Original Article
Bone marrow transplant in patients with sickle cell anaemia. Experience in one centre
Trasplante de médula ósea en pacientes con anemia falciforme. Experiencia en un centro
Read
8926
Timeswas read the article
2791
Total PDF
6135
Total HTML
Share statistics
array:24 [ "pii" => "S234128791730008X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.03.012" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "2084" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:142-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2278 "formatos" => array:3 [ "EPUB" => 140 "HTML" => 1543 "PDF" => 595 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403316301527" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2016.03.014" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "2084" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:142-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5418 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 4359 "PDF" => 906 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Trasplante de médula ósea en pacientes con anemia falciforme. Experiencia en un centro" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "142" "paginaFinal" => "150" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bone marrow transplant in patients with sickle cell anaemia. Experience in one centre" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 535 "Ancho" => 2000 "Tamanyo" => 151164 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Paciente 1 (A, B, C y D). Imagen de TC de cráneo axial simple donde se evidencia hiperdensidad de los surcos como signo de hemorragia subaracnoidea en la cisura de Silvio del lado derecho, en surcos de la convexidad cerebral, de predominio en el lado derecho y en la cisterna perimesencefálica izquierda (A). Imágenes de RM secuencia TSE T2 axial en el día +27 donde se evidencian lesiones corticosubcorticales frontales bilaterales y lesiones de sustancia blanca profunda frontales bilaterales y parietooccipital izquierda compatibles con toxicidad por ciclosporina (B y C). Imagen de RM TSE T2 axial 6 meses post-TPH donde se evidencian lesiones residuales (D). Paciente 9 (E): imagen de TC de cráneo axial donde se evidencia hiperdensidad de surcos frontotemporales izquierdos como signo de hemorragia subaracnoidea en el día +2.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marina García Morin, Elena Cela, Carmen Garrido, Eduardo Bardón Cancho, Alejandra Aguado del Hoyo, Cristina Pascual, Ana Pérez-Corral, Cristina Beléndez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Marina" "apellidos" => "García Morin" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Cela" ] 2 => array:2 [ "nombre" => "Carmen" "apellidos" => "Garrido" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Bardón Cancho" ] 4 => array:2 [ "nombre" => "Alejandra" "apellidos" => "Aguado del Hoyo" ] 5 => array:2 [ "nombre" => "Cristina" "apellidos" => "Pascual" ] 6 => array:2 [ "nombre" => "Ana" "apellidos" => "Pérez-Corral" ] 7 => array:2 [ "nombre" => "Cristina" "apellidos" => "Beléndez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S234128791730008X" "doi" => "10.1016/j.anpede.2016.03.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791730008X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316301527?idApp=UINPBA00005H" "url" => "/16954033/0000008600000003/v1_201702231632/S1695403316301527/v1_201702231632/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287917300042" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.01.013" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "2047" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:151-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1734 "formatos" => array:3 [ "EPUB" => 115 "HTML" => 1123 "PDF" => 496 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Ethical attitudes of intensive care paediatricians as regards patients with spinal muscular atrophy type 1" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "151" "paginaFinal" => "157" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actitudes éticas de los pediatras de Cuidados Intensivos ante pacientes con atrofia muscular espinal tipo 1" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1267 "Ancho" => 1599 "Tamanyo" => 91745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Subjective estimation by paediatricians of the quality of life of children with SMA-1 based on long-term use of ventilatory support (noninvasive or invasive). Quality of life scale, from 0 (very poor) to 10 (very good).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Carmen Agra Tuñas, Ramón Hernández Rastrollo, Arturo Hernández González, Carmen Ramil Fraga, Francisco J. Cambra Lasaosa, Sebastián Quintero Otero, Angela Ruiz Extremera, Antonio Rodríguez Núñez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "María Carmen" "apellidos" => "Agra Tuñas" ] 1 => array:2 [ "nombre" => "Ramón" "apellidos" => "Hernández Rastrollo" ] 2 => array:2 [ "nombre" => "Arturo" "apellidos" => "Hernández González" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Ramil Fraga" ] 4 => array:2 [ "nombre" => "Francisco J." "apellidos" => "Cambra Lasaosa" ] 5 => array:2 [ "nombre" => "Sebastián" "apellidos" => "Quintero Otero" ] 6 => array:2 [ "nombre" => "Angela" "apellidos" => "Ruiz Extremera" ] 7 => array:2 [ "nombre" => "Antonio" "apellidos" => "Rodríguez Núñez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316000242" "doi" => "10.1016/j.anpedi.2016.01.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316000242?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300042?idApp=UINPBA00005H" "url" => "/23412879/0000008600000003/v1_201702231638/S2341287917300042/v1_201702231638/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287917300030" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.04.006" "estado" => "S300" "fechaPublicacion" => "2017-03-01" "aid" => "2106" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:135-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1827 "formatos" => array:3 [ "EPUB" => 136 "HTML" => 1092 "PDF" => 599 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prenatal treatment with magnesium sulphate: Initial clinical outcomes in pre-term infants less than 29 weeks and correlation with neonatal magnesium levels" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "135" "paginaFinal" => "141" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Terapia prenatal con sulfato de magnesio: evolución clínica de los recién nacidos pretérmino menores de 29 semanas y correlación con la magnesemia neonatal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura García Alonso, Marcelino Pumarada Prieto, Eva González Colmenero, Ana Concheiro Guisán, María Suárez Albo, Cristina Durán Fernández-Feijoo, Luisa González Durán, José Ramón Fernández Lorenzo" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "García Alonso" ] 1 => array:2 [ "nombre" => "Marcelino" "apellidos" => "Pumarada Prieto" ] 2 => array:2 [ "nombre" => "Eva" "apellidos" => "González Colmenero" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Concheiro Guisán" ] 4 => array:2 [ "nombre" => "María" "apellidos" => "Suárez Albo" ] 5 => array:2 [ "nombre" => "Cristina" "apellidos" => "Durán Fernández-Feijoo" ] 6 => array:2 [ "nombre" => "Luisa" "apellidos" => "González Durán" ] 7 => array:2 [ "nombre" => "José Ramón" "apellidos" => "Fernández Lorenzo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316301849" "doi" => "10.1016/j.anpedi.2016.04.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316301849?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300030?idApp=UINPBA00005H" "url" => "/23412879/0000008600000003/v1_201702231638/S2341287917300030/v1_201702231638/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Bone marrow transplant in patients with sickle cell anaemia. Experience in one centre" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "142" "paginaFinal" => "150" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marina García Morin, Elena Cela, Carmen Garrido, Eduardo Bardón Cancho, Alejandra Aguado del Hoyo, Cristina Pascual, Ana Pérez-Corral, Cristina Beléndez" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Marina" "apellidos" => "García Morin" "email" => array:2 [ 0 => "m.garciamorin@gmail.com" 1 => "mgmorin@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elena" "apellidos" => "Cela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carmen" "apellidos" => "Garrido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Bardón Cancho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Alejandra" "apellidos" => "Aguado del Hoyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Cristina" "apellidos" => "Pascual" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "Ana" "apellidos" => "Pérez-Corral" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 7 => array:3 [ "nombre" => "Cristina" "apellidos" => "Beléndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hematología-Oncología Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiología Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicios de Hematología y Hemoterapia, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante de médula ósea en pacientes con anemia falciforme. Experiencia en un centro" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1263 "Ancho" => 2507 "Tamanyo" => 171497 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evolution of haemolysis parameters: haemoglobin (Hb) (A), lactase dehydrogenase (LDH) (B), reticulocytes (C), bilirubin (D): median values at baseline and at 3 months, 6 months and 1 year post HSCT.