Clinical Hematology International最新文献

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Conditioning Regimens for Frail Patients with Acute Leukemia Undergoing Allogeneic Stem Cell Transplant: How to Strike Gently. 接受同种异体干细胞移植的虚弱急性白血病患者的调理方案:如何轻击。
Clinical Hematology International Pub Date : 2021-08-19 eCollection Date: 2021-12-01 DOI: 10.2991/chi.k.210731.001
Francesco Saraceni, Ilaria Scortechini, Alessandro Fiorentini, Maria Vittoria Dubbini, Giorgia Mancini, Irene Federici, Francesca Romana Colaneri, Antonio Federico Lotito, Selene Guerzoni, Bruna Puglisi, Attilio Olivieri
{"title":"Conditioning Regimens for Frail Patients with Acute Leukemia Undergoing Allogeneic Stem Cell Transplant: How to Strike Gently.","authors":"Francesco Saraceni,&nbsp;Ilaria Scortechini,&nbsp;Alessandro Fiorentini,&nbsp;Maria Vittoria Dubbini,&nbsp;Giorgia Mancini,&nbsp;Irene Federici,&nbsp;Francesca Romana Colaneri,&nbsp;Antonio Federico Lotito,&nbsp;Selene Guerzoni,&nbsp;Bruna Puglisi,&nbsp;Attilio Olivieri","doi":"10.2991/chi.k.210731.001","DOIUrl":"https://doi.org/10.2991/chi.k.210731.001","url":null,"abstract":"<p><p>Despite the recent dramatic progress in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) therapy, allogeneic transplant remains a mainstay of treatment for patients with acute leukemia. The availability of novel compounds and low intensity chemotherapy regimens made it possible for a significant proportion of elderly and comorbid patients with AML or ALL to undergo curative treatment protocols. In addition, the expansion of donor availability and the recent dramatic progress in haploidentical stem cell transplant, allow the identification of an available donor for nearly every patient. Therefore, an increasing number of transplants are currently performed in elderly and frail patients with AML or ALL. However, allo-Hematopoietic stem cell transplant (HSCT) in this delicate setting represents an important challenge, especially regarding the selection of the conditioning protocol. Ideally, conditioning intensity should be reduced as much as possible; however, in patients with acute leukemia relapse remains the major cause of transplant failure. In this article we present modern tools to assess the patient health status before transplant, review the available data on the outcome of frail AML an ALL patients undergoing allo-HSCT, and discuss how preparatory regimens can be optimized in this setting.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a2/c2/CHI-3-4-153.PMC8690700.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39750574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 10
CD3/CD19 Depletion for T-cell Reduction of Allogeneic Transplants: Mostly Efficient, but not Robust. CD3/CD19去除t细胞减少的异体移植:大部分是有效的,但不是稳健的。
Clinical Hematology International Pub Date : 2021-08-02 eCollection Date: 2021-09-01 DOI: 10.2991/chi.k.210725.001
Eliza Wiercinska, Erhard Seifried, Halvard Bonig
{"title":"CD3/CD19 Depletion for T-cell Reduction of Allogeneic Transplants: Mostly Efficient, but not Robust.","authors":"Eliza Wiercinska,&nbsp;Erhard Seifried,&nbsp;Halvard Bonig","doi":"10.2991/chi.k.210725.001","DOIUrl":"https://doi.org/10.2991/chi.k.210725.001","url":null,"abstract":"<p><p>Aggressive T-cell depletion, <i>in vitro</i> or <i>in vivo</i>, is a prerequisite for survival of haplo-identical stem cell transplantation. The classical T-cell-depleted transplant, immunomagnetically enriched CD34+ cells, is very safe with respect to graft-versus-host reactivity, but associated with very high transplant-related and relapse mortality with an overall probability of survival of only 20%. Protocols for T- and B-cell depletion were therefore developed, reasoning that transplantation of the majority of Natural Killer (NK) cells and the substantial dose of residual T-cells might improve survival, which was, in principle, confirmed. Anecdotal reports of frequent failure to achieve adequate T-cell depletion prompted review of the aggregate data for transplant quality at our center. The first observation is the relative paucity of combined CD3/CD19 depletion processes as PTCy protocols have made inroads, 13 depletions in 8 years. Median T- and B-cell log-depletion were -3.89 and -1.92, respectively; instead of, CD34+ cell recovery was generally high (median 92%), as was NK-cell recovery (median 52%). However, the process failed to yield satisfactory T- and B-cell depletion in two out of 13 preparations, of which one product could be rescued by a second round of depletion, at the expense of CD34+ cell recovery. In our hands, the process is thus insufficiently robust for routine clinical use. Assuming similar observations in other centers, this may explain implementation of alternative protocols, such as TCR<i>αβ</i>/CD19 depletion or transplantation of unmanipulated grafts with subsequent <i>in vivo</i> depletion.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/f3/CHI-3-3-103.PMC8486974.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
High Sensitivity Troponin T and NT-proBNP in Patients Receiving Chimeric Antigen Receptor (CAR) T-Cell Therapy. 接受嵌合抗原受体 (CAR) T 细胞疗法患者的高敏肌钙蛋白 T 和 NT-proBNP.
