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Article ; Online: What is photopheresis? Role of extracorporeal photopheresis in the treatment of GvHD and its practice in Sweden.

Karlsson, Yoshimi Fukumaki / Berlin, Gösta

Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy

2023 Volume 27, Issue 6, Page(s) 1051–1052

MeSH term(s)	Humans ; Photopheresis ; Sweden ; Hematopoietic Stem Cell Transplantation ; Graft vs Host Disease/therapy ; Chronic Disease
Language	English
Publishing date	2023-09-10
Publishing country	Australia
Document type	Letter
ZDB-ID	2119809-3
ISSN	1744-9987 ; 1091-6660 ; 1744-9979
ISSN (online)	1744-9987
ISSN	1091-6660 ; 1744-9979
DOI	10.1111/1744-9987.14051
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Zs.A 5208: Show issues

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Article ; Online: Extracorporeal photopheresis for graft-vs-host disease: A literature review and treatment guidelines proposed by the Nordic ECP Quality Group.

Nygaard, Marietta / Wichert, Stina / Berlin, Gösta / Toss, Fredrik

European journal of haematology

2020 Volume 104, Issue 5, Page(s) 361–375

Abstract: Extracorporeal photopheresis (ECP) is one of the most used and established therapies for steroid-refractory graft-vs-host disease (GvHD), with a good effect to side effect profile. In this review, we present a summary of present literature and provide ... ...

Abstract	Extracorporeal photopheresis (ECP) is one of the most used and established therapies for steroid-refractory graft-vs-host disease (GvHD), with a good effect to side effect profile. In this review, we present a summary of present literature and provide evidence-based treatment guidelines for ECP in GvHD. The guidelines constitute a consensus statement formed by the Nordic ECP Quality Group representing all ECP centres in the Nordic countries, and aims to facilitate harmonisation and evidence-based practice. In developing the guidelines, we firstly conducted a thorough literature search of original articles and existing guidelines. In total, we identified 26 studies for ECP use in acute GvHD and 36 in chronic GvHD. The studies were generally small, retrospective and heterogeneous regarding patient characteristics, treatment schedule and outcome assessment. In general, a majority of patients achieved partial response or better, but response rates varied by the organs affected. Head-to-head comparisons to other treatment modalities were lacking. Overall, we consider the quality of evidence to be low-moderate (GRADE) and encourage future prospective multi-armed trials to strengthen the present recommendations. However, despite limitations in evidence strength, standardised treatment schedules and regular follow-up are imperative to ensure the best possible patient outcome.
MeSH term(s)	Acute Disease ; Animals ; Chronic Disease ; Disease Management ; Graft vs Host Disease/diagnosis ; Graft vs Host Disease/etiology ; Graft vs Host Disease/therapy ; Hematopoietic Stem Cell Transplantation/adverse effects ; Humans ; Photopheresis/adverse effects ; Photopheresis/instrumentation ; Photopheresis/methods ; Practice Guidelines as Topic ; Quality Assurance, Health Care ; Quality of Health Care ; Transplantation, Homologous ; Trauma Severity Indices
Language	English
Publishing date	2020-02-22
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	392482-8
ISSN	1600-0609 ; 0902-4441
ISSN (online)	1600-0609
ISSN	0902-4441
DOI	10.1111/ejh.13381
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Zs.A 323: Show issues

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Article: Granulocyte concentrates prepared from residual leukocyte units produced by the Reveos automated blood processing system.

Sahlin, Angelica / Blomgran, Robert / Berlin, Gösta

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis

2019 Volume 59, Issue 2, Page(s) 102682

Abstract: Background: Granulocyte concentrates are mainly derived by apheresis technique from donors stimulated with granulocyte colony-stimulating factor and steroids. The automated blood processing system Reveos, which is now increasingly used across the world, ...

