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Hematopoietic cell transplantation (HCT) uses cytotoxic chemotherapy and/or radiation followed by intravenous infusion of stem cells to cure malignancies, bone marrow failure and inborn errors of immunity, hemoglobin and metabolism. Lung injury is a known complication of the process, due in part to disruption in the pulmonary microenvironment by insults such as infection, alloreactive inflammation and cellular toxicity. How microorganisms, immunity and the respiratory epithelium interact to contribute to lung injury is uncertain, limiting the development of prevention and treatment strategies. Here we used 278 bronchoalveolar lavage (BAL) fluid samples to study the lung microenvironment in 229 pediatric patients who have undergone HCT treated at 32 childrens hospitals between 2014 and 2022. By leveraging paired microbiome and human gene expression data, we identified high-risk BAL compositions associated with in-hospital mortality (P = 0.007). Disadvantageous profiles included bacterial overgrowth with neutrophilic inflammation, microbiome contraction with epithelial fibroproliferation and profound commensal depletion with viral and staphylococcal enrichment, lymphocytic activation and cellular injury, and were replicated in an independent cohort from the Netherlands (P = 0.022). In addition, a broad array of previously occult pathogens was identified, as well as a strong link between antibiotic exposure, commensal bacterial depletion and enrichment of viruses and fungi. Together these lung-immune system-microorganism interactions clarify the important drivers of fatal lung injury in pediatric patients who have undergone HCT. Further investigation is needed to determine how personalized interpretation of heterogeneous pulmonary microenvironments may be used to improve pediatric HCT outcomes.

PurposeUltrahigh resolution (UHR) HLA matching is reported to result in better outcomes following unrelated donor hematopoietic cell transplantation, improving survival and reducing post-transplant complications. However, most studies included relatively small numbers of patients. Here we report the findings from a large, multicenter validation study.MethodsUHR HLA typing was available on 5,140 conventionally 10 out of 10 HLA-matched patients with malignant disease transplanted between 2008 and 2017.ResultsAfter UHR HLA typing, 82% of pairs remained 10 out of 10 UHR-matched; 12.3% of patients were 12 out of 12 UHR HLA-matched. Compared with 12 out of 12 UHR-matched patients, probabilities of grade 2-4 acute graft-versus-host disease (aGVHD) were significantly increased with UHR mismatches (overall P = .0019) and in those patients who were HLA-DPB1 T-cell epitope permissively mismatched or nonpermissively mismatched (overall P = .0011). In the T-cell-depleted subset, the degree of UHR HLA mismatch was only associated with increased transplant-related mortality (TRM) (overall P = .0068). In the T-cell-replete subset, UHR HLA matching was associated with a lower probability of aGVHD (overall P = .0020); 12 out of 12 UHR matching was associated with reduced TRM risk when compared with HLA-DPB1 T-cell epitope permissively mismatched patients, whereas nonpermissive mismatching resulted in a greater risk (overall P = .0003).ConclusionThis study did not confirm that UHR 12 out of 12 HLA matching increases the probability of overall survival but does demonstrate that aGVHD risk, and in certain settings TRM, is lowest in UHR HLA-matched pairs and thus warrants consideration when multiple 10 out of 10 HLA-matched donors of equivalent age are available.

Limited data exist on characteristics of central nervous system viruses (CNS-V) in allogeneic hematopoietic stem cell transplant (HCT) recipients. Between 2007 and 2015, the Center for International Blood and Marrow Transplant Research (CIBMTR) received information on 27,532 patients undergoing HCT. Of these, centers reported 165 HCT recipients with CNS-V detected in cerebrospinal fluid within 6 months after HCT. CNS viruses predominantly included human herpes virus 6 (HHV-6) (73%), followed by Epstein-Barr Virus (10%), cytomegalovirus (3%), varicella zoster virus (3%), herpes simplex virus (3%) and Adenovirus (3%). Median time of viral detection in CNS was 31 days after HCT; and viral detection was earlier in patients with CNS HHV-6. Concurrent viremia occurred in 52% of patients. Cord blood transplant recipients (CBT) accounted for the majority (53%) of patients with CNS-V. Myeloablative conditioning (65%), use of fludarabine (63%), or use of anti-thymocyte globulin (61%) were also predominant. Overall survival from the time of detection of CNS-V was 50% at 6 months and 30% at 5 years. Infections were the leading cause of death (32%). In summary, CBT recipients predominated in the population with CNS-V. Outcomes after CNS-V were poor with significant mortality seen in the first 6 months.

