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ABSTRACT: We, and others, previously reported the expansion of CD5+CD19+ B-cells after allogeneic hematopoietic stem cell transplantation (HSCT). Recently the equivalent of the B1 cells in mice have been described in human as CD20+CD27+CD43+CD70- B cells. Here we report that while 20% of CD5+CD19+ cells in controls were CD43+, over 75% of CD5+CD19+ were CD43 positive in patients whether or not they previously developed chronic GvHD (p=0.0001). CD5+CD19+ B cells, CD5+CD43+CD19+ B cells and B1 cells counts were significantly decreased in patients who previously developed chronic GvHD and this effect of GvHD affected CD5+ and CD5- similarly within the B1 cell subset. Thus our results strongly suggest that the previously reported expansion of the CD5+CD19+ population might be related to an expansion of the B1 cell subset, and that B1 cell reconstitution was impaired in patients who developed chronic GvHD.
Biol Blood Marrow Transplant. 01/2013;
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ABSTRACT: L’allogreffe de cellules souches hématopoïétiques (CSH) est l’un des traitements contre le cancer induisant le plus de séquelles
physiques et psychologiques à long terme. L’objectif de cet article est de discuter et questionner les résultats, issus d’articles
scientifiques publiés au sein de revues internationales, sur les conséquences psychologiques et sociales de la greffe de CSH,
à la lumière de certains concepts analytiques. Nous nous concentrons plus spécifiquement sur les notions de qualité de vie
(QOL), de syndrome de stress post-traumatique (PTSD) et de développement post-traumatique (PTG).
Allogeneic bone marrow transplant (BMT) or hematopoietic stem cell transplant (HSCT) is one of the most arduous cancer treatments
to endure and is therefore likely to have more long-term sequelae. The aim of this article is to discuss and analyze the results
of international scientific articles on the psychological impact of HSCT, based on psychoanalytic concepts. We focus on the
concepts of psychosocial distress, quality of life (QOL), posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG).
Mots clésGreffe de cellules souches hématopoïétiques–Qualité de vie–Syndrome de stress post-traumatique–Résilience
KeywordsHematopoietic stem cell transplant–Quality of life–Posttraumatic stress disorder–Posttraumatic growth
Psycho-Oncologie 05/2012; 5(3):191-196. · 0.26 Impact Factor
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P Chevallier,
M Labopin,
N Milpied,
J J Cornelissen,
D Blaise,
E Petersen,
A Sandstedt,
H Goker, G Socie,
V Rocha,
M Mohty
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ABSTRACT: So far the impact of cytogenetics risk on outcome in the context of reduced intensity conditioning (RIC) allo-SCT has been poorly studied. We have identified 378 AML patients in first CR who underwent RIC allo-SCT from an HLA-matched sibling donor between 2000 and 2007 reported to the European Group for Bone and Marrow Transplantation and for whom detailed cytogenetics data were available (good risk: n=21; intermediate risk: n=304; and poor risk: n=53). With a median follow-up of 24 months (range: 1-93), 2-year non-relapse mortality, relapse rate (RR), leukemia-free survival (LFS) and OS were 14%, 31%, 55% and 61%, respectively. Cytogenetics was significantly associated with RR (good risk: 10%; intermediate risk: 28%; and poor risk: 55% at 2 years, P<0.0001) and LFS (good risk: 64%; intermediate risk: 57%; and poor risk: 38% at 2 years, P=0.003). In a multivariate analysis, RR and LFS were significantly higher and lower, respectively, in the high-risk cytogenetics group (P=0.001, P=0.004) and in patients with a higher WBC at diagnosis (>10 × 10(9)/L) (P<0.001, P=0.004). As documented in the setting of myeloablative allo-SCT, patients with poor cytogenetics had increased RR and decreased LFS after RIC allo-SCT, requiring new prospective strategies to improve results in this subgroup.Bone Marrow Transplantation advance online publication, 16 April 2012; doi:10.1038/bmt.2012.55.
