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Epperly R, Li Y, Selukar S, Zeng E, Madden R, Mamcarz E, Naik S, Qudeimat A, Sharma A, Talleur A, Dallas MH, Gottschalk S, Srinivasan A, Triplett B. Disease Status and Interval between Hematopoietic Cell Transplantations Predict Outcome of Pediatric Patients Who Undergo Subsequent Transplantation for Relapsed Hematologic Malignancy. Transplant Cell Ther 2024; 30:526.e1-526.e11. [PMID: 38387720 PMCID: PMC11056306 DOI: 10.1016/j.jtct.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Patients with hematologic malignancies who relapse after allogeneic hematopoietic cell transplantation (HCT) have a poor prognosis. Although proceeding to subsequent HCT can provide potential for long-term survival, there are limited data to guide which patients are most likely to benefit and which HCT strategies are best in this heavily pretreated population. The goals of this study were to describe the clinical outcomes of subsequent HCT in pediatric patients with relapsed hematologic malignancies in a cohort enriched for haploidentical donors, and to evaluate the associations of patient-, disease-, and treatment-related factors with survival. We retrospectively evaluated patients who underwent a subsequent HCT for management of post-HCT relapse at a single institution between 2000 and 2021. Among 106 patients who underwent a second allogeneic HCT, the 1-year event-free survival (EFS) was 34% and 1-year overall survival (OS) was 46%, with a 5-year EFS of 26% and 5-year OS of 31%. Only disease-related factors were associated with outcome after second HCT-specifically, the interval between HCTs and the presence or absence of active disease at the time of HCT. In this cohort, patient- and treatment-related factors were not associated with differences in EFS or OS. Patients undergoing a third or fourth HCT (n = 13) had comparable survival outcomes to those undergoing a second HCT. Our experience highlights that a subsequent HCT has curative potential for a subset of patients who relapse after HCT, including those who undergo a subsequent HCT from a haploidentical donor. Although relapse and treatment-related toxicities remain major challenges, our study indicates that achieving complete remission prior to subsequent HCTs has the potential to further improve outcomes.
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Affiliation(s)
- Rebecca Epperly
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ying Li
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Subodh Selukar
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Emily Zeng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Renee Madden
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ewelina Mamcarz
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Swati Naik
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amr Qudeimat
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Aimee Talleur
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Mari H Dallas
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Stephen Gottschalk
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ashok Srinivasan
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brandon Triplett
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee.
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2
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Kobayashi S, Sano H, Mochizuki K, Ohara Y, Takahashi N, Kudo S, Ikeda K, Ohto H, Kikuta A. Effects of second transplantation with T-cell-replete haploidentical graft using low-dose anti-thymocyte globulin on long-term overall survival in pediatric patients with relapse of leukemia after first allogeneic transplantation. Int J Hematol 2021; 115:414-423. [PMID: 34822127 DOI: 10.1007/s12185-021-03266-9] [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: 09/06/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the preferred treatment for children with high-risk hematologic malignancies, but post-allo-HSCT relapse has a poor prognosis and limited treatment options. We evaluated the feasibility, outcome, and risk factors influencing survival after T-cell-replete haploidentical HSCT with low-dose anti-thymocyte globulin (ATG) in 30 patients with post-allo-HSCT relapse of acute lymphoblastic leukemia and acute myeloid leukemia. Overall, 50% of the patients had complete remission (CR) before the second transplant and the overall survival (OS) rate was 52%. In surviving patients (median follow-up 614 days), Kaplan-Meier analysis revealed estimated 2-year leukemia-free survival and OS rates of 48.1% and 61.1%, respectively. Cumulative incidences of 2-year non-relapse mortality and relapse were 24.7% and 36.3%, respectively. Achieving CR before the second allo-HSCT was a predominant independent prognostic factor identified in the multivariate analysis, with a significantly improved 2-year OS rate of 86.7%. T-cell-replete haplo-HSCT with low-dose ATG for second allo-HSCT may benefit a selected patient population.
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Affiliation(s)
- Shogo Kobayashi
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Hideki Sano
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Kazuhiro Mochizuki
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Yoshihiro Ohara
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Nobuhisa Takahashi
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Shingo Kudo
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan
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3
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Hazar V, Karasu GT, Uygun V, Özbek N, Karakükçü M, Öztürk G, Daloğlu H, Kılıç SÇ, Aksu T, Ünal E, Koçak Ü, Yeşilipek A, Akçay A, Gürsel O, Küpesiz A, Okur FV, İleri T, Kansoy S, Bayram İ, Karagün BŞ, Gökçe M, Kaya Z, Ok Bozkaya İ, Patıroğlu T, Aksoylar S. Role of a second transplantation for children with acute leukemia following posttransplantation relapse: a study by the Turkish Bone Marrow Transplantation Study Group. Leuk Lymphoma 2020; 61:1465-1474. [PMID: 32037917 DOI: 10.1080/10428194.2020.1716220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined outcomes of 51 pediatric patients with relapsed acute leukemia (AL) who underwent a second allogeneic hematopoietic stem cell transplantation (alloHSCT). After a median follow-up of 941 days (range, 69-2842 days), leukemia-free survival (LFS) and overall survival (OS) at 3 years were 26.6% and 25.6%, respectively. The nonrelapse mortality rate (NMR) and cumulative incidence of relapse (CIR) were 36.4% and 42.4%, respectively. The Cox regression analysis demonstrated that the risk factors at second transplantation for predicting limited LFS were active disease (hazard ratio (HR) = 5.1), reduced intensity conditioning (RIC) (HR = 5.0), matched unrelated donor (MUD) (HR = 3.4) and performance score <80 (HR = 3.2). Pediatric patients with AL who relapsed after their first alloHSCT may survive with a second alloHSCT. Disease status, conditioning intensity, donor type, and performance score at the second transplantation are the relevant risk factors. A score based on these factors may predict the results of the second transplantation.
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Affiliation(s)
- Volkan Hazar
- Pediatric BMT Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | | | - Vedat Uygun
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Namık Özbek
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Musa Karakükçü
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gülyüz Öztürk
- Pediatric BMT Unit, Acıbadem University Faculty of Medicine, Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Hayriye Daloğlu
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Suar Çakı Kılıç
- Pediatric BMT Unit, Medical Park Göztepe Hospital, Istanbul, Turkey
| | - Tekin Aksu
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ekrem Ünal
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ülker Koçak
- Pediatric BMT Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Akif Yeşilipek
- Pediatric BMT Unit, Medical Park Antalya Hospital, Antalya, Turkey
| | - Arzu Akçay
- Pediatric BMT Unit, Acıbadem University Faculty of Medicine, Acıbadem Atakent Hospital, Istanbul, Turkey
| | - Orhan Gürsel
- Pediatric BMT Unit, University of Health Sciences Faculty of Medicine, Ankara GATA Hospital, Ankara, Turkey
| | - Alphan Küpesiz
- Pediatric BMT Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Fatma Visal Okur
- Pediatric BMT Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Talia İleri
- Pediatric BMT Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Savaş Kansoy
- Pediatric BMT Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - İbrahim Bayram
- Pediatric BMT Unit, Çukurova University Faculty of Medicine, Adana, Turkey
| | | | - Müge Gökçe
- Pediatric BMT Unit, Yüzüncü Yıl University Faculty of Medicine, GOP Hospital, Istanbul, Turkey
| | - Zühre Kaya
- Pediatric BMT Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Pediatric BMT Unit, Ankara Dışkapı Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Türkan Patıroğlu
- Pediatric BMT Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Serap Aksoylar
- Pediatric BMT Unit, Ege University Faculty of Medicine, Izmir, Turkey
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Yaniv I, Krauss AC, Beohou E, Dalissier A, Corbacioglu S, Zecca M, Afanasyev BV, Berger M, Diaz MA, Kalwak K, Sedlacek P, Varotto S, Peters C, Bader P. Second Hematopoietic Stem Cell Transplantation for Post-Transplantation Relapsed Acute Leukemia in Children: A Retrospective EBMT-PDWP Study. Biol Blood Marrow Transplant 2018; 24:1629-1642. [PMID: 29548831 DOI: 10.1016/j.bbmt.2018.03.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/06/2018] [Indexed: 02/05/2023]
Abstract
