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Port-Saint-Louis-du-Rhône, France

Tichelli A.,University of Basel | Rovo A.,University of Basel | Socie G.,Service dHematologie greffe
Current Problems in Dermatology | Year: 2012

Today, long-term prognosis after hematopoietic stem cell transplantation (HSCT) has greatly improved. Nevertheless, there are still a number of malignant and nonmalignant late effects that can cause substantial morbidity, with considerable impact on the health status and quality of life in the long-term survivors. Transplant-preparative regimen and graft-versus-host disease are considered the main risk factors after allogeneic HSCT. The continuous changes in the transplantation practice and in the type of patients selected are responsible that the pattern of the late effects after HSCT is changing over time. Relevant recent changes concern the avoidance of total body irradiation conditioning whenever possible, the higher age of the patients transplanted, the increasing use of unrelated donors as well as the introduction of reduced intensity conditioning. The detection of an increasing number of late effects should not be considered as a drawback of HSCT. The experience gathered during the past decades has become the main source of information on which the current management of the long-term survivors is based. A broad expertise is mandatory to manage long-term survivors. Aftercare of long-term survivors includes a standardized screening, counseling of the patients as well as prevention and treatment of late effects. Counseling should include self-examination for early cancer detection, and advice for healthy lifestyle behavior. Beyond immediate survival, allogeneic HSCT is a lifelong commitment between long-term survivors and the transplant team, involving the recipient's family and the general health care providers. Proper information on 'life after HSCT' should also be provided to the whole community, which plays a key role in the social reinsertion of the long-term survivors. © 2012 S. Karger AG, Basel. Source

Malcovati L.,University of Pavia | de Latour R.P.,Service dHematologie greffe | Risitano A.,University of Naples Federico II
Leukemia Research | Year: 2011

Aplastic anemia (AA) and myelodysplastic syndromes (MDS) are a heterogeneous group of rare hematological disorders belonging to the Bone Marrow Failure (BMF) syndromes. The Aplastic Anemia and Myelodysplastic Syndromes International Foundation (AA&MDSIF) is a non-profit organization dedicated to supporting patients and families living with a BMF disease. They work to bring investigators together in a collaborative manner. This article summarizes key presentations from the last AA&MDSIF scientific symposium held in Bethesda, Maryland on March 2010. © 2010 Elsevier Ltd. Source

De Latour R.P.,Service dHematologie greffe | De Latour R.P.,University Paris Diderot | De Latour R.P.,European Group for Blood and Marrow Transplantation | Soulier J.,University Paris Diderot | Soulier J.,French Institute of Health and Medical Research
Blood | Year: 2016

Fanconi anemia (FA) is the most frequent inherited cause of bone marrow failure (BMF). Most FA patients experience hematopoietic stem cell attrition and cytopenia during childhood, which along with intrinsic chromosomal instability, favor clonal evolution and the frequent emergence in their teens or young adulthood of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). To early identify and further predict bone marrow (BM) clonal progression and enable timely treatment, the follow-up of FA patients includes regular BM morphological and cytogenetic examinations. Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative treatment of FA patients with MDS or AML. Although questions remain concerning HSCT itself (including the need for pretransplant chemotherapy, the best conditioning regimen, and the optimal long-termfollow-upofsuchpatients especially regarding secondary malignancies), clonal evolution in the absence of significant BMdysplasia and blast cells can be difficult to address in FA patients, for whom the concept of preemptive HSCT is discussed. Illustrated by 3 representative clinical vignettes showing specific features of MDS and AML in FA patients, this paper summarizes our practical approach from diagnosisthroughtreatment inthisparticular situation. © 2016 by The American Society of Hematology. Source

Genital chronic graft-versus-host disease (GVHD) is a frequent but underdiagnosed complication of allogeneic stem-cell transplantation impairing quality of life. We identified 32 female patients with genital chronic GVHD (cGVHD) who underwent allogeneic hematopoietic stem-cell transplantation in our center between 2000 and 2010 and who were followed after transplantation in a specialized gynecological consultation. Pre- and posttransplantation clinical data and detailed acute and cGVHD data were collected. All patients received the same local treatment for genital lesions. At presentation, most patients complained about vaginal dryness and dyspareunia with impairment in sexual activity. Fifty percent of patients had grade I genital lesions and 50% had grade II or III lesions. Patients seen later in gynecological consultation had more severe lesions than patients seen early after transplantation. At the time of diagnosis, most patients had other cutaneous or mucous localizations of cGVHD. In most cases, lesions were stabilized or decreased with local steroids and estrogen treatment, and most patients could resume sexual activity. Treatment was more efficient in patients with mild lesions than in others. Genital cGVHD should be systematically searched for in women who have received allogeneic hematopoietic stem-cell transplantation in an early specialized consultation, especially in case of other cutaneous or mucous localizations of cGVHD. Local treatment associating steroids and estrogen seemed to prevent further evolution of grade I genital lesions and to avoid surgical treatment. Source

Warlick E.D.,University of Minnesota | Peffault de Latour R.,Service dHematologie greffe | Shanley R.,University of Minnesota | Robin M.,Service dHematologie greffe | And 9 more authors.
Biology of Blood and Marrow Transplantation | Year: 2015

The use of alternative donor transplants is increasing as the transplantation-eligible population ages and sibling donors are less available. We evaluated the impact of donor source on transplantation outcomes for adults with acute myeloid leukemia undergoing myeloablative (MA) or reduced-intensity conditioning (RIC) transplantation. Between January 2000 and December 2010, 414 consecutive adult patients with acute myeloid leukemia in remission received MA or RIC allogeneic transplantation from either a matched related donor (n=187), unrelated donor (n=76), or umbilical cord blood donor (n=151) at the University of Minnesota or HÔpital St. Louis in Paris. We noted similar 6-year overall survival across donor types: matched related donor, 47% (95% confidence interval [CI], 39% to 54%); umbilical cord blood, 36% (95% CI, 28% to 44%); matched unrelated donor, 54% (95% CI, 40% to 66%); and mismatched unrelated donor, 51% (95% CI, 28% to 70%) (. P <.11). Survival differed based on conditioning intensity and age, with 6-year survival of 57% (95% CI, 47% to 65%), 39% (95% CI, 28% to 49%), 23% (95% CI, 6% to 47%), 47% (95% CI, 36% to 57%), and 28% (95% CI, 17% to 41%) for MA age 18 to 39, MA age 40+, or RIC ages 18 to 39, 40 to 56, and 57 to 74, respectively (. P<.01). Relapse was increased with RIC and lowest in younger patients receiving MA conditioning (hazard ratio, 1.0 versus 2.5 or above for all RIC age cohorts), P <.01. Transplantation-related mortality was similar across donor types. In summary, our data support the use of alternative donors as a graft source with MA or RIC for patients with acute myeloid leukemia when a sibling donor is unavailable. © 2015 American Society for Blood and Marrow Transplantation. Source

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