bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of Hematopoietic Progenitor Cell Count: To Optimize Peripheral Blood Stem Cell Harvest
Authors: Takeshita Masataka , Hirai Risen , Tanimura Akira , Nakamura Miki , Hagiwara Shotaro , Miwa Akiyoshi 
Published: October 2019

Abstract
background.
High dose therapy and autogenic or allogeneic stem cell transplantation plays an important role in the treatment course of hematological malignancies. In some countries, major method of unrelated stem cell donation programs had shifted from bone marrow harvest (BM) to peripheral blood stem cell harvest (PBSCH). PBSCH is a heavy duty not only for donor or patient, also for medical staffs. In some cases, poor mobilization may cause poor collection of stem cells. Hemogram needs time for May-Giemsa stain, and CD34 count needs complicated technique and running cost. New simple tool to predict the count of mobilized stem cell is needed to optimize PBSCH.
methods.
Since 2009, we started measuring peripheral blood hematopoietic progenitor cell (HPC) with Sysmex XE-5000(R) blood cell counter. With IMI channel method, we could rapidly know the count of circulating stem cells. Daily HPC count and yielded CD 34 positive cell count were analyzed.
results.
189 samples were collected from 122 donors/patients. Diagnosis of patients: malignant lymphoma (n=29), leukemia (3), multiple myeloma (74), amyloidosis (5), cryoglobulinemia (1). 10 healthy donors were also included. Age: 18-66, Sex: male 82/female 40. Mobilization regimen: G-CSF 57, chemo+G-CSF 74, G-CSF+plerixafor 1
HPC count (cells/ul) and collected CD34 positive cells (106cells/kg) had positive correlation. When HPC count was above 25/ul, collected CD34 positive cells were above 1x106/kg (positive predictive value: 80.9%). Number of PBSCH operation was 1.59 in average. We also show three cases in which HPC count was useful to make clinical decision of initiating PBSCH.
discussion.
HPC and CD34 had positive correlation, and HPC >25/ul seems to be appropriate cut-off to start PBSCH. With our former threshold of PBSCH (G-CSF day>4, WBC >3000/ul), 241 operations were to be planned. Including HPC count, we could reduce PBSCH operation to 204.
Hematopoietic progenitor cell count is rapid and inexpensive method. Within 5 minutes, mobilized stem cells can be measured, and it may be also useful in outpatient-based harvest settings.
Figure 1 Figure 1.

Disclosures
No relevant conflicts of interest to declare.
Reduced Intensity Versus Myeloablative Conditioning for Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia
Authors: Fan Donna , Sabry Waleed , Stakiw Julie , MacKay Rebecca Ellyn , Bosch Mark , Sarker Sabuj , Elemary Mohamed 
Published: October 2019

Abstract

Introduction
Reduced intensity conditioning (RIC) regimens for allogeneic hematopoietic stem cell transplantation (SCT) offer a potential treatment for otherwise incurable cases of acute myelogenous leukemia (AML) with less associated toxicity compared to myeloablative conditioning (MAC). Eradication of malignant cells after RIC depends largely on the graft-versus leukemia effect (GVL). These regimens are becoming increasingly popular, particularly in older patients or those with comorbidities. They may also be offered to otherwise healthy patients based on personal or physician preference, as there is growing evidence that overall survival may be equivalent for both treatments. We retrospectively reviewed the charts of Saskatoon Cancer Centre patients receiving either RIC or MAC to compare the incidence and grade of graft versus host disease (GVHD), progression free survival (PFS), and overall survival (OS).
Methods
We identified 74 patients who underwent HSCT for AML in complete remission (CR) between January 2000- December 2013. Of these patients, 55 received MAC and 19 received RIC.
Median age at HSCT was 48 years (range 18-68). In the group receiving MAC, 36% of patients were >50 years, whereas 74% of patients receiving RIC were >50 yrs of age.
Results
Patients receiving RIC experienced greater incidence of chronic GVHD (63% vs 41%, p=.09) and relapse (54% vs 30%, p=.07). Incidence of acute GVHD was the same for either regimen (53%).
Median overall survival was similar (39 vs 38 months), with lower early mortality in RIC later overtaking MAC at 27 months. Progression free survival demonstrated a non-statistically significant advantage for MAC (median 43 vs 49 months).
Conclusion
RIC has been associated with greater incidence of chronic GVHD and relapse, with no difference in overall survival. Patients receiving RIC are more likely to be >50 years of age, making comparisons challenging. The results of this review suggest that MAC is the preferred regimen for patients who can tolerate its toxic effects due to reduced incidence of chronic GVHD and relapse, however the similarity in overall survival makes the choice of either conditioning regimen reasonable. Future studies to identify the best conditioning regimen are warranted.
Overall Survival
Figure 1 Figure 1.
Progression Free Survival
Figure 2 Figure 2.

