5 research outputs found
In utero stem cells transplantation after a mild immunosuppression: evidence of paternal ABO cDNA in β β β β β-thalassaemia affected fetus
Background. In utero haematopoietic stem cell transplantation (IUHSCT) could represent an alternative option to therapeutic abortion after prenatal diagnosis of thalassaemia. However, although in immunodeficiency syndromes chimerism has been described, in thalassaemia poor clinical success has been reported. One of the reasons is probably the graft failure due to an immune response of the fetuses. Materials and methods. Therefore, we set up a clinical protocol by which two female fetuses affected by ß-thalassaemia at 20 and 21 weeks of gestation were prenatally treated with low-dose dexamethasone and then transplanted with paternal circulating haematopoietic progenitor cells. Results. Chimerism analysis performed after birth showed the presence, in both newborns, of Y cells in peripheral blood. Moreover, in one case an erythroid microchimerism was shown by the presence of paternal ABO allele A cDNA obtained from mononuclear peripheral blood cells at 2 months of age and by an unusual HbA value of 14.4%, thus indicating a slight transitory engraftment of infused paternal stem cells. However, because of both babies required transfusions before 12 months, these data confirm the difficulty for long-term successful with IUHSCT. Conclusions. To obtain safe and successful results for fetuses with β β β β β-thalassaemia will remain a challenge of the next years. Introduzione I rapidi progressi conseguiti nelle indagini genetiche e molecolari hanno consentito di individuare numerose malattie genetiche ereditarie in periodi precoci di gestazione, mediante il campionamento dei villi coriali (CVC) e l'analisi del DNA. Il trapianto in utero di cellule staminali ematopoietiche (In utero Haematopoietic Stem Cell Transplantation, IUHSCT) potrebbe rappresentare una opzione alternativa all'aborto terapeutico in alcune emopatie genetiche ereditarie, quali le emoglobinopatie, in quanto, potenzialmente, potrebbe consentire la nascita di un neonato sano. Tuttavia, attualmente, l'attecchimento dopo IUHSCT si è ottenuto soltanto in caso di feti affetti da disordini immunologici, quali la sindrome di Bare (sindrome dei linfociti "nudi") o l'immunodeficienza combinata grave (Severe Combined ImmunoDeficiency, SCID
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Allogeneic Hematopoietic Cell Transplantation from Unrelated Donors in Multiple Myeloma: Study from the Italian Bone Marrow Donor Registry
Incidence, Risk Factors and Outcome of Pre-engraftment Gram-Negative Bacteremia after Allogeneic and Autologous Hematopoietic Stem Cell Transplantation: An Italian Prospective Multicenter Survey
Abstract
BACKGROUND:
Gram-negative bacteremia (GNB) is a major cause of illness and death after hematopoietic stem cell transplantation (HSCT), and updated epidemiological investigation is advisable.
METHODS:
We prospectively evaluated the epidemiology of pre-engraftment GNB in 1118 allogeneic HSCTs (allo-HSCTs) and 1625 autologous HSCTs (auto-HSCTs) among 54 transplant centers during 2014 (SIGNB-GITMO-AMCLI study). Using logistic regression methods. we identified risk factors for GNB and evaluated the impact of GNB on the 4-month overall-survival after transplant.
RESULTS:
The cumulative incidence of pre-engraftment GNB was 17.3% in allo-HSCT and 9% in auto-HSCT. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common isolates. By multivariate analysis, variables associated with GNB were a diagnosis of acute leukemia, a transplant from a HLA-mismatched donor and from cord blood, older age, and duration of severe neutropenia in allo-HSCT, and a diagnosis of lymphoma, older age, and no antibacterial prophylaxis in auto-HSCT. A pretransplant infection by a resistant pathogen was significantly associated with an increased risk of posttransplant infection by the same microorganism in allo-HSCT. Colonization by resistant gram-negative bacteria was significantly associated with an increased rate of infection by the same pathogen in both transplant procedures. GNB was independently associated with increased mortality at 4 months both in allo-HSCT (hazard ratio, 2.13; 95% confidence interval, 1.45-3.13; P <.001) and auto-HSCT (2.43; 1.22-4.84; P = .01).
CONCLUSIONS:
Pre-engraftment GNB is an independent factor associated with increased mortality rate at 4 months after auto-HSCT and allo-HSCT. Previous infectious history and colonization monitoring represent major indicators of GNB.
CLINICAL TRIALS REGISTRATION:
NCT02088840