51
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Reprint of: Aging: Treating the Older Patient. Biol Blood Marrow Transplant 2017; 23:S10-S17. [PMID: 28236837 DOI: 10.1016/j.bbmt.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/04/2016] [Indexed: 12/23/2022]
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52
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Related haploidentical donors are a better choice than matched unrelated donors: Counterpoint. Blood Adv 2017; 1:401-406. [PMID: 29296955 DOI: 10.1182/bloodadvances.2016002188] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 01/18/2023] Open
Abstract
Publisher's Note: This article has a companion Point by Fuchs. Publisher's Note: Join in the discussion of these articles at Blood Advances Community Conversations.
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53
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Related haploidentical donors are a better choice than matched unrelated donors: Point. Blood Adv 2017; 1:397-400. [PMID: 29296954 DOI: 10.1182/bloodadvances.2016002196] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023] Open
Abstract
Publisher's Note: This article has a companion Counterpoint by Shaw. Publisher's Note: Join in the discussion of these articles at Blood Advances Community Conversations.
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54
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Rosko A, Artz A. Aging: Treating the Older Patient. Biol Blood Marrow Transplant 2017; 23:193-200. [PMID: 27864162 PMCID: PMC5967228 DOI: 10.1016/j.bbmt.2016.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/04/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Ashley Rosko
- Department of Internal Medicine, Ohio State University, Columbus, Ohio
| | - Andrew Artz
- Department of Medicine, University of Chicago, Chicago, Illinois.
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55
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Baker M, Wang H, Rowley SD, Cai L, Pecora AL, Skarbnik A, Vesole DH, Adler-Brecher B, Kim D, Donato ML. Comparative Outcomes after Haploidentical or Unrelated Donor Bone Marrow or Blood Stem Cell Transplantation in Adult Patients with Hematological Malignancies. Biol Blood Marrow Transplant 2016; 22:2047-2055. [DOI: 10.1016/j.bbmt.2016.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/08/2016] [Indexed: 02/04/2023]
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Ruggeri A, Sun Y, Labopin M, Bacigalupo A, Lorentino F, Arcese W, Santarone S, Gülbas Z, Blaise D, Messina G, Ghavamzadeh A, Malard F, Bruno B, Diez-Martin JL, Koc Y, Ciceri F, Mohty M, Nagler A. Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. Haematologica 2016; 102:401-410. [PMID: 27758821 DOI: 10.3324/haematol.2016.151779] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/30/2016] [Indexed: 11/09/2022] Open
Abstract
Severe graft-versus-host disease is a major barrier for non-T-cell-depleted haploidentical stem cell transplantation. There is no consensus on the optimal graft-versus-host disease prophylaxis. This study compared the two most commonly used graft-versus-host disease prophylaxis regimens (post-transplant cyclophosphamide-based vs. the anti-thymocyte globulin-based) in adults with acute myeloid leukemia reported to the European Society for Blood and Bone Marrow Transplantation. A total of 308 patients were analyzed; 193 received post-transplant cyclophosphamide-based regimen and 115 anti-thymocyte globulin-based regimen as anti-graft-versus-host disease prophylaxis. The post-transplant cyclophosphamide-based regimen was more likely to be associated to bone marrow as graft source (60% vs. 40%; P=0.01). Patients in the post-transplant cyclophosphamide-based regimen group had significantly less grade 3-4 acute graft-versus-host disease than those in the anti-thymocyte globulin-based group (5% vs. 12%, respectively; P=0.01), comparable to chronic graft-versus-host disease. Multivariate analysis showed that non-relapse mortality was lower in the post-transplant cyclophosphamide-based regimen group [22% vs. 30%, Hazard ratio (HR) 1.77(95%CI: 1.09-2.86); P=0.02] with no difference in relapse incidence. Patients receiving post-transplant cyclophosphamide-based regimen had better graft-versus-host disease-free, relapse-free survival [HR 1.45 (95%CI: 1.04-2.02); P=0.03] and leukemia-free survival [HR 1.48 (95%CI: 1.03-2.12); P=0.03] than those in the anti-thymocyte globulin-based group. In the multivariate analysis, there was also a trend for a higher overall survival [HR 1.43 (95%CI: 0.98-2.09); P=0.06] for post-transplant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with non-relapse mortality and graft-versus-host disease-free, relapse-free survival. Haplo-SCT using a post-transplant cyclophosphamide-based regimen can achieve better leukemia-free survival and graft-versus-host disease-free, relapse-free survival, lower incidence of graft-versus-host disease and non-relapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia.