Abstract	Background: Granulocyte concentrates are mainly derived by apheresis technique from donors stimulated with granulocyte colony-stimulating factor and steroids. The automated blood processing system Reveos, which is now increasingly used across the world, separates whole blood into four components, including a residual leukocyte unit containing granulocytes. The aim of this study was to produce an alternative granulocyte concentrate from leukocyte units produced by the Reveos system, and to assess the function of the granulocytes. Methods: The number of granulocytes was measured in residual leukocyte units, derived from whole blood donations, with different volumes ranging from 10 to 40 ml. After deciding the optimal volume of the leukocyte unit (30 ml), ten ABO-matched units were pooled to form a granulocyte concentrate. The function of the granulocytes from residual leukocyte units was assessed by analyzing surface markers, phagocytosis of yeast, and production of reactive oxygen species. Results: Residual leukocyte units with a volume of 30 ml contained a median number of 0,7 × 10 Conclusions: Granulocyte concentrates prepared from residual leukocyte units contain in vitro functional granulocytes and may be considered as an alternative product in acute situations before regular granulocyte concentrates from stimulated donors are available.
MeSH term(s)	Blood Component Removal/instrumentation ; Blood Preservation/methods ; Granulocytes/metabolism ; Humans ; Leukocytes/metabolism
Language	English
Publishing date	2019-11-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2046795-3
ISSN	1878-1683 ; 1473-0502
ISSN (online)	1878-1683
ISSN	1473-0502
DOI	10.1016/j.transci.2019.102682
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Zs.A 1739: Show issues

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Article ; Online: Transfusion-related Acute Lung Injury: 36 Years of Progress (1985-2021).

Toy, Pearl / Looney, Mark R / Popovsky, Mark / Palfi, Miodrag / Berlin, Gösta / Chapman, Catherine E / Bolton-Maggs, Paula / Matthay, Michael A

Annals of the American Thoracic Society

2022 Volume 19, Issue 5, Page(s) 705–712

Abstract: The term transfusion-related acute lung injury (TRALI) was coined in 1985 to describe acute respiratory distress syndrome (ARDS) after transfusion, when another ARDS risk factor was absent; TRALI cases were mostly associated with donor leukocyte antibody. ...

Abstract	The term transfusion-related acute lung injury (TRALI) was coined in 1985 to describe acute respiratory distress syndrome (ARDS) after transfusion, when another ARDS risk factor was absent; TRALI cases were mostly associated with donor leukocyte antibody. In 2001, plasma from multiparous donors was implicated in TRALI in a randomized controlled trial in Sweden. In 2003 and in many years thereafter, the U.S. Food and Drug Administration reported that TRALI was the leading cause of death from transfusion in the United States. In 2003, the United Kingdom was the first among many countries to successfully reduce TRALI using male-predominant plasma. These successes are to be celebrated. Nevertheless, questions remain about the mechanisms of non-antibody TRALI, the role of blood products in the development of ARDS in patients receiving massive transfusion, the causes of unusual TRALI cases, and how to reduce inaccurate diagnoses of TRALI in clinical practice. Regarding the latter, a study in 2013-2015 at 169 U.S. hospitals found that many TRALI diagnoses did not meet clinical definitions. In 2019, a consensus panel established a more precise terminology for clinical diagnosis: TRALI type I and TRALI type II are cases where transfusion is the likely cause, and ARDS are cases where transfusion is not the likely cause. For accurate diagnosis using these clinical definitions, critical care or pulmonary expertise is needed to distinguish between permeability versus hydrostatic pulmonary edema, to determine whether an ARDS risk factor is present, and, if so, to determine whether respiratory function was stable within the 12 hours before transfusion.
MeSH term(s)	Blood Transfusion ; Humans ; Male ; Pulmonary Edema/etiology ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Transfusion Reaction/complications ; Transfusion-Related Acute Lung Injury/complications ; Transfusion-Related Acute Lung Injury/diagnosis
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202108-963CME
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Zs.A 5828: Show issues

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Article: Real-world clinical characterization, healthcare resource utilization and productivity loss in chronic graft versus host patients exposed to extracorporeal photopheresis in Sweden.

Schain, Frida / Boissin, Constance / Laczik, Tamas / Fedeli, Stefano / Remberger, Mats / Blennow, Ola / Dykes, Josefina / Eich, Torsten / Jones, Christina / Mattsson, Jonas / Berlin, Gösta

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis

2023 Volume 62, Issue 3, Page(s) 103705

Abstract: Background: Extracorporeal photopheresis (ECP) is frequently used to treat moderate-severe chronic graft versus host disease (cGVHD), however limited data exists describing ECP treatment effects on healthcare and societal costs. We aimed to characterize ...

