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[PMID]:29211700
[Au] Autor:Kim MJ; Kim JH; Jeon HS; Wee WR; Hyon JY
[Ad] Endereço:*Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; and†Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
[Ti] Título:Effect of Histocompatibility Y Antigen Matching on Graft Survival in Primary Penetrating Keratoplasty.
[So] Source:Cornea;37(1):33-38, 2018 Jan.
[Is] ISSN:1536-4798
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To investigate the influence of histocompatibility Y (H-Y) antigen matching on corneal graft survival in primary penetrating keratoplasty (PK). METHODS: Medical records of patients who underwent primary PK at Seoul National University Bundang Hospital between June 2005 and October 2015 were retrospectively analyzed. The eyes were classified into 2 groups: H-Y-compatible (115 eyes) and H-Y-incompatible (23 eyes). The H-Y-compatible group included donor/recipient combinations of male/male (57 eyes), female/male (44 eyes), and female/female (14 eyes). The H-Y-incompatible group included the male/female (23 eyes) combination alone. A subgroup analysis of low- and high-risk patients according to preoperative diagnoses was also performed. Survival analysis was conducted using the Kaplan-Meier method; differences between groups were assessed with a log-rank test. RESULTS: A total of 138 eyes from 136 patients (age: 58 ± 18 years) were enrolled. Rejection-free graft survival and graft survival were not significantly different between H-Y-compatible and H-Y-incompatible groups (χ = 0.4, P = 0.548; χ = 1.9; P = 0.17, respectively). Preoperative diagnoses of high-risk cases included those with corneal perforation or thinning (8.7%) and infectious keratitis (7.2%). Low-risk cases included corneal opacity (50.0%), bullous keratopathy (25.4%), keratoconus (5.8%), and corneal dystrophy (2.9%). In the high-risk group, rejection-free graft survival rate was significantly higher in the H-Y-compatible group (χ = 3.9, P = 0.049). CONCLUSIONS: H-Y antigen matching does not influence graft rejection and failure in cases of primary PK. However, matching the H-Y antigen could help reduce graft rejection, especially in preoperatively high-risk patients.
[Mh] Termos MeSH primário: Doenças da Córnea/cirurgia
Sobrevivência de Enxerto/imunologia
Antígeno H-Y/imunologia
Ceratoplastia Penetrante
[Mh] Termos MeSH secundário: Idoso
Aloenxertos
Feminino
Rejeição de Enxerto/diagnóstico
Teste de Histocompatibilidade
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (H-Y Antigen)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1097/ICO.0000000000001394


  2 / 15395 MEDLINE  
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[PMID]:28460445
[Au] Autor:Lv W; Fan Z; Huang F; Xu N; Xuan L; GuopanYu; Jiang Q; Zhou H; Lin R; Zhang X; Sun J; Liu Q
[Ad] Endereço:Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 China.
[Ti] Título:Autoimmune hematological diseases following haploidentical donor hematopoietic stem cell Transplant compared with matched sibling and unrelated donor.
[So] Source:Oncotarget;8(16):26505-26514, 2017 Apr 18.
[Is] ISSN:1949-2553
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Autoimmune hematological diseases (AHDs) occur more frequently than other autoimmune complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and are often refractory to treatment. This study was to analyze the incidence and risk factors of AHDs as well as their response to treatment . Four hundred and forty-five adult malignant hematopoietic disorders underwent allo-HSCT were enrolled in this retrospective study, including 124 haploidentical donor (HRD), 140 unrelated donor (MUD) and 181 HLA-matched sibling donor (MSD) transplants. Twelve patients developed AHDs, including 6 autoimmune hemolytic anemia and 6 Evans syndrome. Evans syndrome all occurred in HRD transplants. The 3-year cumulative incidence of AHDs was 4.0 ± 1.3%, and HRD had higher incidence than MUD (8.7 ± 3.0% vs 1.8 ± 1.2%, P = 0.012) and MSD (8.7 ± 3.0% vs 3.5 ± 2.6%, P = 0.004 ). The steroids combined with Cyclosporine A were acted as the first line treatment, and the response rate was 73%. No patients experienced recurrence at a median follow up of 313 days after stopping treatment. HRD transplants (vs MUD: HR, 5.87; CI, 1.24 to 27.73; p = 0.026 and vs MSD: HR, 7.70; CI, 1.63 to 36.44; P = 0.010) and concurrent chronic graft versus host disease (HR, 3.76; CI, 1.18 to 11.92; P = 0.025) were risk factors for AHDs.
