bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Features and Risk Factors of Pure Red Cell Aplasia Following Major ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation.
Authors: Zhu Kanger , Li Jun-ping , Zhang Tao 
Published: October 2019

Abstract
Objective:To study the incidence, risk factors, clinical outcome, management and prevention of pure red cell aplasia (PRCA) following major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Method:We retrospectively analyzed 11 cases of PRCA from a series of 42 patients undergoing major ABO-incompatible allo-HSCT from April, 1997 to December, 2005.
Results:1. 11 out of the 42 patients developed PRCA (26.1%); 2. All the 11 cases of PRCA were in blood group O recipients of grafts from blood group A donor (n=9) or blood group B donor (n=2). 3. The following factors were associated with an increased risk of PRCA:(1) blood group O recipient;(2) blood group A donor;(3) blood group O/A in recipient/donor pair;4. Only blood group O/A in recipient/donor pair was identified as being significantly associated with the occurrence of PRCA by multivariate analysis (P=0.006); 5. 6 patients who received donor-type plasma exchange did not develop PRCA, and among them, 5 cases were the O blood group recipients. 8 patients obtained spontaneous remission and in the remaining 3 patients, 2 patients with long-lasting PRCA were successfully treated with plasma exchange with donor-type plasma replacement and the other one who was also complicated by EBV-associated lymphoproliferative disorder (EBV-PTLD) responded rapidly to anti-CD20 monoclonal antibody and achieved complete resolution of clinical finding and symptom of both EBV-PTLD and PRCA.
Conclusions:The incidence of PRCA in this series of patients was 26.1%. Only blood group A/O in donor/recipient pair is identified as being significantly associated with the occurrence of PRCA by multivariate analysis. Donor-type plasma exchange is an effective approach for the treatment and prophylaxis of PRCA. Anti-CD20 monoclonal antibody is indicated for patients who are not response to conventional therapy.
Adverse Events after Infusions of Cryopreserved Hematopoietic Stem Cells Depend on Non-Mononuclear Cell in Infused Suspension and on Patient Age.
Authors: Milone Giuseppe , Pinto Valeria , Mercurio Salvatore , Strano Aurora , Coppoletta Stefania , Farsaci Benedetto , Poidomani Massimo , Leotta Salvatore , Giustolisi Rosario 
Published: October 2019

Abstract
We have prospectively collected data on Adverse Events (AE) that occurred in 179 Hemopoietic Progenitor Cell (HPC) infusions performed in patients affected with haematological neoplasm, after high dose chemotherapy. Stem cell source was Hemopoietic Progenitor Cells Aphaeresis (HPC-A) in 157 cases and Hemopoietic Progenitor Cells Bone Marrow (HPC-BM) in 22 cases. In all cases, an endotoxin-free DMSO was used. One or more AE were registered in 51/179 infusions (28.6%). Frequency of AE was higher after HPC-A than after HPC-BM (31.3% versus 4.5%, (chi square test: p=0.008). In univariate logistic regression other factors found important for AE were: Age (p=0.028), Number of Total Nucleated Cells infused/kg (P=0.002), Volume/kg infused (p=0.057), Volume of Packed Red Blood Cells (p=0.019), a content of Non-Mononuclear Cells >0.500 × 108/Kg (<p=0.0001) and Actual Time of infusion (p=0.058). When all aforementioned factors were evaluated in multivariate logistic regression only Age of patient (P=0.024) and a content of Non-Mononuclear Cells > 0.5×108/kg (P=0.0003) remained significant. No cardiovascular events were recorded during infusions. A significant correlation existed between reduction of cardiac frequency both with Volume/Kg infused (r 0.221; p=0.02) and with Actual Time of infusion (r 0.269; p=0.005). In conclusion, while Cardiovascular Changes are influenced by Volume/Kg infused and by Actual Time of infusion, Non-Cardiovascular AE are dependent on patient Age and on contamination by Non-Mononuclear Cells in apheretic harvests.
