T cell-depleted stem-cell transplantation for adults with hematologic malignancies: Sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin

Adult Allogeneic Bone Marrow Transplant Service, Division of Hematologic-Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY 10065, USA.
Blood (Impact Factor: 10.43). 01/2008; 110(13):4552-9. DOI: 10.1182/blood-2007-06-093880
Source: PubMed

ABSTRACT Antithymocyte globulin (ATG) has been used in allogeneic stem-cell transplantation to prevent graft rejection and graft-versus-host disease (GvHD). Its use, however, has been associated with delayed T-cell reconstitution and prolonged susceptibility to opportunistic infections (OIs) especially in patients undergoing T cell-depleted (TCD) transplantation. Recently, a prospective trial was conducted in 52 adult patients (median age, 47 years) with various hematologic malignancies undergoing TCD transplantation from HLA-matched related donors without the use of ATG. The cytoreductive regimen consisted of hyperfractionated total body irradiation (HFTBI), thiotepa, and fludarabine. The preferred source of the graft was peripheral blood stem cells (PBSCs). No additional graft rejection or GvHD prophylaxis was given. All evaluable patients engrafted without any immune-mediated graft rejections. Disease-free survival (DFS) at 3 years was 61% in all patients, and 70% in patients with standard-risk disease. Acute GvHD was limited to grade 2 in 8% and chronic GvHD in 9% of patients. Life-threatening OIs occurred in 3 of 52 patients and was fatal in 1. This study demonstrates durable engraftment with a low incidence of GvHD despite the lack of ATG, as well as the curative potential of this regimen.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the authors' research is to develop a pH based, ischemia measuring system which will be used for postoperative monitoring of transplanted tissue over a four day period. Currently, most pH monitors are difficult for hospital personnel to operate and lack sufficient long-term stability, resulting in false readings of tissue pH (drifts >±0.48 pH units per 100 hours). An electronic multi-channel pH measuring device which interfaces with a laptop computer was constructed. The system uses an algorithm to compensate for inherent pH measurement instabilities. This is accomplished using separate pH reference electrode channels from which multiple measurements are averaged. The authors' system provides tissue pH measurements that are sufficiently stable during 96 hour postoperative monitoring periods
    Engineering in Medicine and Biology Society, 1997. Proceedings of the 19th Annual International Conference of the IEEE; 01/1997
  • [Show abstract] [Hide abstract]
    ABSTRACT: Solving the inverse problem to reconstruct endocardial electrograms from cavitary probe data requires measuring cavitary electrograms and determining probe-cavity geometry. To identify the importance of geometry, endocardial electrograms were computed using two geometric models of the endocardium: (1) realistic, and (2) idealized. Endocardial electrograms were computed during pacing and were compared to directly measured electrograms at 8 sites during each paced rhythm. Using realistic geometry, computed electrograms were in excellent agreement with measured electrograms (r=0.88; error in activation time=4.7 ms). Whereas, the idealized geometry significantly increased the error in computed electrograms (r=0.75; error in activation time=9.9 ms). Therefore, in situ determination of realistic geometry is essential to successfully solve the inverse problem
    Engineering in Medicine and Biology Society, 1997. Proceedings of the 19th Annual International Conference of the IEEE; 01/1997
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: An orbit correction algorithm is developed to achieve the following goals for the CEBAF accelerator at Jefferson Lab.: (1) Preprocessing of orbit input to account for estimated misalignment and monitor errors. (2) Automatic elimination of blind spots caused by response matrix degeneracy. (3) Transparency of exception handling to interchangeable generic steering engines. (4) CEBAF-specific demands on control of injection angle, path length, orbit effects on optics, simultaneous multiple pass steering, and orbit control at un-monitored locations. All of the above can be accomplished by the introduction of virtual monitors into the processed input orbit, whose theoretical basis is to be discussed in this report. Implementation of all or part of these features and operational experience during the CEBAF variable energy runs are also be discussed
    Particle Accelerator Conference, 1997. Proceedings of the 1997; 06/1997
Show more