ISSN 1866-8836
Клеточная терапия и трансплантация

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Clinical studies

Microbiota of nasal cavity in sinusitis following hematopoietic stem cell transplantation

Oleg I. Dolgov1, Sergey A. Karpishchenko1, Ekaterina S. Utimisheva1, Diana A. Grigoryanz1, Anna A. Spiridonova1,2, Ivan S. Moiseev1, Ludmila S. Zubarovskaya1, Alexei B. Chukhlovin1, Alexander D. Kulagin1

Peripheral blood stem cell transplantation from haploidentical and unrelated versus related donors for acute leukemia in children, adolescents and young adults (CAYA): A competing risk analysis

Tahereh Rostami1, Mohammad R. Rostami2, Azadeh Kiumarsi1, Amir Kasaeian3, Neda Alijani4, Hosein K. Fumani2, Soroush Rad2, Davood Babakhani2, Tanaz Bahri2, Mohammad Vaezi2, Maryam Barkhordar2, Seied A. Mirhosseini2, Seied A. Mousavi2

Pre- and post-transplantation factors associated with primary graft failure and severe poor graft function after allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia

Elena V. Morozova, Tatiana A. Rudakova, Julia Ju. Vlasova, Maria V. Barabanshchikova, Tatiana L. Gindina, Alexander L. Alyanskiy, Maria D. Vladovskaya, Ivan S. Moiseev, Ludmila S. Zubarovskaya, Alexander D. Kulagin

Clinical studies

Outcomes of liver transplantation to the patients with hepatocellular carcinoma from living donors versus transplants from deceased donors

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Mohamed R. Abdelfattah, Hussein Elsiesy

Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt


Correspondence:
Prof. Dr. Mohamed Rabei Abdelfattah, Associate Professor, Department of Surgery, Faculty of Medicine, University of Alexandria, Azzaritta, Alexandria, Egypt, PO BOX 21131
Phone: 002010 2306 1111
Email: mohamad.rabie@gmail.com


Citation: Abdelfattah MR, Elsiesy H. Outcomes of liver transplantation to the patients with hepatocellular carcinoma from living donors versus transplants from deceased donors. Cell Ther Transplant 2022; 11(1): 43-49.

Our objective was to compare overall and tumor-free survival for the hepatocellular carcinoma (HCC) patients subjected to liver transplantation from living donor (LDLT) versus liver transplantation from deceased donor (DDLT) treated at our center.

Patients and methods

Seventy-three patients underwent liver transplantation for HCC staged according to Milan criteria (MC). The cases have been divided into two groups: (a) forty-four patients transplanted by means of LDLT, and (b) twenty-nine patients underwent DDLT. The patients beyond MC, or those who underwent downstaging locoregional therapy were excluded from the study.

Results

Overall survival outcomes at 5 years were, respectively, 80.3% vs 70.4%, in LDLT and DDLT groups whereas tumor-free survival was 79.1% vs 76% for LDLT and DDLT cases. LT from living donors showed slightly better patients’ survival compared to liver transplantation from deceased donors DDLT (P=0.09). However, the difference in tumor-free survival between both groups was virtually absent (P=0.6).

Conclusion

The present study confirmed that LDLT, while offering a slightly better overall survival, is associated with similar terms of tumor-free survival compared to transplants from deceased donors. This similarity is especially clear when avoiding biases caused by different tumor features and analyzing a perfectly matched cohort of patients presenting with HCC classified according to the Milan criteria.

Keywords

Hepatocellular carcinoma, liver transplant, living donor, deceased donor, survival.

Clinical studies

Microbiota of nasal cavity in sinusitis following hematopoietic stem cell transplantation

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Oleg I. Dolgov1, Sergey A. Karpishchenko1, Ekaterina S. Utimisheva1, Diana A. Grigoryanz1, Anna A. Spiridonova1,2, Ivan S. Moiseev1, Ludmila S. Zubarovskaya1, Alexei B. Chukhlovin1, Alexander D. Kulagin1

1 Pavlov University, St. Petersburg, Russia
2 St. Petersburg Pasteur Institute, St. Petersburg, Russia


Correspondence:
Dr. Oleg I. Dolgov, Department of Otorhinolaryngology, Pavlov University, 6-8 Tolstoy St, 197022, St. Petersburg, Russia
Phone: +7 (921) 845-03-51
E-mail: oidolgov@yandex.ru


Citation: Dolgov OI, Karpishchenko SA, Utimisheva ES, et al. Microbiota of nasal cavity in sinusitis following hematopoietic stem cell transplantation. Cell Ther Transplant 2022; 11(1): 36-42.

Hematopoietic stem cell transplantation (HSCT) is often accompanied by infectious complications. The aim of this study was a comparative evaluation of facultative anaerobic microbiota members of nasal and paranasal cavity in sinusitis, which often develops in immunocompromised patients, due to intensive chemotherapy and massive antibiotic treatment followed by hematopoietic cell transplantation (HSCT).

