151
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Dahlberg A, Milano F. Cord blood transplantation: rewind to fast forward. Bone Marrow Transplant 2016; 52:799-802. [PMID: 27991893 DOI: 10.1038/bmt.2016.336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022]
Abstract
The utilization of cord blood as a source of stem cells for transplantation has decreased in recent years. Although cord blood transplantation (CBT) is an established practice for the treatment of adult and pediatric patients with hematological malignancies, the high acquisition cost of CB units along with high transplant-related mortality due to delayed hematopoietic recovery and immune reconstitution have contributed to the slowing in widespread adoption of CBT. Strategies aimed to enhance speed of engraftment and ongoing clinical trials are investigating ways to make CBT more widely available. Meanwhile, the recent clinical data suggest that the choice of CBT might be preferable for patients with pre-transplant minimal residual disease. We review here the background data on the utilization of CB for the treatment of hematological malignancies, and discuss the current challenges and future directions in the field of CBT.
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Affiliation(s)
- A Dahlberg
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - F Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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152
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Duchez P, Rodriguez L, Chevaleyre J, De La Grange PB, Ivanovic Z. Clinical-scale validation of a new efficient procedure for cryopreservation of ex vivo expanded cord blood hematopoietic stem and progenitor cells. Cytotherapy 2016; 18:1543-1547. [DOI: 10.1016/j.jcyt.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/04/2016] [Accepted: 08/06/2016] [Indexed: 01/21/2023]
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153
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154
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Abu-Khader A, Pasha R, Ward GCD, Boisjoli G, Pineault N. Characterization of the growth modulatory activities of osteoblast conditioned media on cord blood progenitor cells. Cytotechnology 2016; 68:2257-2269. [PMID: 27757713 DOI: 10.1007/s10616-016-0019-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/19/2016] [Indexed: 12/25/2022] Open
Abstract
Engraftment outcomes are strongly correlated with the numbers of hematopoietic stem and progenitor cells (HSPC) infused. Expansion of umbilical cord blood (CB) HSPC has gained much interest lately since infusion of expanded HSPC can accelerate engraftment and improve clinical outcomes. Many novel protocols based on different expansion strategies of HSPC and their downstream derivatives are under development. Herein, we describe the production and properties of serum-free medium (SFM) conditioned with mesenchymal stromal cells derived-osteoblasts (OCM) for the expansion of umbilical CB cells and progenitors. After optimization of the conditioning length, we show that OCM increased the production of human CB total nucleated cells and CD34+ cells by 1.8-fold and 1.5-fold over standard SFM, respectively. Production of immature CD34+ subpopulations enriched in hematopoietic stem cells was also improved with a shorter conditioning period. Moreover, we show that the growth modulatory activities of OCM on progenitor expansion are regulated by both soluble factors and non-soluble cellular elements. Finally, the growth and differentiation modulatory activities of OCM were fully retained after high dose-ionizing irradiation and highly stable when OCM is stored frozen. In summary, our results suggest that OCM efficiently mimics some of the natural regulatory activities of osteoblasts on HSPC and highlight the marked expansion potentials of SFM conditioned with osteoblasts.
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Affiliation(s)
- Ahmad Abu-Khader
- Centre for Innovation, Canadian Blood Services, 1800 Alta Vista, Ottawa, ON, K1G 4J5, Canada
| | - Roya Pasha
- Centre for Innovation, Canadian Blood Services, 1800 Alta Vista, Ottawa, ON, K1G 4J5, Canada
| | - Gwendoline C D Ward
- Centre for Innovation, Canadian Blood Services, 1800 Alta Vista, Ottawa, ON, K1G 4J5, Canada
| | - Gavin Boisjoli
- Centre for Innovation, Canadian Blood Services, 1800 Alta Vista, Ottawa, ON, K1G 4J5, Canada
| | - Nicolas Pineault
- Centre for Innovation, Canadian Blood Services, 1800 Alta Vista, Ottawa, ON, K1G 4J5, Canada. .,Biochemistry, Microbiology and Immunology Department, University of Ottawa, Ottawa, Ottawa, ON, Canada.
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155
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Strategies before, during, and after hematopoietic cell transplantation to improve T-cell immune reconstitution. Blood 2016; 128:2607-2615. [PMID: 27697775 DOI: 10.1182/blood-2016-06-724005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/28/2016] [Indexed: 12/11/2022] Open
Abstract
T-cell immune reconstitution (IR) after allogeneic hematopoietic cell transplantation (allo-HCT) is highly variable between patients and may take several months to even years. Patients with delayed or unbalanced T-cell IR have a higher probability of developing transplantation-related morbidity, mortality, and relapse of disease. Hence, there is a need for strategies to better predict and improve IR to reduce these limitations of allo-HCT. In this review, we provide an update of current and in-near-future clinically relevant strategies before, during, and after transplantation to achieve successful T-cell IR. Potent strategies are choosing the right HCT source (eg, donor-recipient matching, cell dose, graft manipulation), individualized conditioning and serotherapy (eg, antithymocyte globulin), nutritional status, exercise, home care, modulation of microbiota, enhancing homeostatic peripheral expansion, promoting thymopoiesis, and the use of adjuvant-targeted cellular immunotherapies. Strategies to prevent graft-versus-host disease are important as well because this complication and the subsequent need for immunosuppression affects T-cell IR and function. These options aim for personalized precision transplantation, where allo-HCT therapy is designed to boost a well-balanced T-cell IR and limit complications in individual patients, resulting in overall lower morbidity and higher survival chances.
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156
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Tarunina M, Hernandez D, Kronsteiner-Dobramysl B, Pratt P, Watson T, Hua P, Gullo F, van der Garde M, Zhang Y, Hook L, Choo Y, Watt SM. A Novel High-Throughput Screening Platform Reveals an Optimized Cytokine Formulation for Human Hematopoietic Progenitor Cell Expansion. Stem Cells Dev 2016; 25:1709-1720. [PMID: 27554619 DOI: 10.1089/scd.2016.0216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The main limitations of hematopoietic cord blood (CB) transplantation, viz, low cell dosage and delayed reconstitution, can be overcome by ex vivo expansion. CB expansion under conventional culture causes rapid cell differentiation and depletion of hematopoietic stem and progenitor cells (HSPCs) responsible for engraftment. In this study, we use combinatorial cell culture technology (CombiCult®) to identify medium formulations that promote CD133+ CB HSPC proliferation while maintaining their phenotypic characteristics. We employed second-generation CombiCult screens that use electrospraying technology to encapsulate CB cells in alginate beads. Our results suggest that not only the combination but also the order of addition of individual components has a profound influence on expansion of specific HSPC populations. Top protocols identified by the CombiCult screen were used to culture human CD133+ CB HSPCs on nanofiber scaffolds and validate the expansion of the phenotypically defined CD34+CD38lo/-CD45RA-CD90+CD49f+ population of hematopoietic stem cells and their differentiation into defined progeny.
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Affiliation(s)
- Marina Tarunina
- 1 Plasticell Ltd. , Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | - Diana Hernandez
- 1 Plasticell Ltd. , Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | - Barbara Kronsteiner-Dobramysl
- 2 Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford , Oxford, United Kingdom .,3 Stem Cell Research, NHS Blood and Transplant, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, United Kingdom
| | - Philip Pratt
- 4 Department of Surgery and Cancer, Faculty of Medicine, Imperial College London , South Kensington, United Kingdom
| | - Thomas Watson
- 1 Plasticell Ltd. , Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | - Peng Hua
- 2 Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford , Oxford, United Kingdom .,3 Stem Cell Research, NHS Blood and Transplant, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, United Kingdom
| | - Francesca Gullo
- 2 Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford , Oxford, United Kingdom .,3 Stem Cell Research, NHS Blood and Transplant, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, United Kingdom
| | - Mark van der Garde
- 2 Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford , Oxford, United Kingdom .,3 Stem Cell Research, NHS Blood and Transplant, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, United Kingdom
| | - Youyi Zhang
- 2 Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford , Oxford, United Kingdom .,3 Stem Cell Research, NHS Blood and Transplant, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, United Kingdom
| | - Lilian Hook
- 1 Plasticell Ltd. , Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | - Yen Choo
- 1 Plasticell Ltd. , Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | - Suzanne M Watt
- 2 Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford , Oxford, United Kingdom .,3 Stem Cell Research, NHS Blood and Transplant, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, United Kingdom
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157
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Abstract
The identification of mechanisms that regulate stem cell renewal has led to the development of innovative approaches to expand hematopoietic stem cells ex vivo. One approach reported by Wagner et al. (2016) in this issue of Cell Stem Cell has demonstrated dramatic expansion of umbilical cord blood stem cells that promote rapid engraftment while maintaining capacity for long-term hematopoiesis.
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Affiliation(s)
- Sarah Nikiforow
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Jerome Ritz
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA.