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sickle cell disease (SCD) is currently the abnormality detected most frequently in newborn screening tests in several countries, including Spain. In the Autonomous Community of Madrid, where screening has been performed since May 2003, this is corroborated with an incidence of 1 in every 5000 live births.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> Sickle cell disease is a significant source of multisystemic morbidity and carries an increased risk of early death.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> In the past three decades, the introduction of several measures, such as penicillin prophylaxis, vaccination against <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>, the use of hydroxyurea, have been implemented leading to a decrease in morbidity and mortality in patients with SCD.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3–5</span></a> There is evidence that hydroxyurea considerably reduces the incidence of vaso-occlusive events and acute chest syndrome<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6,7</span></a>; however, this treatment does not reverse organ damage or reduce the risk of stroke. The use of transcranial Doppler ultrasonography (TCD) in the followup of these patients allows the identification of those that are at high risk of experiencing an acute stroke, while of brain magnetic resonance imaging (MRI) allows the diagnosis of silent strokes.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a> Transfusion therapy has proven to be useful in the primary prevention of stroke, but it has the disadvantage of secondary iron overload and poor long-term adherence.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At present, haematopoietic stem cell transplantation (HSCT) is the only available curative treatment. The first successful HSCT was performed in 1984 in the Untied States in a patient with SCD and acute myeloid leukaemia.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a> Subsequent multicentre studies have reported good outcomes, with an overall survival of 93–94% and an event-free survival of 82–86%, while the most frequent complications are graft failure and graft-versus-host disease (GVHD).<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">10–14</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to describe the clinical and analytical outcomes of patients with SCD that underwent allogeneic HSCT from an HLA-identical sibling donor in our hospital.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a retrospective descriptive single-centre study. We collected data for paediatric patients with homozygous (HbSS) or double heterozygous (HbSβ<span class="elsevierStyleSup">0</span>) SCD that underwent bone marrow transplantation from an HLA-identical sibling donor (Hb AA or Hb AS phenotype) between January 2010 and December 2014, with followup until December 2015. We studied demographic variables (age, sex) and variables concerning the patients’ history of complications associated with the disease: acute chest syndrome (ACT), vaso-occlusive crises (VOCs), dactylitis, priapism, stroke, splenic sequestration and need for splenectomy. As regards treatment prior to HSCT, we documented whether patients received hydroxyurea (HU), transfusion therapy or iron chelation therapy. Other variables under study associated with HSCT were donor-recipient ABO compatibility, stem cell infusion, day of platelet and neutrophil engraftment and chimerism outcomes in bone marrow at day +30 post transplant and in peripheral blood later in time. We collected the following laboratory parameters measured at baseline and at 3, 6, 9 and 12 months post transplantation: haemoglobin, reticulocytes, lactase dehydrogenase (LDH), bilirubin, ferritin, glomerular filtration rate based on cystatin C, lymphocyte differential count (B and T lymphocytes, NK cells), and immunoglobulins (Igs). Last of all, we gathered data for post-transplant complications: acute GVHD, neurologic complications (seizures, subarachnoid haemorrhage [SAH], neurotoxicity), acute renal failure, hypertension (HTN), cytomegalovirus (CMV) reactivation and cause of death.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conditioning regimen</span><p id="par0025" class="elsevierStylePara elsevierViewall">The conditioning regimen was myeloablative, and consisted of intravenous busulfan (dose by weight of 3.2–4.8<span class="elsevierStyleHsp" style=""></span>mg/kg/day, administered as a single dose every 24<span class="elsevierStyleHsp" style=""></span>h on days −9 to −6), intravenous alemtuzumab (0.1<span class="elsevierStyleHsp" style=""></span>mg/kg/day on days −8 to −6) and intravenous cyclophosphamide (50<span class="elsevierStyleHsp" style=""></span>mg/kg/day, on days −5 to −2, combined with mesna). Prophylaxis treatment against GVHD was administered from day −1 and consisted of intravenous ciclosporin for three to six months and two doses of methotrexate (at days +4 and +7). Polymerase chain reaction was used to assess for the presence of CMV and EBV and antibody testing to assess for <span class="elsevierStyleItalic">Aspergillus</span>, and infection prophylaxis treatment given consisting of micafungin, levofloxacin and acyclovir, as well as cotrimoxazol after engraftment. Additional care measures included intravenous immunoglobulin therapy, ursodiol, phenytoin, antihypertensive drugs to maintain blood pressure at approximately the 95th percentile, supplementation with magnesium as needed and transfusion support with irradiated blood products. The procedure was carried out in individual rooms with positive pressure ventilation systems with HEPA filters.</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients underwent monthly transfusions or exchange transfusions to achieve a level of Hb S of less than 30% before HSTC, and during transplantation, platelet counts were maintained at more than 50<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>units/μL and Hb concentrations at 11–13<span class="elsevierStyleHsp" style=""></span>g/dL. Infusion of haematopoietic stem cells was always done from fresh bore marrow. In donor 1, due to the difference in weight with the recipient, bone marrow was extracted in the months preceding transplantation and cryopreserved until infusion (day +1), 24<span class="elsevierStyleHsp" style=""></span>h after the fresh bone marrow infusion.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">We used the SPSS<span class="elsevierStyleSup">®</span> software to analyse the data. We have expressed the data as frequencies, percentages, mean and medians (ranges). We compared paired quantitative data by means of Wilcoxon's test, and considered results with <span class="elsevierStyleItalic">p</span>-values of less than 0.05 statistically significant.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We studied overall survival and even-free survival by the Kaplan and Meier method. We defined event as death, graft loss (chimerism<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>95% of recipient cells) or recurrence of SCD.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definitions</span><p id="par0045" class="elsevierStylePara elsevierViewall">We defined neutrophil and platelet engraftment as the first of three consecutive days with total counts of more than 500<span class="elsevierStyleHsp" style=""></span>neutrophils/μL or more than 50<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>platelets/μL. We defined full donor chimerism as more than 95% of hematopoietic cells of donor origin.