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Ye Y, Labopin M, Chen J, Wu D, Gedde-Dahl T, Blaise D, Socie G, Forcade E, Salmenniemi U, Maury S, Versluis J, Bazarbachi A, Nagler A, Brissot E, Li L, Luo Y, Shi J, Ciceri F, Huang H, Mohty M, Gorin NC. Lower relapse incidence with HAPLO versus MSD or MUD HCTs for AML patients with KMT2A rearrangement: a study from the Global Committee and the ALWP of the EBMT. Blood Cancer J 2024; 14:85. [PMID: 38802349 PMCID: PMC11130289 DOI: 10.1038/s41408-024-01072-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Yishan Ye
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Myriam Labopin
- EBMT Paris Office, Hôpital Saint Antoine 184, rue du faubourg Saint Antoine, 75571, Paris, cedex 12, France
| | - Jia Chen
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Didier Blaise
- Program of Transplant and cellular immunotherapy, Department of Hematology, Institut Paoli Calmettes, Management Sport Cancer (MSC) Lab, Aix Marseille University (AMU), Marseille, France
| | | | | | | | | | | | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Eolia Brissot
- EBMT Paris Office, Hôpital Saint Antoine 184, rue du faubourg Saint Antoine, 75571, Paris, cedex 12, France
- Department of Hematology and Cell therapy, Hospital Saint-Antoine, Sorbonne University, Paris, France
| | - Lin Li
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Luo
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jimin Shi
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - He Huang
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Mohamad Mohty
- EBMT Paris Office, Hôpital Saint Antoine 184, rue du faubourg Saint Antoine, 75571, Paris, cedex 12, France.
- Department of Hematology and Cell therapy, Hospital Saint-Antoine, Sorbonne University, Paris, France.
| | - Norbert Claude Gorin
- EBMT Paris Office, Hôpital Saint Antoine 184, rue du faubourg Saint Antoine, 75571, Paris, cedex 12, France.
- Department of Hematology and Cell therapy, Hospital Saint-Antoine, Sorbonne University, Paris, France.
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Bazarbachi AH, Labopin M, Raiola AM, Blaise D, Arcese W, Santarone S, Koc Y, Bramanti S, Kulagin A, Kwon M, Sica S, Sanz J, Brissot E, Nagler A, Ciceri F, Mohty M. Posttransplant cyclophosphamide versus anti-thymocyte globulin versus combination for graft-versus-host disease prevention in haploidentical transplantation for adult acute myeloid leukemia: A report from the European Society for Blood and Marrow Transplantation Acute Leukemia Working Party. Cancer 2024. [PMID: 38758817 DOI: 10.1002/cncr.35365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The optimal choice for graft-versus-host disease (GVHD) prophylaxis in haploidentical stem cell transplantation (haplo-SCT) remains debatable. Posttransplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are two common strategies, but little is known about their combination. METHODS Using the European Society for Blood and Marrow Transplantation (EBMT) registry, the authors identified 3649 adult patients with acute myeloid leukemia (AML) who underwent haplo-SCT in complete remission between 2007 and 2021 at 260 EBMT-participating centers who received either PTCy (n = 2999), ATG (n = 358), or combination prophylaxis (n = 292). Cord blood transplants, combined bone marrow and peripheral grafts, and transplants with ex vivo graft manipulation were excluded. Median follow-up was 31.8 months. RESULTS On multivariate analysis, adjusting for patient age and performance status, disease status at transplant, cytogenetic risk, conditioning intensity, stem cell source, female-to-male graft, and donor and patient CMV status, we present the following. Compared to PTCy, ATG had a higher risk of nonrelapse mortality (hazard ratio [HR], 1.6; p = .003), worse leukemia-free survival (HR, 1.4; p = .002), overall survival (HR, 1.49; p = .0009), and GVHD-free and relapse-free survival (HR, 1.29; p = .012). The combination of PTCy and ATG, however, led to significantly reduced rates of grade 2-4 (HR, 0.51; p = .0003) and grade 3-4 (HR, 0.5; p = .018) acute GVHD and did not affect any transplant outcomes compared to PTCy without ATG. CONCLUSION The authors conclude that ATG alone is a less effective prophylaxis strategy compared to PTCy, however, the combination of PTCy and ATG is superior to either monotherapy. They propose that this combination could be considered a potential new standard of care for GVHD prophylaxis in haplo-SCT for AML.
