scholarly journals Mid-term (4-7 years) Results of Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the First Metatarsophalangeal Joint

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0035
Author(s):  
Martinus Richter ◽  
Stefan Zech ◽  
Stefan Meissner ◽  
Issam Naef
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Pelvic Bone ◽  
First Metatarsophalangeal Joint ◽  
Chondral Defects

Category: Midfoot/Forefoot Introduction/Purpose: Matrix-associated stem cell transplantation (MAST) has shown good short-term results for treatment of chondral defects at first metatarsophalangeal joint (MTP1). The aim of the study was to assess mid-term results (=4-year-follow- up). Methods: In a prospective consecutive non-controlled clinical follow-up study, 61 patients with 81 chondral defects at MTP1 that were treated with MAST from October 1, 2011 to October 31, 2014 were analysed. Degree of osteoarthritis, range of motion (ROM), size and location of the chondral defects, pedographic parameters, and the Visual Analogue Scale Foot and Ankle (VAS FA) before treatment and at follow-up were registered and analysed. Bone marrow aspirate was harvested from the ipsilateral pelvic bone marrow and centrifuged (10 minutes, 1,500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. Results: Following mean (range) values were registered at time of surgery: age 44 (35-72) years, VAS FA 49.4 (12.3-82.3), ROM 20.4/0/8.4° (dorsiflexion/plantarflexion), degree of osteoarthritis 1.9 (1-3). The 81 chondral defects were located as follows, dorsal metatarsal head, n=28 (35%), plantar metatarsal head, n=12 (15%); dorsal & plantar, n=21 (26%); medial sesamoid, n=14 (17%); lateral sesamoid, n=6 (7%)(two defects, n=14, three defects, n=3). The defect size was 0.9 (.5 - 3.0) cm2. Fifty-six patients (92%) completed follow-up at 62 (48-84) months. VAS FA increased to 82.5 (45.6-100; t-test, p<.01). ROM increased to 30.2/0/15.4 (p=.05). Degree of osteoarthritis decreased to 1.1 (0-3, p=.04) Conclusion: The surgical treatment of chondral defects at MTP1 including MAST led to improved clinical scores, ROM and degree of osteoarthritis after 4-7 years. No adverse effects of MAST were registered. Even though a control group is missing, we conclude that MAST is an effective method for the treatment of chondral defects at MTP1.

scholarly journals Matrix-associated Stem Cell Transplantation (MAST) in Chondral Lesions at the Ankle as Part of a Complex Surgical Approach

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Martinus Richter ◽  
Stefan Zech
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Surgical Approach ◽  
Pelvic Bone ◽  
Control Group ◽  
Chondral Defect ◽  
Chondral Lesions ◽  
Chondral Defects

Category: Ankle Introduction/Purpose: The aim of the study was to assess the 5-year-follow-up after matrix-associated stem cell transplantation (MAST) in chondral lesions at the ankle as part of a complex surgical approach. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April1 2009 to September 30, 2011 were analyzed. Size and location of the chondral defects and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow with a Jamshidi needle (10 x 3 mm, Cardinal, Dublin, OH, USA) and a special syringe (Arthrex-ACP, Arthrex, Naples, FL, USA) through a stab incision. The syringe was centrifuged (10 minutes, 1,500 rotations per minute). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide, Geistlich, Wollhusen, Switzerland) that was cut to the size of the cartilage defect roughly before and definitely after. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, IL, USA). Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12-64 years). VAS FA before surgery was 48.9 on average (range, 16.5-75.9). The defects were located as follows, medial talar shoulder, n=28; lateral talar shoulder, n=28 (medial and lateral talar shoulder, n=3), tibia, n=3. The defect size was 1.4 cm2 on average (range, .6 - 6 cm2). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8-100; p=.01). Conclusion: MAST as part of a complex surgical approach led to improved and high validated outcome scores in the mid-term-follow-up. No method related complications were registered. Even though a control group is missing, we conclude that MAST as part of a complex surgical approach is an effective method for the treatment of chondral lesions of the ankle for at least five years.

scholarly journals Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the Ankle is Safe and Effective - 5-Year-Followup

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Martinus Richter ◽  
Stefan Meissner ◽  
Stefan Zech
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Pelvic Bone ◽  
Control Group ◽  
Chondral Defect ◽  
Chondral Defects ◽  
Ankle Replacement ◽  
The Matrix