Abstract	Background: Extracorporeal photopheresis (ECP) is frequently used to treat moderate-severe chronic graft versus host disease (cGVHD), however limited data exists describing ECP treatment effects on healthcare and societal costs. We aimed to characterize clinical and health economic outcomes and productivity loss in cGVHD patients exposed to ECP. Methods: We identified 2708 patients aged ≥ 18 years with a record of allogeneic hematopoietic stem cell transplantation (HSCT) in the Swedish Patient Register between 2006 and 2020. Patients exposed to ECP from 3-months post HSCT (index) were included (n= 183). Data was linked to the Prescribed Drug Register, the Cause of Death Register, and the Longitudinal Integrated Database for Health Insurance and Labor Market Studies (LISA). Results: The median patient age at index was 51 years (IQR1-3; 38-61). In the 3-month period before ECP initiation compared to 9-12 months post-ECP, the cumulative three-month dose per patient decreased prednisolone/prednisone (1,381 mg vs. 658 mg, p < 0.001) and cyclosporin (12,242 mg vs. 3,501 mg, p < 0.001). Infection incidence also decreased over the same period (79.2% vs 59.1%, p < 0.001). Time spent in healthcare decreased from 68.9% to 22.1% from the first and fifth follow-up year respectively, and corresponding annual healthcare cost reduced from €27,719 to €1,981. Among patients < 66 years of age, sickness-related workplace absence decreased from 73.2% to 31.9% between the first and fifth follow-up year, with median annual productivity loss decreasing from €20,358 to €7,211 per patient. Conclusions: ECP was associated with reduced use of corticosteroids, immunosuppressive agents, and fewer infections. Furthermore, cost and healthcare utilization decreased over time.
MeSH term(s)	Humans ; Graft vs Host Disease/etiology ; Graft vs Host Disease/therapy ; Sweden/epidemiology ; Photopheresis ; Hematopoietic Stem Cell Transplantation/adverse effects ; Patient Acceptance of Health Care ; Chronic Disease
Language	English
Publishing date	2023-03-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2046795-3
ISSN	1878-1683 ; 1473-0502
ISSN (online)	1878-1683
ISSN	1473-0502
DOI	10.1016/j.transci.2023.103705
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Zs.A 1739: Show issues

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Article ; Online: Does prophylactic calcium in apheresis cause more harm than good? - Centre heterogeneity within the World Apheresis Association Register prevents firm conclusions.

Toss, Fredrik / Edgren, Gustaf / Berlin, Gösta / Stegmayr, Bernd / Witt, Volker

Vox sanguinis

2018 Volume 113, Issue 7, Page(s) 632–638

Abstract: Background and objectives: Symptomatic hypocalcaemia is common during apheresis procedures based on citrate-based anticoagulants. As a consequence, patients often receive prophylactic calcium treatment. However, a recent publication based on the World ... ...

Abstract	Background and objectives: Symptomatic hypocalcaemia is common during apheresis procedures based on citrate-based anticoagulants. As a consequence, patients often receive prophylactic calcium treatment. However, a recent publication based on the World Apheresis Association (WAA) register suggested harmful effects of such prophylactic calcium use. Recognizing possible limitations in the previous WAA register analyses, we critically re-evaluate the data, to test whether a change in prophylactic calcium usage may be warranted. Materials and methods: Using the WAA register, we reanalysed previous data by means of centre and treatment type stratification, to explore the role of prophylactic calcium as a risk factor for adverse events. Results: There was large variability in adverse event rates dependent on the centre performing the apheresis procedure and dependent on the type of procedure. When this variability was accounted for, there was no clear effect of calcium administration on risk of adverse effects. Conclusion: Shortcomings in the previous WAA register analyses may have failed to account for important confounding factors resulting in a substantial overestimation of the risk attributable to calcium usage. Overall our findings do not support a negative effect of prophylactic calcium administration in the apheresis setting.
MeSH term(s)	Adult ; Aged ; Blood Component Removal/methods ; Calcium/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Registries
Chemical Substances	Calcium (SY7Q814VUP)
Language	English
Publishing date	2018-08-06
Publishing country	England
Document type	Evaluation Studies ; Journal Article
ZDB-ID	80313-3
ISSN	1423-0410 ; 0042-9007
ISSN (online)	1423-0410
ISSN	0042-9007
DOI	10.1111/vox.12698
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Zs.A 74: Show issues

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Article ; Online: Storage-induced change in platelet transfusion response evaluated by serial transfusions from one donor to one patient.

