Haematologica
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One of the most important potential advantages in the use of human umbilical cord blood (HUCB) for hematopoietic reconstitution after myeloablative therapy seems to be the lower occurrence of acute graft-versus-host-disease (GvHD) in recipients after allogeneic transplantation. Since mature T cells play an important role in GvHD pathogenesis, we tried to verify whether a different immunophenotypic pattern exists between HUCB and peripheral blood (PB) T cells. ⋯ In the present study we found significant difference between HUCB and adult PB lymphocytes in their immunophenotypic profile. In particular HUCB showed T lymphocytes that appeared to be phenotypically immature. Indeed, as a likely consequence of poor antigenic experience during pregnancy, the majority of HUCB cells were naive, expressing the RA isoform of the CD45 molecule. These findings could justify the previously reported reduced cord blood lymphocyte alloreactivity when allogeneic transplantation is performed and require further functional studies in order to confirm the impairment of HUCB immune system response to alloantigens.
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Comparative Study Clinical Trial
Allogeneic peripheral blood stem cell transplantation in patients with early-phase hematologic malignancy: a retrospective comparison of short-term outcome with bone marrow transplantation.
Transplantation of mobilized allogeneic peripheral blood stem cells (PBSC) has recently been reported by several groups. However, few patients receiving an allograft in the early stage of their disease have been described so far. ⋯ This retrospective comparison suggests that allogeneic PBSC transplantation performed in the early stage of the disease is safe and may be associated with a more rapid hematopoietic reconstitution than BMT, as well as lower transplant-related toxicity and earlier hospital discharge with apparently no increased risk of acute and chronic GVHD.
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The incidence of acute GVHD (aGVHD) in allogeneic peripheral blood progenitor cell transplantation (allo-PBPCT) seems to be similar to that seen in allogeneic bone marrow transplantation (allo-BMT). In contrast, some preliminary results suggest that the incidence of chronic GVHD (cGVHD) might be higher. The aim of the present study was to analyze the actuarial probability of developing cGVHD in allo-PBPCT, its clinical manifestations and response to treatment. ⋯ It would appear from this retrospective and multicenter study that, after a median follow-up of 12 months, cGVHD after allo-PBPCT could be more frequent than after allo-BMT. A randomized trial with a large number of patients and a sufficient follow-up will be necessary to answer this question definitively.
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Pulmonary embolism (PE), with an incidence of 23 per 100,000 patients per year, is a frequent clinical problem, responsible for 200,000 deaths each year in the United States. Pulmonary angiography, the gold standard for diagnosing PE, is invasive, costly and not universally available. Moreover, PE is confirmed in only approximately 30% of patients in whom it is suspected, rendering noninvasive screening tests necessary. Several strategies have been recently proposed to reduce the need for pulmonary angiography in the diagnostic workup of pulmonary embolism. The objective of this article is to analyze the individual performance of the new diagnostic instruments and their combination in rational diagnostic strategies. ⋯ Even though PE remains a difficult diagnostic challenge, the availability of novel noninvasive tests (plasma D-dimer and ultrasonography of the lower limbs) and the rehabilitation of clinical assessment allow a more rational and sparse prescription of pulmonary angiography. More work needs to be done to assess test performances and refine diagnostic strategies in distinct patient subgroups, particularly those hospitalized. Screening patients with plasma D-dimer and ultrasonography of the lower limbs may be the most cost-effective strategy, at least in outpatients.