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Affiliation(s)
- Annalisa Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Yuqian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Myriam Labopin
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France
| | | | | | - William Arcese
- Tor Vergata University, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Stella Santarone
- Ospedale Civile Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy
| | - Zafer Gülbas
- Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Institut Paoli Calmettes, Marseille, France
| | - Giuseppe Messina
- Centro Unico Regionale Trapianti, Alberto Neri, Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Florent Malard
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Benedetto Bruno
- A.O.U Citta della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Jose Luis Diez-Martin
- Instituto de Investigacion Sanitaria Gregorio Marañon, Division of Hematology, Hospital Gregorio Marañon, Madrid, Spain
| | - Yener Koc
- Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Arnon Nagler
- Université Pierre et Marie Curie, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; Tel Aviv University (TAU), Israel.,EBMT Paris Office, Hospital Saint Antoine, Paris, France
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57
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Rubio MT, Savani BN, Labopin M, Polge E, Niederwieser D, Ganser A, Schwerdtfeger R, Ehninger G, Finke J, Renate A, Craddock C, Kröger N, Hallek M, Jindra P, Mohty M, Nagler A. The impact of HLA-matching on reduced intensity conditioning regimen unrelated donor allogeneic stem cell transplantation for acute myeloid leukemia in patients above 50 years-a report from the EBMT acute leukemia working party. J Hematol Oncol 2016; 9:65. [PMID: 27488518 PMCID: PMC4971653 DOI: 10.1186/s13045-016-0295-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background Data comparing fully matched and mismatched-unrelated-donor (M- and mM-URD) allogeneic hematopoietic stem cell transplant (allo-SCT) following reduced intensity conditioning regimens for acute myeloid leukemia are limited. Methods We retrospectively compared the outcome of 3398 patients above the age of 50 years who underwent 10/10 M-URD (n = 2567), 9/10 (n = 723), or 8/10 (n = 108) mM-URD allo-SCT for acute myeloid leukemia after reduced intensity conditioning regimen between 2000 and 2013. The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results HLA matching had no impact on engraftment (p = 0.31). In univariate analysis, in comparison to 10/10 M-URD, mM-URD was associated with higher incidence of grade II–IV acute graft-versus-host disease (GVHD) (p = 0.0002), similar rates of chronic GVHD (p = 0.138) but increased incidence of its extensive form (p = 0.047). Compared to 10/10 M-URD, patients transplanted in the first complete remission (CR1) with a 9 or an 8/10 mM-URD had decreased 2-year leukemia free (LFS) (p = 0.005) and overall survivals (OS) (56.7, 46.1, and 50.2 %, respectively, p = 0.005), while outcomes were comparable between all groups for patients transplanted beyond CR1. In multivariate analysis, 9/10 versus 10/10 URD was associated with higher non-relapse mortality (HR 1.34, p = 0.001), similar risk of relapse and chronic GVHD and inferior LFS (HR 1.25, p = 0.0001), and OS (HR 1.27, p = 0.0001). There was no difference in adjusted transplant outcomes between 9/10 and 8/10 mM-URD. Conclusions Reduced intensity conditioned allo-SCT with a 10/10 M-URD remains the preferable option for AML patients above the age of 50 years. The use of a 9/10 or an 8/10 mM-URD in patients not having a fully matched donor represents an alternative therapeutic option that should be compared to other alternative donor transplant strategies. Electronic supplementary material The online version of this article (doi:10.1186/s13045-016-0295-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie T Rubio
- Department of Hematology, Hôpital Brabois, CHRU Nancy, Vandœuvre-lès-Nancy, France. .,CNRS UMR 7365, IMoPA, Nancy, France. .,Université de Lorraine, Nancy, France. .,Acute Leukemia Working Party of EBMT, Paris, France.
