Journal of Clinical Apheresis最新文献_第4页

Immunogenicity of SARS-CoV-2 vaccines in patients treated with chronic double filtration plasmapheresis 慢性双滤过血浆置换术患者接种 SARS-CoV-2 疫苗的免疫原性。

IF 1.4 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-26 DOI: 10.1002/jca.22136

Emilie Pambrun, Paul Loubet, Thomas Fourneron, Olivier Moranne

Background

The impact of chronic therapeutic plasmapheresis on humoral response following COVID-19 vaccination is poorly documented, especially among patients treated with double filtration plasmapheresis (DFPP).

Objectives

This retrospective single-center study evaluated the humoral response after SARS-CoV-2 vaccination and studied anti-SPIKE seropositivity and antibody dynamics in patients with chronic DFPP at our institution.

Method

All patients undergoing chronic DFPP at a tertiary center in France from December 2020 to November 2022 were included. We defined one patient subgroup as Group 1 to evaluate anti-SPIKE seropositivity after vaccination, with three groups based on their anti-SPIKE titers: (Group 1A) nonresponders (<0.8 UI/mL), (Group 1B) weak responders (0.8 to <250 binding antibody unit [BAU]/mL), and (Group 1C) strong responders (>250 BAU/mL). Group 2 served to evaluate antibody dynamics with anti-SPIKE levels measured 3 months after initial vaccination, Group 2A having a sustained level and Group 2B a declining pattern.

Results

The 21 patients included had a median age of 63 years, and 13 (56%) were male. The indications for chronic DFPP mainly included dysimmune pathologies (15; 71%) and familial dyslipidemia (6; 29%). For the humoral response to vaccination in Patient Group 1, the only nonresponder was a patient who had undergone kidney transplantation 30 months earlier and was on immunosuppressive medication. For Patient Group 2, the median follow-up of antibody titers was 13 months [12–13]. Two distinct patterns of anti-SPIKE dynamics were observed: a rapid decline in anti-SPIKE antibody titers within 6 months following the initial vaccination or booster dose (n = 10 [71.4%] Group 2A) and stable anti-SPIKE levels above 250 BAU/mL over >6 months (n = 4 [28.6%] Group 2B) with more patients with familial dyslipidemia in the former.

Conclusions

Humoral response to SARS-CoV-2 vaccination appears robust in patients undergoing chronic DFPP and may be linked to patients' immune status rather than DFPTP itself. Our results support current recommendations for administering three doses of vaccine with a booster every 6 months.

背景：慢性治疗性浆细胞分离对接种COVID-19疫苗后体液反应的影响鲜有记载，尤其是在接受双滤过性浆细胞分离（DFPP）治疗的患者中：这项回顾性单中心研究评估了我院慢性 DFPP 患者接种 SARS-CoV-2 疫苗后的体液反应，并研究了抗 SIKE 血清阳性率和抗体动态：纳入 2020 年 12 月至 2022 年 11 月期间在法国一家三级中心接受慢性 DFPP 的所有患者。我们将一个患者亚组定义为第1组，以评估接种疫苗后抗SPIKE血清阳性率，根据抗SPIKE滴度分为三组：（第1A组）无应答者（250 BAU/mL）。第 2 组用于评估抗体动态，在首次接种疫苗 3 个月后测量抗SPIKE 水平，第 2A 组具有持续水平，而第 2B 组则呈下降趋势：结果：21 名患者的中位年龄为 63 岁，其中 13 人（56%）为男性。慢性 DFPP 的适应症主要包括免疫障碍性疾病（15 例，占 71%）和家族性血脂异常（6 例，占 29%）。在患者 1 组的疫苗接种体液反应中，唯一没有反应的患者是一名在 30 个月前接受过肾移植手术并正在服用免疫抑制药物的患者。对于患者 2 组，抗体滴度的中位随访时间为 13 个月 [12-13]。观察到两种不同的抗 SIKE 动态模式：抗 SIKE 抗体滴度在首次接种或加强剂量后 6 个月内迅速下降（n = 10 [71.4%] 组 2A），抗 SIKE 水平在超过 6 个月后稳定在 250 BAU/mL 以上（n = 4 [28.6%] 组 2B），前者中家族性血脂异常患者较多：结论：慢性 DFPP 患者对 SARS-CoV-2 疫苗接种的体液反应似乎很强，这可能与患者的免疫状况而非 DFPTP 本身有关。我们的研究结果支持目前关于接种三剂疫苗并每 6 个月加强一次的建议。

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引用次数: 0

Therapeutic plasma exchange as treatment modality in pediatric patients with neurologic and nonneurologic diseases at the Philippine Children's Medical Center: A 12-year single center experience 菲律宾儿童医疗中心将治疗性血浆置换作为神经系统和非神经系统疾病儿科患者的治疗方式：12年的单一中心经验

IF 1.4 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-22 DOI: 10.1002/jca.22137

Alexander B. Suplico Jr, Maria Beatriz P. Gepte

Objective

To determine the clinical characteristics, indications, technical aspects, complications, and outcomes of therapeutic plasma exchange (TPE) procedures performed in pediatric patients with neurologic and nonneurologic diseases at the Philippine Children's Medical Center during a 12-year period (January 2010–March 2023).

