3 results on '"Maharaj, Dipnarine"'
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2. Unrelated donor allogeneic transplantation after failure of autologous transplantation for acute myelogenous leukemia: a study from the center for international blood and marrow transplantation research.
- Author
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Foran JM, Pavletic SZ, Logan BR, Agovi-Johnson MA, Pérez WS, Bolwell BJ, Bornhäuser M, Bredeson CN, Cairo MS, Camitta BM, Copelan EA, Dehn J, Gale RP, George B, Gupta V, Hale GA, Lazarus HM, Litzow MR, Maharaj D, Marks DI, Martino R, Maziarz RT, Rowe JM, Rowlings PA, Savani BN, Savoie ML, Szer J, Waller EK, Wiernik PH, and Weisdorf DJ
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Follow-Up Studies, Graft vs Host Disease immunology, Graft vs Host Disease mortality, Graft vs Host Disease pathology, Humans, Infant, International Cooperation, Leukemia, Myeloid, Acute immunology, Leukemia, Myeloid, Acute mortality, Leukemia, Myeloid, Acute pathology, Male, Middle Aged, Recurrence, Survival Analysis, Transplantation, Autologous, Transplantation, Homologous, Unrelated Donors, Antineoplastic Agents therapeutic use, Graft vs Host Disease prevention & control, Hematopoietic Stem Cell Transplantation methods, Leukemia, Myeloid, Acute therapy, Transplantation Conditioning
- Abstract
The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n = 242) or reduced-intensity conditioning (RIC; n = 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P = .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P = .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P = .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed., (Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
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3. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation
- Author
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Shahrukh K. Hashmi, Jean A. Yared, Arthur Flatau, Sunita Nathan, Yoshihiro Inamoto, Dipnarine Maharaj, Bipin N. Savani, Lana Desnica Grkovic, André Tichelli, Mahmoud Aljurf, Stephanie M. Smith, Rachel Phelan, Hélène Schoemans, Richard J. Ross, Lauren M. Walker, Robert Peter Gale, Zachariah DeFilipp, Daniel Wolff, Karen C. Baker, Hesham Eissa, Sherif M. Badawy, Hermann Einsele, Alicia Rovó, Isabel Sanchez-Ortega, Maria Teresa Lupo-Stanghellini, Douglas Tremblay, Michael L. Eisenberg, Hildegard T. Greinix, Hemant S. Murthy, Annie Im, Amir Steinberg, Grzegorz W. Basak, Peiman Hematti, Tal Schechter, Andrea Salonia, David Buchbinder, Elizabeth M. Suelzer, Vaibhav Agrawal, Steven Pavletic, Kareem Jamani, John Murray, Seema Naik, Ami J. Shah, Sarah C. Vij, Akshay Sharma, Rebecca Hunter, Zinaida Peric, Narendranath Epperla, Linda J. Burns, Ajoy Dias, Nosha Farhadfar, Pinki Prasad, John A. Snowden, Betty K. Hamilton, D. Pulanić, Phelan, Rachel, Im, Annie, Hunter, Rebecca L, Inamoto, Yoshihiro, Lupo-Stanghellini, Maria Teresa, Rovo, Alicia, Badawy, Sherif M, Burns, Linda, Eissa, Hesham, Murthy, Hemant S, Prasad, Pinki, Sharma, Akshay, Suelzer, Elizabeth, Agrawal, Vaibhav, Aljurf, Mahmoud, Baker, Karen, Basak, Grzegorz W, Buchbinder, David, Defilipp, Zachariah, Grkovic, Lana Desnica, Dias, Ajoy, Einsele, Hermann, Eisenberg, Michael L, Epperla, Narendranath, Farhadfar, Nosha, Flatau, Arthur, Gale, Robert Peter, Greinix, Hildegard, Hamilton, Betty K, Hashmi, Shahrukh, Hematti, Peiman, Jamani, Kareem, Maharaj, Dipnarine, Murray, John, Naik, Seema, Nathan, Sunita, Pavletic, Steven, Peric, Zinaida, Pulanic, Drazen, Ross, Richard, Salonia, Andrea, Sanchez-Ortega, Isabel, Savani, Bipin N, Schechter, Tal, Shah, Ami J, Smith, Stephanie M, Snowden, John A, Steinberg, Amir, Tremblay, Dougla, Vij, Sarah C, Walker, Lauren, Wolff, Daniel, Yared, Jean A, Schoemans, Hélène, and Tichelli, André
- Subjects
Adult ,Male ,Infertility ,medicine.medical_specialty ,Evidence-based practice ,Sexual Dysfunction ,Survivorship ,Late effects ,Male-specific ,Hematopoietic cell transplantation ,Genital ,Chronic graft-versus-host disease ,Hypogonadism ,Sexual dysfunction ,Subsequent malignancies ,Population ,Graft vs Host Disease ,610 Medicine & health ,Disease ,Article ,Testicular Neoplasms ,Quality of life ,Bone Marrow ,medicine ,Humans ,Immunology and Allergy ,Hematopoietic Cell Transplantation ,Intensive care medicine ,education ,Late Effects ,Reproductive health ,education.field_of_study ,Subsequent Malignancies ,Transplantation ,business.industry ,Male-Specific ,Hematopoietic Stem Cell Transplantation ,Cell Biology ,Hematology ,medicine.disease ,Transplant Recipients ,surgical procedures, operative ,Genital Chronic Graft-versus-Host Disease ,Disease Progression ,Quality of Life ,Molecular Medicine ,Female ,medicine.symptom ,business - Abstract
Background : Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies, such as prostate, penile, and testicular cancer. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. Objective : Here, we provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Study Design : We utilized systematic review methodology to summarize incidence, risk factors, screening, prevention and treatment of these complications and provide consensus evidence-based recommendations for clinical practice and future research. Results : Most of the evidence regarding male GvHD is still based on limited data, precluding strong therapeutic recommendations. We therefore recommend to systematically screen for male genital GvHD regularly and report it to large registries to allow for a better understanding. Future research should also address treatment since little published evidence is available to date. Male-specific endocrine consequences of HCT include hypogonadism which may also affect bone health. Since the evidence is scarce, current recommendations for hormone substitution and/or bone health treatment are based on similar principles as for the general population. Following HCT, sexual health decreases and this topic should be addressed at regular intervals. Future studies should focus on interventional strategies to address sexual dysfunction. Infertility remains prevalent in patients having undergone myeloablative conditioning, which warrants offering sperm preservation in all HCT candidates. Most studies on fertility rely on descriptive registry analysis and surveys, hence the importance of reporting post-HCT conception data to large registries. Although the quality of evidence is low, the development of cancer in male genital organs does not seem more prevalent than in the general population; however, subsequent malignancies in general seem to be more prevalent in males than females, and special attention should be given to skin and oral mucosa. Conclusion : Male-specific late effects, probably more under-reported than female-specific complications, should be systematically considered during the regular follow-up visits of male survivors who have undergone HCT. Care of patients with male-specific late effects warrants close collaboration between transplant physicians and specialists from other involved disciplines. Future research should be directed towards better data collection on male-specific late effects and on studies about the interrelationship between these late effects, to allow the development of evidence based effective management practices.
- Published
- 2022
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