Materials and methods

The study involved 194 patients with various myelo- and lymphoproliferative diseases aged 1 to 62 years who underwent intensive chemotherapy and allogeneic HSCT. As based on appropriate clinical indications, the biomaterial was taken from patients (washings from the paranasal sinuses and/or nasal swabs) within the time period of +100 to +180 days after allogeneic HSCT. We studied 124 samples from maxillary sinus punctures of 97 patients and 973 scrapings from the nasal cavity. Seeding of biological material and isolation of the microorganisms were performed by classical bacteriological techniques. Antibiotic susceptibility of clinical isolates was determined by disk diffusion methods. The data on microbial sensitivity were interpreted by the EUCAST criteria.

Results

In the samples from nasal cavity and paranasal sinuses, S. epidermidis was most often detected (34.7%, 377/1097); S.viridans (2.2%, 24/1097); S. aureus (1.91%, 21/1097); Klebsiella spp (1%, 11/1097). Detection frequency of S.epidermidis and S.viridans was minimal in the younger age group (up to 5 years), and increased in older groups (>15 years old). Profound suppression of S.epidermidis growth was noted, especially in paranasal sinuses, within 1 month after HSCT in presence of massive antibiotic therapy. High frequency of Klebsiella spp detection was noted in the samples from maxillar sinuses at later terms (2-3 months) after HSCT, at low detection frequency of the pathogen in the specimens from nasal cavity (average 16.3% vs 2.1%, p=2×10^14). In addition, we have estimated frequency of bacterial inoculation within +30 days upon the diagnosis of sinusitis. At the same time, an increased frequency of Pseudomonas spp isolation (1/378 vs 7/217) was revealed in the material from paranasal sinuses.

Conclusion

Bacteriological study of biological samples from maxillary sinuses is of limited value during the 1st month after HSCT accompanied by massive antibiotic therapy which was followed by selection of resistant strains of Klebsiella spp, Pseudomonas spp, E. coli, S. aureus, mainly at the terms of >2 months after HSCT.

Keywords

Hematopoietic stem cell transplantation, paranasal sinuses, microbiota, antibiotic resistance.

Clinical studies

Peripheral blood stem cell transplantation from haploidentical and unrelated versus related donors for acute leukemia in children, adolescents and young adults (CAYA): A competing risk analysis

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Tahereh Rostami1, Mohammad R. Rostami2, Azadeh Kiumarsi1, Amir Kasaeian3, Neda Alijani4, Hosein K. Fumani2, Soroush Rad2, Davood Babakhani2, Tanaz Bahri2, Mohammad Vaezi2, Maryam Barkhordar2, Seied A. Mirhosseini2, Seied A. Mousavi2

1 Department of Pediatric Cell Therapy, Research Institute for Oncology, Hematology and Cell Therapy (RIOHCT), Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
2 Research Institute for Oncology, Hematology and Cell Therapy (RIOHCT), Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
3 Department of Biostatistics and Epidemiology, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
4 Department of lnfectious Diseases, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran


Correspondence:
Dr. Azadeh Kiumarsi, MD, Assistant Professor, Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatric Cell Therapy, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Kargar Shomali Street, 1411713131, Tehran, Iran
Phone: +98 9121037104
Fax: +98 (21) 8802 9397
Email: akiumarsi@sina.tums.ac.ir


Citation: Tahereh Rostami, Mohammad R. Rostami, Azadeh Kiumarsi et al. Peripheral blood stem cell transplantation from haploidentical and unrelated versus related donors for acute leukemia in children, adolescents and young adults (CAYA): A competing risk analysis. Cell Ther Transplant 2022; 11(1): 24-35.

Allogeneic hematopoietic stem cell transplantation (HSCT) is the only potentially curative treatment for acute leukemia. Various parameters have significant impact on the final results of HSCT, such as donor type, stem cell source, and the applied conditioning regimen. In the absence of HLA-matched related or unrelated donors, haploidentical donors present a possible alternative for the patients with indications for HSCT. The present single-center study compared the outcomes of HSCT from different donor types using a radiation-free MAC regimen. We compared the results of unmanipulated peripheral blood stem cell transplantation (PBSCT) from matched, or mismatched related, and unrelated donors with those from haploidentical donors in the children, adolescents and young adults (CAYA) treated for acute leukemia.

Patients and methods

In this retrospective study performed since 2014 to 2021, we have evaluated the clinical outcomes among CAYA patients with acute leukemia who underwent peripheral blood T cell-replete HSCT from haploidentical donors versus unrelated donors (including 10/10 or 9/10 HLA-matched), and versus related donors (including 10/10 or 9/10 HLA-matched). The myeloablative conditioning for HSCT was performed as irradiation-free regimen including busulfan and cyclophosphamide. GvHD prophylaxis was based on administration of cyclosporine A in all the patients, accomplished by rabbit anti-human thymocyte globulin in HSCT from unrelated and haploidentical donors, and post-transplant cyclophosphamide in cases of haploidentical donors. For statistical evaluation, an adjusted multivariable proportional hazard Cox and competing risk analyses were used.