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158
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Tiwari A, Wong CS, Nekkanti LP, Deane JA, McDonald C, Jenkin G, Kirkland MA. Impact of Oxygen Levels on Human Hematopoietic Stem and Progenitor Cell Expansion. Stem Cells Dev 2016; 25:1604-1613. [PMID: 27539189 DOI: 10.1089/scd.2016.0153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Oxygen levels are an important variable during the in vitro culture of stem cells. There has been increasing interest in the use of low oxygen to maximize proliferation and, in some cases, effect differentiation of stem cell populations. It is generally assumed that the defined pO2 in the incubator reflects the pO2 to which the stem cells are being exposed. However, we demonstrate that the pO2 experienced by cells in static culture can change dramatically during the course of culture as cell numbers increase and as the oxygen utilization by cells exceeds the diffusion of oxygen through the media. Dynamic culture (whereby the cell culture plate is in constant motion) largely eliminates this effect, and a combination of low ambient oxygen and dynamic culture results in a fourfold increase in reconstituting capacity of human hematopoietic stem cells compared with those cultured in static culture at ambient oxygen tension. Cells cultured dynamically at 5% oxygen exhibited the best expansion: 30-fold increase by flow cytometry, 120-fold increase by colony assay, and 11% of human CD45 engraftment in the bone marrow of NOD/SCID mice. To our knowledge, this is the first study to compare individual and combined effects of oxygen and static or dynamic culture on hematopoietic ex vivo expansion. Understanding and controlling the effective oxygen tension experienced by cells may be important in clinical stem cell expansion systems, and these results may have relevance to the interpretation of low oxygen culture studies.
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Affiliation(s)
- Abhilasha Tiwari
- 1 The Ritchie Centre, Hudson Institute of Medical Research , Clayton, Australia
| | | | - Lakshmi P Nekkanti
- 1 The Ritchie Centre, Hudson Institute of Medical Research , Clayton, Australia
| | - James A Deane
- 1 The Ritchie Centre, Hudson Institute of Medical Research , Clayton, Australia .,3 Department of Obstetrics and Gynaecology, Southern Clinical School, Monash University , Clayton, Australia
| | - Courtney McDonald
- 1 The Ritchie Centre, Hudson Institute of Medical Research , Clayton, Australia
| | - Graham Jenkin
- 1 The Ritchie Centre, Hudson Institute of Medical Research , Clayton, Australia .,3 Department of Obstetrics and Gynaecology, Southern Clinical School, Monash University , Clayton, Australia
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159
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Sotnezova E, Andreeva E, Grigoriev A, Buravkova L. Ex Vivo Expansion of Hematopoietic Stem and Progenitor Cells from Umbilical Cord Blood. Acta Naturae 2016; 8:6-16. [PMID: 27795840 PMCID: PMC5081707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
Transplantation of umbilical cord blood cells is currently widely used in modern cell therapy. However, the limited number of hematopoietic stem and progenitor cells (HSPCs) and prolonged time of recovery after the transplantation are significant limitations in the use of cord blood. Ex vivo expansion with various cytokine combinations is one of the most common approaches for increasing the number of HSPCs from one cord blood unit. In addition, there are protocols that enable ex vivo amplification of cord blood cells based on native hematopoietic microenvironmental cues, including stromal components and the tissue-relevant oxygen level. The newest techniques for ex vivo expansion of HSPCs are based on data from the elucidation of the molecular mechanisms governing the hematopoietic niche function. Application of these methods has provided an improvement of several important clinical outcomes. Alternative methods of cord blood transplantation enhancement based on optimization of HPSC homing and engraftment in patient tissues have also been successful. The goal of the present review is to analyze recent methodological approaches to cord blood HSPC ex vivo amplification.
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Affiliation(s)
- E.V. Sotnezova
- Institute of Biomedical Problems of the Russian Academy of Sciences, Khoroshovskoye shosse 76A, Moscow, 123007, Russia
| | - E.R. Andreeva
- Institute of Biomedical Problems of the Russian Academy of Sciences, Khoroshovskoye shosse 76A, Moscow, 123007, Russia
| | - A.I. Grigoriev
- Institute of Biomedical Problems of the Russian Academy of Sciences, Khoroshovskoye shosse 76A, Moscow, 123007, Russia
| | - L.B. Buravkova
- Institute of Biomedical Problems of the Russian Academy of Sciences, Khoroshovskoye shosse 76A, Moscow, 123007, Russia
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160
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Arnold SD, Bhatia M, Horan J, Krishnamurti L. Haematopoietic stem cell transplantation for sickle cell disease - current practice and new approaches. Br J Haematol 2016; 174:515-25. [PMID: 27255787 DOI: 10.1111/bjh.14167] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sickle cell disease is an inherited disorder that affects over 5 million people worldwide. Current maintenance therapy has been successful in reducing complications and enhancing life expectancy; yet subclinical complications persist. To date, allogeneic haematopoietic stem cell transplant (HSCT) remains the only available curative therapy for sickle cell disease. With declining incidences of rejection and transplant- related mortality, disease-free survival after human leucocyte antigen-identical sibling transplant exceeds 90%. However, the majority of individuals with sickle cell disease do not have an human leucocyte antigen (HLA)-identical sibling; therefore, research is expanding to focus on new approaches to alternative donor transplant. Advances in supportive care and conditioning regimens have led to expansion of the pool of donors to unrelated donors and haploidentical donors. Challenges remain in improving the safety and efficacy of HSCT from alternate donors. Early results from gene therapy may provide another curative option in patients with sickle cell disease. These approaches show early promise, but larger, longitudinal studies are needed to better determine the optimal clinical circumstances for transplant in sickle cell disease.
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Affiliation(s)
- Staci D Arnold
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Monica Bhatia
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - John Horan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
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161
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Abstract
Clinical cord blood (CB) hematopoietic cell transplantation (HCT) has progressed well since the initial successful CB HCT that saved the life of a young boy with Fanconi anemia. The recipient is alive and well now 28 years out since that first transplant with CB cells from his HLA-matched sister. CB HCT has now been used to treat over 35,000 patients with various malignant and non-malignant disorders mainly using HLA-matched or partially HLA-disparate allogeneic CB cells. There are advantages and disadvantages to using CB for HCT compared to other sources of transplantable hematopoietic stem (HSC) and progenitor (HPC) cells. One disadvantage of the use of CB as a source of transplantable HSC and HPC is the limited number of these cells in a single CB collected, and slower time to neutrophil, platelet and immune cell recovery. This review describes current attempts to: increase the collection of HSC/HPC from CB, enhance the homing of the infused cells, ex-vivo expand numbers of collected HSC/HPC and increase production of the infused CB cells that reach the marrow. The ultimate goal is to manipulate efficiency and efficacy for safe and economical use of single unit CB HCT.
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Affiliation(s)
- Hal E Broxmeyer
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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162
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Single- vs double-unit cord blood transplantation for children and young adults with acute leukemia or myelodysplastic syndrome. Blood 2016; 127:3450-7. [PMID: 27099151 DOI: 10.1182/blood-2016-01-694349] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/09/2016] [Indexed: 12/26/2022] Open
Abstract
Transplantation of 2 unrelated cord blood (UCB) units instead of 1 has been proposed to increase the cell dose. We report a prospective randomized study, designed to compare single- vs double-UCB transplantation in children and young adults with acute leukemia in remission or myelodysplasia. Eligible patients had at least two 4-6 HLA-identical UCBs with >3 × 10(7) nucleated cells/kg for the first and >1.5 × 10(7) for the second. The primary end point was the 2-year cumulative incidence of transplantation strategy failure, a composite end point including transplant-related mortality (TRM), engraftment failure, and autologous recovery. Randomized patients who did not proceed to transplantation due to refractory disease were considered transplantation failures. A total of 151 patients were randomized and included in the intent-to-treat analysis; 137 were transplanted. Double-UCB transplantation did not decrease transplantation strategy failure (23.4% ± 4.9% vs 14.9% ± 4.2%). Two-year posttransplant survival, disease-free survival, and TRM were 68.8% ± 6.0%, 67.6% ± 6.0%, and 5.9% ± 2.9% after single-unit transplantation compared with 74.8% ± 5.5%, 68.1% ± 6.0%, and 11.6% ± 3.9% after double-unit transplantation. The final relapse risk did not significantly differ, but relapses were delayed after double-unit transplantation. Overall incidences of graft-versus-host disease (GVHD) were similar, but chronic GVHD was more frequently extensive after double-UCB transplantation (31.9% ± 5.7% vs 14.7% ± 4.3%, P = .02). In an exploratory subgroup analysis, we found a significantly lower relapse risk after double-unit transplantation in patients receiving total body irradiation without antithymocyte globulin (ATG), whereas the relapse risk was similar in the group treated with busulfan, cyclophosphamide, and ATG. Single-UCB transplantation with adequate cell dose remains the standard of care and leads to low TRM. Double-unit transplantation should be reserved for patients who lack such units. This trial was registered at www.clinicaltrials.gov as #NCT01067300.
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163
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Psatha N, Karponi G, Yannaki E. Optimizing autologous cell grafts to improve stem cell gene therapy. Exp Hematol 2016; 44:528-39. [PMID: 27106799 DOI: 10.1016/j.exphem.2016.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
Over the past decade, stem cell gene therapy has achieved unprecedented curative outcomes for several genetic disorders. Despite the unequivocal success, clinical gene therapy still faces challenges. Genetically engineered hematopoietic stem cells are particularly vulnerable to attenuation of their repopulating capacity once exposed to culture conditions, ultimately leading to low engraftment levels posttransplant. This becomes of particular importance when transduction rates are low or/and competitive transplant conditions are generated by reduced-intensity conditioning in the absence of a selective advantage of the transduced over the unmodified cells. These limitations could partially be overcome by introducing megadoses of genetically modified CD34(+) cells into conditioned patients or by transplanting hematopoietic stem cells hematopoietic stem cells with high engrafting and repopulating potential. On the basis of the lessons gained from cord blood transplantation, we summarize the most promising approaches to date of increasing either the numbers of hematopoietic stem cells for transplantation or/and their engraftability, as a platform toward the optimization of engineered stem cell grafts.
