Chronic Central Nervous System Graft-Versus-Host Disease to Unravel Progressive Visual Loss and Ischemic Stroke Recurrence Post-Allogeneic Hematopoietic Stem Cell Transplant: A Case Report

International Journal of Molecular Sciences, Год журнала: 2025, Номер 26(5), С. 2289 - 2289

Опубликована: Март 4, 2025

Chronic graft-versus-host disease (cGVHD) is a prognostically negative event following hematopoietic stem cell transplant (HSCT). While cGVHD mainly affects the muscles, skin, oral mucosa, eyes, lungs, gastrointestinal tract, and liver, central nervous system (CNS) involvement remains possible and, moreover, rare when it occurs isolated. CNS-cGVHD can manifest with wide spectrum of CNS disorders, including cerebrovascular diseases, autoimmune demyelinating immune-mediated encephalitis. We present case 65-year-old man previously treated HSCT presenting progressive disorder optic neuropathy without any clear alternative causal processes except for microangiopathy in context CNS-cGVHD, along suggestive imaging instrumental laboratory findings. Starting one year after acute myeloid leukemia, first cerebral ischemic occurred was then associated reduction visual acuity, an extensive diagnostic work-up had remained inconclusive over many years, leading us to hypothesis therefore, start immunosuppressive therapy. Our experience highlighted not ignoring possibility as underlying mechanism disorder, even absence other systemic presentations, once more common etiologies pathological have been ruled out.

Язык: Английский

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Updates in chronic graft-versus-host disease: novel treatments and best practices in the current era

Bone Marrow Transplantation, Год журнала: 2024, Номер 59(10), С. 1360 - 1368

Опубликована: Июль 31, 2024

Язык: Английский

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A diagnostic classifier for pediatric chronic graft-versus-host disease: results of the ABLE/PBMTC 1202 study

Blood Advances, Год журнала: 2022, Номер 7(14), С. 3612 - 3623

Опубликована: Окт. 11, 2022

The National Institutes of Health Consensus criteria for chronic graft-versus-host disease (cGVHD) diagnosis can be challenging to apply in children, making pediatric cGVHD difficult. We aimed identify diagnostic biomarkers that would complement the current clinical and help differentiate from non-cGVHD. Applied Biomarkers Late Effects Childhood Cancer (ABLE) study, open at 27 transplant centers, prospectively evaluated 302 patients after hematopoietic cell (234 evaluable). Forty-four developed cGVHD. Mixed fixed effect regression analyses were performed on onset blood samples cellular plasma biomarkers, with individual markers declared relevant if they met 3 criteria: an ratio ≥1.3 or ≤0.75; area under curve (AUC) ≥0.60; a P value <5.814 × 10-4 (Bonferroni correction) (mixed effect) <.05 (fixed effect). To address complexity we built machine learning-based classifier combined multiple factors. Decreases regulatory natural killer cells, naïve CD4 T helper elevated levels CXCL9, CXCL10, CXCL11, ST2, ICAM-1, soluble CD13 (sCD13) characterize Evaluation time dependence revealed sCD13, ICAM-1 varied timing onset. achieved AUC 0.89, positive predictive 82% negative 80% diagnosing Our polyomic approach building could improve children but requires validation future prospective studies. This trial was registered www.clinicaltrials.gov as #NCT02067832.

Язык: Английский

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Pediatric Transplant and Cellular Therapy Consortium RESILIENT Conference on Pediatric Chronic Graft-versus-Host Disease Survivorship after Hematopoietic Cell Transplantation: Part II. Organ Dysfunction and Immune Reconstitution Considerations for children with chronic GVHD after Hematopoietic Cell Transplantation

Transplantation and Cellular Therapy, Год журнала: 2025, Номер unknown

Опубликована: Янв. 1, 2025

Язык: Английский

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A novel reduced toxicity conditioning regimen for older myelodysplastic neoplasms patients undergoing haploidentical stem cell transplantation: a prospective cohort study

American Journal of Cancer Research, Год журнала: 2025, Номер 15(1), С. 182 - 194

