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  • American Society of Hematology  (30)
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  • American Society of Hematology  (30)
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  • 1
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 4295-4295
    Abstract: Abstract 4295 Syngeneic blood and marrow transplantation (BMT) has been applied in the treatment of many malignant or nonmalignant hematologic disorders with no or minimal and transient graft-versus-host disease (GVHD), much less transplant-related mortality (TRM) in contrast to allogeneic BMT, and lower relapse rate compared with autologous BMT. However, limited data in a single BMT center is not sufficient for statistical analysis. To evaluate the clinical outcomes of syngeneic BMT, CSBMT has performed a cooperative survey among BMT centers in mainland, Taiwan, and Hong Kong. From January 1964 to May 2009, 94 transplants from syngeneic donors have been performed in 32 BMT centers. The median age was 20 (1.5 to 51) years old. The diagnosis included AML (29 cases), SAA (26 cases), ALL (17 cases), CML (12 cases), lymphoma (3 cases), MDS (4 cases), neuroblastoma (2 cases), and large granular lymphocytosis (1 case). The main conditioning regimens were CYTBI or BUCY for malignant diseases, none or CY plus ATG for SAA. Bone marrow (BM, 34) or peripheral blood (PB, 49) or both BM and PB (11) as grafts were used. Five patients (SAA 2, AML 3) underwent the same donor's syngeneic BMT twice. One patient with large granular lymphocytosis and 1 case with SAA underwent the same donor's syngeneic BMT thrice. The median follow-up time was 28 months (1 month to 45 years). The median time for white blood cells 〉 1.0 × 109/L, and platelets 〉 20 × 109/L was 11 (2-30) days, 13 (0-122) days, respectively. Two patients (2.1%) had grade I acute GVHD (aGVHD), and 4 cases (4.3%) had grade II aGVHD. However, only one patient's specimen was consulted by pathologist. All aGVHD was controlled easily with low-dose steroid. No chronic GVHD was noted. Three-year disease-free survival (DFS) for the patients with nonmalignant disorders was 88.5%. Among them, the longest survivor was living and well for 45 years after transplant. Three-year DFS for the patients with malignant diseases was 62.9%. The overall survival rates at 3 years were 87.9%, and 69.5% for nonmalignant, and malignant diseases, respectively. 22 of 94 patients died after BMT (nonmalignant 3, malignant 19). The only cause of death for the patients with nonmalignant disorders was rejection. Relapse was the main cause of death in patients with malignancies (17/19). TRM was 2.1%. In conclusion, syngeneic BMT is a safe and effective therapeutic option for both nonmalignant and malignant hematologic disorders. Syngeneic donor, if available, should be the first choice in all cases of AA and hematological malignancies in general. The longest survivor of 45 years post-BMT is presented in this series. The good results and advantage of syngeneic BMT cast light on the potential utility of stored autologous placental-cord blood which is shared by the identical twin through the same placenta. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
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  • 2
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 3786-3786
    Abstract: BACKGROUND B-lineage acute lymphoblastic leukemia (B-ALL) represents the most common subtype in ALL. Genomic sequence information has been lacking in adult B-ALL, whose outcome remains dismal, while a comparison between genomic abnormalities in adult and pediatric groups is useful to further decipher disease mechanisms. METHODS We used whole exome sequencing (WES), copy number variation and molecular cytogenetics to catalog somatic mutations in 95 B-ALL patients (43 adults and 52 children).WES was conducted with appropriate depths for paired genomic DNA from bone marrow mononuclear cells at diagnosis and their matched peripheral blood samples during complete remission (CR) or saliva samples. Targeted deep sequencing (TDS) was performed in a validation cohort of 179 adult and 199 pediatric B-ALLs. RESULTS Eighty-four recurrent gene mutations were revealed by WES. Integrative analysis identified the involvement of 9 functional categories of genes: key fusions (KFs), epigenetic modifiers (EMs), signaling molecules (SMs), transcription factors (TFs), tumor suppressors (TSs), actin binding/cytoskeletons (ABCs), ion binding proteins (IBPs), trans-membrane proteins (TPs) and the others. Mutually cooperative or exclusive relationships were revealed among some of these categories. Genomic landscapes suggested two distinct mechanisms involved in the leukemogenesis: one is mainly driven by KFs together with mutations of TFs and TSs; the other results from the abnormalities of TFs and TSs, in cooperation with mutations of EMs, SMs, ABCs and IBPs recapitulating the role of KFs. A panel of histone/DNA methylation modifiers (HMMs) were revealed to bear potential value of relatively favorable prognosis in both adult and childhood patients. CONCLUSIONS We described the genome-wide abnormality patterns in adult B-ALL patients in comparison with those of pediatric cases, contributing to the understanding of leukemogenesis and the identification of potential new prognostic markers. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 132, No. 11 ( 2018-09-13), p. 1146-1158
    Abstract: Alterations in JAK/STAT signaling pathway are highly prevalent in PTCL and NKTL, where STAT3 and TP53 are the most frequently mutated genes. STAT3 activation drives PD-L1 expression in NKTL, providing a rationale to combine STAT3 inhibitors with immune checkpoint inhibitors.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: Blood Advances, American Society of Hematology, Vol. 3, No. 21 ( 2019-11-12), p. 3406-3418
    Abstract: Overexpression of WT1 and PRAME are common in MDS patients with thrombocytopenia. Both are independent poor prognostic factor for outcome. The evaluation of WT1/PRAME transcript analysis can better risk-stratify the patients, thus guiding individualized treatment.