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Affiliation(s)
- Nikoletta Psatha
- Gene and Cell Therapy Center, Hematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece; Department of Medicine, University of Washington, Seattle, WA
| | - Garyfalia Karponi
- Gene and Cell Therapy Center, Hematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Gene and Cell Therapy Center, Hematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece; Department of Medicine, University of Washington, Seattle, WA.
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164
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Admiraal R, Boelens JJ. Individualized conditioning regimes in cord blood transplantation: Towards improved and predictable safety and efficacy. Expert Opin Biol Ther 2016; 16:801-13. [DOI: 10.1517/14712598.2016.1164688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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165
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Torikai H, Mi T, Gragert L, Maiers M, Najjar A, Ang S, Maiti S, Dai J, Switzer KC, Huls H, Dulay GP, Reik A, Rebar EJ, Holmes MC, Gregory PD, Champlin RE, Shpall EJ, Cooper LJN. Genetic editing of HLA expression in hematopoietic stem cells to broaden their human application. Sci Rep 2016; 6:21757. [PMID: 26902653 PMCID: PMC4763194 DOI: 10.1038/srep21757] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/27/2016] [Indexed: 11/21/2022] Open
Abstract
Mismatch of human leukocyte antigens (HLA) adversely impacts the outcome of patients after allogeneic hematopoietic stem-cell transplantation (alloHSCT). This translates into the clinical requirement to timely identify suitable HLA-matched donors which in turn curtails the chances of recipients, especially those from a racial minority, to successfully undergo alloHSCT. We thus sought to broaden the existing pool of registered unrelated donors based on analysis that eliminating the expression of the HLA-A increases the chance for finding a donor matched at HLA-B, -C, and -DRB1 regardless of a patient’s race. Elimination of HLA-A expression in HSC was achieved using artificial zinc finger nucleases designed to target HLA-A alleles. Significantly, these engineered HSCs maintain their ability to engraft and reconstitute hematopoiesis in immunocompromised mice. This introduced loss of HLA-A expression decreases the need to recruit large number of donors to match with potential recipients and has particular importance for patients whose HLA repertoire is under-represented in the current donor pool. Furthermore, the genetic engineering of stem cells provides a translational approach to HLA-match a limited number of third-party donors with a wide number of recipients.
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Affiliation(s)
- Hiroki Torikai
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Tiejuan Mi
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Loren Gragert
- Bioinformatics Research, National Marrow Donor Program, Minneapolis, MN, U.S.A
| | - Martin Maiers
- Bioinformatics Research, National Marrow Donor Program, Minneapolis, MN, U.S.A
| | - Amer Najjar
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Sonny Ang
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Sourindra Maiti
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Jianliang Dai
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Kirsten C Switzer
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Helen Huls
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | | | | | | | | | | | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - Laurence J N Cooper
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A.,Ziopharm Oncology, Inc., Boston, MA, U.S.A
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166
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Abstract
PURPOSE OF REVIEW Hematopoietic stem and progenitor cell (HSPC) transplantation is frequently used in the treatment of hematological diseases. The outcome of the procedure is strongly influenced by the quantity of injected cells, especially if low cell numbers are infused as frequently encountered with cord blood transplants. Ex-vivo expansion of cord blood HSPCs would increase cell numbers, thus accelerating engraftment and reducing infectious complications and transplant-related mortality. In addition, expansion would maximize accessibility to better HLA-matched units, further improving patients' outcome. Similarly, in-vitro maintenance or expansion of leukemic stem cells (LSCs) would enable research into the much awaited targeted therapies that spare normal hematopoietic stem cells (HSCs). Here, we review recent findings on small molecules (excluding biologicals) regulating the activity of normal and leukemic stem cells and provide insights into basic science and clinical implications. RECENT FINDINGS High-throughput screening of small molecules active on primary hematopoietic cells has led to the identification of two potent series of chemical compounds, best exemplified by StemRegenin1 and UM171, that both expand HSPCs. Current data suggest that the aryl hydrocarbon receptor antagonist StemRegenin1 is most active on primitive normal hematopoietic progenitors and LSCs and that UM171 expands long-term normal HSCs. SUMMARY Small molecules are clinically useful and powerful tools for expanding HSPCs. They are also of potential value for dissecting the still elusive regulatory networks that govern self-renewal of human HSCs.
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167
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Baron F, Ruggeri A, Nagler A. Methods of ex vivo expansion of human cord blood cells: challenges, successes and clinical implications. Expert Rev Hematol 2016; 9:297-314. [PMID: 26635058 DOI: 10.1586/17474086.2016.1128321] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
More than 40,000 unrelated cord blood transplantations (UCBT) have been performed worldwide as treatment for patients with malignant or non-malignant life threatening hematologic disorders. However, low absolute numbers of hematopoietic stem and progenitor cells (HSPCs) within a single cord blood unit has remained a limiting factor for this transplantation modality, particularly in adult recipients. Further, because UCB contains low numbers of mostly naïve T cells, immune recovery after UCBT is slow, predisposing patients to severe infections. Other causes of UCBT failure has included graft-versus-host disease (GVHD) and relapse of the underlying disease. In this article, we first review the current landscape of cord blood engineering aimed at improving engraftment. This includes approaches of UCB-HSPCs expansion and methods aimed at improving UCB-HSCPs homing. We then discuss recent approaches of cord blood engineering developed to prevent infection [generation of multivirus-specific cytotoxic T cells (VSTs) from UCB], relapse [transduction of UCB-T cells with tumor-specific chimeric receptor antigens (CARs)] and GVHD (expansion of regulatory T cells from UCB). Although many of these techniques of UCB engineering remain currently technically challenging and expensive, they are likely to revolutionize the field of UCBT in the next decades.
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Affiliation(s)
- Frédéric Baron
- a Division of Hematology, Department of Medicine , University and CHU of Liège , Liège , Belgium.,b GIGA-I3, Section of Hematology , University of Liège , Liège , Belgium
| | - Annalisa Ruggeri
- c Eurocord Hospital Saint Louis, AP-HP , Paris , France.,d Hospital Saint Antoine , Service d'Hématologie et Thérapie Cellulaire, AP-HP , Paris , France.,e Cord Blood Committee, Cellular Therapy and Immunobiology Working Party , EBMT , Leiden , Netherlands
| | - Arnon Nagler
- f Division of Hematology and Bone Marrow Transplantation , The Chaim Sheba Medical Center, Tel-Hashomer , Ramat-Gan , Israel.,g EBMT Paris Office , Hospital Saint Antoine , Paris , France.,h Université Pierre et Marie Curie , Paris , France.,i Tel Aviv University (TAU) , Tel Aviv , Israel
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Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with hematological diseases. The probability of finding a human leukocyte antigen (HLA)- identical donor among family members is around 25% and 30% that of having a full matched unrelated donor in the registry. Patients in need may also benefit of a HLA-mismatched HSCT either from an haploidentical donors or from umbilical cord blood (UCB). Much has been learned about UCB transplant (UCBT) since the first human UCBT was performed back in 1988. Cord blood banks have been established worldwide for the collection, cryopreservation, and distribution of UCB for HSCT. Today, a global network of cord blood banks and transplant centers has been established with a large common inventory of more than 650,000 UCB units available, allowing for more than 40,000 UCBT worldwide in children and adults with severe hematological diseases. Several studies have been published on UCBT, assessing risk factors such as cell dose and HLA mismatch. Outcomes of several retrospective comparative studies showed similar results using other stem cell sources both in pediatric and adult setting. New strategies are ongoing to facilitate engraftment and reduce transplant-related mortality. In this issue, we review the current results of UCBT in adults with hematological malignancies and the clinical studies comparing UCBT with other transplant strategies. We provide guidelines for donor algorithm selection in UCBT setting.
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Affiliation(s)
- Annalisa Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Eurocord, Hôpital Saint Louis, Paris, France.
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169
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Ballen KK, Lazarus H. Cord blood transplant for acute myeloid leukaemia. Br J Haematol 2016; 173:25-36. [PMID: 26766286 DOI: 10.1111/bjh.13926] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/17/2015] [Indexed: 12/14/2022]
Abstract
Umbilical cord blood is a haematopoietic progenitor cell source for patients with acute myeloid leukaemia (AML), other haematological malignancies and metabolic diseases who can be cured by allogeneic haematopoietic cell transplantation, but who do not have a human leucocyte antigen compatible related or unrelated donor. Although the first cord blood transplants were done in children, there are currently more cord blood transplants performed in adults. In this review, we explore the history of umbilical cord blood transplantation, paediatric and adult outcome results, and novel trends to improve engraftment and reduce infection. Umbilical cord blood transplantation cures approximately 30-40% of adults and 60-70% of children with AML. Controversial issues, including the use of double versus single cord blood units for transplantation, optimal cord blood unit selection, infection prophylaxis, conditioning regimens and graft versus host disease prophylaxis, will be reviewed. Finally, comparison to other graft sources, cost, access to care, and the ideal graft source are discussed.