Outcome data were collected from the European Society for Blood and Marrow Transplantation registry on 373 children from 120 centers with relapsed leukemia (214 with acute lymphoblastic leukemia [ALL] and 159 with acute myelogenous leukemia [AML]) who underwent second allogeneic hematopoietic stem cell transplantation (HSCT) between 2004 and 2013. Overall survival (OS) was 38% at 2 years and 29% at 5 years, and leukemia-free survival (LFS) was 30% at 2 years and 25% at 5 years. Median follow-up after second HSCT was 36.4 months in the ALL group and 50.2 months in the AML group. In the ALL group, OS was 43% at 2 years and 33% at 5 years, and LFS was 34% at 2 years and 31% at 5 years. In the AML group, OS was 32% at 2 years and 24% at 5 years, and LFS was 24% at 2 years and 17% at 5 years. The 2-year nonrelapse mortality (NRM) rate was 22% in the ALL group and 18% in the AML group. Favorable prognostic factors (P < .05) for OS and LFS included >12 months between transplantations and chronic graft-versus-host disease after the first HSCT (in both groups), complete response before the second HSCT (ALL group only), and age >12 years (AML group only). Findings were more consistent over time in the ALL group, with no significant differences between 2-year and 5-year rates of relapse, NRM, and LFS. Children with relapsed acute leukemias have a substantial likelihood of long-term survival following second HSCT. Given the many novel targeted and immunomodulation therapies currently under development, it is important to identify specific patient subpopulations that may benefit from a second HSCT compared with those better suited to new approaches.
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Affiliation(s)
- Isaac Yaniv
- Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviva C Krauss
- Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Eric Beohou
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Arnaud Dalissier
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Selim Corbacioglu
- Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Marco Zecca
- Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Boris V Afanasyev
- Hematology and Transplantation Department, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Massimo Berger
- Pediatric Onco-Hematology, Regina Margherita Children Hospital, Torino, Italy
| | - Miguel Angel Diaz
- Division of Hematopoietic Stem Cell Transplantation, "Nino Jesus" Children Hospital, Madrid, Spain
| | - Krzysztof Kalwak
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Cape of Hope Wroclaw Medical University, Wroclaw, Poland
| | - Petr Sedlacek
- Pediatric Hematology-Oncology, University Hospital Motol, Prague, Czech Republic
| | - Stefania Varotto
- Oncoematologia Pediatrica, Azienda Ospedaliera-Universita, Padova, Italy
| | - Christina Peters
- AustriaStem Cell Transplantation Unit, St. Anna Children's Hospital, Vienna, Austria
| | - Peter Bader
- Department for Children and Adolescents; Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt, Germany
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5
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Taga T, Murakami Y, Tabuchi K, Adachi S, Tomizawa D, Kojima Y, Kato K, Koike K, Koh K, Kajiwara R, Hamamoto K, Yabe H, Kawa K, Atsuta Y, Kudo K. Role of Second Transplantation for Children With Acute Myeloid Leukemia Following Posttransplantation Relapse. Pediatr Blood Cancer 2016; 63:701-5. [PMID: 26670954 DOI: 10.1002/pbc.25866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/16/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND In children with acute myeloid leukemia (AML), hematopoietic stem cell transplantation (HSCT) in first remission is indicated for patients with a relatively high risk of relapse. Second HSCT is a curative option; however, few reports have been published about a second HSCT in children for AML with posttransplantation relapse. PROCEDURE Using the database provided by the Japanese Society of Hematopoietic Cell Transplantation, we analyzed 46 children with AML who underwent a second allogeneic HSCT after achieving a second remission. RESULTS The median duration from the first to second HSCT was 20 months, and the source of the second HSCT was related bone marrow (BM) in 22, related peripheral blood in 6, unrelated BM in 14, and unrelated cord blood in 4 patients. Twenty-five children eventually died of the following causes: progressive disease in 14 and transplant-related toxicities in 9. The 5-year overall survival rate was 41.7 ± 7.7%. An interval of less than 24 months between the first and second HSCT was a significant poor prognostic factor. CONCLUSIONS Children with AML who experience a relapse after HSCT in first remission have a good chance of survival with a second HSCT if a second remission is achieved.
