1,721,367 research outputs found
Matched and mismatched unrelated donor transplantation: is the outcome the same as for matched sibling donor transplantation?
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A Modified Post-Transplant Cyclophosphamide Regimen, for Unmanipulated Haploidentical Marrow Transplantation, in Acute Myeloid Leukemia: A Multicenter Study
No full textWe report a modified post-transplant cyclophosphamide (PT-CY) regimen, for unmanipulated haploidentical marrow transplants, in 150 patients with acute myeloid leukemia (AML). All patients received a myeloablative regimen, cyclosporine A (CsA) on day 0, mycophenolate on day +1, and PT-CY 50 mg/kg on days +3 and +5. The median age was 51 (range, 17-74) years, 51 (34%) patients had active disease at transplant, and the median follow-up of surviving patients 903 (range, 150-1955) days. The cumulative incidence (CI) of engraftment, acute graft-versus-host disease (GVHD) grade II to IV, and moderate/severe chronic GVHD was 92%, 17%, and 15%, respectively. The 4-year CI of transplant-related mortality (TRM) and relapse was 20% and 24%, respectively. Four-year survival for remission patients was 72% (74% versus 67% for <60 or ≥60 years of age) and 26% for advanced patients (17% versus 41% for <60 or ≥60 years of age). In a multivariate analysis, active disease at transplant was the only negative predictor of survival, TRM and relapse. The original PT-CY regimen can be modified with CsA on day 0, still providing protection against GVHD, low toxicity, and encouraging low relapse incidence in AML patients, also over 60 years of age
Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies:uptade consensus recommendations of the European Society for Blood
No full textGraft-versus-host disease (GVHD) is a major factor contributing to mortality and morbidity after allogeneic stem-cell transplantation. Because of the small number of results from well designed, large-scale, clinical studies there is considerable variability in the prevention and treatment of GVHD worldwide. In 2014, to standardise treatment approaches the European Society of Blood and Marrow Transplantation published recommendations on the management of GVHD in the setting of HLA-identical sibling or unrelated donor transplantation in adult patients with haematological malignancies. Here we update these recommendations including the results of study published after 2014. Evidence was searched in three steps: first, a widespread scan of published trials, meta-analyses, and systematic reviews; second, expert opinion was added for specific issues following several rounds of debate; and third, a refined search to target debated or rapidly updating issues. On the basis of this evidence and the 2014 recommendations, five members of the EBMT Transplant Complications Working Party created 38 statements on GVHD prophylaxis, drug management, and treatment of acute and chronic GVHD. Subsequently, they created the EBMT GVHD management recommendation expert panel by recruiting 20 experts with expertise in GVHD management. An email-based, two-round Delphi panel approach was used to manage the consensus. Modified National Comprehensive Cancer Network categories for evidence and consensus were applied to the approved statements. We reached 100% consensus for 29 recommendations and 95% consensus for nine recommendations. Key updates to these recommendations include a broader use of rabbit anti-T-cell globulin; lower steroid doses for the management of grade 2 acute GVHD with isolated skin or upper gastrointestinal tract manifestations; fluticasone, azithromycin, and montelukast should be used for bronchiolitis obliterans syndrome; and the addition of newer treatment options for resteroid-refractory acute and chronic GVHD. In addition, we discuss specific aspects of GVHD prophylaxis and management in the setting of haploidentical transplantation and in paediatric patients, but no formal recommendations on those procedures have been provided in this Review. The European Society of Blood and Marrow Transplantation proposes to use these recommendations as a basis for the routine management of GVHD during stem-cell transplantation
Antithymocyte globulin in the conditioning regimen: why not?
No full textUnexpected outbreak of Epstein-Barr virus post-transplantation lymphoproliferative disorder after hematopoietic stem cell transplantation conditioning with thymoglobuli
Rabbit ATG/ATLG in preventing graft-versus-host disease after allogenic stem cell transplantation: consensus-besed recommendations by an international expert panel
No full textThis collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT
Allogeneic stem cell transplantation for nonmalignant diseases
No full textAllogeneic stem cell transplantation for nonmalignant disease
High continuity second-order homogenization of in-plane loaded periodic masonry
No full textIn this paper the second-order homogenization of periodic masonry based on a computational analysis of the unit cell representative of the masonry wall is derived. The multi-scale approach is based on an appropriate representation of the micro-displacement field as the superposition of a local macroscopic displacement field, represented in a polynomial form related to the macro-displacement field, and an unknown micro-fluctuation field accounting for the effects of the heterogeneities. By this approach a continuous micro-displacement field is obtained, i.e. in each unit cell and across the interfaces between adjacent unit cells. The computational procedure is applied in two steps: the first one corresponds to the standard homogenization, while the second step is a second-order homogenization based on the results of the first step. Two numerical examples are presented concerning running bond and English bond masonry. For both the masonry patterns the overall elastic moduli of the second-order model and the corresponding characteristic lengths are obtained; the effects on the characteristic lengths of the stiffness mismatch between the brick phase and the mortar phase are considered. Moreover, the wave propagation in the homogenized medium is considered and dispersive waves are obtained. It is shown that remarkable differences in the phase and group velocities between the first-order and the second-order homogenized models are obtained for wavelengths shorter than ten times the average brick unit siz
Design of a chiral waveguide with mechanically-tunable stiffness for Bloch wave propagation control
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