High Incidence of BK-Virus-Related Hemorrhagic Cystitis after Busulfan/Fludarabine Myeloablative Conditioning in Allogeneic Stem Cell Transplantation Recipients.
Authors: Akpek Gorgun , Badros Ashraf , Rapoport Aaron P. , Ruehle Kathleen , Barton Kristen , Meisenberg Barry , Yanovich Saul 
Published: October 2019

Abstract
Busulfan (BU) and Fludarabine (F) has been reported by de Lima et al. to be a well-tolerated myeloablative conditioning regimen with 3% incidence of hemorrhagic cystitis (Blood2004;104:857). Between 5/2005 and 5/2006, we performed allogeneic stem cell transplantation (SCT) in 29 patients following BU+F (n=17) and other (n=12) myeloablative regimens. Nineteen (66%) patients were in remission and 10 (34%) had active disease at BMT. Twenty patients had AML, 4 ALL and 5 had other malignancies. Busulfan was given at 130mg/M2 over 3 hours on 4 successive days, along with Fludarabine 40mg/M2 on 4 successive days. Eighteen (72%) had matched-related 7 (24%) had matched-unrelated donor (MUD) transplant. GVHD prophylaxis consisted of Tacrolimus and low-dose Methotrexate. Thymoglobulin (n=4) and CAMPATH (n=3) were given along with conditioning in MUD/one-antigen mismatch transplant recipients (5 BU+F and 2 other). As of August 1st, 2006, 19 (65%) patients are alive. Of 26 evaluable patients, the incidence of bacterial (59% vs. 89%), fungal (29% vs. 11%) infections were similar between Bu+F and other group, respectively. CMV reactivation was observed in 78% in other group as compared to 35% in BU+F recipients (p=0.09). Hemorrhagic cystitis (HC) occurred in 6 patients (35%) in BU+F group and in 1 (11%) patient in other group (p=0.35). BK virus was detected by quantitative PCR in all patients with HC. Two BK(+) cases were in BU+F+CAMPATH group. Considering 18 AML patients who received transplant in remission and had at least 2 months of follow-up, 5 patients (38%) in BU+F group relapsed within 6 months of transplant. Two out of 5 patients relapsed in the other group. Our findings suggest that BU+F myeloablative conditioning appears to be associated with high incidence of BK-related hemorrhagic cystitis and may have long-term consequences. Further studies are warranted.
Bone Marrow Transplantation from Alternative Donors in Children Receiving Rabbit ATG for Prophylaxis of Graft-Versus-Host Disease.
Authors: Hama Asahito , Yagasaki Hiroshi , Nishio Nobuhiro , Yoshida Nao , Tanaka Makito , Hidaka Hirokazu , Takahashi Yoshiyuki , Matsumoto Kimikazu , Kato Koji , Kojima Seiji 
Published: October 2019

Abstract
Rabbit antithymocyte globulin (ATG) has been used in allogeneic stem cell transplantation to facilitate engraftment as well as prevent graft-versus-host disease (GVHD). ATG can reduce the incidence of acute and chronic GVHD, but it prolongs the period of immunodeficiency and increases the incidence of infectious complications such as Epstein-Barr virus-related lymphoproliferative disorders (EBV-LPD). To evaluate the advantages and disadvantages of incorporating ATG into the preconditioning regimen, we reviewed records of 70 children with malignant (n=16) or non-malignant disease (n=54) who received unmanipulated bone marrow transplant (BMT) from alternative donors at our hospitals. Eleven patients (15.7%) received BMT from an HLA-mismatched related donor and 59 (84.3%) received BMT from an unrelated voluntary donor. The median age was 9 years (range, 0–21 years). The ratio of boys to girls was 2:1. The serological compatibility of HLA was as follows: 6/6 matched (n=43), 5/6 matched (n=21), 4/6 matched (n=5), and 3/6 matched (n=1). Fifty-one patients (72.9%) received a preconditioning regimen including total body irradiation, 15 (21.4%) received busulfan-based regimens, and 4 (5.7%) received other regimens. ATG (2.5mg/kg/day) was administered for 4 days (day -5, -4, -3, and -2) in all patients. For prophylaxis against GVHD, cyclosporine + methotrexate (MTX) was administered to 34 (48.6%) patients and tacrolimus + MTX to 36 (51.4%). Stable engraftment was not achieved in 2 of 70 (2.9%) patients. Both patients were rescued by second transplants from another donor. Acute GVHD (grade 2–4) developed in 13 of 68 (19.1%) evaluable patients and chronic GVHD in 16 of 62 (25.8%) evaluable patients (limited type, 4; extensive type, 12). Six patients (8.8%) suffered from interstitial pneumonitis and 5 patients (7.4%) developed EBV-LPD. Ten patients died of regimen-related toxicities and 3 died due to relapse of malignant disease. The estimate for 5-year survival from BMT was 88.5% for patients with non-malignant disease and 51.1% for patients with malignant disease. Our dose schedule of ATG appeared to be well tolerated and effective at reducing the incidence of acute and chronic GVHD in high-risk recipients.
