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  • 1
    In: Clinical Transplantation, Wiley, Vol. 36, No. 7 ( 2022-07)
    Abstract: Organ Procurement and Transplantation Network (OPTN) implemented medical eligibility and safety‐net policy on 8/10/17 to optimize simultaneous liver‐kidney (SLK) utilization. We examined impact of this policy on SLK listings and number of kidneys used within 1‐yr. of receiving liver transplantation (LT) alone. Methods and results OPTN database (08/10/14‐06/12/20) on adults (N = 66 709) without previous transplant stratified candidates to listings for SLK or LT alone with pre‐LT renal dysfunction at listing (eGFR  〈  30 mL/min or on dialysis). Outcomes were compared for pre (08/10/14‐08/09/17) vs. post (08/10/17‐06/12/20) policy era. SLK listings decreased in post vs. pre policy era (8.7% vs. 9.6%; P   〈  .001), with 22% reduced odds of SLK listing in the postpolicy era, with a decrease in all OPTN regions except regions 6 and 8, which showed an increase. Among LT‐alone recipients with pre‐LT renal dysfunction (N = 3272), cumulative 1‐year probability was higher in post vs. prepolicy period for dialysis (5.6% vs. 2.3%; P   〈  .0001), KT listing (11.4% vs. 2.0%; P   〈  .0001), and KT (3.7% vs. .25%; P   〈  .0001). Sixty‐seven (2.4%) kidneys were saved in post policy era, with 18.1%, 16.6%, 4.3%, and 2.9% saving from regions 7, 2, 11, and 1, respectively. Conclusion Medical eligibility and safety‐net OPTN policy resulted in decreased SLK use and improved access to LT alone among those with pre‐LT renal dysfunction. Although decreased in postpolicy era, regional variation of SLK listings remains. In spite of increased use of KT within 1‐year of receiving LT alone under safety net, less number of kidneys were used without impact on patient survival in postpolicy era.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 2
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2022
    In:  Digestive Diseases and Sciences Vol. 67, No. 4 ( 2022-04), p. 1399-1408
    In: Digestive Diseases and Sciences, Springer Science and Business Media LLC, Vol. 67, No. 4 ( 2022-04), p. 1399-1408
    Type of Medium: Online Resource
    ISSN: 0163-2116 , 1573-2568
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2015102-0
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  • 3
    In: Blood, American Society of Hematology, Vol. 118, No. 21 ( 2011-11-18), p. 4696-4696
    Abstract: Abstract 4696 Combinations of busulfan (Bu) and low dose total body irradiation are commonly used in conditioning regimens for allogeneic stem cell transplant in acute myeloid leukemia (AML). In this study we tested the in vitro effect of physiologic doses of Bu and ionizing radiation (IR) to address the question whether additive or synergistic antileukemic activity can be demonstrated in two leukemic cell lines, one sensitive (HL60) and one resistant (K562) to radiation. Cells were treated for 24 hours with Bu at 0, 12.5, 25, 50, 100 or 200 μ g/ml, or IR at 1.5, 3 or 6 Gy, or a combination of both with 12.5 or 25 μ g/ml for 24 hours, followed by IR at 1.5 or 3Gy. Cells were then tested for proliferation by thymidine uptake, apoptosis by surface expression of annexin V and caspase 3, and in-vitro colony formation assays. Exposure to Bu or IR for 24, 48 and 72 hours induced a dose dependent inhibition of proliferation and colony formation in both cell lines. However, 3 or 6 Gy of IR were both very effective against HL60 cells whereas a significant increase in cytotoxicity in K562 cells was observed only by using 6Gy (p=0.008). In-vitro treatment with either Bu or IR caused apoptotic cell death mainly in HL60 cells, but in a very limited amount in K562 cells. To test the effect of the combination of Bu and IR we utilized a low dose of Bu for 24 hours with low doses of radiation. HL60 cells were strongly inhibited by both agents when separate or combined. In contrast, treatment of the relatively radio-resistant K562 cells with low dose IR (3Gy) alone inhibited colony formation by 28%. The