58 research outputs found
Ex Vivo Expansion of Cd34-Positive Peripheral Blood Progenitor Cells from Patients with Non-Hodgkin's Lymphoma: No Evidence of Concomitant Expansion of Contaminating Bcl2/Jh-Positive Lymphoma Cells
No full textThe aim of the present study was to evaluate the capacity to expand of hematopoietic stem cell (HSC) samples from eight patients with NHL,, and to follow in parallel the fate of tumor cells in four of eight samples still containing bcl2/ JH tumor cells after CD34(+) or CD19(-/)20(-)/34(+) cell selection. The presence of bcl2/JH(+) cells was also investigated after expansion in four of eight samples, two of which were bcl2/JH at harvesting and two which were initially bcl2/JH(+) but became bcl2/JH(-) ( below the level of PCR detection) after cell selection, to assess a possible reappearance of occult tumor cells after expansion culture. We used culture conditions that we previously had established to allow high level expansion of normal precursors, progenitors and LTC-ICs, In this study, particular attention was given to the role of Flt3-ligand, known to favor the growth of B cells. The expansion conditions were: 1.5 x 10(3) cells/ml in serum-free medium containing stem cell factor (SCF), interleukin-3 (1L-3), IL- 6, granulocyte-stimulating factor (G-CSF), erythropoietin ( Epo) +/- Flt3-ligand (Flt3-L) for 10 days, After culture, total cells, CFU-GMs, BFU-Es and LTC-ICs were expanded to a mean of 833-, 6.6-, 4.6-, and 1.8-fold, respectively with the cocktail of cytokines not including Flt3-L. When Flt3-L was added, the mean expansion values were 1095-, 31-, 15- and three-fold, respectively. Residual bcl2/JH(+) cells present in four of eight samples before expansion were not detected after expansion. Similarly, no tumor cells reappeared after expansion of the two samples which had become negative after selection, as well as in the two samples which were bcl2/JH at harvesting, These results suggest first that ex vivo expansion of hematopoietic stem cells in patients with non- Hodgkin's lymphoma is feasible without incurring the parallel risk of amplifying tumor cells; second, that Flt3-L did not stimulate the growth of tumor cells while it clearly favored the growth of normal progenitors
Comparison of BAVC to BUCY regimens in autologous stem cell transplantation for adult patients with acute myeloid leukemia
No full textThe dismal outcome in patients with acute leukaemia who relapse after an autograft is improved if a second autograft or a matched allograft is performed
No full textAll patients receiving autografts for acute leukaemia in remission between 1 January 1981 and 31 December 1996 and reported to the European Group for Blood and Marrow Transplantation and had a relapse, were included. The patients underwent an allograft (n = 90, group A), were treated with chemotherapy (n = 2584, group B) or received a second autograft (n = 74, group C). The 2-year survival after relapse was 32 +/- 5%, 11 +/- 1% and 42 +/- 6% in groups A, B and C, respectively. In group A, those with an HLA-A, -B and -DR compatible related or unrelated donor had a 2-year survival of 37 +/- 7% compared to 13 +/- 8% for those receiving a graft from an HLA mismatched donor (n = 20). The following factors were associated with better survival in multivariate analyses: an interval from first autograft to relapse >5 months (P < 0.00001), a first autograft performed later than 1991 (P < 0.00001), patient age below 26 years (median, P < 0.002), group B vs HLA mismatches from group A (P = 0.002), group C vs group B (P < 0.005), patients who were not treated with total body irradiation at first autograft (P < 0.02) and patients in first remission at first autograft (P = 0.02). To conclude, the poor outcome in these patients was improved if a second autograft was feasible (P < 0.005), or if an HLA-matched allograft was performed (NS). Bone Marrow Transplantation (2000)
Feasibility and recent improvement of autologous stem cell transplantation for acute myelocytic leukaemia in patients over 60 years of age: importance of the source of stem cells