Empiric or Presumptive Anti-Aspergillus Treatments for Allogeneic Hematopoietic Stem Cell Transplant Recipients with Sustained Febrile Neutropenia.
Authors: Oshima Kumi , Kanda Yoshinobu , Asano-Mori Yuki , Sato Hiroyuki , Watabane Takuro , Hosoya Noriko , Izutsu Koji , Asai Takashi , Hangaishi Akira , Motokura Toru , Chiba Shigeru , Kurokawa Mineo 
Published: October 2019

Abstract
Background: Although the onset of invasive pulmonary aspergillosis (IPA) after allogeneic hematopoietic stem cell transplantation (HSCT) was bimodal, IPA early after HSCT has become less frequent, partly due to the shortening of neutropenic periods by the use of peripheral blood stem cells or colony-stimulating factors. Therefore, the validity of empiric anti-Aspergillus treatments based on sustained febrile neutropenia according to the IDSA guideline should be re-evaluated.
Patients and Methods: We retrospectively reviewed the clinical records of 114 adult patients who underwent allogeneic HSCT between September 2002 and December 2005 in HEPA-filtered clean rooms at the University of Tokyo Hospital. Fluconazole at 200 mg/day was given as anti-Candida prophylaxis. In general, anti-Aspergillus agents were not started empirically, but presumptively started after the detection of positive Aspergillus antigen, positive beta-D-glucan, halo-sign on chest X-ray or CT-scan, and so on, associated with sustained febrile neutropenia. For the definition of early IPA, we employed proven or probable IPA according to the EORTC/MSG criteria that developed between the day of HSCT and seven days after engraftment.
Results: All but two who experienced early death showed neutrophil engraftment at a median of 16.5 days after HSCT. Although 15 patients developed IPA after HSCT, early IPA was observed only in 2 (1.8 %) patients. Among 73 patients who experienced sustained febrile neutropenia for more than 7 days before engraftment, we empirically started anti-Aspergillus agents in 13 patients a median of 9 days after the development of febrile neutropenia, whereas fluconazole was continued in 60 patients who had febrile neutropenia for 15 days in median. Four of the 60 patients received presumptive anti-Aspergillus therapy, one of whom developed probable IPA after the initiation of treatment. There was another patient who received anti-Aspergillus treatment only after the development of probable IPA because he showed no prior signs for presumptive therapy. There was no difference in the incidence of early IPA between patients who received empiric anti-Aspergillus therapy and those who did not (0% vs. 3.3%, P>0.99). The two patients who developed early probable IPA were successfully treated with anti-Aspergillus agents.
Conclusions: These findings throw doubt on the validity of empiric anti-Aspergillus treatments for allogeneic HSCT recipients with sustained febrile neutropenia, provided that they are treated in clean units with anti-Candida prophylaxis. A randomized controlled trial is warranted to compare empiric and presumptive anti-Aspergillus treatments for allogeneic HSCT recipients with sustained febrile neutropenia.
