Przyczyny dyskwalifikacji niespokrewnionych dawców krwiotwórczych komórek macierzystych

BackgroundIn the recent years the population of registered unrelated hematopoietic stem cell donors in Poland expanded to over 768 000 in 2014. In parallel the number of hematopoietic stem cell donations rose to over 900 in 2014. So far there are very little data about unrelated hematopoietic stem cell donors in Poland.AimsAnalysis of most common deferral reasons of unrelated hematopoietic stem cell donors at the time of final clearance before transplantation.Methods465 medical records of unrelated donors who underwent final clearance were analyzed. The deferral reasons were analyzed and compared with recent World Marrow Donor Association (WMDA) and National Marrow Donor Program (NMDP) guidelines for donor selection.Results1.5% of donors were permanently deferred at the final clearance – mostly with random medical conditions. 8% of donors (n=38) were temporarily deferred at the final clearance. Among them the deferral causes included: suspicion of recent or ongoing Toxoplasmosis (n=17); autoimmune thyroiditis (n=3); ongoing CMV infection (n=2) and other reasons (n=16). The median time of temporal deferral was 6 weeks. Except for the cases with suspicion of Toxoplasmosis, the temporal deferral over 3 weeks results in very low chances of donation (5%, n=19).ConclusionThe percentages of permanent deferrals are low in Polish donors. The temporal deferrals are mostly based on suspicion of infectious diseases. The temporal deferrals of over 3 weeks in most of the cases effectively block the donation possibility

Niespokrewnieni dawcy komórek macierzystych — motywacja i satysfakcja w procesie donacji komórek krwiotwórczych

Background. Poland has the most rapidly growing population of registered stem cell donors worldwide. The aim of the study was the analysis of motivation, ways of recruitment, major side effects and general satisfaction related to donation process among unrelated hematopoietic stem cell (HSC) donors at a major stem cell facility in Poland. Material and methods. The prospective study was based on data from online questionnaire completed by unrelated HSC donors — before and after donation. The study included 109 questionnaires completed prior to donation and 80 questionnaires completed after donation. Results. The wish to help others was motivation for registration in 84% of the donors. The most common recruitment site were local actions (49%), the Internet however has also become a major source of registration — 42% of donors were recruited through the Internet based service. The most common side effects or general discomforts related to donation as reported by donors were: G-CSF injections (45%) and duration of the procedure (29%) in the case of peripheral blood stem cell donors (PBSC) and in the case of bone marrow harvest in general anesthesia — weakness after donation (27%), duration of hospital stay (27%) as well as pain after intubation (18%). Pain related to G-CSF mobilization procedure was higher than that reported after bone marrow harvest (1.51 vs 0.67; p = 0,83). Only 6% PBSC donors regarded this pain as significant compared to 9% of marrow donors. Conclusion. The outcome of the study provides a positive overview of stem cell donation in Poland. Stem cell donors report satisfaction with information provided by health care personnel on recruitment, qualification and donation procedure, the procedure-related side effects and discomforts are few and the sense of contentment and satisfaction is high.Wstęp. W ostatnich latach polski rejestr niespokrewnionych dawców komórek krwiotwórczych był najszybciej rozwijającym się rejestrem w skali świata. Celem niniejszej pracy jest analiza procesu rekrutacji i pobierania komórek macierzystych od dawców. Analizę tę przeprowadzono w największym ośrodku pobierającym w Polsce — w Samodzielnym Publicznym Centralnym Szpitalu Klinicznym. Materiał i metody. Przeprowadzono badanie ankietowe online wśród niespokrewnionych dawców komórek krwiotwórczych przed donacją i po. Łącznie dawcy wypełnili 109 kwestionariuszy przed donacją i 80 kwestionariuszy po donacji. Wyniki. Chęć niesienia pomocy drugiemu człowiekowi była głównym powodem rejestracji dla 84% dawców. Najczęściej rekrutowano ich podczas lokalnych akcji (49% dawców) i przez Internet — poprzez kwestionariusze dostępne w sieci (42%). Najczęściej zgłaszanymi przez dawców niedogodnościami związanymi z pobraniem komórek były: konieczność wykonywania zastrzyków czynnika wzrostu granulocytów (45%) i czas trwania procedury (29%) — wśród dawców komórek krwiotwórczych z krwi obwodowej — oraz osłabienie po pobraniu (27%), konieczność pobytu w szpitalu (27%) i ból gardła po intubacji (18%) związane z pobraniem szpiku w znieczuleniu ogólnym. Natężenie bólu zgłaszanego przez dawców w trakcie pobrania komórek z krwi obwodowej było większe niż u dawców po pobraniu szpiku, ale nie była to różnica istotna statystycznie (1,51 vs 0,67; p = 0,83). Tylko 6% dawców komórek z krwi obwodowej uważało ten ból za istotny w porównaniu do 9% dawców, od których pobierano szpik. Wnioski. Wyniki pracy pokazują pozytywny obraz donacji komórek krwiotwórczych. Zadowolenie z otrzymanych informacji w trakcie rekrutacji, kwalifikacji i donacji, mała liczba niekorzystnych doświadczeń dawców oraz ogólne zadowolenie z przebiegu donacji przyczyniają się do kształtowania pozytywnego obrazu dawstwa i przeszczepiania szpiku w Polsce

