[CIS-PAGID] looking for transplant advice

[Jack Bleesing]

Just for my education:

BCG / MAI: same thing? Or asked in a different way; can you actually
clear MAI versus BCG post-BMT?

In cases, donors were used that had received BCG themselves (perhaps too
rare an occurrence): does it speed-up or improve BCG control post BMT
(agreeing with Gigi that using a TCD graft would not make sense to me)

Would it be possible (perhaps in the case of a matched sibling or
single-allele mismatched family donor - theorizing of course) that BCG
is given to the donor before donating? In other words, just like in
other BMT scenarios in which an infectious agent is giving lots of
trouble (for example EBV in XLP), I would consider a not-fully matched
donor, over a fully matched donor if the former is EBV+ and the latter
is EBV-, if I really need adoptive transfer of EBV-specific T-cells.

jb


---------------------------------------------------------------------------
Jack J.H. Bleesing, M.D., Ph.D.
Associate Professor of Pediatrics
Cincinnati Children's Hospital Medical Center
Division of Bone Marrow Transplantation & Immune Deficiency
3333 Burnet Avenue, MLC 7015
Cincinnati, OH 45229
513-636-4266 (phone)
513-636-3549 (fax)
Jack.Bleesing at CCHMC.org
http://www.cincinnatichildrens.org/immunodeficiencies/

>>> "Notarangelo, Luigi"  06/23/11 4:08 PM >>>

I agree with Antonio that this patient needs multi-drug treatment of BCG
and that this needs to be continued across transplant, including
engraftment (because this is the time when inflammatory complications
would otherwise develop). I would start treatment now but I would try to
perform the transplant within the next month or so. This is the only way
to save the patient. Who will be the donor? I would personally favor an
unmanipulated MUD (as long as full match)vs. a T-cell depleted haplo.

Gigi

Luigi D. Notarangelo
Division of Immunology
Children's Hospital boston
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Prof. Dr. Antonio Condino Neto" 
Sender: "pagid-bounces at list.clinimmsoc.org"
    
Date: Thu, 23 Jun 2011 15:52:44 
To: pagid at list.clinimmsoc.org; Sullivan,Kathleen
Reply-To: "pagid at list.clinimmsoc.org" 
Subject: Re: [CIS-PAGID] looking for transplant advice

Dear Kate

All of my CGD cases that underwent BMT started receiving drugs for BCG  
at least 6 weeks before the BMT or even earlier if they developed  
complications with BCG (25% of them complicate with BCG). The drugs  
against BCG were given continuously, before and after the BMT  
procedure and ALL of them worsened during BMT procedure, bringing it  
to real risk that has to explained to the family. As the BMT engrafted  
the BCG was brought to control.

In your case I would try to have it as more stable as possible before  
BMT and do it as quick as possible, the patient´s only chance to cure  
it.

Hope this helps your decision

All best

Condino
-- 
Antonio Condino-Neto
Professor of Experimental Medicine
Institute of Biomedical Sciences, University of São Paulo
1730 Lineu Prestes Avenue, São Paulo - SP. ZIP 05508-000. Brazil
Tel (55) (11) 3091-7387 / Fax (55) (11) 3091-7224



Citando "Sullivan, Kathleen" :


> I am posting this question on behalf of others but the big question

is:

>

> Does it make more sense to transplant now or to try to achieve some  

> clearance of mycobacteria prior to BMT?

>

> The patient is a two year old with very low T cell numbers (CD3  

> about 100-200) and no TRECS.  Her mitogens are not completely flat  

> but about 2-4% of the control.  She has immunoglobulin and B cells  

> and has had some responses to vaccines.  She had PCP and now  

> presents with MAI and huge nodes.  She was treated with triple  

> therapy for about three weeks for her MAI and the nodes enlarged.   

> We have increased her MAI coverage to 5 drugs and are thinking about  

> adding gamma-interferon.  We do not have a genetic type of SCID  

> identified although she has a mutation of uncertain significance in  

> the IL-7R

a gene and she has uniparental isodisomy of that chromosome.

>

> Given this picture, what do other people think about hurrying to do  

> a transplant on the theory that this is the only curative maneuver  

> that can clear her MAI vs waiting to achieve some level of control  

> and then transplanting?

>

>

> Kate

>

> Kate Sullivan, MD PhD

> Professor of Pediatrics

> ARC 1216 Immunology CHOP

> 3615 Civic Center Blvd.

> Philadelphia, PA 19104

> (p) 215-590-1697

> (f) 267-426-0363

>

>

>




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