Disclosures
No relevant conflicts of interest to declare.
Safety and Outcomes of Extracorporeal Photopheresis with the Therakos Cellex System for Graft Versus Host Disease in Pediatric Patients
Authors: Uygun Vedat , Daloglu Hayriye , Karasu Gulsun , Hazar Volkan , Yesilipek M. Akif 
Published: October 2019

Abstract
Background: Graft-versus-host disease (GVHD) is a serious complication with a significant negative impact on survival following allogeneic hematopoietic stem cell transplantation (HSCT) in both adults and children. Immunosuppressants like steroids remain the mainstay of treatment which carries risks of increased infection frequency, a negative impact on the graft-versus-leukemia effect, and an increased probability of secondary malignancies. Extracorporeal photopheresis (ECP) treatment, seems to ameliorate GVHD by immunomodulation, rather than immunosuppression. However it is difficult to perform in pediatric population. This is a retrospective review of 17 pediatric patients who underwent photopheresis with the Therakos Cellex system for graft-versus-host disease (GVHD).
Procedure: Extracorporeal photopheresis regimen was same for all acute and chronic GVHD patients: initially every week (2 sessions/week) for two months, then every two weeks for two months; and finally, every month for at least one year. Demographic data, degree of GVHD before photopheresis, adverse reactions during photopheresis procedure, modification in immunosuppressive treatment, and response to photopheresis were recorded.
Results: Acute GVHD occurred in seven patients, overlap and chronic GVHD occurred in five patients in each group. The improvement observed in eleven of twelve patients who have acute GVHD (90%) and in seven of ten chronic GVHD patients (70%). Thirteen patients had skin involvement before ECP and eleven of them responded to treatment (84%). Gastrointestinal involvement occurred in ten patients and seven of them improved during ECP treatment (70%). All of the four patient´s liver involvements failed to respond. No serious adverse reactions occurred.
Conclusions: In conclusion, our study demonstrates that ECP with the Therakos Cellex system is a safe treatment option for GVHD in children.

Disclosures
No relevant conflicts of interest to declare.
Reduction in the Incidence and Severity of Graft Versus Host Disease in HLA-Matched and Haploidentical Bone Marrow Transplantation Using Posttrasplant Cyclophosphamide. Experience of Two Latino-American Institutions
Authors: Ovilla Roberto , Perez-Lozano Uendy , Calles-Payan Dannia , Reynolds-Ocampo Lucia A , Ruiz-Reyes Gabriela , Balderas-Delgado Carolina , Cabrera Garcia Alvaro 
Published: October 2019

Abstract
The Graft Versus Host Disease (GVHD) grades II-IV is present in up to 40% in Human Leucocyte Antigen (HLA) - identical related transplants and up to 80% of non-related. The HLA-haploidentical bone marrow transplantation (BMT) has been associated with significant risks of graft rejection and severe GVHD, as an excessive alloreactivity by host and donor T cells. High dose of Cyclofosfamide (Cy) after BMT inhibits both graft rejection and GVHD. We want to share our experience in preventing GVHD in HLA - haploidentical alloBMT and HLA-matched related BMT using the strategy of Cy post-Transplant. We evaluated 25 patients from March 2013 to June 2014, all of them were in advanced stages of the disease or they have characteristics of poor prognosis before transplantation. All patients received non-myeloablative conditioning and Cyclofosfamide (Cy) 50 mg/Kg postrasplant (on days 3 and 4 after transplantation), Mycophenolate mofetil (from day 5 to 35) and Tacrolimus (from day 5 to 180). The 64% (16) were male, mean age 30.6 years (range 2 – 67 years), with a average follow-up of 198 days (range 14-512 days). The 76% (19) were HLA-matched related alloBMT (7 patients) and HLA-haploidentical alloBMT (12 patients) in hematological malignancies, the rest of trasplants (24%) were HLA-haploidentical alloBMT in benign hematological diseases, overall survival (OS) at day 180 by type of transplant was 70%, 64%, and 67% respectively. 28% (7) had graft failure. 11 patients had no acute GVHD, 10 patients had GVHD grade I-II, and 3 patients had grade III, only 1 patient died because of grade IV (P = 0.005). Chronic GVHD occurred in 4 patients (16%). As a complication related to Cy therapy, hemorrhagic cystitis was observed 32%(8). Posttransplantation cyclophosphamide is able to reduce the likelihood of developing chronic GVHD and reduces the severity of acute GVHD, it plays an important role in the feasibility of a haploidentical transplant because the lower incidence of GVHD. Our results showed one of the most satisfactory and encouraging studies on the use of post-transplantation Cy performed in Latin America.

