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1.
Sensors (Basel) ; 23(24)2023 Dec 18.
Article in English | MEDLINE | ID: mdl-38139743

ABSTRACT

Methane leaks are a significant component of greenhouse gas emissions and a global problem for the oil and gas industry. Emissions occur from a wide variety of sites with no discernable patterns, requiring methodologies to frequently monitor these releases throughout the entire production chain. To cost-effectively monitor widely dispersed well pads, we developed a methane point instrument to be deployed at facilities and connected to a cloud-based interpretation platform that provides real-time continuous monitoring in all weather conditions. The methane sensor is calibrated with machine learning methods of Gaussian process regression and the results are compared with artificial neural networks. A machine learning approach incorporates environmental effects into the sensor response and achieves the accuracies required for methane emissions monitoring with a small number of parameters. The sensors achieve an accuracy of 1 part per million methane (ppm) and can detect leaks at rates of less than 0.6 kg/h.

2.
Curr Biol ; 32(21): 4707-4718.e8, 2022 11 07.
Article in English | MEDLINE | ID: mdl-36115340

ABSTRACT

Development is a highly dynamic process in which organisms often experience changes in both form and behavior, which are typically coupled to each other. However, little is known about how organismal-scale behaviors such as body contractility and motility impact morphogenesis. Here, we use the cnidarian Nematostella vectensis as a developmental model to uncover a mechanistic link between organismal size, shape, and behavior. Using quantitative live imaging in a large population of developing animals, combined with molecular and biophysical experiments, we demonstrate that the muscular-hydraulic machinery that controls body movement also drives larva-polyp morphogenesis. We show that organismal size largely depends on cavity inflation through fluid uptake, whereas body shape is constrained by the organization of the muscular system. The generation of ethograms identifies different trajectories of size and shape development in sessile and motile animals, which display distinct patterns of body contractions. With a simple theoretical model, we conceptualize how pressures generated by muscular hydraulics can act as a global mechanical regulator that coordinates tissue remodeling. Altogether, our findings illustrate how organismal contractility and motility behaviors can influence morphogenesis.


Subject(s)
Sea Anemones , Animals , Larva , Morphogenesis
3.
Soft Matter ; 17(42): 9745-9754, 2021 Nov 03.
Article in English | MEDLINE | ID: mdl-34647567

ABSTRACT

When a thin stream of aqueous sodium alginate is extruded into a reacting calcium chloride bath, it polymerizes into a soft elastic tube that spontaneously forms helical coils due to the ambient fluid drag. We quantify the onset of this drag-induced instability and its nonlinear evolution using experiments, and explain the results using a combination of scaling, theory and simulations. By co-extruding a second (internal) liquid within the aqueous sodium alginate jet and varying the diameter of the jet and the rates of the co-extrusion of the two liquids, we show that we can tune the local composition of the composite filament and the nature of the ensuing instabilities to create soft filaments of variable relative buoyancy, shape and mechanical properties. Altogether, by harnessing the fundamental varicose (jetting) and sinuous (buckling) instabilities associated with the extrusion of a submerged jelling filament, we show that it is possible to print complex three-dimensional filamentous structures in an ambient fluid.

4.
Indian Dermatol Online J ; 12(3): 423-428, 2021.
Article in English | MEDLINE | ID: mdl-34211909

ABSTRACT

BACKGROUND: Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs. MATERIALS AND METHODS: An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained. RESULTS: Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in-patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work. CONCLUSION: Since the after-effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs.