Clinical Hematology International Pub Date : 2021-08-02 eCollection Date: 2021-09-01 DOI: 10.2991/chi.k.210718.001
Jiun-Ruey Hu, Ameet Patel, Shi Huang, Yan Ru Su, Kimberly B Dahlman, Kelsey Tomasek, Yueli Zhang, Richard T O'Neil, Jamye F O'Neal, Isik Turker, Douglas B Johnson, Joe-Elie Salem, Javid J Moslehi, Olalekan Oluwole
{"title":"High Sensitivity Troponin T and NT-proBNP in Patients Receiving Chimeric Antigen Receptor (CAR) T-Cell Therapy.","authors":"Jiun-Ruey Hu, Ameet Patel, Shi Huang, Yan Ru Su, Kimberly B Dahlman, Kelsey Tomasek, Yueli Zhang, Richard T O'Neil, Jamye F O'Neal, Isik Turker, Douglas B Johnson, Joe-Elie Salem, Javid J Moslehi, Olalekan Oluwole","doi":"10.2991/chi.k.210718.001","DOIUrl":"10.2991/chi.k.210718.001","url":null,"abstract":"<p><p>Retrospective studies suggest that chimeric antigen receptor T-cell (CAR T) therapy may lead to cardiac injury, but this has not been assessed systematically or prospectively. In this prospective study of 40 patients who received CAR T, we systematically measured high-sensitivity troponin T (hsTropT) and N-terminal pro-B natriuretic peptide (NTproBNP) at baseline and on day 1, days 7, and 21 after CAR T. Biomarker elevations with respect to timepoint and cytokine release syndrome (CRS) status were examined using repeated measure analysis of variance. hsTropT did not differ with time or with the presence of grade 2 CRS. Median hsTropT was 12.1 ng/L [interquartile range (IQR): 9.2, 20.1] at baseline, 13.1 ng/L (IQR: 9.6, 24.2) at day 1, 11.9 ng/L (IQR: 9.6, 18.0) at day 7, and 15.3 ng/L (10.8, 20.2) at day 21. In contrast, NTproBNP rose on day 1 (<i>P</i> <sub>Wilcox</sub> = 0.0002) and day 7 (<i>P</i> <sub>Wilcox</sub> = 2.7 × 10<sup>-5</sup>), and the degree of elevation differed by the presence of grade 2 CRS (<i>P</i> <sub>interaction</sub> = 0.002). Median NTproBNP was 179 pg/mL (IQR: 116, 325) at baseline, 357 pg/mL (IQR: 98, 813) at day 1, 420 pg/mL (IQR: 239, 1242) at day 7, and 177 pg/mL (IQR: 80, 278) at day 21. In conclusion, hsTropT l did not differ across timepoints after CAR T therapy, but NTproBNP rose at day 7, the prognostic implications of which should be the target of future research, as the indications for this therapy expand.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e5/b6/CHI-3-3-96.PMC8486972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
History of Acute Promyelocytic Leukemia. 急性早幼粒细胞白血病病史。
Clinical Hematology International Pub Date : 2021-07-19 eCollection Date: 2021-12-01 DOI: 10.2991/chi.k.210703.001
Miguel A Sanz, Eva Barragán
{"title":"History of Acute Promyelocytic Leukemia.","authors":"Miguel A Sanz,&nbsp;Eva Barragán","doi":"10.2991/chi.k.210703.001","DOIUrl":"https://doi.org/10.2991/chi.k.210703.001","url":null,"abstract":"<p><p>In this article, we discuss the history of acute promyelocytic leukemia (APL) from the pre-therapeutic era, which began after its recognition by Hillestad in 1947 as a nosological entity, to the present day. It is a paradigmatic history that has transformed the \"most malignant leukemia form\" into the most curable one. The identification of a balanced reciprocal translocation between chromosomes 15 and 17, resulting in fusion between the promyelocytic leukemia gene and the retinoic acid receptor alpha, has been crucial in understanding the mechanisms of leukemogenesis, and responsible for the peculiar response to targeted therapy with all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). We review the milestones that marked successive therapeutic advances, beginning with the introduction of the first successful chemotherapy in the early 1970s, followed by a subsequent incorporation of ATRA and ATO in the late 1980s and early 1990s which have revolutionized the treatment of this disease. Over the past two decades, treatment optimization has relied on the combination of ATRA, ATO, and chemotherapy according to risk-adapted approaches, which together with improvements in supportive therapy have paved the way for cure for most patients with APL.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/e0/CHI-3-4-142.PMC8690702.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39750573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
History and Development of Autologous Stem Cell Transplantation for Acute Myeloid Leukemia. 自体干细胞移植治疗急性髓细胞白血病的历史与发展。
Clinical Hematology International Pub Date : 2021-07-15 DOI: 10.2991/chi.k.210703.002
Norbert Claude Gorin