[Mh] Termos MeSH primário: Doenças Autoimunes/terapia
Doenças Hematológicas/terapia
Transplante de Células-Tronco Hematopoéticas
Irmãos
Doadores não Relacionados
[Mh] Termos MeSH secundário: Adolescente
Adulto
Doenças Autoimunes/diagnóstico
Doenças Autoimunes/mortalidade
Feminino
Doença Enxerto-Hospedeiro/diagnóstico
Doença Enxerto-Hospedeiro/etiologia
Antígenos HLA/genética
Antígenos HLA/imunologia
Doenças Hematológicas/diagnóstico
Doenças Hematológicas/mortalidade
Transplante de Células-Tronco Hematopoéticas/efeitos adversos
Transplante de Células-Tronco Hematopoéticas/métodos
Teste de Histocompatibilidade
Seres Humanos
Incidência
Masculino
Meia-Idade
Transplante Homólogo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HLA Antigens)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.18632/oncotarget.15710


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[PMID]:29266059
[Au] Autor:Tambur AR; Wiebe C
[Ad] Endereço:Transplant Immunology Laboratory, Comprehensive Transplant Center, Northwestern University, Chicago, IL.
[Ti] Título:HLA Diagnostics: Evaluating DSA Strength by Titration.
[So] Source:Transplantation;102(1S Suppl 1):S23-S30, 2018 01.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:HLA antibodies, and specifically donor-specific-HLA antibodies, play a key role in transplant-related diagnostics and decision-making. It is now clear that the simple differentiation between absence and presence of HLA donor-specific antibodies does not provide sufficient granularity in all clinical circumstances. It addition, knowledge of HLA antibody strength has potential utility at different stages of recipient evaluation along the transplant timeline from initial pretransplant evaluation, evaluation of a specific potential donor, and posttransplant monitoring for de novo donor-specific antibodies. Here we compare data evaluating HLA antibody strength using the conventional IgG-mean fluorescence intensity approach with serial dilution studies (titration) and of C1q binding (C1q-mean fluorescence intensity). The added value of titration studies along the 3 milestones of the transplant cycle is emphasized.
[Mh] Termos MeSH primário: Complemento C1q/imunologia
Imunofluorescência/métodos
Rejeição de Enxerto/imunologia
Antígenos HLA/imunologia
Teste de Histocompatibilidade/métodos
Imunoglobulina G/sangue
Isoanticorpos/sangue
[Mh] Termos MeSH secundário: Biomarcadores/sangue
Rejeição de Enxerto/prevenção & controle
Seres Humanos
Isoanticorpos/imunologia
Transplante de Órgãos
Assistência Perioperatória
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (HLA Antigens); 0 (Immunoglobulin G); 0 (Isoantibodies); 80295-33-6 (Complement C1q)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001817


  4 / 15395 MEDLINE  
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[PMID]:29266058
[Au] Autor:Lan JH; Tinckam K
[Ad] Endereço:Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
[Ti] Título:Clinical Utility of Complement Dependent Assays in Kidney Transplantation.