Bone marrow transplantation 04/2012; · 3.00 Impact Factor
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N S Majhail,
J D Rizzo,
S J Lee,
M Aljurf,
Y Atsuta,
C Bonfim,
L J Burns,
N Chaudhri,
S Davies,
S Okamoto,
A Seber, G Socie,
J Szer,
M T Van Lint,
J R Wingard,
A Tichelli
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ABSTRACT: Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (for example, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This report provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
Bone marrow transplantation 03/2012; 47(3):337-41. · 3.00 Impact Factor
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A Spyridonidis,
M Labopin,
C Schmid,
L Volin,
I Yakoub-Agha,
M Stadler,
N Milpied, G Socie,
P Browne,
S Lenhoff,
M A Sanz,
M Aljurf,
M Mohty,
V Rocha
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ABSTRACT: To describe outcomes, treatment and prognostic factors that influence survival of adult patients with acute lymphoblastic leukemia (ALL), who relapsed after allogeneic hematopoietic cell transplantation (HCT), we retrospectively analyzed 465 ALL adult patients from European Group for Blood and Marrow Transplantation (EBMT) centers who relapsed after a first HCT performed in complete remission (CR1 65%, CR2/3 35%). Salvage treatments were: supportive care (13%), cytoreductive therapy (43%), donor lymphocyte infusion without or with prior chemotherapy (23%) and second HCT (20%). Median time from HCT to relapse was 6.9 months, median follow-up was 46 months and median survival after relapse was 5.5 months. Estimated 1-, 2- and 5-year post-relapse survival was 30 ± 2%, 16 ± 2% and 8 ± 1%, respectively. In a multivariate analysis, adverse factors for survival were: late CR (CR2/3) at transplant (P<0.012), early relapse after transplant (<6.9 months, P <0.0001) and peripheral blast percent at relapse (P <0.0001). On the basis of multivariate model for survival, three groups of patients were identified with estimated 2 year survival of 6 ± 2, 17 ± 3 and 30 ± 7%. Outcome of ALL patients relapsing after HCT is dismal and there is a need for new therapies. Our study provides the standard expectations in ALL relapse and may help in the decision of post-relapse therapy.
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 01/2012; 26(6):1211-7. · 8.30 Impact Factor
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L Karlin,
B Arnulf,
S Chevret,
L Ades,
M Robin,
R P De Latour,
M Malphettes,
N Kabbara,
B Asli,
V Rocha,
J P Fermand, G Socie
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ABSTRACT: We retrospectively studied a series of 23 patients (median age 50 years, range 29-59 years) with multiple myeloma (MM), treated in first relapse by a sequential autologous-allogeneic tandem approach. Tandem transplantation (TT) consisted in high dose melphalan (HDT) and auto-SCT followed by an (allo-SCT) preceded by two gray TBI non-myeloablative conditioning. All patients received a first HDT as frontline treatment. At day 100 post allo-SCT, complete donor chimerism was detected in 22 patients (95%). Acute GVHD was observed in 19 patients (15 grade I-II (65%) and 4 grade III-IV (17%)). Ten patients (43%) developed an extensive chronic GVHD. The non-relapse mortality at 1 year was 17%. After TT, the overall response rate was 91% (17% partial response, 35% very good partial remission and 39% complete remission). At 2 years, OS was 61%. Median event-free survival and OS were 36.8 and 60 months, respectively. Based on the propensity score matching method, a significant survival advantage could be seen in patients treated with TT as compared with non-allografted patients. Thus, allo-SCT, in TT approach, provides a high response rate with low toxicity and may improve survival of patients with relapsing MM.