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Affiliation(s)
- Abdul-Hamid Bazarbachi
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
- Division of Hematology/Oncology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Myriam Labopin
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
| | - Anna Maria Raiola
- Hematology and Cellular Therapy Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Didier Blaise
- Transplantation and Cellular Immunotherapy Program, Department of Hematology, Institut Paoli Calmettes, MSC Lab, Aix Marseille University, Marseille, France
| | - William Arcese
- Stem Cell Transplant Unit, "Tor Vergata" University of Rome, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Stella Santarone
- Dipartimento Oncologico Ematologico, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbul, Turkey
| | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, Istituto Clinico Humanitas, Milano, Italy
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Mi Kwon
- Sección de Trasplante de Medula Osea, Hospital Gregorio Marañón, Madrid, Spain
| | - Simona Sica
- Universita Cattolica S. Cuore, Istituto di Ematologia, Rome, Italy
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Eolia Brissot
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fabio Ciceri
- IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris study office/CEREST-TC, Paris, France
- Department of Hematology, Saint Antoine Hospital, Paris, France
- INSERM UMR 938, Sorbonne University, Paris, France
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3
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Chen J, Labopin M, Pabst T, Zhang X, Jiang E, Tucci A, Cornelissen J, Meijer E, Khevelidze I, Polge E, Wu D, Mohty M, Gorin NC. Autologous stem cell transplantation in adult patients with intermediate-risk acute myeloid leukemia in first complete remission and no detectable minimal residual disease. A comparative retrospective study with haploidentical transplants of the global committee and the ALWP of the EBMT. Bone Marrow Transplant 2023; 58:1322-1330. [PMID: 37640797 PMCID: PMC10691968 DOI: 10.1038/s41409-023-02070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
In patients with acute myeloid leukemia (AML) of intermediate-risk (IR) in first remission (CR1) with no measurable residual disease (MRD negative), the choice of the best consolidation is questionable. 1122 adult patients from 196 centers, transplanted in 2010-21 were analyzed: 547 received an autologous stem cell transplantation (ASCT) and 575 a Haploidentical donor transplant. Because of a significant interaction, comparisons were done separately for patients with wild-type FLT3 (FLT3-wt) and FLT3-ITD mutation (FLT3-ITD). In FLT3-wt patients, haploidentical transplants had two year lower relapse incidence (RI) (16.9% versus 32.6%; HR = 0.40, p < 0.001), higher NRM higher (17.2% vs 3.5%; HR = 7.02, p < 0.001), similar LFS (65.9% vs 63.8%; p = 0.37) and lower OS (73.2% vs 80.6%; HR = 1.69, p = 0.018). In FLT3-ITD patients, haploidentical transplants had two year lower RI (8.2% vs 47.8%; HR = 0.14, p < 0.001) higher NRM (20.2% vs 5.6%; HR = 3.43, p = 0.002), better LFS (71.5% vs 46.6%; HR = 0.53, p = 0.007) and similar OS (73.5% vs 61.9%; p = 0.44). In IR AML patients with FLT3-wt in MRD negative CR1, autologous stem cell transplantation is a valid option, while in patients with FLT3-ITD, haploidentical transplant is better. Whether autologous transplantation is superior to chemotherapy in FLT3-wt patients and the role of maintenance therapy with FLT3 inhibitors remain to be studied.
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Affiliation(s)
- Jia Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Myriam Labopin
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, EBMT Paris office, Paris, France
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Xi Zhang
- Medical center of hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Erlie Jiang
- Institute of Hematology, Chinese Academy of Medical Sciences, Hematopoietic stem cell transplantation center, Tianjin, China
| | - Alessandra Tucci
- Spedali Civili - Brescia, Hematology Division, Department of Medical Oncology, Brescia, Italy
| | - Jan Cornelissen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, Netherlands
| | - Ellen Meijer
- VU University Medical Center, Department of Hematology, Amsterdam, Netherlands
| | - Irma Khevelidze
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, EBMT Paris office, Paris, France
| | - Emmanuelle Polge
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, EBMT Paris office, Paris, France
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, EBMT Paris office, Paris, France
| | - Norbert-Claude Gorin
- Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, EBMT Paris office, Paris, France.