{"title":"History and Development of Autologous Stem Cell Transplantation for Acute Myeloid Leukemia.","authors":"Norbert Claude Gorin","doi":"10.2991/chi.k.210703.002","DOIUrl":"10.2991/chi.k.210703.002","url":null,"abstract":"<p><p>This review describes the development of cryopreservation, the birth of autologous stem cell transplantation (ASCT) and its past and present use to consolidate adult patients with acute myelogenous leukemia (AML). It summarizes the first autografts in patients in relapse, the experience of autografting in complete remission (CR), using bone marrow unpurged or purged <i>in vitro</i> with cyclophosphamide-derivatives, and the important shift to peripheral blood stem cells. The review also discusses the results of recent studies in favor of the use of ASCT to consolidate good- and intermediate-risk patients who reach CR with no detectable minimal residual disease, and those which support the inclusion of maintenance therapy post autograft with hypomethylating agents, anti-BCL-2, and, possibly, in the future, anti AML chimeric antigen receptor-T cells. Carefully applied to well-selected patients, ASCT may regain interest, because of its simplicity, its reduced toxicity, lower non-relapse mortality and better quality of life.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/c1/CHI-3-3-83.PMC8486970.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Achieving Complete Remission Prior to Allogeneic Stem Cell Transplantation on Progression-Free Survival in Hodgkin Lymphoma. 同种异体干细胞移植前完全缓解对霍奇金淋巴瘤无进展生存期的影响。
Clinical Hematology International Pub Date : 2021-07-15 eCollection Date: 2021-09-01 DOI: 10.2991/chi.k.210704.002
Nadira Duraković, Zinaida Perić, Sandra Bašić Kinda, Lana Desnica, Dino Dujmović, Ivo Radman Livaja, Ranka Serventi Seiwerth, Igor Aurer, Radovan Vrhovac
{"title":"The Impact of Achieving Complete Remission Prior to Allogeneic Stem Cell Transplantation on Progression-Free Survival in Hodgkin Lymphoma.","authors":"Nadira Duraković,&nbsp;Zinaida Perić,&nbsp;Sandra Bašić Kinda,&nbsp;Lana Desnica,&nbsp;Dino Dujmović,&nbsp;Ivo Radman Livaja,&nbsp;Ranka Serventi Seiwerth,&nbsp;Igor Aurer,&nbsp;Radovan Vrhovac","doi":"10.2991/chi.k.210704.002","DOIUrl":"https://doi.org/10.2991/chi.k.210704.002","url":null,"abstract":"Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a potential curative option for patients suffering from relapsed/ refractory (r/r) Hodgkin lymphoma (HL) after autologous stem cell transplantation (ASCT), offering a survival advantage over standard chemotherapy approaches [1]. However, two recently approved new drug treatments for r/r HL after ASCT [antiCD30 antibody-drug conjugate, brentuximab-vedotin (BV) and immune-checkpoint inhibitors (ICI)], demonstrated long-term disease control, with 38% and 16% of patients achieving complete response (CR), respectively [2]. These results have lately triggered much debate whether patients need to undergo alloHSCT at all after achieving response with BV or ICI [3,4].","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/34/CHI-3-3-116.PMC8486971.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39657246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Baseline Photos and Confident Annotation Improve Automated Detection of Cutaneous Graft-Versus-Host Disease. 基线照片和自信注释提高了皮肤移植物抗宿主病的自动检测。
Clinical Hematology International Pub Date : 2021-07-15 eCollection Date: 2021-09-01 DOI: 10.2991/chi.k.210704.001
Xiaoqi Liu, Kelsey Parks, Inga Saknite, Tahsin Reasat, Austin D Cronin, Lee E Wheless, Benoit M Dawant, Eric R Tkaczyk
{"title":"Baseline Photos and Confident Annotation Improve Automated Detection of Cutaneous Graft-Versus-Host Disease.","authors":"Xiaoqi Liu,&nbsp;Kelsey Parks,&nbsp;Inga Saknite,&nbsp;Tahsin Reasat,&nbsp;Austin D Cronin,&nbsp;Lee E Wheless,&nbsp;Benoit M Dawant,&nbsp;Eric R Tkaczyk","doi":"10.2991/chi.k.210704.001","DOIUrl":"https://doi.org/10.2991/chi.k.210704.001","url":null,"abstract":"<p><p>Cutaneous erythema is used in diagnosis and response assessment of cutaneous chronic graft-versus-host disease (cGVHD). The development of objective erythema evaluation methods remains a challenge. We used a pre-trained neural network to segment cGVHD erythema by detecting changes relative to a patient's registered baseline photo. We fixed this change detection algorithm on human annotations from a single photo pair, by using either a traditional approach or by marking definitely affected (\"Do Not Miss\", DNM) and definitely unaffected skin (\"Do Not Include\", DNI). The