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1.
Blood ; 121(6): 1059-64, 2013 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-23247725

RESUMEN

To describe the incidence, risk factors, and treatment of autoimmune diseases (ADs) occurring after cord blood transplantation (CBT), we analyzed both CBT recipients reported to EUROCORD who had developed at least 1 new AD and those who had not. Fifty-two of 726 reported patients developed at least 1 AD within 212 days (range, 27-4267) after CBT. Cumulative incidence of ADs after CBT was 5.0% +/- 1% at 1 year and 6.6% +/- 1% at 5 years. Patients developing ADs were younger and had more nonmalignant diseases (P < .001). ADs target hematopoietic (autoimmune hemolytic anemia, n = 20; Evans syndrome, n = 9; autoimmune thrombocytopenia, n = 11; and immune neutropenia, n = 1) and other tissues (thyroiditis, n = 3; psoriasis, n = 2; Graves disease, n 1; membranous glomerulonephritis, n = 2; rheumatoid arthritis, n = 1; ulcerative colitis, n = 1; and systemic lupus erythematosus, n = 1). Four patients developed 2 ADs (3 cases of immune thrombocytopenia followed by autoimmune hemolytic anemia and 1 Evans syndrome with rheumatoid arthritis). By multivariate analysis, the main risk factor for developing an AD was nonmalignant disease as an indication for CBT (P = .0001). Hematologic ADs were most often treated with steroids, rituximab, and cyclosporine. With a median follow-up of 26 months (range, 2-91), 6 of 52 patients died as a consequence of ADs. We conclude that CBT may be followed by potentially life-threatening, mainly hematologic ADs.


Asunto(s)
Enfermedades Autoinmunes/etiología , Trasplante de Células Madre de Sangre del Cordón Umbilical/efectos adversos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Enfermedades Autoinmunes/tratamiento farmacológico , Niño , Preescolar , Ciclosporina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Lactante , Masculino , Persona de Mediana Edad , Análisis Multivariante , Evaluación de Resultado en la Atención de Salud/métodos , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Rituximab , Esteroides/uso terapéutico , Análisis de Supervivencia , Adulto Joven
2.
Blood ; 116(11): 1849-56, 2010 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-20538797

RESUMEN

We analyzed risk factors influencing outcomes after related (R) human leukocyte antigen-identical cord blood transplantation (CBT) for 147 patients with malignancies reported to Eurocord-European Group for Blood and Marrow Transplantation. CBT has been performed since 1990; median follow-up was 6.7 years. Median patient age was 5 years. Acute leukemia was the most frequent diagnosis (74%). At CBT, 40 patients had early, 70 intermediate, and 37 advanced disease. CB grafts contained a median of 4.1 × 10(7)/kg total nucleated cells (TNCs) after thawing. The cumulative incidence (CI) of neutrophil recovery was 90% at day +60. CIs of acute and chronic graft-versus-host disease (GVHD) were 12% and 10% at 2 years, respectively. At 5 years, CIs of nonrelapse mortality and relapse were 9% and 47%, respectively; the probability of disease-free survival (DFS) and overall survival were 44% and 55%, respectively. Among other factors, higher TNCs infused was associated with rapid neutrophil recovery and improved DFS. The use of methotrexate as GVHD prophylaxis decreased the CI of engraftment. Patients without advanced disease had improved DFS. These results support banking and use of CB units for RCBT. Cell dose, GVHD prophylaxis not including methotrexate, and disease status are important factors for outcomes after RCBT.


Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical/métodos , Antígenos HLA/inmunología , Neoplasias Hematológicas/cirugía , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Trasplante de Células Madre de Sangre del Cordón Umbilical/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/inmunología , Neoplasias Hematológicas/inmunología , Neoplasias Hematológicas/mortalidad , Humanos , Lactante , Leucemia/inmunología , Leucemia/mortalidad , Leucemia/cirugía , Recuento de Leucocitos , Masculino , Análisis Multivariante , Neutrófilos/citología , Recurrencia , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
3.
Cancers (Basel) ; 13(14)2021 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-34298729

RESUMEN

Pancreatic ductal adenocarcinoma (PDAC) remains a major public health challenge, and faces disparities and delays in the diagnosis and access to care. Our purposes were to describe the medical path of PDAC patients in the real-life setting and evaluate the overall survival at 1 year. We used the national hospital discharge summaries database system to analyze the management of patients with newly diagnosed PDAC over the year 2016 in Auvergne-Rhône-Alpes region (AuRA) (France). A total of 1872 patients met inclusion criteria corresponding to an incidence of 22.6 per 100,000 person-year. Within the follow-up period, 353 (18.9%) were operated with a curative intent, 743 (39.7%) underwent chemo- and/or radiotherapy, and 776 (41.4%) did not receive any of these treatments. Less than half of patients were operated in a high-volume center, defined by more than 20 PDAC resections performed annually, mainly university hospitals. The 1-year survival rate was 47% in the overall population. This study highlights that a significant number of patients with PDAC are still operated in low-volume centers or do not receive any specific oncological treatment. A detailed analysis of the medical pathways is necessary in order to identify the medical and territorial determinants and their impact on the patient's outcome.