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4
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Nagler A, Labopin M, Blaise D, Raiola AM, Corral LL, Bramanti S, Sica S, Kwon M, Koc Y, Pavlu J, Kulagin A, Busca A, Rodríguez AB, Reményi P, Schmid C, Brissot E, Sanz J, Bazarbachi A, Giebel S, Ciceri F, Mohty M. Non-T-depleted haploidentical transplantation with post-transplant cyclophosphamide in patients with secondary versus de novo AML in first complete remission: a study from the ALWP/EBMT. J Hematol Oncol 2023; 16:58. [PMID: 37248463 PMCID: PMC10226209 DOI: 10.1186/s13045-023-01450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
We compared outcomes of adult patients with secondary acute myeloid leukemia (sAML) versus de novo AML after non-T-depleted haploidentical stem cell transplant (HaploSCT) with post-transplant cyclophosphamide (PTCy). Seventeen hundred and eleven AML patients (sAML-231, de novo-1480) in first complete remission transplanted from 2010 to 2021, were included. Patients with de novo AML were younger, median age 55.8 versus 60.8 years, p < 0.0001, had better transplantation comorbidity index (HCT-CI) ≥ 3 21.3% versus 40.8%, p < 0.0001 and Karnofsky performance status (KPS) with KPS ≥ 90 in 78% versus 68.5%, respectively, p = 0.002. The two patient groups did not differ with respect to gender, cytomegalovirus serostatus, and cell source. Median time from diagnosis to HaploSCT was 5.2 versus 4.9 months, respectively, p = 0.005. Fewer sAML patients received myeloablative conditioning 35.1% versus 50.1%, p < 0.0001. Two hundred and eleven sAML and 410 de novo AML patients were included in the matched-pair analysis matching two de novo AML with each sAML. No significant difference was observed in any transplantation outcome parameter between the sAML versus de novo AML groups. Two-year non-relapse mortality and relapse incidence did not differ with HaploSCT for de novo versus sAML; 21.4% versus 21%, hazard ratio (HR) = 0.98, p = 0.9 and 23.4% versus 20.6%, HR = 0.92, p = 0.67, respectively. Two-year leukemia-free survival, overall survival, and graft-versus-host disease (GVHD)-free, relapse-free survival were also not different between the de novo AML and sAML groups 55.2% versus 58.4%, HR = 0.95, p = 0.67; 61.4% versus 66.4%, HR = 0.91, p = 0.51 and 46.3% versus 48.2%, HR = 0.92, p = 0.48, respectively. Similarly, the incidence of engraftment as well as acute and chronic GVHD was similar between the 2 cohorts. In conclusion, HaploSCT with PTCy may be able to overcome the bad prognosis of sAML as results are not significantly different to those of HaploSCT in de novo AML.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Anna Maria Raiola
- Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefania Bramanti
- Transplantation Unit Department of Oncology and Haematology, Istituto Clinico Humanitas, Milan, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mi Kwon
- Hematology Hospital GU Gregorio Marañon, Instituto de Investigacion Sanitaria Gregorio Marañon, Medicina UCM, Madrid, Spain
| | - Yener Koc
- Bone Marrow Transplant Unit, Medicana International Hospital Istanbul, Istanbuls, Turkey
| | - Jiri Pavlu
- Department of Haematology, Hammersmith Hospital, Imperial College, London, UK
| | - Alexander Kulagin
- Raisa Gorbacheva Memorial, Research Institute for Paediatric Oncology, Hematology, and Transplantation, First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | - Alessandro Busca
- SSD Trapianto di Cellule Staminali, AOU Citta' Della Salute e della Scienza, Turin, Italy
| | | | - Péter Reményi
- Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Department Hematology and Stem Cell Transplant, Budapest, Hungary
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Sorbonne University, and INSERM UMRs 938, Paris, France
| | - Jaime Sanz
- Hematology Department, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Fabio Ciceri
- Ospedale San Raffaele, Haematology and BMT, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
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Lv M, Guo HD, Huang XJ. A perfect mismatch: haploidentical hematopoietic stem cell transplantation overtakes a bend. Cell Mol Immunol 2023:10.1038/s41423-023-01007-y. [PMID: 36997728 PMCID: PMC10387465 DOI: 10.1038/s41423-023-01007-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Affiliation(s)
- Meng Lv
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Hui-Dong Guo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
- Peking-Tsinghua Center for Life Sciences, Beijing, China.