5.
Bone Marrow Transplant ; 56(1): 185-194, 2021 01.
Article in English | MEDLINE | ID: mdl-32704091

ABSTRACT

CTLA4Ig has a unique property to spare or even potentiate natural killer (NK) cell-mediated cytotoxicity, whilst inhibiting T cell activation. We explored the efficacy of prophylactic DLI following CTLA4Ig (CTLA4Ig-DLI group, n = 75), compared to conventional DLI (DLI group, n = 50), in patients with advanced hematological malignancies receiving PTCy-based haploidentical transplantation. Acute and chronic GVHD in the CTLA4Ig-DLI group were 9.6% and 15.3% compared to 18.8% [p = 0.09] and 36.5% [p = 0.01] in the DLI group. Both non-relapse mortality (4% vs 14.4%) and disease progression (DP) (15.7% vs 31.1%) were lower in CTLA4Ig-DLI group (p = 0.04). GVHD and progression-free survival was significantly improved in the CTLA4Ig-DLI group (p = 0.001). The recovery of CD56dimNK cells, NKG2A-KIR + NK subsets and Tregs was significantly better in the CTLA4Ig-DLI group at all time points and memory T cells at day +90. Immune recovery in relation to DP showed distinct patterns, with T cell subsets in the DLI group and NKG2A-KIR+NK cells in CTLA4Ig-DLI group having favorable impact. CTLA4Ig-DLI was thus associated with an improved outcome, possibly on account of the distinct pattern of immune recovery shown with this novel approach.


Subject(s)
Graft vs Host Disease , Hematologic Neoplasms , Hematopoietic Stem Cell Transplantation , Immune Reconstitution , Hematologic Neoplasms/therapy , Humans , Killer Cells, Natural , Lymphocyte Transfusion , Transplantation, Haploidentical
6.
Mol Cell ; 79(6): 881-901, 2020 09 17.
Article in English | MEDLINE | ID: mdl-32768408

ABSTRACT

Nucleosomes package genomic DNA into chromatin. By regulating DNA access for transcription, replication, DNA repair, and epigenetic modification, chromatin forms the nexus of most nuclear processes. In addition, dynamic organization of chromatin underlies both regulation of gene expression and evolution of chromosomes into individualized sister objects, which can segregate cleanly to different daughter cells at anaphase. This collaborative review shines a spotlight on technologies that will be crucial to interrogate key questions in chromatin and chromosome biology including state-of-the-art microscopy techniques, tools to physically manipulate chromatin, single-cell methods to measure chromatin accessibility, computational imaging with neural networks and analytical tools to interpret chromatin structure and dynamics. In addition, this review provides perspectives on how these tools can be applied to specific research fields such as genome stability and developmental biology and to test concepts such as phase separation of chromatin.


Subject(s)
Chromatin/genetics , Chromosomes/genetics , DNA/genetics , Nucleosomes/genetics , DNA Repair/genetics , DNA Replication/genetics , Epigenesis, Genetic/genetics , Humans
7.
Phys Rev Lett ; 124(25): 258002, 2020 Jun 26.
Article in English | MEDLINE | ID: mdl-32639784

ABSTRACT

When a volatile droplet is deposited on a floating swellable sheet, it becomes asymmetric, lobed and mobile. We describe and quantify this phenomena that involves nonequilibrium swelling, evaporation and motion, working together to realize a self-excitable spatially extended oscillator. Solvent penetration causes the film to swell locally and eventually buckle, changing its shape and the drop responds by moving. Simultaneously, solvent evaporation from the swollen film causes it to regain its shape once the droplet has moved away. The process repeats and leads to complex pulsatile spinning and/or sliding movements. We use a one-dimensional experiment to highlight the slow swelling of and evaporation from the film and the fast motion of the drop, a characteristic of excitable systems. Finally, we provide a phase diagram for droplet excitability as a function of drop size and film thickness and scaling laws for the motion of the droplet.

