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Pretransplant blood transfusions from a dog leukocyte antigen (DLA)-identical canine littermate marrow donor will sensitize the recipient to non-DLA-linked polymorphic minor histocompatibility antigens, which uniformly results in graft rejection. We observed previously that 2000 cGy gamma-irradiation of marrow donor blood transfusions prevented this sensitization and subsequent marrow graft rejection. The purpose of the present study was to determine whether treatment of unrelated blood transfusions with gamma-irradiation would also prevent sensitization. Conceivably, sensitization to minor histocompatibility antigens might be more efficient or potent and thus more difficult to prevent when those antigens are seen in the context of disparity for DLA antigens. Furthermore, this model, in which sensitization to DLA-identical littermate marrow is caused by unrelated blood transfusions, is directly relevant to the clinical circumstances of human marrow transplantation. We assessed sensitization caused by unrelated blood transfusions by monitoring graft outcome in recipients transplanted with DLA-identical littermate marrow after conditioning with 920 cGy total body irradiation. Two thousand cGy gamma-irradiation of unrelated blood transfusions significantly reduced the incidence of transfusion-induced sensitization of recipients. There was successful marrow engraftment in 15 of 16 (94%, P < 0.003) of these animals in contrast to the previous study in which only 7 of 16 (44%) animals engrafted after they were transfused with unmodified blood on the same schedule. These results suggest that blood transfusions for use in humans, especially for patients with aplastic anemia, should be gamma-irradiated in order to reduce the incidence of marrow graft rejection caused by sensitization to minor histocompatibility antigens.

Background: Studies in the late 1940s and early 1950s showed that mice given marrow-ablative lethal doses of total body irradiation (TBI) survived if rescued by the infusion of hemopoietic stem cells or spleen shielding. Methods: Based on these observations, the first clinical studies were carried out in the mid-1950s. The modern era of bone marrow transplantation (BMT) began in the late 1960s, following the initial characterization of the major histocompatibility complex (MHC), termed HLA in man. Several preparative regimens are being used. Hemopoietic stem cells are obtained from the patient’s own (autologous) marrow or peripheral blood, from an identical (syngeneic) twin, or from another related or unrelated (allogeneic) donor. With allogeneic transplantation, T cells are depleted from donor marrow or immunosuppressive agents are given to prevent graft-versus-host disease (GVHD). Results: Many congenital or acquired malignant or nonmalignant diseases are being treated by BMT. Results vary dependent upon diagnosis, disease stage, type of transplant, and others. While survival may be 90% in patients with severe aplastic anemia and 80% in patients with chronic myeloid leukemia transplanted early in their course, survival may be only 10% with advanced leukemia. Outcome is less good with HLA-no-nidentical transplants GVHD and disease recurrence are the most frequent complications. Conclusions: Marrow or hemopoietic stem cell transplantation provides effective treatment (cure) for several diseases and is the treatment of choice for certain diagnoses. New modalities such as growth factors, cytokines or somatic gene transfer are currently being explored.

One of the persistent complications in searches for transiting exoplanets is the low percentage of the detected candidates that ultimately prove to be planets, which significantly increases the load on the telescopes used for the follow-up observations to confirm or reject candidates. Several attempts have been made at creating techniques that can pare down candidate lists without the need of additional observations. Some of these techniques involve a detailed analysis of light curve characteristics; others estimate the stellar density or some proxy thereof. In this paper, we extend upon this second approach, exploring the use of independently-calculated stellar densities to identify the most promising transiting exoplanet candidates. We use a set of CoRoT candidates and the set of known transiting exoplanets to examine the potential of this approach. In particular, we note the possibilities inherent in the high-precision photometry from space missions, which can detect stellar asteroseismic pulsations from which accurate stellar densities can be extracted without additional observations., 33 pages, 9 figures

In this paper, the CoRoT Exoplanet Science Team announces its 14th discovery. Herein, we discuss the observations and analyses that allowed us to derive the parameters of this system: a hot Jupiter with a mass of $7.6 \pm 0.6$ Jupiter masses orbiting a solar-type star (F9V) with a period of only 1.5 d, less than 5 stellar radii from its parent star. It is unusual for such a massive planet to have such a small orbit: only one other known exoplanet with a higher mass orbits with a shorter period., 7 pages, 10 figures, accepted to Astronomy and Astrophysics

Summary. Four patients with Diamond-Blackfan syndrome (congenital hypoplastic anaemia) whose disease was resistant to corticosteroid treatment and who were red blood cell transfusion-dependent, were given marrow grafts from allogeneic human-leucocyte-antigen (HLA)-identical siblings. The patients were conditioned with regimens including cyclophosphamide and busulfan. Three of four patients had sustained and complete marrow engraftment. One patient showed early signs of haematopoietic recovery but died on day 35 of pulmonary toxicity. The three surviving patients are well with normal haematopoiesis and Karnofsky performance scores of 100%, 3·0, 7·4 and 10·6 years after transplantation. Congenital hypoplastic anaemia can be treated successfully by allogeneic marrow grafts.

The effects of recombinant canine stem cell factor (rcSCF) on hematopoiesis were studied in normal dogs and in dogs given otherwise lethal total body irradiation (TBI) without marrow transplant. Results were compared with previous and concurrent data with recombinant granulocyte colony-stimulating factor (rG-CSF). Four normal dogs received 200 micrograms rcSCF per kilogram body weight daily either by continuous intravenous infusion for 28 days (n = 2) or by subcutaneous (SC) injection in two divided doses for 20 days (n = 2). All dogs showed at least a twofold increase in peripheral blood neutrophil counts starting approximately 7 days after the initiation of treatment. Hematocrit level and monocyte, lymphocyte, eosinophil, reticulocyte, and platelet counts were not elevated. Marrow sections after rcSCF treatment showed panhyperplasia. The only toxicity was facial edema during the first few days of rcSCF administration, presumably caused by mast cell stimulation. Ten dogs were given 400 cGy TBI at 10 cGy/min from two opposing 60Co sources. They were given no marrow infusion and received 200 micrograms/kg/d rcSCF SC in two divided doses for 21 days starting within 2 hours of TBI. Five of the 10 dogs showed complete and sustained hematopoietic recovery and survived as compared with 1 of 28 control dogs not receiving growth factor (P < .005). RcSCF treatment allowed for hematopoietic recovery in two of seven dogs administered 500 cGy of TBI but in none of five dogs given 600 cGy of TBI. Results with rcSCF are similar to those obtained with rG-CSF. The rate of neutrophil recovery in rcSCF-treated dogs after 400 cGy TBI was not different from that of rG-CSF-treated dogs (P = .65), but the rate of platelet recovery was faster (P = .06) in the rcSCF-treated animals. Combined treatment with rcSCF and rcG-CSF after 500 cGy TBI did not result in strongly improved survival as compared with results obtained with either factor alone.

