Case Report Rapid Recovery from Chronic PRCA by MSC Infusion in Patient after Major ABO-Mismatched alloSCT

Pure red cell aplasia (PRCA) is a rare complication in recipients of allogenic stem cell from ABO incompatible donors. It is characterized by reticulocytopenia and by an absence of red cell cell precursors in the bone marrow. Despite close isohemagglutinins monitoring and standard immunosupressive treatment in these patients prolong PRCA are still associated with severe transfusion dependence. We report the case of a 31 yr old male patient who underwent HLA-matched ABO-mismatched allo-SCT and developed resistance PRCA despite conventional immunosupressive therapy and prophylaxis cotrasplantation of bone marrow derived MSC at day 0. He responded dramatically to therapy with adipose tissue derived mesenchymal stem cells from HSC donors and continued to be transfusion-independent and AML-disease free. This method of the PRCA therapy of deserves further investigation. Allogeneic stem cell transplantation (allo-SCT) is one of the curative treatment options for patients with acute myeloid leukemia (AML). However, immunological mismatch can increase complications such as GVHD and PRCA. Delayed donor red cell engraftment and partial red cell aplasia (PRCA) occur in cases of major ABO mismatch between donor and recipient due to inhibition of the donor's erythroid progenitors by isohemagglutinins produced by residual plasma cells. After discovery of the high immunomodulatory effect of mesenchymal stem cells (MSCs), it was demonstrated that MSC infusion is a promising method of prophylaxis and treatment for post-BMT complications, such as severe acute GVHD and PRCA in clinical practice The patient was a 31-year-old man with acute myeloid leukemia, M5 variant in the first remission who underwent haematopoietic stem cell transplantation from his HLAmatched sister on February 14, 2008. Conditioning therapy consisted of busulfan 16 mg/kg p.o. and cyclophosphamide 120 mg/kg. The transplanted PBSC allograft contained 4.4 × 10 * 6/kg CD34+ cells with less than 15 mL RBC in this stem cell product. There was a major ABO mismatched between the donor (A+) and recipient (0+). Graft versus host disease prophylaxis included cyclosporine A (CsA) started from day −1 and short courses of methotrexate on days +1, +3, +6, and +11. Also to prevent GVHD, we used a culture-expande

Long-Term Outcomes of Hematopoietic Stem Cell Transplantation for Severe Treatment-Resistant Autoimmune Cytopenia in Children

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Modern possibilities for using stem cells in diabetes mellitus

Diabetes mellitus (DM) is characterised by relative or absolute insulin deficiency. The currently available treatment methods for DM cannot provide normal blood glucose level without hypo- or hyperglycaemia episodes, thus failing to completely prevent the development of diabetic complications. Replacement of ?-cells (transplantation of the pancreas or ?-cells) is accompanied by complications and requires life-long immunosuppressive therapy that is not always followed by restoration of insulin independence; there is also a substantial deficit of donors. Stem cells do not cause such negative effects and can be used in therapy to avoid such problems. Allogeneic stem cell transplantation is complicated by immune rejection of a transplant, whereas the use of embryonic stem cells is associated with ethical concerns, complicated cell line selection, and risk of teratoma formation. The present review focuses on therapeutic pathways of autologous transplantation of tissue stem cells in order to restore the ?-cell pool, for immune reconstitution and modulation of the immune response in DM patients

Rapid Recovery from Chronic PRCA by MSC Infusion in Patient after Major ABO-Mismatched alloSCT

Pure red cell aplasia (PRCA) is a rare complication in recipients of allogenic stem cell from ABO incompatible donors. It is characterized by reticulocytopenia and by an absence of red cell cell precursors in the bone marrow. Despite close isohemagglutinins monitoring and standard immunosupressive treatment in these patients prolong PRCA are still associated with severe transfusion dependence. We report the case of a 31 yr old male patient who underwent HLA-matched ABO-mismatched allo-SCT and developed resistance PRCA despite conventional immunosupressive therapy and prophylaxis cotrasplantation of bone marrow derived MSC at day 0. He responded dramatically to therapy with adipose tissue derived mesenchymal stem cells from HSC donors and continued to be transfusion-independent and AML-disease free. This method of the PRCA therapy of deserves further investigation

Long-term outcomes of hematopoietic stem cell transplantation for severe treatment-resistant autoimmune cytopenia in children

AbstractWe analyzed the long-term outcomes of pediatric patients registered in the European Group for Blood and Marrow Transplantation database who underwent hematopoietic stem cell transplantation (HSCT) for severe treatment refractory autoimmune cytopenia. With a median follow-up of 100 months, event-free survival was 54% overall, with no significant difference between allogeneic HSCT (n = 15) and autologous HSCT (n = 7) recipients (58% versus 42%; P = .50). Despite a trend toward failure of response or relapse after autologous HSCT compared with allogeneic HSCT, the difference was not significant (43% versus 13%; P = .30). Treatment-related mortality was high in both HSCT groups (29% and 16%; P = .09). Based on the limited numbers of subjects in this retrospective analysis, both allogeneic and autologous HSCT may induce complete and persistent responses in approximately one-half of pediatric patients with severe refractory autoimmune cytopenia, although treatment-related toxicity is high

Autologous stem cell transplantation for systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is responsive to treatment with immunosuppressives and steroids, but often pursues a relapsing or refractory course resulting in increasing incapacity and reduced survival. Autologous stem cell transplantation (ASCT) following immunoablative chemotherapy is a newer therapy for autoimmune disease of potential use in severe SLE. A retrospective registry survey was carried out by the European Blood and Marrow Transplant and European League Against Rheumatism (EBMT/EULAR) registry. Data was collected from 53 patients with SLE treated by ASCT in 23 centres. Disease duration before ASCT was 59 (2-155) months (median, range), 44 (83%) were female, and median age was 29 (9-52) years. At the time of ASCT a median of seven American College of Rheumatology (ACR) diagnostic criteria for SLE were present (range 2-10) and 33 (62%) had nephritis. Peripheral blood stem cells were mobilized with cyclophosphamide and granulocyte colony stimulating factor in 93% of cases. Ex vivo CD34 stem cell selection was performed in 42% of patients. Conditioning regimens employed cyclophosphamide in 84%, anti-thymocyte globulin in 76% and lymphoid irradiation in 22%. The mean duration of follow-up after ASCT was 26 (0-78) months. Remission of disease activity (SLEDAI < 3) was seen in 33/50 (66%; 95%CI 52-80) evaluable patients by six months, of which 10/31 (32%; 95%CI 15-50) subsequently relapsed after six (3-40) months. Relapse was associated with negative anti-double stranded DNA (anti-dsDNA) antibodies before ASCT (P = 0.007). There were 12 deaths after 1.5 (0-48) months, of which seven (12%; 95%CI 3-21) were related to the procedure. Mortality was associated with a longer disease course before ASCT (P = 0.036). In conclusion, this registry study demonstrates the efficacy of ASCT for remission induction of refractory SLE, although mortality appeared high. The safety of this procedure is likely to be improved by patient selection and choice of conditioning regimen. The return of disease activity in one-third of patients might be reduced by long-term immunosuppressive therapy post-ASCT.Comparative StudyJournal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe