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Kent A, Gil KB, Jones MK, Linden B, Purev E, Haverkos B, Schwartz M, McMahon C, Amaya M, Smith CA, Bosma G, Abbott D, Rabinovitch R, Milgrom SA, Pollyea DA, Gutman JA. Outcomes of Haplo-Cord Versus Dual Cord Transplants: A Single-Center Retrospective Analysis. Transplant Cell Ther 2024:S2666-6367(24)00552-9. [PMID: 39154914 DOI: 10.1016/j.jtct.2024.07.021] [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: 03/27/2024] [Revised: 07/07/2024] [Accepted: 07/27/2024] [Indexed: 08/20/2024]
Abstract
Despite the concurrent use of haploidentical cord (HCT) and dual cord (DCT) stem cell transplant approaches for over a decade, there have been few comparisons of their outcomes. Our objective in this study is to assess for differences in the outcomes and adverse effects associated with HCTs versus DCTs. Here we report a retrospective analysis of HCTs and DCTs at our institution. From October 2012 to October 2022, 70 HCT and 133 DCT transplants were performed following 50 mg/kg of IV cyclophosphamide, 150 mg/m2 of IV fludarabine, 10 mg/kg of IV thiotepa, and 4 Gy total body irradiation conditioning. With a median follow-up of 3.6 years among survivors, there was no difference in overall survival (OS) (3 years OS 65% DCT versus 63% HCT, P = 1) or relapse-free survival (3 years RFS 62% DCT versus 64% HCT, P = .97) for all patients. Time to neutrophil recovery was faster in HCT recipients (median 17 versus 22 days, P = .021), with no difference in platelet recovery to 20,000/μL (P = .12). Median hospitalization for HCT recipients was 20 days versus 24 days for DCT recipients (P < .0001). Engraftment syndrome treated with steroids occurred in 47/133 (35%) DCT recipients versus 42/70 (60%) HCT recipients (odds ratios 0.37, P value=.001). There was a significant increase in grade 3 to 4 acute graft-versus-host disease (aGVHD) in haplo-cord recipients (P = .007), but no difference in grade 2 to 4 aGVHD (P = .11), all chronic GVHD (cGVHD) (P = .9), or moderate-severe cGVHD (P = .3). Our outcomes demonstrate faster engraftment and shorter hospitalization in HCTs relative to DCTs, but more engraftment syndrome and higher grade 3 to 4 aGVHD. When both are options, these factors should guide the choice between HCTs and DCTs.
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Affiliation(s)
- Andrew Kent
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Kellen B Gil
- Department of Internal Medicine, The University of Colorado School of Medicine, Aurora, Colorado
| | - Michael K Jones
- Department of Internal Medicine, The University of Colorado School of Medicine, Aurora, Colorado
| | - Brooke Linden
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Enkhee Purev
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Bradley Haverkos
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Marc Schwartz
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Christine McMahon
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Maria Amaya
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Clayton A Smith
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Grace Bosma
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Diana Abbott
- Department of Biostatistics and Informatics, The University of Colorado, Center for Innovative Design and Analysis, Aurora, Colorado
| | - Rachel Rabinovitch
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah A Milgrom
- Department of Radiation Oncology, The University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel A Pollyea
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado
| | - Jonathan A Gutman
- The University of Colorado School of Medicine, Division of Hematology, Aurora, Colorado.
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Tian Z, Man Q, Yang Y, Zhang X, Guan H, Gu W, Wang Y, Song D, Luo R, Wang J. Successful Treatment of Severe Steroid-Resistant Engraftment Syndrome Following Haploidentical Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia with Emapalumab: A Case Report. Cancer Manag Res 2024; 16:585-591. [PMID: 38855328 PMCID: PMC11162225 DOI: 10.2147/cmar.s458577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/12/2024] [Indexed: 06/11/2024] Open
Abstract
Engraftment syndrome (ES) is an early complication of hematopoietic stem cell transplantation (HSCT) characterized by fever and additional clinical manifestations including rash, diarrhea, lung infiltrates, weight gain, and neurological symptoms. Steroid-resistant ES following HSCT significantly affects the efficacy of transplantation and may even result in patient mortality. As ES essentially represents a cytokine storm induced by engrafted donor cells with interferon-gamma (IFN-γ) playing a central role, we hypothesized that emapalumab (an anti-IFN-γ monoclonal antibody) may be an effective approach to treat steroid-resistant ES. Here, we present a case report of a 14-year-old female patient who received a second haploidentical HSCT due to a relapse of acute myeloid leukemia. Nine days after the transplantation, the patient developed a fever and exhibited a poor response to antimicrobials (ceftazidime/avibactam). A few days later, the patient presented with a new-onset rash, weight gain, and impaired liver function, leading to a diagnosis of ES. Initial immunosuppressive (tacrolimus and mycophenolate mofetil) treatment failed to control the disease. On day 16 post-transplantation, the patient received two infusions of 50 mg of emapalumab. Following the initiation of emapalumab treatment, the patient's fever returned to normal and ES was effectively controlled. This case report demonstrated that emapalumab had a possible efficacy for steroid-resistant ES and provided a novel therapeutic strategy to treat this clinical complication.