Results

Median follow-up time period was 28.7 months (95% CI: 21.9-34.9). Three-year overall survival rate (OS) and GvHD-free/relapse-free survival (GFRFS) rate were 68.81% (95% CI: 60.08%-76.01%) and 44.19% (95% CI: 35.52%-52.49%), respectively. The patients who underwent HSCT from unrelated HLA-matched donors had the lowest OS and GFRFS compared to other donor types. The 3-year non-relapse mortality (NRM) in all patients was 7.84% (95% CI 4.36-12.62). Adjusted multivariable modeling of OS showed that the hazard of death in patients who had undergone HSCT from an unrelated donor, was 3.6 times more than for the patients who underwent HSCT from their haploidentical donors (P=0.05). Likewise, the hazard of NRM after HSCT from unrelated donors was 6 times more than with haploidentical donors (P=0.002). However, the relapse incidence was not significantly different between the two mentioned groups.

Conclusions

In this study, HSCT from haploidentical donors was associated with superior survival rates compared to HSCT from unrelated HLA-matched donors. Hence, haploidentical transplantation with peripheral blood stem cells could be a practical and valuable clinical option that offers a reasonable opportunity for the disease control in CAYA patients with acute leukemia requiring HSCT and lacking matched available donors.

Keywords

Acute leukemia, allogeneic hematopoietic stem cell transplantation, matched related donors, unrelated donors, haploidentical donors, clinical outcomes.

Clinical studies

Pre- and post-transplantation factors associated with primary graft failure and severe poor graft function after allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia

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Elena V. Morozova, Tatiana A. Rudakova, Julia Ju. Vlasova, Maria V. Barabanshchikova, Tatiana L. Gindina, Alexander L. Alyanskiy, Maria D. Vladovskaya, Ivan S. Moiseev, Ludmila S. Zubarovskaya, Alexander D. Kulagin

RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantology, Pavlov University, St. Petersburg, Russia


Correspondence:
Dr. Elena V. Morozova, RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transpantology, Pavlov University, 6-8 L.Tolstoy St, 197022, St. Petersburg, Russia
Phone: +7 (911) 927-82-29
E-mail: dr_morozova@mail.ru


Citation: Morozova EV, Rudakova TA, Vlasova JJ, et al. Pre- and post-transplantation factors associated with primary graft failure and severe poor graft function after allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia. Cell Ther Transplant 2022; 11(1): 13-23.

Allogeneic stem cell transplantation (allo-HSCT) is used worldwide for long-term management and cure of hematological malignancies, still remaining a valuable option for treatment of chronic myeloid leukemia (CML) in all fit patients who are unable to achieve a durable complete cytogenetic response after treatment with tyrosine kinase inhibitors (TKIs), and in advanced-phase disease. Along with relapse risk, the unfavorable HSCT results may be associated with primary graft failure (PrGF), or poor graft function (PoGF). Hence, the aim of our study was to assess frequency and outcome of PrGF and severe poor graft function (sPGF) after allo-HSCT in CML patients.

Patients and methods

We performed a retrospective analysis of 121 consecutive patients with CML who received allo-HSCT in the RM Gorbacheva Research Institute at the Pavlov University over 25 years. HSCT was indicated in cases of advanced-phase disease, or TKI resistance/intolerance of CML patients. BCR/ABL transcript levels and additional chromosomal abnormalities were used as laboratory markers of advanced disease. 80 patients (66%) were transplanted in chronic phase (CP); 41 patients (34%) were in acceleration phase (AP), or blast crisis (BC) at the time of HSCT. Matched unrelated donors were used in 65% of the cases; matched related donors, in 28%, and haploidentical donors, in 7% of cases.

Results

Engraftment was documented in 106 (88%) patients. Post-transplant relapses were registered in 31 patients within 15-333 days after HSCT. PrGF was documented in 8 cases (7%). Two patients developed secondary graft failure within two months after initial engraftment, with lethal infectious complications. Severe poor graft function (PoGF) was diagnosed in 11 cases (9%) at cumulative incidence of 10% within 1 year post-transplant. Among various pre-transplant characteristics, age factor, and, especially, presence of additional chromosomal abnormalities (ACA) were associated with cumulative incidence of PrGF and sPGF after HSCT. I.e., PrGF was 14% in the group with detectable ACA versus 3% in the group without ACA, (p=0.02), whereas incidence of sPGF in patients with ACA was 2% versus 12% in those without ACA (p=0.09). The incidence of post-transplant relapses did not differ in the patients with PrGF and sPGF.

Conclusions

Primary graft failure (PrGF) contributes to the non-relapse mortality during the first year after allo-HSCT in CML patients. Emergence of post-transplant relapses was not associated with PrGF and sPGF in CML. Further assessment of risk factors for the graft failure or poor graft function is required in order to improve the results of HSCT technologies.

Keywords

Chronic myeloid leukemia, hematopoietic stem cell transplantation, indications, graft failure, risk factors.