1
|
Dybko J, Sobczyk-Kruszelnicka M, Makuch S, Agrawal S, Dudek K, Giebel S, Gil L. The Benefits of the Post-Transplant Cyclophosphamide in Both Haploidentical and Mismatched Unrelated Donor Setting in Allogeneic Stem Cells Transplantation. Int J Mol Sci 2023; 24:ijms24065764. [PMID: 36982839 PMCID: PMC10051342 DOI: 10.3390/ijms24065764] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation (alloHSCT) is a standard therapeutic approach for acute leukemias and many other hematologic malignancies. The proper choice of immunosuppressants applicable to different types of transplantations still requires strict and careful consideration, and data in this regard are divergent. For this reason, in this single-centered, retrospective study, we aimed to compare the outcome of 145 patients who received post-transplant cyclophosphamide (PTCy) for MMUD and haplo-HSCT or GvHD prophylaxis for MMUD-HSCT alone. We attempted to verify if PTCy is an optimal strategy in MMUD setting. Ninety-three recipients (93/145; 64.1%) underwent haplo-HSCT while 52 (52/145; 35.9%) underwent MMUD-HSCT. There were 110 patients who received PTCy (93 in haplo and 17 in MMUD group) and 35 patients received conventional GvHD prophylaxis based on antithymocyte globulin (ATG), cyclosporine (CsA), and methotrexate (Mtx) in the MMUD group only. Our study revealed that patients receiving post-transplant cyclophosphamide (PTCy) show decreased acute GvHD rates and CMV reactivation as well as a statistically lower number of CMV copies before and after antiviral treatment compared to the CsA + Mtx + ATG group. Taking into account chronic GvHD, the main predictors are donor age, ≥40 years, and haplo-HSCT administration. Furthermore, the survival rate of patients following MMUD-HSCT and receiving PTCy with tacrolimus and mycophenolate mofetil was more than eight times greater in comparison to patients receiving CsA + Mtx + ATG (OR = 8.31, p = 0.003). These data taken together suggest that the use of PTCy displays more benefits in terms of survival rate compared to ATG regardless of the type of transplantation performed. Nevertheless, more studies with a larger sample size are required to confirm the conflicting results in the literature studies.
Collapse
Affiliation(s)
- Jarosław Dybko
- Department of Hematology and Cellular Transplantation, Lower Silesian Oncology Center, 53-413 Wroclaw, Poland
| | - Małgorzata Sobczyk-Kruszelnicka
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Sebastian Makuch
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Krzysztof Dudek
- Statistical Analysis Center, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Sebatian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznań, Poland
| |
Collapse
|
2
|
Choi Y, Choi EJ, Park HS, Lee JH, Lee JH, Lee YS, Kang YA, Jeon M, Woo JM, Kang H, Baek S, Kim SM, Bong CE, Lee KH. A uniform conditioning regimen of busulfan, fludarabine, and antithymocyte globulin for allogeneic haematopoietic cell transplantation from haploidentical family, matched sibling, or unrelated donors-A single-centre, prospective, explorative study. Br J Haematol 2023; 200:608-621. [PMID: 36370064 DOI: 10.1111/bjh.18550] [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: 08/08/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
In a prospective, explorative study, the donor-source difference of haploidentical family (HF), matched sibling (MS), and unrelated donors (UD) was evaluated for the outcome of haematopoietic cell transplantations (HCT) in 101 patients with acute myeloid leukaemia (AML) in complete remission (CR). To eliminate compounding effects, a uniform conditioning regimen containing antithymocyte globulin (ATG) was used. After transplantation, there was a significantly higher cumulative incidence of acute graft-versus-host disease (GVHD) in HF-HCT patients (49%, 7%, and 16% for HF-, MS- and UD-HCT respectively; p < 0.001). A quarter of acute GVHD cases observed in HF-HCT patients occurred within three days of engraftment and were characterized by diffuse skin rash, fever, weight gain, and hypoalbuminaemia. This peri-engraftment acute GVHD was not observed in MS-HCT or UD-HCT patients. Additionally, a significantly higher proportion of HF-HCT patients achieved complete donor chimaerism in the peripheral mononuclear cells at one month (88%, 46%, and 69% for HF-, MS- and UD-HCT respectively; p = 0.001). There was no significant difference in engraftment, chronic GVHD, leukaemia recurrence, non-relapse mortality, and patient survival. In patients with AML in CR who received HCT using ATG-containing conditioning, stronger donor-patient alloreactivity was observed in HF-HCT, in terms of increased acute GVHD and higher likelihood of complete donor chimaerism.
