Improving Safety and Outcomes After Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience

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Improving Safety and Outcomes After Allogeneic Hematopoietic Cell Transplantation : A Single-Center Experience

Salas, Maria Queralt (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.;Hosp Clin Barcelona, IDIBAPS, Dept Hematol, Bone Marrow Transplant Unit, Barcelona, Spain.

Pasic, Ivan (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Remberger, Mats, Professor, 1955- (författare): Uppsala universitet,Hematologi,Uppsala Univ Hosp, KFUE, Uppsala, Sweden.

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Novitzky-Basso, Igor (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Law, Arjun Datt (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Lam, Wilson (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Chen, Carol (författare): Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Kim, Dennis (Dong Hwan) (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Michelis, Fotios, V (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Gerbitz, Armin (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Viswabandya, Auro (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Lipton, Jeffrey Howard (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Kumar, Rajat (författare): Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.

Mattsson, Jonas (författare): Karolinska Institutet

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Univ Toronto, Dept Med, Toronto, ON, Canada;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada.;Hosp Clin Barcelona, IDIBAPS, Dept Hematol, Bone Marrow Transplant Unit, Barcelona, Spain. Univ Toronto, Dept Med, Toronto, ON, Canada.;Univ Hlth Network, Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Hans Messner Allogene Transplant Program, Toronto, ON, Canada. (creator_code:org_t)

Elsevier, 2022
2022
Engelska.
Ingår i: Transplantation and Cellular Therapy. - : Elsevier. - 2666-6375 .- 2666-6367. ; 28:5

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; visa färre...

Tidskriftsartikel (refereegranskat)

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The implementation of dual T-cell depletion comprising 4.5 mg/kg of antithymocyte globulin (ATG), post-transplantation cyclophosphamide, and cyclosporine A for reduced-intensity allogeneic hematopoietic cell transplantation (HCT) independent of donor source in 2015 significantly improved graft-versus-host disease (GVHD) control at our Institution. Further advances were made between 2017 to 2020 in supportive care of allogeneic HCT recipients and were the subject of this study, with 651 adults included. Transplant outcomes were compared between patients who underwent transplantation during Period 1 (2017-2018) and Period 2 (2019-2020). Main changes implemented during the study period were reduction of ATG dose from 4.5 to 2 mg/kg in matched unrelated donor transplants, abandoning of dual T-cell depletion in matched related donor transplants, combining dual T-cell depletion with myeloablative conditioning for selected patients, and reduction of the target therapeutic cyclosporine level from 200 to 400 ng/L to 150 to 250 ng/L. Other improvements included addition of ursodiol until day 100, implementation of a double responsible physician model, and personalized patient supportive care plan focused on activity and calorie intake. The reduction in intensity of GVHD prophylaxis provided comparable acute GVHD and moderate-severe chronic GVHD between both time periods. Altogether the described improvements in transplant methodology and supportive care showed that compared to Period 1, patients transplanted in Period 2 had superior 1-year overall survival, relapse-free survival, and non-relapsemortality and showed a trend toward better GVHD- and relapse-free survival, without an increase in relapse risk. This study reports the results of outcomes-directed improvements in transplantation design, GVHD prophylaxis, and supportive care, highlighting how transplantation outcomes can be improved through careful modifications in response to meticulously monitored outcomes. (C) 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Hematologi

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Av lärosätet: Uppsala universitet; Karolinska Institutet

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Improving Safety and Outcomes After Allogeneic Hematopoietic Cell Transplantation : A Single-Center Experience

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