8.
Ann Hematol ; 99(4): 839-845, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32025839

ABSTRACT

Hemorrhagic cystitis (HC) has been reported with increased frequency following post-transplantation cyclophosphamide (PTCy)-based haploidentical hematopoietic cell transplantation (HCT) along with a strong association with BK viruria. We prospectively evaluated the incidence of BK viruria and HC in 115 patients (median age 20 years, 2-65) undergoing PTCy-based haploidentical HCT with (n = 71) or without (n = 44) CTLA4Ig. HC prophylaxis consisted of a continuous infusion of mesna 30 min prior and 48 h post-PTCy. The overall incidence of BK viruria was 65.7%. None with BK viruria < 104 copies/ml developed clinical symptoms (n = 65). The incidence of BK viruria ≥ 104 copies/ml was 7.1% (n = 8) and 75% developed HC. The incidence of HC was 5.4% at a median of 30 days. Both BK viruria ≥ 104 copies/ml and HC were strongly associated with acute GVHD (p < 0.001). A higher NRM was observed in those with BK viruria ≥ 104 copies/ml, related to GVHD and its complications (41.7% vs 12.6%, p = 0.04). The incidences of acute GVHD, vis-à-vis, overall BK viruria, BK viruria ≥ 104 copies/ml, and HC, tended to be lower in patients receiving CTLA4Ig. Thus, extended infusional mesna, coupled with significant reduction in alloreactivity along with possible preservation of antiviral immunity associated with the use of CTLA4Ig, was probably responsible for a much lower incidence of BK viruria and resultant HC than reported previously following PTCy-based haploidentical HCT.


Subject(s)
Abatacept/therapeutic use , BK Virus/isolation & purification , Cyclophosphamide/adverse effects , Cystitis/prevention & control , Hematopoietic Stem Cell Transplantation , Hematuria/prevention & control , Immunosuppressive Agents/adverse effects , Mesna/therapeutic use , Polyomavirus Infections/urine , Transplantation, Haploidentical , Tumor Virus Infections/urine , Abatacept/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cyclophosphamide/administration & dosage , Cystitis/chemically induced , Cystitis/urine , Cystitis/virology , Female , Graft vs Host Disease/prevention & control , Hematologic Diseases/complications , Hematologic Diseases/therapy , Hematologic Neoplasms/complications , Hematologic Neoplasms/therapy , Hematuria/chemically induced , Hematuria/virology , Humans , Immunosuppressive Agents/administration & dosage , Infusions, Intravenous , Kaplan-Meier Estimate , Male , Mesna/administration & dosage , Middle Aged , Polyomavirus Infections/complications , Polyomavirus Infections/virology , Tumor Virus Infections/complications , Tumor Virus Infections/virology , Urine/virology , Young Adult
9.
Transplantation ; 104(1): e23-e30, 2020 01.
Article in English | MEDLINE | ID: mdl-31478993

ABSTRACT

BACKGROUND: The impact of newer approaches to haploidentical transplantation on Epstein-Barr virus (EBV) is largely unknown. METHODS: We prospectively evaluated the incidence of EBV reactivation and its impact on transplantation outcomes in 71 patients undergoing haploidentical transplantation with posttransplantation cyclophosphamide in combination with CTLA4Ig-based T-costimulation blockade. RESULTS: Eight patients developed EBV reactivation at a median of 96 days with no incidence of lymphoproliferative disorder. There was no impact of EBV reactivation on acute graft-versus-host disease (GVHD), nonrelapse mortality, progression-free, or overall survival. Despite an overall incidence of 19%, there was a significant increase in chronic GVHD following EBV reactivation (62.5% versus 8%; P = 0.01). NKG2A subset of CD56 natural killer cells increased substantially and persisted following EBV reactivation and chronic GVHD, with a reciprocal decrease in NKG2C subset, whereas the reverse was witnessed in those without chronic GVHD (P < 0.01). Increase in NKG2C subset and a decrease in the NKG2A subset were witnessed within 3 months of subsidence of chronic GVHD. CONCLUSIONS: Thus, CTLA4Ig-based haploidentical transplantation was associated with a low incidence of EBV reactivation without EBV-lymphoproliferative disorder. However, EBV reactivation was associated with a sustained alteration in NKG2A and NKG2C subsets of CD56 natural killer cells which might have a pathogenic role in chronic GVHD.