Collapse
Affiliation(s)
- Yunsuk Choi
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Ji Choi
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han-Seung Park
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Hee Lee
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Je-Hwan Lee
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Shin Lee
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-A Kang
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mijin Jeon
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Min Woo
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeran Kang
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seunghyun Baek
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Mi Kim
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Eun Bong
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoo-Hyung Lee
- Hematology Section, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
3
|
Novitzky-Basso I, Remberger M, Chen C, Ellison C, Pasic I, Lam W, Law A, Gerbitz A, Viswabandya A, Lipton JH, Kim DD, Kumar R, Michelis FV, Mattsson J. Anti-thymocyte Globulin and Post-Transplant Cyclophosphamide do not abrogate the inferior outcome risk conferred by human leukocyte antigen-A and -B mismatched donors. Eur J Haematol 2021; 108:288-297. [PMID: 34905239 DOI: 10.1111/ejh.13735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023]
Abstract
In donor selection for allogeneic stem cell transplant, several factors are considered for potential impact on transplant outcome. Previous publications suggested single HLA-mismatched unrelated donors (MMUD) may be equivalent to 10/10 matched unrelated donors (MUDs). We retrospectively examined factors affecting outcome in a single-center study using ATG followed by post-transplant cyclophosphamide, termed ATG-PTCy, GvHD prophylaxis. Fifty-two patients who received grafts from MMUD and 188 patients transplanted from MUD between January 2015 and December 2019, at Princess Margaret Cancer Centre, Canada, were enrolled. All patients received reduced-intensity conditioning. Overall survival for 9/10 recipients at 2 years was significantly worse, 37.2% versus 68.5% for 10/10 MUDs, p < .001, as were NRM at 1 year 39.5% versus 11.7%, p < .001, and GRFS at 2 years 29.8% versus 58.8%, p < .001, respectively, potentially due to higher incidence of infections including CMV. By multivariable analysis, factors correlating with survival negatively were DRI, and MMUD, whereas for NRM MMUD and increasing age were unfavorable. For GRFS significant unfavorable factors included donor age ≤32 years, female donor to male recipient, DRI high-very high and MMUD. These data suggest that MMUD, primarily HLA-A and HLA-B MMUD, confer significantly inferior outcome despite use of ATG-PTCy. Further development of novel conditioning regimens and GvHD prophylaxis is needed to mitigate these risks.
Collapse
Affiliation(s)
- Igor Novitzky-Basso
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mats Remberger
- Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden
| | - Carol Chen
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Cynthia Ellison
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Ivan Pasic
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Wilson Lam
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Arjun Law
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Armin Gerbitz
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Auro Viswabandya
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Jeffrey H Lipton
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Dennis D Kim
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Fotios V Michelis
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada.,Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Modi D, Kondrat K, Kim S, Deol A, Ayash L, Ratanatharathorn V, Uberti JP. Post-transplant Cyclophosphamide Versus Thymoglobulin in HLA-Mismatched Unrelated Donor Transplant for Acute Myelogenous Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2021; 27:760-767. [PMID: 34174469 DOI: 10.1016/j.jtct.2021.