Disclosures
No relevant conflicts of interest to declare.
Donor KIR B Haplotype Is Associated with a Increased Rate of Leukemia Relapse and Worse Overall Survival after HLA Match Sibling Pediatric Stem Cell Transplantation
Authors: Pérez-Martínez Antonio , Martinez Isabel , Valentin Jaime , Fernandez Lucia , José Luis Vicario , Miguel Ángel Diaz 
Published: October 2019

Abstract
Introduction
Graft versus leukemia (GvL) effect after hemotopoietic stem cell transplantation (HSCT) is mediated by donor immune cells recovery. Natural Killer (NK) cell alloreactivity is controlled by the interaction of activatory receptors and inhibitory killer-immunoglobulin-like receptors (KIRs) with major histocompatibility locus class I antigens on the leukemia cells. Haploidentical setting is a plattform for NK cell alloreactivity however HLA identical setting remains unclear.
Methods and Patients
We performed KIR-genotyping of HLA-identical sibling donors in 35 pediatric CD34 selection peripheral blood stem cell transplantations to identify genetic factors affecting leukemia relapse and overall survival. Univariate analysis of leukemia relapse and KIR genotyping was performed in order to identify independent variables predictive of outocome for pediatric acute lymphoblastic leukemia (ALL), (n=20) and acute myeloblastic leukemia (AML), (n=15).
Results
Donor B haplotype was observed in 21 cases (60%). Statistical analysis shown that donor B haplotype was associated with significantly more relapse in leukemia pediatric patients (38% vs. 0%) and worse overall survival (40% vs. 7%). Further analysis revealed that 2DL5a, 2DS3 and 2DS5 were associated with an increased rate of leukemia relapse (47% vs. 6%, 54% vs. 10% and 58% vs. 13%, respectively) and 2DL5a, 2DS1 and 3DS1 were associated with a worse overall survival (48% vs. 6%, 64% vs. 10% and 58% vs. 13%, respectively). No difference was observed in patients KIR haplotype or donor-recipient KIR haplotype mismatch.
Conclusion
In our study, which included only reduced intensity conditioning without antithymocyte globulin followed by related peripheral blood stem cell transplantation, we found a significant worse impact of donor KIR B haplotype in stem cell transplantation outcome. Our results suggest that donor KIR B haplotype (2DL5a, 2DS3 and 2DS5) increases leukemia relapse and also donor KIR B haplotype (2DL5a, 2DS1 and 3DS1) confer significant survival damage to HLA-identical sibling HSCT.
Figure 1. Donor KIR genotyping (2DL5A, 2DS1 and 3DS1) impacts in overall survival. Figure 1. Donor KIR genotyping (2DL5A, 2DS1 and 3DS1) impacts in overall survival.