    Type of Medium: Online Resource
    ISSN: 2473-9529 , 2473-9537
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
    detail.hit.zdb_id: 2876449-3
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  • 5
    In: Blood Advances, American Society of Hematology, Vol. 6, No. 14 ( 2022-07-26), p. 4320-4329
    Abstract: Intracranial hemorrhage (ICH) is a rare and life-threatening hemorrhagic event in patients with immune thrombocytopenia (ITP). However, its mortality and related risk factors remain unclear. Herein, we conducted a nationwide multicenter real-world study of ICH in adult ITP patients. According to data from 27 centers in China from 2005 to 2020, the mortality rate from ICH was 33.80% (48/142) in ITP adults. We identified risk factors by logistic univariate and multivariate logistic regression for 30-day mortality in a training cohort of 107 patients as follows: intraparenchymal hemorrhage (IPH), platelet count ≤10 × 109/L at ICH, a combination of serious infections, grade of preceding bleeding events, and Glasgow coma scale (GCS) level on admission. Accordingly, a prognostic model of 30-day mortality was developed based on the regression equation. Then, we evaluated the performance of the prognostic model through a bootstrap procedure for internal validation. Furthermore, an external validation with data from a test cohort with 35 patients from 11 other centers was conducted. The areas under the receiver operating characteristic (ROC) curves for the internal and external validation were 0.954 (95% confidence interval [CI], 0.910-0.998) and 0.942 (95% CI, 0.871-1.014), respectively. Both calibration plots illustrated a high degree of consistency in the estimated and observed risk. In addition, the decision curve analysis showed a considerable net benefit for patients. Thus, an application (47.94.162.105:8080/ich/) was established for users to predict 30-day mortality when ICH occurred in adult patients with ITP.
    Type of Medium: Online Resource
    ISSN: 2473-9529 , 2473-9537
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 2876449-3
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  • 6
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 1663-1663
    Abstract: Natural-killer/T cell lymphoma (NKTCL) is a malignant proliferation of CD56+/cytoCD3+ lymphocytes and constitutes a heterogeneous group of aggressive lymphoma prevalent in Asian and South American populations. NKTCL represents a distinct clinicopathologic entity of non-Hodgkin’s lymphoma, characterized by male predominance, strong association with Epstein-Barr virus (EBV) infection, prominent tissue necrosis and aggressive clinical course. However, molecular pathogenesis of NKTCL remains largely elusive. Here we identified somatic mutations by whole-exome sequencing in 25 NKTCL patients and extended validation through targeted sequencing in an additional 80 cases. Functional experiments including RNA unwinding test, colony forming assay, cell proliferation assay and gene expression profiling were also performed. Overall, 50.5% of NKTCL patients displayed somatic mutations of RNA helicase family, tumor suppressors (TP53 and MGA), and/or epigenetic modifiers (MLL2, ARID1A, EP300 and ASXL3). Recurrent mutations were most frequently discovered in RNA helicase gene DDX3X (21/105 cases, 20.0%). Mutations of DDX3X were seldom overlapped with those of TP53. Functionally, DDX3X mutants exhibited reduced RNA unwinding activity and enhanced cell proliferation. Similar stimulatory effect on cell proliferation was observed in cells transfected with specific siRNA targeting DDX3X. Gene expression profiling revealed an association of DDX3X mutations with activation of NF-kB and MAPK pathways. The clinical follow-up data showed that DDX3X-mutated patients presented a poor prognosis. Our work suggests the heterogeneity of gene mutational spectrum of NKTCL and provides a potential therapeutic target for relevant cases. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 7
    In: Blood, American Society of Hematology, Vol. 132, No. Supplement 1 ( 2018-11-29), p. 4990-4990