Subject(s)
Abatacept/administration & dosage , Epstein-Barr Virus Infections/epidemiology , Graft vs Host Disease/epidemiology , Hematopoietic Stem Cell Transplantation/adverse effects , Immunosuppressive Agents/administration & dosage , Killer Cells, Natural/metabolism , Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease/epidemiology , Epstein-Barr Virus Infections/blood , Epstein-Barr Virus Infections/immunology , Epstein-Barr Virus Infections/virology , Female , Graft vs Host Disease/blood , Graft vs Host Disease/immunology , Graft vs Host Disease/virology , Herpesvirus 4, Human/isolation & purification , Herpesvirus 4, Human/physiology , Humans , Incidence , Killer Cells, Natural/immunology , Male , Middle Aged , NK Cell Lectin-Like Receptor Subfamily C/immunology , NK Cell Lectin-Like Receptor Subfamily C/metabolism , Transplantation Conditioning/methods , Transplantation, Haploidentical/adverse effects , Virus Activation/immunology , Young Adult
11.
Transpl Infect Dis ; 21(5): e13136, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31251433

ABSTRACT

We evaluated the incidences and consequences of rotavirus induced diarrhea in a cohort of 115 patients undergoing T-cell replete haploidentical transplantation. Four out of 115 patients developed rotavirus-induced diarrhea between 47 and 147 days. The incidence of rotavirus infection was 9.7% in children compared to none in adults (P = .01). This was 25.3% in those with GVHD compared to 1.2% in those without GVHD (P = .001). Rotavirus infection was followed by post-transplantation hemophagocytic syndrome (PTHPS) at a median of 4 days (range, 3-10 days) in all four patients. Three patients succumbed to the complications related to PTHPS. Only one patient, who is long-term survivor, was able to eliminate this virus after 2 weeks. Children undergoing T-replete haploidentical hematopoietic cell transplantation who develop GVHD are at a higher risk of community-acquired rotavirus infection which was strongly associated with PTHPS with poor outcome.


Subject(s)
Cyclophosphamide/administration & dosage , Hematopoietic Stem Cell Transplantation/adverse effects , Immunosuppressive Agents/administration & dosage , Lymphohistiocytosis, Hemophagocytic/mortality , Rotavirus Infections/complications , Transplantation Conditioning , Adolescent , Child , Child, Preschool , Cohort Studies , Community-Acquired Infections/virology , Diarrhea/virology , Female , Graft vs Host Disease/etiology , Humans , Incidence , Lymphohistiocytosis, Hemophagocytic/virology , Male , Rotavirus Infections/etiology , Transplantation, Haploidentical/adverse effects
12.
Biol Blood Marrow Transplant ; 25(8): 1621-1628, 2019 08.
Article in English | MEDLINE | ID: mdl-31048086

ABSTRACT

We prospectively studied the impact of preemptive granulocyte infusions (pGIs) in 69 patients colonized with carbapenem-resistant gram-negative bacteria (CRGNB) undergoing haploidentical hematopoietic cell transplantation (HCT) compared with a previous cohort of 33 patients who received only antimicrobials directed toward CRGNB at the onset of neutropenic fever (non-pGI group). All patients developed neutropenic fever at a median of day +8 (range, -4 to +12) after transplantation. Engraftment kinetics were similar for both groups. The median number of GIs was 2 (range, 1 to 7), and the median dose of granulocytes infused was 5 × 1010 granulocytes per infusion (range, 1 to 30). The overall incidence of CRGNB bloodstream infections (BSIs) was 21.2% in non-pGI group (7/33) and 17.5% (12/69) in the pGI group (P = .8). However, the CRGNB-related mortality among those with BSI was 100% (7/7) in the non-pGI group versus 16.6% (2/12) in the pGI group (P = .001). The day 100 (4.4% versus 24.4%, P = .002) and 2-year nonrelapse mortality (7.5% versus 35.6%, P = .0001) were significantly reduced in the pGI group. The overall survival at 2 years was 75.6% in the pGI group versus 21.2% in the non-pGI group (P = .0001). Colonization and subsequent BSI with CRGNB are associated with a high incidence of mortality in patients undergoing HCT. pGI reduced early mortality associated with CRGNB in colonized patients undergoing post-transplant cyclophosphamide-based haploidentical HCT.