Disclosures
No relevant conflicts of interest to declare.
Evidence of Effect Modification of Graft-Versus-Leukemia Effect of Cytomegalovirus By Alemtuzumab in Myeloid Malignancies Undergoing Unrelated Donor Transplantation
Authors: Shanavas Mohamed , Uhm Jieun , Alam Naheed , Atenafu Eshetu G , Kuruvilla John , Lipton Jeffrey H. , Messner Hans A. , Seftel Matthew , Gupta Vikas , Kim Dennis 
Published: October 2019

Abstract
Several studies have suggested a beneficial effect of CMV seropositivity and or reactivation on relapse risk after allogeneic hematopoietic cell transplantation (HCT) in myeloid malignancies. Inability to replicate this finding in T cell depleted HCT is suggestive of a potential effect modification between TCD and CMV in this setting, but this has not been addressed in previously published studies.
We have retrospectively analyzed transplant outcomes in 192 patients with myeloid malignancies who have undergone unrelated donor HCT at our center during January 2006 –November 2013. Among this 111 patients received in vivo TCD with low dose (30 mg) alemtuzumab and 81 patients received non-TCD transplants. Recipients were CMV seropositive in 57% of TCD transplants and 59% of non-TCD transplants.
Analysis showed a significant effect modification (p=0.03 for interaction) between alemtuzumab and CMV serostatus on relapse risk, and stratified analysis based on recipient CMV status showed inferior outcomes with alemtuzumab in CMV seropositive recipients but not in CMV seronegative recipients. In CMV seropositive recipients alemtuzumab was an independent predictor of higher relapse (Hazard Ratio=13.95, p=0.008), inferior relapse free survival (HR=2.30, p=0.002), and inferior overall survival (HR= 2.04, p=0.008).
There was no difference in NRM between CMV seropositive and CMV seronegative groups, or between TCD and non-TCD transplants.
These findings suggest the presence of an effect modification by TCD on CMV's effect on relapse, resulting in inferior transplant outcomes with low dose Alemtuzumab in CMV seropositive recipients, but not in seronegative recipients.
Figure 1. CIR, NRM, RFS, and OS showing differential effects of T cell depletion between CMV seropositive and seronegative recipients (A-B) Cumulative incidence of relapse, (C-D) Non-relapse mortality, (E-F) Relapse free survival, and (G-H) Over all survival. Figure 1. CIR, NRM, RFS, and OS showing differential effects of T cell depletion between CMV seropositive and seronegative recipients. / (A-B) Cumulative incidence of relapse, (C-D) Non-relapse mortality, (E-F) Relapse free survival, and (G-H) Over all survival.

Disclosures
Off Label Use: Alemtuzumab for GVHD prophylaxis.
Multiple Elements Classified Hematological Malignancies from Healthy Population
Authors: Hagiwara Shotaro , Suzuki Yoshinari , Nakayama Akihiro , Matsunaga Akihiro , Iida Yutaka , Shimura Mari 
Published: October 2019

Abstract
Introduction
It is a little known about how multiple elements interacts and functions in cells, although a specific element had already reported to take a role, enzymatic, transcriptional activities, etc. Although, several metals such as cadmium, nickel, lead, and chrome were known as carcinogen, it is also not known about relations of multiple elements in disease mechanisms. To investigate the impact of multiple elements on the features of hematological malignancies, we analyzed the multiple elements in the serum of patients with hematological malignancies and healthy persons.
Methods
We obtained 47 of peripheral blood samples from 40 patients with hematological malignancies, and 102 of healthy persons: 50 persons who visited to medical check-up and 52 volunteers.
Hematological malignancies were 16 acute myeloid leukemia, 5 acute lymphoblastic leukemia, 9 non-Hodgkin's lymphoma, 9 Multiple myeloma, and 1 Chronic myeloid leukemia.
Samples were centrifuged, and 1.0-1.5ml of plasma was separated. We measured 23 elements were measured using inductively coupled plasma mass spectrometry.
To assess the difference of the element patterns between hematological malignancies and healthy persons, multivariate discrimination analysis was performed. Overall survival of hematological malignancies was assessed by Log-rank test.
Multivariate analysis with the elements highly discriminated hematological malignancies from healthy persons' samples. Elements data increased the accuracy to discriminate hematological malignancies from healthy persons close to 100 % in addition to clinical data such as complete blood count, albumin, total bilirubin, blood urine nitrogen, creatinine. To our knowledge, this is the first report on the successful classifying disease from healthy persons by measurements of multiple elements with more than 90% accuracy using peripheral blood serum (Table 1). Five year overall survival of patients with hematological malignancy was likely dependent on this discriminant score. Data suggested the potential interaction between multiple elements and hematological malignancies, and the possibility future applications on diagnosis and prognosis.
Table 1. Accuracy of cross-validated classification patients with hematological malignancies and healthy persons by discriminant analysis Accuracy Clinical data Multi-elements Multi-elements + Clinical data % 93.7 91.3 98.9

