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EBMT MED-B AllograftJakob R Passweg

No conflicts of interest

Lisboa 20.3.18

2

SerologyAntibodies against an infectious agent

measures the defense mounted against this agent

Antigens by antigen detection measures presence of immunologically detectable parts of the agent

by molecular biology = PCR = measures the presence of genes of the virus = viral replication

Why do we want to know this?

Some viruses stay in the body foreverEven if they do not cause disease prior to HSCT= latent viruses (herpes virus family)These viruses may reactivate

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4

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Comorbidity Index

= cumulative number of co-morbidities

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7

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HLA-A2

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Ap Am

Bm

Bp

Cp

Cm

DRB1m

DRB1p

DQm

DQp

DPm

DPp

HLA class I

HLA class II

(DRB3p ou m)[ ]

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A-B-

DR-

-A-B-DR

A-B-

DR-

-A-B-DR

patienthaploidentical genotypicallyidentical

prob= 1 – (0.75 # sibs-1)

Sibs Chance (%)

0 0

1 25

2 43

3 58

4 68

5 76

6 82

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HLA a does not recognize the pathogen

HLA b recognizes the pathogen

HLA a

HLA b

population dies

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Let‘s assumeunrelated donor

patient:A: 0101 0201B: 1501 3502DRB1: 0401 0302

donor:A: 0101 0201B: 1501 3502DRB1: 0404 0302

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:02

Is this a haplo or not?

Patient

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Negative selectionRemove cells

Positive selectionSelect for stem cells

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3.0 X

4.0 X

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Conditioning Intensity

Maxi Midi Mini

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• Myeloablative

• Reduced Intensity

• Non myeloablative

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If you cannot agree on conditioning Intensity:List the drugs and the doses

Conditioning

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TBI

12 Gy 6 3

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Standards:CSA + MTXCSA + MMF

TAC + MTXTAC + MMF

+- ATG

posttransplant Cyclophosphamide

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Cause of Death

ToxicityRelapseGvHDInfection

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Variable number tandem repeats or short tandem repeats

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• The patient and the donor

the patient the donor

What happenedAfter the transplant?

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Time to GvHDOnset =Cumulative Incidence

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Safety and Feasibility of Administration of High Doses of Ex Vivo Expanded NK Cells for Prevention of Disease Relapse after Transplantation for Patients with Myeloid Malignancies - Final Results of a Phase I Clinical TrialStefan O. Ciurea, MD, The University of Texas MD Anderson Cancer Center

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NEJM Original Article Ipilimumab for Patients with

Relapse after Allogeneic Transplantation

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The many facets of cGvHD

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Diagnosis MRD

34++CD56+:0.01% of

TNC

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Thank you for your hard work