[So] Source:Transplantation;102(1S Suppl 1):S14-S22, 2018 01.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Formation of antibodies against polymorphic HLA molecules on donor endothelium is central to the pathogenesis of antibody-mediated rejection, the dominant cause of long-term kidney allograft loss. Although introduction of the single-antigen bead assay has greatly facilitated the immune risk assessment of transplant recipients, it is recognized that not all IgG HLA antibodies detected using this method are equally relevant. In recent years, novel assays (C4d, C1q, C3d) have been developed to interrogate the complement-activating potential of anti-HLA antibodies in vitro, with the hypothesis that complement-fixing antibodies are more immediately injurious to the graft compared with noncomplement-binding antibodies. Although initial studies demonstrated the potential of these assays to risk-stratify antibodies beyond the conventional limited metric of mean fluorescence intensity values, new data from recent analyses challenge some of these early findings. In this review, we examine the technical aspects of these assays and key studies that evaluated the discriminant capacity of these tests to predict numerous outcomes in kidney transplantation. We discuss conflicting data and emerging controversies in the context of recent experimental evidence which offer new insights into the major factors that influence complement activation. Finally, we provide our perspective on the current role and utility of complement diagnostic assays as 1 variable in the multifactorial risk assessment and management of kidney transplant recipients.
[Mh] Termos MeSH primário: Ativação do Complemento/imunologia
Proteínas do Sistema Complemento/imunologia
Rejeição de Enxerto/imunologia
Antígenos HLA/imunologia
Teste de Histocompatibilidade/métodos
Isoanticorpos/metabolismo
Transplante de Rim
[Mh] Termos MeSH secundário: Biomarcadores/metabolismo
Rejeição de Enxerto/prevenção & controle
Seres Humanos
Isoanticorpos/imunologia
Medição de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (HLA Antigens); 0 (Isoantibodies); 9007-36-7 (Complement System Proteins)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001819


  5 / 15395 MEDLINE  
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[PMID]:29266057
[Au] Autor:Valenzuela NM; Schaub S
[Ad] Endereço:UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA.
[Ti] Título:The Biology of IgG Subclasses and Their Clinical Relevance to Transplantation.
[So] Source:Transplantation;102(1S Suppl 1):S7-S13, 2018 01.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Immunoglobulin G (IgG) is the dominant immunoglobulin and can be divided into 4 distinct subclasses. The evolution of IgG subclass switches is regulated by interaction with T cells and follows a 1-way direction (IgG3 → IgG1 → IgG2 → IgG4). Based on their structure, the 4 IgG subclasses can initiate different effector function such as complement activation, recruitment of various cells by Fc receptors, and agonistic signaling. Using current assays for HLA antibody detection as a template and replacing the generic reporter antibody with IgG subclass-specific reporter antibodies, it is possible to investigate the IgG subclasses of HLA antibodies. There are 15 different IgG subclass compositions possible. Based on the capability to activate the complement system and the class switch direction, 3 arbitrary patterns can be defined (ie, only complement-binding subclasses [IgG3 and/or IgG1], expansion to noncomplement-binding subclasses [IgG3 and/or IgG1 plus IgG2 and/or IgG4], and switch to noncomplement-binding subclasses [IgG2 and/or IgG4]). The latter group accounts for less than 5%, whereas the former 2 groups have a similar prevalence close to 50%. In the past 5 years, several studies correlated the IgG subclass pattern with occurrence of antibody-mediated rejection and allograft outcomes. Because of differences of the used IgG subclass assay, the time point of analyses, and the definition of outcomes, a clear picture has not emerged yet. Future needs are standardization of the assay, a more detailed knowledge of the initiated effector functions, and more well-designed clinical studies also looking at changes of the IgG subclass pattern over time.
[Mh] Termos MeSH primário: Antígenos HLA/imunologia
Teste de Histocompatibilidade
Switching de Imunoglobulina/imunologia
Imunoglobulina G/imunologia
Isoanticorpos/imunologia
Transplante de Órgãos
[Mh] Termos MeSH secundário: Ativação do Complemento/imunologia
Seres Humanos
Imunoglobulina G/classificação
Imunoglobulina G/genética
Isoanticorpos/classificação
Isoanticorpos/genética
Receptores Fc/imunologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (HLA Antigens); 0 (Immunoglobulin G); 0 (Isoantibodies); 0 (Receptors, Fc)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001816


  6 / 15395 MEDLINE  
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[PMID]:29266056
[Au] Autor:Liwski RS; Gebel HM
[Ad] Endereço:Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
[Ti] Título:Of Cells and Microparticles: Assets and Liabilities of HLA Antibody Detection.
