EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest...
Transcript of EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest...
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#EBMT18
EBMT MED-B AllograftJakob R Passweg
No conflicts of interest
Lisboa 20.3.18
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SerologyAntibodies against an infectious agent
measures the defense mounted against this agent
Antigens by antigen detection measures presence of immunologically detectable parts of the agent
by molecular biology = PCR = measures the presence of genes of the virus = viral replication
Why do we want to know this?
Some viruses stay in the body foreverEven if they do not cause disease prior to HSCT= latent viruses (herpes virus family)These viruses may reactivate
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Comorbidity Index
= cumulative number of co-morbidities
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HLA-A2
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Ap Am
Bm
Bp
Cp
Cm
DRB1m
DRB1p
DQm
DQp
DPm
DPp
HLA class I
HLA class II
(DRB3p ou m)[ ]
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A-B-
DR-
-A-B-DR
A-B-
DR-
-A-B-DR
patienthaploidentical genotypicallyidentical
prob= 1 – (0.75 # sibs-1)
Sibs Chance (%)
0 0
1 25
2 43
3 58
4 68
5 76
6 82
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HLA a does not recognize the pathogen
HLA b recognizes the pathogen
HLA a
HLA b
population dies
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Let‘s assumeunrelated donor
patient:A: 0101 0201B: 1501 3502DRB1: 0401 0302
donor:A: 0101 0201B: 1501 3502DRB1: 0404 0302
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Is this a haplo or not?
Patient
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Negative selectionRemove cells
Positive selectionSelect for stem cells
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3.0 X
4.0 X
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Conditioning Intensity
Maxi Midi Mini
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• Myeloablative
• Reduced Intensity
• Non myeloablative
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If you cannot agree on conditioning Intensity:List the drugs and the doses
Conditioning
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TBI
12 Gy 6 3
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Standards:CSA + MTXCSA + MMF
TAC + MTXTAC + MMF
+- ATG
posttransplant Cyclophosphamide
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Cause of Death
ToxicityRelapseGvHDInfection
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Variable number tandem repeats or short tandem repeats
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• The patient and the donor
the patient the donor
What happenedAfter the transplant?
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Time to GvHDOnset =Cumulative Incidence
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Safety and Feasibility of Administration of High Doses of Ex Vivo Expanded NK Cells for Prevention of Disease Relapse after Transplantation for Patients with Myeloid Malignancies - Final Results of a Phase I Clinical TrialStefan O. Ciurea, MD, The University of Texas MD Anderson Cancer Center
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NEJM Original Article Ipilimumab for Patients with
Relapse after Allogeneic Transplantation
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The many facets of cGvHD
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Diagnosis MRD
34++CD56+:0.01% of
TNC
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Thank you for your hard work