| | - Bipin N Savani
- Acute Leukemia Working Party of EBMT, Paris, France. .,Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Myriam Labopin
- Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Emmanuelle Polge
- Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Dietger Niederwieser
- Division Hematology, Oncology and Hemostasiology, University Hospital Leipzig, Leipzig, Germany
| | - Arnold Ganser
- Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Gerhard Ehninger
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus der TU Dresden, Dresden, Germany
| | - Jürgen Finke
- Department of Medicine, Hematology, Oncology, University of Freiburg, Freiburg, Germany
| | - Arnold Renate
- MedizinischeKlinik m. S. Hämatologie/Onkologie, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Michael Hallek
- Department of Medicine, University of Cologne, Cologne, Germany
| | - Pavel Jindra
- Department of Hematology/Oncology, Charles University Hospital, Pilsen, Czech Republic
| | - Mohamad Mohty
- Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Arnon Nagler
- Acute Leukemia Working Party of EBMT, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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58
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Slade M, Fakhri B, Savani BN, Romee R. Halfway there: the past, present and future of haploidentical transplantation. Bone Marrow Transplant 2016; 52:1-6. [DOI: 10.1038/bmt.2016.190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 02/03/2023]
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59
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Haploidentical Stem Cell Transplantation in Adult Haematological Malignancies. Adv Hematol 2016; 2016:3905907. [PMID: 27313619 PMCID: PMC4904087 DOI: 10.1155/2016/3905907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/28/2016] [Accepted: 04/04/2016] [Indexed: 12/22/2022] Open
Abstract
Haematopoietic stem cell transplantation is a well-established treatment option for both hematological malignancies and nonmalignant conditions such as aplastic anemia and haemoglobinopathies. For those patients lacking a suitable matched sibling or matched unrelated donor, haploidentical donors are an alternative expedient donor pool. Historically, haploidentical transplantation led to high rates of graft rejection and GVHD. Strategies to circumvent these issues include T cell depletion and management of complications thereof or T replete transplants with GVHD prophylaxis. This review is an overview of these strategies and contemporaneous outcomes for hematological malignancies in adult haploidentical stem cell transplant recipients.
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60
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Devillier R, Granata A, Fürst S, Harbi S, Faucher C, Weiller PJ, Chabannon C, Castagna L, Blaise D. Low incidence of chronic GVHD after HLA-haploidentical peripheral blood stem cell transplantation with post-transplantation cyclophosphamide in older patients. Br J Haematol 2016; 176:132-135. [PMID: 27073182 DOI: 10.1111/bjh.13923] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Raynier Devillier
- Haematology Department, Institut Paoli Calmettes, Marseille, France.,Aix Marseille University, Marseille, France
| | - Angela Granata
- Haematology Department, Institut Paoli Calmettes, Marseille, France
| | - Sabine Fürst
- Haematology Department, Institut Paoli Calmettes, Marseille, France
| | - Samia Harbi
- Haematology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Pierre-Jean Weiller
- Haematology Department, Institut Paoli Calmettes, Marseille, France.,Aix Marseille University, Marseille, France
| | - Christian Chabannon
- Aix Marseille University, Marseille, France.,Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France