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Lv M, Gorin NC, Huang XJ. A vision for the future of allogeneic hematopoietic stem cell transplantation in the next decade. Sci Bull (Beijing) 2022; 67:1921-1924. [PMID: 36546194 DOI: 10.1016/j.scib.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Meng Lv
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - Norbert Claude Gorin
- Department of Hematology and Cell Therapy, European Society for Blood and Marrow Transplantation Global Committee, Hôpital Saint-Antoine AP-HP, Paris Sorbonne University, Paris 75012, France.
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; Peking-Tsinghua Center for Life Sciences, Beijing 100871, China.
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7
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Han L, Li Y, Wu J, Peng J, Han X, Zhao H, He C, Li Y, Wang W, Zhang M, Li Y, Sun H, Cao H, Sang L, Jiang Z, Yu J. Post-remission measurable residual disease directs treatment choice and improves outcomes for patients with intermediate-risk acute myeloid leukemia in CR1. Int J Hematol 2022; 116:892-901. [PMID: 36031670 PMCID: PMC9668963 DOI: 10.1007/s12185-022-03441-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 11/29/2022]
Abstract
Objectives This study retrospectively investigated in which cycle measurable residual disease (MRD) is associated with prognosis in patients in first complete remission (CR1) of intermediate-risk acute myeloid leukemia (AML). Methods The study enrolled 235 younger patients with intermediate-risk AML. MRD was evaluated by multiparameter flow cytometry after the 1st, 2nd, and 3rd chemotherapy cycles (MRD1–3, respectively). Results No significant association was detected after the 1st and 2nd cycles. However, the 5-year incidence of relapse was higher in the MRD3-positive group (n = 99) than in the negative group (n = 136) (48.7% vs. 13.7%, P = 0.005), while 5-year disease-free survival (DFS) and overall survival (OS) were lower in the MRD3-positive group than in the negative group (43.2% vs. 81.0% and 45.4% vs. 84.1%; P = 0.003 and 0.005, respectively). Allogeneic hematopoietic stem cell transplantation led to a lower 5-year relapse, and higher DFS and OS rates than chemotherapy in the MRD3-positive group (22.3% vs. 71.5%, 65.9% vs. 23.0%, and 67.1% vs. 23.9%; P < 0.001, 0.002, and 0.022, respectively), but did not affect the MRD-negative group. Conclusions MRD3 could serve as an indicator for post-remission treatment choice and help improve outcomes for intermediate-risk AML in CR1. Supplementary Information The online version contains supplementary material available at 10.1007/s12185-022-03441-6.
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Wang L, Dai B, Gao W, Wang J, Wan M, Wang R, Wang L, Jiang J, Blaise D, Hu J. Clinical Significance of Haplo-Fever and Cytokine Profiling After Graft Infusion in Allogeneic Stem Cell Transplantation From Haplo-Identical Donors. Front Med (Lausanne) 2022; 9:820591. [PMID: 35463028 PMCID: PMC9021571 DOI: 10.3389/fmed.2022.820591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Allogeneic stem cell transplantation from haplo-identical donors (haplo-HSCT) has become a well-established therapeutic option for hematological malignancies. The fever of unknown origin (haplo-fever) early after the infusion of T cell repleted graft, which returned to normal right after post-transplantation cyclophosphamide (PTCy), is a unique clinical feature in patients undergoing haplo-HSCT. In the current study, the characteristics of haplo-fever and cytokine profiles during haplo-fever were retrospectively analyzed in a cohort of 37 patients undergoing T cell repleted haplo-HSCT with PTCy as graft versus host disease (GvHD) prophylaxis. In total, 33 patients (89.2%) developed haplo-fever from day 0 to day +7. Patients with high peak temperatures tended to have a lower incidence of chronic GvHD (cGvHD) (p = 0.07), moderate to severe cGvHD (p = 0.08), and superior GvHD and relapse-free survival (GRFS, p = 0.04). During the haplo-fever, there were significant increases in multiple cytokines, such as interferon gamma, interleukin (IL) 6, IL2, IL2 receptor, IL8, IL10, IL17, and tumor necrosis factor (TNF). The increases in IL2 receptor (p = 0.037) and TNF (p < 0.001) on day +4 were correlated with the lower risk of cGvHD. Increased TNF > 1.8055-fold on day +4 was the best predictive threshold for cGvHD, and was correlated with a lower incidence of cGvHD (p < 0.001), moderate to severe cGvHD (p = 0.003), and superior GRFS (p < 0.001). These observations may reflect the early reactivation of donor T cells after haplo graft infusion, which would potentially be eliminated by PTCy. Further studies with larger independent cohorts of patients are warranted, to clarify the clinical significance of haplo-fever, and day +4 TNF as a potential biomarker to predict GvHD and GRFS.