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The aim of the study was to assess the 5-year-follow-up of matrix-associated stem cell transplantation (MAST) in chondral defects of the ankle. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April1 2009 to September 30, 2011 were analyzed. Size and location of the chondral defects and the Visual- Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow with a Jamshidi needle (10 x 3 mm, Cardinal, Dublin, OH, USA) and a special syringe (Arthrex-ACP, Arthrex, Naples, FL, USA) through a stab incision. The syringe was centrifuged (10 minutes, 1,500 rotations per minute). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide, Geistlich, Wollhusen, Switzerland) that was cut to the size of the cartilage defect roughly before and definitely after. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, IL, USA). Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12-64 years). VAS FA before surgery was 48.9 on average (range, 16.5-75.9). The defects were located as follows, medial talar shoulder, n=28; lateral talar shoulder, n=28 (medial and lateral talar shoulder, n=3), tibia, n=3. The defect size was 1.4 cm2 on average (range, .6 - 6 cm2). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8-100; p=.01). Conclusion: MAST led to improved and high validated outcome scores at 5-year-followup. No method related complications were registered. Even though a control group is missing, we conclude that MAST is an effective method mid-term for the treatment of chondral defects of the ankle.

scholarly journals Revesz syndrome revisited

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael Karremann ◽  
Eva Neumaier-Probst ◽  
Frank Schlichtenbrede ◽  
Fabian Beier ◽  
Tim H. Brümmendorf ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
English Literature ◽  
Bone Marrow Failure ◽  
Dyskeratosis Congenita ◽  
Kaplan Meier ◽  
Low Prevalence

Abstract Background Revesz syndrome (RS) is an extremely rare variant of dyskeratosis congenita (DKC) with only anecdotal reports in the literature. Methods To further characterize the typical features and natural course of the disease, we screened the English literature and summarized the clinical and epidemiological features of previously published RS cases. In addition, we herein describe the first recorded patient in central Europe. Results The literature review included 18 children. Clinical features are summarized, indicating a low prevalence of the classical DKC triad. All patients experienced early bone marrow failure, in most cases within the second year of life (median age 1.5 years; 95% CI 1.4–1.6). Retinopathy occurred typically between 6 and 18 months of age (median age 1.1 years; 95% CI 0.7–1.5). The incidence of seizures was low and was present in an estimated 20% of patients. The onset of seizures was exclusively during early childhood. The Kaplan–Meier estimate of survival was dismal (median survival 6.5 years; 95% CI 3.6–9.4), and none of the patients survived beyond the age of 12 years. Stem cell transplantation (SCT) was performed in eight children, and after a median of 22 months from SCT four of these patients were alive at the last follow up visit. Conclusion RS is a severe variant of DKC with early bone marrow failure and retinopathy in all patients. Survival is dismal, but stem cell transplantation may be performed successfully and might improve prognosis in the future.

Pregnancy after Allogeneic Hematopoietic Stem Cell Transplantation in Fanconi Anemia Patients: Multi-Institution Cases Report of Female Fertility Recovery

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 456-456
Author(s):  
Samir Kanaan Nabhan ◽  
Marco Bittencourt ◽  
Michel Duval ◽  
Manuel Abecasis ◽  
Carlo Dufour ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Fanconi Anemia ◽  
Myeloablative Conditioning ◽  
Hematopoietic Stem ◽  
Fertility Recovery

Abstract Introduction. Fanconi anemia (FA) is a rare autosomal recessive syndrome characterized by chromosome instability. Main clinical features include progressive bone marrow failure, skeletal defects, increased susceptibility to malignancy and reduced fertility. Moreover, most recipients of allogeneic hematopoietic stem cell transplantation (HSCT) suffer from secondary infertility owing to gonadal damage from myeloablative conditioning. We report a rare clinical situation of FA patients pregnancy after allogeneic HSCT. Methods. Retrospective analysis of transplanted FA female patients from 1982 to 2008. Five centers participated in this study on behalf of Aplastic Anaemia Working Party-EBMT. Medical records were reviewed and data collected on a standard case report form including detailed information on diagnosis, transplant procedure, gynecological and obstetrics follow-up. Results. Among 387 transplanted FA patients we identified 202 females who performed a HSCT with a median age of 10,5 years. Five patients became pregnant after the procedure and one of them, twice. They all had their FA diagnosis confirmed by chromosomal breakage test and a bone marrow aspirate with severe hypoplasia/aplasia. Median age at transplantation was 12 years (range 5–17 years). All patients received myeloablative conditioning regimens (cyclophosphamide with or without thoraco-abdominal irradiation) before a bone marrow transplantation, 4 patients from HLA matched sibling donors and 1 from unrelated donor. During follow-up, 4 patients presented signs of ovarian failure (amenorrhea, low levels of FSH/LH and high levels of estradiol). Apart from 1 patient who spontaneously recovered regular menses, the other three received hormonal replacement therapy (HRT) for this purpose. Pregnancy occurred from 3,5 to 17 years after transplant. One patient had an early interruption with a caesarian section at 27 weeks because of an imminent HELLP syndrome. Other pregnancies were uneventful. Among the newborns, there were no FA positive tests, no congenital anomalies and all of them had normal growth and development. Patients remain alive with a median follow-up of 12 years after transplantation with normal hematological status. Conclusion. Fertility recovery after HSCT can result from incomplete depletion of the ovarian follicle reserve. HRT should begin promptly to prevent the early and late unwanted effects related to oestrogen deficiency after HSCT. Recovery of normal ovarian function and a viable pregnancy, is a realistic possibility even in Fanconi anemia patients following allogeneic SCT.

