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PubMed | University of Rome La Sapienza and Immunohematology and Transfusion Medicine.
Type: | Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy | Year: 2016

Therapeutic apheresis (TA) is a complex extracorporeal procedure for the treatment of several acute and chronic diseases. TA in pregnancy is considered safe for both mother and fetus and has the same indications of non-pregnant patients. TA can be used during the entire course of the pregnancy with the following purposes: (i) to treat several maternal acute and chronic conditions; (ii) to treat fetal conditions; (iii) to avoid administration of drugs potentially harmful to the fetus; and (iv) to reach a more advanced gestational age in order to prevent fetal prematurity. We report three successfully treated patients throughout pregnancy, for differential indications: thrombotic thrombocytopenic purpura, red blood cells alloimmunization and ulcerative colitis. Multiple courses of TA have been performed without any complications for the mother and the fetus. A review and a discussion on the particular TA implications related to maternal-fetal medicine have been reported. When approaching TA in pregnancy, clinicians have to consider the severity of disease, the strength of the indications, and the gestational age. Each case must be evaluated individually on the basis of existing evidence since, despite the increasing use, specific guidelines for apheresis in pregnancy are still lacking.


Stefanutti C.,SapienzaUniversity of Rome | D'Alessandri G.,Immunohematology and Transfusion Medicine | Petta A.,Kaneka Pharma Europe NV | Harada-Shiba M.,Japan National Cardiovascular Center Research Institute | And 26 more authors.
Atherosclerosis Supplements | Year: 2015

The MightyMedic (Multidisciplinary International Group for Hemapheresis TherapY and MEtabolic DIsturbances Contrast) Working Group has been founded in 2013. The leading idea was to establish an international network of interdisciplinary nature aimed at working to cross national borders research projects, clinical trials, educational initiatives (meetings, workshops, summer schools) in the field of metabolic diseases, namely hyperlipidemias, and diabetes, preventive cardiology, and atherosclerosis. Therapeutic apheresis, its indications and techniques, is a parallel field of investigation. The first on-line survey of the Group has been completed in the first half of 2014. The survey included # 24 Centers in Italy, Germany, Greece, UK, Sweden, Japan and USA. Relevant data have been collected on current practice in diagnosis, therapy and follow-up of dyslipidemias. 240 subjects with hyperlipidemia and treated with lipoprotein apheresis have been reported in the survey, but a large percentage of patients (35%) who could benefit from this therapeutic option are still treated by conventional drug approach. Genetic molecular diagnosis is performed in only 33% of patients while Lipoprotein(a) (Lp(a)) is included in cardiovascular disease risk assessment in 71% of participating Centers. New detailed investigations and prospective multicenter studies are needed to evaluate changes induced by the impact of updated indications and strategies, as well as new treatment options, targeting standardization of therapeutic and diagnostic approaches. © 2015 Elsevier Ireland Ltd.


Re A.,Hematology | Cattaneo C.,Hematology | Skert C.,University of Brescia | Balsalobre P.,Hospital General Universitario Gregorio Maranon | And 17 more authors.
Haematologica | Year: 2013

High-dose chemotherapy with autologous peripheral blood stem cell rescue has been reported as feasible and effective in HIV-associated lymphoma. Although a sufficient number of stem cells seems achievable in most patients, there are cases of stem cell harvest failure. The aim of this study was to describe the mobilization policies used in HIV-associated lymphoma, evaluate the failure rate and identify factors influencing mobilization results. We analyzed 155 patients who underwent attempted stem cell mobilization at 10 European centers from 2000-2012. One hundred and twenty patients had non-Hodgkin lymphoma and 35 Hodgkin lymphoma; 31% had complete remission, 57% chemosensitive disease, 10% refractory disease, 2% untested relapse. Patients were mobilized with chemotherapy + G-CSF (86%) or G-CSF alone (14%); 73% of patients collected >2 and 48% >5 × 106 CD34+ cells/kg. Low CD4+ count and refractory disease were associated with mobilization failure. Low CD4+ count, low platelet count and mobilization with G-CSF correlated with lower probability to achieve >5 × 106 CD34+ cells/kg, whereas cyclophosphamide ≥3 g/m2 + G-CSF predicted higher collections. Circulating CD34+ cells and CD34/WBC ratio were strongly associated with collection result. HIV infection alone should not preclude an attempt to obtain stem cells in candidates for autologous transplant as the results are comparable to the HIV-negative population. © 2013 Ferrata Storti Foundation.

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