4.
Eur J Cancer ; 135: 251-259, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32540204

RESUMEN

BACKGROUND: Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. METHODS: PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion of COVID-19 from March 1st to April 25th 2020. Data were collected using a web-based tool within electronic patient record approved by the Institutional Review Board. Patient characteristics symptoms and survival were collected and compared in SARS-COV-2 real-time or reverse-transcriptase PCR (RT-PCR)-positive and RT-PCR-negative patients. RESULTS: Fifty-five of the 302 (18.2%) patients with suspected COVID-19 had detectable SARS-COV-2 with RT-PCR in nasopharyngeal samples. RT-PCR-positive patients were older, had more frequently haematological malignancies, respiratory symptoms and suspected COVID-19 pneumonia of computed tomography (CT) scan. However, respectively, 38% and 20% of SARS-COV-2 RT-PCR-negative patients presented similar respiratory symptoms and CT scan images. Thirty of the 302 (9.9%) patients died during the observation period, including 24 (80%) with advanced disease. At the median follow-up of 25 days after the first symptoms, the death rate in RT-PCR-positive and RT-PCR-negative patients were 21% and 10%, respectively. In both groups, independent risk factors for death were male gender, Karnofsky performance status <60, cancer in relapse and respiratory symptoms. Detection of SARS-COV-2 on RT-PCR was not associated with an increased death rate (p = 0.10). None of the treatment given in the previous month (including cytotoxics, PD1 Ab, anti-CD20, VEGFR2…) correlated with survival. The survival of RT-PCR-positive and -negative patients with respiratory symptoms and/or COVID-19 type pneumonia on CT scan was similar with a 18.4% and 19.7% death rate at day 25. Most (22/30, 73%) cancer patients dying during this period were RT-PCR negative. CONCLUSION: The 30-day death rate of cancer patients with or without documented SARS-COV-2 infection is poor, but the majority of deaths occur in RT-PCR-negative patients.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/mortalidad , Recurrencia Local de Neoplasia/mortalidad , Neoplasias/mortalidad , Neumonía Viral/mortalidad , Factores de Edad , Betacoronavirus/genética , COVID-19 , Prueba de COVID-19 , Vacunas contra la COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Femenino , Estudios de Seguimiento , Humanos , Estado de Ejecución de Karnofsky/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Recurrencia Local de Neoplasia/complicaciones , Neoplasias/complicaciones , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/virología , ARN Viral/aislamiento & purificación , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/estadística & datos numéricos , Factores de Riesgo , SARS-CoV-2 , Factores Sexuales , Análisis de Supervivencia , Factores de Tiempo
5.
Transplantation ; 77(10): 1617-20, 2004 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-15239632

RESUMEN

Chronic graft-versus-host disease (cGVHD) frequently complicates allogeneic hematopoietic stem cell transplantation (HSCT), but small bowel involvement with obstruction is rarely observed. We report two patients who underwent allogeneic sibling HSCT and developed severe cGVHD involving the small bowel, causing unremitting obstructive symptoms and malnutrition despite maximal immunosuppression. Both patients underwent ileal resection and stricturoplasties. The first patient promptly improved, and remains asymptomatic 32 months after transplant. Three weeks after the resection of 90 cm of small bowel, the second patient developed leaking stricturoplasty and peritonitis, with a relapse of chronic myelogenous leukemia in accelerated phase. Later, an enterocutaneous fistula required additional small bowel resection and ileostomy. The patient subsequently died from pulmonary infection a few weeks after the last surgical procedure. Similar to inflammatory bowel disease, these two cases highlight that surgery may be a valuable option in patients who present with obstructive severe cGVHD refractory to aggressive immunosuppression.


Asunto(s)
Enfermedad Injerto contra Huésped/cirugía , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Adulto , Femenino , Enfermedad Injerto contra Huésped/patología , Humanos , Enfermedades del Íleon/patología , Infecciones/etiología , Leucemia Mielógena Crónica BCR-ABL Positiva/etiología , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Peritonitis/etiología , Complicaciones Posoperatorias
6.
Best Pract Res Clin Haematol ; 23(2): 223-9, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20837334

RESUMEN

Unrelated umbilical cord blood (UCB) has been widely used to treat patients lacking a well-matched HLA donor. Cell dose is a critical determinant of outcomes in cord blood transplantation, limiting the use of this strategy for low body weight patients. To overcome this limitation, infusion of two partially HLA-matched cord units was adopted as a new strategy. Since 2005, number of adult patients treated with UCB transplant is increased due to the higher number of cells available using two units and to the feasibility of reduced intensity conditioning regimen, extending successfully this strategy to heavier patients or for those with co-morbidities. Approximately 993 adults with hematological diseases have been transplanted with double UCB graft, and reported to Eurocord registry from 1999 to 2010. This article reviews the state of art and future directions with double umbilical cord blood units as a source of hematopoietic stem cells for transplantation.


