بایگانی برچسب برای: Transplantation

Sickle.Cell.Disease.and.Hematopoietic.Stem.[taliem.ir]

Sickle Cell Disease and Hematopoietic Stem Cell Transplantation

SCD is the quintessential chronic disease of childhood, manifesting signifcant clinical sequelae despite a defned molecular origin. Children and adults with SCD are anemic, make frequent emergency department visits, and are often hospitalized for pain and acute complications associated with progressive organ damage. Mortality for patients with SCD in high-income countries is shifting from infectious and cerebrovascular complications in childhood to progressive multisystem organ failure (MSOF) in adulthood . An expanding population of adults with SCD, the happy result of decades of improved pediatric care, is facing the multifaceted consequences of decades of chronic and cumulative vascular damage. However, there is new hope for treating people with SCD. Hydroxyurea (HU) modulates many complications of SCD, and hematopoietic stem cell transplant (HSCT) is curative. Gene therapies and genome editing (of the gene itself or disease-modifying genes) are transforming prospects for curative therapy in single-gene disorders like SCD . In this setting, clinicians, patients, and their families are increasingly challenged by the complicated therapeutic risk-beneft analyses for a disease that may be mild in children but can cause relentless morbidity and early mortality in adults . Figure 1.1 provides an overview of major milestones in SCD since its recognition as a pathobiologically distinct hemolytic anemia in the early decades of the last century.
Patient.Safety.and.Quality.in.Pediatric.Hematology.[taliem.ir]

Patient Safety and Quality in Pediatric Hematology/ Oncology and Stem Cell Transplantation

A family takes their 4-year-old girl into the hospital for concerns of new bruising and lower extremity pain. The child has been symptomatic for a few weeks, but the symptoms signifcantly worsened over the past few days. The parents anxiously wait for the lab results to return, not knowing what to expect. The emergency room physician enters the room with a solemn face and explains that their child likely has leukemia and would need to be admitted to the hospital. The words hang in the air, “your child has cancer.” The parents do not yet know the massive lifestyle change in store for them. They do not realize the amount of time they will spend in the clinic, in the inpatient unit, and in a waiting room while their child undergoes yet another procedure. They do not know, at this time, the number of medications their child will take on a daily basis for the next several years and how easy it will be to confuse these complicated-sounding medications. There are many long days and sleepless nights ahead for them, but they will do it. They will give their complete trust to the physicians, nurses, pharmacists, and hospital staff to care for their girl.
Clinical.Guide.to.Heart.Transplantation.[taliem.ir]

Clinical Guide to Heart Transplantation

In modern times, heart failure has increasingly become a major public health issue, with a prevalence of approximately 5.1 million in North America . Furthermore, one in 7 Americans are age 65 or greater, with this proportion set to rise to one in 5 by 2050 . Given the agedependent increase in incidence and prevalence of heart failure, the proportion of heart failure will only continue to increase; already, it is one of the main causes of death and hospitalization in this age group. Combined with demographic improvements in life expectancies and recent improvements in the treatment of heart-failure, the proportion of patients that develop advanced heart failure has also increased substantially. The majority of patients with so-called “end-stage” heart failure are characterized by advanced structural heart disease and profound symptoms of heart failure at rest or upon minimal exertion despite maximal guideline-directed medical treatment, and typically fall into stage D of the ABCD classifcation of the American College of Cardiology (ACC)/American Heart Association (AHA), and class III–IV of the New York Heart Association (NYHA) functional classifcation (see Table 1.2 for a full explanation of heart failure classifcations). There are varying etiologies of such severe heart failure, which can broadly be divided into ischemic and non-ischemic; these may include unstable arrhythmias, idiopathic cardiomyopathies and many others. Regardless of the etiology, the subgroup of stage D heart failure demonstrates a particularly high 5-year mortality rate of 80%.
Haploidentical ,Stem Cell ,Transplantation[taliem.ir]

Haploidentical Stem Cell Transplantation

Recognition of human leucocyte antigen (HLA) incompatibilities by the immune system represents a major barrier to allogeneic stem cell transplantation (allo-SCT). Compatibility between donor and recipient at the HLA-A, -B, -C, -DRB1 and -DQB1 level is therefore an important predictor of success of allo-SCT. Therefore, use of an HLA genotypically identical sibling donor is the gold standard for alloSCT. However, given the 25% chance that any sibling is fully HLA-matched to the patient and the generally small family sizes in developed country, the probability to identify a fully HLA-matched sibling donor is at best 30%. For others patients, alternative source of donor graft include suitable HLA-matched adult unrelated donors, umbilical cord blood and HLA-haploidentical related donors. The choice of the donor source depends mainly upon the clinical situation and of the practices of each transplant center.