Subject(s)
Carbapenems , Febrile Neutropenia , Gram-Negative Bacteria , Gram-Negative Bacterial Infections , Granulocytes/transplantation , Hematopoietic Stem Cell Transplantation , Leukocyte Transfusion , beta-Lactam Resistance , Adolescent , Adult , Aged , Allografts , Child , Child, Preschool , Disease-Free Survival , Febrile Neutropenia/etiology , Febrile Neutropenia/microbiology , Febrile Neutropenia/mortality , Febrile Neutropenia/therapy , Female , Gram-Negative Bacterial Infections/etiology , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/mortality , Gram-Negative Bacterial Infections/therapy , Humans , Incidence , Male , Middle Aged , Prospective Studies , Survival Rate , Time Factors
13.
Biol Blood Marrow Transplant ; 25(4): 673-682, 2019 04.
Article in English | MEDLINE | ID: mdl-30610925

ABSTRACT

CTLA4Ig attenuates T cell activation by co-stimulation blockade, but natural killer (NK) cells are not only resistant to CTLA4Ig, they also may demonstrate better antileukemia effect in the presence of CTLA4Ig. To explore this phenomenon we used sequential CTLA4Ig primed donor lymphocyte infusion (DLI) after post-transplant cyclophosphamide-based haploidentical transplantation. Thirty patients (CTLA4Ig-DLI group) with advanced leukemia received CTLA4Ig on day -1 and subsequently on days +7, +21, and +35, followed 12hours later by DLI of 1 to 10 × 106 CD3+ T cells/kg containing .1 to 3.27 × 106/kg CD56+ NK cells, with low dose cyclosporine for 60days. The incidences of acute graft-versus-host disease (GVHD), chronic GVHD and nonrelapse mortality (NRM) were 6.7%, 21%, and 4.5 %, respectively, with disease progression of 23.3% and overall survival of 79% at 18 months. Patients without disease progression had a significant early surge in CD56dimCD16+NK cells with lower NKG2A expression. CTLA4Ig primed DLI was associated with an upregulation of CD86 in mature NK cells that was not witnessed with CTLA4Ig administration alone. Thus, CTLA4Ig primed DLI resulted in early proliferation of mature NK cells with cytotoxic potential enabling early institution of adoptive immunotherapy to mitigate the risk of relapse in advanced leukemia with reduced GVHD and NRM.


Subject(s)
Abatacept/therapeutic use , Immunosuppressive Agents/therapeutic use , Immunotherapy/methods , Leukemia/therapy , Lymphocyte Transfusion/methods , Transplantation, Haploidentical/methods , Abatacept/pharmacology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Immunosuppressive Agents/pharmacology , Killer Cells, Natural , Leukemia/pathology , Male , Middle Aged , Young Adult
14.
Biol Blood Marrow Transplant ; 24(10): 2025-2033, 2018 10.
Article in English | MEDLINE | ID: mdl-29906568

ABSTRACT

To understand the phenomenon of early alloreactivity (EA) in younger children undergoing post-transplantation cyclophosphamide (PTCy)-based haploidentical transplantation, we studied the graft composition and the immune reconstitution in 32 consecutive patients (aged 2 to 25 years) undergoing PTCy and T cell costimulation blockade based peripheral blood stem cell transplantation with emphasis on CD45RA+ subset of regulatory T cells (Tregs). All but 1 engrafted, and 14 patients experienced EA (acute graft-versus-host disease grades II to IV, n = 8; and post-transplantation hemophagocytic syndrome, n = 6) with a cumulative incidence of 43.7%; 42% developed mild chronic graft-versus-host disease. The overall survival was 70.2% with a nonrelapse mortality of 16.8% at a median of 19 months. Age < 10 years, donor age > 45 years, and poor recovery of Tregs correlated with EA. Not Tregs but higher CD45RA+ Tregs in the graft was associated with less EA (11.7% versus 32.5%, P = .0001). Higher donor age correlated with a lower CD45RA+ Tregs in the graft (P = .01). However, only higher CD45RA+ Treg percentage in the graft favorably impacted EA as well as nonrelapse mortality and overall survival. Our study demonstrates a critical role for CD45RA+ Tregs in determining EA and outcome after PTCy-based haploidentical peripheral blood stem cell transplantation, and the age-related physiologic decline in this population might be responsible for adverse impact of donor age.