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Affiliation(s)
- Lining Wang
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Dai
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Gao
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Wang
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Wan
- Shanghai Clinical Research Center, Fenglin International Centre, Shanghai, China
| | - Runshu Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Ling Wang
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieling Jiang
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Didier Blaise
- Transplantation and Cell Therapy Program, Leukemia Program, Centre de Recherche en Cancérologie de Marseille, Department of Hematology, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
- Didier Blaise,
| | - Jiong Hu
- Shanghai Institute of Hematology, Blood and Marrow Transplantation Center, Collaborative Innovation Center of Hematology, Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiong Hu,
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Gorin NC. How antithymocyte globulin, a polyclonal soup of the past century, when carefully dosed, has become crucial for hematopoietic stem cell transplantation with haplo-identical donors in the 21st century. Sci Bull (Beijing) 2021; 66:2445-2447. [PMID: 36654200 DOI: 10.1016/j.scib.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Norbert Claude Gorin
- Department of Hematology and Cell Therapy, Hopital Saint Antoine and Paris Sorbonne University, Paris 75012, France.
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10
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Zhang M, Xiao H, Shi J, Tan Y, Zhao Y, Yu J, Lai X, Hu Y, Zheng W, Luo Y, Huang H. Improved survival for young acute leukemia patients following a new donor hierarchy for allogeneic hematopoietic stem cell transplantation: A phase III randomized controlled study. Am J Hematol 2021; 96:1429-1440. [PMID: 34370319 DOI: 10.1002/ajh.26317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/22/2021] [Accepted: 08/03/2021] [Indexed: 11/11/2022]
Abstract
The aim of our study was to evaluate the most optimal donor for young acute leukemia (AL) patients with multiple donors available for allogeneic hematopoietic stem cell transplantation (allo-HSCT), including HLA-matched sibling donors (MSDs), HLA-matched unrelated donors (URDs), haploidentical parental donors (HPDs), and haploidentical sibling donors (HSDs). From March 2008 to December 2016, 430 AL patients ≤ 35 years of age were included in the discovery, retrospective study. Patients who received transplantation from a MSD or a HSD had better 5-year OS rates compared with patients who received transplantation from a URD or a HPD. A superior graft-versus-leukemia effect was observed for high-risk patients undergoing HSD-HSCT with a lower relapse rate (p = 0.014) and a higher disease-free survival (DFS) rate (p = 0.029) compared with those undergoing MSD-HSCT. Outcomes of high-risk patients receiving an URD or HPD were equivalent. For intermediate/standard-risk patients, either a MSD or HSD may be the front-line donor selection with comparable outcomes. HLA-matched unrelated donors were preferred over HPDs with reduced non-relapse mortality and higher overall survival (OS) and DFS rates. We further conducted an independent prospective randomized study to evaluate the survival advantage with the new donor hierarchy. Two hundred and fifty patients were randomly assigned to follow our new donor hierarchy or the traditional donor hierarchy at a 2:1 ratio. The new donor hierarchy contributed to significantly superior 2-year OS and DFS rates (OS: 76.2% vs. 67.8%, p = 0.046; DFS: 71.8% vs. 64.5%, p = 0.039).