The effects of recombinant canine stem cell factor (rcSCF) on hematopoiesis were studied in normal dogs and in dogs given otherwise lethal total body irradiation (TBI) without marrow transplant. Results were compared with previous and concurrent data with recombinant granulocyte colony-stimulating factor (rG-CSF). Four normal dogs received 200 micrograms rcSCF per kilogram body weight daily either by continuous intravenous infusion for 28 days (n = 2) or by subcutaneous (SC) injection in two divided doses for 20 days (n = 2). All dogs showed at least a twofold increase in peripheral blood neutrophil counts starting approximately 7 days after the initiation of treatment. Hematocrit level and monocyte, lymphocyte, eosinophil, reticulocyte, and platelet counts were not elevated. Marrow sections after rcSCF treatment showed panhyperplasia. The only toxicity was facial edema during the first few days of rcSCF administration, presumably caused by mast cell stimulation. Ten dogs were given 400 cGy TBI at 10 cGy/min from two opposing 60Co sources. They were given no marrow infusion and received 200 micrograms/kg/d rcSCF SC in two divided doses for 21 days starting within 2 hours of TBI. Five of the 10 dogs showed complete and sustained hematopoietic recovery and survived as compared with 1 of 28 control dogs not receiving growth factor (P < .005). RcSCF treatment allowed for hematopoietic recovery in two of seven dogs administered 500 cGy of TBI but in none of five dogs given 600 cGy of TBI. Results with rcSCF are similar to those obtained with rG-CSF. The rate of neutrophil recovery in rcSCF-treated dogs after 400 cGy TBI was not different from that of rG-CSF-treated dogs (P = .65), but the rate of platelet recovery was faster (P = .06) in the rcSCF-treated animals. Combined treatment with rcSCF and rcG-CSF after 500 cGy TBI did not result in strongly improved survival as compared with results obtained with either factor alone.

The space telescope CoRoT searches for transiting extrasolar planets by continuously monitoring the optical flux of thousands of stars in several fields of view. We report the discovery of CoRoT-10b, a giant planet on a highly eccentric orbit (e=0.53 +/- 0.04) revolving in 13.24 days around a faint (V=15.22) metal-rich K1V star. We use CoRoT photometry, radial velocity observations taken with the HARPS spectrograph, and UVES spectra of the parent star to derive the orbital, stellar and planetary parameters. We derive a radius of the planet of 0.97 +/- 0.07 R_Jup and a mass of 2.75 +/- 0.16 M_Jup. The bulk density, rho_pl=3.70 +/- 0.83 g/cm^3, is ~2.8 that of Jupiter. The core of CoRoT-10b could contain up to 240 M_Earth of heavy elements. Moving along its eccentric orbit, the planet experiences a 10.6-fold variation in insolation. Owing to the long circularisation time, tau_circ > 7 Gyr, a resonant perturber is not required to excite and maintain the high eccentricity of CoRoT-10b.

A novel immunosuppressant, succinyl acetone (4,6-dioxoheptanoic acid), was studied in dogs. Results with bolus intravenous injections at doses ranging from 50 to 1600 mg/kg showed dose-dependent alpha and beta half-lives, ranging from 30 to 80 min and 7 to 27 hr, respectively. Results suggested that continuous i.v. infusion was necessary to maintain constant plasma levels. Four dogs were given 9.2 Gy total-body irradiation and autologous marrow transplants along with continuous i.v. infusion of succinyl acetone at 50, 100, 200, or 400 mg/kg/day for 21 days, and all four had rapid, sustained hematopoietic engraftment. However, two of the four dogs receiving 200 and 400 mg succinyl acetone/kg/day, respectively, developed bilateral hind-limb ataxia, with histologically confirmed cerebellar lesions in the dog given the higher dose, thus establishing a potential dose-limiting neurotoxicity. Prevention of graft-versus-host disease was studied in recipients of allogeneic marrow. Dogs were given 9.2 Gy TBI, followed by hematopoietic grafts from unrelated DLA-nonidentical or DLA-haploidentical littermate dogs. Succinyl acetone was given as continuous infusion for 21 days after transplant at doses of 100-300 mg/kg/day. Starting succinyl acetone on the day of marrow infusion in four dogs failed to prevent rapid onset of acute GVHD, and dogs survived no longer than controls. Starting succinyl acetone 3 days before transplant delayed the onset of acute GVHD and prolonged survival significantly compared with that of dogs not given postgrafting immunosuppression (P = 0.008); survival was comparable to that in previously reported dogs given either methotrexate or cyclosporine as postgrafting immunosuppression (P = 0.88 and 0.99, respectively). Seven of the sixteen allogeneic recipients developed evidence of neurotoxicity during succinyl-acetone infusion. Neurological dysfunctions were manifested by hind-limb ataxia and posterior paresis. In conclusion, succinyl acetone significantly delayed the onset of GVHD and prolonged survival of DLA-nonidentical marrow graft recipients but did not induce graft-host tolerance and was associated with dose-limiting neurotoxicity.

Previous studies of risk factors for acute graft-versus-host disease (GVHD) involved patients receiving predominantly single-agent prophylaxis. Therefore, a retrospective analysis was performed on 446 patients, from a single institution, who received transplants of marrow from HLA-identical siblings and the combination of cyclosporine (CSP) and methotrexate (MTX) to determine risk factors for acute GVHD associated with this more effective form of GVHD prophylaxis. The incidences of Grades II-IV and Grades III-IV (severe) acute GVHD were 35% and 16%, respectively. Increased clinical grades of acute GVHD in patients without advanced malignant disease were associated with a decreased survival. In a multivariate Cox regression analysis, risk factors associated with the onset of Grades II-IV acute GVHD were sex mismatch and donor parity (P = .001), increased dose of total body irradiation (TBI) (P = .001), and reduction to less than 80% of the scheduled dose of MTX (P = .02) or CSP (P = .02). The multivariate analysis indicated a relative risk of 1.37 for acute GVHD in a group defined as having advanced malignant disease at transplant; however, this difference failed to reach conventional levels of statistical significance (P = .07). Reduction of MTX and CSP occurred in up to 36% and 44% of patients, respectively, primarily because of renal or hepatic dysfunction. The periods of increased risk for the onset of acute GVHD were up to 1 week after a reduction of MTX and 2 weeks after a reduction in CSP. When only patients who developed Grades II-IV acute GVHD were considered, the more severe acute GVHD of Grades III-IV was associated with increased patient age of 40 years or greater (P = .05) and dose reductions of CSP (P = .008). Serologic status of patient and donor for cytomegalovirus (CMV), HLA antigens in the A and B loci, and isolation in a laminar air flow room during marrow transplantation, all previously identified as risk factors for acute GVHD, were not confirmed as risk factors in this study population. The toxicity of MTX and CSP and the development of acute GVHD from inadequate immunosuppression because of dose reduction warrants further trials with potentially less toxic immunosuppressive agents. Risk factors for acute GVHD should be considered in clinical management and in the design of clinical trials.