inhibitory effect increased to 84% when combined with low dose Bu. In order to identify genes associated with a response to Bu, we formed a linear regression model controlled for cancer type and also leukemic cell lines using GI50 and Stanford cDNA array data from the NCI-60. Among 7 genes (p 〈 0.001 and FDR ∼50%) that were identified for all cancers, CLK-2 was also shown to correlate with response to Bu in leukemic cell lines (p=0.047). We then tested how these significant genes performed in the Affymetric U133 plus 2.0 platform. Six other genes (ERC2, HCLS1, CD74, KCNH2, HLADQB2, CD53) were significantly associated with response to Bu (p 〈 0.05). In conclusion, we demonstrated an additive effect of Bu and low dose IR even on radioresistant leukemic cells. These findings prompted the design of a clinical trial with IV Bu and marrow irradiation in the conditioning regimen prior to allogeneic stem cell transplant for acute leukemia. Expression of genes correlating with response to Bu may represent a novel biomarker to predict the outcome of leukemic patients undergoing stem cell transplant and could lead to a personalized anti-leukemic therapy with Bu. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2011
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 4870-4870
    Abstract: We have previously demonstrated that allogeneic blood T cells stimulate cord blood (CB) CD34+ cell differentiation into professional antigen presenting cells (APC) in-vitro and in-vivo (Abbasian J, Blood2006:108:203–208). In this study we immunomagnetically selected human CD4+CD25+ regulatory T cells (Tregs) and showed that 〉 80% of these cells were positive for FoxP3 intracellular expression. Then we tested whether Tregs may affect CB CD34+ cell clonogenic activity in-vitro an in-vivo, and if co-incubation of Tregs and CD34+ cells may modify the phenotype and function of Tregs. A colony-forming cells (CFU-C) assay performed with CD34+ cells mixed with allogeneic Tregs at 1:2 ratio resulted in comparable numbers of Granulocyte- Macrophage CFU (CFU-GM), burst-forming unit-erythroid (BFU-E) and CFU-Mix as compared to cultures with CD34+ cells alone (p=0.2, p=0.5 and p=0.5, respectively)(n=3 exps). Human CD34+ cells were co-transplanted with human CD4+CD25+ allogeneic Tregs into NOD/SCID mice at 1:1 and 1:2 ratio. After 6 weeks mice marrow was harvested and showed a 1.3±1.1% (n=3 mice) and 1.6±0.8% (n=4 mice) engraftment of huCD45+ cells, respectively, which was comparable to the engraftment observed in control animals transplanted with CD34+ cells alone (1.4±0.4). In addition, among the engrafted huCD45+ cells similar proportion of CD33+ myeloid cells, CD14+ monocytes and CD1c+ dendritic cells were observed in the three groups of animals. Mixed lymphocyte culture (MLC) experiments showed that irradiated CD34+ cells stimulated brisk proliferative responses of CD4+CD25- cells (S:R=1:2), but did not induce any proliferation of Tregs (n=3 exps). After incubation with CD34+ cells in the presence of IL2, on average 〉 80% CD4+CD25+ cells maintained the intracellular expression of FoxP3 and surface expression of CD62L and CD152 (n=3 exps). Then, Tregs autologous to CD34+ cells were isolated from the CB CD34- cell fraction while allogeneic Tregs were isolated from healthy individuals’ peripheral blood. When 2.5 x 104 autologous or allogeneic Tregs were added to an MLC with 2.5 x 104 irradiated CD34+ stimulator cells and allogeneic responders at 1:2 ratio, they suppressed T cell alloreactivity to CD34+ cells on average by 68±14% and 41±16%, respectively (n=3 exps). Our findings suggest that co-transplantation of CD34+ cells and autologous or allogeneic Tregs may allow normal stem cell engraftment while limiting T cell alloreactivity. These results will prompt the design of new strategies in allogeneic hematopoietic stem cell transplantation, particularly in an HLA incompatible setting.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 5
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 4271-4271