No full textA total of 193 patients with acute myelocytic leukaemia (AML) [147 in first complete remission (CR1)], ranging from 60 years to 75 years of age (median 63 years), were autografted between January 1984 and December 1998. The source of stem cells was peripheral blood (PB) in 128 patients, bone marrow in 51 patients and a combination of both in 14 patients. Total body irradiation (TBI) was used in 34 cases. Ninety-seven per cent of patients had successful engraftment of neutrophils on day 15 (range days 7-71) and of platelets on day 30 (range days 9-894). In patients autografted in CR1, the transplant-related mortality (TRM) was 15 +/- 4%, the relapse incidence (RI) was 58 +/- 5%, the leukaemia-free survival (LFS) was 36 +/- 5% and the overall survival was 47 +/- 5% at 3 years. The source and dose of stem cells were studied in particular; in patients transplanted in CR1, the RI was 44 +/- 11% in those receiving marrow compared with 63 +/- 6% in those receiving PB (P = 0.04). Patients autografted in CR1 who received higher granulocyte-macrophage colony-forming units (CFU-GM) doses (above the median) had a lower RI (47 +/- 11% vs. 79 +/- 9%, P = 0.009). There was a significant improvement in patients transplanted after March 1996; for those in CR1, the RI was 41 +/- 8% vs. 65 +/- 6% (P = 0.01), the LFS was 53 +/- 8% vs. 28 +/- 5% (P = 0.01) and the overall survival was 72 +/- 7% vs. 36 +/- 6% (P = 0.02). By multivariate analyses, significant factors for the outcome were the date of transplant with recent improvement and the source of stem cells, with a lower RI for marrow. Autologous stem cell transplantation (ASCT) is a potential therapeutic approach in patients with AML over 60 years of age; results have improved recently
Évaluation des besoins des médecins généralistes concernant la prescription de matériel médical et d aides techniques gériatriques (proposition d un outil)
No full textUn questionnaire destiné aux médecins généralistes d Isère a permis de mettre en évidence les principales difficultés concernant les prescriptions de matériel médical et aides techniques destinées au patient gériatrique. Conformément aux attentes de cette étude, portant sur les problèmes d intitulé exact de prescription, de choix du type de matériel en fonction du degré d autonomie du patient, du choix achat ou location, des modalités de remboursement par la sécurité sociale, des conditions de renouvellement, il apparaît que 85 à 95% des praticiens sondés adhérent a l idée d utiliser le livret proposé en annexe. Les items pouvant être retrouvés dans ce guide de prescription regroupent : les lits médicalisés, le matériel anti-escarres, les aides à la mobilité, les aides à l hygiène, les aides de la vie quotidienne, les structures et systèmes de financement pouvant être sollicités, quelques arbres décisionnels d aide à la prescription.A questionnaire intended for the general practitioners of Isere allowed to bring to light the main difficulties concerning the prescriptions of medical materiel and technical helps intended for the geriatrique patient. According to the waits of this study, concerning the problems of exact title of prescription, the choice of the type of purchase or rent, modalities of repayment by the social security, the conditions of renewal, it seems that 85 to 95% of the pooled practitioners adhere at the idea of using the notebook proposed in appendix. Items which can be found in this guide of prescription group include: clinic beds, materiel anti-bedorses, the helps in the mobility, the helps in the hygiene, assistants of the everyday life, the structures and the systems of financing which can be sought, some decision-making trees of help to the prescription.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF
Retrospective evaluation of autologous bone marrow transplantation vs allogeneic bone marrow transplantation from an HLA identical related donor in acute myelocytic leukemia. A study of the European Cooperative Group for Blood and Marrow Transplantation (EBMT)