    Abstract: Introduction Hepatitis B virus (HBV) is a widespread virus that severely affects people's health, especially in China. HBV has infected over 400 million people worldwide (Liaw YF et al, Lancet, 2009), of which 93 million are Chinese (Hou J.L. et al, 2015). People infected with hepatitis B virus may develop chronic HBV infection, leading to a high risk of liver cirrhosis or hepatocellular carcinoma. Thrombocytopenia can be observed in patients with chronic HBV infection, especially in patients with liver cirrhosis. Thrombocytopenia plays a key role in thrombin generation and possibly bleeding tendencies in patients with chronic HBV infection. Those patients are at a higher risk of bleeding comparing to the patients without thrombocytopenia, which may lead to a higher mortality. However, its pathogenesis is considered to be complicated and remains poorly understood. Currently, there are not many effective treatments for chronic HBV infection patients with concomitant thrombocytopenia. Moreover, due to the invasiveness of procedures or inadequate effectiveness, the current treatments still have limited applications. Recombinant human thrombopoietin (rh-TPO) can promote megakaryocyte development and platelet production, resulting in an elevation in platelet counts both in vitro and in vivo, though there is still no information available for its effect in chronic HBV infection patients with concomitant thrombocytopenia. Methods The aim of the study is to explore the effectiveness and safety of rh-TPO in the treatment of thrombocytopenia in patients with chronic HBV infection. This was a multicenter, observational study conducted in China between January 2003 and May 2018. Patients with chronic HBV infection (defined as seropositive for HBV surface antigen (HBsAg) for more than 6 months and/or had serum HBV DNA levels greater than 500 copies/ml) accompanied with thrombocytopenia (defined as a platelet count of 〈 100 000 per cubic millimeter) were enrolled and divided into 2 groups by the occurrence of liver cirrhosis. Each patient received nucleoside analog (NA) alone treatment, or NA plus prednisone or NA plus rh-TPO treatment. Platelet counts, occurrence of bleeding events and adverse events were evaluated before and after treatment. Results Through our research, we have noticed that among patients with chronic HBV infection associated thrombocytopenia, patients with liver cirrhosis had significantly lower platelet counts compared to those without liver cirrhosis, especially in cirrhotic patients with splenomegaly. After treatment, patients treated with NA plus prednisone and patients treated with NA plus rh-TPO had significantly higher platelet count elevations than those treated with NA alone, respectively. Chronic HBV infection patients with liver cirrhosis reacted superior to both prednisone and rh-TPO treatment compared to patients without liver cirrhosis, especially in those without splenomegaly. During the observations before and after treatment, fewer bleeding events were observed in patients treated with rh-TPO or prednisone, compared to the NA alone group. No severe bleeding events occurred during the treatment. 22 variables considered relevant to the presence of bleeding events were tested using univariate analysis. The platelet counts, prothrombin time (PT), prothrombin activity (PTA) and methods of treatment were significantly associated with bleeding events. The platelet counts, and methods of treatment were risk factors associated with bleeding events in multivariate analysis. The adverse events among patients receiving different methods of treatment were mild and balanced. Liver function and HBV replication were not worsened after treatment. No severe adverse events were observed during the treatment with rh-TPO, and no patients stopped treatment due to adverse events during the observation. Conclusion Treatment with rh-TPO could elevate the platelet counts and reduce the risk of bleeding events in chronic HBV infection patients with thrombocytopenia. The treatment with rh-TPO was more effective in patients with liver cirrhosis, especially in those without splenomegaly. No severe adverse events were observed during rh-TPO treatment, proving the safety of rh-TPO in the use of treatment in chronic HBV infection associated thrombocytopenia. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2018
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    detail.hit.zdb_id: 80069-7
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  • 8
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 2778-2778