Low Relapse without Excessive Transplant-Related Mortality Following Allogeneic Stem Cell Transplantation in Patients with High Risk Secondary Acute Myeloblastic Leukaemia and Myelodysplastic Syndromes, Long-Term Outcomes in a Single Centre Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4308-4308
Author(s):  
Jean El-cheikh ◽  
Luca Castagna ◽  
Sabine Furst ◽  
Catherine Faucher ◽  
Benjamin Esterni ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Allogenic Stem Cell Transplantation ◽  
Related Mortality

Abstract Abstract 4308 Allogenic stem cell transplantation (Allo-SCT) as a therapy for secondary acute myeloid leukaemia (sAML) and myelodisplastic syndromes (MDS) is the most powerful treatment option. However, (Allo-SCT) is also complicated by a high risk for treatment-related morbidity and mortality. We analysed retrospectively the data of 70 patients transplanted at our institution from June 1995 to december 2008, 44 patients (63%) with sAML and 26 patients (37%) with MDS was treated with (Allo-SCT); median age at diagnosis was 41 years, (15-70), and the median age of 42, 5 years (16-70) at transplantation; The conditioning regimen was myeloablative combining (cyclophosphamide and TBI) in 16 patients (23%) and 54 patients (77%) was with a reduced intensity conditioning (RIC) regimens combining fludarabine, busulfan, and antithymocyte globulin; 11 patients (16%) were infused with bone marrow (BM), 55 patients (79%) peripherical blood stem cells (PBSC), and 4 patients (5%) cord blood cells; in 49 cases (70%) donor was a HLA identical sibling and in 21 (30%) was a matched unrelated donor; 41 patients (59%) carried high risk cytogenetic features, like (7q-, 5q-, > 3 alterations), while was normal in 24 patients (34%), and in 5 patients (7%) was unknown. Disease status at transplantation was as follow: CR in 24 patients (34%), 34 patients (49%) was refractory or in progression after treatment, and 12 patients (17%) was with a stable disease. With a median follow-up of 55 months (3-150), 30 patients (43%) are alive, the overall survival OS at 2 years and 5 years was 48 % and 39% respectively, and after ten years of follow up, OS was 30%, 95%CI [17.8-50.8]. We observed also that 26 % of refractory patients and 54% of patients in CR are alive at five years of transplantation. The probability of progression after transplantation at five and ten years was 31% with 95%CI [20.-46.5]. 2 years and 5 years treatment related mortality (TRM) was 23% and 26% respectively, and no modification at ten year, 95%CI [14.3-37.3]. TRM occurred in 16 patients (23%). Cause of death was; infections in 5 patients (7%), GvHD in 3 patients (4%), GvHD and infection in 3 patients (4%), multi organ failure (MOF) in 5 patients (7%). In multivariate analysis; OS, PFS or TRM, were not influenced by donor type (HLA id sibling vs others), conditioning regimen (RIC vs MAC), and stem cell source (bone marrow vs PBSC). Allogenic stem cell transplantation can be considered as a good option for the treatment of patients with high risk sAML and MDS when compared with the remission rate at five years of the other nonallogeneic SCT therapies. Disclosures: No relevant conflicts of interest to declare.

The Outcome of Allogeneic Stem Cell Transplantation in Chronic Lymphocytic Leukaemia: A Single Centre 10-Year-Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4515-4515
Author(s):  
Patrycja Zielinska ◽  
Malgorzata Krawczyk-Kulis ◽  
Miroslaw Markiewicz ◽  
Monika Dzierzak-Mietla ◽  
Anna Koclega ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Peripheral Blood ◽  
Conflicts Of Interest ◽  
Cumulative Probability

