ابرام العقد الإداري لدى وحدة مراجعة المنازعات والتي تقبل الطعن بطريق الإلغاء وكذلك تم التطرق إلى القرارات الصادرة في مرحلة تنفيذ العقد والتي لا يكون للتظلم دور فيها حيث انها تتعلق بنصوص العقد ومخالفة نصوص العقد فيكون الاختصاص فيها للقضاء الشامل. وقد خلصت الدراسة إلى بعض النتائج أهمها أن التظلم الإداري يعتبر إجراء لتسوية المنازعات الإدارية وهذا في ظل تراكم الدعاوى أمام القضاء الإداري ضد جهة الإدارة. كما وانتهت الرسالة إلى بعض التوصيات من أهمها تفعيل دور لجنة مراجعة المنازعات بشكل أكبر وذلك من خلال النص على وجوب أن يكون التظلم لديها اجباري بموجب القانون لإنها تضم خبراء ذو خبرة وكفاءة مختصين للفصل في المنازعات المعروضة عليها قبل اللجوء إلى القضاء.This study aims to highlight the administrative grievance submitted by an interested party to the administrative authority as a public entity with the goal of achieving public interest. However, the administrative authority may deviate from this objective, leading to the annulment or withdrawal of an unlawful administrative decision. The research emphasizes the grievance as an amicable procedure for resolving administrative disputes, which helps the aggrieved party avoid the slow administrative litigation process. The research seeks to examine the administrative grievance as an amicable method for settling administrative contract disputes. This procedure can be either mandatory or optional, depending on the issuing administrative authority and the governing legal text. The study also sheds light on the administrative grievance process in terms of the entity to which the grievance is submitted. It refers to another entity, known as the special administrative committee, to which a grievance can be submitted. If the aggrieved party does not receive justice from this committee, they can resort to litigation to resolve their contractual disputes. The study delves into the procedures for administrative grievances before the Dispute Review Unit established by Decree-Law No. (8) of 2014 on public procurement. It explores the composition of this unit, its competencies, and the grievance procedures before it. Furthermore, the study addresses the formation of the dispute review unit according to Article (57) of Decree-Law No. (8) of 2014 concerning public procurement. It examines the practical reality of grievances submitted to the Dispute Review Unit by presenting some examples published on the public procurement portal. The study also discusses administrative contract disputes by outlining the decisions made in administrative contracts and the process for appealing these decisions at the contract formation stage before the Dispute Review Unit, which accepts annulment appeals. It additionally addresses decisions made during the contract execution stage, where grievances do not play a role, as these decisions pertain to contract terms and violations thereof, falling under the jurisdiction of comprehensive judiciary. The study concludes with several findings, the most significant being that the administrative grievance is a procedure for resolving administrative disputes in light of the accumulation of lawsuits before the administrative judiciary against the administrative authority. The study also provides recommendations, the most important of which is to enhance the role of the Dispute Review Committee. It suggests mandating that grievances be submitted to this committee as a compulsory step by law, given that it comprises experts with the experience and competence needed to resolve disputes presented to them before resorting to the judiciar

Acceptance of COVID-19 vaccines in Palestine: a cross-sectional online study

IntroductionIn Palestine (West Bank and Gaza), there have been more than 320 890 known cases of COVID-19, resulting in 3452 deaths. The detrimental effects of the virus can be seen in the nation’s health, economy and government operations, leading to radical uncertainty that is exacerbated by the absence of any definitive treatment or vaccines. The level of knowledge about and trust in treatment and vaccination varies worldwide. This study aims to assess the willingness of Palestinians to receive a COVID-19 vaccine and their knowledge about such vaccines.MethodsAn online survey of adults over 18 years old (n=1080) was conducted in Palestine in October 2020. Using multivariate logistic regression, we identified correlates of participants’ willingness to get a COVID-19 vaccine.ResultsWe found that about 63% of participants were willing to get a COVID-19 vaccine. However, acceptance varied with the specific demographic variables that were investigated. Women, married participants and those aged 18–24 years are more likely to take the vaccine. Further, participants with good knowledge about the vaccine and its side effects are more willing to get the vaccine.ConclusionThe availability of a safe and effective COVID-19 vaccine in Palestine is crucial to decrease the burden of COVID-19 morbidity and mortality. In addition, to ensure a high vaccination rate, health awareness campaigns should target those who are not willing to get the vaccine, especially those who are more vulnerable and the elderly.</jats:sec

Graft-versus-host disease in recipients of male unrelated donor compared with parous female sibling donor transplants.

