The cost of emission mitigation by legume crops in French agriculture

Transplantation and immunomodulatio

Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon

Developmen

Clinical features, treatment, and outcome of pediatric steroid refractory acute graft-versus-host disease: a multicenter study

Steroid-refractory acute graft-versus-host disease (SR-aGvHD) is a severe complication in pediatric allogeneic hematopoietic stem cell transplantation (HSCT). We aimed to assess clinical course and outcomes of pediatric SR-aGvHD. We performed a retrospective nationwide multicenter cohort study in the Netherlands. All patients aged 0 to 18 years who underwent transplantation between 2010 and 2020 with SR-aGvHD were included. For each patient, weeldy clinical aGvHD grade and stage, immunosuppressive treatment and clinical outcomes were collected. The primary study endpoint was the clinical course of SR-aGvHD over time. As a secondary outcome, factors influencing overall survival and SR-aGvHD remission were identified using a multistate Cox model. 20% of transplanted children developed grade II-IV aGvHD, of which 51% (n = 81) was SR-aGvHD. In these patients, second-line therapy was started at a median of 8 days after initial aGvHD-diagnosis. Forty-nine percent of SR-aGvHD patients received 3 or more lines of therapy. One year after start of second-line therapy, 34 patients (42%) were alive and in remission of aGvHD, 14 patients (17%) had persistent GvHD, and 33 patients (41%) had died. SR-aGvHD remission rate was lower in cord blood graft recipients than in bone marrow (BM) or peripheral blood stem cell (PBSC) recipients (hazard ratio [HR] = 0.51, 0.27-0.94, P = .031). Older age was associated with higher mortality (HR = 2.62, 1.04-6.60, P = .04, fourth quartile [aged 13.9-17.9] versus first quartile [aged 0.175-3.01]). In BM/PBSC recipients older age was also associated with lower remission rates (HR = 0.9, 0.83-0.96, P = .004). Underlying diagnosis, donor matching or choice of second-line therapy were not associated with outcome. Respiratory insufficiency caused by pulmonary GvHD was a prominent cause of death (26% of deceased). Our study demonstrates that SR-aGvHD confers a high mortality risk in pediatric HSCT. Older age and use of CB grafts are associated with an unfavorable outcome. Multicenter studies investigating novel treatment strategies to prevent pediatric SR-aGvHD and inclusion of children in ongoing trials, together with timely initiation of second-line interventions are pivotal to further reduce GvHD-related mortality. (C) 2022 The American Society for Transplantation and Cellular Therapy.Transplantation and immunomodulatio

Automating outcome analysis after stem cell transplantation: the YORT tool

Hematopoietic stem cell transplantation is a high-risk procedure. Auditing and yearly outcome reviews help keep optimal quality of care and come with increased survival, but also has significant recurring costs. When data has been entered in a standardized registry, outcome analyses can be automated, which reduces work and increases standardization of performed analyses. To achieve this, we created the Yearly Outcome Review Tool (YORT), an offline, graphical tool that gets data from a single center EBMT registry export, allows the user to define filters and groups, and performs standardized analyses for overall survival, event-free survival, engraftment, relapse rate and non-relapse mortality, complications including acute and chronic Graft vs Host Disease (GvHD), and data completeness. YORT allows users to export data as analyzed to allow you to check data and perform manual analyses. We show the use of this tool on a two-year single-center pediatric cohort, demonstrating how the results for both overall and event-free survival and engraftment can be visualized. The current work demonstrates that using registry data, standardized tools can be made to analyze this data, which allows users to perform outcome reviews for local and accreditation purposes graphically with minimal effort, and help perform detailed standardized analyses. The tool is extensible to be able to accommodate future changes in outcome review and center-specific extensions.Transplantation and immunomodulatio

Predicting patient death after allogeneic stem cell transplantation for inborn errors using machine learning (PREPAD): a European society for blood and marrow transplantation inborn errors working party study

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for many inborn errors of immunity, metabolism, and hematopoiesis. No predictive models are available for these disorders. We created a machine learning model using XGBoost to predict survival after HSCT using European Society for Blood and Marrow Transplant registry data of 10,888 patients who underwent HSCT for inborn errors between 2006 and 2018, and compared it to a simple linear Cox model, an elastic net Cox model, and a random forest model. The XGBoost model had a cross-validated area under the curve value of .73 at 1 year, which was significantly superior to the other models, and it accurately predicted for countries excluded while training. It predicted close to 0% and >30% mortality more often than other models at 1 year, while maintaining good calibration. The 5-year survival was 94.7% in the 25% of patients at lowest risk and 62.3% in the 25% at highest risk. Within disease and donor subgroups, XGBoost outperformed the best univariate predictor. We visualized the effect of the main predictors-diagnosis, performance score, patient age and donor type-using the SHAP ML explainer and developed a stand-alone application, which can predict using the model and visualize predictions. The risk of mortality after HSCT for inborn errors can be accurately predicted using an explainable machine learning model. This exceeds the performance of models described in the literature. Doing so can help detect deviations from expected survival and improve risk stratification in trials.(c) 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)Transplantation and immunomodulatio