    Abstract: The aims of this study were to analyze the role of T cells on the engraftment of allogeneic CD34+ cells after transplantation in immunodeficient nonobese diabetic/ltsz-scid/scid (NOD/SCID) IL2 receptor gamma chain knockout (NSG) mice and to test the in-vivo ability of abatacept (CTLA4-Ig) in preventing graft failure. Human CD34+ cells (0.2x106 cells/animal) were co- transplanted with allogeneic CD3+ T cells into sublethally irradiated NSG mice at ratios ranging from 1:50 to 1:0.5, or without T cells as a control. The engraftment of huCD45+ cell subsets in the bone marrow and spleen was measured by flow cytometry after 4-8 weeks. An expansion of T cells without engraftment of CD34+ cells was detected in each group of mice transplanted with CD34:T cells at ratios ≥ 1:0.5. To test whether T cells prevented any engraftment of CD34+ cells, or caused rejection after initial CD34+ cell homing in the bone marrow, kinetics experiments were performed by analyzing the marrow and spleen of mice at 1,2 or 4 weeks after transplant of CD34+ and T cells at 1:1 ratio. These experiments showed that at two weeks after transplant, CD34+ cells had repopulated the bone marrow but not the spleen, while T cells were found primarily in the spleen. Instead, in mice sacrificed at 4 weeks after transplant the marrow and the spleen contained only T cells and the CD34+ cells had been rejected. Based on our previous in-vitro studies showing that CD34+ cell immunogenicity is mainly dependent on B7:CD28 costimulatory signaling, we then tested whether costimulatory blockade with abatacept (CTLA4-Ig, Bristol Myers Squibb) would block stem cell rejection. Three groups of mice were transplanted with CD34+ and allo-T cells at 1:1 ratio and injected with Abatacept at 250 ug i.p. every other day from: a) day -1 to +28, b) day -1 to day +14 or c) day +14 to +28, then the animals were sacrificed at day +56 (8 weeks) after transplant to assess the engraftment. In Group a) the overall engraftment of huCD45+ cells was only 〈 10%, but Abatacept completely prevented T cell-mediated stem cell rejection with 〉 98% huCD45+ cells of myeloid or B cell lineage and 〈 1% T cells in the marrow and spleen. In Group b) 70% of huCD45+ cells both in the marrow and spleen were T cells, and the remaining fraction of myeloid or B cells were derived from CD34+ cells. In Group c), instead, 100% of huCD45+ cells were T cells, with complete rejection of CD34+ cells. T cells recovered from the spleen of mice in groups b) and c) were also tested as responders in MLC stimulated with the original CD34+ cells and showed a brisk proliferation, consistent with lack of tolerance. Finally, another group of mice that received Abatacept from day -1 to + 28 was rechallenged with a boost of CD34+ cells on day +28 to test whether the low CD34+ cell engraftment was secondary to a latent rejection or partial stem cell exhaustion. The CD34+ cell boost resulted in a full hematopoietic recovery with 37% huCD45+CD3- cells, including myeloid and B cells, as well as CD34+ cells in the bone marrow and spleen. In this preclinical xenograft model we demonstrated that costimulatory blockade with Abatacept at the time of allogeneic transplant of human CD34+ cells can prevent T cell mediated rejection provide the basis for the future non-myeloablative protocols for incompatible stem cell transplantation. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 6
    Online Resource
    Online Resource
    American Society of Hematology ; 2016
    In:  Blood Vol. 128, No. 22 ( 2016-12-02), p. 3301-3301
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 3301-3301
