RESUMEN
Currently, approximately 19 million people with a migration background live in Germany. The majority of those descend from regions where the population has a genetically different distribution of HLA antigens when compared to the HLA frequencies usually found in North Western Europe. In case of severe haematological disorders of these individuals, allogeneic stem cell transplantation may be the treatment of choice. However, finding appropriate histocompatible hematopoietic stem cell donors continues to be a major challenge. If no matching sibling donors are available, there are only few suitable donors with a similar genetic background available in international blood stem cell donor registries. The "BluStar.NRW" project aimed to recruit new blood and hematopoietic stem cell donors with a migration background and to noticeably increase the number of suitable donors for patients within this group. Since December 2017, a total number of 9100 blood and stem cell donors with a migration background were recruited and typed for this project. HLA typing for HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 was performed by Next Generation Sequencing. We assessed the proportion of rare alleles according to HLA frequency tables, as defined by a frequency of <1:1000. The rare HLA allele frequencies according to HLA frequency tables of the BluStar.NRW cohort were compared with a matched control donor cohort: Rare HLA-A, -B, -C, -DRB1 and -DQB1 alleles occurred three times more frequent than in the control group, but rare HLA-DPB1 alleles occurred more frequently in the control cohort. This difference was highly significant for all HLA alleles (p < 0.0001 for HLA-A, -B, -C, -DRB1, -DPB1; p = 0.0002 for HLA-DQB1). In addition, the distribution of rare alleles differed between the two groups. To date, 29 work-ups were initiated, 12 PBSC, one BM and three DLI were collected so far out of the BluStar.NRW cohort. The apheresis probability is twofold higher (0.18% vs. 0.07%) compared to the control group which clearly shows a serious medical need. However, 13 work-ups were cancelled in the BluStar.NRW donor cohort which represents an almost twice as higher cancellation rate (45% vs. 25%). This single registry analysis with a large sample cohort clearly indicates that hematopoietic stem cell donors with a migration background represent an adequate donor pool to serve patients of comparable ethnicity.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Refugiados , Migrantes , Humanos , Etnicidad/genética , Donantes de Tejidos , Antígenos de Histocompatibilidad Clase I/genética , Células Madre Hematopoyéticas , Frecuencia de los Genes , Antígenos HLA-A/genética , Alelos , Prueba de Histocompatibilidad , HaplotiposRESUMEN
Although reduced intensity conditioning (RIC) before allografting is associated with low treatment-related morbidity and mortality, graft-versus-host disease (GVHD) remains a significant complication of hematopoietic stem cell transplantation (HSCT). T cell depletion (TCD) has been successfully used in conventional allotransplantation to reduce the incidence of GVHD, but was associated with an increased rate of engraftment failure. In a small cohort of six patients at high risk of developing GVHD we have determined whether sustained engraftment could be achieved using reduced intensity conditioning and T cell depletion in combination. All patients engrafted and 5/6 developed high levels (i.e. > or =95%) of donor chimerism, even though mismatched related or matched unrelated donors were used. Only one patient developed acute GVHD, as he received donor lymphocyte infusions (DLI) for relapse. In summary, TCD might be a useful prophylactic tool in RIC allogeneic HSCT. Although TCD after RIC might be associated with high relapse rate, as 5/6 patients are not in remission, this combined strategy might be appropriate for patients with less aggressive malignant or non-malignant diseases in which high transplant-related morbidity and mortality is not acceptable.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Depleción Linfocítica , Quimera por Trasplante , Acondicionamiento Pretrasplante , Trasplante Homólogo , Vidarabina/uso terapéutico , Irradiación Corporal Total , Adulto , Estudios de Cohortes , Progresión de la Enfermedad , Estudios de Factibilidad , Femenino , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/epidemiología , Enfermedad Injerto contra Huésped/prevención & control , Neoplasias Hematológicas/terapia , Humanos , Transfusión de Linfocitos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Donantes de Tejidos , Resultado del Tratamiento , Vidarabina/análogos & derivadosRESUMEN
Kant's discussion of the ethical implications of smallpox inoculation is presented here. In four fragments Kant analyzes the moral legitimacy of endangering other people in medical practice and especially endangering people who are incapable of giving consent. In addition, we re-evaluate the alleged "success story" of the development of smallpox prevention and review the technical and theoretical difficulties of smallpox inoculation at the time of Kant.
Asunto(s)
Ética Médica/historia , Inmunización/historia , Viruela/historia , Alemania , Historia del Siglo XVIII , Humanos , Filosofía/historiaAsunto(s)
Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide Aguda/sangre , Leucemia Mieloide Aguda/prevención & control , Depleción Linfocítica , Transfusión de Linfocitos , Receptores de Antígenos de Linfocitos T alfa-beta , Aloinjertos , Femenino , Humanos , Leucemia Mieloide Aguda/patología , RecurrenciaRESUMEN
BACKGROUND AND OBJECTIVE: Resuscitation is the most important emergency action in a life-threatening cardiopulmonary arrest. The organizational, personnel and equipment requirements for an optimal treatment of emergency patients in a university hospital are described, as well as the short- and mid-term results. PATIENTS AND METHODS: Retrospective analysis of 132 cases of cardiopulmonary resuscitation based on a two-pages reporting form whose completion by the involved physician and intensive care nurse is mandatory after each event. RESULTS: About 65â% of all events were triggered by cardiac and respiratory causes. In 50â% of all cases there was an acute life-threatening situation, requiring an intubation in 46â% and mechanical reventilation in 42â% of all cases. One third of all patients who were successfully reanimated were discharged alive from hospital after the intensive care treatment. CONCLUSION: A well organized and adequately equipped resuscitation team is the basis for achieving optimal chances of survival in life-threatening emergencies. This is especially so in large university hospitals with often care for patients with multiple morbidities.