Subject(s)
Cyclophosphamide/administration & dosage , Hematologic Neoplasms , Living Donors , Peripheral Blood Stem Cell Transplantation , T-Lymphocytes, Regulatory/metabolism , Adolescent , Adult , Age Factors , Child , Child, Preschool , Disease-Free Survival , Female , Graft vs Host Disease/blood , Graft vs Host Disease/mortality , Graft vs Host Disease/pathology , Graft vs Host Disease/prevention & control , Hematologic Neoplasms/blood , Hematologic Neoplasms/mortality , Hematologic Neoplasms/pathology , Hematologic Neoplasms/therapy , Humans , Male , Survival Rate , T-Lymphocytes, Regulatory/pathology , Transplantation, Haploidentical
15.
Langmuir ; 34(13): 3894-3900, 2018 04 03.
Article in English | MEDLINE | ID: mdl-29533669

ABSTRACT

When a soft hydrogel sphere is placed on a rigid hydrophilic substrate, it undergoes arrested spreading by forming an axisymmetric foot near the contact line, while conserving its global spherical shape. In contrast, liquid water (that constitutes greater than 90% of the hydrogel's volume) spreads into a thin film on the same surface. We study systematically this elastowetting of gel spheres on substrates of different surface energies and find that their contact angle increases as the work of adhesion between the gel and the substrate decreases, as one would observe for drops of pure water-albeit being larger than in the latter case. This difference in the contact angles of gel and water appears to be due to the elastic shear stresses that develop in the gel and oppose its spreading. Indeed, by increasing the elastic modulus of the gel spheres, we find that their contact angle also increases. In addition, the length of the contact foot increases with the work of adhesion and sphere size, while it decreases when the elastic modulus of the gel is increased. We discuss those experimental results in light of a minimal analysis based on energy minimization, volume conservation, and scaling arguments.

16.
Cytotherapy ; 19(4): 531-542, 2017 04.
Article in English | MEDLINE | ID: mdl-28131632

ABSTRACT

We conducted a pilot study on the feasibility of CD56-enriched donor cell infusion after post-transplantation cyclophosphamide (PTCy) for 10 patients with advanced myeloid malignancies undergoing haploidentical peripheral blood stem cell transplantation with cyclosporine alone as graft-versus-host disease (GVHD) prophylaxis and compared the outcome and immune reconstitution with a control group of 20 patients undergoing the same without CD56-enriched donor cell infusion. An early and rapid surge of mature NK cells as well as CD4+ T cells and regulatory T cells (Tregs) was noted compared with the control group. KIR of donor phenotype reconstituted as early as day 30 with expression of CD56dimCD16+NKG2A-KIR+ phenotype. None experienced viral or fungal infections, and non-relapse mortality was 10% only. The incidence of grade 2-4 acute GVHD was 50% in the control group with none in the CD56 group (P = 0.01). Only two had de novo chronic GVHD in each group. Relapse occurred in five patients in CD56 group with a median follow-up of 12 months, similar to the control group. Our preliminary data show that CD56+ donor cell infusion after PTCy and short-course cyclosporine is feasible with prompt engraftment, rapid reconstitution of CD4+T cells, Tregs and NK cells and reduced incidence of acute GVHD.


Subject(s)
CD56 Antigen/metabolism , Cyclophosphamide/administration & dosage , Graft vs Host Disease/prevention & control , Hematologic Neoplasms/therapy , Killer Cells, Natural/transplantation , Peripheral Blood Stem Cell Transplantation/adverse effects , T-Lymphocytes, Regulatory/transplantation , Adolescent , Adult , Aged , Child , Child, Preschool , Disease Progression , Drug Administration Schedule , Feasibility Studies , Female , Graft vs Host Disease/epidemiology , Haplotypes , Hematologic Neoplasms/epidemiology , Histocompatibility Testing/methods , Humans , Incidence , Killer Cells, Natural/immunology , Killer Cells, Natural/metabolism , Male , Middle Aged , Peripheral Blood Stem Cell Transplantation/methods , Pilot Projects , T-Lymphocytes, Regulatory/metabolism , Tissue Donors , Transplantation Conditioning/methods , Transplantation, Homologous/adverse effects , Young Adult
17.
Transpl Immunol ; 39: 46-51, 2016 11.
Article in English | MEDLINE | ID: mdl-27577170

