| 1. |
- Pahnke, Simon
(författare)
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Potential Hazards for Haematopoietic Stem Cell Donors
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis has been to increase our knowledge about the allogeneic stem cell donation procedure and the associated risks for stem cell donors. In a first study (paper I), we described the donation procedure and short-term side effects of 1957 donors included in the Nordic Register of Haematopoietic Stem Cell Donors. Donors of bone marrow or peripheral blood stem cells experienced side effects such as bone/muscle pain, headache and /or fatigue in more than 90% of cases, with symptoms lasting less than one week for the majority of donors. Bone marrow donors had side effects of longer duration, experienced more fatigue, and were more likely to need sick leave longer than one week. Related donors were older than unrelated donors, had more comorbidities, and more frequently needed a central venous catheter and/or multiple apheresis during peripheral blood stem cell donation.For a second study (paper II), we analysed global survey data from the World Marrow Donor Association (WMDA), regarding the use of biosimilar versions of stem cell mobilising drug filgrastim. A third of donor registers (10/30) had adopted the use of biosimilar filgrastim, with the majority doing so during the last five years. A review of studies of biosimilar filgrastim use for healthy donor stem cell mobilisation, showed biosimilar drugs to exhibit similar pharmacokinetic and pharmacodynamic properties to the reference product Neupogen®. No differences in stem cell mobilising capacity or adverse events were found. The study resulted in the endorsement by WMDA of the use of biosimilar filgrastim for stem cell mobilisation in healthy donors.In two studies (paper III and V) of almost 1100 donors, we linked data from multiple Swedish national registers to investigate if peripheral blood stem cell donation with the use of granulocyte-colony stimulating factor (G-CSF) is associated with an increased risk of cancer or cardiovascular disease. No increased risk of cancer, haematological malignancies or cardiovascular disease was found, after a median follow up of close to 10 years.In a national survey of 210 potential stem cell donors, using validated mental health screening tools (paper IV), we found female gender, lower age, and an increased level of worry for one-self in regards to becoming a donor, to be associated with lower mental health, and higher levels of anxiety.
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| 2. |
- Pearce, Kim F., et al.
(författare)
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Regulation of advanced therapy medicinal products in Europe and the role of academia
- 2014
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Ingår i: Cytotherapy. - : Elsevier BV. - 1477-2566 .- 1465-3249. ; 16:3, s. 289-297
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Forskningsöversikt (refereegranskat)abstract
- Background aims. Advanced therapy medicinal products (ATMP) are gene therapy, somatic cell therapy or tissue-engineered products regulated under (EC) No. 1394/2007 to ensure their free movement within the European Union while guaranteeing the highest level of health protection for patients. Academic good manufacturing practice (GMP) centers are major contributors in the development of ATMPs and this study assessed the impact of regulations on them. Methods. European academic and non-industrial facilities (n = 747) were contacted, and a representative sample of 50 replied to a detailed questionnaire. Experienced centres were further selected in every Member State (MS) for semi-structured interviews. Indicators of ATMP production and development success were statistically assessed, and opinions about directive implementation were documented. Results. Facilities experienced in manufacturing cell therapy transplant products are the most successful in developing ATMPs. New centres lacking this background struggle to enter the field, and there remains a shortage of facilities in academia participating in translational research. This is compounded by heterogeneous implementation of the regulations across MS. Conclusions. GMP facilities successfully developing ATMPs are present in all MS. However, the implementation of regulations is heterogeneous between MS, with substantial differences in the definition of ATMPs and in the approved manufacturing environment. The cost of GMP compliance is underestimated by research funding bodies. This is detrimental to development of new ATMPs and commercialization of any that are successful in early clinical trials. Academic GMP practitioners should strengthen their political visibility and contribute to the development of functional and effective European Union legislation in this field.
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| 3. |
- Sharrack, Basil, et al.