Bone marrow transplantation 02/2011; 46(2):250-6. · 3.00 Impact Factor
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S Lissandre,
J-O Bay,
J-Y Cahn,
R Porcher,
V Cacheux,
A Cabrespine,
J Cornillon,
B Cassinat,
R Peffault de Latour, G Socie,
M Robin
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ABSTRACT: Allogeneic haematopoietic stem-cell transplantation (HSCT) is the only curative treatment for myelofibrosis. We retrospectively analyzed the outcome of patients who underwent allogeneic HSCT, 1994-2008, and the potential risk factors affecting non-relapse mortality (NRM), OS and relapse-free survival (RFS). A total of 39 patients, 15-65 (median 49) years old, diagnosed with primary (n=27) or secondary (n=12) myelofibrosis underwent HSCT (25 related and 14 unrelated). In ten patients, disease had transformed into acute leukaemia. Lille prognosis score was low for 9, intermediate for 16 and high for 14 patients. The conditioning regimen was myeloablative (MAC) for 15 and reduced-intensity (RIC) fludarabine-based for 24, with successful engraftment in 38 patients. A total of 31 patients developed grade I-IV GvHD; 19 developed chronic GvHD. The 3-year OS, RFS and NRM rates (95% confidence interval) were 60% (42-74), 54% (37-59) and 30% (30-45), respectively.
Bone marrow transplantation 11/2010; 46(4):557-61. · 3.00 Impact Factor
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P Chevallier,
M Labopin,
A Nagler,
P Ljungman,
L F Verdonck,
L Volin,
A R Zander,
J Finke, G Socie,
C Cordonnier,
J-L Harousseau,
M Mohty,
V Rocha
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ABSTRACT: The aim of this multicenter retrospective analysis was to carry out a survey of overall outcomes after allo-hematopoietic SCT of AML patients harboring trisomy 8 (+8) as the sole chromosomal abnormality or associated with other abnormalities. We have identified 182 de novo AML patients who underwent allo-hematopoietic SCT between 1990 and 2007 exhibiting isolated +8 (n=136) or +8 (n=46) associated with other favorable (n=8), intermediate (n=30), high-risk (n=7) or unknown (n=1) cytogenetic abnormalities reported to the European Group of Blood and Marrow Transplantation (EBMT). With a median follow-up of 48 months, 5-year non-relapse mortality, relapse rate, leukemia-free survival and OS were 25, 30, 45 and 47%, respectively. In a multivariate analysis, leukemia-free survival rate was improved when patients were female and transplanted in CR with an HLA-identical sibling donor. Five-year leukemia-free survival was 41, 88, 57 and 21% in patients bearing isolated +8 or +8 and other cytogenetic abnormalities of good, intermediate or poor-risk, respectively. Our retrospective data show that allo-hematopoietic SCT is an effective treatment for AML patients harboring +8. The accompanying cytogenetic abnormality to +8 seems to influence outcomes of these patients.
Bone marrow transplantation 05/2009; 44(9):589-94. · 3.00 Impact Factor
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V Rocha,
R Porcher,
J F Fernandes,
A Filion,
H Bittencourt,
W Silva,
G Vilela,
D L Zanette,
C Ferry,
J Larghero,
A Devergie,
P Ribaud,
Y Skvortsova,
R Tamouza,
E Gluckman, G Socie,
M A Zago
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ABSTRACT: Individual differences in drug efficacy or toxicity can be influenced by genetic factors. We investigated whether polymorphisms of pharmacogenes that interfere with metabolism of drugs used in conditioning regimen and graft-versus-host disease (GvHD) prophylaxis could be associated with outcomes after HLA-identical hematopoietic stem cell transplantation (HSCT). Pharmacogenes and their polymorphisms were studied in 107 donors and patients with leukemia receiving HSCT. Candidate genes were: P450 cytochrome family (CYP2B6), glutathione-S-transferase family (GST), multidrug-resistance gene, methylenetetrahydrofolate reductase (MTHFR) and vitamin D receptor (VDR). The end points studied were oral mucositis (OM), hemorrhagic cystitis (HC), toxicity and venoocclusive disease of the liver (VOD), GvHD, transplantation-related mortality (TRM) and survival. Multivariate analyses, using death as a competing event, were performed adjusting for clinical factors. Among other clinical and genetic factors, polymorphisms of CYP2B6 genes that interfere with cyclophosphamide metabolism were associated with OM (recipient CYP2B6(*)4; P=0.0067), HC (recipient CYP2B6(*)2; P=0.03) and VOD (donor CYP2B6(*)6; P=0.03). Recipient MTHFR polymorphisms (C677T) were associated with acute GvHD (P=0.03), and recipient VDR TaqI with TRM and overall survival (P=0.006 and P=0.04, respectively).Genetic factors that interfere with drug metabolisms are associated with treatment-related toxicities, GvHD and survival after HLA-identical HSCT in patients with leukemia and should be investigated prospectively.