ABSTRACT

The outcome of hyperacute grade 3-4 steroid-refractory graft-versus-host-disease (SR-GVHD) remains dismal despite a plethora of agents being tried alone or in combination. Following T replete haploidentical transplantation with post-transplantation cyclophosphamide on 75 patients, 10 patients (13%) aged 2-20years, developed hyperacute SR-GVHD. We report on the outcome of two different regimens for treatment of SR-GVHD on the outcome of these patients. Five patients were treated in Regimen A consisting of anti-thymocyte globulin, Etanercept and Basiliximab. The next 5 patients were treated combining T cell costimulation blockade with Abatacept along with Etanercept and Basiliximab. The overall response at days 29 and 56 were 40% and 0% with Regimen A and100% and 40% with Regimen B. The major cause of treatment failure was progression of GVHD and opportunistic infections. Two of the patients achieving a complete remission on Regimen B are long term disease free survivors off immunosuppression. Our study demonstrates the dismal outcome of early onset SR-GVHD in children following T replete haploidentical transplantation. However, the combination of Abatacept with anticytokine agents seems to produce encouraging early response and might warrant further investigation.


Subject(s)
Abatacept/therapeutic use , Antibodies, Monoclonal/therapeutic use , Antilymphocyte Serum/therapeutic use , Etanercept/therapeutic use , Graft vs Host Disease/drug therapy , Hematopoietic Stem Cell Transplantation , Immunotherapy/methods , Recombinant Fusion Proteins/therapeutic use , Acute Disease , Adolescent , Basiliximab , Child , Child, Preschool , Cytokines/immunology , Disease-Free Survival , Drug Resistance , Drug Therapy, Combination , Female , Humans , Male , Steroids/therapeutic use , T-Lymphocytes/immunology , Transplantation, Haploidentical , Withholding Treatment , Young Adult
18.
Biol Blood Marrow Transplant ; 22(10): 1867-1873, 2016 10.
Article in English | MEDLINE | ID: mdl-27470289

ABSTRACT

We carried out post-transplantation cyclophosphamide (PTCy)-based haploidentical peripheral blood stem cell transplantation in 51 patients with refractory/relapsed acute myeloid leukemia not in remission. The first 10 patients received nonmyeloablative conditioning followed by planned granulocyte colony-stimulating factor (G-CSF)-mobilized donor lymphocyte infusions (DLIs) on days 35, 60, and 90. No patient developed graft-versus-host disease (GVHD), but 90% had disease progression between 3 and 6 months. A subsequent 41 patients received myeloablative conditioning (MAC); the first 20 patients did not receive DLIs (MAC group) and the next 21 patients received G-CSF-mobilized DLIs (G-DLI) on days 21, 35, and 60 (MAC-DLI group). The incidence of disease progression and progression-free survival at 18 months were 66% and 25% in the MAC group compared with 21.4% and 61.9% in the MAC-DLI group (P = .01). Chronic GVHD but not acute GVHD was increased in the MAC-DLI group (41.2% versus 11%, P = .05). Natural killer cell alloreactive donor was associated with lower incidence of disease progression in the MAC but not in MAC-DLI group. The only factor favorably influencing disease progression and progression-free survival was administration of G-DLI after myeloablative conditioning. Our study shows that early administration of G-DLI is feasible after PTCy-based haploidentical hematopoietic stem cell transplantation for refractory/relapsed acute myeloid leukemia and might be associated with improved survival after MAC.


