DAVID GRANOVSKY

Posts Tagged ‘leukemia’

LEUKEMIA SURVIVAL IMPROVED THROUGH STEM CELLS

In SCIENCE & STEM CELLS, STEM CELLS IN THE NEWS on March 1, 2013 at 9:10 am

cool

Twice given, twice used: Infusion of stem cells and specially generated T-cells from same donor improves leukemia survival

In a significant advance for harnessing the immune system to treat leukemias, researchers at Fred Hutchinson Cancer Research Center for the first time have successfully infused large numbers of donor T-cells specific for a key anti-leukemic antigen to prolong survival in high-risk and relapsed leukemia patients after stem cell transplantation. Both the stem cells for transplant and the T-cells came from the same matched donors.  Reporting results of a pilot clinical trial in the Feb. 27 issue of the journal Science Translational Medicine, researchers describe the use of T-cells that were taken from a donor, programmed in the lab to recognize the Wilm’s Tumor Antigen 1 (WT1) and kill leukemia cells, grown in large numbers, and then infused into patients to promote anti-leukemic activity. The WT1 protein is over expressed in leukemias and is in part responsible for why the cells have become leukemic.

The best results were achieved when some of the patients received T-cell clones that were exposed to interleukin 21 (IL-21) during the programming and growth process, based on the hypothesis that such exposure would create cells that could survive longer and produce greater anti-leukemic activity after transfer. IL-21 promotes T-cell expansion while helping those cells acquire characteristics of central memory T-cells.

“This is the first time patients have received an infusion of WT1 specific T-cells, and thus also the first demonstration that such cells can provide a therapeutic anti-leukemic effect, as has been suggested from earlier vaccine trials that induce less potent responses,” said Philip Greenberg, M.D., corresponding author and head of the Immunology Program at Fred Hutch.

“Ours is also the first report to show that greatly improved T-cell in-vivo persistence can be achieved after transfer by modifying the way cells are generated in tissue culture for therapy with inclusion of the cytokine IL-21,” said Aude Chapuis, M.D., lead author on the study and a research associate in the Fred Hutch Immunology Program.

The findings support expanding efforts to target WT1 and provide insights into what is necessary to establish potent and persistent T-cell responses in patients, and such second generation studies have recently been initiated at Fred Hutch. All of the patients, who were treated post-transplant at Seattle Cancer Care Alliance, Fred Hutch’s site for patient care, received adoptively transferred infusions of billions of enhanced CD8 cytotoxic T-cell clones. They were considered at high risk of death because they had already relapsed and/or had a poor prognosis due to unfavorable characteristics of their leukemia.

Four of the 11 patients in the trial received infusions of T-cells that targeted WT1 and were generated in the presence of IL-21. One had detectable relapsed disease and entered complete remission shortly after the T-cells were infused. All four survived after T-cell therapy without relapse for more than 30 months without suffering graft-vs.-host-disease and required no additional anti-leukemic treatment, according to the study. GVHD is a major complication of stem cell transplantation.

Among the seven patients who received infused T-cells generated without the presence of IL-21, two showed direct evidence of anti-leukemic activity, including one patient with advanced progressive disease who had a temporary response.

Researchers undertook the clinical trial because relapse remains a leading cause of death after allogeneic hematopoietic cell transplantation for patients with high-risk leukemias. An obstacle to survival is that the beneficial graft-vs.-tumor effect of a transplant can be offset by concurrent GVHD. Interestingly, patients who develop GVHD have reduced relapse rates. This suggests that lymphocytes present in engrafted donor stem cells can cause a concurrent therapeutic graft-vs.-tumor effect. However, because donor stem cells are not selected for specificity for leukemia antigens and commonly recognized proteins expressed by many other host tissues, substantial morbidity and mortality from GVHD can occur.

The scientists theorized that infusions of T-cells that target WT1 could potentially promote additional anti-leukemic activity without inducing GVHD.

http://www.fhcrc.org

TODDLER BEATS LEUKAEMIA AFTER RECEIVING CORD BLOOD STEM CELLS

In ALL ARTICLES, STEM CELLS IN THE NEWS, VICTORIES & SUCCESS STORIES on January 12, 2013 at 8:54 am

William

Toddler beats leukaemia after receiving life-saving stem cell transplant from the U.S

“A seriously ill toddler has been given a second chance at life after receiving a stem cell transplant from the U.S following a transatlantic appeal.  Toddler William Morris had been diagnosed with leukaemia at just six weeks old and intensive chemotherapy had failed to eradicate the cancer.  The 18-month-old desperately needed a stem cell transplant to help his body make new healthy blood cells after his own had been destroyed by the disease. However, no matches from umbilical cord blood donations could be found in the UK.”