    Abstract: Introduction: Thrombocytopenia is a frequent manifestation of liver cirrhosis (LC) related to the hepatitis B virus (HBV). Severe thrombocytopenia is associated with bleeding events that increase morbidity and mortality in patients with LC. No effective treatment has been identified for patients with composited liver cirrhosis associated with HBV and severe thrombocytopenia. The pathogenesis of thrombocytopenia in liver diseases has not been well established. It has been suggested that autoantibody-mediated platelet destruction might contribute, at least in part, to hepatitis B cirrhotic thrombocytopenia. We aimed to explore the effectiveness and safety of low dose prednisone or low dose cyclosporine combined with a nucleoside analogue in patients with severe thrombocytopenia associated with HBV-related LC. Methods: In this observational cohort study, we included 145 consecutive compensated HBV-associated LC patients with severe thrombocytopenia (PLT 〈 30,000 per cubic millimeter, accompanied by a tendency towards bleeding) between January 1, 2006 and December 31, 2013. We divided the patients into three groups by treatment strategy, including NA alone (n=57), NA plus prednisone (n=46), and NA plus cyclosporine (CsA) (n=42). Prednisone was given at a dosage of 0.5 mg/kg/d for 4 weeks until a response was observed or until the side effects became intolerable. The cyclosporine regimen consisted of oral CsA at a dosage of 1 mg/kg/d given in two divided doses. The dose of prednisone or CsA was then slowly tapered in the patients who responded to the drugs. We analyzed the platelet counts, bleeding events, liver function, replication of HBV, and outcomes in each group. The platelet counts following the treatments were estimated using mixed-effects linear models that included all available platelet counts after treatment. These models were adjusted by age, sex, the Child-Pugh score, other systemic complications, platelet transfusion, and research center. Cox proportional hazards analyses were performed to examine the factors related to bleeding events. Data was analyzed using IBM SPSS Statistics version 19.0 (SPSS Inc., an IBM company). P values less than 0.05 were considered significant. This study is registered with ClinicalTrials.gov under number NCT01987791. Results: At all time points during this observation, platelet counts in the prednisone plus NA and CsA plus NA groups were higher than those in the NA group. In the group receiving prednisone plus NA, 35 of the 46 patients (76.1%) had platelet counts of 50,000 per cubic millimeter or greater during this observation. As in the CsA plus NA group, 30 of the 42 patients (71.4%) had platelet counts of 50,000 per cubic millimeter or greater. Only 4 of the 57 patients (7.0%) in the NA treatment group had platelet counts that were higher than 50,000 per cubic millimeter. The cumulative bleeding events in the three treatment groups were 67.0% in the NA only group, 56.9% in the prednisone group and 62.2% in the CsA group. The cumulative rates of bleeding events were significantly different among the three groups (p=0.001). The platelet counts, treatment with prednisone plus NA and treatment with CsA plus NA were factors associated with bleeding events in the multivariate analysis. After treatment, serum alanine transaminase levels were significantly lower than those before treatment in all groups. The differences in the HBV-DNA negative rates, HBV-DNA elevated rates, normal serum alanine transaminase rates, serum alanine transaminase rates that elevated more than two times the baseline rate, and HBeAg seropositive conversion ratios among the groups did not reach statistical significance. Levels of the platelet-associated anti-GPIIb-IIIa antibodies after the 4-week treatment were lower than those at baseline in the prednisone group and CsA group; no difference was observed in the NA alone group. The adverse events in our study were mild in general and balanced among the three treatment groups. Conclusions: Treatment with low dose prednisone or low dose CsA plus NA could elevate the platelet count and reduce the risk of bleeding events in HBV LC patients with severe thrombocytopenia; the treatment had no obvious adverse effects on liver function and HBV DNA replication. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 9
    In: Blood, American Society of Hematology, Vol. 140, No. Supplement 1 ( 2022-11-15), p. 4564-4565
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 126, No. 23 ( 2015-12-03), p. 3075-3075