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Affiliation(s)
- Zhengqin Tian
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Qihang Man
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Yixin Yang
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Xiaomei Zhang
- Department of Hematology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, People’s Republic of China
| | - Hexian Guan
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Wenjing Gu
- Department of Hematology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, People’s Republic of China
| | - Ying Wang
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
| | - Dandan Song
- Department of Hematology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, People’s Republic of China
| | - Rongmu Luo
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
- Department of Hematology, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, People’s Republic of China
| | - Jingbo Wang
- Department of Hematology, Aerospace Center Hospital, Beijing, People’s Republic of China
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Little CJ, Kim SC, Fechner JH, Post J, Coonen J, Chlebeck P, Winslow M, Kobuzi D, Strober S, Kaufman DB. Early allogeneic immune modulation after establishment of donor hematopoietic cell-induced mixed chimerism in a nonhuman primate kidney transplant model. Front Immunol 2024; 15:1343616. [PMID: 38318170 PMCID: PMC10839019 DOI: 10.3389/fimmu.2024.1343616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background Mixed lymphohematopoietic chimerism is a proven strategy for achieving operational transplant tolerance, though the underlying immunologic mechanisms are incompletely understood. Methods A post-transplant, non-myeloablative, tomotherapy-based total lymphoid (TLI) irradiation protocol combined with anti-thymocyte globulin and T cell co-stimulatory blockade (belatacept) induction was applied to a 3-5 MHC antigen mismatched rhesus macaque kidney and hematopoietic cell transplant model. Mechanistic investigations of early (60 days post-transplant) allogeneic immune modulation induced by mixed chimerism were conducted. Results Chimeric animals demonstrated expansion of circulating and graft-infiltrating CD4+CD25+Foxp3+ regulatory T cells (Tregs), as well as increased differentiation of allo-protective CD8+ T cell phenotypes compared to naïve and non-chimeric animals. In vitro mixed lymphocyte reaction (MLR) responses and donor-specific antibody production were suppressed in animals with mixed chimerism. PD-1 upregulation was observed among CD8+ T effector memory (CD28-CD95+) subsets in chimeric hosts only. PD-1 blockade in donor-specific functional assays augmented MLR and cytotoxic responses and was associated with increased intracellular granzyme B and extracellular IFN-γ production. Conclusions These studies demonstrated that donor immune cell engraftment was associated with early immunomodulation via mechanisms of homeostatic expansion of Tregs and early PD-1 upregulation among CD8+ T effector memory cells. These responses may contribute to TLI-based mixed chimerism-induced allogenic tolerance.
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Affiliation(s)
- Christopher J. Little
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, United States
| | - Steven C. Kim
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - John H. Fechner
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Jen Post
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Jennifer Coonen
- Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI, United States
| | - Peter Chlebeck
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Max Winslow
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Dennis Kobuzi
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
| | - Samuel Strober
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Dixon B. Kaufman
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States
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Ji Q, Zhang Y, Hu Y, Liu L, Cao S, Gao L, Li B, Tian Y, Kong L, Wu S, Ling J, Xiao P, Lu J, Li J, Yao Y, Qin J, Hu S. The influence of methotrexate-related transporter and metabolizing enzyme gene polymorphisms on peri-engraftment syndrome and graft-versus-host disease after haplo-hematopoietic stem cell transplantation in pediatric patients with malignant hematological diseases. Front Immunol 2023; 14:1229266. [PMID: 37731501 PMCID: PMC10507719 DOI: 10.3389/fimmu.2023.1229266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Background Methotrexate (MTX), utilized as a graft-versus-host disease (GvHD) prophylactic agent in allogeneic hematopoietic stem cell transplantation (allo-HSCT), has been proven to effectively decrease the occurrence of the peri-engraftment syndrome (Peri-ES) and acute GvHD (aGvHD). Changes in the pharmacodynamics of MTX are closely associated with gene polymorphisms in genes encoding drug-metabolizing enzymes and transporters. Nevertheless, the current studies mainly concentrate on leukemia or autoimmune diseases, and limited studies on allo-HSCT were reported. Methods Here, we retrospectively assessed the relationship between MTX-related transporter and metabolizing enzyme gene polymorphisms, clinical characteristics, and outcomes in 57 pediatric patients who received haploid HSCT (haplo-HSCT) with malignant tumors at a single center. Results We discovered all gene polymorphisms were in the Hardy-Weinberg equilibrium in our cohort. We discovered a significant correlation between platelet recovery time and ABCB1 (1236C>T) (p = 0.042). Compared with patients with SLCO1B1 (1865+4846T>C) TT, patients with SLCO1B1 (1865+4846T>C) TC/CC had an increased incidence of Peri-ES (p = 0.030). Based on the multivariate Cox analysis, we discovered that SLCO1B1 (1865+4846T>C) TT genotype was an independent protective factor for Peri-ES morbidity (hazard ratio (HR) = 0.464, p = 0.031), and the dose of mononuclear cells reinfused was significantly correlated with II-IV aGvHD (HR = 2.604, p = 0.039). Conclusion In summary, our findings prove that the host's genotypes might modify the risk of developing Peri-ES, contribute to a better understanding of the inter-individual difference in efficacy, and facilitate the development of individualized approaches to GvHD prophylaxis.
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Affiliation(s)
- Qi Ji
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Yongping Zhang
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Yixin Hu
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Lixia Liu
- Department of Medical Affairs, Acornmed Biotechnology Co., Ltd., Tianjin, China
| | - Shanbo Cao
- Department of Medical Affairs, Acornmed Biotechnology Co., Ltd., Tianjin, China
| | - Li Gao
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Bohan Li
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Tian
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Lingjun Kong
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Shuiyan Wu
- Pediatric Intensive Care Unit, Children’s Hospital of Soochow University, Suzhou, China
| | - Jing Ling
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Peifang Xiao
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Jun Lu
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Jie Li
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Yanhua Yao
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
| | - Jiayue Qin
- Department of Medical Affairs, Acornmed Biotechnology Co., Ltd., Tianjin, China
| | - Shaoyan Hu
- Department of Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, China
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