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We defined primary graft failure as failure to achieve by day +28 post transplantation a neutrophil count greater than 500<span class="elsevierStyleHsp" style=""></span>μL<span class="elsevierStyleSup">−1</span>, platelet count greater than 50<span class="elsevierStyleHsp" style=""></span>000<span class="elsevierStyleHsp" style=""></span>μL<span class="elsevierStyleSup">−1</span> and a haemoglobin concentration greater than 8<span class="elsevierStyleHsp" style=""></span>g/dL, and secondary graft failure as the lost of at least two cell lineages that had been functional after initial engraftment. We defined graft rejection or autologous reconstitution as recurrence of SCD symptoms.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Patient characteristics (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)</span><p id="par0055" class="elsevierStylePara elsevierViewall">From January 2010 to December 2014, 11 patients (8 male and 3 female) underwent allogeneic HSCT from the bone marrow of an HLA-identical sibling. All of them had a homozygous haemoglobin S phenotype (Hb SS). The median age was 7 years (2–13). Pathological manifestations before HSCT included recurrent VOCs (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9), recurrent ACS (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6), stroke (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2), abnormal flow velocity in TCD (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4), splenectomy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) and testicular atrophy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1). The baseline treatment prior to HSCT consisted of hydroxyurea in four patients, transfusion therapy in one, and hydroxyurea and periodic transfusions in three. Two patients developed iron overload and required iron chelation therapy (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">All bone marrow donors were HLA-identical siblings; 55% had an Hb AS phenotype. There was minor blood group incompatibility in four patients and major incompatibility in two.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Graft and post-haematopoietic stem cell transplantation complications (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>)</span><p id="par0065" class="elsevierStylePara elsevierViewall">A stable graft was achieved in ten out of eleven patients, nine of who developed full donor chimerism (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The median neutrophil engraftment was 22 days (16–27) and the median platelet engraftment was 28 (19–94).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Patient 9 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) had full donor chimerism in the overall bone marrow at day +30 (1.3% cells of recipient origin), but chimerism analysis of cell subpopulations showed that 51% of T lymphocytes were of recipient origin. Immunosuppression was discontinued and the patient was given three infusions of donor T lymphocytes at days +71 (1<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>), +105 (1.95<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">5</span><span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>) and +170 (0.85<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>) with no improvement in chimerism, and the symptoms of SCD recurred on day +180 (admission for VOC). Patient 11 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) had full donor chimerism in the overall bone marrow at day +30 (2.5% cells of recipient origin) but partial chimerism in the T lymphocyte population (59% of recipient origin). Immunosuppression was intensified, adding mycophenolate to ciclosporin and maintaining the treatment for one year. The mixed chimerism values remained stable: 4.2% at three months, 6% at six months, 6% at one year, with a gradual decrease of recipient T lymphocytes (12% at one year).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The most frequent complication after HSCT was reactivation of CMV, which occurred in nine out of eleven patients and was treated with foscarnet when it developed prior to engraftment and valganciclovir if the graft was stable. Hypertension developed in seven out of eleven children in association with stem cell infusion (patients 1 and 7), secondary to administration of drugs such as corticosteroids for the treatment of acute GVHD (patient 3), foscarnet for reactivation of CMV (patient 5) or ciclosporin (patient 9), or due to multiple factors in the context of impaired renal function (patient 10). All patients achieved adequate control of blood pressure, save for patient 10, who still needs oral hypertensive treatment one year later, although blood pressure has normalised and treatment is being tapered off. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the evolution of glomerular filtration assessed by measurement of cystatin C in patients that developed acute kidney failure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">When it came to neurologic complications, three patients developed SAH in the context of hypertension, two of who had associated epileptic seizures (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Patient 1 had a second episode of seizures on day +27, and computed tomography (CT) did not detect new sites of bleeding, although it showed bilateral parieto-occipital and frontal hypodense lesions. The investigation was expanded with brain MRI, which ruled out vascular malformations and found lesions in both cerebral hemispheres compatible with ciclosporin toxicity and development of oedema post transplantation. The patient had a favourable neurologic outcome (cognitive and motor) after discontinuation of ciclosporin, although a mild cognitive impairment remained. A follow-up MRI scan at six months revealed the persistence of the previously observed lesions, with no new lesions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The neurologic evaluation of patients that had SAH at one year post transplantation was normal, and while patient 1 experienced academic difficulties (mild cognitive impairment), he did not require grade retention and has college-level studies.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Six patients developed acute GVHD, five with isolated skin involvement that responded well to corticosteroid treatment. Patient 7 had acute GVHD refractory to corticosteroids with grade IV skin and intestinal involvement and grade III liver involvement that did not respond to intensification of immunosuppression (mycophenolate, infliximab) or photopheresis, leading to his death on day +51. None of the patients developed chronic GVHD or hepatic sinusoidal obstruction syndrome.</p><p id="par0095" class="elsevierStylePara elsevierViewall">At the time of this writing, 10 out of the 11 patients are alive after a mean duration of followup of 3.1 years (range, 1–5.7). The Kaplan–Meier curve shows an overall survival of 90.9% and an event-free survival of 81.8% (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> presents the evolution of haemolysis parameters (haemoglobin, reticulocytes, LDH and bilirubin), with significant differences (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05) between the median patient levels at baseline and at one year after HSCT. <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a> presents graphs of the evolution of immune reconstitution (T and B lymphocytes, NK cells, T CD4/CD8 ratio) with the median counts at baseline and at three months, six months and one year post transplantation.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Despite the small sample size (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11), the results of our study were consistent with those of multicentre studies<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8,9,15</span></a> conducted in countries with more experience in the treatment of children with SCD. Performance of HSCT in these patients requires not only knowledge of transplantation technique, but also a thorough understanding of the overall treatment of haemoglobinopathies. In Spain, access to cohorts of children with SCD is a relatively new phenomenon, so this is the largest series studied to date.