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Affiliation(s)
- Takashi Taga
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | | | - Ken Tabuchi
- Division of Pediatrics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Souichi Adachi
- Department of Human Health Science, Kyoto University, Kyoto, Japan
| | - Daisuke Tomizawa
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuko Kojima
- Department of Pediatrics, Toho University Omori Hospital, Tokyo, Japan
| | - Koji Kato
- Department of Pediatric Hematology/Oncology, Nagoya First Red Cross Hospital, Nagoya, Japan
| | - Kazutoshi Koike
- Department of Hematology/Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryosuke Kajiwara
- Department of Pediatrics, Yokohama City University, Yokohama, Japan
| | - Kazuko Hamamoto
- Department of Pediatrics, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Keisei Kawa
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Yoshiko Atsuta
- Department of Healthcare Administration, Nagoya University, Nagoya, Japan.,Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University, Nagoya, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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6
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Factors associated with improved outcomes after second allogeneic hematopoietic cell transplantation for relapsed pediatric leukemia. Ann Hematol 2016; 95:637-44. [PMID: 26787415 DOI: 10.1007/s00277-016-2599-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
Abstract
A second allogeneic (allo) hematopoietic cell transplant (HCT) is an important therapeutic consideration for patients relapsing after their first. We conducted a retrospective review of 41 pediatric patients with leukemia that underwent a second allo-HCT at our institution. Overall, 53.7 and 43.9 % of patients were alive and disease-free at 1 and 5 years, respectively, after the second allo-HCT. The factors affecting outcome by both univariate and multivariate analysis were interval between transplants and the use of a myeloablative conditioning (MAC) regimen prior to second transplant. Outcomes were inferior in patients who received their second transplant <6 months from their first HCT when compared to patients in whom the interval between HCTs was 6-12 or more than 12 months. Interval between HCTs was also significant when each type of leukemia (acute lymphoblastic leukemia (ALL) n = 21, acute myelogenous leukemia (AML) n = 11, and chronic myelogenous leukemia (CML) n = 7) was analyzed separately. In univariate analysis, use of the same donor and use of a matched sibling donor resulted in significant improved outcome. There was not a significant association between disease-free survival (DFS) and age, remission status, use of total body irradiation (TBI) before second HCT, or type of leukemia. Second allogeneic HCT can be a curative therapeutic option for leukemia patients relapsing after their first transplant. As more targeted therapies have become available, patients that relapse after first HCT are more likely to achieve remission. Therefore, it is anticipated that there will be more candidates for second HCT with improved performance and remission status, ultimately leading to a better outcome with the second HCT.