“When William was diagnosed with leukaemia, it was devastating. It was the last thing that we had expected. William was diagnosed with acute myeloid leukaemia, a cancer of the white blood cells and bone marrow, when he was just six weeks old. He underwent four courses of intensive chemotherapy, which were unsuccessful, and within a month had a relapse of his condition.”

“But in March last year William was matched with an anonymous donor in the U.S. He was treated on Mother’s Day while in isolation in Newcastle for two months and is now in remission.  William was given a cord blood stem-cell transplant at the end of March and soon began to respond well to the treatment.”

William’s condition is in remission and he continues to be regularly monitored by consultants. Dr Sujith Samarasinghe, a consultant paediatric haematologist at Newcastle Hospitals NHS Foundation Trust, said: ‘William had a high-risk leukaemia.  Since the transplant he is doing extremely well.  It is early days, but there is now no evidence of leukaemia in his system.”

William 7 mom

“I don’t know who the donor is, but I wish I could send a letter to the mum saying ‘thank you for helping to save my son’s life”, said William’s mother Catherine Wray.

http://www.dailymail.co.uk/health/article-2260718.html

For more success stories click HERE.

PROMISING RESULTS FOUND IN NEW STEM CELL TRANSPLANT TECHNIQUE

In STEM CELLS IN THE NEWS on January 4, 2013 at 9:00 am

Many years ago, researchers tested a theory of using two unrelated units of cord blood to produce an increased volume of stem cells, which would decrease the engraftment time frame in adults suffering from blood disorders. The newly expanded procedure proves promising results and will soon begin human clinical trials.

A team of researchers from the MD Anderson Cancer Center in Houston has come up with a new way to make stem cell transplants more effective in patients with leukemia, lymphoma and other blood cancers and disorders. The study, whose findings were published last week in the New England Journal of Medicine, is the first of its kind to show favorable results in manipulating one batch of stem cells in patients who undergo a double cord blood transplant. The promising results have paved the way for expanding the study from one site to an international, multicenter clinical trial.
University Hospitals Seidman Cancer Center is poised to become one of those sites. Between 15 and 25 patients will be enrolled, said Dr. Marcos de Lima, lead study author who joined UH in the fall to become section chief of hematologic malignancies and bone marrow transplantation at Seidman and professor of medicine at Case Western Reserve University School of Medicine. With study sites opening up elsewhere in the United States and in Europe, several hundred patients will be able to take part in the trial, said de Lima. He said he hopes enrollment will start within the next year.
Cord blood, which is filled with adult stem cells similar to those found in bone marrow, is extracted from an umbilical cord and placenta shortly after a baby is born. Transplanting cord blood instead of bone marrow or peripheral blood has several advantages, among them that the cord blood doesn’t have to be a perfect match for a patient. That opens up the number of potential matches that are available for patients, especially those who are ethnic minorities. But among the limitations were the time it took for donor cells to begin making new blood cells, called engraftment, and the relatively small amount of cells that can be obtained from one cord blood unit — a problem for adult patients.
The first double cord blood transplants using two unrelated units of cord blood, designed to make transplantation more effective in adults, were conducted more than a dozen years ago. The ability to produce a higher volume of stem cells from the two transplanted units still did not solve the problem of the length of time from infusion to engraftment. “The longer you go without red blood cells, white blood cells and platelets, the more trouble you have,” de Lima said. All of those things are essential to ward off infection, bleeding, and anemia.  To get around that hurdle, the MD Anderson team decided to see if they could make more of the cord blood cells in the lab in conditions that mimic that of bone marrow. One unit was transplanted unchanged, while the second unit was “expanded” in the lab — before transplant — using a type of cell found in bone marrow called mesenchymal stromal cell.
The study, which opened in 2007 and lasted for three years, enrolled 31 patients at MD Anderson, all of whom received two cord blood units with the new treatment. An additional 140 patients from MD Anderson and elsewhere also received two units of unmanipulated cord blood, and were the control group. The result of the expansion treatment was quicker engraftment, compared to other patients treated with the more traditional double cord blood transplant method. The most unexpected study outcome, de Lima said, was the reduction in time it took to resume production of platelets, a key in protecting against excessive bleeding.
“Traditionally, platelets are a big problem,” said de Lima, adding that patients typically have to undergo numerous transfusions. With the new method, “We saw much more consistent, solid [development], and people needed less transfusion. That was a pleasant surprise,” he said.

