Publications by authors named "Elisabetta Metafuni"

Background: Extracorporeal photopheresis (ECP) has been demonstrated as an effective treatment for graft-versus-host disease (GvHD). The inline system was developed by Therakos in 1987. Recently, Fresenius Kabi implemented an integration of cell separator Amicus and a UVA photoactivation device (Phelix), realizing an inline photopheresis system.

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Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) post-hematopoietic stem cell transplantation (HSCT) are an unmet medical need with no established standard of care, significantly affecting the patient quality of life and posing a challenge for clinicians. The anti-CD38 IgG-kappa Daratumumab appears to be a safe and efficace treatment compared to prior drugs. Our study is a prospective monocentric investigation assessing the use of daratumumab in these complications following allo-HSCT.

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Introduction: Autoimmune hemolytic anemia (AIHA) occurs in 0.7-5.6% of patients undergoing hematopoietic stem cell transplantation, especially from unrelated or haploidentical donor or after lympho-depleted transplant; the majority of cases are represented by warm AIHA, occurring in a full donor chimerism setting.

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Introduction: Donor-specific antibodies (DSAs) correspond to anti-HLA antibodies of the recipient that are specifically directed to a mismatched antigen of the donor. In the setting of solid organ transplantation DSAs are associated with rejection. Their role is still debated in allogeneic cell transplantation.

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  • Vitamin B12 deficiency can lead to serious health issues like megaloblastic anemia and neurological damage, often caused by malabsorption or dietary restrictions.
  • The study investigates the impact of specific MTHFR gene polymorphisms (C677T and A1298C) on anemia and gastritis in Italian patients with B12 deficiency, revealing significant correlations between these genetic variants and hematological issues.
  • The findings indicate that reduced MTHFR enzyme activity may worsen the symptoms of vitamin B12 deficiency and increase the risk of developing atrophic gastritis.
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  • The study focused on the effectiveness of tixagevimab/cilgavimab (T/C) as pre-exposure prophylaxis (PrEP) in immunocompromised individuals, categorizing them into groups based on their COVID-19 history.
  • A total of 231 participants were included, with a significant portion having hematological diseases and receiving multiple vaccine doses; breakthrough infections (BTIs) occurred in 56 participants (24%) but were mostly mild to moderate.
  • Immune markers were measured over time, showing an initial increase in anti-RBD IgG antibodies at 3 months, a decline at 6 months, and low neutralizing antibodies, reinforcing T/C's clinical efficacy in reducing severe COVID-19
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  • - The study assessed COVID-19 mortality rates among patients receiving Chimeric Antigen Receptor (CAR) T-cell therapy for blood cancers, comparing outcomes across three years (2020, 2021, 2022) during the Omicron period.
  • - There was a significant decline in COVID-19-related mortality: from 43.6% in 2020 to 7.5% in 2022, indicating improvement over time, with year of infection identified as a key predictor of survival.
  • - Although mortality decreased, CAR T-cell recipients still face a higher risk of complications compared to the general population, highlighting the need for ongoing monitoring and preventive measures during their treatment.
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  • Pure red cell aplasia (PRCA) can occur after major ABO mismatched hemopoietic stem cell transplantation, leading to prolonged anemia and increased need for blood transfusions.
  • A study reviewed literature on PRCA treatments and analyzed 194 patients over 13 years, identifying key risk factors such as older age and specific antibody levels.
  • Successful treatment options included plasma-exchange, immunoadsorption, and medications like daratumumab; notably, pre-HSCT IgG antibody levels were highlighted as a significant risk factor for developing PRCA.
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  • The use of stem cell transplants is growing, and more people are needed to donate these cells.
  • A study looked at 455 potential adult donors over 5 years to see if they were healthy enough to donate, checking their medical histories and other health factors.
  • Out of the donors, 351 were eligible, and 233 actually donated; some had health issues but still qualified, showing that these issues didn’t greatly affect the success of the transplants.
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While there is intense interest in the production of allogeneic CAR-T cells from umbilical cord units, little is known about the reactivity and persistence of CAR-T cells of umbilical origin. We report the case of a patient at our hematological center with multiple relapsing Ph+ B-ALL, notably a Blinatunomab non-responder, who underwent therapy with Brexucabtagene Autoleucel following relapse on Ponatinib post-allogeneic hematopoietic stem cell transplantation. The patient achieved a rapid CAR-T expansion and durable remission presenting in good clinical conditions 6 months post-CAR-T infusion, without manifestations of graft-versus-host disease.

