The transplant cohort of the German center for infection research (DZIF Tx-Cohort): study design and baseline characteristics

Infectious complications are the major cause of morbidity and mortality after solid organ and stem cell transplantation. To better understand host and environmental factors associated with an increased risk of infection as well as the effect of infections on function and survival of transplanted organs, we established the DZIF Transplant Cohort, a multicentre prospective cohort study within the organizational structure of the German Center for Infection Research. At time of transplantation, heart-, kidney-, lung-, liver-, pancreas- and hematopoetic stem cell- transplanted patients are enrolled into the study. Follow-up visits are scheduled at 3, 6, 9, 12 months after transplantation, and annually thereafter; extracurricular visits are conducted in case of infectious complications. Comprehensive standard operating procedures, web-based data collection and monitoring tools as well as a state of the art biobanking concept for blood, purified PBMCs, urine, and faeces samples ensure high quality of data and biosample collection. By collecting detailed information on immunosuppressive medication, infectious complications, type of infectious agent and therapy, as well as by providing corresponding biosamples, the cohort will establish the foundation for a broad spectrum of studies in the field of infectious diseases and transplant medicine. By January 2020, baseline data and biosamples of about 1400 patients have been collected. We plan to recruit 3500 patients by 2023, and continue follow-up visits and the documentation of infectious events at least until 2025. Information about the DZIF Transplant Cohort is available at https://www.dzif.de/en/working-group/transplant-cohort.

Consolidation: Autologous Stem Cell Transplantation in Acute Leukemia

The goal of complete remission (CR) in acute leukemias could be achieved with intensive induction chemotherapy however patients need post remission consolidation strategies such as high-dose chemotherapy, or autologous (ASCT) or allogeneic (allo-SCT) hematopoetic stem cell transplantation for durable response. However, Allo-SCT is getting more attention in last decades because of improvements of conditioning regimens and graft versus host disease (GVHD) prohylaxis strategies and alternatively available donor sources, it is not suitable for all leukemia patients. The patients who would benefit from Allo-SCT or ASCT could be defined more easily by using risk stratification systems and minimal residual disease (MRD) monitoring. ASCT is considered a treatment option even if its use is declining in the world. Herein, we tried to summarize the studies that report the outcomes of ASCT in acute myeloid leukemia (AML) and acute, lymphoblastic leukemia and describe the patients who would be good candidate for ASCT.

Association of human leukocyte antigen groups with oral mucositis in patients undergoing bone marrow transplantation

Background: Oral mucositis (OM) after hematopoetic stem cell transplantation (HSCT) may lead to toxicity that impair quality of life. Associations between some diseases and human leukocyte antigen (HLA) groups have been long recognized. A genetic contribution as the association of HLA groups with OM after HSCT, has not been reported to date. We aimed to assess whether an association of HLA phenotype and OM after allogeneic HSCT exists.Methods: This was a prospective observational study in which OM was assessed with clinical questioning and examination. Association of OM with gender, age, HLA phenotypes, diagnosis, conditioning regimen, stem cell source, engraftment times, and complications was investigated.Results: 45 patients were enrolled. All the patients with HLA-B44 phenotype developed mild OM, while all patients with HLA-DR15 phenotype developed severe OM. HLA-A23, HLA-B21, HLA-B44, HLA-DR15, and HLA-DR11 were associated with shorter OM duration. HLA-A26 and HLA-B52 were associated with longer OM duration. Myeloablative conditioning regimen and longer duration of neutropenia were associated with longer OM duration. Regression analysis revealed HLA-B44 and HLA-DR11 as independent factors associated with milder OM.Conclusion: We identified that some HLA alleles correlated with OM severity and duration. These findings may facilitate predicting risk of morbidity and may provide incorporation of individualized preventive and treatment approaches.

Minimal residual disease in Acute Lymphoblastic Leukemia in the context of hematopoetic stem cell transplantation

Minimal or measurable residual disease (MRD) is considered the most important independent prognostic factor in acute lymphoblastic leukemia (ALL). MRD status after clinical remission has been used to establish the risk of relapse and therapeutic stratification, identifying patients who can benefit from therapeutic intensification, including allogeneic stem cell transplantation (alloSCT). The pre alloSCT MRD also identifies patients eligible for transplant and those with low or high risk of relapse after transplantation, according to the level of MRD detected. However, MRD status post-alloSCT has been shown to be a more powerful predictor of relapse than pre-transplant MRD. In addition, it is important to take into account that there are some factors to be considered to better interpret MRD information, these include: the method used for MRD assessment and its sensitivity and specificity, which may vary according to each specific time point of evaluation; the treatment regimen used; and the identification of genetic lesions that combined with MRD information can further improve the management of patients with ALL.

Resiliency, the Lived Experience of Patients Undergoing Hematopoietic Stem Cell Transplantation

Background: Hematopoetic stem cell transplantation is considered as a standard treatment for cancer patients to stay hopeful toward treatment outcome. However, these patients experience many complications which might affect different aspects of their life. The aim of this study was to investigate the lived experience of patients after hematopoetic stem cell transplantation and introduce supportive care strategies. Materials and Methods: In this study, Van Manen’s Hermeneutic phenomenological approach was used. Eleven patients (7 males and 4 females) were chosen by targeted sampling from visitors of Shariati Hospital’s outpatient clinic. Semi-structured interviews were conducted and the final data were analyzed by MAXQDA 10 software. Results: Data analysis revealed that the main theme was resiliency with two sub-themes of “not surrendering to disease” and “feeling closer to God”. Conclusion: Participants declared that transplantation was like a second chance for life and considered this opportunity as a gift from God to overcome their disease. According to our findings, spirituality aids can help patients control the disturbances following HSCT and health professionals can use constructive strategies to support patients with spiritual needs.