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 12/2008; 23(3):545-56. · 8.30 Impact Factor
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E Holler,
G Rogler,
J Brenmoehl,
J Hahn,
H Greinix,
A M Dickinson, G Socie,
D Wolff,
J Finke,
G Fischer,
G Jackson,
V Rocha,
I Hilgendorf,
G Eissner,
J Marienhagen,
R Andreesen
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ABSTRACT: Previous studies from our group indicated a role of SNPs within the innate immunity receptor NOD2/CARD15 as a risk factor for GvHD and treatment-related mortality allogeneic stem cell transplantation from HLA-identical siblings. We now extended these studies to assess the role of NOD2/CARD15 SNPs in 342 unrelated donor transplants. Overall, presence of any SNPs in patients or donor resulted in an increased risk of severe GvHD (25% in wildtype versus 38% in recipients and donors with variants, P= 0.01), which did not translate in increased mortality. When the analysis was broken down to individual SNPs, the presence of a SNP13 in the donor turned out to be the only highly significant risk factor (GvHD III/IV 22% wt, 42% SNP13 donor, P < 0.004; TRM 33% wt versus 59% SNP13 donor, P= 0.01; overall survival 49% wt versus 26% SNP13 donor, P= 0.007). This association was confirmed in multivariate analysis. Analysis of clinical risk factors suggested that this effect was most prominent in patients receiving any form of T cell depletion. Thus our observation indicates that the presence of a defect in innate immunity signalling in donor monocytes and possibly antigen presenting cells is most prominent in patients having additional T cell deficiency.
International Journal of Immunogenetics 08/2008; 35(4-5):381-4. · 1.29 Impact Factor
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Régis Peffault de Latour,
Jean Yves Mary,
Célia Salanoubat,
Louis Terriou,
Gabriel Etienne,
Mohamad Mohty,
Sophie Roth,
Sophie de Guibert,
Sebastien Maury,
Jean Yves Cahn, Gerard Socié
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ABSTRACT: The natural history of paroxysmal nocturnal hemoglobinuria (PNH) clinical subcategories (classic PNH and aplastic anemia [AA]/PNH syndrome) is still unknown. We retrospectively studied 460 PNH patients diagnosed in 58 French hematologic centers from 1950 to 2005. The median (SE) follow-up time was 6.8 (0.5) years. The median survival time (SE) was 22 (2.5) years. We identified 113 patients with classic PNH, 224 patients with AA-PNH syndrome, and 93 (22%) intermediate patients who did not fit within these 2 categories. At presentation, classic PNH patients were older, with more frequent abdominal pain and displayed higher levels of GPI-AP-deficient granulocytes. A time-dependent improved survival was observed. In classic PNH, diagnoses before 1986 (hazard ratio [HR]: 3.6; P = .01) and increasing age (P < .001) were associated with worse survival prognoses, whereas use of androgens within the first year after diagnosis was protective (HR, 0.17; P = .01). Transfusions before 1996 (HR, 2.7; P = .007) led to lower survival rates in patients with AA-PNH syndrome, whereas immunosuppressive treatment was associated with better outcomes (HR, 0.33; P = .03). Evolution to thrombosis affected survival in both subcategories (classic PNH: HR, 7.8 [P < .001]; AA-PNH syndrome: HR, 33.0 [P < .001]). Evolution to bicytopenia or pancytopenia for classic PNH (HR, 7.3, P < .001) and malignancies for AA-PNH syndrome (HR, 48.8; P < .001) were associated with worse outcomes. Although clinical presentation and prognosis factors are different, classic PNH and AA-PNH syndrome present roughly similar outcomes, affected mainly by complications.