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Listeriosis is rare after hematopoietic stem cell transplantation (HCT). Little is known about listeriosis in this population. In this retrospective international case-control study, we evaluated 41 listeriosis episodes occurring between 2000 and 2021 in HCT recipients (111 transplant centers in 30 countries) and assessed risk factors for listeriosis by comparisons with matched controls.

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Objectives: Whether pre-exposure prophylaxis (PrEP) with tixagevimab/cilgavimab 150 mg/150 mg (T/C) in individuals with hematologic disease (HD) may lead to a reduced risk of SARS-CoV-2 breakthrough infection (BTI)/hospitalization, or death in the Omicron era remains to be established.

Methods: An observational study included participants with HD who received PrEP. BTIs were defined as SARS-CoV-2 positivity by reverse transcription-polymerase chain reaction.

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We studied the incidence of acute graft versus host disease (GvHD) and its outcome in three consecutive time frames (year <2000; 2000-2010; >2010), in 3,120 patients allografted in two transplant Centers between 1976 and 2020. The median age increased over the three periods from 32 to 42 to 54 years ( < 0.00001).

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  • A patient who underwent Chimeric Antigen Receptor-T (CAR-T) therapy experienced hematological toxicity after having a previous allogeneic stem cell transplant.
  • The issue was resolved by infusing unselected donor-derived stem cells into the patient.
  • As a result of the donor's lymphocytes, there was a manageable flare-up of acute graft versus host disease in the patient.
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Background: We previously reported that the "Endothelial Activation and Stress Index" (EASIX; ((creatinine×lactate dehydrogenase)÷thrombocytes)) measured before start of conditioning predicts mortality after allogeneic hematopoietic stem cell transplantation (alloSCT) when used as continuous score. For broad clinical implementation, a prospectively validated EASIX-pre cut-off is needed that defines a high-risk cohort and is easy to use.

Method: In the current study, we first performed a retrospective cohort analysis in n=2022 alloSCT recipients and identified an optimal cut-off for predicting non-relapse mortality (NRM) as EASIX-pre=3.

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Hemorrhagic cystitis (HC) is a highly impacting complication in allogeneic hematopoietic stem cell transplantation (HSCT), occurring in 12%-37% of patients. The impact of transplant- and patient-specific variables has been described, with a possible role for JCV and BKV, which may be cooperating with cytomegalovirus (CMV). Here, we analyze 134 letermovir-exposed, CMV-free patients, treated with the same cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, describing risk factors for HC.

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Microbiota changes during allogeneic hematopoietic stem cell transplantation has several known causes: conditioning chemotherapy and radiation, broad-spectrum antibiotic administration, modification in nutrition status and diet, and graft-versus-host disease. This article aims to review the current knowledge about the close link between microbiota and allogeneic stem cell transplantation setting. The PubMed search engine was used to perform this review.

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  • The study investigates the association of specific single nucleotide polymorphisms (SNPs) in the heparanase (HPSE) gene with the occurrence of graft-versus-host disease (aGvHD) following allogeneic stem cell transplants (HSCT).
  • Researchers analyzed data from 228 patients who underwent HSCT, using genetic testing methods to identify the HPSE SNPs rs4693608 and rs4364254.
  • Findings revealed that certain genotypes, particularly in the rs4364254 SNP, significantly increased the risk of aGvHD and impacted overall transplant outcomes, indicating the potential of these SNPs as predictive biomarkers for patient management.
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Impaired function of hematopoiesis after treatment with chimeric antigen T-cells (CAR-T) is a frequent finding and can interest a wide range of patients, regardless of age and underlying disease. Trilinear cytopenias, as well as hypogammaglobulinemia, B-cell aplasia, and T-cell impairment, can severely affect the infectious risk of CAR-T recipients, as well as their quality of life. In this review, we provide an overview of defects in hematopoiesis after CAR-T, starting with a summary of different definitions and thresholds.

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Background: Human metapneumovirus (hMPV) epidemiology, clinical characteristics and risk factors for poor outcome after allogeneic stem cell transplantation (allo-HCT) remain a poorly investigated area.

Methods: This retrospective multicenter cohort study examined the epidemiology, clinical characteristics, and risk factors for poor outcomes associated with human metapneumovirus (hMPV) infections in recipients of allo-HCT.

Results: We included 428 allo-HCT recipients who developed 438 hMPV infection episodes between January 2012 and January 2019.

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