No full textWe analyzed retrospectively data from 1696 patients with AML transplanted in Europe from January 1987 to December 1992 and reported to the acute leukemia EBMT registry. Groups of patients were analyzed according to age (adults and children) and status at transplant (first remission = CR1; second remission CR2). (1) 1114 adult patients were transplanted in CR1; 516 received an allograft; 598 received an autograft. Following alloBMT, the transplant-related mortality (TRM) was significantly higher (27 vs 13%, P < 10(-4)), the relapse incidence (RI) lower (25 vs 52%, P < 10(-4)) and the leukemia-free survival (LFS) better (55 vs 42%, P = 0.006). Favorable prognostic factors for alloBMT were a FAB type other than M4-M5, a donor-recipient combination excluding a female donor to a male recipient, and a younger age. Favorable prognostic factors for ABMT were a younger age of the patients at time of transplant, the AML3 FAB type, and a longer interval from CR1 to ABMT. (2) 288 adult patients were transplanted in CR2: 98 received an allograft; 190 received an autograft. The TRM was higher following allogeneic BMT (32 vs 20%, P = 0.02) and the RI lower (42 vs 63%, P = 0.001). The LFS was not significantly different (alloBMT: 39%; ABMT: 30%, P = 0.22). (3) 242 children were transplanted in CR1; 129 received an allograft; 113 received an autograft. Following alloBMT, the RI was lower (25 + 5 vs 48 + 6%, P < 10(-4)), and the LFS better (68 vs 47%, P = 0.002), The use of TBI was a favorable prognostic factor in allografted patients with a lower RI and a better LFS. (4) The number of children transplanted in CR2 was too small for a comparative analysis. These results confirm that both allogeneic and autologous BMT are suitable curative approaches for AML, They favor the use of an HLA identical related allogeneic transplant when available, especially in younger patients, over ABMT with unpurged marrow. The role of purging in ABMT could not be addressed in this study
Hematopoietic stem cell transplantation for de novo erythroleukemia: a study of the European Group for Blood and Marrow Transplantation (EBMT)
No full textDe novo erythroleukemia (EL) is a rare disease. Reported median survival are poor and vary from 4 to 14 months. The value of hematopoietic stem cell transplantation (HSCT) for EL is unknown. This EBMT registry study reports on the largest series of patients with EL treated with HSCT in first complete remission-103 autologous and 104 HLA identical sibling allogeneic HSCT. Outcome and identification of prognostic factors for each type of transplantation were evaluated. For autologous HSCT, outcome at 5 years showed a leukemia-free survival (LFS) of 26% +/- 5%, a relapse-incidence (RI) of 70% +/- 6%, and a transplant-related mortality (TRM) of 13% +/- 4%. By multivarlate analysis, the only prognostic factor was age. For allogeneic HSCT, outcome at 5 years showed an LFS of 57% +/- 5%, an RI of 21% +/- 5%, and a TRM of 27% +/- 5%. By multivariate analysis, prognostic factors were graft-versus-host disease and age. This study represents the largest series of de novo EL treated with HSCT and shows that allogeneic HSCT is by far the most effective treatment. (C) 2002 by The American Society of Hematology
Immunomodulatory effect of mesenchymal stromal cells: possible mechanisms.
No full textInternational audienceCo-transplantation of mesenchymal stem cells (MSCs) and hematopoietic stem cells ameliorate hematopoietic reconstitution and induce tolerance. The immunomodulatory properties of MSCs have been demonstrated both in vivo and in vitro. MSCs can modulate function of immune cells such as T lymphocytes, antigen-presenting cells and natural killer cells. However, it is unknown whether MSCs given to patients that have undergone HSC transplantation could alleviate graft versus leukemia effect or could increase the risk of the infection. Proper characterization of MSC immunomodulatory mechanisms are crucial to anticipate the possible effect of MSC in the host. In the current report, interesting and contradictory results in the literature are reviewed in an attempt to understand the underlying mechanism. Differences in experimental designs and models used seem to be the underlying causes of discrepancy in reported results. Results of the few in vivo studies are controversial and further clinical studies are needed to confirm the efficiency and safety of MSCs in transplantation management
Human bone marrow-derived mesenchymal stem cells
No full textMesenchymal stem cells (MSCs) have elicited a great clinical interest, particularly in the areas of regenerative medicine and induction of tolerance in allogeneic transplantation. Previous reports demonstrated the feasibility of transplanting MSCs, which generates new prospects in cellular therapy. Recently, injection of MSCs induced remission of steroid-resistant acute graft-versus-host disease (GVHD). This review summarizes the knowledge and possible future clinical uses of MSCs
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