Blood 07/2008; 112(8):3099-106. · 9.90 Impact Factor
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ABSTRACT: Chronic graft-versus-host disease (GVHD) has been a difficult problem to address and clinical research in this area lags behind other innovations in hematopoietic stem cell transplantation (HCT). Recently the international transplant community has focused more on chronic GVHD. This new focus is well represented by the development of the National Institutes of Health sponsored chronic GVHD consensus project, which has unified the transplant community's approach to chronic GVHD through the activities of focused working groups. From December 2005 through May 2006, a series of consensus documents have been published addressing the areas of diagnosis and staging, histopathology, strategies for the development and validation of biomarkers, response criteria, ancillary therapy and supportive care and the design of clinical trials. This paper summarizes and discusses these reports, focusing specifically on diagnosis and scoring and response criteria. Although these documents represent a huge effort by the research community, they must be prospectively implemented and validated. These new criteria should advance the standards and uniformity of chronic GVHD clinical research. The ultimate success of this project is dependent on whether these recommendations move the field forward. This is an opportunity for the transplant community to unite and make a significant impact in chronic GVHD.
Bone Marrow Transplantation 12/2006; 38(10):645-51. · 3.75 Impact Factor
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P Ljungman,
A Urbano-Ispizua,
M Cavazzana-Calvo,
T Demirer,
G Dini,
H Einsele,
A Gratwohl,
A Madrigal,
D Niederwieser,
J Passweg,
V Rocha,
R Saccardi,
H Schouten,
N Schmitz, G Socie,
A Sureda,
J Apperley
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ABSTRACT: The Accreditation Subcommittee of the EBMT regularly publishes special reports on current practice of haemopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred since the first report was published in 1996. Haemopoietic stem cell transplantation today includes grafting with allogeneic and autologous stem cells derived from bone marrow, peripheral blood and cord blood. With reduced intensity conditioning regimens in allogeneic transplantation, the age limit has increased, permitting the inclusion of older patients. New indications have emerged such as autoimmune disorders and AL amyloidosis for autologous, and solid tumours for allogeneic transplants. The introduction of alternative therapies has challenged well-established indications such as imatinib for chronic myeloid leukaemia. An updated report with revised tables and operating definitions is presented here.
Bone Marrow Transplantation 04/2006; 37(5):439-49. · 3.75 Impact Factor
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H Bittencourt,
V Rocha,
A Filion,
I Ionescu,
A-L Herr,
F Garnier,
L Ades,
H Esperou,
A Devergie,
P Ribaud, G Socie,
E Gluckman
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ABSTRACT: Poor graft function (PGF) is a frequent cause of morbidity after allogeneic hematopoietic stem cell transplantation (allo-HSCT). To study the value of granulocyte colony-stimulating factor (G-CSF) in PGF, we retrospectively analyzed 81 episodes of PGF in 66 patients transplanted from 01/94 to 01/99 from an HLA-identical sibling (n = 45) or an unrelated (n = 21) donor. Median age was 29 years, 55 patients had malignancies. A total of 11 patients received a CD34+ selected graft. Viral infections (25%), myelotoxic drug (33%), fungal/bacterial infections (14%), and GVHD (31%) were present before PGF diagnosis. Median time from allo-HSCT to PGF was 75 (25-474) days. All patients were treated with G-CSF. In 77/81 episodes, there was a response that was sustained in 57. A total of 27 patients presented an increase of white cell count (WBC) >0.1 x 10(9)/l after 3 days of G-CSF. The 5-year survival was 37% and was significantly better in patients with increased WBC > 0.1 x 10(9)/l after 3 days of G-CSF (65 vs 18%, P < 0.0001). In multivariate analysis, increased WBC > 0.1 x 10(9)/l after 3 days of G-CSF (P = 0.002) was associated with better survival, while BuCy-based conditioning (P = 0.02) and GVHD (P = 0.005) were associated with higher risk of death. In conclusion, hematological response after 3 days with G-CSF predicted a better survival for patients with PGF after allo-SCT.