(författare)
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Autologous haematopoietic stem cell transplantation and other cellular therapy in multiple sclerosis and immune-mediated neurological diseases : updated guidelines and recommendations from the EBMT Autoimmune Diseases Working Party (ADWP) and the Joint Accreditation Committee of EBMT and ISCT (JACIE)
- 2020
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Ingår i: Bone Marrow Transplantation. - : Springer Nature. - 0268-3369 .- 1476-5365. ; 55:2, s. 283-306
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Tidskriftsartikel (refereegranskat)abstract
- These updated EBMT guidelines review the clinical evidence, registry activity and mechanisms of action of haematopoietic stem cell transplantation (HSCT) in multiple sclerosis (MS) and other immune-mediated neurological diseases and provide recommendations for patient selection, transplant technique, follow-up and future development. The major focus is on autologous HSCT (aHSCT), used in MS for over two decades and currently the fastest growing indication for this treatment in Europe, with increasing evidence to support its use in highly active relapsing remitting MS failing to respond to disease modifying therapies. aHSCT may have a potential role in the treatment of the progressive forms of MS with a significant inflammatory component and other immune-mediated neurological diseases, including chronic inflammatory demyelinating polyneuropathy, neuromyelitis optica, myasthenia gravis and stiff person syndrome. Allogeneic HSCT should only be considered where potential risks are justified. Compared with other immunomodulatory treatments, HSCT is associated with greater short-term risks and requires close interspeciality collaboration between transplant physicians and neurologists with a special interest in these neurological conditions before, during and after treatment in accredited HSCT centres. Other experimental cell therapies are developmental for these diseases and patients should only be treated on clinical trials.
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| 4. |
- Worel, Nina, et al.
(författare)
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Suitability Criteria for Adult Related Donors : A Consensus Statement from the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Donor Issues
- 2015
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Ingår i: Biology of blood and marrow transplantation. - : Elsevier BV. - 1083-8791 .- 1523-6536. ; 21:12, s. 2052-2060
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Tidskriftsartikel (refereegranskat)abstract
- The number of allogeneic hematopoietic stem cell (HSC) transplants performed globally each year continues to increase. Advances in HLA typing, better supportive care, and administration of reduced-intensity conditioning regimens allow treatment of older patients with older sibling donors. Pretransplant donor assessment and testing are very important processes affecting the quality and safety of donation. For unrelated HSC donors detailed recommendations for health assessment have been published, allowing donation only if they are unrestrictedly healthy. Eligibility criteria for related donors are less strict and vary significantly between centers. In situations where a family donor does not meet the suitability criteria for unrelated donors, involved physicians often struggle with the decision whether the matched relative is suitable for donation or not. On behalf of the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Donor Issues, we intended to develop a consensus document with recommendations for donor workup and final clearance of family donors who would not be able to serve as unrelated donors because of their age or pre-existing diseases. This article covers different topics intending to support decision-making, with the goal of minimizing medical risk to the donor and protection of the recipient from transmissible diseases.
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| 5. |
- Worel, Nina, et al.
(författare)
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Suitability of haematopoietic cell donors : updated consensus recommendations from the WBMT standing committee on donor issues
- 2022
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Ingår i: The Lancet Haematology. - 2352-3026. ; 9:8, s. 605-614
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Forskningsöversikt (refereegranskat)abstract
- The contribution of related donors to the globally rising number of allogeneic haematopoietic stem cell transplantations (HSCT) remains increasingly important, particularly because of the growing use of haploidentical HSCT. Compared with the strict recommendations on the suitability for unrelated donors, criteria for related donors allow for more discretion and vary between centres. In 2015, the donor outcome committee of the Worldwide Network for Blood and Marrow Transplantation (WBMT) proposed consensus recommendations of suitability criteria for paediatric and adult related donors. This Review provides updates and additions to these recommendations from a panel of experts with global representation, including the WBMT, the European Society for Blood and Marrow Transplantation donor outcome committee, the Center for International Blood and Marrow Transplant Research donor health and safety committee, the US National Marrow Donor Program, and the World Marrow Donor Association, after review of the current literature and guidelines. Sections on the suitability of related donors who would not qualify as unrelated donors have been updated. Sections on communicable diseases, clonal haematopoiesis of indeterminate potential, paediatric aspects including psychological issues, and reporting on serious adverse events have been added. The intention of this Review is to support decision making, with the goal of minimising the medical risk to the donor and protecting the recipient from transmissible diseases.
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