Allogeneic stem cell transplantation from unrelated donors in acute leukaemia.

PURPOSE OF REVIEW: To summarize the past and current knowledge of the use of unrelated donors (URDs) in allogeneic stem cell transplantation for patients with acute leukaemia. RECENT FINDINGS: The outcome of URD stem cell transplants in terms of treatment-related mortality, relapse rates, disease free survival and overall survival is comparable to sibling donors. SUMMARY: Haematopoietic stem cell transplantation (HSCT) is the therapy of choice in many haematological malignant diseases but only one-third of the patients will have an HLA-matched sibling. The possibility of finding a matched URD is more than 70% because of recent advances in HLA typing and continuous expansion of URD registries around the world. The use of URD as a source of stem cells in adult patients are steadily increasing and in the last 8 years, superseded the matched sibling donors and became the most commonly used stem cell source. There is also an increasing trend of using peripheral blood stem cells than bone marrow stem cells. Outcomes following URD transplants depend mainly upon the indication and urgency of transplant, age and comorbidities of recipients, cytomegalovirus matching/mismatching between donor and the recipient and degree of HLA matching.

Matched unrelated donor transplants-State of the art in the 21st century.

Hematopoietic stem cell transplantation (HSCT) is the therapy of choice in many hematological malignant and non-malignant diseases by using human leukocyte antigen (HLA)-matched siblings as stem cell source but only one third of the patients will have HLA-matched siblings. Hence, physicians rely on the availability of matched unrelated donors (URD). The possibility of finding a matched URD is now more than 70% due to continuous expansion of URD registries around the world. The use of URD in adult patients is steadily increasing and in the last 8 years has superseded the numbers of matched sibling donor transplants and has become the most commonly used stem cell source. There is also an increasing trend to use peripheral blood (PB) stem cells rather than bone marrow (BM) stem cells. Outcomes following URD transplants depend mainly upon the indication and urgency of transplant, age and comorbidities of recipients, cytomegalovirus (CMV) matching/mismatching between donor and the recipient, and degree of HLA matching. In some studies outcome of unrelated stem cell transplants in terms of treatment-related mortality (TRM), disease-free survival (DFS), and overall survival (OS) is comparable to sibling donors.

A difficult diagnosis - constrictive pericarditis and its treatment: a case report.

The diagnosis of constrictive pericarditis requires a high degree of clinical suspicion, for the signs and symptoms of this disease can be falsely attributed to other causes. Herein, we present a case of a 70-year old retired farmer whose symptoms of right heart failure were initially attributed to co-existing pneumonia and pulmonary embolism. He was discharged. Three weeks later he presented with worsening breathlessness and ascites. Echocardiography, computed tomography and cardiac catheterization revealed the diagnosis of constrictive pericarditis. He underwent complete pericardectomy and to date has made a good recovery. This case exemplifies the difficulty in diagnosing this condition, the investigation required, and provides a discussion of the benefit and outcomes of prompt treatment.