Mobilizacja macierzystych komórek krwiotwórczych u chorych z niedawnorozpoznaną cukrzycą typu 1 przed przeszczepieniem autologicznych komórek krwiotwórczych

BackgroundThe immunoablation with autologous hematopoietic stem cell transplantation is a new experimental treatment of early diabetes type 1. The treatment is based on destruction of immune system with cytotoxic drugs which leads to halt of immune reaction directed against beta cells of pancreas. During that treatment young patients with diabetes type 1 who are otherwise healthy undergo mobilization with cyclophosphamide (CY) and G-CSF. They are naïve to cytotoxic drugs and mobilization is their first contact with chemotherapy. We analyzed the efficiency of mobilization with cyclophosphamide and G-CSF in this population.MethodsWe analyzed the medical records of 25 patients with diabetes who underwent mobilization with cyclophosphamide and G-CSF.ResultsThe median white blood cell count on the first day of apheresis was 14.6×103/μL (range 1.5–33.3) in CY+G-CSF mobilized patients. Median absolute CD 34+ cell count in peripheral blood on the first apheresis day was 0.095 127×103/μL (range 0.026–0.477). The median total number of collected CD34+ cells during one or two (if needed) aphereses was 466×106 (range 204–816) or 7.24×106 CD34+ cells per kg of patient body weight (range 3.03–13.1). There were no poor mobilizers who were unable to collect sufficient cell numbers.ConclusionThe mobilization of hematopoietic stem cells with CY+G-CSF in patients with early diabetes type 1 is efficient and the underlying diabetes does not impair the efficiency of hematopoietic stem cell collection

Single Positive Commensal Blood Culture in hospital setting is associated with higher mortality after hematopoietic stem cell transplantation

BackgroundSingle positive staphylococcal blood culture in a hematopoietic stem cell transplantation (HSCT) recipient is generally regarded as contamination. Such a blood culture (BC) does not fill the criteria for Laboratory-Confirmed Bloodstream Infection (LCBI) and could be described as Single Positive Commensal Blood Culture. The aim of this retrospective cohort analysis was to determine the clinical significance of SPCBC in HSCT recipients.Methods206 patients transplanted between 2007 and 2013 were followed until January 2015.ResultsThe 100-day survival for patients without positive BC was 99.6% compared with 83.9% for LCBI and 82.8% for SPCBC (p=0.0036). The 5-year overall survival (5yOS) was 67.1% for patients without positive BC, 44.9% for LCBI, 34.0% for SPCBC (

Common, Intermediate and Well-Documented HLA Alleles in World Populations: CIWD Version 3.0.0

A catalog of common, intermediate and well-documented (CIWD) HLA-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5, -DQB1 and -DPB1 alleles has been compiled from over 8 million individuals using data from 20 unrelated hematopoietic stem cell volunteer donor registries. Individuals are divided into seven geographic/ancestral/ethnic groups and data are summarized for each group and for the total population. P (two-field) and G group assignments are divided into one of four frequency categories: common (≥1 in 10 000), intermediate (≥1 in 100 000), well-documented (≥5 occurrences) or not-CIWD. Overall 26% of alleles in IPD-IMGT/HLA version 3.31.0 at P group resolution fall into the three CIWD categories. The two-field catalog includes 18% (n = 545) common, 17% (n = 513) intermediate, and 65% (n = 1997) well-documented alleles. Full-field allele frequency data are provided but are limited in value by the variations in resolution used by the registries. A recommended CIWD list is based on the most frequent category in the total or any of the seven geographic/ancestral/ethnic groups. Data are also provided so users can compile a catalog specific to the population groups that they serve. Comparisons are made to three previous CWD reports representing more limited population groups. This catalog, CIWD version 3.0.0, is a step closer to the collection of global HLA frequencies and to a clearer view of HLA diversity in the human population as a whole

Zastosowanie ruksolitynibu w leczeniu przewlekłej, opornej na glikokortykosteroidy choroby przeszczep przeciwko gospodarzowi

Chronic graft-versus-host disease (cGvHD) occurs in approximately 50% of recipients who undergo allogeneic stem-cell transplantation and is a leading cause of non-relapse-associated death. Glucocorticoids are the standard of care for cGvHD, but approximately 50% of patients are refractory to such treatment. The study describes a case of a 22-year-old patient with steroid-refractory GvHD, without improvement after multiple lines of immunosuppressive treatment, who was treated with an inhibitor of the JAK-STAT signalling pathway — ruxolitinib.Przewlekła choroba przeszczep przeciwko gospodarzowi (cGvHD) występuje u ponad połowy biorców allogenicznych komórek krwiotwórczych i jest najczęstszą przyczyną śmiertelnych powikłań niezwiązanych z nawrotem. Standardem w leczeniu cGvHD pozostają glikokortykosteroidy, ale ponad połowa chorych jest na nie oporna. W pracy przedstawiono przypadek 22-letniego chorego z ciężką steroidooporną cGvHD, bez poprawy po wielu liniach leczenia immunosupresyjnego, u którego zastosowano inhibitor szlaku sygnałowego JAK-STAT — ruksolitynib

Salvage treatment with plerixafor in poor mobilizing allogeneic stem cell donors: results of a prospective phase II-trial

We conducted a prospective clinical trial to investigate the safety and efficacy of plerixafor (P) in allogeneic peripheral blood stem cells (PBSC) donors with poor mobilization response to standard-dose granulocyte colony-stimulating factor (G-CSF), defined by <2 × 1