| | - Luca Castagna
- Haematology Department, Institut Paoli Calmettes, Marseille, France.,Haematology Department, Humanitas Cancer Centre, Rozzano, Italy
| | - Didier Blaise
- Haematology Department, Institut Paoli Calmettes, Marseille, France.,Aix Marseille University, Marseille, France
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61
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Crocchiolo R, Castagna L, Furst S, Devillier R, Sarina B, Bramanti S, El-Cheikh J, Granata A, Harbi S, Morabito L, Faucher C, Rimondo A, Girardi D, Mohty B, Calmels B, Carlo-Stella C, Chabannon C, Bouabdallah R, Santoro A, Vey N, Weiller PJ, Blaise D. The patient’s CMV serological status affects clinical outcome after T-cell replete haplo-HSCT and post-transplant cyclophosphamide. Bone Marrow Transplant 2016; 51:1134-6. [DOI: 10.1038/bmt.2016.69] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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62
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Rubio MT, Savani BN, Labopin M, Piemontese S, Polge E, Ciceri F, Bacigalupo A, Arcese W, Koc Y, Beelen D, Gülbas Z, Wu D, Santarone S, Tischer J, Afanasyev B, Schmid C, Giebel S, Mohty M, Nagler A. Impact of conditioning intensity in T-replete haplo-identical stem cell transplantation for acute leukemia: a report from the acute leukemia working party of the EBMT. J Hematol Oncol 2016; 9:25. [PMID: 26980295 PMCID: PMC4791867 DOI: 10.1186/s13045-016-0248-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Increasing numbers of patients are receiving haplo-identical stem cell transplantation (haplo-SCT) for treatment of acute leukemia with reduced intensity (RIC) or myeloablative (MAC) conditioning regimens. The impact of conditioning intensity in haplo-SCT is unknown. METHODS We performed a retrospective registry-based study comparing outcomes after T-replete haplo-SCT for patients with acute myeloid (AML) or lymphoid leukemia (ALL) after RIC (n = 271) and MAC (n = 425). Regimens were classified as MAC or RIC based on published criteria. RESULTS A combination of post-transplant cyclophosphamide (PT-Cy) with one calcineurin inhibitor and mycophenolate mofetil (PT-Cy-based regimen) for graft-versus-host disease (GVHD) prophylaxis was used in 66 (25%) patients in RIC and 125 (32%) in MAC groups. Patients of RIC group were older and had been transplanted more recently and more frequently for AML with active disease at transplant. Percentage of engraftment (90 vs. 92%; p = 0.58) and day 100 grade II to IV acute GVHD (24 vs. 29%, p = 0.23) were not different between RIC and MAC groups. Multivariable analyses, run separately in AML and ALL, showed a trend toward higher relapse incidence with RIC in comparison to MAC in AML (hazard ratio (HR) 1.34, p = 0.09), and no difference in both AML and ALL in terms of non-relapse mortality (NRM) chronic GVHD and leukemia-free survival. There was no impact of conditioning regimen intensity in overall survival (OS) in AML (HR = 0.97, p = 0.79) but a trend for worse OS with RIC in ALL (HR = 1.44, p = 0.10). The main factor impacting outcomes was disease status at transplantation (HR ≥ 1.4, p ≤ 0.01). GVHD prophylaxis with PT-Cy-based regimen was independently associated with reduced NRM (HR 0.63, p = 0.02) without impact on relapse incidence (HR 0.99, p = 0.94). CONCLUSIONS These data suggest that T-replete haplo-SCT with both RIC and MAC, in particular associated with PT-Cy, are valid options in first line treatment of high risk AML or ALL.
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Affiliation(s)
- Marie T Rubio
- Service d'Hématologie et de Thérapie cellulaire, Saint Antoine Hospital, Paris, France. .,INSERM UMR 938, Paris, France. .,Université Pierre et Marie Curie, Paris, France. .,Acute Leukemia Working Party of EBMT, Paris, France.