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Affiliation(s)
- Mingming Zhang
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Haowen Xiao
- Institute of Hematology Zhejiang University Hangzhou China
- Department of Hematology Sir Run Run Shaw Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Jimin Shi
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Yamin Tan
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Yanmin Zhao
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Jian Yu
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Xiaoyu Lai
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Yongxian Hu
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Weiyan Zheng
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - Yi Luo
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
| | - He Huang
- Bone Marrow Transplantation Center The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
- Institute of Hematology Zhejiang University Hangzhou China
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11
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Pan W, Zhao X, Shi W, Jiang Z, Xiao H. Venetoclax induced complete remission in extramedullary relapse of AML co-harboring NPM1, TET2, and NRAS mutations after haploidentical hematopoietic stem cell transplantation. Leuk Lymphoma 2020; 61:2756-2759. [PMID: 33167720 DOI: 10.1080/10428194.2020.1779255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wenjue Pan
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, P R China
| | - Xiujie Zhao
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, P R China
| | - Wei Shi
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, P R China
| | - Zhinong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, P R China
| | - Haowen Xiao
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, P R China.,Institute of Hematology, Zhejiang University, Hangzhou, P R China
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12
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Bazarbachi A, Bug G, Baron F, Brissot E, Ciceri F, Dalle IA, Döhner H, Esteve J, Floisand Y, Giebel S, Gilleece M, Gorin NC, Jabbour E, Aljurf M, Kantarjian H, Kharfan-Dabaja M, Labopin M, Lanza F, Malard F, Peric Z, Prebet T, Ravandi F, Ruggeri A, Sanz J, Schmid C, Shouval R, Spyridonidis A, Versluis J, Vey N, Savani BN, Nagler A, Mohty M. Clinical practice recommendation on hematopoietic stem cell transplantation for acute myeloid leukemia patients with FLT3-internal tandem duplication: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica 2020; 105:1507-1516. [PMID: 32241850 PMCID: PMC7271578 DOI: 10.3324/haematol.2019.243410] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
The FMS-like tyrosine kinase 3 (FLT3) gene is mutated in 25-30% of patients with acute myeloid leukemia (AML). Because of the poor prognosis associated with FLT3-internal tandem duplication mutated AML, allogeneic hematopoietic stem-cell transplantation (SCT) was commonly performed in first complete remission. Remarkable progress has been made in frontline treatments with the incorporation of FLT3 inhibitors and the development of highly sensitive minimal/measurable residual disease assays. Similarly, recent progress in allogeneic hematopoietic SCT includes improvement of transplant techniques, the use of haploidentical donors in patients lacking an HLA matched donor, and the introduction of FLT3 inhibitors as post-transplant maintenance therapy. Nevertheless, current transplant strategies vary between centers and differ in terms of transplant indications based on the internal tandem duplication allelic ratio and concomitant nucleophos-min-1 mutation, as well as in terms of post-transplant maintenance/consolidation. This review generated by international leukemia or transplant experts, mostly from the European Society for Blood and Marrow Transplantation, attempts to develop a position statement on best approaches for allogeneic hematopoietic SCT for AML with FLT3-internal tandem duplication including indications for and modalities of such transplants and on the potential optimization of post-transplant maintenance with FLT inhibitors.
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Affiliation(s)
- Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Gesine Bug
- Department of Medicine 2, Hematology and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Eolia Brissot
- Sorbonne Universités, UPMC University of Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Hematology Department, AP-HP, Saint Antoine Hospital, Paris, France
| | - Fabio Ciceri
- Vita-Salute San Raffaele University of Milan, Milan, ItalyHematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iman Abou Dalle
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hartmut Döhner
- Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Jordi Esteve
- Hematology Department, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcellona, Spain
| | - Yngvar Floisand
- Department of Hematology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
- Center for Cancer Cell Reprogramming, Institute for Cancer Research, Oslo University Hospital, Montebello, Oslo, Norway
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Maria Gilleece
- Department of Haematology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Norbert-Claude Gorin
- Department of Hematology and Cell Therapy, European Society for Blood and Marrow Transplantation, Paris Office, Hopital Saint-Antoine, Paris, France
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mahmoud Aljurf
- Department of Hematology King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation and Cellular Therapies Program, Mayo Clinic, Jacksonville, FL, USA
| | - Myriam Labopin
- Acute Leukemia Working Party, Paris Study Office, European Society for Blood and Marrow Transplantation, Paris, France