fixed algorithm was applied to each of the remaining 47 test photo pairs from six follow-up sessions of one patient. We used both the Dice index and the opinion of two board-certified dermatologists to evaluate the algorithm performance. The change detection algorithm correctly assigned 80% of the pixels, regardless of whether it was fixed on traditional (median accuracy: 0.77, interquartile range 0.62-0.87) or DNM/DNI segmentations (0.81, 0.65-0.89). When the algorithm was fixed on markings by different annotators, the DNM/DNI achieved more consistent outputs (median Dice indices: 0.94-0.96) than the traditional method (0.73-0.81). Compared to viewing only rash photos, the addition of baseline photos improved the reliability of dermatologists' scoring. The inter-rater intraclass correlation coefficient increased from 0.19 (95% confidence interval lower bound: 0.06) to 0.51 (lower bound: 0.35). In conclusion, a change detection algorithm accurately assigned erythema in longitudinal photos of cGVHD. The reliability was significantly improved by exclusively using confident human segmentations to fix the algorithm. Baseline photos improved the agreement among two dermatologists in assessing algorithm performance.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/48/14/CHI-3-3-108.PMC8486973.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Allogeneic Stem Cell Transplantation with a Novel Reduced Intensity Conditioning Regimen for the Treatment of Patients with Primary Cutaneous T-cell Lymphomas. 同种异体干细胞移植治疗原发性皮肤t细胞淋巴瘤的新型低强度调节方案。
Clinical Hematology International Pub Date : 2021-06-12 eCollection Date: 2021-06-01 DOI: 10.2991/chi.k.210529.001
Maria Stamouli, Konstantinos Gkirkas, Aggeliki Karagiannidi, Theodoros Iliakis, Spiros Chondropoulos, Thomas Thomopoulos, Vassiliki Nikolaou, Vassiliki Pappa, Evangelia Papadavid, Panagiotis Tsirigotis
{"title":"Allogeneic Stem Cell Transplantation with a Novel Reduced Intensity Conditioning Regimen for the Treatment of Patients with Primary Cutaneous T-cell Lymphomas.","authors":"Maria Stamouli,&nbsp;Konstantinos Gkirkas,&nbsp;Aggeliki Karagiannidi,&nbsp;Theodoros Iliakis,&nbsp;Spiros Chondropoulos,&nbsp;Thomas Thomopoulos,&nbsp;Vassiliki Nikolaou,&nbsp;Vassiliki Pappa,&nbsp;Evangelia Papadavid,&nbsp;Panagiotis Tsirigotis","doi":"10.2991/chi.k.210529.001","DOIUrl":"https://doi.org/10.2991/chi.k.210529.001","url":null,"abstract":"<p><p>The prognosis of patients with mycosis fungoides (MF) and Sezary Syndrome (SS) varies greatly, from near normal life expectancy in patients with early stage, to a median survival of less than 2 years for those diagnosed with advanced stage disease. Initial response to treatment is almost always followed by relapse and, finally, most of patients enter a phase of advanced multi-drug resistant disease with a short life expectancy after multiple lines of treatment. Allogeneic stem cell transplantation (allo-SCT) is usually limited to patients with advanced disease resistant to multiple treatments. Retrospective registry-based studies have shown increased Non-relapse Mortality (NRM) rates in patients with poor performance status, as well as in patients treated with myeloablative conditioning regimens. Another major limitation of allo-SCT is the increased relapse rate which occurs in nearly 50% of the cases, and is probably due to the fact that only heavily pretreated patients with advanced disease are referred for allo-SCT. Due to the paucity of data, the ideal conditioning regimen which will provide the maximum therapeutic benefit without the cost of increased NRM is not currently known. In this article we present our experience with a novel regimen in the treatment of patients with advanced MF/SS.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/3b/CHI-3-2-72.PMC8432398.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39475689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Passive Immunity Should and Will Work for COVID-19 for Some Patients. 被动免疫应该也将对某些患者的COVID-19起作用。
Clinical Hematology International Pub Date : 2021-04-16 eCollection Date: 2021-06-01 DOI: 10.2991/chi.k.210328.001
Nevio Cimolai