Materials and Methods

All TPE performed between January 2010 and March 2023 were retrospectively evaluated. The indications for TPE were classified according to the 2019 American Society for Apheresis (ASFA) categorization.

Results

Fifty-seven patients underwent a total of 297 TPE procedures. The median age was 12 years (2–18), with 51% male (n = 29) and 49% female (n = 28). The most common indication was N-methyl-d-aspartate receptor antibody encephalitis, accounting for 54% of cases (n = 31), followed by Guillain-Barré syndrome at 16% (n = 9), Hemolytic Uremic Syndrome at 7% (n = 4), and Sepsis with multiorgan failure at 7% (n = 4). Forty-one patients (71.8%) were classified under ASFA category 1, seven (12.4%) as category II, and nine (15.8%) as category III. All TPE procedures were conducted using the centrifugation technique and citrate anticoagulation. Ninety-nine percent of the procedures were performed through the internal jugular vein. Albumin was utilized as a replacement fluid in 88% of the procedures. Most complications were related to patient factors and occurred in 10% of cases (n = 31), while problems associated with the extracorporeal circuit were observed in only 4.37% of cases (n = 13). Overall response rate was 91% and there was no TPE-related deaths. No clear association was found between clinical responses to TPE and specific diagnoses within ASFA categories.

Conclusion

TPE is a safe and effective adjuvant treatment for pediatric patients with neurologic and nonneurologic diseases. The outcome in these patients requiring TPE is excellent. However, response varies with failed organs and the need for life-sustaining therapies.

目的确定菲律宾儿童医学中心在 12 年内（2010 年 1 月至 2023 年 3 月）为患有神经系统疾病和非神经系统疾病的儿科患者实施的治疗性血浆置换术（TPE）的临床特征、适应症、技术方面、并发症和疗效。材料与方法对 2010 年 1 月至 2023 年 3 月期间实施的所有 TPE 进行了回顾性评估。TPE的适应症根据2019年美国血液净化协会（ASFA）的分类进行了分类。结果 57名患者共接受了297例TPE手术。中位年龄为12岁（2-18岁），51%为男性（n = 29），49%为女性（n = 28）。最常见的适应症是N-甲基-d-天冬氨酸受体抗体脑炎，占病例数的54%（n = 31），其次是格林-巴利综合征，占16%（n = 9），溶血性尿毒症综合征占7%（n = 4），败血症合并多器官功能衰竭占7%（n = 4）。41 名患者（71.8%）被归入 ASFA 第一类，7 名（12.4%）被归入第二类，9 名（15.8%）被归入第三类。所有 TPE 手术均采用离心技术和枸橼酸盐抗凝法。99%的手术通过颈内静脉进行。88%的手术使用白蛋白作为置换液。大多数并发症与患者因素有关，发生率为 10%（31 例），而与体外循环有关的问题仅占 4.37%（13 例）。总体反应率为 91%，没有出现与 TPE 相关的死亡病例。对 TPE 的临床反应与 ASFA 类别中的特定诊断之间没有明显关联。结论 TPE 是一种安全有效的辅助治疗方法，适用于患有神经系统疾病和非神经系统疾病的儿科患者。这些需要接受 TPE 治疗的患者疗效极佳。但是，反应因器官衰竭和对维持生命疗法的需求而异。

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引用次数: 0

Interest of therapeutic plasmapheresis in a chronic hemodialysis patient with severe bullous pemphigoid 一名患有严重大疱性类天疱疮的慢性血液透析患者对治疗性浆膜穿刺的兴趣。

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-16 DOI: 10.1002/jca.22133

Pedram Ahmadpoor, Mathilde Beck, Moise Michel, Emilie Pambrun, Pierre Stoebner, Olivier Moranne

Bullous pemphigoid is the most common autoimmune blistering disease induced by autoantibodies against basement membrane anchoring proteins (anti-BP-180 and anti-BP-230). The disease generally appears after the age of 70 and is associated with a 23.5% 1-year mortality, especially in diabetics, or in the presence of ischemic heart disease and high anti-BP-180. Treatment starts with topical steroids but some patients may require oral steroids and systemic immunosuppression. We, hereby, discuss a diabetic patient on chronic hemodialysis, with severely relapsed bullous pemphigoid under biotherapy with omalizumab, who was successfully treated with five sessions of double filtration plasmapheresis, thus avoiding the need for systemic steroids.