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7
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Niederwieser C, Starke S, Fischer L, Krahl R, Beck J, Gruhn B, Ebell W, Körholz D, Wößmann W, Bader P, Lang P, Al-Ali HK, Cross M, Eisfeld AK, Heyn S, Vucinic V, Franke GN, Lange T, Pönisch W, Behre G, Christiansen H. Favorable outcome in children and adolescents with a high proportion of advanced phase disease using single/multiple autologous or matched/mismatched allogeneic stem cell transplantations. Ann Hematol 2015; 95:473-81. [DOI: 10.1007/s00277-015-2569-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
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Konuma T, Kato S, Ooi J, Ebihara Y, Mochizuki S, Ishii H, Takei T, Oiwa-Monna M, Tojo A, Takahashi S. Second allogeneic transplantation using unrelated cord blood for relapsed hematological malignancies after allogeneic transplantation. Leuk Lymphoma 2015; 57:103-9. [PMID: 25926066 DOI: 10.3109/10428194.2015.1045900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The efficacy of second allogeneic stem cell transplantation (SCT2) using cord blood (CB) for patients with relapsed hematological malignancies after initial allogeneic stem cell transplantation (SCT1) is unknown. We analyzed the results of SCT2 using single-unit unrelated CB in 34 adult patients with relapsed hematological malignancies after SCT1 in our institution. The patients had acute myeloid leukemia (n = 23), acute lymphoblastic leukemia (n = 7), chronic myelogenous leukemia (n = 2), and myelodysplastic syndrome (n = 2). The cumulative incidence of neutrophil and platelet engraftment was 81.6% at 30 days and 68.5% at 100 days, respectively. With a median follow-up of 40 months, the probability of overall survival at 3 years was 29.0%. The cumulative incidence of relapse and transplant-related mortality at 3 years were 60.7% and 27.2%, respectively. The use of CB could offer the opportunity to receive SCT2 for patients who experienced disease relapse after SCT1 without HLA-identical related or unrelated donors.
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Affiliation(s)
- Takaaki Konuma
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Seiko Kato
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Jun Ooi
- b Department of Hematology/Oncology , Teikyo University School of Medicine , Tokyo , Japan
| | - Yasuhiro Ebihara
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Shinji Mochizuki
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Hiroto Ishii
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Tomomi Takei
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Maki Oiwa-Monna
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Arinobu Tojo
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Satoshi Takahashi
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
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9
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Konuma T, Kato S, Ooi J, Ebihara Y, Mochizuki S, Oiwa-Monna M, Tojo A, Takahashi S. Third allogeneic stem cell transplantation (SCT) using unrelated cord blood for relapsed acute leukemia after second allogeneic SCT. Int J Hematol 2015; 101:392-7. [DOI: 10.1007/s12185-015-1755-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/30/2022]
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10
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Abstract
β-thalassemia is an inherited disorder due to mutations found in the β-globin gene, leading to anemia and requiring sporadic or chronic blood transfusions for survival. Without proper chelation, β-thalassemia results in iron overload. Ineffective erythropoiesis can lead to iron overload even in untransfused patients who are affected by β-thalassemia intermedia. Better understanding of the molecular biologic aspects of this disorder has led to improvements in population screening and prenatal diagnosis, which, in turn, have led to dramatic reductions in the number of children born with β-thalassemia major in the Mediterranean littoral. However, as a consequence of decreases in neonatal and childhood mortality in other geographical areas, β-thalassemia has become a worldwide clinical problem. A number of unsolved pathophysiological issues remain, such as ineffective erythropoieis, abnormal iron absorption, oxidative stress, splenomegaly and thrombosis. In the last few years, novel studies have the potential to introduce new therapeutic approaches that might reduce these problems and limit the need for blood transfusion.