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Affiliation(s)
- Karen K Ballen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Hillard Lazarus
- Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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170
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171
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Jawdat D. Banking of Human Umbilical Cord Blood Stem Cells and Their Clinical Applications. RECENT ADVANCES IN STEM CELLS 2016. [DOI: 10.1007/978-3-319-33270-3_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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172
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Thompson PA, Perera T, Marin D, Oran B, Popat U, Qazilbash M, Shah N, Parmar S, Rezvani K, Olson A, Kebriaei P, Anderlini P, Rondon G, Alousi A, Ciurea S, Champlin RE, Bajel A, Szer J, Shpall EJ, Ritchie D, Hosing CM. Double umbilical cord blood transplant is effective therapy for relapsed or refractory Hodgkin lymphoma. Leuk Lymphoma 2015; 57:1607-15. [PMID: 26472485 DOI: 10.3109/10428194.2015.1105370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A sub-group of patients with Hodgkin Lymphoma (HL) who relapse after autologous stem cell transplant can achieve long-term disease-free-survival after allogeneic stem cell transplant (alloSCT). There is limited information regarding the tolerability and efficacy of double umbilical cord blood transplant (dUCBT) for relapsed/refractory HL. We analyzed 27 consecutive, heavily pre-treated patients receiving dUCBT for relapsed/refractory HL at two centers from 2003-2014. The majority of patients relapsed <6 months after autologous stem cell transplant. A total of 15 patients received myeloablative (most commonly melphalan, fludarabine, thiotepa and anti-thymocyte globulin [ATG]) and 12 non-myeloablative conditioning regimens (fludarabine, cyclophosphamide, 200cGy total body irradiation +/- ATG). All patients engrafted; median time to neutrophil and platelet engraftment was 17 and 37 days, respectively. Overall response rate was 68%; 58% achieved complete remission. Median progression-free survival (PFS) was 12.2 months; median overall survival was 27 months. Cumulative incidences of relapse and of non-relapse mortality at 5 years were 30% and 37.9%, respectively; 5-year PFS was 31.3% (95%CI 10.1-52.5). There was a trend toward inferior PFS in patients with lymph node size ≥2 cm at the time of alloSCT (p = 0.07) and toward inferior survival in patients with chemorefractory disease pre-alloSCT (p = 0.12). dUCBT is feasible in patients with heavily pre-treated HL and can achieve long-term disease-free survival in approximately 30% of patients.
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Affiliation(s)
- Philip A Thompson
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Travis Perera
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia
| | - David Marin
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Betul Oran
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Uday Popat
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Muzaffar Qazilbash
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Nina Shah
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Simrit Parmar
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Katayoun Rezvani
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Amanda Olson
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Partow Kebriaei
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Paolo Anderlini
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Gabriela Rondon
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Amin Alousi
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Stefan Ciurea
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Richard E Champlin
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - Ashish Bajel
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia
| | - Jeffrey Szer
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia ;,c The Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville , Australia
| | - Elizabeth J Shpall
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
| | - David Ritchie
- b Department of Clinical Haematology and Bone Marrow Transplant Service , Royal Melbourne Hospital , Parkville , Australia ;,c The Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne , Parkville , Australia
| | - Chitra M Hosing
- a Department of Stem Cell Transplantation and Cellular Therapy , University of Texas M.D. Anderson Cancer Center , Houston , TX , USA
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173
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Park B, Yoo KH, Kim C. Hematopoietic stem cell expansion and generation: the ways to make a breakthrough. Blood Res 2015; 50:194-203. [PMID: 26770947 PMCID: PMC4705045 DOI: 10.5045/br.2015.50.4.194] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 12/28/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is the first field where human stem cell therapy was successful. Flooding interest on human stem cell therapy to cure previously incurable diseases is largely indebted to HSCT success. Allogeneic HSCT has been an important modality to cure various diseases including hematologic malignancies, various non-malignant hematologic diseases, primary immunodeficiency diseases, and inborn errors of metabolism, while autologous HSCT is generally performed to rescue bone marrow aplasia following high-dose chemotherapy for solid tumors or multiple myeloma. Recently, HSCs are also spotlighted in the field of regenerative medicine for the amelioration of symptoms caused by neurodegenerative diseases, heart diseases, and others. Although the demand for HSCs has been growing, their supply often fails to meet the demand of the patients needing transplant due to a lack of histocompatible donors or a limited cell number. This review focuses on the generation and large-scale expansion of HSCs, which might overcome current limitations in the application of HSCs for clinical use. Furthermore, current proof of concept to replenish hematological homeostasis from non-hematological origin will be covered.
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Affiliation(s)
- Bokyung Park
- Department of Bioscience and Biotechnology, Sejong University, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Changsung Kim
- Department of Bioscience and Biotechnology, Sejong University, Korea
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174
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Ex Vivo Expansion or Manipulation of Stem Cells to Improve Outcome of Umbilical Cord Blood Transplantation. Curr Hematol Malig Rep 2015; 11:12-8. [DOI: 10.1007/s11899-015-0297-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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175
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Mehta RS, Rezvani K, Olson A, Oran B, Hosing C, Shah N, Parmar S, Armitage S, Shpall EJ. Novel Techniques for Ex Vivo Expansion of Cord Blood: Clinical Trials. Front Med (Lausanne) 2015; 2:89. [PMID: 26697430 PMCID: PMC4675847 DOI: 10.3389/fmed.2015.00089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/30/2015] [Indexed: 12/25/2022] Open
Abstract
Cord blood (CB) provides an excellent alternative source of hematopoietic progenitor cells (HPC) for patients lacking human leukocyte antigen-matched peripheral blood or bone marrow graft for transplantation. However, due to the limited cell dose in CB graft, it is associated with prolonged time to engraftment, risk of graft rejection, infections, and treatment-related mortality. To increase the cell dose, a variety of ex vivo expansion techniques have been developed. Results of traditional methods of CB expansion using cytokines alone were disappointing. Expanding CB cells with mesenchymal progenitor cells led to sizeable increase in graft content and improved engraftment. Other methods used HPC-differentiation blockers, such as nicotinamide analogs, copper chelators, inducing constitutive Notch signaling, or an aryl hydrocarbon receptor antagonist (StemReginin1). Many of these methods lead to substantial expansions of total nucleated cells and CD34(+) cells, and significantly improved time to neutrophil or platelet engraftment in patients transplanted with the expanded products compared to the recipients of unmanipulated CBT. These studies differ not only in the expansion method but also with regards to the cytokines used, patient population, conditioning regimens, and transplantation practices, to name a few. Some of these methods employed expansion of a portion of CB unit in the setting of single CBT, while others in the setting of double CBT. Here, we review various procedures used for CB expansion and highlight some of the key differences. Novel methods of improving engraftment that aim at improving bone marrow homing potential of CB cells are not reviewed.
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Affiliation(s)
- Rohtesh S Mehta
- Division of Hematology, Oncology and Transplantation, University of Minnesota Medical Center , Minneapolis, MN , USA
| | - Katayoun Rezvani
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Amanda Olson
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Betul Oran
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Chitra Hosing
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Nina Shah
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Simrit Parmar
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Sue Armitage
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Elizabeth J Shpall
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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176
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Abstract
Abstract
For patients without a human leukocyte antigen (HLA)-matched sibling or unrelated donor, options include transplantation from HLA-mismatched related donors, HLA-mismatched unrelated donors, or unrelated cord blood units. Graft failure remains a problem in 10%-20% of cord blood transplants that contain a limited number of hematopoietic cells. Many approaches are tested in clinical trials to offset the risk of graft failure after cord blood transplantation. GVHD remains a hurdle with any HLA mismatched graft. The use of post-transplant cyclophosphamide holds the promise to overcome the HLA barrier and prevent GVHD despite donor mismatch for a full HLA haplotype. Priority should be given to enrolling patients onto transplant protocols addressing the fundamental problems of engraftment, GVHD, relapse or treatment-related mortality tested with one or more of the alternative stem cell sources. Principles for prioritization of alternative stem cell sources are discussed separately for children and adults who cannot be enrolled on clinical trials. It is difficult ranking currently available sources in the face of multiple factors affecting outcomes, rapidly changing transplant technology and without results from comparative trials.
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177
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Wagner JE, Brunstein CG, Boitano AE, DeFor TE, McKenna D, Sumstad D, Blazar BR, Tolar J, Le C, Jones J, Cooke MP, Bleul CC. Phase I/II Trial of StemRegenin-1 Expanded Umbilical Cord Blood Hematopoietic Stem Cells Supports Testing as a Stand-Alone Graft. Cell Stem Cell 2015; 18:144-55. [PMID: 26669897 DOI: 10.1016/j.stem.2015.10.004] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/12/2015] [Accepted: 10/19/2015] [Indexed: 01/17/2023]
Abstract
Clinical application of umbilical cord blood (UCB) as a source of hematopoietic stem cells for transplantation is limited by low CD34+ cell dose, increased risk of graft failure, and slow hematopoietic recovery. While the cell dose limitation is partially mitigated by using two UCB units, larger-dosed single units would be preferable. We have evaluated the feasibility and safety of StemRegenin-1 (SR-1), an aryl hydrocarbon receptor antagonist that expands CD34+ cells, by placing one of the two units in expansion culture. SR-1 produced a 330-fold increase in CD34+ cells and led to engraftment in 17/17 patients at a median of 15 days for neutrophils and 49 days for platelets, significantly faster than in patients treated with unmanipulated UCB. Taken together, the marked expansion, absence of graft failure, and enhanced hematopoietic recovery support testing of SR-1 expansion as a stand-alone graft and suggest it may ameliorate a limitation of UCB transplant.