大疱性类天疱疮是由针对基底膜锚定蛋白（抗-BP-180 和抗-BP-230）的自身抗体诱发的最常见的自身免疫性水疱病。该病一般出现在 70 岁以后，1 年死亡率为 23.5%，尤其是糖尿病患者或患有缺血性心脏病和高抗 BP-180 的患者。治疗首先从局部类固醇开始，但有些患者可能需要口服类固醇和全身免疫抑制剂。我们在此讨论一名长期血液透析的糖尿病患者，他患有严重复发的大疱性类天疱疮，在使用奥马珠单抗进行生物治疗后，成功接受了五次双滤过性浆细胞分离治疗，从而避免了全身使用类固醇的需要。

引用次数: 0

Therapeutic plasma exchange provides native liver survival benefit in children with acute liver failure: A propensity score-matched analysis 治疗性血浆置换对急性肝衰竭患儿的肝脏存活有益：倾向评分匹配分析

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-14 DOI: 10.1002/jca.22130

Tamoghna Biswas, Bikrant Bihari Lal, Vikrant Sood, Avalareddy Ashritha, Ashish Maheshwari, Meenu Bajpai, Guresh Kumar, Rajeev Khanna, Seema Alam

Objectives

This study aimed to evaluate the safety and efficacy of therapeutic plasma exchange (TPE) in pediatric acute liver failure (PALF).

Methods

All children aged 2-18 years with PALF were included. The intervention cohort included a subset of PALF patients undergoing complete three sessions of TPE, whereas the matching controls were derived by propensity score matching from the patient cohort who did not receive any TPE. Propensity matching was performed based on the international normalized ratio (INR), grade of hepatic encephalopathy (HE), age, bilirubin, and ammonia levels. The primary outcome measure was native liver survival (NLS) in the two arms on day 28.

Results

Of the total cohort of 403 patients with PALF, 65 patients who received TPE and 65 propensity-matched controls were included in analysis. The 2 groups were well balanced with comparable baseline parameters. On day 4, patients in the TPE group had significantly lower INR (P = 0.001), lower bilirubin (P = 0.008), and higher mean arterial pressure (MAP) (P = 0.033) than controls. The NLS was 46.15% in the TPE arm and 26.15% in the control arm. The overall survival (OS) was 50.8% in the TPE arm and 35.4% in the control arm. Kaplan-Meier survival analysis showed a significantly higher NLS in patients receiving TPE than controls (P = 0.001). On subgroup analysis, NLS benefit was predominantly seen in hepatitis A-related and indeterminate PALF.

Conclusion

TPE improved NLS and OS in a propensity-matched cohort of patients with PALF. Patients receiving TPE had lower INR and bilirubin levels and higher MAP on day 4.

研究目的本研究旨在评估治疗性血浆置换术（TPE）在小儿急性肝衰竭（PALF）中的安全性和有效性：方法：纳入所有 2-18 岁的 PALF 患儿。干预队列包括接受了三次完整TPE治疗的PALF患者子集，而匹配对照组是从未接受任何TPE治疗的患者队列中通过倾向得分匹配得出的。倾向匹配根据国际正常化比值（INR）、肝性脑病（HE）分级、年龄、胆红素和氨水平进行。主要结果是两组患者在第28天的原肝存活率（NLS）：在总共 403 名 PALF 患者中，65 名接受 TPE 治疗的患者和 65 名倾向匹配对照组患者被纳入分析。两组患者均衡性良好，基线参数相当。第 4 天，TPE 组患者的 INR（P = 0.001）、胆红素（P = 0.008）和平均动脉压（MAP）（P = 0.033）均明显低于对照组。TPE治疗组的NLS为46.15%，对照组为26.15%。TPE治疗组的总生存率（OS）为50.8%，对照组为35.4%。卡普兰-梅耶生存分析显示，接受TPE治疗的患者的NLS明显高于对照组（P = 0.001）。在亚组分析中，NLS的益处主要体现在甲型肝炎相关和不确定的PALF中：结论：TPE改善了PALF患者倾向匹配队列中的NLS和OS。接受TPE治疗的患者INR和胆红素水平较低，第4天的MAP较高。

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引用次数: 0

Comparison of efficacy of plasma exchange versus intravenous immunoglobulin as an add-on therapy in acute attacks of neuromyelitis optica spectrum disorder 比较血浆置换与静脉注射免疫球蛋白作为神经脊髓炎视网膜频谱障碍急性发作附加疗法的疗效。

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-08 DOI: 10.1002/jca.22129

Garima Siwach, Rekha Hans, Aastha Takkar, Chirag Kamal Ahuja, Divjot Singh Lamba, Vivek Lal, Ratti Ram Sharma

Introduction

Plasma exchange (PE) is considered a Category II option for the treatment of acute attacks and relapse cases of neuromyelitis optica spectrum disorder (NMOSD). However, neurologists are also considering intravenous immunoglobulins (IVIg) as an add-on therapy for this disorder.

Aims

The aim of this study is to evaluate the efficacy of PE in acute attacks of NMOSD when compared with IVIg, in terms of improvement in the Expanded disability status scale (EDSS) and activities of daily living (ADL) scale score and levels of anti-Aquaporin P4 (AQP4) antibody in seropositive patients.

Methods

We enrolled 43 NMOSD patients in two groups: Group 1 (n = 29) received steroids and PE, and Group 2 (n = 14) received steroids with IVIg. The baseline EDSS and ADL scores were recorded and compared with scores at the end of therapy, 4 weeks, and 3 months after. Also, anti-AQP4 antibody was measured at baseline and post-therapy in seropositive patients of both groups.