{"title":"Passive Immunity Should and Will Work for COVID-19 for Some Patients.","authors":"Nevio Cimolai","doi":"10.2991/chi.k.210328.001","DOIUrl":"10.2991/chi.k.210328.001","url":null,"abstract":"<p><p>In the absence of effective antiviral chemotherapy and still in the context of emerging vaccines for severe acute respiratory syndrome-CoV-2 infections, passive immunotherapy remains a key treatment and possible prevention strategy. What might initially be conceived as a simplified donor-recipient process, the intricacies of donor plasma, IV immunoglobulins, and monoclonal antibody modality applications are becoming more apparent. Key targets of such treatment have largely focused on virus neutralization and the specific viral components of the attachment Spike protein and its constituents (e.g., receptor binding domain, N-terminal domain). The cumulative laboratory and clinical experience suggests that beneficial protective and treatment outcomes are possible. Both a dose- and a time-dependency emerge. Lesser understood are the concepts of bioavailability and distribution. Apart from direct antigen binding from protective immunoglobulins, antibody effector functions have potential roles in outcome. In attempting to mimic the natural but variable response to infection or vaccination, a strong functional polyclonal approach attracts the potential benefits of attacking antigen diversity, high antibody avidity, antibody persistence, and protection against escape viral mutation. The availability and ease of administration for any passive immunotherapy product must be considered in the current climate of need. There is never a perfect product, but yet there is considerable room for improving patient outcomes. Given the variability of human genetics, immunity, and disease, and given the nuances of the virus and its potential for change, passive immunotherapy can be developed that will be effective for some but not all patients. An understanding of such patient variability and limitations is just as important as the understanding of the direct interactions between immunotherapy and virus.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/a7/CHI-3-2-47.PMC8432400.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39475691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Therapeutic Use of Convalescent Plasma in COVID-19 Infected Patients with Concomitant Hematological Disorders. 恢复期血浆在新冠肺炎合并血液病患者中的治疗应用
Clinical Hematology International Pub Date : 2021-04-16 eCollection Date: 2021-09-01 DOI: 10.2991/chi.k.210403.001
Francesco Lanza, Vanessa Agostini, Federica Monaco, Francesco Passamonti, Jerard Seghatchian
{"title":"Therapeutic Use of Convalescent Plasma in COVID-19 Infected Patients with Concomitant Hematological Disorders.","authors":"Francesco Lanza,&nbsp;Vanessa Agostini,&nbsp;Federica Monaco,&nbsp;Francesco Passamonti,&nbsp;Jerard Seghatchian","doi":"10.2991/chi.k.210403.001","DOIUrl":"https://doi.org/10.2991/chi.k.210403.001","url":null,"abstract":"<p><p>The use of convalescent plasma (CP) from individuals recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a promising therapeutic modality for the coronavirus disease 2019 (COVID-19). CP has been in use for at least a century to provide passive immunity against a number of diseases, and was recently proposed by the World Health Organization for human Ebola virus infection. Only a few small studies have so far been published on patients with COVID-19 and concomitant hematological malignancies (HM). The Italian Hematology Alliance on HM and COVID-19 has found that HM patients with COVID-19 clinically perform more poorly than those with either HM or COVID-19 alone. A COVID-19 infection in patients with B-cell lymphoma is associated with impaired generation of neutralizing antibody titers and lowered clearance of SARS-CoV-2. Treatment with CP was seen to increase antibody titers in all patients and to improve clinical response in 80% of patients examined. However, a recent study has reported impaired production of SARS-CoV-2-neutralizing antibodies in an immunosuppressed individual treated with CP, possibly supporting the notion of virus escape, particularly in immunocompromised individuals where prolonged viral replication occurs. This may limit the efficacy of CP treatment in at least some HM patients. More recently, it has been shown that CP may provide a neutralising effect against B.1.1.7 and other SARS-CoV-2 variants, thus expanding its application in clinical practice. More extensive studies are needed to further assess the use of CP in COVID-19-infected HM patients.</p>","PeriodicalId":10368,"journal":{"name":"Clinical Hematology International","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/a6/CHI-3-3-77.PMC8486975.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
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