Stem Cell Transplantation Unit

Siena, Italy

Stem Cell Transplantation Unit

Siena, Italy
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Vagliano L.,University of Turin | Feraut C.,Stem Cell Transplantation Unit | Gobetto G.,Stem Cell Transplantation Unit | Trunfio A.,CSU of Haematology | And 19 more authors.
Bone Marrow Transplantation | Year: 2011

Oral mucositis (OM) is a common side effect experienced during haematopoietic SCT (HSCT), and it can have a significant impact on the quality of life of patients. A descriptive nurse-led study was undertaken in 19-member centres of the Italian national transplant group (GITMO) evaluating incidence, severity and duration of OM in patients undergoing HSCT. Data from 1841 patients between 2002 and 2006 was analyzed. Initial medical history and oral cavity assessment was performed. Assessment was repeated on the day of transplant, then daily, using the WHO (World Health Organisation) oral toxicity scale. A total of 71% of the patients evaluated developed mucositis and 21.6% developed severe mucositis. Duration of OM in most cases lasted for 10-14 days and resolved along with marrow reconstitution. Oral mucostitis is a frequent side effect in patients undergoing HSCT. The onset of severe mucositis seems to be related to the conditioning regimen used. This database provides a descriptive overview of the incidence and severity of mucositis and has encouraged participating centres to adopt routine evaluation and measurement of the oral cavity. The assessment tools are still used in some centres, providing a basis for further collaborative research projects. © 2011 Macmillan Publishers Limited All rights reserved.


Sureda A.,Hospital Duran I Reynals | Bader P.,Goethe University Frankfurt | Cesaro S.,Paediatric Haematology Oncology | Dreger P.,University of Heidelberg | And 11 more authors.
Bone Marrow Transplantation | Year: 2015

This is the sixth special report that the European Society for Blood and Marrow Transplantation regularly publishes on the current practice and indications for haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred in the field of haematopoietic SCT over the last years. Cord blood units as well as haploidentical donors have been increasingly used as stem cell sources for allo-SCT, thus, augmenting the possibility of finding a suitable donor for a patient. Continuous refinement of conditioning strategies has also expanded not only the number of potential indications but also has permitted consideration of older patients or those with co-morbidity for a transplant. There is accumulating evidence of the role of haematopoietic SCT in non-haematological disorders such as autoimmune diseases. On the other hand, the advent of new drugs and very effective targeted therapy has challenged the role of SCT in some instances or at least, modified its position in the treatment armamentarium of a given patient. An updated report with revised tables and operating definitions is presented. © 2015 Macmillan Publishers Limited.


PubMed | Haematology and BMT Unit, Chaim Sheva Medical Center, University of Hamburg, Paediatric Haematology Oncology and 10 more.
Type: Journal Article | Journal: Bone marrow transplantation | Year: 2015

This is the sixth special report that the European Society for Blood and Marrow Transplantation regularly publishes on the current practice and indications for haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred in the field of haematopoietic SCT over the last years. Cord blood units as well as haploidentical donors have been increasingly used as stem cell sources for allo-SCT, thus, augmenting the possibility of finding a suitable donor for a patient. Continuous refinement of conditioning strategies has also expanded not only the number of potential indications but also has permitted consideration of older patients or those with co-morbidity for a transplant. There is accumulating evidence of the role of haematopoietic SCT in non-haematological disorders such as autoimmune diseases. On the other hand, the advent of new drugs and very effective targeted therapy has challenged the role of SCT in some instances or at least, modified its position in the treatment armamentarium of a given patient. An updated report with revised tables and operating definitions is presented.


PubMed | King Hussein Cancer Center, University of Hamburg, King Faisal Specialist Hospital And Research Center, Hannover Medical School and 10 more.
Type: Journal Article | Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation | Year: 2014

One hundred and forty patients who had undergone hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML) transformation after treatment of severe aplastic anemia (SAA) were identified in the European Group for Blood and Marrow Transplantation (EBMT) database. The median age at HSCT was 29years (range, 1 to 66years). The transplant donor was related in 49% cases and unrelated in 51% cases. The 5-year probability of relapse was 17%, and that of nonrelapse mortality was 41%. The 5-year overall survival was 45%9%, better for patients untreated and patients in remission compared with patients with refractory disease. Our data indicate that allogeneic HSCT leads to prolonged survival in close to one-half of the patients transforming to MDS or AML from SAA.