Tynngård, Nahreen / Boknäs, Niklas / Trinks, Marie / Dreimane, Arta / Berlin, Gösta

Transfusion

2018 Volume 59, Issue 2, Page(s) 723–728

Abstract: Background: Storage of platelet concentrates (PCs) results in storage lesions with possible detrimental effects on platelet recovery after transfusion, which might affect their ability to prevent or arrest bleeding. The aim of this study was to compare ... ...

Abstract	Background: Storage of platelet concentrates (PCs) results in storage lesions with possible detrimental effects on platelet recovery after transfusion, which might affect their ability to prevent or arrest bleeding. The aim of this study was to compare the quality of PCs stored for 1 to 3 or 5 to 7 days by assessing the corrected count increment (CCI) after transfusion. To isolate the effects of storage time, we studied serial transfusions of PCs obtained from one donor and one donation, and transfused to one single recipient after storage for 1 to 3 days and 5 to 7 days. Study design and methods: Platelets were obtained from one donor by apheresis, divided into two units (>240 × 10 Results: Thirty patients concluded the study according to the protocol. The mean storage time was 2.4 ± 0.7 and 5.7 ± 0.8 days for platelets transfused on Days 1 to 3 and 5 to 7, respectively. Storage for 5 to 7 days decreased the 1-hour transfusion response as compared to platelets stored 1 to 3 days, from a CCI of 17 ± 7 to 13 ± 5. Despite this decrease, 86% of the 5 to 7 days stored PCs resulted in a CCI above the cutoff value for a successful transfusion of 7.5, which was not significantly different to PCs stored for 1 to 3 days. Conclusion: Storage of PCs for 5 to 7 days only slightly altered the transfusion response.
MeSH term(s)	Adult ; Aged ; Blood Donors ; Blood Platelets/cytology ; Blood Platelets/metabolism ; Blood Preservation ; Female ; Humans ; Male ; Middle Aged ; Platelet Transfusion ; Plateletpheresis ; Time Factors
Language	English
Publishing date	2018-12-12
Publishing country	United States
Document type	Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.15079
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Zs.A 284: Show issues

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Article ; Online: Treatment of platelet concentrates with ultraviolet C light for pathogen reduction increases cytokine accumulation.

Sandgren, Per / Berlin, Gösta / Tynngård, Nahreen

Transfusion

2016 Volume 56, Issue 6, Page(s) 1377–1383

Abstract: Background: Pathogen reduction technologies use photoactive substances in combination with ultraviolet (UV) light to inactivate pathogens. A new method uses only UVC light for pathogen reduction. This study assesses the effects of UVC light treatment on ...

Abstract	Background: Pathogen reduction technologies use photoactive substances in combination with ultraviolet (UV) light to inactivate pathogens. A new method uses only UVC light for pathogen reduction. This study assesses the effects of UVC light treatment on cytokine release in platelet (PLT) concentrates (PCs). Study design and methods: A PC with 35% plasma and 65% PLT additive solution (SSP+) was prepared from five buffy coats. Three such PCs were pooled and divided into 3 units. One unit was used as a nonirradiated control, the second was a gamma-irradiated control, and the third unit was treated with UVC light technology. Ten units of each type were investigated. Cytokine release was analyzed on Days 1, 5, and 7 of storage. Correlation between cytokines, PLT surface markers, and hemostatic properties was investigated. Results: Swirling was well preserved and pH was above the reference limit of 6.4 during storage of PLTs in all groups. Cytokine levels increased during storage in all groups but to a larger degree in PCs treated with UVC light. Only weak correlation was found between cytokines and PLT surface markers (r < 0.5). However, several cytokines showed strong correlation (r > 0.6) with the PLTs' ability to promote clot retraction. Conclusion: UVC treatment resulted in increased release from PLT alpha granules as evident by a higher cytokine release compared to nonirradiated and gamma-irradiated PCs. The clinical relevance of these findings needs to be further evaluated.
MeSH term(s)	Blood Platelets/microbiology ; Blood Platelets/radiation effects ; Blood Preservation/methods ; Blood Safety ; Cytokines/metabolism ; Gamma Rays ; Healthy Volunteers ; Hemostatics/radiation effects ; Humans ; Platelet Activation/radiation effects ; Time Factors ; Ultraviolet Rays
Chemical Substances	Cytokines ; Hemostatics
Language	English
Publishing date	2016-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.13601
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Zs.A 284: Show issues