Treosulfan-induced myalgia in pediatric hematopoietic stem cell transplantation identified by an electronic health record text mining tool

Treosulfan is increasingly used as myeloablative agent in conditioning regimen prior to allogeneic hematopoietic stem cell transplantation (HSCT). In our pediatric HSCT program, myalgia was regularly observed after treosulfan-based conditioning, which is a relatively unknown side effect. Using a natural language processing and text-mining tool (CDC), we investigated whether treosulfan compared with busulfan was associated with an increased risk of myalgia. Furthermore, among treosulfan users, we studied the characteristics of given treatment of myalgia, and studied prognostic factors for developing myalgia during treosulfan use. Electronic Health Records (EHRs) until 28 days after HSCT were screened using the CDC for myalgia and 22 synonyms. Time to myalgia, location of pain, duration, severity and drug treatment were collected. Pain severity was classified according to the WHO pain relief ladder. Logistic regression was performed to assess prognostic factors. 114 patients received treosulfan and 92 busulfan. Myalgia was reported in 37 patients; 34 patients in the treosulfan group and 3 patients in the busulfan group (p = 0.01). In the treosulfan group, median time to myalgia was 7 days (0-12) and median duration of pain was 19 days (4-73). 44% of patients needed strong acting opiates and adjuvant medicines (e.g. ketamine). Hemoglobinopathy was a significant risk factor, as compared to other underlying diseases (OR 7.16 95% CI 2.09-30.03, p = 0.003). Myalgia appears to be a common adverse effect of treosulfan in pediatric HSCT, especially in hemoglobinopathy. Using the CDC, EHRs were easily screened to detect this previously unknown side effect, proving the effectiveness of the tool. Recognition of treosulfan-induced myalgia is important for adequate pain management strategies and thereby for improving the quality of hospital stay.Clinical Pharmacy and Toxicolog

Osteosarcoma models : understanding complex disease

A mesenchymal stem cell (MSC) based osteosarcoma model was established. The model provided evidence for a MSC origin of osteosarcoma. Normal MSCs transformed spontaneously to osteosarcoma-like cells which was always accompanied by genomic instability and loss of the Cdkn2a locus. Accordingly loss of human CDKN2A/p16 protein expression in patients__ samples identified a subgroup of patients which did not respond to the chemotherapy and all showed poor survival (< 50 months). Moreover the CDKN2A/p16 gene expression loss in the human samples was caused by the same mechanism as in the mice cells, i.e. homozygous genomic deletion, validating the mouse model. Subsequently other useful models were identified by extensive characterization of osteosarcoma cell lines. From analyses of important signal transduction pathways (Wnt, BMP, TGF_ and Ihh) candidate targets for therapy, like a GSK3_-inhibitor, were identified. Furthermore a novel zebrafish model was established to study the progression of normal MSCs towards osteosarcoma-like cells in a high throughput manner. In this model both the behavior of the cells as well as the response of the host involved in processes like angiogenesis and migration were studied. The exploration of osteosarcoma at different levels was essential to broaden our knowledge about its origin, etiology and behavior. A better understanding of this complex malignancy offers more accurate targets to hit. Moreover it provides better opportunities to model the tumor which in turn allows for discovering and assaying novel treatment strategiesKWF EuroBoNetUBL - phd migration 201

Osteosarcoma models : understanding complex disease

A mesenchymal stem cell (MSC) based osteosarcoma model was established. The model provided evidence for a MSC origin of osteosarcoma. Normal MSCs transformed spontaneously to osteosarcoma-like cells which was always accompanied by genomic instability and loss of the Cdkn2a locus. Accordingly loss of human CDKN2A/p16 protein expression in patients__ samples identified a subgroup of patients which did not respond to the chemotherapy and all showed poor survival (< 50 months). Moreover the CDKN2A/p16 gene expression loss in the human samples was caused by the same mechanism as in the mice cells, i.e. homozygous genomic deletion, validating the mouse model. Subsequently other useful models were identified by extensive characterization of osteosarcoma cell lines. From analyses of important signal transduction pathways (Wnt, BMP, TGF_ and Ihh) candidate targets for therapy, like a GSK3_-inhibitor, were identified. Furthermore a novel zebrafish model was established to study the progression of normal MSCs towards osteosarcoma-like cells in a high throughput manner. In this model both the behavior of the cells as well as the response of the host involved in processes like angiogenesis and migration were studied. The exploration of osteosarcoma at different levels was essential to broaden our knowledge about its origin, etiology and behavior. A better understanding of this complex malignancy offers more accurate targets to hit. Moreover it provides better opportunities to model the tumor which in turn allows for discovering and assaying novel treatment strategie

Concise Review: Mesenchymal Tumors: When Stem Cells Go Mad

Molecular tumour pathology - and tumour genetic

Zebrafish as a Model for Human Osteosarcoma

MTG