- Sorbonne Universités, UPMC University of Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Hematology Department, AP-HP, Saint Antoine Hospital, Paris, France
| | | | - Florent Malard
- Sorbonne Universités, UPMC University of Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Hematology Department, AP-HP, Saint Antoine Hospital, Paris, France
| | - Zinaida Peric
- University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Thomas Prebet
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Annalisa Ruggeri
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Roma, ItalyEurocord, Hôpital Saint Louis, Paris, France
| | - Jaime Sanz
- Hematology Department, Hospital Universitari i Politecnic La Fe. Instituto de Investigación Sanitaria La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Christoph Schmid
- Department of Hematology and Oncology, Augsburg University Hospital, Augsburg, Germany
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jurjen Versluis
- Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Norbert Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Bipin N Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - Mohamad Mohty
- Sorbonne Universités, UPMC University of Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Hematology Department, AP-HP, Saint Antoine Hospital, Paris, France
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13
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Cytryn S, Abdul-Hay M. Haploidentical Hematopoietic Stem Cell Transplantation Followed by 'Post-Cyclophosphamide': The Future of Allogeneic Stem Cell Transplant. Clin Hematol Int 2020; 2:49-58. [PMID: 34595443 PMCID: PMC8432344 DOI: 10.2991/chi.d.200405.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/28/2020] [Indexed: 10/31/2022] Open
Abstract
Allogeneic hematopoietic cell transplant (Allo-HCT) is a potentially curative therapy for many malignant and nonmalignant hematological diseases. However, a suitable human leukocyte antigens (HLAs)-matched donor may not be available when the patient is in urgent need of a stem cell transplant. This challenge has been ameliorated to a large extent by the introduction of haploidentical donors. This type of donor shares one HLA haplotype with the recipient. Therefore, a patient's full sibling has a 50% chance of being haploidentical and a patient's biologic parents and children will all be haploidentical, thus providing an immediately accessible, motivated donor for almost every recipient. Haploidentical transplants previously incurred prohibitively poor outcomes, preventing their widespread use. However, several recent advances have dramatically improved the results, making them a more viable donor source. In this review, we discuss different types of donors used for Allo-HCT with a particular focus on the use of haploidentical donors and their future potential.
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Affiliation(s)
- Samuel Cytryn
- New York University School of Medicine and Department of Medicine, New York, NY, USA
| | - Maher Abdul-Hay
- New York University School of Medicine and Department of Medicine, New York, NY, USA
- Department of Hematology and Medical Oncology, New York University Perlmutter Cancer Center, New York, NY, USA
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14
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Du Y, Zhang MJ, Li LL, Xu XL, Chen H, Feng YB, Li Y, Peng XQ, Chen FH. ATPR triggers acute myeloid leukaemia cells differentiation and cycle arrest via the RARα/LDHB/ERK-glycolysis signalling axis. J Cell Mol Med 2020; 24:6952-6965. [PMID: 32391634 PMCID: PMC7299716 DOI: 10.1111/jcmm.15353] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
Acute myeloid leukaemia (AML) remains a therapeutic challenge and improvements in chemotherapy are needed. 4‐Amino‐2‐trifluoromethyl‐phenyl retinate (ATPR), a novel all‐trans retinoic acid (ATRA) derivative designed and synthesized by our team, has been proven to show superior anticancer effect compared with ATRA on various cancers. However, its potential effect on AML remains largely unknown. Lactate dehydrogenase B (LDHB) is the key glycolytic enzyme that catalyses the interconversion between pyruvate and lactate. Currently, little is known about the role of LDHB in AML. In this study, we found that ATPR showed antileukaemic effects with RARα dependent in AML cells. LDHB was aberrantly overexpressed in human AML peripheral blood mononuclear cell (PBMC) and AML cell lines. A lentiviral vector expressing LDHB‐targeting shRNA was constructed to generate a stable AML cells with low expression of LDHB. The effect of LDHB knockdown on differentiation and cycle arrest of AML cells was assessed in vitro and vivo, including involvement of Raf/MEK/ERK signalling. Finally, these data suggested that ATPR showed antileukaemic effects by RARα/LDHB/ ERK‐glycolysis signalling axis. Further studies should focus on the underlying leukaemia‐promoting mechanisms and investigate LDHB as a therapeutic target.
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Affiliation(s)
- Yan Du
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Mei-Ju Zhang
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Lan-Lan Li
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Xiao-Lin Xu
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Hao Chen
- Department of Pharmacy, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu-Bin Feng
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Yan Li
- Department of Pharmacy, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Qin Peng
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
| | - Fei-Hu Chen
- School of Pharmacy, Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei, China.,Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei, China
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