    Abstract: High dose melphalan is commonly used in patients with multiple myeloma (MM). Resistance to melphalan has been linked to the ability to repair DNA damage. To test whether DNA repair inhibitors overcome resistance to melphalan and and also have a direct anti-MM effect, we tested MM cell lines RPMI8226 and U266 in-vitro and in-vivo, using a NOD/SCID/ gamma null (NSG) xenograft model. RPMI8226 and U266 cells were initially treated in-vitro with the PARP inhibitor ABT-888. Using a proliferative assay, myeloma cells appeared sensitive to ABT-888 with low GI50 values (8.7μM for RPMI8226 cells, 49μM for U266 cells) and increased γH2AX foci, which persisted at 24 hours after treatment. This was confirmed in methycellulose colony assay where ABT-888 treatment reduced RPMI8226 colonies by 35% (p=0.002). Next we showed synergistic cytotoxicity between ABT-888 and melphalan. In both RPMI8226 and U266 cells strong synergy was displayed with a combination index (CI) less than 1 in proliferative assays (CI 0.5 and 0.3 at 50% proliferation respectively). Combination ABT-888 and melphalan treated cells underwent accelerated senescence compared to cells treated by melphalan alone (27% versus 51% βGal+ staining at 24 hours, p=0.02). This was confirmed by upregulation of senescence related genes p16 (1.6 fold increase) and p21 (1.5 fold increase). We did not find significant difference in apoptosis by Annexin V/ PI staining. Given that increased non-homologous end joining (NHEJ) activity has been shown to lead to resistance to melphalan, we tested whether an inhibitor of NHEJ could be synergistic with PARP inhibition and melphalan. Treatment with the DNA-PK inhibitor NU7026 at 10μM in addition to ABT-888 at 4μM resulted in 46% reduction in proliferation in RPMI8226 cells and 52% in U266 cells. When used in combination with melphalan chemotherapy, the dual DNA repair inhibitor therapy showed marked synergy in RPMI8226 cells with a combination index of 0.39. Finally we tested the ability of the combination of ABT-888 and melphalan to treat myeloma in-vivo. NSG mice were injected via tail vein with 5x106 RPMI8226 cells. Control (untreated) mice subsequently developed myeloma infiltrating the marrow, spleen and axial skeleton, with hind limb paralysis occurring at a median of 42 days. Treated mice received intraperitoneal injections of ABT-888 (3 times a week), or melphalan (weekly) or a combination of both agents starting on day 28 post-injection of MM cells for a total of 3 weeks. Using ABT-888, melphalan and a combination of both agents, median survival of mice was progressively prolonged (44 vs. 67 vs. 107 days, respectively) (p=0.02). Here we show that PARP and DNA-PK inhibition synergizes with melphalan in myeloma cells lines, providing a rationale for the addition of these agents to conditioning chemotherapy. In addition, we also show a direct anti-myeloma activity of these agents without the use of alkylator chemotherapy. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 7
    Online Resource
    Online Resource
    Elsevier BV ; 2017
    In:  Biology of Blood and Marrow Transplantation Vol. 23, No. 3 ( 2017-03), p. S269-
    In: Biology of Blood and Marrow Transplantation, Elsevier BV, Vol. 23, No. 3 ( 2017-03), p. S269-
    Type of Medium: Online Resource
    ISSN: 1083-8791
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 3056525-X
    detail.hit.zdb_id: 2057605-5
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  • 8
    In: Biology of Blood and Marrow Transplantation, Elsevier BV, Vol. 20, No. 2 ( 2014-02), p. S244-S245
    Type of Medium: Online Resource
    ISSN: 1083-8791
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 3056525-X
    detail.hit.zdb_id: 2057605-5
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  • 9
    In: Biology of Blood and Marrow Transplantation, Elsevier BV, Vol. 23, No. 12 ( 2017-12), p. 2048-2056
    Type of Medium: Online Resource
    ISSN: 1083-8791
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 3056525-X
    detail.hit.zdb_id: 2057605-5
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  • 10
    In: Biology of Blood and Marrow Transplantation, Elsevier BV, Vol. 20, No. 12 ( 2014-12), p. 2034-2041
    Type of Medium: Online Resource
    ISSN: 1083-8791
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2014
    detail.hit.zdb_id: 3056525-X
    detail.hit.zdb_id: 2057605-5
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