Prospective Investigation of Hemostatic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation.
Authors: Han Yue , Lu Xiaoxu , Wu De Pei , Sun Aining 
Published: October 2019

Abstract
Objective To illustrate the alteration of hemostatic parameters in recipients of hematopoietic stem cell transplantation (HSCT) and then determine its value in transplantation-related complications.
Methods 45 patients receiving HSCT were evaluated prospectively in our institution. Hemostatic parameters were investigated prior to conditioning therapy and then weekly until five weeks after HSCT by enzymimmunoassay.
Results Significant increase was observed in the levels of fibrinogen, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) after transplant, while Protein C decreased significantly. No significant change existed in prothrombin time (PT), activated partial thromboplastin time (APTT) and antithrombin III (ATIII) levels. Six patients with acute grades II–IV graft-versus-host disease (aGVHD) presented with significantly lower level of Protein C compared with those who had grades 0–I aGVHD, PAI-1 level didn’t change apparently as well as fibrinogen and t-PA in the same time. However, three patients with veno-occlusive disease (VOD) extremely showed elevated PAI-1 levels after the clinical onset of VOD by comparison with mean post-HSCT values in the non-VOD patients; similar result was found in the patient who developed thrombotic microangiopathy (TMA).
Conclusion Our results suggest hemostatic imbalance is one important manifestation during HSCT, reflecting prothrombotic states and endothelial damage, which may be caused by the conditioning regimen and/or transplantation-related complications. The extreme elevation of PAI-1 alteration may be useful to recognize the development of VOD and TMA, while Protein C diminution facilitates the early diagnosis of aGVHD.
Selective Embolization of the Vesical Arteries for the Treatment of Severe Hemorrhagic Cystitis after Hematopoietic Stem Cell Transplantation.
Authors: Han Yue , Wu De Pei , Sun Aining , Chang Weirong , Zhu Xiaming 
Published: October 2019

Abstract
Background Hemorrhagic cystitis (HC) is a frequent and sometimes life-threatening complication after hematopoietic stem cell transplantation (HSCT). Many therapeutic approaches have been performed to control HC, but effective treatment for severe HC is still limited. This study investigated the role of selective embolization of the vesical arteries in patients with severe HC following hematopoietic stem cell transplantation (HSCT).
Methods Eight patients with late onset HC receiving HSCT were enrolled in the study, All patients underwent allogeneic transplantation and cyclophosphamide for preconditioning, including grade 3 or 4 HC, no improvement to routine management. A retrograde arterial catheterization of the femoral artery by seldinger’s technique was achieved in order to perform digital angiography of the aorto-iliac sector. Selective catheterization of the hypogastric arteries with a standard angiographic catheter was performed to localize the vesical vessels and confirm their bleeding site. Embolization of these arteries was carried out with gelatin sponge.
Results Eight patients with severe HC were treated with selective embolization of the vesical arteries. Five patients achieved complete response, with hematuria and symptoms ceased after 1–3 days of treatment. Two patients achieved partial response, with diminution of hematuria or presence of microscopic hematuria with no symptoms. One patient obtained no response to treatment.
Conclusion We investigated eight patients, among more than 280 patients treated in our hospital by allogeneic hematopoietic stem cell transplantation, in which HC was severe enough to require embolization. Our study showed that selective embolization of the vesical arteries is an effective treatment option in patients with severe HC following HSCT.
Prophylactic and Preemptive Anti-Fungal Therapy after Cord Blood Transplantation: A Retrospective Analyses of 188 Adult Patients.
Authors: Matsuhashi Yoshiko , Takagi Shinsuke , Yamamoto Hisashi , Kato Daisuke , Matsuno Naofumi , Seo Sachiko , Uchida Naoyuki , Masuoka Kazuhiro , Wake Atsushi , Miyakoshi Shigesaburo , Yoneyama Akiko , Taniguchi Shuichi 
Published: October 2019

Abstract
Background: Therapeutic outcomes for hematological diseases have recently been markedly improved due to the introduction of hematopoietic stem cell transplantation (HSCT), improvement of therapeutic regimens, and advancement of support therapy. Although invasive fungal infections have been one of the major causes of morbidity and mortality after cord blood transplantation(CBT), proper prophylactic and therapeutic approach to them has not been clearly established yet. To address this, we performed retrospective analysis to assess the effectiveness and safety of various antifungal agents for prevention and treatment of invasive fungal infections.