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/11/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Limited information is available on the efficacy of post-transplantation cyclophosphamide (PTcy) or thymoglobulin for graft-versus-host disease (GVHD) prophylaxis in mismatched unrelated donor (MMUD) transplants. We retrospectively compared outcomes of 76 adult patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) who underwent 7/8 HLA-MMUD transplantation and received either PTcy (50 mg/kg on day 3 and 4) or thymoglobulin (total dose 4.5 mg/kg) for GVHD prophylaxis. In addition, tacrolimus and mycophenolate were used in both groups. Propensity score-based multivariable analyses (PSCA) were performed to adjust confounding effects of patient characteristics between both groups. Between January 2006 and June 2019, 25 patients received PTcy, and 51 received thymoglobulin. Median age of the population was 57 years, 78% of patients had AML, most common graft source was peripheral blood (96%), and 46% received myeloablative conditioning regimens. Median time to neutrophil (15 versus 11 days, P < .001) and platelet engraftment (21 versus 15 days, P = .002) was prolonged in the PTcy group. The cumulative incidence of grade III-IV acute GVHD at day 100 was similar (12% versus 19.6%, P = .38), whereas chronic GVHD at 1 year was lower with PTcy compared to thymoglobulin (16% versus 49%, P = .006). Using PSCA, no difference in survival, relapse, relapse-free survival, and GVHD-free relapse-free survival was seen between groups. However, thymoglobulin was associated with higher incidence of acute (hazard ratio [HR] = 2.63, P = .01) and chronic GVHD (HR = 4.43, P = .03), and non-relapse mortality (HR 3.38, P = .04) compared to PTcy. Our study demonstrated that PTcy resulted in significantly lower rates of acute and chronic GVHD and non-relapse mortality compared to thymoglobulin in 7/8 HLA-MMUD transplants for AML and MDS.
Collapse
Affiliation(s)
- Dipenkumar Modi
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
| | - Kyle Kondrat
- Department of Internal Medicine and Pediatrics, DMC and Children's Hospital of Michigan, Detroit, Michigan
| | - Seongho Kim
- Biostatistics Core, Barbara Ann Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, Michigan
| | - Abhinav Deol
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Lois Ayash
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Voravit Ratanatharathorn
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Joseph P Uberti
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| |
Collapse
|
5
|
High-Dose Cyclophosphamide and Tacrolimus as Graft-versus-Host Disease Prophylaxis for Matched and Mismatched Unrelated Donor Transplantation. Transplant Cell Ther 2021; 27:619.e1-619.e8. [PMID: 33895157 DOI: 10.1016/j.jtct.2021.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 02/01/2023]
Abstract
The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of single-locus mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is unclear. The use of high-dose post-transplant cyclophosphamide (PTCy) after haploidentical transplantation is effective at overcoming the negative impact of HLA disparity on survival. Limited information is available regarding the efficacy of this strategy in alloHSCT from MMUDs. Most of the published studies have used the triple immunosuppressant model of haploidentical transplant combining PTCy with calcineurin inhibitors and mycophenolate mofetil or methotrexate. In our study, we propose the use of a simpler GVHD prophylaxis protocol comprising PTCy in combination with tacrolimus for MMUD and matched unrelated donor (MUD) alloHSCT. We performed a retrospective analysis of 109 consecutive recipients of alloHSCT from unrelated donors (MMUD, n = 55; MUD, n = 54) in a single center. Graft source was primarily peripheral blood (98%). No differences were observed between the MMUD and MUD groups with respect to 100-day cumulative incidence of grade II to IV acute GVHD (aGVHD; 31% versus 32%, respectively, P = .9), grade III to IV aGVHD (9% versus 7%, P = .7), and moderate/severe chronic GVHD (cGVHD) at 2 years (18% versus 14%, P = .6). Both groups showed similar cumulative incidence of 1 year nonrelapse mortality (13% versus 9%; P = .5) and 3-year relapse rates (24% versus 25%, P = .7). Progression-free survival and overall survival at 3 years for MMUD and MUD were 56% and 57% (P = .9) and 64% and 65% (P = .6), respectively. The 3-year probability of survival free of moderate/severe cGVHD and relapse was 56% and 55%, respectively. GVHD prophylaxis with PTCy and tacrolimus achieves low rates of severe aGVHD and cGVHD, as well as good survival outcomes, in recipients of both MMUD and MUD peripheral blood alloHSCT. This strategy overcomes the negative impact of single-locus HLA disparity.