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Affiliation(s)
- John E Wagner
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA; Molecular and Cellular Therapeutics Facility, University of Minnesota, Minneapolis, MN 55108, USA.
| | - Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Anthony E Boitano
- Genomics Institute of the Novartis Research Foundation, San Diego, CA 92121, USA
| | - Todd E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - David McKenna
- Molecular and Cellular Therapeutics Facility, University of Minnesota, Minneapolis, MN 55108, USA
| | - Darin Sumstad
- Molecular and Cellular Therapeutics Facility, University of Minnesota, Minneapolis, MN 55108, USA
| | - Bruce R Blazar
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jakub Tolar
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Chap Le
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Julie Jones
- Novartis Institutes for BioMedical Research, Basel 4000, Switzerland
| | - Michael P Cooke
- Genomics Institute of the Novartis Research Foundation, San Diego, CA 92121, USA
| | - Conrad C Bleul
- Novartis Institutes for BioMedical Research, Basel 4000, Switzerland
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178
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Magalon J, Maiers M, Kurtzberg J, Navarrete C, Rubinstein P, Brown C, Schramm C, Larghero J, Katsahian S, Chabannon C, Picard C, Platz A, Schmidt A, Katz G. Banking or Bankrupting: Strategies for Sustaining the Economic Future of Public Cord Blood Banks. PLoS One 2015; 10:e0143440. [PMID: 26624279 PMCID: PMC4666404 DOI: 10.1371/journal.pone.0143440] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/04/2015] [Indexed: 12/14/2022] Open
Abstract
Background Cord blood is an important source of stem cells. However, nearly 90% of public cord blood banks have declared that they are struggling to maintain their financial sustainability and avoid bankruptcy. The objective of this study is to evaluate how characteristics of cord blood units influence their utilization, then use this information to model the economic viability and therapeutic value of different banking strategies. Methods Retrospective analysis of cord blood data registered between January 1st, 2009 and December 31st, 2011 in Bone Marrow Donor Worldwide. Data were collected from four public banks in France, Germany and the USA. Samples were eligible for inclusion in the analysis if data on cord blood and maternal HLA typing and biological characteristics after processing were available (total nucleated and CD34+ cell counts). 9,396 banked cord blood units were analyzed, of which 5,815 were Caucasian in origin. A multivariate logistic regression model assessed the influence of three parameters on the CBU utilization rate: ethnic background, total nucleated and CD34+ cell counts. From this model, we elaborated a Utilization Score reflecting the probability of transplantation for each cord blood unit. We stratified three Utilization Score thresholds representing four different banking strategies, from the least selective (scenario A) to the most selective (scenario D). We measured the cost-effectiveness ratio for each strategy by comparing performance in terms of number of transplanted cord blood units and level of financial deficit. Results When comparing inputs and outputs over three years, Scenario A represented the most extreme case as it delivered the highest therapeutic value for patients (284 CBUs transplanted) along with the highest financial deficit (USD 5.89 million). We found that scenario C resulted in 219 CBUs transplanted with a limited deficit (USD 0.98 million) that charities and public health could realistically finance over the long term. We also found that using a pre-freezing level of 18 x 108 TNC would be the most cost-effective strategy for a public bank. Conclusion Our study shows that a swift transition from strategy A to C can play a vital role in preventing public cord blood banks worldwide from collapsing.
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Affiliation(s)
- Jeremy Magalon
- ESSEC Business School, Paris-Singapore, France
- Assistance Publique Hôpitaux de Marseille CIC BT 1409, Marseille, France
- Vascular Research Center of Marseille, Aix Marseille University, Marseille, France
| | - Martin Maiers
- National Marrow Donor Program, Minneapolis, Minnesota, United States of America
| | - Joanne Kurtzberg
- Carolinas Cord Blood Bank, Duke University, Durham, North Carolina, United States of America
| | | | - Pablo Rubinstein
- National Cord Blood Program, New York Blood Center, New York, New York, United States of America
| | - Colin Brown
- NHS Cord Blood Bank, NHS Blood and Transplant, London, United Kingdom
| | | | | | - Sandrine Katsahian
- INSERM U1138, Paris Descartes University, UPMC, Paris, France
- Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | - Gregory Katz
- ESSEC Business School, Paris-Singapore, France
- * E-mail:
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179
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Ponce DM, Hilden P, Devlin SM, Maloy M, Lubin M, Castro-Malaspina H, Dahi P, Hsu K, Jakubowski AA, Kernan NA, Koehne G, O'Reilly RJ, Papadopoulos EB, Perales MA, Sauter C, Scaradavou A, Tamari R, van den Brink MRM, Young JW, Giralt S, Barker JN. High Disease-Free Survival with Enhanced Protection against Relapse after Double-Unit Cord Blood Transplantation When Compared with T Cell-Depleted Unrelated Donor Transplantation in Patients with Acute Leukemia and Chronic Myelogenous Leukemia. Biol Blood Marrow Transplant 2015; 21:1985-93. [PMID: 26238810 PMCID: PMC4768474 DOI: 10.1016/j.bbmt.2015.07.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/28/2015] [Indexed: 01/30/2023]
Abstract
Double-unit cord blood (DCB) grafts are a rapidly available stem cell source for adults with high-risk leukemias. However, how disease-free survival (DFS) after DCB transplantation (DCBT) compares to that of unrelated donor transplantation (URDT) is not fully established. We analyzed 166 allograft recipients (66 8/8 HLA-matched URDT, 45 7/8 HLA-matched URDT, and 55 DCBT) ages 16 to 60 years with high-risk acute leukemia or chronic myelogenous leukemia (CML). URDT and DCBT recipients were similar except DCBT recipients were more likely to have lower weight and non-European ancestry and to receive intermediate-intensity conditioning. All URDT recipients received a CD34(+) cell-selected (T cell-depleted) graft. Overall, differences between the 3-year transplantation-related mortality were not significant (8/8 URDT, 18%; 7/8 URDT, 39%; and DCBT, 24%; P = .108), whereas the 3-year relapse risk was decreased after DCBT (8/8 URDT, 23%; 7/8 URDT, 20%; and DCBT 9%, P = .037). Three-year DFS was 57% in 8/8 URDT, 41% in 7/8 URDT, and 68% in DCBT recipients (P = .068), and the 3-year DFS in DCBT recipients was higher than that of 7/8 URDT recipients (P = .021). In multivariate analysis in acute leukemia patients, factors adversely associated with DFS were female gender (hazard ratio [HR], 1.68; P = .031), diagnosis of acute lymphoblastic leukemia (HR, 2.09; P = .004), and 7/8 T cell-depleted URDT (HR, 1.91; P = .037). High DFS can be achieved in adults with acute leukemia and CML with low relapse rates after DCBT. Our findings support performing DCBT in adults in preference to HLA-mismatched T cell-depleted URDT and suggest DCBT is a readily available alternative to T cell-depleted 8/8 URDT, especially in patients requiring urgent transplantation.
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MESH Headings
- Adolescent
- Adult
- Cord Blood Stem Cell Transplantation/methods
- Female
- Graft Survival
- Hematopoietic Stem Cell Transplantation
- Histocompatibility Testing
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Lymphocyte Depletion
- Male
- Middle Aged
- Myeloablative Agonists/therapeutic use
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Recurrence
- Retrospective Studies
- Sex Factors
- Survival Analysis
- T-Lymphocytes/cytology
- T-Lymphocytes/immunology
- Transplantation Conditioning
- Transplantation, Homologous
- Unrelated Donors
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Affiliation(s)
- Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Patrick Hilden
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marissa Lubin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Katharine Hsu
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nancy A Kernan
- Bone Marrow Transplantation Service, Department of Pediatrics; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Guenther Koehne
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard J O'Reilly
- Bone Marrow Transplantation Service, Department of Pediatrics; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Andromachi Scaradavou
- Bone Marrow Transplantation Service, Department of Pediatrics; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - James W Young
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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Bari S, Chu PPY, Lim A, Fan X, Bunte RM, Li S, Ghosh S, Chiu GNC, Hwang WYK. Mitochondrial superoxide reduction and cytokine secretion skewing by carbon nanotube scaffolds enhance ex vivo expansion of human cord blood hematopoietic progenitors. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:1643-56. [DOI: 10.1016/j.nano.2015.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 05/27/2015] [Accepted: 06/06/2015] [Indexed: 01/25/2023]
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181
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van der Garde M, van Hensbergen Y, Brand A, Slot MC, de Graaf-Dijkstra A, Mulder A, Watt SM, Zwaginga JJ. Thrombopoietin treatment of one graft in a double cord blood transplant provides early platelet recovery while contributing to long-term engraftment in NSG mice. Stem Cells Dev 2015; 24:67-76. [PMID: 25137252 DOI: 10.1089/scd.2014.0294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Human cord blood (CB) hematopoietic stem cell (HSC) transplants demonstrate delayed early neutrophil and platelet recovery and delayed longer term immune reconstitution compared to bone marrow and mobilized peripheral blood transplants. Despite advances in enhancing early neutrophil engraftment, platelet recovery after CB transplantation is not significantly altered when compared to contemporaneous controls. Recent studies have identified a platelet-biased murine HSC subset, maintained by thrombopoietin (TPO), which has enhanced capacity for short- and long-term platelet reconstitution, can self-renew, and can give rise to myeloid- and lymphoid-biased HSCs. In previous studies, we have shown that transplantation of human CB CD34(+) cells precultured in TPO as a single graft accelerates early platelet recovery as well as yielding long-term repopulation in immune-deficient mice. In this study, using a double CB murine transplant model, we investigated whether TPO cultured human CB CD34(+) cells have a competitive advantage or disadvantage over untreated human CB CD34(+) cells in terms of (1) short-term and longer term platelet recovery and (2) longer term hematological recovery. Our studies demonstrate that the TPO treated graft shows accelerated early platelet recovery without impairing the platelet engraftment of untreated CD34(+) cells. Notably, this was followed by a dominant contribution to platelet production through the untreated CD34(+) cell graft over the intermediate to longer term. Furthermore, although the contribution of the TPO treated graft to long-term hematological engraftment was reduced, the TPO treated and untreated grafts both contributed significantly to long-term chimerism in vivo.