Patients and Methods: Medical records of a total of 188 patients who underwent umbilical CBT at Toranomon hospital between March 2002 and December 2005 were reviewed. The diagnosis included AML (n=53), ML (n=32), MDS (n=25), ALL (n=24), ATL (n=22), CML (n=7), AA (n=5), MM (n=3), and others (n=17). The median age was 54 (range; 17–79). The conditioning regimen consisted of fludarabine (125mg/m2), melphalan (80 mg/m2) and 4 Gy TBI for most of the patients. The incidence of breakthrough invasive fungal infection within 50 days after transplant was analysed.
Results: Forty-eight of the 188 were administered prophylactic anti-fungal agents other than fluconazole (FLCZ) due to prior mold infection, intorelant to FLCZ, and so on, were excluded. Remaining 140 patients who received FLCZ categolized into 2 groups; those who had empirically switched FLCZ to micafungin (MCFG) and/or amphotericin B (AMPH) and/or itraconazole (ITCZ) capsule at the first sign of infection (group A, n=69), and those who had continued FLCZ (group B, n=71). Four breakthrough invasive fungal infections were observed, 3 of them were invasive pulmonary aspergillosis (IPA), and 1 of them was tricosporon sepsis. Interestingly, all of these 4 were in group B, whereas no breakthrough infections were observed in those who were in group A. All 3 diagnosed IPA died of its exacerbation despite MCFG and/or AMPH treatment.
Conclusion: Proper administration of prophylactic anti-fungal agents can reduce the incidence of invasive fungal infection early after CBT. Although FLCZ has less activity to aspergillus, prophylactic FLCZ is effective enough to prevent breakthrough fungal infection. Immediate switch to other agents at the first sign of infection, such as MCFG, AMPH, ITCZ which are active against aspergillus could be recommended to prevent breakthrough infections.
Autologous Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma: Adverse Events Occurring 5 Years and Beyond.
Authors: Bolwell Brian , Sweetenham John William , Rybicki Lisa , Sobecks Ronald , Dean Robert , Andresen Steven , Brown Stacey , Kalaycio Matt , Pohlman Brad 
Published: October 2019

Abstract
Autologous stem cell transplantation (ASCT) is the treatment of choice for patients with relapsed/refractory DLBCL. ASCT is widely quoted as being potentially curative. We queried whether surviving patients free of disease five years after transplant were still at ongoing risk for relapse or other adverse events. We therefore retrospectively reviewed 174 patients with DLBCL receiving an ASCT from 1/1992 through 12/2001 who have been followed for at least 5 years since the date of transplant. Of these, 121 relapsed or died within the first 5 years of transplant; 42 are alive without disease greater than 5 years after transplant; and 11 relapsed or died greater than 5 years post-transplant. The median follow up among survivors is 7.3 years. Among the 11 patients with late events, 3 experienced non-relapse mortality: one died of secondary malignancy 104 months post-transplant; one died in a car accident 62 months post-transplant; one committed suicide 93 months post-transplant. Eight patients relapsed beyond 5 years from transplant: 3 have died and 5 are still alive. The three patients who expired from their relapse did so at 0.4, 2.5 and 23.2 months after relapse. Five patients relapsed between 63 and 102 months post-transplant and remain alive 6–72 months later. Two demographic trends were of interest: patients experiencing late adverse events were more likely to have bone marrow involvement at diagnosis, as 36% of patients with late events had marrow involvement at diagnosis as compared to 19% who remain alive and disease free; and of patients alive and disease free 5+ years post-transplant, 67% are male and 33% are female; of patients with late adverse events, 45% are male and 55% are female. The relapse-free survival curve for the entire patient cohort is shown below:
Figure Figure
We conclude that there is a low, but detectable, risk of disease relapse that continues beyond 5 years after ASCT for DLBCL. However, in this series the majority of patients experiencing delayed relapse remain alive with additional therapy. This underscores the importance of extended ongoing follow up for DLBCL patients treated with ASCT.