166Holmium ethylenediaminetetramethylene phosphonic acid (166Ho-EDTMP) is a short-lived beta-emitting radionuclide complexed to an aminophosphonate ligand that we have investigated in a canine model as a potential agent for specific marrow ablation before marrow transplantation. After intravenous injections, 166Ho-EDTMP distributed principally to bone and after 24 hours the concentrations of 166Ho- EDTMP in bone were more than 200-fold higher than in any other organ. Increasing dosages of 166Ho-EDTMP led to increasingly prolonged and severe myelosuppression, but myeloablation was not achieved. Histologic examination of recovering animals suggested that the spleen may have acted as a reservoir for circulatory hematopoietic precursors. Four splenectomized animals administered 20 to 30 mCi/kg 166Ho-EDTMP without marrow transplantation died with marrow aplasia, while four splenectomized animals administered similar dosages of 166Ho-EDTMP followed by autologous transplantation recovered. The dose-limiting toxicity of 166Ho-EDTMP appeared to be marrow stromal damage resulting in myelofibrosis, which was reversible. These results suggest that 166Ho-EDTMP can be used to specifically ablate marrow function before marrow transplantation.

We report measurements of the thermal emission of the young and massive planet CoRoT-2b at 4.5 and 8 microns with the Spitzer Infrared Array Camera (IRAC). Our measured occultation depths are 0.510 +- 0.042 % and 0.41 +- 0.11 % at 4.5 and 8 microns, respectively. In addition to the CoRoT optical measurements, these planet/star flux ratios indicate a poor heat distribution to the night side of the planet and are in better agreement with an atmosphere free of temperature inversion layer. Still, the presence of such an inversion is not definitely ruled out by the observations and a larger wavelength coverage is required to remove the current ambiguity. Our global analysis of CoRoT, Spitzer and ground-based data confirms the large mass and size of the planet with slightly revised values (Mp = 3.47 +- 0.22 Mjup, Rp = 1.466 +- 0.044 Rjup). We find a small but significant offset in the timing of the occultation when compared to a purely circular orbital solution, leading to e cos(omega) = -0.00291 +- 0.00063 where e is the orbital eccentricity and omega is the argument of periastron. Constraining the age of the system to be at most of a few hundreds of Myr and assuming that the non-zero orbital eccentricity is not due to a third undetected body, we model the coupled orbital-tidal evolution of the system with various tidal Q values, core sizes and initial orbital parameters. For log(Q_s') = 5 - 6, our modelling is able to explain the large radius of CoRoT-2b if log(Q_p'), 13 pages, 2 tables, 11 figures. Accepted for publication in Astronomy and Astrophysics

Context: CoRoT is a pioneering space mission devoted to the analysis of stellar variability and the photometric detection of extrasolar planets. Aims: We present the list of planetary transit candidates detected in the first field observed by CoRoT, IRa01, the initial run toward the Galactic anticenter, which lasted for 60 days. Methods: We analysed 3898 sources in the coloured bands and 5974 in the monochromatic band. Instrumental noise and stellar variability were taken into account using detrending tools before applying various transit search algorithms. Results: Fifty sources were classified as planetary transit candidates and the most reliable 40 detections were declared targets for follow-up ground-based observations. Two of these targets have so far been confirmed as planets, COROT-1b and COROT-4b, for which a complete characterization and specific studies were performed., 11 pages, 8 figures

The motivation, techniques and performance of the ground-based photometric follow-up of transit detections by the CoRoT space mission are presented. Its principal raison d'\^{e}tre arises from the much higher spatial resolution of common ground-based telescopes in comparison to CoRoT's cameras. This allows the identification of many transit candidates as arising from eclipsing binaries that are contaminating CoRoT's lightcurves, even in low-amplitude transit events that cannot be detected with ground-based obervations. For the ground observations, 'on'-'off' photometry is now largely employed, in which only a short timeseries during a transit and a section outside a transit is observed and compared photometrically. CoRoT planet candidates' transits are being observed by a dedicated team with access to telescopes with sizes ranging from 0.2 to 2 m. As an example, the process that led to the rejection of contaminating eclipsing binaries near the host star of the Super-Earth planet CoRoT-7b is shown. Experiences and techniques from this work may also be useful for other transit-detection experiments, when the discovery instrument obtains data with a relatively low angular resolution., Comment: Accepted for the A&A special issue on CoRoT

We established a model of canine marrow autografts after 9.2 Gy total body irradiation (TBI) to study the role of class II antigens in hematopoietic stem cell growth and differentiation. Twenty dogs were given 9.2 Gy TBI, marrow, and intravenous (IV) murine anti-class II monoclonal antibody (MoAb). Infusion of 0.6 mg/kg/d of MoAb H81.98.21, an IgG2a reactive with HLA-DR, on days 0 to 4 after TBI did not prevent initial engraftment, but dogs died with late graft failure. MoAb B1F6, an IgG2a reactive with HLA-DR + DP, had no adverse effect on engraftment, although both MoAbs detect antigens on stem cells. The critical time for the effect of MoAbs is the first 4 days after transplantation. Our findings argue against several pathogenetic mechanisms, including removal of MoAb-coated stem cells by the reticuloendothelial system (RES), canine complement-mediated cytotoxic effects on stem cells, antibody-dependent cellular cytotoxicity, and inactivation of MoAb-coated cells by dog anti-mouse antibody. To distinguish between MoAb-induced damage to microenvironment (ME)/accessory cells (AC) and late graft failure from a lack of pluripotent stem cells, three dogs were given TBI, a marrow autograft, and MoAb H81.98.21 on days 0 to 4; one, given thoracic duct cells on day 6, developed graft failure; the other two, given marrow depleted of AC by L-leucyl L-leucine o-methyl ester (Leu-Leu-OMe), had sustained grafts. Findings support the notion that originally transplanted pluripotent stem cells are no longer present on day 6 and that the ME is functional and able to support newly injected stem cells.