</p><p id="par0110" class="elsevierStylePara elsevierViewall">One patient died of acute GVHD, which is also one of the main causes of death in other series (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The incidence of acute GVHD (grade<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>II) was 36%, higher than the incidence reported in other series despite similar prophylaxis regimens with ciclosporin and methotrexate, although this result may have been different with a larger sample size. A possible cause is that the source of the stem cells was bone marrow in all cases, whereas in other studies the source is umbilical cord blood, which carries a lower risk of acute GVHD, in up to 14% of cases.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14,16,17</span></a> At any rate, none of the patients in our series developed chronic GVHD.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Cerebrovascular problems are a significant cause of neurologic morbidity associated with transplantation in patients with SCD. Walter et al.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> reported an incidence of neurologic complications post HSCT of 50% in patients with a prior history of cerebral infarction and of 23% in the rest of the patients; however, a French series<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a> did not find a significant increase in risk in patients with a past history of cerebrovascular disease. In our series, the two patients with evidence of stroke in the MRI scan performed before HSCT did not develop acute neurologic complications. Hypertension developed in seven out of the eleven patients and caused significant morbidity, as despite the measures taken for its management, it was probably related to SAH in three patients. The incidence of seizures in the French and North American series was 24% and 28%, respectively, and seizures are the most frequent complication post HSCT<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a>; they usually develop in the first few days after transplantation in association with hypertension and with corticosteroid therapy.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">13,18</span></a> In our study, and despite prophylaxis with phenytoin, three of the eleven patients developed seizures, all of them in association with hypertension. Patient 1 had a new episode of seizures on day +27, this time due to ciclosporin toxicity, and leading to mild cognitive impairment. In our series, patients did not die from neurologic complications nor develop severe neurologic sequelae.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Graft failure and autologous reconstitution also continue to be among the major problems that follow HSCT in patients with SCD, with an incidence that ranges between 7% and 13% (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) and of 9% in our study. Among its causes are previous alloimmunisation due to multiple transfusions, bone marrow hyper-regeneration, blood group incompatibility, cell dose (CD34+) and viral infection. The French series demonstrated that intensification of immunosuppression with addition of rabbit anti-thymocyte globulin to the conditioning regimen reduces the probability of graft rejection from 22.6% to 3%.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a> All our patients received alemtuzumab to induce lymphocyte depletion. Patient 9 experienced autologous reconstitution with recurrence of SCD symptoms on day +180, with the main risk factors for it being a cell dose near the lower limit, major blood group incompatibility and reactivation of CMV (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>). Discontinuation of immunosuppression and infusion of donor T lymphocytes did not succeed in improving chimerism in our patient, who had full donor chimerism in the overall bone marrow at day +30, but with 51% of T lymphocytes already of recipient origin. Similarly, patient 11 had mixed chimerism in the T lymphocyte population at day +30, which led to a change in management, intensifying immunosuppression with the addition of mycophenolate to ciclosporin; this had achieved a stable chimerism at one year of followup in the absence of clinical manifestations of SCD (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Mixed chimerism can be an acceptable option in nonmalignant blood disorders, and although the main risk it carries is autologous reconstitution in the first year, if it remains stable it can prevent the development of clinical manifestations of the disease<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a> and improve haemolysis parameters.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The findings of multicentre studies have led to the development of new management strategies with the purpose of reducing transplant-related mortality, graft failure and treatment toxicity. Thus, a study conducted in Belgium found a significant improvement in event-free survival (no cases of graft failure or autologous reconstitution) in the group treated with hydroxyurea in the months preceding HSCT, compared to the group treated with the standard conditioning regimen with busulfan, cyclophosphamide and anti-thymocyte globulin and no hydroxyurea (97.4% vs. 66.7%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.006).<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Recently, based on the results of studies in adults treated with reduced-toxicity conditioning regimens and one study in children with thalassaemia major,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a> a study in 15 children with SCD used a conditioning regimen consisting of treosulfan, thiotepa and fludarabin. Treosulfan has a structure analogous to that of busulfan and exhibits a potent myeloablative activity combined with minimal extramedullary toxicity and a more linear pharmacokinetic profile. This study obtained excellent results, with an overall survival of 100%, an event-free survival of 93% and a decreased treatment-related toxicity for HSCT, encouraging a change in the conditioning of these patients.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In our study, HSCT was indicated in all patients based on the clinical practice guidelines of SCD of the SEHOP<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a>; however, patients that receive the transplant in the early stages of the disease have the best outcomes, as was observed in the Belgian series, in which overall survival and event-free survival of asymptomatic patients were higher than those of patients with severe forms of disease (100% vs. 88% and 93% vs. 76%, respectively).<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> This is why there is an ongoing debate on whether HSCT from an HLA-identical sibling donor should be performed in asymptomatic patients or its indications should be expanded.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Haematopoietic stem cell transplantation is the only curative treatment available to patients with SCD, and our results are consistent with those of the international literature (overall survival, 90.9%, event-free survival, 81.82%). However, it still carries a risk of death (9%), with the most frequent reason being GVHD, and of significant comorbidities, such as graft failure (9%) and neurologic complications (36%). In light of these results and the reviewed literature, we decided to make changes to the conditioning regimen (treosulfan, fludarabin, thiotepa), the suppression of erythropoiesis in the two months prior to HSCT and pre-transplantation ambulatory blood pressure monitoring, and are contemplating a change in GVHD prophylaxis. T lymphocyte chimerism analysis helps the early detection of mixed chimerism and, in our experience, leads to better outcomes through the subsequent intensification of immunosuppression to prevent graft failure.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres805129" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec803286" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres805128" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec803285" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Conditioning regimen" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Definitions" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Patient characteristics (Table 1)" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Graft and post-haematopoietic stem cell transplantation complications (Table 2)" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-23" "fechaAceptado" => "2016-03-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec803286" "palabras" => array:2 [ 0 => "Sickle cell disease" 1 => "Allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec803285" "palabras" => array:2 [ 0 => "Anemia de células falciformes" 1 => "Alo-trasplante de médula ósea de hermano HLA idéntico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sickle cell disease (SCD), despite the improvement in the medical management, is still associated with severe morbidity and decreased survival. Allogenic hematopoietic stem cell transplantation (Allo-HSCT) currently provides the only curative therapy. A report is presented on our experience in children with SCD, who underwent Allo-HSCT in a single centre.