Optimal donor selection is critical for successful allogeneic hematopoietic cell transplantation (HCT). Donor sex and parity are well-established risk factors for graft-versus-host disease (GVHD), with male donors typically associated with lower rates of GVHD. Well-matched unrelated donors (URDs) have also been associated with increased risks of GVHD as compared with matched sibling donors. These observations raise the question of whether male URDs would lead to more (or less) favorable transplant outcomes as compared with parous female sibling donors. We used the Center for International Blood and Marrow Transplant Research registry to complete a retrospective cohort study in adults with acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome, who underwent T-cell replete HCT from these 2 donor types (parous female sibling or male URD) between 2000 and 2012. Primary outcomes included grade 2 to 4 acute GVHD (aGVHD), chronic GVHD (cGVHD), and overall survival. Secondary outcomes included disease-free survival, transplant-related mortality, and relapse. In 2813 recipients, patients receiving male URD transplants (n = 1921) had 1.6 times higher risk of grade 2 to 4 aGVHD

Graft-versus-host disease in recipients of male unrelated donor compared with parous female sibling donor transplants

Key Points Compared with parous female sibling donors, male URDs confer more aGVHD in all patients and more cGVHD in females. There was no difference in survival, relapse, or transplant mortality between recipients of parous female sibling or male URD grafts.</jats:p

Association between the choice of the conditioning regimen and outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis

Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, the optimal conditioning regimen either with reduced intensity conditioning (RIC) or myeloablative conditioning (MAC) is not well known. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged ≥18 years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MAC cohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (Fludarabine/busulfan=166, Fludarabine/melphalan=327) and 379 using MAC (Fludarabine/busulfan=247, Busulfan/cyclophosphamide=132). In multivariable analysis with RIC, Fludarabine/melphalan was associated with inferior overall survival (HR 1.80, 95% CI 1.15-2.81, p=0.009), higher early non-relapse mortality (HR 1.81, 95% CI 1.12-2.91, p=0.01) and higher acute graft versus host disease (GVHD) (grade II-IV- HR 1.45, 95% CI 1.03-2.03, p=0.03; grade III-IV HR 2.21, 95%CI 1.28-3.83, p=0.004) compared to Fludarabine/busulfan. In the MAC setting, Busulfan/cyclophosphamide was associated with a higher acute GVHD (grade II-IV HR 2.33, 95% CI 1.67-3.25, p<0.001; grade III-IV HR 2.31, 95% CI 1.52-3.52, p<0.001) and inferior GVHD-free relapse-free survival (GRFS) (HR 1.94, 95% CI 1.49-2.53, p<0.001) as compared to Fludarabine/busulfan. Hence, our study suggests that Fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lower early non-relapse mortality, lower acute GVHD) and MAC (lower acute GVHD and better GRFS) in myelofibrosis

Association between the choice of the conditioning regimen and outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis

Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, theoptimal conditioning regimen either with reduced-intensity conditioning (RIC) or myeloablative conditioning (MAC) is not wellknown. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged =18years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MACcohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (fludarabine/busulfan n=166, fludarabine/melphalan n=327) and 379 using MAC (fludarabine/busulfan n=247, busulfan/cyclophosphamide n=132). In multivariable analysis with RIC, fludarabine/melphalan was associated with inferior overall survival (hazardratio [HR]=1.80; 95% confidenec interval [CI]: 1.15-2.81; P=0.009), higher early non-relapse mortality (HR=1.81; 95% CI: 1.12-2.91;P=0.01) and higher acute graft-versus-host disease (GvHD) (grade 2-4 HR=1.45; 95% CI: 1.03-2.03; P=0.03; grade 3-4 HR=2.21;95%CI: 1.28-3.83; P=0.004) compared to fludarabine/busulfan. In the MAC setting, busulfan/cyclophosphamide was associatedwith a higher acute GvHD (grade 2-4 HR=2.33; 95% CI: 1.67-3.25; P&lt;0.001; grade 3-4 HR=2.31; 95% CI: 1.52-3.52; P&lt;0.001) andinferior GvHD-free relapse-free survival (GRFS) (HR=1.94; 95% CI: 1.49-2.53; P&lt;0.001) as compared to fludarabine/busulfan.Hence, our study suggests that fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lowerearly non-relapse mortality, lower acute GvHD) and MAC (lower acute GvHD and better GRFS) in myelofibrosis