Transplant-Associated Thrombotic Microangiopathy (TAM): A Study Comparing Hemopoietic Stem Cells (HSCT) and Solid Organ (SO) Transplant (TX) Recipients.
Authors: Puente Dolores , Tabares Maria , Requejo Alejandro , Cecilia Colorio , Bonini Nicolas , Rossi Andrea , Listello Viviana , Milovic Vera , Jaimovich Gregorio , Pombo Gonzalo , Feldman Leonardo 
Published: October 2019

Abstract
TAM is associated with a poor prognosis and outcome. Reported incidence varies from 0.5 to 76%. Risk factors (RF) include use of calcineurin inhibitors(CNI), infections, conditioning chemotherapy regimen and graft versus host disease. Although treatment (TMT) modalities such as inmunosuppressive drugs withdrawal, plasma exchange or infusion are used to improve the outcome, optimal therapeutic strategies are not clearly defined.
OBJECTIVE: To compare the incidence, RF and outcome of patients (pts) with TAM after HSCT and SOTX.
PATIENTS AND METHODS: In 1172 consecutive pts transplanted between february 2000 and june 2006, 22 TAM episodes were diagnosed. TAM Dg was defined as evidence of hemolysis and schistocytes in blood smear. Thrombocytopenia (TCP), neurological (NRL) or renal (RNL) dysfunction were not included in the diagnostic criteria.
RESULTS: MAT incidence was 5,41% (11/203) in HSCT and 1,13% (11/969) in SOTX pts (p<0,0006). Median follow up of surviving pts was 1144 days (range: 281–2432). Overall mortality was 36,36% (8/22), 4/11 HSCT and 4/11 SOTX.
HSCT m HSCT r SOTX m SOTX r m: media r: range Age (years) 23,6 7–42 54 31–69 Sex (male) (%) 63,6 54,5 Time to Dg (days) 68,2 12–236 111,4 4–1097 TCP at Dg (%) 81,8 100 NRL at Dg (%) 18,2 40 RNL at Dg (%) 18,2 63,6 Hematocrite at Dg/post TMT(%) 26,9/34,3 20–35/25–48 18,5/32,8 18–28/29–37 LDH at Dg/post TMT 1186,4/946,4 607–2247/548–1629 1325,7/522 639–3960/295–630 Platelets at Dg/post TMT (×10 3/ml) 66,9/158 5–30/20–380 48/139 15–90/5–280 Urea/creatinine at Dg 66/1,2 17–95/0,6–2,3 124,8/3,4 41–190/0,9–6,5 Total Bilirrubin/Indirect Bilirrubin at Dg 6,2/2,3 0,7–14/0,4–5,5 3,2/1,9 0,4–13/0,2–7,7 Cyclosporine/FK at Dg (%) 81,8/18,2 9,1/90 TMT response (%) 72,7 80 Days to last evaluation (all/survival pts) 784,8/978,3 26–1584/281–1584 850,6/1310,6 26–2342/374–2237 Days to death since TX 391 26–908 58,7 26–96 Days to death since MAT Dg 361 6–862 12,8 7–20
CONCLUSIONS: In our experience TAM was an uncommon complication and its incidence was higher during the first 3 months after transplantation. It was more frequent among HSCT recipients. At Dg all TAM pts were receiving CNI as part of the immunosuppressive protocol. Drug withdrawal improved laboratory results and pt outcome in both groups. NRL and renal symptoms were more frequently seen in SOTX. Survival after TAM Dg in SOTX was shorter compared to HSCT recipients. Both groups showed similar mortality rate (36,36%).