http://www.cleveland.com

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Cord Blood Treatment May Fulfill Baseballer’s Dreams

In STEM CELLS IN THE NEWS on April 13, 2012 at 11:29 am

Twenty-two-years ago, a doctor performed the first umbilical cord transplant for leukemia in the U.S. He used stem cells from a newborn’s umbilical cord and found that they could clean up leukemia cells…Ten years later, in 2000, he learned that mixing cord blood from two different babies was even more effective. Now, he’s taking it a step further.  “What makes this particularly unique is that Derrick is the first person in the world to receive this therapy,” said Wagner.

http://www.mommymdguides.com/wp-content/uploads/2010/09/QuestionsSecondTrimesterCordBloodBanking2.jpg

gee I hope Texas rules in favor of stem cell treatments today or all of the leukemia patients who follow this guy will be screwed.  they will have to enter a clinical trial in 6 years or so with 30% chance of receiving the cord blood, made into a drug with side effects of course…a trial which excludes anyone with anything else wrong with them (do leukemia patients ever have other sicknesses? probably not.  i seem to remember hearing a lot: “he’s healthy as an ox…except for the leukemia of course). 

so this is good news.  in 10 years or so all you leukemia patients can get a drug…made from cord blood stem cells…with a fraction of the effectiveness…and lots of negative side effects…maybe…

because the truth is, if it’s that rare, then the market sales will not be large enough to pay back the 1/2 billion required to bring the drug to market – so it will never get made anyway…and wait, 10 years?  what’s the life expectancy for  “high-risk form(s) of leukemia which [can] not be cured by chemotherapy?”  never mind readers. skip this article, this doesn’t apply to you.  you’ll all be dead by then.

I REALLY hope Texas rules in favor of stem cell treatments today

Cord Blood Treatment May Fulfill Baseballer’s Dreams

VIDEO – http://minnesota.cbslocal.com/video?autoStart=true&topVideoCatNo=default&clipId=6824750

MINNEAPOLIS (WCCO) — He was set to go to college last fall and play baseball, but leukemia changed that. Now, an 18-year-old man is part of the first-of-its-kind treatment that may allow him to fulfill his dream.

Derrick Keller is supposed to be playing baseball for Southwest Minnesota State University, not sitting in a hospital bed at University of Minnesota Amplatz Children’s Hospital. But last summer, just before he was set to leave for college on a baseball scholarship, Derrick began feeling weak.

“For no reason just jogging to centerfield and back, playing catch, my muscles would get extremely tired and I wasn’t feeling myself,” said Keller.

A blood test confirmed his family’s worst fears. Keller had a high-risk form of leukemia which could not be cured by chemotherapy.

“It was unexpected. I would never expect to hear that news. I was normal and it was just weird, I guess,” said Keller.

College was no longer an option. Neither was baseball, which was probably the hardest thing for Keller. But after months in and out of the hospital, his luck was about to change.

“We were able to show that cord blood was a very effective way of curing leukemia,” said Dr. John Wagner, who believes he may be able to cure Keller.

Twenty-two-years ago, Wagner performed the first umbilical cord transplant for leukemia in the U.S. He used stem cells from a newborn’s umbilical cord and found that they could clean up leukemia cells.

Ten years later, in 2000, he learned that mixing cord blood from two different babies was even more effective. Now, with Keller, he’s taking it a step further.

“What makes this particularly unique is that Derrick is the first person in the world to receive this therapy,” said Wagner.

Wagner says Keller would receive an expanded number of stem cells, beyond anything they’ve done before. On Feb. 7, Keller received 73 times more stem cells than the average patient gets.

Wagner’s theory is that the more stem cells Keller receives, the quicker the recovery time and less hospital visits down the road. The surgery was a success and, so far, Keller looks and feels better.