Results

We observed a significant difference in EDSS (p = 0.00) and ADL score (p = 0.00) at day 10 and 3 months in both groups. However, no significant difference in EDSS, as well as ADL score from baseline (p = 0.83; p = 0.25) to 3 months (p = 0.85; p = 0.19), was observed when delta change of score at 3 months was compared across the two groups (p = 0.39; p = 0.52). We observed improved visual acuity in both groups with mild improvement in findings of magnetic resonance imaging at 3 months. We observed a significant decline in AQP4 antibody concentration (at day 10) in group 1 seropositive patients (p = 0.013) with improved EDSS (p = 0.027) and ADL scores (p = 0.026) of these patients.

Conclusions

PE should be considered as a choice of an add-on therapy in anti-AQP4 antibody-positive NMOSD patients compared with IVIg as it is more effective in reducing antibody concentrations.

导言：血浆置换（PE）被认为是治疗神经脊髓炎视网膜频谱障碍（NMOSD）急性发作和复发病例的第二类选择。目的：本研究的目的是评估血浆置换与静脉注射免疫球蛋白相比，对急性发作的 NMOSD 的疗效，具体表现为血清反应阳性患者的残疾状况扩展量表（EDSS）和日常生活活动能力（ADL）量表评分以及抗喹哪啶 P4（AQP4）抗体水平的改善情况：我们将 43 名 NMOSD 患者分为两组：第一组（29 人）接受类固醇和 PE 治疗，第二组（14 人）接受类固醇和 IVIg 治疗。记录基线 EDSS 和 ADL 评分，并将其与治疗结束时、治疗 4 周后和治疗 3 个月后的评分进行比较。此外，两组血清阳性患者在基线和治疗后均检测了抗 AQP4 抗体：我们观察到，两组患者在第 10 天和 3 个月时的 EDSS（P = 0.00）和 ADL 评分（P = 0.00）均有明显差异。然而，如果比较两组患者 3 个月时的评分△变化（p = 0.39；p = 0.52），则 EDSS 和 ADL 评分从基线（p = 0.83；p = 0.25）到 3 个月（p = 0.85；p = 0.19）没有明显差异。我们观察到两组患者的视力均有改善，3 个月时磁共振成像结果也有轻微改善。我们观察到第 1 组血清反应阳性患者的 AQP4 抗体浓度（第 10 天）明显下降（p = 0.013），这些患者的 EDSS（p = 0.027）和 ADL 评分（p = 0.026）均有所改善：与IVIg相比，PE能更有效地降低抗体浓度，因此应考虑作为抗AQP4抗体阳性NMOSD患者的附加疗法。

{"title":"Comparison of efficacy of plasma exchange versus intravenous immunoglobulin as an add-on therapy in acute attacks of neuromyelitis optica spectrum disorder","authors":"Garima Siwach, Rekha Hans, Aastha Takkar, Chirag Kamal Ahuja, Divjot Singh Lamba, Vivek Lal, Ratti Ram Sharma","doi":"10.1002/jca.22129","DOIUrl":"10.1002/jca.22129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Plasma exchange (PE) is considered a Category II option for the treatment of acute attacks and relapse cases of neuromyelitis optica spectrum disorder (NMOSD). However, neurologists are also considering intravenous immunoglobulins (IVIg) as an add-on therapy for this disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study is to evaluate the efficacy of PE in acute attacks of NMOSD when compared with IVIg, in terms of improvement in the Expanded disability status scale (EDSS) and activities of daily living (ADL) scale score and levels of anti-Aquaporin P4 (AQP4) antibody in seropositive patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 43 NMOSD patients in two groups: Group 1 (<i>n</i> = 29) received steroids and PE, and Group 2 (<i>n</i> = 14) received steroids with IVIg. The baseline EDSS and ADL scores were recorded and compared with scores at the end of therapy, 4 weeks, and 3 months after. Also, anti-AQP4 antibody was measured at baseline and post-therapy in seropositive patients of both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We observed a significant difference in EDSS (<i>p</i> = 0.00) and ADL score (<i>p</i> = 0.00) at day 10 and 3 months in both groups. However, no significant difference in EDSS, as well as ADL score from baseline (<i>p</i> = 0.83; <i>p</i> = 0.25) to 3 months (<i>p</i> = 0.85; <i>p</i> = 0.19), was observed when delta change of score at 3 months was compared across the two groups (<i>p</i> = 0.39; <i>p</i> = 0.52). We observed improved visual acuity in both groups with mild improvement in findings of magnetic resonance imaging at 3 months. We observed a significant decline in AQP4 antibody concentration (at day 10) in group 1 seropositive patients (<i>p</i> = 0.013) with improved EDSS (<i>p</i> = 0.027) and ADL scores (<i>p</i> = 0.026) of these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PE should be considered as a choice of an add-on therapy in anti-AQP4 antibody-positive NMOSD patients compared with IVIg as it is more effective in reducing antibody concentrations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"39 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Therapeutic plasma exchange combined with ribavirin to rescue critical SFTS patients 治疗性血浆置换联合利巴韦林抢救危重的 SFTS 患者。

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-08 DOI: 10.1002/jca.22131

Xuezhen Song, Xiaojun Xu, Xiaoning Ren, Xiaoxuan Ruan, Jinshuang Bo

Background

Severe fever with thrombocytopenia syndrome (SFTS) is a zoonotic infectious disease caused by the severe fever with thrombocytopenia syndrome virus (SFTSV). Endemic in East Asia, SFTS is characterized by an exceptionally high mortality rate. Presently, there is no established treatment for SFTS, particularly for patients in critical condition. In this study, we collected and analyzed laboratory and clinical data from 92 critically ill patients with SFTS treated at Weihai Municipal Hospital between 2019 and 2022. We hope that our study will provide some hints for the treatment of critically ill patients with SFTS.