Abstract Abstract 4515 Chronic lymphocytic leukemia (CLL) is an incurable disease when treated with standard chemotherapy. The only possibility to provide cure is allogeneic stem cell transplantation (allo-SCT). CLL patients aged less than 55 account for about 15% of patients and these cases allo-SCT should be taken into consideration. The indications for allo-SCT are as follows: del17p, resistance to chemoimmunotherapy, Richter’s syndrome or recurrent disease. A retrospective analysis of allo-SCT in 18 patients (10 males, 8 females) with CLL transplanted in years 2000–2010 was performed. The aim of the study was to assess of long term follow-up outcome of allo-SCT in CLL patients. The median age at diagnosis was 41ys (range: 35–51). The sibling donor was available in 16 cases (2 pts were mismatched), unrelated donors were in 2 cases (1 mismatched). Most of the pts (16 out of 18) were MRD positive when allotransplanted. Median lymphocytosis preceeding allo-SCT was 5.9G/l. Peripheral blood was the source of stem cells in 9 cases (50%), and bone marrow in the remaining 9 cases, 2 pts were transplanted with stem cells from bone marrow and peripheral blood. 4 pts (22%) underwent the allograft procedure twice or more. Reduced intensity conditioning with alemtuzumab was performed in 9 pts (50%), myeloablative regimen in 4 cases and RIC with rituximab in one case.The median number of CD34+cellsx10^6/kg was 4.1 (range: 0.86–9.64). All but one patient engrafted (this pt was transplanted again successfully in one year time). Acute graft-versus host disease (GvHD) was noted in 46% of pts (only in 2 pts grade IV). Extensive GvHD was observed only in 2 pts. Donor lymphocyte infusion (DLI) was performed in 8 pts (44%). With a median follow-up of 73 months (range: 9–89) for surviving patients, the five-year Kaplan-Meier of overall survival (OS) and progression free survival (PFS) was 55,5% and 34%, respectively. At five years, the cumulative probability of non-relapse mortality was 15%. Allogeneic stem cell transplantation remains the effective treatment in CLL for selected group of patients. Disclosures: No relevant conflicts of interest to declare.

Encouraging Outcomes of Reduced-Intensity Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric Patients with Acute Lymphoblastic Leukemia in Second Complete Remission

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5933-5933
Author(s):  
Kohei Higuchi ◽  
Maho Sato ◽  
Osamu Kondo ◽  
Aya Ioi ◽  
Azusa Mayumi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Acute Lymphoblastic Leukemia ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Pediatric Patients ◽  
Lymphoblastic Leukemia ◽  
Hematopoietic Stem ◽  
Reduced Intensity

Abstract [Background] We have been performing reduced-intensity stem cell transplantation (RIST) to avoid preconditioning-related complications. However, the effectiveness of RIST in pediatric patients with acute lymphoblastic leukemia (ALL) remains to be clarified. [Methods] We retrospectively reviewed 37 pediatric patients with ALL in second complete remission (CR2) who underwent first allogeneic hematopoietic stem cell transplantation (allo-SCT) between 1993 and 2012 in our institute. We compared the outcomes of RIST with those of myeloablative stem cell transplantation (MAST). [Results] The median age at allo-SCT was 9 years (range, 1 to 18 years). There were 33 B-lineage ALL, 3 T-lineage ALL, 1 lineage unknown ALL, and none of Philadelphia chromosome-positive ALL. Sixteen patients received HLA-matched bone marrow (7 related; 9 unrelated), 12 HLA-mismatched bone marrow (11 unrelated; 1 HLA haploidentical related), 4 cord blood, and 5 CD34 positive peripheral blood stem cells (HLA haploidentical related). In all patients, the 5-year overall survival (5y-OS) rate and the 5-year event free survival (5y-EFS) rate were 75.1% and 56.5%, respectively. Seven patients underwent RIST and 30 patients underwent MAST. The median follow-up durations of RIST and MAST groups were 3.3 years (range, 0.9 to 8.2 years) and 11.3 years (range, 0 to 21.2 years), respectively. The 5y-OS rates in RIST and MAST groups were 85.7% and 59.8%, and the 5y-EFS rates were 71.4% and 53.3%, respectively. The 5-year cumulative transplant-related mortality (TRM) rates in RIST and MAST groups were 0% and 31.0%, and the 5-year cumulative relapse rates were 28.6% and 24.3%, respectively. [Discussion] In our series, the cumulative relapse rate in RIST group was similar with that in MAST group, and the cumulative TRM rate in RIST group was lower than that of MAST group. Therefore, both of the 5y-OS and the 5y-EFS rates in RIST group seem to be better than those in MAST group. The outcomes of RIST in our series do not seem to be poorer. Although further studies are needed because of the small size of patients and short follow-up duration, RIST can be considered as the first transplantation for pediatric patients with ALL in CR2. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

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