“We think we should be able to cure him of leukemia where, six months from now, you had no idea he ever went through a transplant,” said Wagner.

That would make him a part of history. For Keller, the thought of going to college and being able to play the sport he loves is more thrilling than all of his home runs combined.

“It gets tough sitting here when all my friends are off at college doing that kind of stuff. As soon as I can get back to playing ball and being the normal me again, it will feel great,” said Keller.

Wagner says, if successful, this treatment could be used for both children and adults.

If Keller continues to heal as fast as he is, Wagner sees no reason he can’t go to Southwest Minnesota State in Marshall this fall, where a baseball scholarship is still waiting for him.

Cord Blood Treatment May Fulfill Baseballer’s Dreams « CBS Minnesota.

Ethan Zohn undergoes stem-cell transplant

In VICTORIES & SUCCESS STORIES on March 5, 2012 at 4:04 am

Ethan Zohn undergoes stem-cell transplant, thanks ‘Survivor’ girlfriend Jenna Morasca

His fighting spirit, family & friends keep him positive

By Joyce Chen / NEW YORK DAILY NEWS
Thursday, March 1, 2012, 4:39 PM

 	Ethan Zohn had a stem-cell transplant to treat his Hodgkin’s lymphoma.

Rob Loud/Getty Images

Ethan Zohn had a stem-cell transplant to treat his Hodgkin’s lymphoma.

Ethan Zohn is by all measures the definition of a true survivor.

The former “Survivor” winner underwent a stem-cell transplant Wednesday to treat his recurring case of Hodgkin’s lymphoma, and even under the serious circumstances, Zohn still had competition on his mind.

“Ethan asked the doctor what was the record time for getting out of here, so he wants to beat that,” Zohn’s longtime girlfriend Jenna Morasca told People.

“His doctor said there was no prize, and Ethan said, ‘Yes, there is. You’re going to tell the other patients that I made it out in three weeks.’”…

Read more: Ethan Zohn undergoes stem-cell transplant, thanks ‘Survivor’ girlfriend Jenna Morasca – NY Daily News.

ADULT STEM CELLS AND RADIATION?

In SCIENCE & STEM CELLS on November 16, 2011 at 6:51 pm

The question of radiation during adult stem cell treatments came up today:

radiation pic

N says: “Touting adult stem cells as the way to salvation, even with donor human hematopoietic stem cells (hHESCs) (adult stem cells), used in the treatment of leukemia patients, a patient must undergo a radiation treatment to suppress their immune system prior to receiving the donor hHESCs. StemCellBlogger commented on the need for immunosuppression when using hESCs in clinical translational therapy. Given that a patient must receive a near lethal dose of radiation, knocking out their immune system BEFORE receiving hHESCs from a registered DONOR, flies in the face of reason when compared to the immunosuppression required for hESC infusion. A patient receivng either a liver, kidney, pancreas or dual kidney pancreas organ transplant receives immunosuppression in the form of Campath as a prophylactic prior to the transplant and then must either receive Prograf, Cyclosporin, or Sirolimus (depending on the tissue transplanted) in order to suppress the patients immune system, allowing the graft to survive while avoiding graft-vs-host rejection. If we are going to talk about translational therapies, then let’s get into the meat and stop chewing the fat.

regen medicine

My response: I’m not talking about bone marrow transplants for leukemia patients, I’m talking about adult stem cell treatments used in regenerative medicine.  For example, CBS who have called adult stem cells snake oil for years just did a very positive piece on a recent heart trial:

CBS VIDEO on Adult Stem Cell Success with Heart Disease

CBS ARTICLE on Adult Stem Cell Success with Heart Disease

“This study is still in progress. 16 patients were assigned to the treatment group and seven to the control group; no CSC-related adverse effects were reported. In 14 CSC-treated patients who were analysed, LVEF increased from 30·3% (SE 1·9) before CSC infusion to 38·5% (2·8) at 4 months after infusion (p=0·001). By contrast, in seven control patients, during the corresponding time interval, LVEF did not change (30·1% [2·4] at 4 months after CABG vs 30·2% [2·5] at 8 months after CABG). Importantly, the salubrious effects of CSCs were even more pronounced at 1 year in eight patients (eg, LVEF increased by 12·3 ejection fraction units [2·1] vs baseline, p=0·0007). In the seven treated patients in whom cardiac MRI could be done, infarct size decreased from 32·6 g (6·3) by 7·8 g (1·7; 24%) at 4 months (p=0·004) and 9·8 g (3·5; 30%) at 1 year (p=0·04).”