Methods

A total of 92 critically ill patients with SFTS were included in this study. Of these patients, 45 received treatment with therapeutic plasma exchange (TPE) and ribavirin (referred to as the TPE group), while the remaining patients received only ribavirin (referred to as the non-TPE group). Clinical and laboratory parameters were analyzed retrospectively.

Results

The results showed significant improvements in multiple laboratory parameters following treatment with TPE and ribavirin, including white blood cell and neutrophil count, lactate dehydrogenase, creatine kinase isoenzyme-MB, prothrombin time, activated partial thromboplastin time, D-Dimer, serum sodium and copies of virus genomes. The combination of TPE with ribavirin demonstrated a significant reduction in mortality rates, with a mortality rate of 20.0% in the TPE group compared to 40.4% in the non-TPE group (P = 0.033).

Conclusions

Our findings suggest that critically ill patients with SFTS who received TPE and ribavirin experienced improvements in both clinical and laboratory parameters. These results indicate that TPE combined with ribavirin may represent a promising novel therapeutic approach for managing critically ill patients with SFTS. However, comparative studies of large sample size or randomized clinical trials are warranted to confirm the effectiveness of this combination therapy in the treatment of severe SFTS cases.

背景：严重发热伴血小板减少综合征（SFTS）是一种由严重发热伴血小板减少综合征病毒（SFTSV）引起的人畜共患传染病。该病流行于东亚，死亡率极高。目前，还没有针对 SFTS 的成熟治疗方法，尤其是针对危重病人的治疗方法。在本研究中，我们收集并分析了威海市立医院在 2019 年至 2022 年期间收治的 92 名 SFTS 重症患者的实验室和临床数据。希望我们的研究能为SFTS危重症患者的治疗提供一些提示：本研究共纳入 92 名 SFTS 重症患者。其中，45 名患者接受了治疗性血浆置换（TPE）和利巴韦林治疗（简称 TPE 组），其余患者仅接受了利巴韦林治疗（简称非 TPE 组）。对临床和实验室参数进行了回顾性分析：结果显示，在接受 TPE 和利巴韦林治疗后，多种实验室指标均有明显改善，包括白细胞和中性粒细胞计数、乳酸脱氢酶、肌酸激酶同工酶-MB、凝血酶原时间、活化部分凝血活酶时间、D-二聚体、血清钠和病毒基因组拷贝数。TPE与利巴韦林联合治疗可显著降低死亡率，TPE组的死亡率为20.0%，而非TPE组的死亡率为40.4%（P = 0.033）：我们的研究结果表明，接受 TPE 和利巴韦林治疗的 SFTS 重症患者的临床和实验室指标均有所改善。这些结果表明，TPE 联合利巴韦林可能是治疗 SFTS 重症患者的一种很有前景的新型治疗方法。不过，还需要进行大样本量的比较研究或随机临床试验，以确认这种联合疗法在治疗重症 SFTS 病例中的有效性。

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引用次数: 0

Early extracorporeal photopheresis treatment is associated with better survival in patients with chronic or recurrent acute lung allograft dysfunction 对于慢性或复发性急性肺移植功能障碍患者来说，早期体外光动力疗法可提高其存活率。

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-06-03 DOI: 10.1002/jca.22128

Fiorenza Gautschi, Tobias Vogelmann, Gernot Ortmanns, Fabian Knörr, Carolin Steinack, René Hage, Mirjam Nägeli, Macé Matthew Schuurmans

Background

Due to development of chronic lung allograft dysfunction (CLAD), prognosis for patients undergoing lung transplantation (LTx) is still worse compared to other solid organ transplant recipients. Treatment options for slowing down CLAD progression are scarce with extracorporeal photopheresis (ECP) as an established rescue therapy. The aim of the study was to identify characteristics of responders and non-responders to ECP treatment, assess their survival, lung function development and by that define the subset of patients who should receive early ECP treatment.

Methods

We performed a retrospective study of all LTx patients receiving ECP treatment at the University Hospital Zurich between January 2010 and March 2020. Patients were followed-up for a maximum period of 5 years. Mortality and lung function development were assessed by CLAD stage and by CLAD subtype before initiation of ECP treatment.

Results

Overall, 105 patients received at least one ECP following LTx. A total of 57 patients (61.3%) died within the study period with a median survival of 15 months. Mortality was 57% for patients who started ECP at CLAD1, 39% for CLAD2, 93% for CLAD3, and 90% for CLAD4 (p < 0.001). Survival and lung function development was best in young patients at early CLAD stages 1 and 2. Response to ECP treatment was worst in patients with CLAD-RAS/mixed subtype (14.3%) and patients with ECP initiation in CLAD stages 3 (7.1%) and 4 (11.1%). Survival was significantly better in a subset of patients with recurrent acute allograft dysfunction and earlier start of ECP treatment (105 vs 15 months).