Myeloablative (MAC) and reduced-intensity conditioning (RIC) are established approaches for allogeneic stem cell transplantation (SCT) in acute myeloid leukemia (AML). Most deaths after MAC occur within the first 2years after SCT, while patients surviving leukemia-free for 2years can expect a favorable long-term outcome. However, there is paucity of data on the long-term outcome (beyond 10years) and the pattern of late events following RIC due to the relative recent introduction of this approach.We analyzed long-term outcomes in a cohort of 1423 AML patients, age 50years, after SCT from HLA-matched siblings, during the years 1997-2005, median follow-up 8.3years (0.1-17).The 10-year leukemia-free survival (LFS) was 31% (95CI, 27-35) and 32% (28-35) after MAC and RIC, respectively (P=0.57). The 10-year GVHD/ relapse-free survival (GRFS), a surrogate for quality of life was 22% (18-25) and 21% (18-24), respectively (P=0.79). The 10-year non-relapse mortality (NRM) was higher and relapse rate was lower after MAC, throughout the early and late post-transplant course. The 10-year LFS among 584 patients surviving leukemia-free 2years after SCT was 71% (65-76) and 73% (67-78) after MAC and RIC, respectively (P=0.76). Advanced leukemia at SCT was the major predictor of LFS subsequent to the 2-year landmark. Relapse was the major cause of late death after both regimens; however, NRM and in particular chronic graft-versus-host disease and second cancers were more common causes of late death after MAC.Long-term LFS and GRFS are similar after RIC and MAC. Most events after RIC or MAC occur within the first 2years after SCT. Patients who are leukemia-free 2years after SCT can expect similar good subsequent outcome after both approaches.


Aplastic anemia is usually treated with immunosuppression or allogeneic transplant, depending on patient and disease characteristics. Syngeneic transplant offers a rare treatment opportunity with minimal transplant-related mortality, and offers an insight into disease mechanisms. We present here a retrospective analysis of all syngeneic transplants for aplastic anemia reported to the European Group for Blood and Marrow Transplantation. Between 1976 and 2009, 88 patients received 113 transplants. Most transplants (n=85) were preceded by a conditioning regimen, 22 of these including anti-thymocyte globulin. About half of transplants with data available (39 of 86) were followed by posttransplant immunosuppression. Graft source was bone marrow in the majority of cases (n=77). Transplant practice changed over time with more transplants with conditioning and anti-thymocyte globulin as well as peripheral blood stem cells performed in later years. Ten year overall survival was 93% with 5 transplant-related deaths. Graft failure occurred in 32% of transplants. Risk of graft failure was significantly increased in transplants without conditioning, and with bone marrow as graft source. Lack of posttransplant immunosuppression also showed a trend towards increased risk of graft failure, while anti-thymocyte globulin did not have an influence. In summary, syngeneic transplant is associated with a significant risk of graft failure when no conditioning is given, but has an excellent long-term outcome. Furthermore, our comparatively large series enables us to recommend the use of pre-transplant conditioning rather than not and possibly to prefer peripheral blood as a stem cell source. © 2013 Ferrata Storti Foundation.


Rossi G.,Stem Cell Transplantation Unit | Carella A.M.,Stem Cell Transplantation Unit | Minervini M.M.,Stem Cell Transplantation Unit | Savino L.,Stem Cell Transplantation Unit | And 9 more authors.
Leukemia and Lymphoma | Year: 2013

Relapse represents the main cause of treatment failure after allogeneic stem cell transplant (allo-SCT). The detection of minimal residual disease (MRD) by multiparametric flow cytometry (MFC), chimerism, cytogenetics and molecular analysis may be critical to prevent relapse. Therefore, we assessed the overall agreement among chimerism (low level mixed chimerism [LL-MC] vs. complete chimerism [CC]), MFC and Wilms tumor 1 (WT1) mRNA to detect MRD and investigated the impact of MRD obtained from the three methods on patient outcome. Sixty-seven fresh bone marrow (BM) samples from 24 patients (17 acute myeloid leukemia [AML], seven acute lymphoblastic leukemia [ALL]) in complete remission (CR) after allo-SCT were investigated at different time points. A moderate agreement was found among the three techniques investigated. A higher concordance between positive results from MFC (75.0% vs. 32.7%, p = 0.010) and WT1 (58.3% vs. 29.1%, p = 0.090) was detected among LL-MC rather than CC samples. Relapse-free survival (RFS) and overall survival (OS) were found to be higher in MRD negative patients than in MRD positive patients analyzed with MFC and WT1. Our results discourage the use of low autologous signals as the only marker of MRD, and suggest the usefulness of MFC and WT1 real-time quantitative polymerase chain reaction (RQ-PCR) in stratifying patients with respect to risk of relapse. © 2013 Informa UK, Ltd.