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Affiliation(s)
- Stefano Rivella
- Weill College Medical Center, Department of Pediatrics, Division of Hematology, Oncology, 515 E 71st Street, S702, New York, NY 10021, USA, Tel.: +1 212 746 4941, ,
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11
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Lee JW, Jang PS, Chung NG, Cho B, Kim HK. Treatment of children with acute myeloid leukaemia who relapsed after allogeneic haematopoietic stem cell transplantation. Br J Haematol 2012; 160:80-6. [DOI: 10.1111/bjh.12074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Jae Wook Lee
- Division of Haematology and Oncology, Department of Paediatrics; The Catholic University of Korea; Seoul; Korea
| | - Pil-Sang Jang
- Division of Haematology and Oncology, Department of Paediatrics; The Catholic University of Korea; Seoul; Korea
| | - Nack-Gyun Chung
- Division of Haematology and Oncology, Department of Paediatrics; The Catholic University of Korea; Seoul; Korea
| | - Bin Cho
- Division of Haematology and Oncology, Department of Paediatrics; The Catholic University of Korea; Seoul; Korea
| | - Hack-Ki Kim
- Division of Haematology and Oncology, Department of Paediatrics; The Catholic University of Korea; Seoul; Korea
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12
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Schechter T, Avila L, Frangoul H, Domm J, Dupuis LL, Naithani R, Zhao X, Pollock-Barziv S, Roifman C, Gassas A, Doyle J. Effect of acute graft-versus-host disease on the outcome of second allogeneic hematopoietic stem cell transplant in children. Leuk Lymphoma 2012; 54:105-9. [DOI: 10.3109/10428194.2012.704998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Efficient generation of multipotent mesenchymal stem cells from umbilical cord blood in stroma-free liquid culture. PLoS One 2010; 5:e15689. [PMID: 21209896 PMCID: PMC3012708 DOI: 10.1371/journal.pone.0015689] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 11/20/2010] [Indexed: 01/08/2023] Open
Abstract
Background Haematopoiesis is sustained by haematopoietic (HSC) and mesenchymal stem cells (MSC). HSC are the precursors for blood cells, whereas marrow, stroma, bone, cartilage, muscle and connective tissues derive from MSC. The generation of MSC from umbilical cord blood (UCB) is possible, but with low and unpredictable success. Here we describe a novel, robust stroma-free dual cell culture system for long-term expansion of primitive UCB-derived MSC. Methods and Findings UCB-derived mononuclear cells (MNC) or selected CD34+ cells were grown in liquid culture in the presence of serum and cytokines. Out of 32 different culture conditions that have been tested for the efficient expansion of HSC, we identified one condition (DMEM, pooled human AB serum, Flt-3 ligand, SCF, MGDF and IL-6; further denoted as D7) which, besides supporting HSC expansion, successfully enabled long-term expansion of stromal/MSC from 8 out of 8 UCB units (5 MNC-derived and 3 CD34+ selected cells). Expanded MSC displayed a fibroblast-like morphology, expressed several stromal/MSC-related antigens (CD105, CD73, CD29, CD44, CD133 and Nestin) but were negative for haematopoietic cell markers (CD45, CD34 and CD14). MSC stemness phenotype and their differentiation capacity in vitro before and after high dilution were preserved throughout long-term culture. Even at passage 24 cells remained Nestin+, CD133+ and >95% were positive for CD105, CD73, CD29 and CD44 with the capacity to differentiate into mesodermal lineages. Similarly we show that UCB derived MSC express pluripotency stem cell markers despite differences in cell confluency and culture passages. Further, we generated MSC from peripheral blood (PB) MNC of 8 healthy volunteers. In all cases, the resulting MSC expressed MSC-related antigens and showed the capacity to form CFU-F colonies. Conclusions This novel stroma-free liquid culture overcomes the existing limitation in obtaining MSC from UCB and PB enabling so far unmet therapeutic applications, which might substantially affect clinical practice.
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Ueki T, Sumi M, Sato K, Shimizu I, Akahane D, Ueno M, Ichikawa N, Nakao S, Kobayashi H. Reduced-intensity cord blood transplantation without prior remission induction therapy induces durable remission in adult patients with relapsed acute leukemia after the first allogeneic transplantation. Eur J Haematol 2010; 86:268-71. [PMID: 21114536 DOI: 10.1111/j.1600-0609.2010.01555.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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