Context. The CoRoT space mission routinely provides high-precision photometric measurements of thousands of stars that have been continuously observed for months. Aims. The discovery and characterization of the first very massive transiting planetary companion with a short orbital period is reported. Methods. A series of 34 transits was detected in the CoRoT light curve of an F3V star, observed from May to October 2007 for 152 days. The radius was accurately determined and the mass derived for this new transiting, thanks to the combined analysis of the light curve and complementary ground-based observations: high-precision radial-velocity measurements, on-off photometry, and high signal-to-noise spectroscopic observations. Results. CoRoT-Exo-3b has a radius of 1.01+-0.07 RJup and transits around its F3-type primary every 4.26 days in a synchronous orbit. Its mass of 21.66+-1.0 MJup, density of 26.4+-5.6 g cm^-3, and surface gravity of log g = 4.72 clearly distinguish it from the regular close-in planet population, making it the most intriguing transiting substellar object discovered so far. Conclusions. With the current data, the nature of CoRoT-Exo-3b is ambiguous, as it could either be a low-mass brown-dwarf or a member of a new class of "superplanets". Its discovery may help constrain the evolution of close-in planets and brown-dwarfs better. Finally, CoRoT-Exo-3b confirms the trend that massive transiting giant planets (M >= 4 MJup) are found preferentially around more massive stars than the Sun., 11 pages, 12 figures, accepted for A&A

The CoRoT satellite has announced its fourth transiting planet (Aigrain et al. 2008) with space photometry. We describe and analyse complementary observations of this system performed to establish the planetary nature of the transiting body and to estimate the fundamental parameters of the planet and its parent star. We have analysed high precision radial-velocity data, ground-based photometry, and high signal-to-noise ratio spectroscopy. The parent star CoRoT-Exo-4 (2MASS 06484671-0040219) is a late F-type star of mass of 1.16 Msun and radius of 1.17 Rsun. The planet has a circular orbit with a period of 9.20205d. The planet radius is 1.19 Rjup and the mass is 0.72 Mjup. It is a gas-giant planet with a ''normal'' internal structure of mainly H and He. CoRoT-Exo-4b has the second longest period of the known transiting planets. It is an important discovery since it occupies an empty area in the mass-period diagram of transiting exoplanets., accepted in A&AL

Sodium-concrete interactions were investigated experimentally and theoretically. The experiments revealed important effects of quartzitic material within the concrete and of the sodium temperature on the interaction mechanisms, the energy release and the consequent hydrogen production. The numerical model shows good agreement with the experimental results

Clinical Presentation.- Differential Diagnosis.- Etiology and Epidemiology.- Molecular Biology of Myelodysplasia.- Classification an Staging of Myelodysplastic Syndromes.- Cytogenetic Diagnosis of Myelodysplastic Syndromes.- Myelodysplastic Syndrome in Children.- Management of Patients with Myelodysplastic Syndromes.- Supportive Care.- Hematopoietic Growth Factors.- Biologically Based Treatment.- Hemopoietic Cell Transplantation.- Second Malignancies.

Allogeneic haematopoietic cell transplantation (HCT) is effective therapy for Fanconi anaemia (FA). FA patients do not tolerate conditioning with 200 mg/kg of cyclophosphamide (Cy), typically used in aplastic anaemia. We previously published results of studies in which Cy doses were gradually reduced from 200 to 100 mg/kg. Here we update results of the initial studies and report data on 30 new patients conditioned with Cy either at 80 mg/kg (n = 7) or at 60 mg/kg (n = 23), given over 4 days before HCT from human leucocyte antigen-matched related donors. Methotrexate and cyclosporine were given for graft-versus-host disease (GVHD) prophylaxis. All seven patients given Cy at 80 mg/kg and 21 of 23 given Cy at 60 mg/kg had sustained engraftment, while two patients, both with clonal cytogenetics abnormalities, experienced graft failure. Grades 2-3 acute GVHD rates were 57% and 14% for patients given the higher and lower Cy doses, respectively (P = 0.001). Four patients given Cy at 80 mg/kg and 22 given Cy at 60 mg/kg were alive at a median of 47 (44-58) months and 16 (3-52) months, respectively. Cy at 60 mg/kg has acceptable toxicities, low rates of GVHD, and is sufficient for engraftment of related grafts in most FA patients.

To investigate the biological changes in myelodysplastic syndromes (MDS) myeloid blast cell line MDS-L after different duration and concentration of As2O3/TRAIL (TNF related apoptosis inducing ligand) treatment.MDS-L cells were treated with As2O3 and TRAIL at 9 different concentrations and the treated cells were detected at 24 h, 48 h and 72 h for biologic indexes. The same detections were conducted in untreated MDS-L cells and normal and MDS marrow cells as controls. Apoptosis was assayed by flow cytometry after Annexin V-FITC labelling. Differentiation-induction effect of these drugs on the cells were detected by morphologic examination and CD34(+) proportion analysis after 24 hours treatment and further agar culture for 18 days; P15(ink4b) mRNA expression were detected by RT-PCR and its protein expression by DAB immunocytochemistry, P15(ink4b) DNA methylation by methylation specific PCR (Msp).As2O3/TRAIL treatment promoted MDS-L cells to undergo apoptosis and As2O3 plus TRAIL showed obvious differentiation-induction effect on MDS-L. P15(ink4b) mRNA expression was upregulated in MDS-L cell line after different drug treatment but almost no protein expression increased. Increased P15 expression seemed to be related with DNA demethylation effect of these drugs.As2O3 or/and TRAIL treatment could promote apoptosis of the clonal cells and induce incomplete cell differentiation. The drugs treatment could also increase P15(ink4b) expression in MDS-L cell line through their demethylation effects.

Transplantation immunobiology: thymic T-cell development MHC class 1: structure and function MHC class II: structure and function biological inhibitors of lymphocyte coreceptors for antigen-specific immunosuppression immunosuppression andimmunophilin ligands: cyclosporin A, FK506, and rapamycin leucocyte adhesion, trafficking, and migration cytokine networks mechanisms of T-cell-mediated cytotoxicity in vivo and in vitro natural killer cells. GVHD pathophysiology - target organs: theimmune system: effector and target of Graft-vs.-Host disease cellular pathology of cutaneous Graft-vs-Host disease Graft-vs.-Host disease of the liver intestinal Graft-vs. disease Graft versus leukaemia lung injuries associated with Graftvs.-Hostreactions the effect of GVHD on the haematopoietic system. Network activation and dysregulation: Graft-vs.-Host disease as the Th-1 type process: regulation by donor cells of Th2 cytokine phenotype the role of endotoxin in the pathogenesis of acuteGraft-vs.-Host disease. Clinical GVHD - prevention and treatment: clinical spectrum of Graft-vs.-Host disease the immunobiology of syngeneic/autologous Graft-vs.-Host disease transfusion-associated Graft-vs.-Host disease. Current strategies: role ofhistocompatibility antigens in the development of graft-vs.-Host disease T-cell depletion of GVHD prevention in humans in vivo prevention and treatment of GVHD antagonists of inflammatory cytokines: prophylactic and therapeutic applications the roleof interleukin-10 in transplantation and GVHD. Alternative approaches: positive stem-cell selection for hermatopoietic transplantation adoptive immunotherapy in bone marrow transplantation genetherapy recent advances and future directions.