Subject(s)
Immunotherapy, Adoptive/methods , Killer Cells, Natural/transplantation , Salvage Therapy/methods , Transplantation, Haploidentical/methods , Adolescent , Adult , Aged , Child , Child, Preschool , Disease Progression , Disease-Free Survival , Female , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Immunotherapy, Adoptive/trends , Killer Cells, Natural/immunology , Lymphocyte Transfusion , Male , Middle Aged , Myeloablative Agonists/therapeutic use , Receptors, KIR/immunology , Salvage Therapy/adverse effects , Salvage Therapy/mortality , Transplantation Conditioning/methods , Transplantation, Haploidentical/adverse effects , Transplantation, Haploidentical/mortality , Treatment Outcome , Young Adult
19.
Pediatr Transplant ; 20(5): 675-82, 2016 Aug.
Article in English | MEDLINE | ID: mdl-27217372

ABSTRACT

Haploidentical transplantation with PTCY following marrow or PBSC graft has been associated with low incidence of GVHD in adults with similar data lacking in children. We report on the outcome of 25 patients <20 yr of age (median age 12 yr), undergoing a haploidentical PBSC transplantation for both malignant and non-malignant disorders. Engraftment was prompt and sustained. Cumulative incidences of acute GVHD and chronic GVHD were 40.3% and 16.7%, respectively. On subgroup analysis, it was evident that acute GVHD developed in 80% of patients <10 yr compared to only 13.3% in those between 10 and 20 yr [log-rank p = 0.001], despite similar graft composition with significantly higher NRM (60% vs. 0%; p = 0.001). The FFS was 63.5%; (79% in >10 yr and 40% in <10 yr, p = 0.01). Our data suggest that PTCY-based haploidentical PBSC transplantation is feasible in older children, but results in early and severe alloreactivity in younger children. These findings, despite being counterintuitive, could be explained by the variable metabolism of CY and oral mycophenolate in younger children indicating that PTCY-based approach as used in adults might not be adequate for younger children.


Subject(s)
Donor Selection , Graft vs Host Disease/prevention & control , Haplotypes , Peripheral Blood Stem Cell Transplantation/methods , Tissue Donors , Acute Disease , Adolescent , Adult , Child , Child, Preschool , Chronic Disease , Cyclophosphamide/therapeutic use , Female , Follow-Up Studies , Graft vs Host Disease/epidemiology , Graft vs Host Disease/genetics , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Male , Middle Aged , Pilot Projects , Treatment Outcome , Young Adult
20.
Int J Hematol ; 103(2): 234-42, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26619832

ABSTRACT

Hemophagocytic syndrome (HPS) is a rare but serious complication after allogeneic transplantation which has been reported to be particularly high after unrelated cord blood transplantation. We report on the incidence, risk factors and outcome of HPS in 51 patients (age 2-64 years) after haploidentical peripheral blood stem cell (PBSC) transplantation with post-transplantation cyclophosphamide (PTCY). The incidence of HPS was 12.2 %, occurring at a median of 18 days. The non-relapse mortality in patients with HPS was 83.3 % compared to 11.6 % in patients without HPS. Complete donor chimerism was documented in all patients with HPS. Definite infective etiology was identified in two patients only. The others were refractory to multiple lines of treatment and 3 patients underwent a second transplant. Even though the symptoms and biochemical markers of HPS showed prompt response in 2/3 patients undergoing a second allograft, they succumbed to infections before haematological recovery. The others succumbed to multi-organ failure or infections. Age < 10 years, transplantation for non-malignant disease and high CD34 content of the graft were identified as risk factors for HPS. Considering the fact that post-transplant HPS is usually a refractory and fatal condition, we discuss further attempts at deciphering the pathogenesis, developing modalities to prevent this complication and improve the outcome.


Subject(s)
Cyclophosphamide/administration & dosage , Haploidy , Immunosuppressive Agents/administration & dosage , Lymphohistiocytosis, Hemophagocytic/etiology , Peripheral Blood Stem Cell Transplantation/adverse effects , Postoperative Care , Adolescent , Adult , Allografts , Antigens, CD34 , Child , Child, Preschool , Female , Humans , Incidence , Lymphohistiocytosis, Hemophagocytic/epidemiology , Lymphohistiocytosis, Hemophagocytic/prevention & control , Male , Middle Aged , Risk Factors , Time Factors , Tissue Donors , Transplantation Chimera , Young Adult
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