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Affiliation(s)
- Mark van der Garde
- 1 Jon J. van Rood Center for Clinical Transfusion Research , Sanquin Blood Supply Foundation, Leiden, The Netherlands
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Cellular engineering and therapy in combination with cord blood allografting in pediatric recipients. Bone Marrow Transplant 2015; 51:27-33. [PMID: 26367220 DOI: 10.1038/bmt.2015.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/01/2015] [Accepted: 07/08/2015] [Indexed: 11/08/2022]
Abstract
Cord blood (CB) transplantation is an alternate source of human hematopoietic progenitor cells for allogeneic stem cell transplantation in children and adolescents with both malignant and nonmalignant diseases. Current limitations included delay in hematopoietic reconstitution, increased incidence of primary graft failure and slow cellular immunoreconstitution. These limitations lead to a significant increase in primary graft failure, infectious complications and increased transplant-related mortality. There is a number of experimental approaches currently under investigation including cellular engineering to circumvent these limitations. In this review, we summarize the recent findings of utilizing ex vivo CB expansion with Notch1 ligand Delta 1, mesenchymal progenitor cells, the use of human placenta-derived stem cells and CB-derived natural killer cells. Early and preliminary results suggest some of these experimental cellular strategies may in part ameliorate the incidence of primary graft failure, delays in hematopoietic reconstitution and/or slowness in cellular immune reconstitution following unrelated CB transplantation.
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183
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Strocchio L, Romano M, Cefalo MG, Vinti L, Gaspari S, Locatelli F. Cord blood transplantation in children with hemoglobinopathies. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1076724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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184
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Oran B, Cao K, Saliba RM, Rezvani K, de Lima M, Ahmed S, Hosing CM, Popat UR, Carmazzi Y, Kebriaei P, Nieto Y, Rondon G, Willis D, Shah N, Parmar S, Olson A, Moore B, Marin D, Mehta R, Fernández-Viña M, Champlin RE, Shpall EJ. Better allele-level matching improves transplant-related mortality after double cord blood transplantation. Haematologica 2015; 100:1361-70. [PMID: 26250579 DOI: 10.3324/haematol.2015.127787] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/24/2015] [Indexed: 11/09/2022] Open
Abstract
Cord blood transplant requires less stringent human leukocyte antigen matching than unrelated donors. In 133 patients with hematologic malignancies who engrafted after double cord blood transplantation with a dominant unit, we studied the effect of high resolution testing at 4 loci (-A, -B, -C, -DRB1) for its impact on 2-year transplant-related mortality. Ten percent of the dominant cord blood units were matched at 7-8/8 alleles using HLA-A, -B, -C, and -DRB1; 25% were matched at 6/8, 40% at 5/8, and 25% at 4/8 or less allele. High resolution typing at 4 loci showed that there was no 2-year transplant-related mortality in 7-8/8 matched patients. Patients with 5-6/8 matched dominant cord blood units had 2-year transplant-related mortality of 39% while patients with 4/8 or less matched units had 60%. Multivariate regression analyses confirmed the independent effect of high resolution typing on the outcome when adjusted for age, diagnosis, CD34(+) cell dose infused, graft manipulation and cord to cord matching. The worst prognostic group included patients aged over 32 years with 4/8 or less matched cord blood units compared with patients who were either younger than 32 years old independent of allele-level matching, or aged over 32 years but with 5-6/8 matched cord blood units (Hazard Ratio 2.2; 95% confidence interval: 1.3-3.7; P<0.001). Patients with 7-8/8 matched units remained the group with the best prognosis. Our data suggest that high resolution typing at 4 loci and selecting cord blood units matched at at least 5/8 alleles may reduce transplant-related mortality after double cord blood transplantation.
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Affiliation(s)
- Betül Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kai Cao
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcos de Lima
- University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra M Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yudith Carmazzi
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dana Willis
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brandt Moore
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Xie J, Zhang C. Ex vivo expansion of hematopoietic stem cells. SCIENCE CHINA-LIFE SCIENCES 2015; 58:839-53. [PMID: 26246379 DOI: 10.1007/s11427-015-4895-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 06/03/2015] [Indexed: 02/03/2023]
Abstract
Ex vivo expansion of hematopoietic stem cells (HSCs) would benefit clinical applications in several aspects, to improve patient survival, utilize cord blood stem cells for adult applications, and selectively propagate stem cell populations after genetic manipulation. In this review we summarize and discuss recent advances in the culture systems of mouse and human HSCs, which include stroma/HSC co-culture, continuous perfusion and fed-batch cultures, and those supplemented with extrinsic ligands, membrane transportable transcription factors, complement components, protein modification enzymes, metabolites, or small molecule chemicals. Some of the expansion systems have been tested in clinical trials. The optimal condition for ex vivo expansion of the primitive and functional human HSCs is still under development. An improved understanding of the mechanisms for HSC cell fate determination and the HSC culture characteristics will guide development of new strategies to overcome difficulties. In the future, development of a combination treatment regimen with agents that enhance self-renewal, block differentiation, and improve homing will be critical. Methods to enhance yields and lower cost during collection and processing should be employed. The employment of an efficient system for ex vivo expansion of HSCs will facilitate the further development of novel strategies for cell and gene therapies including genome editing.
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Affiliation(s)
- JingJing Xie
- Taishan Scholar Immunology Program, Binzhou Medical University, Yantai, 264003, China
- Departments of Physiology and Developmental Biology, University of Texas Southwestern Medical Center, Dallas, 75390, USA
| | - ChengCheng Zhang
- Departments of Physiology and Developmental Biology, University of Texas Southwestern Medical Center, Dallas, 75390, USA.
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186
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Pineault N, Abu-Khader A. Advances in umbilical cord blood stem cell expansion and clinical translation. Exp Hematol 2015; 43:498-513. [DOI: 10.1016/j.exphem.2015.04.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
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187
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Ballen KK. Is there a best graft source of transplantation in acute myeloid leukemia? Best Pract Res Clin Haematol 2015; 28:147-54. [DOI: 10.1016/j.beha.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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188
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Umbilical cord blood donation: public or private? Bone Marrow Transplant 2015; 50:1271-8. [PMID: 26030051 DOI: 10.1038/bmt.2015.124] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/15/2015] [Indexed: 02/01/2023]
Abstract
Umbilical cord blood (UCB) is a graft source for patients with malignant or genetic diseases who can be cured by allogeneic hematopoietic cell transplantation (HCT), but who do not have an appropriately HLA-matched family or volunteer unrelated adult donor. Starting in the 1990s, unrelated UCB banks were established, accepting donations from term deliveries and storing UCB units for public use. An estimated 730 000 UCB units have been donated and stored to date and ~35 000 UCB transplants have been performed worldwide. Over the past 20 years, private and family banks have grown rapidly, storing ~4 million UCB units for a particular patient or family, usually charging an up-front and yearly storage fee; therefore, these banks are able to be financially sustainable without releasing UCB units. Private banks are not obligated to fulfill the same regulatory requirements of the public banks. The public banks have released ~30 times more UCB units for therapy. Some countries have transitioned to an integrated banking model, a hybrid of public and family banking. Today, pregnant women, their families, obstetrical providers and pediatricians are faced with multiple choices about the disposition of their newborn's cord blood. In this commentary, we review the progress of UCB banking technology; we also analyze the current data on pediatric and adult unrelated UCB, including the recent expansion of interest in transplantation for hemoglobinopathies, and discuss emerging studies on the use of autologous UCB for neurologic diseases and regenerative medicine. We will review worldwide approaches to UCB banking, ethical considerations, criteria for public and family banking, integrated banking ideas and future strategies for UCB banking.
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189
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Duchez P, Rodriguez L, Chevaleyre J, Lapostolle V, Vlaski M, Brunet de la Grange P, Ivanovic Z. Interleukin-6 enhances the activity of in vivo long-term reconstituting hematopoietic stem cells in "hypoxic-like" expansion cultures ex vivo. Transfusion 2015; 55:2684-91. [PMID: 26013839 DOI: 10.1111/trf.13175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since interleukin (IL)-6 synergizes with the physiologically relevant O2 concentration in the maintenance of primitive hematopoietic stem cell (HSC) subpopulations, we hypothesized that its addition to our hypoxic response mimicking cultures (HRMCs), composed of an antioxidant-supplied serum-free xeno-free medium supplemented with the cytokines stabilizing hypoxia-inducible factor-1α and balancing HSC self-renewal and commitment, will result in a similar effect even if they are exposed to 20% O2 . STUDY DESIGN AND METHODS HRMCs were exposed to 20 and 5% O2 with and without IL-6. Functional committed progenitors (colony-forming cells [CFCs]: CFU-GM, BFU-E, CFU-Mix, and CFU-Mk) were evaluated as well as the short- and long-term repopulating HSCs using in vivo NSG mice model (primary and secondary recipients, respectively). RESULTS The addition of IL-6 to HRMCs exposed to 20% O2 did not significantly impact either the CFCs or in vivo short-term repopulating cells. However, it enhanced both the frequency and the individual proliferative capacity of the most primitive long-term repopulating cell population evidenced by the generation of human CFCs in the marrow of secondary recipient mice. The exposure of HRMCs to 5% O2 negatively affected the amplification of CFCs, which was not changed by the addition of IL-6 and exhibited a partial enhancing effect on the long-term repopulating cells. CONCLUSION The addition of IL-6 to the cytokine cocktail further improves our expansion procedure based on atmospheric O2 concentration-exposed HRMCs by enhancing the maintenance of the most primitive HSCs without a negative impact on the less primitive HSC populations and CFCs.