Graft-mediated antileukemia (GVL) activity is a major factor contributing to the success of allogeneic hematopoietic stem transplantation (aHCT). Recent advances have permitted the establishment of GVL activity without the need for a myeloablative conditioning regimen, thereby permitting even older and sicker patients to avail of potentially curative therapy. Use of adoptive immunotherapy by combining reduced intensity conditioning and donor leukocyte infusion (DLI) has resulted in strategies that can be exploited to maximize GVL effects while minimizing toxicity. These advances, combined with new molecularly targeted agents, creates new possibilities to develop less toxic, curative therapy for a greater number of patients. This review summarizes pertinent information regarding the evidence in favor of GVL effects, the impact of disease type and mechanisms of GVL.

The purpose of this study was to evaluate the role of allogeneic bone marrow transplantation (BMT) in children with myelodysplastic syndrome (MDS). In total, 94 consecutive pediatric patients with MDS received an allogeneic BMT from 1976 to 2001 for refractory anemia (RA) (n=25), RA with ringed sideroblasts (RARS) (n=2), RA with excess blasts (RAEB) (n=20), RAEB in transformation (RAEB-T) (n=14), juvenile myelomonocytic leukemia (JMML) (n=32) or chronic myelomonocytic leukemia (CMML) (n=1). The estimated 3-year probabilities of survival, event-free survival (EFS), nonrelapse mortality and relapse were 50, 41, 28 and 29%, respectively. Patients with RA/RARS had an estimated 3-year survival of 74% compared to 68% in those with RAEB and 33% in patients with JMML/CMML. In multivariable analysis, patients with RAEB-T or JMML were 3.9 and 3.7 times more likely to die compared to those with RA/RARS and RAEB (P=0.005 and 0.004, respectively). Patients with RAEB-T were 5.5 times more likely to relapse (P=0.01). The median follow-up among the 43 surviving patients is 10 years (range 1-25). We conclude that allogeneic BMT for children with MDS is well tolerated and can be curative.

In this paper we present multi-epoch observations of the pre-main sequence binary HK Ori. These data have been drawn from the EXPORT database and are complemented by high quality spectro-astrometric data of the system. The spectroscopic data appear to be very well represented by a combination of an A dwarf star spectrum superposed on a (sub-)giant G-type spectrum. The radial velocity of the system is consistent with previous determinations, and does not reveal binary motion, as expected for a wide binary. The spectral, photometric and polarimetric properties and variability of the system indicate that the active object in the system is a T Tauri star with UX Ori characteristics. The spectro-astrometry of HK Ori is sensitive down to milli-arcsecond scales and confirms the speckle interferometric results from Leinert et al. The spectro-astrometry allows with fair certainty the identification of the active star within the binary, which we suggest to be a G-type T Tauri star based on its spectral characteristics., MNRAS in press 8 pages 7 figures

In a canine model we investigated the toxicity and pharmacokinetics of a water soluble busulfan preparation. Busulfan was dissolved in dimethylsulfoxide (DMSO) and administered either orally or intravenously in a single dose of 1 mg/kg. The application in either preparation was well tolerated. In seven dogs, peak levels in the range of 730 ng/mL to 1,000 ng/mL were measured after intravenous injection with an area under curve (AUC) of 75 ng.h/kg.mL to 146 ng.h/kg.mL. It was of note that even the oral administration of the same busulfan preparation resulted in AUC values in the same range as observed after parenteral application. The absorption rate of busulfan tablets in our model was as unpredictable as documented in clinical trials. On the basis of the present study, clinical trials using busulfan dissolved in DMSO given either intravenously or orally appear warranted. This approach should lead to predictable blood levels, reduced toxicity, and increased efficacy of busulfan-containing regimens.

The deletion (5q) karyotype [del (5q)] in patients with myelodysplastic syndrome (MDS) is considered a good risk feature, while the impact of del (5q) combined with other karyotypic abnormalities [del (5q)+] is less well defined. We analysed the outcome of haematopoietic cell transplants (HCT) in patients with MDS with del (5q) or del (5q)+. Fifty-seven patients, aged 6-72 years, with MDS and del (5q) abnormalities received HCT from related (n = 32) or unrelated (n = 25) donors. By French-American-British (FAB) criteria, 27 patients had refractory anaemia (RA), 10 RA with excess blasts (RAEB), eight RAEB in transformation (RAEB-T) and 12 acute myeloid leukaemia evolving from MDS (tAML). Non-relapse mortality at 1-year post-transplantation was 30% for del (5q) and 38% for del (5q)+ patients. Relapse occurred in one of 20 del (5q) patients and 15 of 37 del (5q)+ patients (P = 0.001). After adjusting for del (5q) status, blast count (5%) was the only factor significantly associated with relapse-free survival. Patients with del (5q), either as a '5q- syndrome' or with MDS in general, had better outcomes than did patients with del (5q)+. The indication for transplantation in patients with del (5q) was generally severe cytopenias, compared with disease progression to a more advanced FAB stage in patients with del (5q)+. Conceivably, outcome for patients with del (5q)+ would be improved with transplantation earlier in the disease course.

In a pilot trial we evaluated the toxicity and efficacy of sirolimus (rapamycin) as second-line therapy for the treatment of acute graft-versus-host disease (GVHD) in 21 patients (1-46 years of age) after allogeneic hematopoietic stem cell transplantation (HSCT).All patients were treated with methylprednisolone at 2 mg/kg/day, but failed to respond satisfactorily. Sirolimus was started 19-78 (median 37) days after HSCT when 10 patients had grade III and 11 had grade IV GVHD. The first four patients received a loading dose (15 mg/m2) of oral sirolimus on day 1 followed by 5 mg/m2/day for 13 days. The next 17 patients received either 5 (n=7) or 4 (n=10) mg/m2/day for 14 days without a loading dose. Eleven patients completed the 14-day sirolimus course. Five patients were treated for 9-13 days, two for 6 days, and three for 1-3 days.Sirolimus was discontinued early in 10 patients because of lack of improvement in GVHD (n=5), myelosuppression (n=2), seizure (n=2), and attending physician preference (n=1). The most common and significant adverse events were thrombocytopenia (n=7) and neutropenia (n=4). Other side effects included increased blood triglycerides (n=8) and cholesterol (n=3). Five patients had evidence of a hemolytic uremic syndrome concurrently with or after sirolimus treatment. Eighteen of the 21 patients received 6 or more doses of sirolimus and 12 responded, 5 with complete and 7 with partial responses. Six of the 12 responders (28% of all patients enrolled) and 1 nonresponder are currently alive at 400-907 days after HSCT, 3 with chronic GVHD. Fourteen of the 21 patients (66%) died 40-263 days after transplant.These data suggest that sirolimus has activity in the treatment of steroid-refractory acute GVHD. However, there was considerable toxicity and further dose optimization studies seem warranted.