Conclusion

In this retrospective analysis of a large group of CLAD patients treated with ECP after LTx, early initiation of ECP was associated with better long-term survival. Besides a subset of patients suffering of recurrent allograft dysfunction, especially a subset of patients defined as responders showed an improved response rate and survival, suggesting that ECP should be initiated in early CLAD stages and young patients. ECP might therefore prevent long-term disease progression even in patients with CLAD refractory to other treatment options and thus prevent or delay re-transplantation.

背景：由于慢性肺移植功能障碍（CLAD）的发生，肺移植（LTx）患者的预后仍比其他实体器官移植受者差。延缓 CLAD 进展的治疗方案很少，体外光动力疗法（ECP）是一种成熟的抢救疗法。本研究旨在确定对 ECP 治疗有反应者和无反应者的特征，评估他们的存活率和肺功能发展情况，从而确定应尽早接受 ECP 治疗的患者子集：我们对 2010 年 1 月至 2020 年 3 月期间在苏黎世大学医院接受 ECP 治疗的所有 LTx 患者进行了回顾性研究。对患者进行了最长 5 年的随访。在开始 ECP 治疗前，按照 CLAD 分期和 CLAD 亚型对死亡率和肺功能发展情况进行了评估：结果：总计105名患者在LTx治疗后接受了至少一次ECP治疗。共有 57 名患者（61.3%）在研究期间死亡，中位生存期为 15 个月。在 CLAD1 开始接受 ECP 治疗的患者死亡率为 57%，CLAD2 为 39%，CLAD3 为 93%，CLAD4 为 90% (p 结论：在这项对大量在LTx治疗后接受ECP治疗的CLAD患者进行的回顾性分析中，尽早开始ECP与较好的长期生存率相关。除了复发性同种异体移植功能障碍患者外，尤其是被定义为应答者的部分患者的应答率和生存率均有所提高，这表明 ECP 应在 CLAD 早期和年轻患者中使用。因此，即使是对其他治疗方案难治的CLAD患者，ECP也能防止疾病长期恶化，从而避免或推迟再次移植。

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引用次数: 0

Optimizing autologous stem cell collections for patients with multiple myeloma receiving G-CSF and Plerixafor: A single center project 为接受 G-CSF 和 Plerixafor 治疗的多发性骨髓瘤患者优化自体干细胞采集：单中心项目。

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-05-27 DOI: 10.1002/jca.22127

Ayda Javanbakht, Stephanie Stringer, Hollie Anderson, Ellie Hamilton, Anisha Philip, Edmund K. Waller, Amelia A. Langston, Nisha Joseph, John D. Roback, Thomas Schneider, H. Cliff Sullivan, Jeanne E. Hendrickson

Background

Increasing indications for cellular therapy collections have stressed our healthcare system, with autologous collections having a longer than desired wait time until apheresis collection. This quality improvement initiative was undertaken to accommodate more patients within existing resources.

Study Design and Methods

Patients with multiple myeloma who underwent autologous peripheral blood stem cell collection from October 2022 to April 2023 were included. Demographic, mobilization, laboratory, and apheresis data were retrospectively collected from the medical record.

Results

This cohort included 120 patients (49.2% male), with a median age of 60 years. All received G-CSF and 95% received pre-emptive Plerixafor approximately 18 hours pre-collection. Most (79%) had collection goals of at least 8 × 10⁶/kg CD34 cells, with 63% over 70 years old having this high collection goal (despite 20 years of institutional data showing <1% over 70 years old have a second transplant). With collection efficiencies of 55.9%, 44% of patients achieved their collection goal in a single day apheresis collection. A platelet count <150 × 10³/μL on the day of collection was a predictor for poor mobilization; among 27 patients with a low baseline platelet count, 17 did not achieve the collection goal and 2 failed to collect a transplantable dose.

Conclusions

With minor collection goal adjustments, 15% of all collection appointments could have been avoided over this 6-month period. Other strategies to accommodate more patients include mobilization modifications (Plerixafor timing or substituting a longer acting drug), utilizing platelet counts to predict mobilization, and modifying apheresis collection volumes or schedule templates.

背景：细胞疗法采集适应症的增加给我们的医疗系统带来了压力，自体采集到无细胞采集的等待时间比预期的要长。为了在现有资源范围内满足更多患者的需求，我们采取了这项质量改进措施：纳入2022年10月至2023年4月期间进行自体外周血干细胞采集的多发性骨髓瘤患者。从病历中回顾性收集人口统计学、动员、实验室和无细胞疗法数据：该队列包括120名患者（49.2%为男性），中位年龄为60岁。所有患者均接受了 G-CSF，95%的患者在采集前约 18 小时接受了预防性普利沙夫治疗。大多数患者（79%）的CD34细胞采集目标至少为8×106/kg，其中63%的70岁以上患者有如此高的采集目标（尽管20年的机构数据显示，采集当天3/μL是动员不良的预测因素；在27名基线血小板计数较低的患者中，17人未达到采集目标，2人未采集到可移植剂量）：只要对采集目标稍作调整，6 个月内就可以避免 15% 的采集预约。其他可满足更多患者需求的策略包括：调整动员时间（Plerixafor时间或替代长效药物）、利用血小板计数预测动员时间，以及修改无细胞采集量或计划模板。

