![Page 1: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/1.jpg)
www.ebmt.org
#EBMT18
EBMT MED-B AllograftJakob R Passweg
No conflicts of interest
Lisboa 20.3.18
![Page 2: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/2.jpg)
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
![Page 3: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/3.jpg)
3
![Page 4: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/4.jpg)
4
![Page 5: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/5.jpg)
5
Comorbidity Index
= cumulative number of co-morbidities
![Page 6: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/6.jpg)
6
![Page 7: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/7.jpg)
7
![Page 8: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/8.jpg)
8
![Page 9: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/9.jpg)
9
HLA-A2
![Page 10: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/10.jpg)
10
![Page 11: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/11.jpg)
11
Ap Am
Bm
Bp
Cp
Cm
DRB1m
DRB1p
DQm
DQp
DPm
DPp
HLA class I
HLA class II
(DRB3p ou m)[ ]
![Page 12: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/12.jpg)
12
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
![Page 13: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/13.jpg)
13
HLA a does not recognize the pathogen
HLA b recognizes the pathogen
HLA a
HLA b
population dies
![Page 14: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/14.jpg)
14
![Page 15: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/15.jpg)
15
Let‘s assumeunrelated donor
patient:A: 0101 0201B: 1501 3502DRB1: 0401 0302
donor:A: 0101 0201B: 1501 3502DRB1: 0404 0302
![Page 16: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/16.jpg)
16
:02
Is this a haplo or not?
Patient
![Page 17: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/17.jpg)
17
![Page 18: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/18.jpg)
18
Negative selectionRemove cells
Positive selectionSelect for stem cells
![Page 19: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/19.jpg)
19
![Page 20: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/20.jpg)
20
3.0 X
4.0 X
![Page 21: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/21.jpg)
21
![Page 22: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/22.jpg)
22
![Page 23: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/23.jpg)
23
![Page 24: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/24.jpg)
24
Conditioning Intensity
Maxi Midi Mini
![Page 25: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/25.jpg)
25
• Myeloablative
• Reduced Intensity
• Non myeloablative
![Page 26: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/26.jpg)
26
If you cannot agree on conditioning Intensity:List the drugs and the doses
Conditioning
![Page 27: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/27.jpg)
27
TBI
12 Gy 6 3
![Page 28: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/28.jpg)
28
Standards:CSA + MTXCSA + MMF
TAC + MTXTAC + MMF
+- ATG
posttransplant Cyclophosphamide
![Page 29: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/29.jpg)
29
Cause of Death
ToxicityRelapseGvHDInfection
![Page 30: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/30.jpg)
30
![Page 31: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/31.jpg)
31
Variable number tandem repeats or short tandem repeats
![Page 32: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/32.jpg)
32
• The patient and the donor
the patient the donor
What happenedAfter the transplant?
![Page 33: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/33.jpg)
33
![Page 34: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/34.jpg)
34
![Page 35: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/35.jpg)
35
Time to GvHDOnset =Cumulative Incidence
![Page 36: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/36.jpg)
36
![Page 37: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/37.jpg)
37
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
![Page 38: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/38.jpg)
38
NEJM Original Article Ipilimumab for Patients with
Relapse after Allogeneic Transplantation
![Page 39: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/39.jpg)
39
![Page 40: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/40.jpg)
40
![Page 41: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/41.jpg)
41
![Page 42: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/42.jpg)
42
The many facets of cGvHD
![Page 43: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/43.jpg)
43
Diagnosis MRD
34++CD56+:0.01% of
TNC
![Page 44: EBMT MED-B Allograft · g #EBMT18 EBMT MED-B Allograft Jakob R Passweg No conflicts of interest Lisboa 20.3.18](https://reader034.vdocuments.mx/reader034/viewer/2022042200/5ea060ddb1ac4e2262464dad/html5/thumbnails/44.jpg)
44
Thank you for your hard work