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Weissinger EM, Borchers S, Silvani A, Provasi E, Radrizzani M, Beckmann IK, Benati C, Schmidtke J, Kuehnau W, Schweier P, Luther S, Fernandez-Munoz I, Beutel G, Ciceri F, Bonini C, Ganser A, Hertenstein B, Stadler M. Long term follow up of patients after allogeneic stem cell transplantation and transfusion of HSV-TK transduced T-cells. Front Pharmacol 2015; 6:76. [PMID: 25954199 PMCID: PMC4407574 DOI: 10.3389/fphar.2015.00076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/24/2015] [Indexed: 11/13/2022] Open
Abstract
Allogeneic stem cell transplantation (allo-HSCT) is one of the curative treatments for hematologic malignancies, but is hampered by severe complications, such as acute or chronic graft-versus-host-disease (aGvHD; cGvHD) and infections. CD34-selection of stem cells reduces the risk of aGvHD, but also leads to increased infectious complications and relapse. Thus, we studied the safety, efficacy, and feasibility of transfer of gene modified donor T-cells shortly after allo-HSCT in two clinical trials between 2002 and 2007 and here we compare the results to unmodified donor leukocyte infusion (DLI). The aim of these trials was to provide patients with the protection of T-cells after T-cell-depleted allo-HSCT in the matched or mismatched donor setting with an option to delete transduced T-cells, if severe aGvHD occurred within the trial period. Donor-T-cells were transduced with the replication-deficient retrovirus SFCMM-3, expressing HSV-TK and the truncated ΔLNGFR for selection of transduced cells. Transduced cells were transfused either after day +60 (matched donors) or on day +42 (haploidentical donors). Nine patients were included in the first trial (MHH; 2002 until 2007), two were included in TK007 (2005–2009) and six serves as a control group for outcome after haploidentical transplantation without HSV-TK-transduced DLI. Three patients developed acute GvHD, two had grade I of the skin, one had aGvHD on day +131 (post-HSCT; +89 post-HSV-TK DLI) grade II, which was successfully controlled by ganciclovir (GCV). Donor chimerism was stabilized after transfusion of the transduced cells in all patients treated. Functionality of HSV-TK gene expressing T-cells was shown by loss of bcr-able gene expression as well as by control of cytomegalovirus-reactivation. To date, six patients have relapsed and died, two after a second hematopoietic stem cell transplantation without T-cell depletion or administration of unmodified T-cells. Eleven patients (seven post-HSV-TK DLI) are alive and well to date.
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Affiliation(s)
- Eva M Weissinger
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | - Sylvia Borchers
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | | | - Elena Provasi
- Cancer Immunotherapy and Gene Therapy Program, San Raffaele Hospital Milano, Italy
| | | | - Irene K Beckmann
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | | | - Joerg Schmidtke
- Institute of Human Genetics, Hannover Medical School Hannover, Germany
| | - Wolfgang Kuehnau
- Institute of Human Genetics, Hannover Medical School Hannover, Germany
| | - Patrick Schweier
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | - Susanne Luther
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | - Ivonne Fernandez-Munoz
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | - Gernot Beutel
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | - Fabio Ciceri
- Cancer Immunotherapy and Gene Therapy Program, San Raffaele Hospital Milano, Italy
| | - Chiara Bonini
- Cancer Immunotherapy and Gene Therapy Program, San Raffaele Hospital Milano, Italy
| | - Arnold Ganser
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
| | - Bernd Hertenstein
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany ; Department of Hematology/Oncology, Klinikum Bremen-Mitte Bremen, Germany
| | - Michael Stadler
- Laboratory for Transplantation Biology, Department of Hematology/Hemostasis/Oncology/Stem Cell Transplantation, Hannover Medical School Hannover, Germany
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Muscaritoli M, Conversano L, Torelli GF, Arcese W, Capria S, Cangiano C, Falcone C, Rossi Fanelli F. Clinical and metabolic effects of different parenteral nutrition regimens in patients undergoing allogeneic bone marrow transplantation. Transplantation 1998; 66:610-6. [PMID: 9753341 DOI: 10.1097/00007890-199809150-00011] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nutrients may interfere with physiological and pathophysiologic mechanisms. The present study was aimed at evaluating whether the differences in the quality of energy substrates administered with total parenteral nutrition (TPN) after cytoreductive therapy may influence the clinical outcome of patients undergoing bone marrow transplantation (BMT). METHODS Sixty-six consecutive allogeneic BMT patients with hematologic malignancies were randomized to receive either a glucose-based (100% glucose) or a lipid-based (80% lipid, using an omega-6 long-chain triacylglycerol emulsion + 20% glucose) TPN, providing 146.3 kJ/kg body weight, 1.4 g of protein/kg of body weight, administered from day +1 to day +15 after BMT. Time to engraftment (EGT), incidence of sepsis and metabolic complications (hyperglycemia and hypertriglyceridemia), incidence of acute graft-versus-host-disease (A-GVHD) and relapse, survival at 18 months, incidence of deaths for A-GVHD and relapse were evaluated. RESULTS Six patients dropped out before completing the study period. Thirty-one patients in the glucose-based TPN group and 29 patients in the lipid-based TPN group were evaluated. The incidence of hyperglycemia was significantly lower in the lipid-based TPN group than in the glucose-based TPN group (3.4% vs. 32%, respectively; P=0.004). Five patients in the glucose group and none in the lipid group died for A-GVHD (P<0.05). Survival at 18 months tended to be higher in the lipid group than in the glucose group (62% vs. 42%, P=NS). Rate of bone-marrow EGT, time to EGT, incidence of sepsis and fungal infections during TPN, incidence of A-GVHD, and rate of relapse at 18 months were not different in the two groups. CONCLUSIONS The results obtained suggest that the use of lipid-based TPN after allogeneic BMT is associated with lower incidence of lethal A-GVHD and hyperglycemia, without negatively affecting the EGT of infused cells. Intravenously administered lipids might have influenced the severity of A-GVHD likely via modulation of immune response and synthesis of cytokines, prostaglandins, and leukotrienes that participate in the pathogenesis of graft-versus-host disease.
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Affiliation(s)
- M Muscaritoli
- Department of Clinical Medicine, University La Sapienza, Rome, Italy
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