[So] Source:Transplantation;102(1S Suppl 1):S1-S6, 2018 01.
[Is] ISSN:1534-6080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The evolution of antibody detection from cell- to bead-based technology has positively impacted the ability to allocate organs in a safe and timely manner. The devil, of course, is in the details that delineate how these assays are performed and applied and to recognize that while there have been some truly amazing technological advances (assets), they are still imperfect and subject to error (liabilities). This review identifies the strengths of HLA antibody assays, highlights their weaknesses and offers approaches for standardization.
[Mh] Termos MeSH primário: Micropartículas Derivadas de Células/imunologia
Antígenos HLA/imunologia
Teste de Histocompatibilidade/métodos
Isoanticorpos/metabolismo
[Mh] Termos MeSH secundário: Biomarcadores/metabolismo
Teste de Histocompatibilidade/normas
Seres Humanos
Transplante de Órgãos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (HLA Antigens); 0 (Isoantibodies)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1097/TP.0000000000001818


  7 / 15395 MEDLINE  
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[PMID]:29250743
[Au] Autor:Yang J; Cai Y; Jiang J; Wan L; Bai H; Zhu J; Li S; Wang C; Song X
[Ad] Endereço:Department of Hematology, Shanghai General Hospital affiliated to Shanghai Jiao Tong University, Haining road 100, Shanghai, 200080, China.
[Ti] Título:Early tapering of immunosuppressive agents after HLA-matched donor transplantation can improve the survival of patients with advanced acute myeloid leukemia.
[So] Source:Ann Hematol;97(3):497-507, 2018 Mar.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Disease recurrence is the most important obstacle to achieve long-term survival for patients with advanced acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In order to reduce the relapse risk and improve the survival, the strategy of early tapering of immunosuppressive agents was prospectively evaluated. Thirty-one patients with advanced AML received early tapering of immunosuppressive drugs, while 32 patients with AML in complete remission (CR) were given the routine tapering of immunosuppressive agents after HLA-matched donor transplantation. All advanced AML patients achieved CR after allo-HSCT. At 24 months after transplantation, relapse incidences were 22% in advanced group and 16% in CR group (P = 0.553); disease-free survival (DFS) and overall survival (OS) were 57.7 and 57.8% in advanced group, while in CR group were 66.6% (P = 0.388) and 66.2% (P = 0.423); immunosuppressive agent-free DFS (IDFS) were similar between two groups (P = 0.407). Acute graft-versus-host disease (aGvHD) incidences were similar between two groups (P = 0.311). Chronic GvHD (cGvHD) incidence was much higher in advanced group than in CR group (70.4 vs 38.7%, P = 0.02), but severe cGvHD had no difference. In multivariate analysis, cGvHD was an independent prognostic factor for lower risk of relapse and better DFS and OS; early tapering of immunosuppressive agents was an independent prognostic factor for cGvHD. The study suggested that advanced AML patients could be directly treated with allo-HSCT and its survival could be improved through the strategy of early tapering of immunosuppressive agents without significant adverse effects ( Clinicaltrials.org NCT03150134).