This study was undertaken to evaluate the toxicity and pharmacokinetics of a dimethyl sulphoxide (DMSO)-based intravenous formulation of busulphan in the conditioning of 45 patients undergoing allogeneic or autologous stem cell transplantation (SCT). Busulphan was given as a single daily dose. In 15 patients a single dose of intravenous busulphan, given over 3 h in 1 d, was combined with additional oral (single daily) doses. Thirty patients received all four daily doses intravenously. Busulphan plasma levels were analysed using high performance liquid chromatography. There was no major acute toxicity with daily intravenous doses of 2.8-3.1 mg/kg infused over 3 h. No veno-occlusive disease (VOD) was seen in 30 patients receiving busulphan as an intravenous formulation over 4 d. In the group of 15 patients receiving three oral doses and one intravenous single daily dose, one patient experienced mild VOD. Pharmacokinetic samples were taken over at least 2 d of treatment in 44 patients. The area under the concentration time curve (AUC) values normalized for a dose of 1 mg/kg were 7000 ng/ml x h on d 1 and 5890 ng/ml x h on d 4, thus showing a moderate decrease over time. This was accompanied by a moderate increase of the clearance from 2.6 to 3.0 ml/min/kg. Administration of busulphan as a DMSO-based intravenous formulation was well tolerated. The total dose of busulphan can be given in four (rather than the typical 16) doses. With such a regimen, the intravenous administration becomes feasible on an outpatient basis.

During fetal development, the spleen is a major hemopoietic organ. In the adult human, this task is relinquished to the bone marrow. However, under the stress of certain pathologic conditions, extramedullary hemopoiesis may again occur in the spleen. This is especially true for diseases of the marrow, in particular, myeloproliferative disorders such as agnogenic myeloid metaplasia, which is associated with severe fibrosis of the marrow space. At the same time, the spleen sequesters blood cells and contributes to peripheral blood cytopenias, which may improve following splenectomy. However, success is unpredictable, and the operative mortality of splenectomy is on the order of 10%. As a growing number of patients undergo hemopoietic stem cell transplantation as definitive therapy for myelofibrosis, the decision on splenectomy has additional ramifications since the spleen plays an important role in the kinetics of engraftment of donor cells and in immune reconstitution. We conclude from our analysis of available information that the benefit of splenectomy is difficult to predict, although after transplantation splenectomized patients have faster hemopoietic recovery. It appears that the most important indication for splenectomy in these patients is the relief of symptoms from massive spleen enlargement.

This paper presents optical UBVRI broadband photo-polarimetry of the EXPORT sample obtained at the 2.5m Nordic Optical Telescope. The database consists of multi-epoch photo-polarimetry of 68 pre-main-sequence and main-sequence stars. An investigation of the polarization variability indicates that 22 objects are variable at the 3sigma level in our data. All these objects are pre-main sequence stars, consisting of both T Tauri and Herbig Ae/Be objects while the main sequence, Vega type and post-T Tauri type objects are not variable. The polarization properties of the variable sources are mostly indicative of the UXOR-type behaviour; the objects show highest polarization when the brightness is at minimum. We add seven new objects to the class of UXOR variables (BH Cep, VX Cas, DK Tau, HK Ori, LkHa 234, KK Oph and RY Ori). The main reason for their discovery is the fact that our data-set is the largest in its kind, indicating that many more young UXOR-type pre-main sequence stars remain to be discovered. The set of Vega-like systems has been investigated for the presence of intrinsic polarization. As they lack variability, this was done using indirect methods, and apart from the known case of BD +31.643, the following stars were found to be strong candidates to exhibit polarization due to the presence of circumstellar disks: 51 Oph, BD +31.643C, HD 58647 and HD 233517., A&A accepted

This retrospective study describes the outcome in 53 patients who had immunosuppressive treatment changed from cyclosporine (CSP) to tacrolimus for resistant acute GVHD (n = 23), hemolytic uremic syndrome (HUS) (n = 13) or CSP-associated neurotoxicity (n = 17). Tacrolimus was administered at doses of 0.03 mg/kg/day intravenously or 0.12 mg/kg/day orally in divided doses, as tolerated. Median time of conversion to tacrolimus after transplant was day 47. Nineteen patients had treatment changed to tacrolimus for resistant acute GVHD grades III or IV, with the median day of conversion being day 49 after transplant. Two of 20 evaluable patients had a complete resolution of GVHD after changing treatment to tacrolimus, with 18 showing no improvement. Eleven evaluable patients had therapy changed to tacrolimus for CSP-associated neurotoxicity at a median of 36 days after transplant. Eight patients had resolution of neurotoxicity and three had partial improvement. Eleven evaluable patients had therapy changed to tacrolimus for HUS at a median of 46 days after transplant. One patient had complete resolution of HUS and 10 showed no response. Side-effects related to tacrolimus included renal toxicity (34%), neurotoxicity (15%) and HUS (9%). Nine (17%) patients remain alive, including six patients who had therapy changed to tacrolimus for CSP-associated neurotoxicity. While often successful for dealing with neurotoxicity, only a rare patient improved after therapy was changed from CSP to tacrolimus for HUS or resistant acute GVHD.