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A single centre descriptive study was conducted on patients with SCD who underwent a bone marrow transplant from an HLA-identical sibling donor between January 2010 and December 2014. Epidemiological, clinical and analytical parameters were collected with a follow-up to December 2015. Data are presented as frequencies, percentages, and medians (range).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Allo-HCST was performed in 11 patients (8 males) with a median age of 7 years (2–13), all of them with comorbidity prior to the HCST. A stable graft was achieved in 10 out of 11 patients, 9 of them with complete donor chimerism, and one patient with stable mixed chimerism after 1 year of allo-HSCT. One patient has secondary graft failure with re-appearance of symptoms associated with SCD on day 180. Complications of Allo-HSCT are: arterial hypertension 7/11, acute renal failure 3/11, CMV reactivation 9/11, neurological complications 4/11 (subarachnoid haemorrhage, seizure), and acute graft versus host disease (aGVHD) of the skin 6/11, one of whom developed grade IV intestinal aGVHD, causing his death (day 51). None of the patients developed chronic GVHD. The overall survival and event-free survival was 90.9% and 81.9%, respectively, with a median follow-up of 3.1 (1–5.7) years.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Allo-HSCT, the only curative therapy, remains associated with morbidity. There was a transplant related mortality in our study, consistent with multicentre studies (1/11), and with aGVHD being the main cause. Other problems still include graft failure (1/11), and neurological complications (4/11), although the permanent sequelae are mild.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de células falciformes (ECF), pese a la mejora en el manejo médico, persiste asociada a morbilidad y a menor supervivencia. El alotrasplante de progenitores hematopoyéticos (alo-TPH) es actualmente la única opción curativa. Describir la evolución clínico-analítica de los pacientes trasplantados en nuestro centro.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio unicéntrico descriptivo, incluye a pacientes con ECF en los que se realizó alo-TPH de médula ósea de hermano HLA-idéntico desde enero del 2010 hasta diciembre del 2014. Se recogen datos epidemiológicos, clínicos y analíticos con tiempo de seguimiento hasta diciembre del 2015. Los datos se presentan como frecuencias, porcentajes y medianas (rango).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se recluta a 11 pacientes (8 varones), mediana de edad: 7 años (2–13), todos ellos con comorbilidad previa al TPH. Se consigue injerto estable en 10/11 pacientes, quimerismo completo en 9/11 y quimerismo mixto estable tras un año del TPH en 1/11. Un paciente presenta fallo secundario de injerto con reaparición de clínica el día +180. Complicaciones post-TPH: complicaciones neurológicas 4/11 pacientes (hemorragia subaracnoidea, crisis), HTA 7/11, fallo renal agudo 3/11, reactivación CMV 9/11, EICHa cutáneo 6/11, uno de ellos desarrolla EICH intestinal grado IV causando su fallecimiento (día +51). Ningún paciente desarrolla EICH crónico. Supervivencia global y libre de eventos a los 3,1 años de seguimiento: 90,9 y 81,9%, respectivamente.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El alo-TPH, única opción curativa, no está exento de morbimortalidad, encontramos un riesgo de muerte similar a otras series (1/11), siendo su primera causa el EICH agudo. Otros problemas son fallo de injerto (1/11) y complicaciones neurológicas (4/11), aunque las secuelas permanentes son leves.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García Morin M, Cela E, Garrido C, Bardón Cancho E, Aguado del Hoyo A, Pascual C, et al. Trasplante de médula ósea en pacientes con anemia falciforme. Experiencia en un centro. An Pediatr (Barc). 2017;86:142–150.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 810 "Ancho" => 1662 "Tamanyo" => 77907 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evolution of glomerular filtration rate (GFR) in patients that developed acute kidney failure during HSCT.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 535 "Ancho" => 2000 "Tamanyo" => 151164 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient 1 (A–D). Simple axial CT scan with sulcus hyperdensity suggestive of subarachnoid haemorrhage in the right lateral sulcus, superolateral sulci with right-side predominance, and the left peripeduncular cistern (A). T2 TSE axial MRI at day +27 with evidence of bilateral frontal cortical and subcortical lesions and bilateral frontal and left parietal deep white matter lesions compatible with ciclosporin toxicity (B and C). T2 TSE axial MRI at six months post HSCT with evidence of residual lesions (D). Patient 9 (E): axial head CT scan with hyperdensity in left frontotemporal sulci as evidence of subarachnoid haemorrhage on day +2.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1471 "Ancho" => 1489 "Tamanyo" => 82925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan–Meier curve.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1263 "Ancho" => 2507 "Tamanyo" => 171497 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Evolution of haemolysis parameters: haemoglobin (Hb) (A), lactase dehydrogenase (LDH) (B), reticulocytes (C), bilirubin (D): median values at baseline and at 3 months, 6 months and 1 year post HSCT.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1186 "Ancho" => 2387 "Tamanyo" => 175537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Immune reconstitution. Evolution of T lymphocyte count (A), CD4/CD8 ratio (B), B lymphocyte count (C) and NK cells (D): median values at baseline and at 3 months, 6 months and 1 year post HSCT.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ACS, acute chest syndrome; BMT, bone marrow transplant; y, years; m, months; F, female; M, male; TCD, transcranial Doppler; TX, treatment; VOC, vaso-occlusive crisis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Age of BMT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Hydroxyurea TX \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">BMT indication \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Comorbidities \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Donor</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hb type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recipient/donor ABO group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recipient/donor CMV IgG \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 y, 10 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abnormal TCD, VOC, ACS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A Rh+/O Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 y, 10 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke, abnormal TCD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Moya-Moya syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AB Rh+/AB Rh- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 y, 5 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abnormal TCD, VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A Rh+/B Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 y, 6 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">VOC, ACS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Testes: atrophy (right), microcalcifications (left) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A Rh+/A Rh + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 y, 8 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Stroke, abnormal TCD, VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B Rh+/O Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 y, 9 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ACS, VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B Rh+/B Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 y, 2 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ACS, VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">O Rh+/O Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 y, 7 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ACS, VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A Rh+/A Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 y, 10 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ACS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Splenectomy.