Опубликована: Янв. 1, 2025

A novel reduced-toxicity conditioning (RTC) regimen of busulfan, fludarabine, cyclophosphamide, and antithymocyte globulin (Bu/Flu/Cy/ATG) followed by haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in older patients with hematologic malignancies has been reported the results was encouraging. However, safety efficacy this unknown myelodysplastic neoplasms (MDS) patients. From January 2018 to December 2021, 68 consecutive (aged over 50) using RTC for T-cell replete haplo-HSCT (RTC group) at our center were eligible, aged under 50 modified cyclophosphamide plus (Bu/Cy/ATG) (Bu/Cy/ATG randomly selected from 223 MDS during same period a 1:1 ratio matched-pair analysis patient sex, World Health Organization (WHO) category, international prognostic scoring system (IPSS) risk group, time diagnosis HSCT, chemotherapy advanced, response after chemotherapy, donor infused mononuclear cells CD34-positive count. The transplant outcomes also compared between group matched sibling (MSD) (HSCT) busulfan (Bu/Cy) regimen. cumulative incidences grade II-IV acute graft versus host disease (aGVHD) significantly lower than that Bu/Cy/ATG group. 3-year treatment related mortality (TRM) two groups 12.3% 14.7% (P=0.613). relapse, disease-free survival (DFS) overall (OS) comparable groups. better those received MSD transplant, incidence TRM, higher OS DFS. advantages still significant when comparing receiving children donors HSCT TRM. Children could be choice Bu/Cy elderly encouraging suggest is potentially promising method trail number prospective study "NCT03412409" trial URL "https://clinicaltrials.gov/study/NCT03412409?term=NCT03412409&rank=1".

Язык: Английский

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Lung transplantation for pulmonary chronic graft-versus-host disease: a missed opportunity?

JHLT Open, Год журнала: 2025, Номер unknown, С. 100209 - 100209

Опубликована: Янв. 1, 2025

Chronic graft-versus-host disease is a common complication after allogeneic hematopoietic stem cell transplantation, with pulmonary chronic (PcGvHD) particularly associated dismal prognosis. Lung transplantation (LuTx) final therapeutic option for well-selected patients affected by this condition. Nevertheless, only small group of PcGvHD are referred LuTx. This review addresses concerns regarding referral and listing LuTx (such as risk relapse hematological malignancy, infectious complications rejection) survival outcomes specific cohort patients. Importantly, has comparable to other indications. The establishment indication criteria may improve rates timing both suitable candidates.

Язык: Английский

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Chronic graft-versus-host disease myelitis successfully treated with rituximab

International Journal of Hematology, Год журнала: 2025, Номер unknown

Опубликована: Янв. 31, 2025

Chronic graft-versus-host disease (cGVHD) is a major serious complication after allogeneic stem-cell transplantation (allo-HSCT), and often mimics autoimmune diseases. Central nervous system (CNS) symptoms are rare manifestations of cGVHD, difficult to diagnose. CNS cGVHD were discussed in the 2020 National Institutes Health Consensus Project as one "atypical manifestations" with involvement various organ systems other than classical organs. We experienced case myelitis allo-HSCT diagnosed CNS. The neurological progressed corticosteroid pulse therapy, resulting severe paralysis paresthesia lower extremities. clinical course magnetic resonance imaging findings showed some similarities multiple sclerosis. decided use rituximab patient became refractory corticosteroids because has been reported be effective sclerosis by suppressing B cells on both sides blood-brain barrier. Rituximab was for neurologic our case. In atypical treatments used corresponding diseases may reasonable effective.

Язык: Английский

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Graft-Versus-Host Disease Mouse Models: A Clinical-Translational Perspective

Methods in molecular biology, Год журнала: 2025, Номер unknown, С. 1 - 56

Опубликована: Янв. 1, 2025

Язык: Английский

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NIH Chronic Graft-versus-Host Disease Consensus Conference 2025 Update

Transplantation and Cellular Therapy, Год журнала: 2025, Номер unknown

Опубликована: Май 1, 2025

Язык: Английский

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What’s new in the management of pulmonary complications in allogeneic stem cell transplantation?

Expert Review of Respiratory Medicine, Год журнала: 2025, Номер unknown

Опубликована: Май 29, 2025

As survival increases after allogeneic hematopoietic stem cell transplantation (allo-HCT), several organ complications have emerged, including those involving the lung, which require a multidisciplinary management approach. The constant evolution of allo-HCT procedures, advances in diagnostic tools for infections and pulmonary disease, as well new treatment approaches, frequent updating knowledge this field. We review multiple infectious noninfectious lung that occur both early late allo-HCT. This includes an updated description these complications, risk factors, approach outcome. A literature search was performed using PubMed-indexed journals. diagnosis remains challenging, further complicated by association co-infections and/or links between infection complications. development metagenomic next-generation sequencing (mNGS) should enhance yield bronchoalveolar lavage but its clinical relevance to be evaluated. better understanding pathophysiology chronic graft-versus-host disease (GVHD) improved phenotyping are essential advancing therapeutic management. requires revision criteria identification biomarkers disease.

Язык: Английский

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