via Clinical Trial in The Lancet CBS Based Their Reporting On

While the study is still in prgress and the results are preliminary, I find it extremely ironic that CBS uses words like “breakthrough” and “first ever” and N acts as if he doesn’t know about the 443 clinical trials at clinicaltrials.gov with the keywords “stem cell” and “cardiac?,” over 2,000 completed Adult stem cell trials, thousands of patients treated safely and effectively around the world and over 5,170 peer reviewed published studies with the keywords “adult stem cell” and “cardiac?”

The results are great the history is extensive and no radiation is needed.In fact, even MS which used to need radiation to treat with adult stem cells no longer needs radiation.

MEDICAL MARIJUANA (CANNABIS) CURES CANCER

In Medical Marijuana on March 29, 2011 at 2:58 pm
How Cannabinoids Kill Cancer Cells

This clip is from the recently-aired PBS documentary, ‘Clearing the Smoke: The Science of Cannabis,’ which explores the scientifically proven fact that cannabinoids kill cancer cells in test tubes and in laboratory animals.

Here are 1,500 more videos on “Cannabis Cures Cancer”: http://bit.ly/Cannnabis_cures_cancer

Cannabinoid receptors exist throughout organs of the human body, especially in the brain and in the immune system. These act like targets for cannabinoids. Once they bind to the receptors, peptides are released that tell the cancer cells to die, i.e., to commit suicide.

One doctor interviewed has been so encouraged by the laboratory results that he has begun cannabis trials with his own leukemia patients.

Medical Marijuana Cannabis Cures Cancers.

Girl cured of brain cancer using umbilical cord stem cells

In VICTORIES & SUCCESS STORIES on March 11, 2011 at 2:07 pm

In the first transplant of umbilical cord stem cells in Spanish history, a four year old girl has been cured of a brain tumor…

Alba Martinez was born in the province of Cádiz in 2007 and despite her good health, her parents say they decided to provide her with “life insurance” by means of preserving her umbilical cord in cold storage, an option taken by only a handful of parents in Spain.

At 22 months, Martinez began to suffer from a brain tumor and needed several intensive rounds of chemotherapy, which destroyed her blood cells, requiring her to receive infusions of stem cells from her umbilical cord.  The availability of such a treatment in infants suffering from cancer is rare, due to the fact that in most cases the child suffers from leukemia, which originates in a genetic defect also found in the child’s stem cells.

Today, 16 months after her stem cells restored her blood system, Martinez remains cancer free. Doctors will be able to certify her as “cured” after living a total of five years without a relapse. Her parents say that the procedure is their “best investment” ever.  “Conserving the umbilical cord is betting on the future, a life insurance that you don’t know if you will need sometime, but that can save a life,” said Theresa Molina, the child’s mother…

Girl cured of brain cancer using umbilical cord stem cells | LifeSiteNews.com.

Taunton Elks Lodge the host of marrow drive to save a 5-year-old girl – Taunton, MA – The Taunton Gazette

In STEM CELLS IN THE NEWS on March 11, 2011 at 1:11 am

For three hours on Thursday, the main room of the Elks Lodge 150 on High Street was the scene of an effort to help save the life of a 5-year-old girl.

Unless she receives a successful bone marrow transplant, doctors say Katelyn Bailey won’t survive.

 

Katelyn, who had been living at home in Middletown, R.I. with her parents Michelle and Larry, and her now 9-month-old sister Meghan, has recently undergone chemotherapy at Hasbro Children’s Hospital in Providence.

Her parents have taken temporary, partial leaves from their jobs to be by her bedside, and relatives are helping out by taking turns baby-sitting baby Meghan, said Taunton Police Patrolman Ernie Chretien.

Chretien, a first cousin of Meghan’s mom Michelle, organized and arranged the “Be The Match Registry” drive, in conjunction with Rhode Island Blood Center, to be held at the Elks Lodge.

To say Katelyn is facing an uphill battle is putting it lightly, Chretien said.

When she was 9 months old, she was diagnosed with a rare form of brain cancer known as AT/RT, or atypical teratoid rhabdoid tumor. She responded to chemo and radiation, and the cancer went into remission, he said.

