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2014/2015 Medium-term fellowship report

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by Alexandra Laberko

I was awarded an ESID medium term fellowship grant giving me an opportunity to spend 3 months at the “Great North Children Hospital”, Newcastle upon Tyne, UK from April-June  2015.

During my fellowship I was working as a part of the HSCT and Immunology team deepening my knowledge in diagnosis and management of patients with many different and diverse primary immunodeficiencies. It was important for me to have an opportunity to work in a big multi-faceted hospital experiencing many different immunology and HSCT practices to those in my home unit.

I was able to learn aspects of PID diagnoses, seeing patients in immunology outpatient clinics and inpatient pediatric wards, participating in patient’s discussions on weekly multidisciplinary meetings, and collaborating with referring hospital teams.  Visiting immunology clinic and pediatric wards for 3 months I could follow the evolution of management approaches of PID patients requiring different treatment applications. It was useful to spend time in the diagnostic immunology laboratory observing a diverse range of diagnostic tests for PID diagnosis.

One of the most important aspects of staying in Newcastle was the daily work on the children’s HSCT ward, observing patients undergoing HSCT in pre-, peri- and post- transplant periods. I could see complex individual approaches in every patient from transplant planning and pre-treatment, pre-transplant conditioning and using different graft manipulating technologies with accompanying therapuetic regimens; and to see post-transplant long-term patients follow up in HSCT outpatient clinic.

It was valuable to be the part of the HSCT team taking part in daily ward working, patient management and ward rounds, and having the opportunity to present clinical cases for discussion. I had also an opportunity to attend local meetings, lectures and conferences. During my stay, I attended the IEWP ‘HSCT for PID’ workshop in Leuven, and the national UK ECP meeting.

As a part of my fellowship working with Dr. Andrew Gennery I carried out a project in long-term outcomes of patients with SCID. From the SCETIDE database we obtained initial data about patients transplanted more than 20 years ago in Europe, selected patients using pre-determined inclusion criteria and applied for additional information to participating centers. In collaboration with the North American PIDTC group joining this study, we are going to analyze the information from approximately 300 SCID patients, undergoing HSCT before 1995. Currently there are no published > 20 year long-term follow up data of SCID patients, so this study is important to gauge immune function, clinical status and quality of life and correlate with genotype and HSCT approach and will be the benchmark for the future research in this field.

In June 2015 I had an opportunity to present the first preliminary data at the annual UK national audit meeting between Great Ormond Street Hospital and Newcastle “Great North Children Hospital” PID HSCT units, and also presented data on outcome of CD3 TCRab/CD19 depleted HSCT for PID from my own centre in Moscow. Updated results of the SCID long term follow up study will be presented at the IEWP Autumn meeting in Seville in October 2015, and we will prepare a manuscript for publication. I also had the opportunity to write a review article with my supervisor, which has recently been published (Laberko A, Gennery AR. Cytoreductive conditioning for Severe Combined Immunodeficiency – help or hindrance? Expert Rev Clin Immunol 2015;11:285-288)

I am grateful to all the people I worked with in Newcastle for sharing their experience and knowledge with me, giving me possibilities to discuss new insights in my own hospital. I also thank the colleagues collaborating with my project and in particular thank Virginie Couteille and Nizar Mahlaoui at SCETIDE for their invaluable help in setting up the project. The ESID fellowship has given me a wonderful opportunity to learn more about my specialty, become more involved in the international network, and make some new friends too.

Alexandra Laberko, August 2015