In a randomized, placebo-controlled, double-blind trial, thalidomide or placebo together with glucocorticoids and either cyclosporine or tacrolimus was administered as initial therapy for clinical extensive chronic graft-versus-host disease (cGVHD). All patients had thrombocytopenia or cGVHD that evolved directly from acute GVHD as an indicator of a poor prognosis. The study drug (thalidomide or placebo) was administered initially at a dose of 200 mg orally per day, followed by a gradual increase to 800 mg/d if side effects were tolerable. Treatment with the study drug was discontinued before resolution of cGVHD in 23 (92%) of the 25 patients who received thalidomide and in 17 (65%) of the 26 patients who received placebo (P =.02). Neutropenia and neurologic symptoms were the most frequent reasons for early discontinuation of treatment with thalidomide. The duration of treatment with thalidomide was too short to assess its efficacy in controlling cGVHD. (Blood. 2000;96:3995-3996)

We evaluated the outcome of allogeneic bone marrow transplantation (BMT) in 21 patients with chronic myelomonocytic leukaemia (CMML) who were treated at the Fred Hutchinson Cancer Research Center between 1990 and 1998. There were 11 male and 10 female patients with a median age of 47.4 years (range 1.0-62.9). Patients were conditioned either with total body irradiation (TBI) and chemotherapy, with or without antithymocyte globulin (n = 19), or with chemotherapy alone (n = 2). The marrow donor was an HLA-identical sibling in 12 patients, an HLA-non-identical related donor in three patients and an unrelated volunteer donor in six patients. All evaluable patients achieved sustained engraftment. Fifteen patients developed grades II-IV acute graft-versus-host disease (GVHD). Nine patients (43.0%) are surviving disease free at 0.7-8.1 years (median 6.9) after transplantation. Five patients relapsed 75-660 d after transplant and all died. Five patients died with organ failure and two died with GVHD and associated infections. The Kaplan-Meier estimates of disease-free survival and relapse at 3 years were 39% and 25% respectively. The probability of survival was improved in patients with shorter disease duration compared with those with a long interval from diagnosis to BMT. Thus, as with other myeloproliferative diseases or myelodysplastic syndromes, BMT offers curative therapy for a proportion of patients with CMML. We suggest that patients with CMML who have a suitable donor should be considered for transplantation, probably early in their disease course. However, it will be important to develop new regimens with enhanced antileukaemic efficacy without further increasing regimen-related toxicity and mortality.

We studied whether blocking of the T cell costimulatory signal from B7--CD28 by cytotoxic T lymphocyte antigen 4-immunoglobulin fusion protein would, either by itself or when added to methotrexate/cyclosporine, result in improved graft-versus-host disease prevention after dog leukocyte antigen nonidentical canine hematopoietic stem cell transplantation after 920 cGy total body irradiation.Survivals of cytotoxic T lymphocyte antigen 4-immunoglobulin fusion protein-treated dogs were only slightly prolonged over controls. It appeared that the addition of cytotoxic T lymphocyte antigen 4-immunoglobulin fusion protein failed to induce graft-host tolerance in this model beyond that achieved with methotrexate/cyclosporine alone.

Marrow transplantation results in disease-free survival for less than one-third of patients treated for secondary leukemia. The objective of this report is to review results following allogeneic marrow transplantation for treatment of secondary leukemia or myelodysplasia at a single tertiary referral center to determine the patient characteristics which lead to better survival and lower relapse.The medical records of 99 patients with secondary leukemia or myelodysplasia transplanted consecutively at the Fred Hutchinson Cancer Research Center between 1971 and 1997 were reviewed. Prior to development of secondary leukemia or myelodysplasia, the patients' original diagnoses were hematopoietic malignancies, solid tumors, aplastic anemia, or miscellaneous individual disorders previously treated by chemotherapy alone, radiation alone, chemoradiotherapy, or immunosuppressive therapy. At the time of transplantation, at each stage of myelodysplasia the numbers of patients were 52 with acute myelogenous leukemia (AML), 15 with refractory anemia with excess blasts in transition (RAEB-T), 18 with refractory anemia with excess blasts (RAEB), 11 with refractory anemia (RA), 1 with refractory anemia with ringed sideroblasts (RARS), and 2 with hypoplastic unclassifiable hematologic disorders. Sixty-five patients received marrow from an HLA identical or partially identical family member, and 34 received marrow from an HLA identical unrelated donor after conditioning with chemotherapy and total body irradiation or chemotherapy alone.The Kaplan-Meier probability of survival after transplantation for all patients was 13%, and by stage of disease was 33% for RA/RARS, 20% for RAEB, and 8% for RAEB-T/AML. The probability of relapse for all patients was 47%, was 34% for RAEB, and 58% for RAEB-T/AML. None of the patients with RA/RARS has relapsed. The overall probability of non-relapse mortality was 78%, divided equally among infection or organ failure-related causes of death.The main impediments to long-term survival after transplantation for secondary leukemia or myelodysplasia are relapse and mortality from infections or organ failure. The survival is better when transplantation is done during the early stages of myelodysplasia because it is then associated with a lower relapse rate. These data suggest that patients at risk of secondary myelodysplasia should be followed prospectively to detect the early stages of myelodysplasia, and be considered for transplantation at that time.

The role of major histocompatibility complex class II antigens in hematopoiesis is not well defined. We have shown that in vitro depletion of HLA-DR+ cells from canine marrow (e.g., by anti-HLA-DR monoclonal antibody [mAb] H81.9 and complement) prevents hematopoietic recovery. In vivo administration of the same mAb H81.9 after transplantation of unmanipulated autologous marrow results in graft failure. In vitro mAb H81.9 inhibited colony formation from short-term and long-term marrow cultures.We investigated the effect of another mAb, Ca1.41, which also recognizes nonpolymorphic determinants on human (HLA-DR) and canine major histocompatibility complex class II antigens but is reactive with a narrower spectrum of cells in both canine peripheral blood and marrow than mAb H81.9 (and other anti-HLA-DR mAbs). In contrast to all other anti-HLA-DR mAbs tested, Ca1.41 did not interfere with colony formation in short-term or long-term marrow cultures and spared a population of small mononuclear cells with low forward light scatter that was eliminated via apoptosis by exposure to mAb H81.9. These target cells included lymphocytes and CD34+ hemopoietic precursors that expressed MHC class II molecules as determined by mAb H81.9 but not by mAb Ca1.41. In addition, transmembrane signaling and up-regulation of interleukin-1beta mRNA occurred with mAb H81.9 but not with Ca1.41. Transplantation of autologous marrow treated in vitro cytolytically with mAb Ca1.41 allowed for complete hematopoietic reconstitution. Further, in vivo administration of Ca1.41 posttransplant did not lead to autologous graft failure as had been observed with mAb H81.9.These results support the notion that major histocompatibility complex class II is expressed on early hematopoietic precursor cells but recognition is dependent upon the mAb used. Preliminary studies show that mAb H81.9 triggered transmembrane signaling, resulting in up-regulation of interleukin-1beta and apoptosis, although mAb Ca1.41 did not. The fact that Ca1.41 binding was modified in the presence of exogenous invariant chain-derived peptide suggests that both binding and signaling are peptide dependent.