But she also suffered side effects as a result. Chretien said her speech development was delayed and she relied on a feeding tube; it wasn’t until she was 4, he said, that she began eating solid food.

Chretien said the last time he saw Katelyn was Christmas week when he visited at her home.

“She seemed healthy and cheerful,” he said.

But by early February she was exhibiting flu-like symptoms and was taken to Hasbro, where she was diagnosed with an advanced form of leukemia…

Read more: Taunton Elks Lodge the host of marrow drive to save a 5-year-old girl – Taunton, MA – The Taunton Gazette http://www.tauntongazette.com/archive/x13267752/Taunton-Elks-Lodge-the-host-of-marrow-drive-to-save-a-5-year-old-girl#ixzz1GGSxUGZR

Taunton Elks Lodge the host of marrow drive to save a 5-year-old girl – Taunton, MA – The Taunton Gazette.

New Hope for Baby Boomers with Leukemia and Lymphomia

In VICTORIES & SUCCESS STORIES on March 1, 2011 at 9:12 am

New Hope for Baby Boomers with Leukemia and Lymphomia

Loyola University Health System
2/17/2011

Newswise — MAYWOOD, Ill. — As the first baby boomers turn 65, Loyola University Hospital has begun offering stem cell transplants to leukemia and lymphoma patients who previously were too old to qualify.

Hospitals traditionally have not offered stem cell transplants to patients older than 60 due to potentially severe complications. But Loyola now offers this treatment to patients in their 60s and early 70s.

“A lot of seniors are taking very good care of themselves. They’re in excellent shape, even running marathons and half-marathons,” said Dr. Patrick Stiff, director of Loyola’s Cardinal Bernardin Cancer Center. “As they potentially could live another 15 or 20 years, we believe they are just as worthy of receiving transplants as people in their teens or 20s.”

The median age of patients who are diagnosed with leukemia is between 65 and 68. For patients older than 60 who have aggressive forms of leukemia and undergo conventional therapy, the five-year survival rate is less than 5 percent.
But six of the first seven plus-60 patients who have undergone umbilical cord blood stem cell transplants at Loyola have survived. “They’re doing much better than we anticipated,” Stiff said.

William Karris of Carol Stream, Il. was 65 when he received a cord blood transplant at Loyola for an aggressive form of chronic lymphocytic leukemia. Without the transplant, Karris was expected to live only about six months. The transplant was successful, and Karris now is in remission more than a year and a half after transplant. The chances of a relapse are less than 2 percent, Stiff said.
Karris now plans to go ahead with a delayed knee-replacement surgery, and then return to work as a Bellwood police officer. “I feel pretty good,” he said.

A stem cell transplant can be a grueling and risky procedure. The patient undergoes high-dose chemotherapy, and sometimes high-dose radiation, to kill cancer cells. The treatment also destroys the patient’s immune system cells. To compensate, the patient receives an infusion of donor stem cells, which develop into healthy immune cells.

In addition to the side effects of chemotherapy and radiation, a patient is at risk for severe infections until the new immune system takes hold. And once established, the new immune system can attack the patient’s own body, a condition called graft-vs.-host disease. In such cases, the patient receives drugs to suppress the immune system, which in turn can increase the risk of infections.

Donor cells can come from a donor’s bone marrow or from a newborn’s umbilical cord blood. Stiff said cord blood transplants are easier on elderly patients than bone marrow transplants. Less than 10 percent of cord blood transplant patients experience significant graft-vs.-host disease, compared with about 50 percent of patients who receive bone marrow transplants.

Loyola has treated more than 3,000 patients with stem cell transplants, more than any other center in Illinois, and has one of the largest unrelated donor transplant programs in the world. Loyola physicians are currently focusing on umbilical cord blood transplants and have a number of novel therapies available for patients with leukemia, lymphoma and multiple myeloma who otherwise can not find a donor elsewhere.

Loyola has performed more than 90 cord blood transplants, and a new study has shown that a center’s experience is indeed an important factor in patient outcomes. Researchers examined records of 514 cord blood transplant patients in North America and Europe. They found that, 100 days after the transplant, the mortality rate was more than twice as high at centers with limited experience (fewer than 10 transplants). The study is published in the January, 2011 issue of the journal Bone Marrow Transplantation.

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