<br>Left ventricular noncompaction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">O Rh+/B Rh– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/− \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 y, 1 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A Rh+/O Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 y, 1 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">VOC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Splenectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hb AS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">O Rh+/O Rh+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−/+ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1351141.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients and donors.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BM, bone marrow; CMV, cytomegalovirus; aGVHD, acute graft-versus-host disease; AKF, acute kidney failure; BM, bone marrow; HTN, hypertension; NEU, neutrophil; y, years; m, months; PB, peripheral blood; Plat, platelet; SCD, sickle cell disease; SAH, subarachnoid haemorrhage; VOC, vaso-occlusive crisis.</p>" "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Pt \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Cell dose: CD34+ (×10<span class="elsevierStyleSup">6</span><span class="elsevierStyleHsp" style=""></span>kg<span class="elsevierStyleSup">−1</span>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Day NEU engraftment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Day Plat engraftment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Chimerism (% recipient origin)</th><th class="td" title="table-head " align="left" valign="top" scope="col">CMV (day and treatment) \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day +30 (BM) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Last chimerism (time post HSCT) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Day 0 (fresh BM): 3.8<br>Day +1 (cryopreserved BM): 6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.4% (5 y 7 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +9, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.8% (4 y 8 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +13, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6% (4 y 7 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +11, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6% (4 y 1 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% (3 y 1 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +13, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% (3 y 9 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +7, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +39, ganciclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% (1 y 9 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +47, ganciclovir \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.3%<br>51% T cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92%<br>88% T cells (1 y 7 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +8, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% (1 and 2 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +9, foscarnet \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5%<br>59% T cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6%<br>12% T cells (1 y 0 m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1351140.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Pt \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Acute neurologic complications (day of onset)</th><th class="td" title="table-head " align="left" valign="top" scope="col">HTN (day of onset) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">AKF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">aGVHD-localization and grade \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Other complications post-HSCT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Event (death/graft loss/SCD clinical recurrence/alive) \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Seizures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SAH \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +1<br>+27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (+1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<br>Cutaneous II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Day +27: brain MRI: ciclosporin toxicity<br>Mild cognitive impairment<br>Mucositis grade 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (day 0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (+17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<br>Cutaneous I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucositis grade 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (+13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<br>Cutaneous II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Possible <span class="elsevierStyleItalic">Aspergillus</span> infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Catheter-related infection and left gluteus myositis due to MRSA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (+1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<br>Cutaneous IV<br>Gastrointestinal IV<br>Hepatic III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BK virus-associated haemorrhagic cystitis<br>Cholestasis and development of biliary sludge and cholelithiasis<br>Fever without microbial isolation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Died on day +51 (aGVHD grade IV and multiple organ failure) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<br>Cutaneous I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucositis grade 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes, +2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (day −1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucositis grade 1<br>BK virus-associated haemorrhagic cystitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical recurrence (VOC) on day +180 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes (+23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes<br>Cutaneous III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mucositis grade 3<br>Fever and neutropaenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pt 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mixed chimerism: intensified immunosuppression for 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1351143.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Haematopoietic stem cell transplantation (HSCT), outcomes and complications post transplantation.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">aGVHD, acute graft-versus-host disease; cGVHD, chronic graft-versus-host disease.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Current study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Vermylen 1998 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Walters 2000 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bernaudin 2007 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Panepinto 2007 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Overall survival \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Event-free survival \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Graft failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">aGVHD (≥ grade <span class="elsevierStyleSmallCaps">ii</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">cGVHD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No. deaths/cause \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/GVHD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2:<br>GVHD<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CMV<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aspergillus</span><br>Sudden death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/GVHD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:<br>4: GVHD<br>CNS haemorrhage<br>Sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3:<br>GVHD<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CNS haemorrhage<br>Multiple organ failure<br>Unknown cause \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1351142.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">International experience. Comparison of the current study with previously published series.