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Article ; Online: In vitro function of platelets treated with ultraviolet C light for pathogen inactivation: a comparative study with nonirradiated and gamma-irradiated platelets.

Tynngård, Nahreen / Trinks, Marie / Berlin, Gösta

Transfusion

2015 Volume 55, Issue 6, Page(s) 1169–1177

Abstract: Background: During storage of platelet concentrates (PCs) replication of contaminating pathogens might occur, which can be prevented by various pathogen inactivation (PI) methods using photoactive substances in combination with ultraviolet (UV) light. A ...

Abstract	Background: During storage of platelet concentrates (PCs) replication of contaminating pathogens might occur, which can be prevented by various pathogen inactivation (PI) methods using photoactive substances in combination with ultraviolet (UV) light. A new method uses only UVC light for PI without photoactive substances. This study evaluates the in vitro function, including hemostatic properties (clot formation and elasticity), of platelets (PLTs) treated with UVC light. Study design and methods: A PC with 35% plasma and 65% PLT additive solution (SSP+) was prepared from five buffy coats. Three PCs were pooled and divided into 3 units. One unit was used as a nonirradiated control, the second was a gamma-irradiated control, and the third unit was treated with UVC light. In vitro variables including analysis of coagulation by free oscillation rheometry were analyzed on Days 1, 5, and 7 of storage. Ten units in each group were investigated. Results: Swirling was well preserved, and the pH level was higher than the reference limit (6.4) during storage of PLTs in all groups. Glycolysis and PLT activation were higher for UVC-treated PLTs but the clot-forming capacity was unaffected. However, immediately after UVC treatment, the clot elastic properties were slightly affected. Hypotonic shock response decreased immediately after UVC treatment but recovered partly during the storage period. Conclusion: UVC treatment affected the in vitro properties, but PLT quality and storage stability were well preserved for up to 7 days, and the in vitro hemostatic capacity of UVC-treated PLTs was only minimally altered. The clinical relevance of these changes needs to be evaluated in controlled trials.
MeSH term(s)	Adult ; Apoptosis/radiation effects ; Blood Coagulation Tests ; Blood Glucose/analysis ; Blood Platelets/physiology ; Blood Platelets/radiation effects ; Blood Preservation ; Blood-Borne Pathogens/radiation effects ; Carbon Dioxide/blood ; Elasticity ; Gamma Rays/adverse effects ; Glycolysis/radiation effects ; Humans ; Hydrogen-Ion Concentration ; Mean Platelet Volume ; Osmotic Pressure ; Oxygen/blood ; P-Selectin/blood ; Phosphatidylserines/blood ; Platelet Activation ; Platelet Function Tests ; Ultraviolet Rays/adverse effects ; Virus Inactivation
Chemical Substances	Blood Glucose ; P-Selectin ; Phosphatidylserines ; Carbon Dioxide (142M471B3J) ; Oxygen (S88TT14065)
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.12963
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Article: Ostergötland satsar på klinisk forskning. Hälsouniversitetet och landstinget vill stärka forskningens roll i vården.

Berlin, Gösta / Hammar, Mats

Lakartidningen

2011 Volume 108, Issue 3, Page(s) 81–84

Title translation	Ostergotland concentrates on clinical research. The Faculty of Health Sciences and the county council want to strengthen the role of research in health care.
MeSH term(s)	Biomedical Research/economics ; Biomedical Research/manpower ; Biomedical Research/standards ; Clinical Competence ; Health Services/economics ; Health Services/manpower ; Health Services/standards ; Humans ; Professional Competence ; Research Support as Topic ; Sweden
Language	Swedish
Publishing date	2011-01
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	391010-6
ISSN	1652-7518 ; 0023-7205
ISSN (online)	1652-7518
ISSN	0023-7205
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