[Mh] Termos MeSH primário: Transplante de Células-Tronco Hematopoéticas
Imunossupressores/administração & dosagem
Leucemia Mieloide Aguda/mortalidade
Leucemia Mieloide Aguda/terapia
Condicionamento Pré-Transplante/métodos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Progressão da Doença
Esquema de Medicação
Feminino
Doença Enxerto-Hospedeiro/epidemiologia
Doença Enxerto-Hospedeiro/etiologia
Doença Enxerto-Hospedeiro/prevenção & controle
Transplante de Células-Tronco Hematopoéticas/efeitos adversos
Teste de Histocompatibilidade
Seres Humanos
Incidência
Leucemia Mieloide Aguda/patologia
Masculino
Meia-Idade
Análise de Sobrevida
Doadores de Tecidos
Transplante Homólogo/efeitos adversos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunosuppressive Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-017-3204-6


  8 / 15395 MEDLINE  
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[PMID]:28466469
[Au] Autor:Zhao XY; Luo XY; Yu XX; Zhao XS; Han TT; Chang YJ; Huo MR; Xu LP; Zhang XH; Liu KY; Li D; Jiang ZF; Huang XJ
[Ad] Endereço:Peking University People's Hospital, Peking University Institute of Haematology, Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation, Beijing, China.
[Ti] Título:Recipient-donor KIR ligand matching prevents CMV reactivation post-haploidentical T cell-replete transplantation.
[So] Source:Br J Haematol;177(5):766-781, 2017 06.
[Is] ISSN:1365-2141
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Licensed natural killer (NK) cells have been demonstrated to have anti-cytomegalovirus (CMV) activity. We prospectively analysed the human leucocyte antigen typing of donor-recipient pairs and the killer cell immunoglobulin-like receptor (KIR) typing of donors for 180 leukaemia patients to assess the predictive roles of licensed NK cells on CMV reactivation post-T-cell-replete haploidentical stem cell transplantation. Multivariate analysis showed that donor-recipient KIR ligand graft-versus-host or host-versus-graft direction mismatch was associated with increased refractory CMV infection (Hazard ratio = 2·556, 95% confidence interval, 1·377-4·744, P = 0·003) post-transplantation. Donor-recipient KIR ligand matching decreased CMV reactivation [51·65% (46·67, 56·62%) vs. 75·28% (70·87, 79·69%), P = 0·012], refractory CMV infection [17·58% (13·77, 21·40%) vs. 35·96% (31·09, 40·82%), P = 0·004] and CMV disease [3·30% (1·51, 5·08%) vs. 11·24% (8·04, 14·43%), P = 0·024] by day 100 post-transplantation. In addition, the percentage of γ-interferon expression on donor-derived NK cells was significantly higher in the recipients among the recipient-donor pairs with a KIR ligand match compared with that in the recipients among the pairs with a KIR ligand graft-versus-host or host-versus-graft direction mismatch on days 30 and 100 post-transplantation (P = 0·036 and 0·047, respectively). These findings have suggested that donor-recipient KIR ligand matching might promote the NK cell licensing process, thereby increasing NK cell-mediated protection against CMV reactivation.
[Mh] Termos MeSH primário: Infecções por Citomegalovirus/prevenção & controle
Linfócitos T/transplante
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Citomegalovirus/fisiologia
Feminino
Neoplasias Hematológicas/terapia
Teste de Histocompatibilidade/métodos
Seres Humanos
Células Matadoras Naturais/imunologia
Células Matadoras Naturais/fisiologia
Masculino
Meia-Idade
Estudos Prospectivos
Receptores KIR/genética
Receptores KIR/imunologia
Transplante de Células-Tronco/métodos
Transplantados
Condicionamento Pré-Transplante/métodos
Ativação Viral/genética
Ativação Viral/imunologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (KIR2DS2 protein, human); 0 (Receptors, KIR)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1111/bjh.14622


  9 / 15395 MEDLINE  
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[PMID]:27775231
[Au] Autor:Wang SX; Xu YP
[Ad] Endereço:Key Laboratory of Shenzhen for Histocompatibility and Immunogenetics, Shenzhen Blood Center, Shenzhen, P. R. China.
[Ti] Título:Genomic full-length sequence of two HLA-A alleles, A*24:08 and A*24:10, identified by cloning and sequencing.