Asunto(s)
Trasplante de Células Madre de Sangre del Cordón Umbilical/métodos , Enfermedades Hematológicas/terapia , Histocompatibilidad , Sistema de Registros , Acondicionamiento Pretrasplante/métodos , Adulto , Trasplante de Células Madre de Sangre del Cordón Umbilical/tendencias , Unión Europea , Femenino , Antígenos HLA , Enfermedades Hematológicas/mortalidad , Humanos , Masculino , Trasplante Homólogo
7.
Transplantation ; 89(11): 1354-61, 2010 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-20216480

RESUMEN

BACKGROUND: Bone complications after hematopoietic stem-cell transplantation (HSCT) are relatively frequent. Evaluation of biomarkers of bone turnover and dual energy x-ray absorptiometry (DEXA) are not known in this context. METHODS: We prospectively evaluated bone mineral density, biomarkers of bone turnover, and the cumulative incidence of bone complications after allogeneic HSCT. One hundred forty-six patients were included. Bone mineral density was measured by DEXA 2-month and 1-year post-HSCT. The markers of bone turnover were serum C-telopeptide (C-TP), 5 tartrate-resistant acid phosphatase (bone resorption), and osteocalcin (bone formation) determined pre-HSCT and 2 months and 1 year thereafter. Potential association between osteoporosis at 2 months, osteoporotic fracture or avascular necrosis and, individual patient's characteristics and biologic markers were tested. RESULTS: C-TP was high before and 2 months after transplant. At 2 months, DEXA detected osteoporosis in more than half the patients tested. Male sex, median age less than or equal to 15 years, and abnormal C-TP before HSCT were risk factors significantly associated with osteoporosis. Three-year cumulative incidences of fractures and avascular necrosis were 8% and 11%, respectively. Children were at higher risk of fracture, whereas corticosteroid treatment duration was a significant risk factor for developing a clinical bone complication post-HSCT. Bone complications and osteoporosis are frequent after HSCT. Bone biologic markers and DEXA showed that subclinical bone abnormalities appeared early post-HSCT. CONCLUSION: The risk factors, age, gender, and C-TP easily available at the time of transplantation were identified. Biphosphonates should probably be given to patients with those risk factors.


Asunto(s)
Enfermedades Óseas/epidemiología , Huesos/metabolismo , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Trasplante Homólogo/fisiología , Adolescente , Adulto , Densidad Ósea , Enfermedades Óseas/etiología , Enfermedades Óseas/patología , Niño , Colágeno Tipo I/sangre , Ciclosporina/uso terapéutico , Femenino , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Humanos , Inmunosupresores/uso terapéutico , Incidencia , Masculino , Necrosis , Péptidos/sangre , Factores de Riesgo , Caracteres Sexuales , Factores de Tiempo , Trasplante Homólogo/efectos adversos , Irradiación Corporal Total/efectos adversos
8.
J Rheumatol ; 30(11): 2385-91, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14677182

RESUMEN

OBJECTIVE: To explore the effect of multiple prothrombotic risk factors in individuals with anticardiolipin antibodies (aCL), we evaluated immunologic, coagulation, and genetic prothrombotic abnormalities in a cohort of individuals with different aCL titers. METHODS: We recruited 87 individuals into 4 categories (normal, low, intermediate, or high) based on their baseline IgG aCL (aCL-IgG) titers. We measured at followup: repeat aCL-IgG, IgM aCL (aCL-IgM), antibodies to beta2-glycoprotein I (anti-beta2-GPI), lupus anticoagulant (LAC) antibodies, protein C, protein S, activated protein C resistance, factor V506 Leiden mutation, methyl tetrahydrofolate reductase (MTHFR) C677T genotype, and prothrombin 20210A gene mutation. Thrombotic events were confirmed. RESULTS: At recruitment, 20 individuals were negative for aCL-IgG and 67 were positive (22 low, 20 intermediate, and 25 high titer). Twenty of the 87 participants had experienced a previous thrombotic event: 4 in the aCL-IgG negative group and 16 in the aCL-IgG positive group. Among the 87 individuals, the number of those with concomitant prothrombotic risk factors was as follows: 5 had no other prothrombotic risk factors, 32 had 1 risk factor, 24 had 2 risk factors, 10 had 3 risk factors, 10 had 4 risk factors, and 6 had 5 risk factors. Thrombotic events were observed in 20%, 13%, 33%, 10%, 30%, and 50% of these groups, respectively, and the odds ratio associated with a previous thrombotic event was 1.46 per each additional prothrombotic risk factor (95% confidence interval: 1.003-2.134). CONCLUSION: In individuals with positive aCL-IgG, we observed an association between the number of prothrombotic risk factors and history of thrombotic events.


Asunto(s)
Anticuerpos Anticardiolipina/metabolismo , Trombosis/etiología , Adulto , Estudios de Cohortes , Estudios Transversales , Demografía , Femenino , Humanos , Inmunoglobulina G/metabolismo , Masculino , Registros Médicos , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Medición de Riesgo , Factores de Riesgo
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