Stable mixed chimerism can be established in dogs given a sublethal dose of 200 cGy total body irradiation (TBI) before and immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP) for 28 and 35 days, respectively, after dog leukocyte antigen-identical marrow transplantation. Most likely, the role of pretransplant TBI was to provide host immunosuppression, since stable mixed chimerism was also achieved in MMF/CSP-treated dogs when 450 cGy irradiation, targeted to cervical, thoracic, and upper abdominal lymph nodes, was substituted for TBI. When TBI was reduced from 200 to 100 cGy, all grafts were rejected within 3 to 12 weeks. Here, we asked whether stable engraftment after 100 cGy TBI could be accomplished by first reducing the intensity of host immune responsiveness with help of the fusion peptide CTLA4Ig, which blocks T-cell costimulation through the B7-CD28 signal pathway. Accordingly, recipient T cells were activated with intravenous (IV) injections of 10(6) donor peripheral blood mononuclear cells (PBMC)/kg per day on days -7 to -1 before 100 cGy TBI, with concurrent administration of CTLA4Ig 4 mg/kg/d IV. All 7 dogs so treated showed initial mixed chimerism. Two rejected their allografts after 8 and 20 weeks, respectively, and survived with autologous marrow recovery; 1 mixed chimera was unevaluable because of death at 3 weeks from intussusception; and 4 showed persisting mixed chimerism, including unirradiated marrow and lymph node spaces, for now more than 46 to 70 weeks after transplant. Data support the hypothesis that stable marrow allografts can be established by combining nonmyeloablative pretransplant host immunosuppression with posttransplant host and donor cell immunosuppression using MMF/CSP.

We evaluated 18,014 patients who underwent allogeneic bone marrow transplantation (BMT) at 235 centers worldwide to examine the incidence of and risk factors for posttransplant lymphoproliferative disorders (PTLD). PTLD developed in 78 recipients, with 64 cases occurring less than 1 year after transplantation. The cumulative incidence of PTLD was 1.0% +/- 0.3% at 10 years. Incidence was highest 1 to 5 months posttransplant (120 cases/10,000 patients/yr) followed by a steep decline to less than 5/10,000/yr among/=1-year survivors. In multivariate analyses, risk of early-onset PTLD (1 year) was strongly associated (P.0001) with unrelated or human leukocyte antigen (HLA) mismatched related donor (relative risk [RR] = 4.1), T-cell depletion of donor marrow (RR = 12.7), and use of antithymocyte globulin (RR = 6.4) or anti-CD3 monoclonal antibody (RR = 43.2) for prophylaxis or treatment of acute graft-versus-host disease (GVHD). There was a weaker association with the occurrence of acute GVHD grades II to IV (RR = 1.9, P =.02) and with conditioning regimens that included radiation (RR = 2.9, P =.02). Methods of T-cell depletion that selectively targeted T cells or T plus natural killer (NK) cells were associated with markedly higher risks of PTLD than methods that removed both T and B cells, such as the CAMPATH-1 monoclonal antibody or elutriation (P =.009). The only risk factor identified for late-onset PTLD was extensive chronic GVHD (RR = 4.0, P =.01). Rates of PTLD among patients with 2 or/=3 major risk factors were 8.0% +/- 2.9% and 22% +/- 17.9%, respectively. We conclude that factors associated with altered immunity and T-cell regulatory mechanisms are predictors of both early- and late-onset PTLD.

Stable mixed donor/host hematopoietic chimerism can be accomplished in dog leukocyte antigen (DLA)-identical littermate dogs given sublethal (200 cGy) total-body irradiation (TBI) before and immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP) after transplant (Blood 89:3048, 1997). Studies were based on the hypothesis that drugs that prevent graft-versus-host disease (GVHD) after transplant also suppress host-versus-graft (HVG) reactions and thereby enhance engraftment. Here, we asked whether pretransplant TBI provided marrow space for the graft to home or caused host immunosuppression. To address the questions, recipients were given pretransplant irradiation to cervical, thoracic, and abdominal lymph nodes (except pelvis), DLA-identical littermate marrow grafts, and MMF/CSP posttransplant. Six dogs that received 450 cGy irradiation showed initial engraftment. Two rejected their grafts after 8 and 18 weeks, 1 died with GVHD and engraftment, and 3 are alive as mixed chimeras after 57 to 97 weeks. Four dogs given 200 cGy irradiation also showed initial engraftment, but rejected their grafts after 10 to 18 weeks. Mixed chimerism was present in nonirradiated marrow and lymph node spaces and involved granulocytes, T cells, and monocytes. While other explanations are possible, results seem consistent with the hypothesis that pretransplant radiation provides host immunosuppression, and grafts can create their own marrow space. These data set the stage for the development of novel transplant regimens that substitute immunosuppressive for cytotoxic agents.

Agnogenic myeloid metaplasia (AMM) is a chronic myeloproliferative disorder in which patients with poor prognostic features, receiving conventional treatments, have a median survival of less than 3 years. In this retrospective multicenter study, we analyze the results and try to define the indications for allogeneic stem cell transplantation in AMM. From January 1979 to November 1997, 55 patients with a median age of 42 years were transplanted from HLA-matched related (n = 49) or alternative (n = 6) donors for AMM. A multivariate analysis was conducted to identify factors associated with posttransplant outcome. The median posttransplant follow-up was 36 months (range, 6 to 223). The 5-year probability of survival was 47% +/- 8% for the overall group, and 54% +/- 8% for patients receiving an unmanipulated HLA-matched related transplant. The 1-year probability of transplant-related mortality was 27% +/- 6%. Hemoglobin level/=100 g/L and osteomyelosclerosis before transplant adversely affected the outcome. The probability of developing grade III-IV acute graft-versus-host disease (GVHD) was 33% +/- 8%. Sixteen of 45 patients developed extensive chronic GVHD. At last follow-up, 22 patients were in complete histohematologic remission. Treatment failure was observed in 13 cases. Age at transplant and karyotype were predictors of treatment failure. Allogeneic stem cell transplantation is an effective treatment leading to cure in a substantial number of patients with AMM. A better characterization of the variables affecting the posttransplant outcome should lead to a decreased transplant-related mortality and an improvement in these results.

The development of recombinant DNA technology and gene delivery systems has made possible the genetic manipulation of hematopoietic cells. Use of this technology in transplantation medicine is being increasingly felt both in diagnostic and therapeutic applications. The fact that a relatively small number of hematopoietic stem cells normally supports an individual’s blood cell production through an entire lifespan has made these cells attractive targets for gene manipulation. Genetic modification of stem cells, may confer on all of their mature blood cell progeny, and for extended periods of time, the desired therapeutic genetic alteration. Thus, if an individual is deficient in a given gene product, and the defective gene has been cloned, then transduction and expression of a normal copy in reinfused hematopoietic cells of this individual might allow for correction of the defect. If the gene product can reach all sites in the patient where it is required, for example through normal vascular access of blood, such a manipulation should correct the gene deficiency and result in clinical benefit to the patient.