Roos-Weil D.,Hopitaux de Paris | Dietrich S.,University of Heidelberg | Dietrich S.,European Group for Blood and Marrow Transplantation Lymphoma Working Party | Boumendil A.,European Group for Blood and Marrow Transplantation Lymphoma Working Party | And 17 more authors.
Blood | Year: 2013

Patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN) have a poor prognosis with conventional chemotherapy. In the present study, we retrospectively analyzed the outcome of patients with BPDCN who underwent allogeneic stem cell transplantation (allo-SCT) or autologous stem cell transplantation (auto-SCT). A total of 39 patients (allo-SCT, n = 34; auto-SCT, n = 5) were identified in the European Group for Blood and Marrow Transplantation registry. The 34 allo-SCT patients had a median age of 41 years (range, 10-70) and received transplantations from sibling (n = 11) or unrelated donors (n = 23) between 2003 and 2009. MAC was used in 74% of patients. Nineteen allo-SCT patients (56%) received transplantations in first complete remission. The 3-year cumulative incidence of relapse, disease-free survival, and overall survival was 32%, 33%, and 41%, respectively. By univariate comparison, being in first remission at allo-SCT favorably influenced survival, whereas age, donor source, and chronic GVHD had no significant impact. We conclude that high-dose therapy followed by allo-SCT from related or unrelated donors can provide durable remission even in elderly patients with BPDCN. However, it remains to be shown if graft-versus-malignancy effects can contribute significantly to BPDCN control after allo-SCT. © 2013 by The American Society of Hematology.


Vakeva L.,Skin and Allergy Hospital | Niittyvuopio R.,Stem Cell Transplantation Unit | Leppa S.,University of Helsinki | Heiskanen J.,Stem Cell Transplantation Unit | And 3 more authors.
Acta Dermato-Venereologica | Year: 2016

Cutaneous T-cell lymphomas (CTCL) are rare non- Hodgkin’s lymphomas with homing preference to the skin. The most common type of CTCL is mycosis fungoides (MF) (1). The clinical course of MF is mostly indolent, but approximately 25% may progress to advanced disease, with a median survival below 4 years. Some subtypes of MF, such as folliculotropic MF, can be very therapyresistant and present with a progressive disease course. Sézary syndrome (SS) and primary skin peripheral T-cell lymphoma, unclassified (PCTCL) are less common variants of CTCL with an aggressive course. SS was previously considered a leukaemic variant of CTCL, but it is today understood to be a subtype of its own, originating primarily from central memory T cells (2). In SS, 5-year survival is 18–20% (3). Also, for advanced stages of MF there are few treatment options. Allogeneic haematopoietic stem cell transplantation (allo-SCT) is a treatment modality for patients with malignant or non-malignant haematological disease. Conditioning regimens may be either myeloablative or non-myeloablative. Patients treated with allo-SCT may experience life-threatening acute or chronic graft-versushost disease (GVHD) or serious infectious complications. Allo-SCT has been used to treat advanced-stage MF and SS (4, 5) but the experience is limited and treatment protocols vary to a great extent. However, long-term follow-up data of the European Group for Blood and Marrow Transplantation show that patients with CTCL may benefit from allo-SCT (6). We report here 3 patients with CTCL who received allo-STC, one of whom achieved complete remission. © 2016 The Authors.


Imataki O.,Shizuoka Cancer Center | Nakajima K.,Stem Cell Transplantation Unit | Inoue N.,Stem Cell Transplantation Unit | Tamai Y.,Shizuoka Cancer Center | Kawakami K.,Shizuoka Cancer Center
Japanese Journal of Cancer and Chemotherapy | Year: 2010

BACKGROUND: Quality of life (QOL) measurement is a powerful instrument for assessing medical morbidity from the patient's perspective. We measured the QOL of patients undergoing autologous and allogeneic stem cell transplantation (SCT) in Japan to validate the FACT-BMT scale in comparison to SF-36. METHODS: We performed a cross-sectional survey for transplant recipients receiving treatment at our outpatient clinic. Recipients undergoing autologous and allogeneic SCT between October 2002 and March 2006 were eligible. Participants completed both the Medical Outcomes Study 36-Item Short Form (SF-36) and a Functional Assessment of Cancer Therapy survey specific to bone marrow transplantation (FACT-BMT). RESULTS: Thirty-six patients were enlisted, including 24 post-autologous SCT patients and 12 post-allogeneic SCT patients. The median time required to answer all questions was 9 and 11 minutes for SF-36 and FACT-BMT surveys, respectively. Cronbach's α was over 0. 7 for all domains in both SF-36 and FACT-BMT. Inter-scale correlations between all domains except for BP in SF-36 and BMT in FACT-BMT had correlation coefficients greater than 0.4. The internal consistencies of both surveys were confirmed in Japanese patients. CONCLUSIONS: Our study indicated the feasibility and partial validity of FACT-BMT in a one-time follow-up of QOL for Japanese patients after SCT.

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