    Abstract: Idiopathic pneumonia syndrome (IPS) is a life-threatening acute noninfectious diffuse lung injury occurring after allogeneic bone marrow transplantation (BMT). We have recently shown that absence of STAT1 signaling in recipient APC leads to accelerated Graft Versus Host Disease (GVHD) and Transplant-associated mortality and morbidity after lethal irradiation in fully MHC-mismatched allogeneic or in non-irradiated P→F1 BMT models. We now addressed the impact of recipient Type II interferon signaling on the development of lung injury after allogeneic BMT using a non-irradiated P→F1 model. 1x107 BMCs plus 2.5x107 SPCs from C57BL/6 (B6) mice were i.v. injected into IFNγR-deficient CB6F1 (F1.GRKO) or CB6F1 wild type (WT) mice. F1.GRKO recipients had significantly reduced survival (MST 32 days post-BMT vs. not reached p 〈 0.001, Log-rank test). Pulmonary function tests were performed 3 weeks post-BMT on anaesthetized mice that were tracheotomized and mechanically ventilated using a computer-controlled animal ventilator (Flexivent, SCIREQ). Static compliance was derived from plateau pressure measurements between total lung capacity and functional residual capacity, and broadband forced oscillations were used to determine airway resistance at baseline and following increasing doses of methacholine (3.1, 12.5 and 50 mg/ml). Static compliance and inspiratory capacity were reduced in F1.GRKO recipients when compared with WT mice (p 〈 0.01). In addition, airway resistance, both at baseline and in response to methacholine, was increased in the KO recipient mice (p 〈 0.05). Histopathology was evaluated on H & E, Trichrome and PAS stained lung sections to assess for inflammation, fibrosis and mucus hyperplasia, respectively. Lungs from the KO mice showed increased interstitial inflammation involving bronchioles, vasculature and parenchyma (pathology index 10 vs 1; p 〈 0.001), fibrosis (fibrosis score 2.8 vs 0.15; p 〈 0.05) and a trend for mucus hyperplasia/metaplasia. To further evaluate the cellular mediators of the observed lung injury, we assessed the cellular composition of the bronchioalveolar lavage fluid (BAL) at day 30 post-BMT. We observed a 10-fold increase in the total cell number of the BAL in F1.GRKO recipient mice compared to WT mice (4x105 vs.4x104, p 〈 0.01); the majority of the cells in the BAL from wild type mice were macrophages/monocytes, while neutrophils predominated in the F1.GRKO mice. Importantly, more than 50% of the CD45+ BAL cells were donor derived in the F1.GRKO recipients, compared to only 10% in the wild type recipients. Furthermore, the absolute cell number of donor CD4+ and CD8+ cells in the knockout mice significantly outnumbered that in their wild type counterparts (p 〈 0.01). Thus, our results suggest that absence of recipient IFN-γR signaling promotes accumulation and/or trafficking of donor neutrophils and T cells to the lungs. To better understand the underlying mechanisms of enhanced infiltration of donor cells in the lungs of IFNγR-/- mice, the activation, proliferation, and differentiation status of donor lymphocytes were assessed by Flowcytometry after BMT. In line with the lung infiltration, there was significantly increased donor cell engraftment in PBMC, spleen, lymph nodes, and bone marrow in F1.GRKO recipients (all with p 〈 0.01); Moreover, there were also significantly increased activation (measured as CD44high CD62Llow cells), Th1 and Tc1 differentiation of donor CD4 and CD8 cells (p 〈 0.01). Furthermore, enhanced Th17 differentiation, but reduced Foxp3+ Treg cell differentiation was noticed. Interestigly, we observed significantly lower PD-L1 expression on recipient APC in the F1.GRKO mice compared to wild type mice, suggesting that absence of PD-L1 expression may contribute to reduced contraction of activated donor T cells. Interestingly, in line with these findings we also observed significantly reduced PD-L1 expression when single cell suspension from lung tissues were analyzed by flow. Reduced PD-L1 expression was observed on both recipient CD45+, and CD45- cells in F1.GRKO when tested on day 22 post-BMT, meanwhile there was no difference in PD-L1 expression pattern in the cells isolated from small intestine. These results suggest that IFN-γ induced PD-L1 expression on hematopoietic and non-hematopoietic cells in the lung may be of significance in protecting recipients against acute donor-cell mediated lung injury and IPS. Disclosures Lentzsch: Celgene: Membership on an entity's Board of Directors or advisory committees; Axiom: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2015
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    detail.hit.zdb_id: 80069-7
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