{"title":"Optimizing autologous stem cell collections for patients with multiple myeloma receiving G-CSF and Plerixafor: A single center project","authors":"Ayda Javanbakht, Stephanie Stringer, Hollie Anderson, Ellie Hamilton, Anisha Philip, Edmund K. Waller, Amelia A. Langston, Nisha Joseph, John D. Roback, Thomas Schneider, H. Cliff Sullivan, Jeanne E. Hendrickson","doi":"10.1002/jca.22127","DOIUrl":"10.1002/jca.22127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasing indications for cellular therapy collections have stressed our healthcare system, with autologous collections having a longer than desired wait time until apheresis collection. This quality improvement initiative was undertaken to accommodate more patients within existing resources.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design and Methods</h3>\u0000 \u0000 <p>Patients with multiple myeloma who underwent autologous peripheral blood stem cell collection from October 2022 to April 2023 were included. Demographic, mobilization, laboratory, and apheresis data were retrospectively collected from the medical record.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This cohort included 120 patients (49.2% male), with a median age of 60 years. All received G-CSF and 95% received pre-emptive Plerixafor approximately 18 hours pre-collection. Most (79%) had collection goals of at least 8 × 10<sup>6</sup>/kg CD34 cells, with 63% over 70 years old having this high collection goal (despite 20 years of institutional data showing <1% over 70 years old have a second transplant). With collection efficiencies of 55.9%, 44% of patients achieved their collection goal in a single day apheresis collection. A platelet count <150 × 10<sup>3</sup>/μL on the day of collection was a predictor for poor mobilization; among 27 patients with a low baseline platelet count, 17 did not achieve the collection goal and 2 failed to collect a transplantable dose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>With minor collection goal adjustments, 15% of all collection appointments could have been avoided over this 6-month period. Other strategies to accommodate more patients include mobilization modifications (Plerixafor timing or substituting a longer acting drug), utilizing platelet counts to predict mobilization, and modifying apheresis collection volumes or schedule templates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"39 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful management of maternal anti-PP1Pk alloimmunization in pregnancy with therapeutic plasma exchange and intravenous immunoglobulin 通过治疗性血浆置换和静脉注射免疫球蛋白成功控制妊娠期母体抗PP1Pk同种免疫反应

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-05-10 DOI: 10.1002/jca.22120

Yannis Hadjiyannis, Jennifer M. Jones, Irina Chibisov, Joseph Kiss, Kim Gabert, Joan Sevcik, Suzanne Bakdash, Anna Binstock, Carolyn Kilonsky, Kristiina Parviainen, Alesia Kaplan

Anti-PP1P^K alloimmunization is rare given ubiquitous P1PK expression. Prevention of recurrent miscarriages and hemolytic disease of the fetus and newborn (HDFN) in pregnant individuals with anti-PP1P^K antibodies has relied upon individual reports. Here, we demonstrate the successful management of maternal anti-PP1P^K alloimmunization in a 23-year-old, G2P0010, with therapeutic plasma exchange (TPE), intravenous immunoglobulin (IVIG), and monitoring of anti-PP1P^k titers. Twice-weekly TPE (1.5 plasma volume [PV], 5% albumin replacement) with weekly titers and IVIG (1 g/kg) was initiated at 9 weeks of gestation (WG). The threshold titer was ≥16. Weekly middle cerebral artery-peak systolic velocities (MCA-PSV) for fetal anemia monitoring was initiated at 16 WG. PVs were adjusted throughout pregnancy based on treatment schedule, titers, and available albumin. Antigen-negative, ABO-compatible RBCs were obtained through the rare donor program and directed donation. An autologous blood autotransfusion system was reserved for delivery. Titers decreased from 128 to 8 by 10 WG. MCA-PSV remained stable. At 24 WG, TPE decreased to once weekly. After titers increased to 32, twice-weekly TPE resumed at 27 WG. Induction of labor was scheduled at 38 WG. Vaginal delivery of a 2950 g neonate (APGAR score: 9, 9) occurred without complication (Cord blood: 1+ IgG DAT; Anti-PP1P^k eluted). Newborn hemoglobin and bilirubin were unremarkable. Discharge occurred postpartum day 2. Anti-PP1P^k alloimmunization is rare but associated with recurrent miscarriages and HDFN. With multidisciplinary care, a successful pregnancy is possible with IVIG and TPE adjusted to PV and titers. We also propose a patient registry and comprehensive management plan.

