scholarly journals Timing of Initiation of Calcineurin Inhibitors in Pediatric Haploidentical Transplantation with Post-Transplantation Cyclophosphamide: Effects on Survival, Relapse, and Cytokine Release Syndrome

2021 ◽  
Author(s):  
Vedat Uygun ◽  
Gülsün Karasu ◽  
Koray Yalçın ◽  
Seda Ozturkmen ◽  
Hayriye Daloğlu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Calcineurin Inhibitors ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Post Transplantation ◽  
Acceptable Alternative ◽  
Haploidentical Transplantation ◽  
Timing Of Initiation ◽  
Overall Survival Analysis ◽  
Matched Donor

Background: The use of unmanipulated haploidentical stem cell transplantations (haplo-HSCT) with post-transplant cyclophosphamide (PTCY) in children has emerged as an acceptable alternative to the patients without a matched donor. However, the timing of calcineurin inhibitors (CNI) used in combination with PTCY is increasingly becoming a topic of controversy. Method: We evaluated 49 children with acute leukemia who underwent unmanipulated haplo-HSCT with PTCY according to the initiation day of CNIs (pre- or post-CY). Results: There were no significant differences in the overall survival analysis between the two groups. The cumulative incidence of relapse at 2 years was 21.2% in the pre-CY group and 38.9% in the post-CY group (p=0.33). Cytokine release syndrome (CRS) was observed more frequently in the post-CY group (p=0.04). The OS and EFS at 2 years in patients with and without CRS in the pre-Cy group were 42.9% vs 87.5% (p=0.04) and 38.1% vs 87.5% (p=0.04), respectively. Conclusion: Our study shows that the argument for starting CNI administration after CY is tenuous, and the rationale for not starting CNI before CY needs to be reconsidered.

scholarly journals Timing of Initiation of Calcineurin Inhibitors in Pediatric Haploidentical Transplantation with Post-Transplantation Cyclophosphamide: Effects on Survival, Relapse, and Cytokine Release Syndrome

2021 ◽  
Author(s):  
Vedat Uygun ◽  
Gulsun Karasu ◽  
Koray Yalçın ◽  
Seda Öztürkmen ◽  
Hayriye Daloglu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Calcineurin Inhibitors ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Post Transplantation ◽  
Acceptable Alternative ◽  
Haploidentical Transplantation ◽  
Timing Of Initiation ◽  
Overall Survival Analysis ◽  
Matched Donor

Abstract The use of unmanipulated haploidentical stem cell transplantations (haplo-HSCT) with post-transplant cyclophosphamide (PTCY) in children has emerged as an acceptable alternative to the patients without a matched donor. However, the timing of calcineurin inhibitors (CNI) used in combination with PTCY is increasingly becoming a topic of controversy. We evaluated 49 children with acute leukemia who underwent unmanipulated haplo-HSCT with PTCY according to the initiation day of CNIs (pre- or post-CY). There were no significant differences in the overall survival analysis between the two groups. The cumulative incidence of relapse at 2 years was 21.2% in the pre-CY group and 38.9% in the post-CY group (p = 0.33). Cytokine release syndrome (CRS) was observed more frequently in the post-CY group. Our study shows that the argument for starting CNI administration after CY is tenuous, and the rationale for not starting CNI before CY needs to be reconsidered.

scholarly journals Cytokine Release Syndrome after Peripheral Blood T-Cell Replete Haploidentical Transplantation Is Not Prevented By Dexamethasone and Limits Its Full-Outpatient Conduction

2019 ◽  
Vol 25 (3) ◽  
pp. S136-S137
Author(s):  
Perla R. Colunga-Pedraza ◽  
Andrés Gómez-De León ◽  
Julia E. Colunga-Pedraza ◽  
Paola Santana-Hernández ◽  
Emmanuel Bugarín-Estrada ◽  
...  
Keyword(s):  
T Cell ◽  
Peripheral Blood ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Haploidentical Transplantation

scholarly journals Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244853
Author(s):  
Sultan Mehmood Kamran ◽  
Zill-e-Humayun Mirza ◽  
Arshad Naseem ◽  
Jahanzeb Liaqat ◽  
Imran Fazal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Plasma Exchange ◽  
Disease Severity ◽  
Standard Of Care ◽  
Treated Group ◽  
Therapeutic Plasma Exchange ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Resolution Time ◽  
Duration Of Hospitalization

Background Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS. Objective To evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care. Methodology Retrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing. Results After PS-matching, the selected cohort had a median age of 60 years (range 32–73 in TPE, 37–75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3–22 days’ TPE and 3–20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33–97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29–78.76 (log rank 0.002), p<0.001. Median duration of hospitalization was significantly reduced in the TPE treated group (10 days vs 15 days) (p< 0.01). CRS resolution time was also significantly reduced in the TPE group (6 days vs. 12 days) (p< 0.001). In 71 patients who underwent TPE, the mortality was 0 (n = 43) if TPE was done within the first 12 days of illness while it was 17.9% (deaths 5, n = 28 who received it after 12th day (p = 0.0045). Conclusion An earlier use of TPE was associated with improved overall survival, early CRS resolution and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort of PS-matched male patients from one major hospital in Pakistan.

scholarly journals Peripheral Blood Grafts for T Cell–Replete Haploidentical Transplantation Increase the Incidence and Severity of Cytokine Release Syndrome

2018 ◽  
Vol 24 (8) ◽  
pp. 1664-1670 ◽  
Author(s):  
Renju V. Raj ◽  
Mehdi Hamadani ◽  
Aniko Szabo ◽  
Marcelo C. Pasquini ◽  
Nirav N. Shah ◽  
...  
Keyword(s):  
T Cell ◽  
Peripheral Blood ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Haploidentical Transplantation
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