Bone Marrow Transplantation 09/2005; 36(5):431-5. · 3.75 Impact Factor
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ABSTRACT: To determine the incidence of secondary myelodysplasia (sMDS) or acute myeloid leukemia (AML) in node-positive breast cancer patients who received high-dose chemotherapy (HDCT) followed by autologous stem-cell support as adjuvant therapy.
The incidence of sMDS/AML was retrospectively assessed in 364 node-positive breast cancer patients who received HDCT followed by autologous stem-cell support as adjuvant therapy between November 1989 and December 1997 and were reported to the European Group for Blood and Marrow Transplantation registry.
The median age of the patients was 45 years (range 22-62 years). Two hundred and ninety-one patients received peripheral blood stem cells and 55 patients received autologous bone marrow as stem-cell support. The most frequently used conditioning regimen was the STAMP-V regimen (32%), followed by melphalan-thiotepa (22%) and melphalan-mitoxantrone-cyclophosphamide (21%). The 5-year probability of overall survival is 71% (95% CI 65% to 77%). After a median follow-up of 48 months (range 1-108 months) only one case of AML was observed, resulting in a crude incidence of 0.27%. This case of AML was observed 18 months after HDCT consisting of three cycles of epirubicin and cyclophosphamide with a cumulative dose of epirubicin 960 mg and cyclophosphamide 19 g. The French-American-British type of AML was M4, and the cytogenetic analysis showed a translocation t(9;11)(p22;q23). After complete remission following high-dose cytarabine and idarubicin the patient relapsed and died.
In contrast to patients with malignant lymphoma there seems to be no increased risk of sMDS/AML after HDCT in breast cancer. Continued monitoring is required to confirm this low incidence after a longer follow-up period.
Annals of Oncology 05/2003; 14(4):554-8. · 6.43 Impact Factor
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A Urbano-Ispizua,
N Schmitz,
T de Witte,
F Frassoni,
G Rosti,
H Schrezenmeier,
E Gluckman,
W Friedrich,
C Cordonnier, G Socie,
A Tyndall,
D Niethammer,
P Ljungman,
A Gratwohl,
J Apperley,
D Niederwieser,
A Bacigalupo
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[hide abstract]
ABSTRACT: The Accreditation Sub-Committee of the EBMT regularly publishes special reports on current practice of haemopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders. Major changes have occurred since the last report in 1998. Haemopoietic stem cell transplantation today includes allogeneic and autologous stem cells derived from bone marrow, peripheral blood and cord blood. With reduced intensity conditioning regimens in allogeneic transplantation, the age limit has increased, permitting the inclusion of older patients. New indications have emerged, such as autoimmune disorders and AL amyloidosis for autologous, and solid tumours for allogeneic transplants. Other indications, such as autologous transplantation for breast cancer have been challenged. An updated report with revised tables and operating definitions is presented here.
Bone Marrow Transplantation 05/2002; 29(8):639-46. · 3.75 Impact Factor
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ABSTRACT: Toxoplasmosis is a rare but severe complication of bone marrow transplantation. Here, we report three patients in whom toxoplasmic pneumonitis developed, leading to fatal acute respiratory distress syndrome (ARDS). All patients had positive pretransplantation tests for Toxoplasma gondii and were therefore at risk to develop toxoplasmosis reactivation. They all recovered from aplasia, but soon after they died from brutal and severe ARDS. The possible role of an immunopathologic response to T gondii in the lungs in triggering ARDS is discussed.Early screening of parasitemia using highly sensitive polymerase chain reaction methods in seropositive patients with unexplained fever may be needed.