Data are limited on whether to adjust high-dose chemotherapy before autologous hematopoietic cell transplant (autoHCT) in obese patients. This study explores the effects of dose adjustment on the outcomes of obese patients, defined as body mass index (BMI) ≥ 30 kg/m2. Dose adjustment was defined as a reduction in standard dosing ≥20%, based on ideal, reported dosing and actual weights. We included 2 groups of US patients who had received autoHCT between 2008 and 2014. Specifically, we included patients with multiple myeloma (MM, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 781) who received carmustine, etoposide, cytarabine, and melphalan conditioning. Chemotherapy dose was adjusted in 1324 patients (78%) with MM and 608 patients (78%) with lymphoma. Age, sex, BMI, race, performance score, comorbidity index, and disease features (stage at diagnosis, disease status, and time to transplant) were similar between dose groups. In multivariate analyses for MM, adjusting for melphalan dose and for center effect had no impact on overall survival (P = .894) and treatment-related mortality (TRM) (P = .62), progression (P = .12), and progression-free survival (PFS; P = .178). In multivariate analyses for lymphoma, adjusting chemotherapy doses did not affect survival (P = .176), TRM (P = .802), relapse (P = .633), or PFS (P = .812). No center effect was observed in lymphoma. This study demonstrates that adjusting chemotherapy dose before autoHCT in obese patients with MM and lymphoma does not influence mortality. These results do not support adjusting chemotherapy dose in this population.

In the current work, a series of flexible polymer matrix composites (PMCs) based on poly(vinylidene fluoride‐hexafluoropropylene) (PVDF‐HFP) as the polymer matrix and carbon nanofillers, namely single‐walled nanotubes (SWCNT) or carbon blacks (CB), were fabricated via a facile preparation method of blending and solution casting. The electrical conductivity, morphology, dielectric constant, mechanics, and electromagnetic interference (EMI) shielding properties of the composite films were adjusted by varying the carbon type (CB = Ketjenblack, Vulcan, or SWCNT = Tuball) and amount (0.1–15 wt%). The influence of the conductive nanofillers on the EMI shielding effectiveness (SE) and microwave absorbing properties in the X‐band frequency range (8–12 GHz) were investigated. By increasing the carbon content, the EMI shielding properties of the composite films were improved due to an increase in the magnitude of the electromagnetic properties. As the loading of these carbon fillers approach the percolation threshold, the dielectric constant of the composite can dramatically increase because of the construction of a microcapacitor network. However, these nanofillers/polymer composites generally have high dielectric loss near the percolation threshold due to the direct connection between carbon nanofillers. The PVDF‐HFP/Tuball composite particularly contributed low dielectric loss to the electromagnetic (EM) wave, resulting in excellent microwave absorption properties with a SE per unit thickness of 337.5 dB/mm and 2.5× less weight compared with conventional aluminum with the same SE, demonstrating the promise of using these materials as practical EMI shields. [ABSTRACT FROM AUTHOR]

Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P

Abstract: The limits of metal cation substitution and distribution in the sequence Bi2Fe4O9–Bi2Mn4O10 have been investigated by solid state synthesis, X-ray powder diffraction, and Mössbauer spectroscopy. Rietveld refinements conducted for the entire range along the join indicate the structures are orthorhombic with space group Pbam, with partial transition-metal site disorder confirmed and detailed by Mössbauer spectroscopy. Single-phase regions are found near each end-member and a two-phase region is observed at intermediate compositions, extending from about x=1 to 3, according to the general formula of the mixed crystals Bi2Fe4−x Mn x O10−δ . An incorporation of Mn at octahedral sites replacing Fe is taken into account for the Bi2Fe4O9-related side of the system. Charge compensation is believed to be effected by addition of O, which gives rise to the formation of FeO5 pyramids. At the Bi2Mn4O10-related side of the system, substitution of pyramidal Mn3+ by Fe3+ is envisaged. [Copyright &y& Elsevier]

Abstract: Impedance spectroscopy measurements, in the temperature range from room temperature to 600K, were performed in order to investigate the dielectric and ionic properties of Bi2Sn2O7 ceramics. The results show that the conductivity in this pyrochlore is associated with the hopping of ions. An activation energy of 1.26eV was observed and the dielectric constant exhibits a strong contribution from ionic conduction. [Copyright &y& Elsevier]

Abstract: The Bi2Sn2O7 pyrochlore is known to undergo a sequence of structural phase transitions with an increase in temperature. Raman spectroscopy was employed in the investigation of the temperature dependence of the active phonons in the Raman spectrum. We observed 19 broad modes at room temperature, reflecting the low symmetry of the α-phase of Bi2Sn2O7. The modes were discussed in relation to the Raman spectra of other pyrochlore-based oxides. The temperature dependence of the phonons evidences the α→β structural phase transition observed near 127°C. [Copyright &y& Elsevier]

The dawn of the 21st century has brought with it an increasing interest in emulating the adaptive finesse of natural systems by designing materials with on-demand, tunable properties. The creation of such responsive systems could be expected, based on historical precedent, to lead to completely new engineering design paradigms. Using a bioinspired approach of coupling multiple equilibria that operate on different length scales, a material whose bulk mechanical properties can be manipulated by electrical input has been developed. The new macroscale electroplastic elastomer hydrogels can be reversibly cycled through soft and hard states while maintaining a three-dimensional shape by sequential application of oxidative and reductive potentials. This input changes the cross-linking capacity of iron ions within the gel matrix, between a poorly coordinating +2 and a more strongly binding +3 oxidation state. Inclusion of carbon nanotubes in the hydrogel preparation increases conductivity and decreases transition time.