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Affiliation(s)
- Pascale Duchez
- Etablissement Français du Sang Aquitaine-Limousin and UMR 5164 CNRS/Université de Bordeaux, Bordeaux, France
| | - Laura Rodriguez
- Etablissement Français du Sang Aquitaine-Limousin and UMR 5164 CNRS/Université de Bordeaux, Bordeaux, France
| | - Jean Chevaleyre
- Etablissement Français du Sang Aquitaine-Limousin and UMR 5164 CNRS/Université de Bordeaux, Bordeaux, France
| | - Veronique Lapostolle
- Etablissement Français du Sang Aquitaine-Limousin and UMR 5164 CNRS/Université de Bordeaux, Bordeaux, France
| | - Marija Vlaski
- Etablissement Français du Sang Aquitaine-Limousin and UMR 5164 CNRS/Université de Bordeaux, Bordeaux, France
| | | | - Zoran Ivanovic
- Etablissement Français du Sang Aquitaine-Limousin and UMR 5164 CNRS/Université de Bordeaux, Bordeaux, France
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Vertès AA. The potential of cytotherapeutics in hematologic reconstitution and in the treatment and prophylaxis of graft-versus-host disease. Chapter II: emerging transformational cytotherapies. Regen Med 2015; 10:345-73. [DOI: 10.2217/rme.15.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a life-saving treatment for inherited anemias, immunodeficiencies or hematologic malignancies. A major complication of allo-HSCT associated with high transplant-related mortality rates is graft-versus-host disease (GvHD). Current and future clinical benefits in HSCT enabled by advances in hematopoietic stem cells, mesenchymal stem cells, Tregs and natural killer cells technologies are reviewed here and discussed. Among these evolutions, based on the need for mesenchymal stem cells to be recruited by an inflammatory environment, the development and use of novel GvHD biomarkers could be explored further to deliver the right pharmaceutical to the right patient at the right time. The successful commercialization of cytotherapeutics to efficiently manage GvHD will create a virtuous ‘halo’ effect for regenerative medicine.
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Affiliation(s)
- Alain A Vertès
- Sloan Fellow, London Business School, London, UK
- NxR Biotechnologies GmbH, Basel, Switzerland
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191
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Alexaline MM, Trouillas M, Nivet M, Bourreau E, Leclerc T, Duhamel P, Martin MT, Doucet C, Fortunel NO, Lataillade JJ. Bioengineering a human plasma-based epidermal substitute with efficient grafting capacity and high content in clonogenic cells. Stem Cells Transl Med 2015; 4:643-54. [PMID: 25848122 DOI: 10.5966/sctm.2014-0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/23/2015] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED Cultured epithelial autografts (CEAs) produced from a small, healthy skin biopsy represent a lifesaving surgical technique in cases of full-thickness skin burn covering >50% of total body surface area. CEAs also present numerous drawbacks, among them the use of animal proteins and cells, the high fragility of keratinocyte sheets, and the immaturity of the dermal-epidermal junction, leading to heavy cosmetic and functional sequelae. To overcome these weaknesses, we developed a human plasma-based epidermal substitute (hPBES) for epidermal coverage in cases of massive burn, as an alternative to traditional CEA, and set up critical quality controls for preclinical and clinical studies. In this study, phenotypical analyses in conjunction with functional assays (clonal analysis, long-term culture, or in vivo graft) showed that our new substitute fulfills the biological requirements for epidermal regeneration. hPBES keratinocytes showed high potential for cell proliferation and subsequent differentiation similar to healthy skin compared with a well-known reference material, as ascertained by a combination of quality controls. This work highlights the importance of integrating relevant multiparameter quality controls into the bioengineering of new skin substitutes before they reach clinical development. SIGNIFICANCE This work involves the development of a new bioengineered epidermal substitute with pertinent functional quality controls. The novelty of this work is based on this quality approach.
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Affiliation(s)
- Maia M Alexaline
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Marina Trouillas
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Muriel Nivet
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Emilie Bourreau
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Thomas Leclerc
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Patrick Duhamel
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Michele T Martin
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Christelle Doucet
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Nicolas O Fortunel
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
| | - Jean-Jacques Lataillade
- Biomedical Research Institute of French Armies, INSERM U1197, Clamart, France; Celogos, Paris, France; Alternative Energies and Atomic Energy Commission, Institute of Cellular and Molecular Radiobiology, Laboratory of Genomics and Radiobiology of Keratinopoiesis, INSERM UMR 967, Evry, France; Burn Treatment Unit, Percy Hospital, Clamart, France; Plastic Surgery Department, Percy Hospital, Clamart, France
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Gullo F, van der Garde M, Russo G, Pennisi M, Motta S, Pappalardo F, Watt S. Computational modeling of the expansion of human cord blood CD133+ hematopoietic stem/progenitor cells with different cytokine combinations. Bioinformatics 2015; 31:2514-22. [PMID: 25810433 DOI: 10.1093/bioinformatics/btv172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
MOTIVATION Many important problems in cell biology require dense non-linear interactions between functional modules to be considered. The importance of computer simulation in understanding cellular processes is now widely accepted, and a variety of simulation algorithms useful for studying certain subsystems have been designed. Expansion of hematopoietic stem and progenitor cells (HSC/HPC) in ex vivo culture with cytokines and small molecules is a method to increase the restricted numbers of stem cells found in umbilical cord blood (CB), while also enhancing the content of early engrafting neutrophil and platelet precursors. The efficacy of the expanded product depends on the composition of the cocktail of cytokines and small molecules used for culture. Testing the influence of a cytokine or small molecule on the expansion of HSC/HPC is a laborious and expensive process. We therefore developed a computational model based on cellular signaling interactions that predict the influence of a cytokine on the survival, duplication and differentiation of the CD133(+) HSC/HPC subset from human umbilical CB. RESULTS We have used results from in vitro expansion cultures with different combinations of one or more cytokines to develop an ordinary differential equation model that includes the effect of cytokines on survival, duplication and differentiation of the CD133(+) HSC/HPC. Comparing the results of in vitro and in silico experiments, we show that the model can predict the effect of a cytokine on the fold expansion and differentiation of CB CD133(+) HSC/HPC after 8-day culture on a 3D scaffold. Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Francesca Gullo
- Stem Cell Research, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK, NHS Blood and Transplant Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Mark van der Garde
- Stem Cell Research, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK, NHS Blood and Transplant Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | - Marzio Pennisi
- Department of Mathematics and Computer Science, University of Catania, 95125 Catania, Italy
| | - Santo Motta
- Department of Mathematics and Computer Science, University of Catania, 95125 Catania, Italy
| | | | - Suzanne Watt
- Stem Cell Research, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK, NHS Blood and Transplant Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Milano F, Boelens JJ. Stem cell comparison: what can we learn clinically from unrelated cord blood transplantation as an alternative stem cell source? Cytotherapy 2015; 17:695-701. [PMID: 25795270 DOI: 10.1016/j.jcyt.2015.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/24/2015] [Indexed: 02/01/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic option for a variety of malignant and non-malignant disorders (NMD). The use of umbilical cord blood transplantation (UCBT) has made HCT available to many more patients. The increased level of human leukocyte antigen disparity that can be tolerated makes UCBT a very attractive alternative source of hematopoietic stem cells; however, the increased risk of early death observed after UCBT remains an obstacle. Novel strategies such as ex vivo stem cell expansion are now becoming part of the standard clinical approach, and preliminary results are extremely encouraging with suggestion of reduction of early transplant-related mortality. Although there are no randomized studies that compare the risks and benefits of UCBT relative to those observed with related and unrelated donors both for malignant and NMD, several retrospective studies have compared outcomes between UCBT and other stem cell sources. In this review, we aim to describe and summarize the findings of the principal studies in this field. We hope that what we can learn from these studies and how we can use this information will improve the outcomes of HCT for patients with malignant and NMD.
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Affiliation(s)
- Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - Jaap Jan Boelens
- University Medical Center Utrecht, Pediatric Blood and Marrow Transplantation Program, Utrecht, The Netherlands; Laboratory Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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194
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Enforced fucosylation of cord blood hematopoietic cells accelerates neutrophil and platelet engraftment after transplantation. Blood 2015; 125:2885-92. [PMID: 25778529 DOI: 10.1182/blood-2015-01-607366] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/27/2015] [Indexed: 12/30/2022] Open
Abstract
Delayed engraftment is a major limitation of cord blood transplantation (CBT), due in part to a defect in the cord blood (CB) cells' ability to home to the bone marrow. Because this defect appears related to low levels of fucosylation of cell surface molecules that are responsible for binding to P- and E-selectins constitutively expressed by the marrow microvasculature, and thus for marrow homing, we conducted a first-in-humans clinical trial to correct this deficiency. Patients with high-risk hematologic malignancies received myeloablative therapy followed by transplantation with 2 CB units, one of which was treated ex vivo for 30 minutes with the enzyme fucosyltransferase-VI and guanosine diphosphate fucose to enhance the interaction of CD34(+) stem and early progenitor cells with microvessels. The results of enforced fucosylation for 22 patients enrolled in the trial were then compared with those for 31 historical controls who had undergone double unmanipulated CBT. The median time to neutrophil engraftment was 17 days (range, 12-34 days) compared with 26 days (range, 11-48 days) for controls (P = .0023). Platelet engraftment was also improved: median was 35 days (range, 18-100 days) compared with 45 days (range, 27-120 days) for controls (P = .0520). These findings support ex vivo fucosylation of multipotent CD34(+) CB cells as a clinically feasible means to improve engraftment efficiency in the double CBT setting. The trial is registered to www.clinicaltrials.gov as #NCT01471067.