Transplantation 01/2002; 72(11):1838-40. · 4.00 Impact Factor
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N Salooja,
R M Szydlo, G Socie,
B Rio,
R Chatterjee,
P Ljungman,
M T Van Lint,
R Powles,
G Jackson,
M Hinterberger-Fischer,
H J Kolb,
J F Apperley
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ABSTRACT: Some patients treated by transplantation of haemopoietic stem cells (peripheral blood or bone marrow) become permanently infertile, but others retain or recover fertility. We assessed the outcome of conception in women, and partners of men previously treated by autologous or allogeneic stem cell transplantation (SCT).
We sent questionnaires to 229 centres of the European Group for Blood and Marrow Transplantation. We sought details about the original disease, transplant procedure, and outcome of conception for both male and female patients.
199 centres gave information relating to 19412 allogeneic and 17950 autologous transplant patients. 232 (0.6%) patients conceived after SCT. Crude annual birth rate for 4-month survivors of SCT was lower than the national average for England and Wales at 1.7 per 1000 patients. 312 conceptions were reported in 113 patients (74 allograft) and partners of 119 patients (93 allograft). Most pregnancies were uncomplicated and resulted in 271 livebirths. 28 (42%) of 67 allograft recipients had caesarean section compared with 16% in the normal population (difference =26% [95% CI 15-38]), 12 (20%) of 59 had preterm delivery compared with a normal rate of 6% (14% [4-24]), and 12 (23%) of 52 had low birthweight singleton offspring compared with a normal rate of 6% (17% [6-29]).
Pregnancy after SCT is likely to have a successful outcome. Pregnancies in allograft patients who have received total body irradiation should be treated as high risk for maternal and fetal complications.
The Lancet 08/2001; 358(9278):271-6. · 38.28 Impact Factor
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[show abstract]
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ABSTRACT: Secondary malignant diseases are late complications after allogeneic bone marrow transplantation (BMT). Anogenital lesions associated with human papillomavirus (HPV) infection have been described in renal transplant recipients but not after BMT. HPV types 16 and 18 are strongly linked to the malignant transformation.
In a series of 238 patients with allogeneic BMT, three had anogenital lesions. We looked for HPV in DNA extracted from embedded tissue to study HPV genotypes, p53 expression, and ploidy.
In two patients, HPV sequences were detected. One of them, with giant condyloma, had HPV type 18 and two aneuploid clones, but p53 expression was not found.
As in solid organ transplant recipients, anogenital condyloma may develop after BMT. Because the oncoprotein of HPV is able to bind and to degrade p53, it may lead to genetic instability, and subsequently to malignant transformation.
Transplantation 02/2001; 71(1):167-9. · 4.00 Impact Factor
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[show abstract]
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ABSTRACT: Allogeneic bone marrow transplantation (BMT) is an effective treatment for Fanconi's anemia (FA) but it requires a dose reduction of alkylating agents used for conditioning because of the increased sensitivity of FA cells to DNA cross-linking agents. Oesophageal damage has not previously been described as a complication after allogeneic BMT for this indication. We report five cases of severe oesophagitis with stenosis in patients transplanted for FA. It occurred either early, or more surprisingly, several years after BMT and could have easily been misdiagnosed. It could be explained by hypersensitivity of the FA mucosal cells to cytotoxic agents despite the reduced doses of cyclophosphamide and irradiation or to non diagnosed congenital abnormalities of the oesophagogastric junction. However, the evolution of the oesophageal disease was favorable in all, and none of the patients developed secondary cancer. Awareness of this complication will lead to earlier diagnosis and treatment of oesophageal stenosis and related malnutrition.
Bone Marrow Transplantation 08/2000; 26(2):215-8. · 3.75 Impact Factor