| | - Bipin N Savani
- Acute Leukemia Working Party of EBMT, Paris, France.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Myriam Labopin
- Service d'Hématologie et de Thérapie cellulaire, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France
| | - Simona Piemontese
- Acute Leukemia Working Party of EBMT, Paris, France.,Ospedale San Raffaele s.r.l., Ematologia, Milan, Italy
| | - Emmanuelle Polge
- Service d'Hématologie et de Thérapie cellulaire, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Ematologia, Milan, Italy
| | | | - William Arcese
- Rome Transplant Network, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - Yener Koc
- Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - Zafer Gülbas
- Bone Marrow Transplantation Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - Depei Wu
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Johanna Tischer
- Department of Internal Medicine III, Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Munich, Germany
| | - Boris Afanasyev
- SPb State I. Pavlov Medical University, St. Petersburg, Russia
| | | | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Hemato-Oncology, Cancer Center, Gliwice, Poland
| | - Mohamad Mohty
- Service d'Hématologie et de Thérapie cellulaire, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Acute Leukemia Working Party of EBMT, Paris, France.,EBMT Paris study office/CEREST-TC, Paris, France
| | - Arnon Nagler
- Université Pierre et Marie Curie, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
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63
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Fleischhauer K, Beelen DW. HLA mismatching as a strategy to reduce relapse after alternative donor transplantation. Semin Hematol 2016; 53:57-64. [PMID: 27000727 DOI: 10.1053/j.seminhematol.2016.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Human leukocyte antigen (HLA) mismatches are targets of alloreactive T cells, mediators of graft-versus-leukemia (GvL) and graft-versus-host disease (GvHD) after alternative donor transplantation. Exploitation of HLA mismatching in order to reduce relapse is hampered by necessary interventions aimed at controlling GvHD on the one hand, and by the possibility of immune escape through selective loss of mismatched HLA in relapsing leukemia on the other. Retrospective studies reporting the impact of HLA mismatches on post-transplant relapse need to be interpreted with caution, due to many confounding factors, including disease and use of T-cell depletion, and to be constantly updated to the rapidly changing clinical protocols. Current evidence suggests similar relapse rates for 8/8, 7/8 HLA-matched unrelated, T-cell-replete haploidentical and umbilical cord blood transplantation; however, investigations of locus-specific effects are still scarce in the latter two settings. In unrelated transplantation, a specific role for mismatches at HLA-C and HLA-DPB1, and therein of permissive mismatches defined on the basis of T-cell alloreactivity and/or expression levels, in reducing relapse has been demonstrated in independent studies. This observation suggests new approaches to utilize HLA matching in unrelated donor searches, and the need for further research in the field.
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Affiliation(s)
- Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany.
| | - Dietrich W Beelen
- Department for Bone Marrow Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany
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64
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Robinson TM, O'Donnell PV, Fuchs EJ, Luznik L. Haploidentical bone marrow and stem cell transplantation: experience with post-transplantation cyclophosphamide. Semin Hematol 2016; 53:90-7. [PMID: 27000732 DOI: 10.1053/j.seminhematol.2016.01.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Allogeneic blood or bone marrow transplantation (BMT) is a potentially curative therapy for high-risk hematologic malignancies not curable by standard chemotherapy, but the procedure is limited by the availability of human leukocyte antigen-matched donors for many patients, as well as toxicities including graft-versus-host disease (GVHD). Our group has developed the use of high-dose post-transplantation cyclophosphamide (PTCy) to selectively remove alloreactive T cells without compromising engraftment. This protocol has allowed for successful transplantation of human leukocyte antigen (HLA)-haploidentical (haplo) grafts, thus expanding the donor pool for the many patients who would not otherwise be a candidate for this life-saving procedure. In this review we will summarize the data that led to the development of PTCy, then focus on the outcomes of haploBMT trials with PTCy across different transplant platforms for patients with malignant hematologic diseases, and finally we will discuss emerging evidence that suggests equivalency of haploBMT with PTCy compared with more traditional transplants.
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Affiliation(s)
- Tara M Robinson
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Department of Oncology; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Department of Oncology; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Department of Oncology; Johns Hopkins University School of Medicine, Baltimore, MD.
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65
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Hanna R, Majhail NS. HLA-identical siblings versus haploidentical donors: full match still beats half match. Bone Marrow Transplant 2015; 51:344-5. [PMID: 26642336 DOI: 10.1038/bmt.2015.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/23/2015] [Indexed: 01/17/2023]
Affiliation(s)
- R Hanna
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.,Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's, Cleveland, OH, USA
| | - N S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA.,Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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