Collapse
|
6
|
Watanabe M, Kanda J, Kojima H, Ikeda N, Fuji S, Kanda Y, Saji H, Tanaka H. Wide availability of HLA-matched or a few loci-mismatched donors in the graft-vs-host direction among nonsibling first-degree relatives. HLA 2020; 95:543-554. [PMID: 32170853 DOI: 10.1111/tan.13864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/06/2020] [Accepted: 03/11/2020] [Indexed: 01/02/2023]
Abstract
Although outcomes of hematopoietic stem cell transplantation from alternative donors have been improved, it has not yet challenged the precedence of HLA-matched or a few loci-mismatched donors. Because the availabilities of these donors among nonsibling relatives have been scarcely discussed, we analyzed them using a large Japanese dataset of HLA typing. Data set included HLA data from 2838 patients and their relatives, distributed in all parts of Japan. Antigen mismatches at the HLA-A, -B, -DR loci and allele mismatches at the HLA-A, -B, -C, -DRB1 loci were examined. The availabilities of 0 to 1/6 antigen-mismatched donors among one parent-candidate and one sibling-candidate were 24.3% and 33.9%, and those of 0 to 2/8 allele-mismatched donors were 18.6% and 32.1%, respectively. Additional HLA-C antigen mismatches (18.1% vs 0.0%) along with the possession of 1 to 3/8 allele mismatches (31.3% vs 3.0%) were more frequently observed in parent-candidates than in sibling-candidate. Most multiple allele-mismatched pairs had HLA-B allele mismatches. In conclusion, expanding donor searches to include nonsibling relatives could widen the availability of conventional relative donors with 0 to 1/6 antigen mismatches or 0 to 2/8 allele mismatch to 20% to 30%. High-resolution typing including HLA-C locus examination should be performed, because additional mismatches at HLA-C loci along with multiple allele mismatches were often observed, especially among nonsibling pairs.
Collapse
Affiliation(s)
- Mizuki Watanabe
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Saitama Medical Center, Division of Hematology, Jichi Medical University, Saitama, Japan
| | | | | | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Center, Osaka, Japan
| | - Yoshinobu Kanda
- Saitama Medical Center, Division of Hematology, Jichi Medical University, Saitama, Japan
| | | | | |
Collapse
|
7
|
Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation. Blood 2019; 134:892-899. [DOI: 10.1182/blood.2019000487] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023] Open
Abstract
Abstract
The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATG in 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.
Collapse
|
8
|
Liu Y, Yuan HL, Duan XL, Xu JL, Qu JH, Chen G, Shi J, Han CX, Ding LL, Jiang M. [Clinical research of HLA-haploidentical peripheral hematopoietic stem cell transplantation following reduced intensity conditioning regimen with hematological malignancy patients over 50 years old]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:667-672. [PMID: 31495134 PMCID: PMC7342871 DOI: 10.3760/cma.j.issn.0253-2727.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 分析减低剂量预处理单倍型外周血造血干细胞移植(RIC-haplo-PBSCT)治疗50岁以上恶性血液肿瘤患者的疗效。 方法 18例50岁以上恶性血液肿瘤患者纳入研究,男8例,女10例,中位年龄52(50~66)岁;急性髓系白血病(AML)8例,慢性髓性白血病(CML)2例,骨髓增生异常综合征(MDS)5例,急性淋巴细胞白血病(ALL)2例,急性NK细胞白血病(ANKL)1例;采用FAB+ATG(氟达拉滨+阿糖胞苷+白消安+兔抗人胸腺细胞免疫球蛋白)减低剂量预处理方案,输注供者高剂量非去T细胞外周血造血干细胞(PBSC),应用强化移植物抗宿主病(GVHD)预防方案及感染防控措施。 