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195
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Horwitz ME, Frassoni F. Improving the outcome of umbilical cord blood transplantation through ex vivo expansion or graft manipulation. Cytotherapy 2015; 17:730-738. [PMID: 25778757 DOI: 10.1016/j.jcyt.2015.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/14/2015] [Indexed: 12/14/2022]
Abstract
The outcome of umbilical cord blood transplantation for adult patients with hematologic malignancies now rivals that of matched unrelated donor transplantation. However, relatively low lymphocyte and hematopoietic stem and progenitor cell dose is a source of significant morbidity and mortality. Multiple strategies are now being studied to overcome these limitations. One strategy involves ex vivo expansion of the umbilical cord blood unit before transplantation. Ex vivo expansion has the potential to increase the number of lymphocytes, committed progenitors and long-term repopulating hematopoietic stem cells. Increasing the numbers of lymphocytes and committed progenitor cells will address the issue of delayed hematopoietic recovery after umbilical cord blood transplantation. Increasing the hematopoietic stem cell content will improve the availability of adequately sized and matched cord blood units for transplantation. It may also eliminate the need for dual umbilical cord blood transplantation for those without an adequately sized single umbilical cord blood graft. The second strategy involves exposure of the umbilical cord blood graft to compounds aimed at improving homing and engraftment following transplantation. Such a strategy may also address the problem of slow hematopoietic recovery as well as the increased risk of graft failure. Many of these strategies are now being tested in late-phase multi-center clinical trials. If proven cost-effective and efficacious, they may alter the landscape of donor options for allogeneic stem cell transplantation.
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Affiliation(s)
- Mitchell E Horwitz
- Adult Blood and Marrow Transplant Program, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Francesco Frassoni
- Department of Hemato-Oncology and Center for Stem Cell and Cell Therapy, Istituto G. Gaslini Children's Hospital Scientific Institute, Genova, Italy
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196
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van Hensbergen Y, van der Garde M, Brand A, Slot MC, de Graaf-Dijkstra A, Watt S, Zwaginga JJ. Cryopreservation of cord blood CD34+ cells before or after thrombopoietin expansion differentially affects early platelet recovery in NOD SCID mice. Transfusion 2015; 55:1772-81. [DOI: 10.1111/trf.13045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 12/24/2014] [Accepted: 12/30/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Yvette van Hensbergen
- Jon J. Van Rood Center for Clinical Transfusion Research; Sanquin Blood Supply Foundation; Leiden the Netherlands
| | - Mark van der Garde
- Jon J. Van Rood Center for Clinical Transfusion Research; Sanquin Blood Supply Foundation; Leiden the Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
- Stem Cell Research Laboratory; Nuffield Division of Clinical Laboratory Sciences; Radcliffe Department of Medicine; University of Oxford, and NHS Blood and Transplant Oxford; Oxford United Kingdom
| | - Anneke Brand
- Jon J. Van Rood Center for Clinical Transfusion Research; Sanquin Blood Supply Foundation; Leiden the Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
| | - Manon C. Slot
- Jon J. Van Rood Center for Clinical Transfusion Research; Sanquin Blood Supply Foundation; Leiden the Netherlands
| | - Alice de Graaf-Dijkstra
- Jon J. Van Rood Center for Clinical Transfusion Research; Sanquin Blood Supply Foundation; Leiden the Netherlands
| | - Suzanne Watt
- Stem Cell Research Laboratory; Nuffield Division of Clinical Laboratory Sciences; Radcliffe Department of Medicine; University of Oxford, and NHS Blood and Transplant Oxford; Oxford United Kingdom
| | - Jaap Jan Zwaginga
- Jon J. Van Rood Center for Clinical Transfusion Research; Sanquin Blood Supply Foundation; Leiden the Netherlands
- Department of Immunohematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
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197
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Abstract
PURPOSE OF REVIEW The role of hematopoietic cell transplantation in non-malignant disorders has increased exponentially with the recognition that multiple diseases can be controlled or cured if engrafted with donor-derived cells. This review provides an overview of advances made in alternative donor transplants for nonmalignant disorders. RECENT FINDINGS Stem cell sources, novel transplant methods, and sophisticated supportive care have simultaneously made giant strides toward improving the safety and efficacy of hematopoietic cell transplantation. This has led to the utilization of marrow, cord, peripheral blood stem cell and haploidentical stem cell sources, and novel reduced toxicity or reduced intensity conditioning regimens to transplant non-malignant disorders such as immune dysfunctions, marrow failure syndromes, metabolic disorders and hemoglobinopathies. Transplant complications such as graft rejection, infections, and graft versus host disease are better combated in this modern era of medicine, achieving better survival with decreased late effects. These aspects of transplant for non-malignant disorders are discussed. SUMMARY This review presents the progress made in the realm of hematopoietic cell transplantation for non-malignant disorders. It advocates the consideration of alternative donor transplants in the absence of human leukocyte antigen matched siblings when indicated by disease severity. The ultimate goal is to provide curative transplant options for more patients that can benefit from this intervention, prior to detrimental outcomes.
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198
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Bari S, Seah KKH, Poon Z, Cheung AMS, Fan X, Ong SY, Li S, Koh LP, Hwang WYK. Expansion and homing of umbilical cord blood hematopoietic stem and progenitor cells for clinical transplantation. Biol Blood Marrow Transplant 2014; 21:1008-19. [PMID: 25555449 DOI: 10.1016/j.bbmt.2014.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/22/2014] [Indexed: 12/26/2022]
Abstract
The successful expansion of hematopoietic stem and progenitor cells (HSPCs) from umbilical cord blood (UCB) for transplantation could revolutionize clinical practice by improving transplantation-related outcomes and making available UCB units that have suboptimal cell doses for transplantation. New cytokine combinations appear able to promote HSPC growth with minimal differentiation into mature precursors and new agents, such as insulin-like growth factor-binding protein 2, are being used in clinical trials. Molecules that simulate the HSPC niche, such as Notch ligand, have also shown promise. Further improvements have been made with the use of mesenchymal stromal cells, which have made possible UCB expansion without a potentially deleterious prior CD34/CD133 cell selection step. Chemical molecules, such as copper chelators, nicotinamide, and aryl hydrocarbon antagonists, have shown excellent outcomes in clinical studies. The use of bioreactors could further add to HSPC studies in future. Drugs that could improve HSPC homing also appear to have potential in improving engraftment times in UCB transplantation. Technologies to expand HSPC from UCB and to enhance the homing of these cells appear to have attained the goal of accelerating hematopoietic recovery. Further discoveries and clinical studies are likely to make the goal of true HSPC expansion a reality for many applications in future.
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Affiliation(s)
- Sudipto Bari
- Department of Hematology, Singapore General Hospital, Singapore; Department of Pharmacy, National University of Singapore, Singapore
| | | | - Zhiyong Poon
- BioSystems and Micromechanics, Singapore-MIT Alliance for Research and Technology, Singapore
| | | | - Xiubo Fan
- Department of Clinical Research, Singapore General Hospital, Singapore
| | - Shin-Yeu Ong
- Department of Hematology, Singapore General Hospital, Singapore
| | - Shang Li
- Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - William Ying Khee Hwang
- Department of Hematology, Singapore General Hospital, Singapore; Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore; Singapore Cord Blood Bank, Singapore.
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199
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Abstract
The use of umbilical cord blood (UCB) as an alternative haematopoietic cell source in lieu of bone marrow for haematopoietic reconstitution is increasingly becoming a mainstay treatment for both malignant and nonmalignant diseases, as most individuals will have at least one available, suitably HLA-matched unit of blood. The principal limitation of UCB is the low and finite number of haematopoietic stem and progenitor cells (HSPC) relative to the number found in a typical bone marrow or mobilized peripheral blood allograft, which leads to prolonged engraftment times. In an attempt to overcome this obstacle, strategies that are often based on native processes occurring in the bone marrow microenvironment or 'niche' have been developed with the goal of accelerating UCB engraftment. In broad terms, the two main approaches have been either to expand UCB HSPC ex vivo before transplantation, or to modulate HSPC functionality to increase the efficiency of HSPC homing to the bone marrow niche after transplant both of which enhance the biological activities of the engrafted HSPC. Several early phase clinical trials of these approaches have reported promising results.
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200
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Fitzhugh CD, Abraham AA, Tisdale JF, Hsieh MM. Hematopoietic stem cell transplantation for patients with sickle cell disease: progress and future directions. Hematol Oncol Clin North Am 2014; 28:1171-85. [PMID: 25459186 DOI: 10.1016/j.hoc.2014.08.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Research has solidified matched sibling marrow, cord blood, or mobilized peripheral blood as the best source for allogeneic hematopoietic stem cell transplantation for patients with sickle cell disease, with low graft rejection and graft-versus-host disease (GVHD) and high disease-free survival rates. Fully allelic matched unrelated donor is an option for transplant-eligible patients without HLA-matched sibling donors. Unrelated cord transplant studies reported high GVHD and low engraftment rates. Haploidentical transplants have less GVHD, but improvements are needed to increase the low engraftment rate. The decision to use unrelated cord blood units or haploidentical donors depends on institutional expertise.
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Affiliation(s)
| | - Allistair A Abraham
- Division of Blood and Marrow Transplantation, Children's National Health System, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue, North West, Washington, DC 20010, USA
| | - John F Tisdale
- 9000 Rockville Pike, Building 10/9N112, Bethesda, MD 20892, USA
| | - Matthew M Hsieh
- 9000 Rockville Pike, Building 10/9N112, Bethesda, MD 20892, USA.
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