Disclosures
No relevant conflicts of interest to declare.
Neutropenic enterocolitis in adults with hematological malignancy afte intensive cheMotherapy
Authors: Yaping Xie , Huang Xilian , Shi Pengfei , Chen Kuang , Gao Daquan , Qian Shenxian 
Published: October 2019

Abstract
Background. Neutropenic enterocolitis (NE) is a life-threatening complication occurring after intensive chemotherapy; however, only a few data are available for adults with hematological malignancy in China. The aim of this retrospective study was to elucidate the incidence, risk factors, and outcome of NE in adults with hematological malignancy after intensive chemotherapy. Methods. The medical records of 226 adult patients who were diagnosed with hematological malignancy and neutropenic enterocolitis after intensive chemotherapy from 2004 to 2013 were reviewed. Diagnosis of NE was established in case of neutropenic fever, abdominal pain or diarrhea, and bowel wall thickening >4mm on abdominal sonography or CT. Results. Amongst 1804 patients with hematological malignancy treated at the department of hematology, Hangzhou first people's hospital from 2004 to 2013, NE was diagnosed in 226 patients (12.5%), amedian +14(10–19) days after chemotherapy, with a death rate of 11.9%. Bloodstream infections were present in 23 patients, with gram-negative bacteria in 17 patients. Previous therapy with cytarabine and an intestinal wall thickness of ≥10 mm in the ultrasonographic examination affected survival, were associated with greater mortality. In multivariate analysis, the clinical findings of 4 or more symptoms was associated with higher risk of death. Conclusions. NE is a rare but severe complication in patients undergoing intensive chemotherapy. Use of cytarabine, an intestinal wall thickness of ≥10 mm and the clinical findings of 4 or more symptoms were associated with a higher death rate.

Disclosures
No relevant conflicts of interest to declare.
Hematopoietic Stem Cell Transplantation in the Elderly: Nutritional and Geriatric Assessment
Authors: Pereira Andrea Z , Piovacari Silvia MF , Tanaka Marcia , Barrere Ana Paula N , Lucio Fabiana , Silva Juliana Bernardo , Goncalves Polianna M , Koch Ludmila O , Nicastro Mariana , Hamerschlak Nelson 
Published: October 2019

Abstract
Introduction: Hematopoietic stem cell transplantation (HSCT) may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. Being in some diseases the only curative option. HSCT in elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.
Objectives: To study and correlate nutrition and geriatric assessment in elderly patients undergoing HSCT.
Methods: A retrospective study of 17 elderly patients (>60 years) undergoing HSCT May 2012 to January 2014 in the Hematology-Oncology and Bone Marrow Transplantation Center at Albert Einstein Hospital in São Paulo, Brazil. All patients were evaluated approximately one month prior to HSCT. In the geriatric assessment were done hand-grip strength(HGS), questions about mobility and functional limitation. In the nutrition, we studied the Body Mass Index(BMI) (kg/m2), and serum levels of vitamin D, zinc and albumin.
Results: 17 elderly patients were observed in this study, mean age was 65,5±3,8 years, BMI was 28±6,0 kg/m2, HGS was 28±8,5 kg; serum levels of albumin 3,2±0,5g/dl(normal:3,5-5,0); serum level of vitamin D 23,4±14 ng/ml (normal >20); serum levels of zinc 65,5±18 mg/dl (normal: 66-132,5 mg/dl). We found the negative correlation between BMI and HGS (rp=0,42). There were a significant and positive association between serum levels of zinc and albumin, and HGS and grades of mobility questions(p<0,05). The serum levels of vitamin D weren`t significantly associated with geriatric factors.
Conclusion: Our study showed that the obese patients with more risks of complications in HSCT had more functional limitation. Besides low levels of zinc and albumin were associated with worst results in the geriatric assessment. In the elderly the immobility and weakness can increased the complications after HSCT. The geriatric and nutrition assessment are important to improve HSCT results.

Disclosures
No relevant conflicts of interest to declare.