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0125" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "January. Available from: <a class="elsevierStyleInterRef" id="intr0010" href="http://www.sehop.org/">www.SEHOP.org</a>, ISBN 978-84-694-4619-5" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de práctica clínica sobre enfermedad de células falciformes pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Cela" 1 => "A. Cervera" 2 => "Díaz de Heredia" 3 => "S. Rives" 4 => "A. Salinas" 5 => "J. Sevilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2010" "editorial" => "Sociedad Española de Hematología y Oncología Pediátrica (SEHOP)" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0130" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality in sickle cell disease. Life expectancy and risk factors for early death" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O.S. Platt" 1 => "D.J. Brambilla" 2 => "W.F. Rosse" 3 => "P.F. Milner" 4 => "O. Castro" 5 => "M.H. Steinberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199406093302303" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1994" "volumen" => "330" "paginaInicial" => "1639" "paginaFinal" => "1644" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7993409" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0135" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survival of children with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.T. Quinn" 1 => "Z.R. Rogers" 2 => "G.R. Buchanan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2003-11-3758" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2004" "volumen" => "103" "paginaInicial" => "4023" "paginaFinal" => "4027" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14764527" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0140" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub 2010 March 1]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improved survival of children and adolescents with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.T. Quinn" 1 => "Z.R. Rogers" 2 => "T.L. McCavit" 3 => "G.R. Buchanan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2009-07-233700" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2010" "volumen" => "115" "paginaInicial" => "3447" "paginaFinal" => "3452" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20194891" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0145" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prophylaxis with oral penicillin in children with sickle cell anemia. A randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.H. Gaston" 1 => "J.I. Verter" 2 => "G. Woods" 3 => "C. Pegelow" 4 => "J. Kelleher" 5 => "G. Presbury" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198606193142501" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1986" "volumen" => "314" "paginaInicial" => "1593" "paginaFinal" => "1599" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3086721" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0150" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hydroxyurea therapy in children severely affected with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.P. Scott" 1 => "C.A. Hillery" 2 => "E.R. Brown" 3 => "V. Misiewicz" 4 => "R.J. Labotka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "1996" "volumen" => "128" "paginaInicial" => "820" "paginaFinal" => "828" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8648542" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0155" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Three-year follow-up of hydroxyurea treatment in severely ill children with sickle cell disease. The French Study Group on Sickle Cell Disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. De Montalembert" 1 => "M. Belloy" 2 => "F. Bernaudin" 3 => "F. Gauraud" 4 => "R. Capdeville" 5 => "R. Mardini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Hematol Oncol" "fecha" => "1997" "volumen" => "19" "paginaInicial" => "313" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9256830" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0160" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J. Adams" 1 => "V.C. McKie" 2 => "L. Hsu" 3 => "B. Files" 4 => "E. Vichinsky" 5 => "C. Pegelow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199807023390102" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1998" "volumen" => "339" "paginaInicial" => "5" "paginaFinal" => "11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9647873" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0165" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub 2015 May 5]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How I manage cerebral vasculopathy in children with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Brousse" 1 => "M. Kossorotoff" 2 => "M. de Montalembert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.13477" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2015" "volumen" => "170" "paginaInicial" => "615" "paginaFinal" => "625" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25944412" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0170" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone marrow transplantation for sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Walters" 1 => "M. Patience" 2 => "W. Leisenring" 3 => "J.R. Eckman" 4 => "J.P. Scott" 5 => "W.C. Mentzer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199608083350601" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1996" "volumen" => "335" "paginaInicial" => "369" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8663884" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0175" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of bone marrow transplantation for symptomatic sickle cell disease: an interim report. Multicenter investigation of bone marrow transplantation for sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Walters" 1 => "R. Storb" 2 => "M. Patience" 3 => "W. Leisenring" 4 => "T. Taylor" 5 => "J.E. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2000" "volumen" => "95" "paginaInicial" => "1918" "paginaFinal" => "1924" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10706855" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0180" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haematopoietic stem cell transplantation for sickle cell anaemia: the first 50 patients transplanted in Belgium" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Vermylen" 1 => "G. Cornu" 2 => "A. Ferster" 3 => "B. Brichard" 4 => "J. Ninane" 5 => "A. Ferrant" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.bmt.1701291" "Revista" => array:6 [ "tituloSerie" => "Bone Marrow Transplant" "fecha" => "1998" "volumen" => "22" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9678788" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0185" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub 2 July 2007]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term results of related myeloablative stem-cell transplantation to cure sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Bernaudin" 1 => "G. Socie" 2 => "M. Kuentz" 3 => "S. Chevret" 4 => "M. Duval" 5 => "Y. Bertrand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2007-03-079665" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2007" "volumen" => "110" "paginaInicial" => "2749" "paginaFinal" => "2756" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17606762" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0190" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Matched-related donor transplantation for sickle cell disease: report from the Center for International Blood and Transplant Research" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Panepinto" 1 => "M.C. Walters" 2 => "J. Carreras" 3 => "J. Marsh" 4 => "C.N. Bredeson" 5 => "R.P. Gale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2141.2007.06592.x" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2007" "volumen" => "137" "paginaInicial" => "479" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17459050" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0195" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone-marrow transplantation in a patient with sickle-cell anemia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.L. Johnson" 1 => "A.T. Look" 2 => "J. Gockerman" 3 => "M.R. Ruggiero" 4 => "L. Dalla-Pozza" 5 => "F.T. Billings 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198409203111207" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1984" "volumen" => "311" "paginaInicial" => "780" "paginaFinal" => "783" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6382010" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0200" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of patients with hemoglobinopathies given either cord blood or bone marrow transplantation from an HLA-identical sibling" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Eurocord and European Blood and Marrow Transplantation (EBMT) group" "etal" => true "autores" => array:6 [ 0 => "F. Locatelli" 1 => "N. Kabbara" 2 => "A. Ruggeri" 3 => "A. Ghavamzadeh" 4 => "I. Roberts" 5 => "C.K. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2013-03-489112" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2013" "volumen" => "122" "paginaInicial" => "1072" "paginaFinal" => "1078" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23692854" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0205" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allogeneic hematopoietic stem cell transplantation in children with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Locatelli" 1 => "D. Pagliara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/pbc.24177" "Revista" => array:6 [ "tituloSerie" => "Pediatr Blood Cancer" "fecha" => "2012" "volumen" => "59" "paginaInicial" => "372" "paginaFinal" => "376" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22544533" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0210" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurologic complications after allogenic marrow transplantation for sickle cell anemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Walters" 1 => "K.M. Sullivan" 2 => "F. Bernaudin" 3 => "G. Souillet" 4 => "J.P. Vannier" 5 => "F.L. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "1995" "volumen" => "85" "paginaInicial" => "879" "paginaFinal" => "884" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7849310" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0215" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multicenter investigation of bone marrow transplantation for sickle cell disease. Stable mixed hematopoietic chimerism after bone marrow transplantation for sickle cell anemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Walters" 1 => "M. Patience" 2 => "W. Leisenring" 3 => "Z.R. Rogers" 4 => "V.M. Aquino" 5 => "G.R. Buchanan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant" "fecha" => "2001" "volumen" => "7" "paginaInicial" => "665" "paginaFinal" => "673" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11787529" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0220" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mixed haematopoietic chimerism for sickle cell disease prevents intravascular haemolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.J. Wu" 1 => "M. Gladwin" 2 => "J. Tisdale" 3 => "M. Hsieh" 4 => "T. Law" 5 => "M. Biernacki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2141.2007.06803.x" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2007" "volumen" => "139" "paginaInicial" => "504" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17910640" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0225" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haematopoietic stem cell transplantation for severe sickle cell disease in childhood: a single centre experience of 50 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Dedeken" 1 => "P.Q. Lê" 2 => "N. Azzi" 3 => "C. Brachet" 4 => "C. Heijmans" 5 => "S. Huybrechts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.12737" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2014" "volumen" => "165" "paginaInicial" => "402" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24433465" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0230" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allogeneic hematopoietic stem cell transplantation in thalassemia major: results of a reduced-toxicity conditioning regimen based on the use of treosulfan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.E. Bernardo" 1 => "E. Piras" 2 => "A. Vacca" 3 => "G. Giorgiani" 4 => "M. Zecca" 5 => "A. Bertaina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2012-04-423822" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2012" "volumen" => "120" "paginaInicial" => "473" "paginaFinal" => "476" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22645178" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0235" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treosulfan-based conditioning regimen for allogeneic haematopoietic stem cell transplantation in children with sickle cell disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Strocchio" 1 => "M. Zecca" 2 => "P. Comoli" 3 => "T. Mina" 4 => "G. Giorgiani" 5 => "E. Giraldi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjh.13352" "Revista" => array:6 [ "tituloSerie" => "Br J Haematol" "fecha" => "2015" "volumen" => "169" "paginaInicial" => "726" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25818248" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0240" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood and marrow transplantation for sickle cell disease: is less more?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Bolaños-Meade" 1 => "R.A. Brodsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.blre.2014.08.001" "Revista" => array:6 [ "tituloSerie" => "Blood Rev" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "243" "paginaFinal" => "248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25217413" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008600000003/v1_201702231638/S234128791730008X/v1_201702231638/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008600000003/v1_201702231638/S234128791730008X/v1_201702231638/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791730008X?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 14 | 32 |
| 2024 October | 105 | 41 | 146 |
| 2024 September | 75 | 33 | 108 |
| 2024 August | 72 | 80 | 152 |
| 2024 July | 80 | 33 | 113 |
| 2024 June | 92 | 35 | 127 |
| 2024 May | 70 | 38 | 108 |
| 2024 April | 78 | 60 | 138 |
| 2024 March | 52 | 26 | 78 |
| 2024 February | 76 | 28 | 104 |
| 2024 January | 55 | 29 | 84 |
| 2023 December | 103 | 78 | 181 |
| 2023 November | 79 | 30 | 109 |
| 2023 October | 69 | 32 | 101 |
| 2023 September | 39 | 32 | 71 |
| 2023 August | 49 | 24 | 73 |
| 2023 July | 61 | 24 | 85 |
| 2023 June | 80 | 34 | 114 |
| 2023 May | 104 | 26 | 130 |
| 2023 April | 55 | 18 | 73 |
| 2023 March | 95 | 33 | 128 |
| 2023 February | 48 | 15 | 63 |
| 2023 January | 51 | 19 | 70 |
| 2022 December | 86 | 38 | 124 |
| 2022 November | 93 | 34 | 127 |
| 2022 October | 130 | 55 | 185 |
| 2022 September | 62 | 39 | 101 |
| 2022 August | 93 | 48 | 141 |
| 2022 July | 76 | 37 | 113 |
| 2022 June | 67 | 49 | 116 |
| 2022 May | 93 | 45 | 138 |
| 2022 April | 83 | 48 | 131 |
| 2022 March | 78 | 59 | 137 |
| 2022 February | 142 | 36 | 178 |
| 2022 January | 102 | 43 | 145 |
| 2021 December | 76 | 52 | 128 |
| 2021 November | 74 | 44 | 118 |
| 2021 October | 135 | 71 | 206 |
| 2021 September | 80 | 31 | 111 |
| 2021 August | 55 | 54 | 109 |
| 2021 July | 49 | 52 | 101 |
| 2021 June | 68 | 43 | 111 |
| 2021 May | 87 | 73 | 160 |
| 2021 April | 243 | 100 | 343 |
| 2021 March | 200 | 47 | 247 |
| 2021 February | 105 | 35 | 140 |
| 2021 January | 117 | 34 | 151 |
| 2020 December | 74 | 30 | 104 |
| 2020 November | 47 | 28 | 75 |
| 2020 October | 63 | 28 | 91 |
| 2020 September | 54 | 27 | 81 |
| 2020 August | 49 | 17 | 66 |
| 2020 July | 41 | 28 | 69 |
| 2020 June | 50 | 22 | 72 |
| 2020 May | 84 | 14 | 98 |
| 2020 April | 55 | 17 | 72 |
| 2020 March | 44 | 25 | 69 |
| 2020 February | 69 | 17 | 86 |
| 2020 January | 67 | 21 | 88 |
| 2019 December | 72 | 40 | 112 |
| 2019 November | 73 | 23 | 96 |
| 2019 October | 85 | 30 | 115 |
| 2019 September | 59 | 23 | 82 |
| 2019 August | 43 | 27 | 70 |
| 2019 July | 46 | 32 | 78 |
| 2019 June | 56 | 22 | 78 |
| 2019 May | 62 | 24 | 86 |
| 2019 April | 85 | 47 | 132 |
| 2019 March | 53 | 26 | 79 |
| 2019 February | 58 | 14 | 72 |
| 2019 January | 52 | 11 | 63 |
| 2018 December | 51 | 28 | 79 |
| 2018 November | 66 | 19 | 85 |
| 2018 October | 59 | 13 | 72 |
| 2018 September | 28 | 15 | 43 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 3 | 0 | 3 |
| 2018 April | 40 | 0 | 40 |
| 2018 March | 18 | 0 | 18 |
| 2018 February | 16 | 0 | 16 |
| 2018 January | 17 | 0 | 17 |
| 2017 December | 27 | 0 | 27 |
| 2017 November | 23 | 0 | 23 |
| 2017 October | 23 | 0 | 23 |
| 2017 September | 20 | 0 | 20 |
| 2017 August | 22 | 0 | 22 |
| 2017 July | 25 | 0 | 25 |
| 2017 June | 27 | 11 | 38 |
| 2017 May | 47 | 18 | 65 |
| 2017 April | 107 | 94 | 201 |
| 2017 March | 57 | 33 | 90 |
| 2017 February | 12 | 18 | 30 |
Show all