[So] Source:HLA;88(6):300-302, 2016 12.
[Is] ISSN:2059-2310
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Genomic full-length sequences of HLA-A*24:08 and A*24:10, were identified by cloning and sequencing.
[Mh] Termos MeSH primário: Alelos
Éxons
Antígeno HLA-A24/genética
Polimorfismo de Nucleotídeo Único
Doadores de Tecidos
Regiões não Traduzidas
[Mh] Termos MeSH secundário: Sequência de Bases
Clonagem Molecular
Códon/química
Expressão Gênica
Genótipo
Antígeno HLA-A24/imunologia
Transplante de Células-Tronco Hematopoéticas
Teste de Histocompatibilidade
Seres Humanos
Íntrons
Reação em Cadeia da Polimerase
Alinhamento de Sequência
Análise de Sequência de DNA
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Codon); 0 (HLA-A24 Antigen); 0 (Untranslated Regions)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1111/tan.12916


  10 / 15395 MEDLINE  
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[PMID]:28748621
[Au] Autor:Elgarten CW; Arnold DE; Bunin NJ; Seif AE
[Ad] Endereço:Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
[Ti] Título:Outcomes of matched sibling donor bone marrow transplantation in children using single-agent calcineurin inhibitors as prophylaxis for graft versus host disease.
[So] Source:Pediatr Blood Cancer;65(1), 2018 Jan.
[Is] ISSN:1545-5017
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Optimal graft versus host disease (GVHD) prophylaxis prevents severe manifestations without excess immunosuppression. Standard prophylaxis includes a calcineurin inhibitor (CNI) with low-dose methotrexate. However, single-agent CNI may be sufficient prophylaxis for a defined group of patients. Single-agent CNI has been used for GVHD prophylaxis for human leukocyte antigen (HLA)-matched sibling donor (MSD) bone marrow transplants (BMTs) in young patients at the Children's Hospital of Philadelphia for over 20 years. Here, we describe outcomes using this prophylactic strategy in a recent cohort. PROCEDURE: We performed a single-institution chart review and retrospective analysis of consecutive children undergoing MSD BMT who received single-agent CNI for GVHD prophylaxis between January 2002 and December 2014. RESULTS: Fifty-two children with a median age of 6.1 years (interquartile range [IQR] 2.5-8.3) and donor age of 6 years (IQR 3-10), with malignant and nonmalignant diseases (n = 35 and 17, respectively) were evaluated. Forty-three (82.6%) received oral prophylaxis with single-agent tacrolimus after initial intravenous therapy. Rates of GVHD were consistent with reported rates on dual prophylaxis: the overall incidence of grades 2-4 acute GVHD was 25.5%, grades 3-4 GVHD 9.8%, and chronic GVHD 10.4%. The cumulative incidence of relapse among children with malignancy was 20% at a median of 237 days (IQR 194-318) post-transplant. Two-year overall survival was 82.7% (95% confidence interval [CI]: 69.4-90.6%) and event-free survival was 78.9% (95% CI: 65.1-87.7%). No patient experienced graft failure. CONCLUSIONS: Single-agent CNI is a safe, effective approach to GVHD prophylaxis in young patients undergoing HLA-identical sibling BMT. Additionally, single-agent oral tacrolimus is a reasonable alternative to cyclosporine in this population.
[Mh] Termos MeSH primário: Transplante de Medula Óssea
Inibidores de Calcineurina/administração & dosagem
Doença Enxerto-Hospedeiro/prevenção & controle
Neoplasias/terapia
Irmãos
Doadores de Tecidos
[Mh] Termos MeSH secundário: Adolescente
Aloenxertos
Criança
Pré-Escolar
Feminino
Teste de Histocompatibilidade
Seres Humanos
Lactente
Masculino
Metotrexato/administração & dosagem
Neoplasias/patologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Calcineurin Inhibitors); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180101
[Lr] Data última revisão:
180101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1002/pbc.26726



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