由于 P1PK 的表达无处不在，因此抗 P1PK 的同种免疫非常罕见。对抗 P1PK 抗体孕妇的复发性流产和胎儿及新生儿溶血病（HDFN）的预防一直依赖于个别报告。在此，我们展示了通过治疗性血浆置换（TPE）、静脉注射免疫球蛋白（IVIG）和监测抗 PPP1Pk 滴度，成功治疗一名 23 岁 G2P0010 孕妇的母体抗 PPP1PK 同种免疫。在妊娠 9 周（WG）时开始每周两次 TPE（1.5 血浆容量 [PV]，5% 白蛋白置换），每周滴度和静脉注射免疫球蛋白（1 克/千克）。滴度阈值≥16。在妊娠 16 周时开始每周监测大脑中动脉-峰值收缩速度（MCA-PSV），以监测胎儿贫血情况。在整个孕期，根据治疗计划、滴度和可用白蛋白调整收缩压。抗原阴性、ABO相容的红细胞是通过稀有捐献者计划和定向捐献获得的。分娩时使用了自体血液自动输注系统。到 10 WG 时，滴度从 128 降至 8。MCA-PSV 保持稳定。在 24 WG 时，TPE 减少到每周一次。滴度升至 32 后，在 27 WG 时恢复了每周两次的 TPE。计划在 38 WG 时引产。2950克新生儿（APGAR评分：9，9）经阴道分娩，无并发症（脐带血：1+ IgG DAT；抗PP1Pk洗脱）。新生儿血红蛋白和胆红素无异常。产后第 2 天出院。抗PP1Pk同种免疫罕见，但与复发性流产和HDFN有关。在多学科护理下，根据 PV 和滴度调整 IVIG 和 TPE 有可能成功怀孕。我们还提出了患者登记和综合管理计划。

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引用次数: 0

Therapeutic apheresis in kidney transplantation: Emerging trends 肾移植中的治疗性血液净化：新趋势

IF 1.5 4区医学 Q4 HEMATOLOGY

Journal of Clinical Apheresis

Pub Date : 2024-05-06 DOI: 10.1002/jca.22119

Chimezie Godswill Okwuonu, Monarch Shah, Iram Rafique, Abdallah Saleh Abdelrazeq, Jeanne Kamal, Swati Rao, Rasheed Abiodun Balogun

Introduction

The use of therapeutic apheresis (TA) either as stand-alone or adjunctive treatment in kidney transplantation has increased over the years to become a leading indication. This study shows recent trends in indications for TA related to kidney transplantation, adverse events, and patient outcome in this cohort.

Methods

This is a retrospective cohort review of adults who received TA for kidney transplant-related indications from January 1, 2017, to December 31, 2022, at the University of Virginia Medical Centre, Charlottesville, VA, USA. Data extracted include basic demographics, indication for apheresis, number of procedures, procedure characteristics, procedure-related adverse events (complications), and serum ionized calcium and serum creatinine. Data were analyzed using statistical package for social sciences (SPSS 2022 IBM Inc).

Results

Data from a total of 131 patients who received 860 TA procedures were analyzed. Indications for TA were antibody-mediated rejection (65.5%), recurrent focal segmental glomerulosclerosis (15%), thrombotic microangiopathy (5%), desensitization for ABO incompatibility (4.5%) and for HLA-incompatibility (4.5%), and recurrent IgA nephropathy (1%). Some adverse events were encountered in 16.7% of the procedures and include hypocalcemia (7%), vascular access malfunction (0.7%), hypotension (1.2%), arrhythmia (0.6%), and depletion coagulopathy (0.6%). The overall case mortality rate was 8.4% over the 6-year period. There was one death recorded on machine during TA resulting in a procedure-mortality rate of 0.12%.

Conclusion

Antibody-mediated rejection was the most common indication for TA related to kidney transplantation. Adverse events were minor and patient survival over the time was within usual limits.

引言多年来，治疗性无细胞疗法（TA）在肾移植中作为独立治疗或辅助治疗的使用不断增加，已成为一种主要的适应症。本研究显示了与肾移植相关的治疗性无细胞疗法适应症、不良事件和患者预后的最新趋势。方法这是对美国弗吉尼亚州夏洛茨维尔弗吉尼亚大学医学中心自 2017 年 1 月 1 日至 2022 年 12 月 31 日期间因肾移植相关适应症接受 TA 的成人进行的回顾性队列回顾。提取的数据包括基本人口统计学特征、无细胞疗法适应症、手术次数、手术特征、手术相关不良事件（并发症）以及血清离子化钙和血清肌酐。数据使用社会科学统计软件包（SPSS 2022 IBM Inc）进行分析。结果对接受过 860 例 TA 手术的 131 名患者的数据进行了分析。TA的适应症包括抗体介导的排斥反应（65.5%）、复发性局灶节段性肾小球硬化（15%）、血栓性微血管病（5%）、ABO不相容脱敏（4.5%）和HLA不相容脱敏（4.5%）以及复发性IgA肾病（1%）。16.7%的手术发生了一些不良事件，包括低钙血症（7%）、血管通路故障（0.7%）、低血压（1.2%）、心律失常（0.6%）和消耗性凝血病（0.6%）。6 年间的总体病例死亡率为 8.4%。在 TA 过程中，机器上记录了一例死亡，因此手术死亡率为 0.12%。结论抗体介导的排斥反应是肾移植最常见的TA适应症。不良事件较少，患者存活率在正常范围内。

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引用次数: 0