结果 16例患者在移植后15 d获得完全供者嵌合,其中1例在移植后1个月发生移植排斥,其余2例在移植后15 d为混合嵌合并于移植后1个月发生移植排斥。急性GVHD发生率为61.1%(95%CI 49.6%~72.6%),Ⅱ~Ⅳ度急性GVHD发生率为35.4%(95%CI 21.1%~49.7%),Ⅲ/Ⅳ度急性GVHD发生率为13.8%(95%CI 4.7%~22.9%)。2年慢性GVHD累积发生率为38.2%(95%CI 25.5%~50.9%),未发生广泛型慢性GVHD。中位随访14.5(3~44)个月,2年总生存率、无病生存率分别为72.6%(95%CI 60.1%~85.1%)、63.7%(95%CI 49.2%~78.2%),2年累积复发率为31.2%(95%CI 16.5%~45.9%),2年非复发死亡率为12.5%(95%CI 4.2%~20.8%)。 结论 RIC-haplo-PBSCT治疗50岁以上恶性血液肿瘤患者可获得较好的疗效。
Collapse
Affiliation(s)
- Y Liu
- Hematologic Disease Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China; Xinjiang Uygur Autonomous Region Research Institute of Hematology, Urumqi 830061, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Ayuk F, Beelen DW, Bornhäuser M, Stelljes M, Zabelina T, Finke J, Kobbe G, Wolff D, Wagner EM, Christopeit M, Schmid C, Ottinger H, Groth C, Faul C, Bertz H, Rachlis E, Wolschke C, Schetelig J, Horn PA, Mytilineos J, Guellstorf M, Kelsch R, Fleischhauer K, Kröger N, Bethge W. Relative Impact of HLA Matching and Non-HLA Donor Characteristics on Outcomes of Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndrome. Biol Blood Marrow Transplant 2018; 24:2558-2567. [PMID: 29966760 DOI: 10.1016/j.bbmt.2018.06.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/21/2018] [Indexed: 12/13/2022]
Abstract
Increasing donor-recipient HLA disparity is associated with negative outcomes of allogeneic hematopoietic stem cell transplantation (HSCT), but its comparative relevance amid non-HLA donor characteristics is not well established. We addressed this question in 3215 HSCTs performed between 2005 and 2013 in Germany for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). Donors were HLA-matched related (MRD; n = 872) or unrelated (10/10 MUD, n = 1553) or HLA-mismatched unrelated (<10/10 MMUD, n = 790). Overall survival (OS) was similar after MRD compared with 10/10 MUD HSCT, reflecting opposing hazards of relapse (hazard ratio [HR], 1.32; P < .002) and nonrelapse mortality (HR, .63; P < .001). After UD HSCT, increasing HLA disparity was associated with inferior OS (HR, 1.21 [P < .02] and HR, 1.57 [P < .001] for 9/10 and ≤8/10 MMUD, respectively, compared with 10/10 MUD). Among non-HLA donor characteristics, age, sex mismatching (male recipient-female donor), and cytomegalovirus (CMV) mismatching (positive recipient-negative donor) impacted OS. Multivariate subgroup analysis showed that OS was similar after HSCT from the youngest 9/10 MMUD (<30 years) compared with the oldest 10/10 MUD (>40 years) (HR, 1.18; P = .25) and also in male patients transplanted from female 10/10 MUD compared with male 9/10 MMUD (HR, .89; P = .46). In contrast, OS of CMV-positive patients tended to be better with CMV-negative 10/10 MUDs compared with CMV-positive 9/10 MMUDs (HR, 1.31; P = .04). Because of low patient numbers in subgroups, definite conclusions and establishment of a hierarchy among HLA matching and non-HLA donor characteristics could not be made. Our data suggest that the impact of donor age and sex mismatch but not CMV mismatch on outcome of allogeneic HSCT may be comparable with that of single HLA disparity.
Collapse
Affiliation(s)
- Francis Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany.
| | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany; DRST - German Registry for Stem Cell Transplantation, Essen, Germany
| | - Martin Bornhäuser
- Medical Clinic and Policlinic I, University Hospital of TU, Dresden, Germany
| | | | - Tatjana Zabelina
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Jürgen Finke
- Hematology/Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - Daniel Wolff
- Department of Hematology and Medical Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Eva-Maria Wagner
- Third Department of Medicine-Hematology, Oncology and Pneumology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Christoph Schmid
- Department of Haematology and Oncology, Klinikum Augsburg, Augsburg, Germany
| | - Hellmut Ottinger
- DRST - German Registry for Stem Cell Transplantation, Essen, Germany
| | - Christoph Groth
- Medizinische Klinik A, Universitätsklinikum Münster, Germany
| | - Christoph Faul
- Department of Hematology and Oncology, Eberhard Karls University Tubingen, Tubingen, Germany
| | - Hartmut Bertz
- Hematology/Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Elena Rachlis
- Department of Hematology, Oncology and Clinical Immunology, Heinrich-Heine University, Düsseldorf, Germany
| | - Christine Wolschke
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Johannes Schetelig
- Medical Clinic and Policlinic I, University Hospital of TU, Dresden, Germany
| | - Peter A Horn
- Department of Transfusion medicine, University Hospital Essen, Essen, Germany
| | | | - Martina Guellstorf
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Reinhard Kelsch
- Department of Transfusion medicine, University of Münster, Münster, Germany
| | | | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany
| | - Wolfgang Bethge
- Department of Hematology and Oncology, Eberhard Karls University Tubingen, Tubingen, Germany
| |
Collapse
|
10
|
Jorge AS, Suárez-Lledó M, Pereira A, Gutierrez G, Fernández-Avilés F, Rosiñol L, Llobet N, Solano T, Urbano-Ispízua Á, Rovira M, Martínez C. Single Antigen-Mismatched Unrelated Hematopoietic Stem Cell Transplantation Using High-Dose Post-Transplantation Cyclophosphamide Is a Suitable Alternative for Patients Lacking HLA-Matched Donors. Biol Blood Marrow Transplant 2018; 24:1196-1202. [PMID: 29410343 DOI: 10.1016/j.bbmt.2018.01.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022]
Abstract
The optimal prophylaxis regimen for graft-versus-host disease (GVHD) in the setting of mismatched unrelated donor (MMUD) allogeneic hematopoietic stem cell transplantation (alloHSCT) is not defined. The use of high-dose post-transplant cyclophosphamide (PTCy) in haploidentical transplantation has proven feasible and effective in overcoming the negative impact of HLA disparity on survival. We hypothesized that PTCy could also be effective in the setting of MMUD transplantation. We retrospectively analyzed 86 consecutive adult recipients of alloHSCT in our institution, comparing 2 contemporaneous groups: PTCy MMUD (n = 26) versus matched unrelated donor (MUD) (n = 60). Graft source was primarily peripheral blood (92%). All PTCy MMUD were HLA 7/8 (differences in HLA class I loci in 92% of patients) and received PTCy plus tacrolimus ± mofetil mycophenolate as GVHD prophylaxis. No differences were observed between PTCy MMUD and MUD in the 100-day cumulative incidence of acute GVHD grades II to IV (31% versus 22%, respectively; P = .59) and III to IV (8% versus 10%, P = .67). There was a trend for a lower incidence of moderate to severe chronic GVHD at 1 year after PTCy MMUD in comparison with MUD (22% versus 41%, P = .098). No differences between PTCy MMUD and MUD were found regarding nonrelapse mortality (25% versus 18%, P = .52) or relapse rate (11% versus 19%, P = .18). Progression-free survival and overall survival at 2 years were similar in both cohorts (67% versus 54% [HR, .84; 95% CI, .38 to 1.88; P = .68] and 72% versus 57% [HR, .71; 95% CI, .31 to 1.67; P = .44], respectively). The 2-year cumulative incidence of survival free of moderate to severe chronic GVHD and relapse tended to be higher in the PTCy MMUD group (47% versus 24%; HR, .60; 95% CI, .31 to 1.14; P = .12). We conclude that HLA 7/8 MMUD transplantation using PTCy plus tacrolimus is a suitable alternative for those patients who lack a MUD.
Collapse
Affiliation(s)
- Ana Sofia Jorge
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Arturo Pereira
- Hemotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain
| | - Gonzalo Gutierrez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Noemí Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Teresa Solano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Álvaro Urbano-Ispízua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Barcelona, Spain; Josep Carreras Leukaemia Research Foundation, Hospital Clínic, Barcelona, Spain.
| |
Collapse
|
11
|
Lee KH, Lee JH, Lee JH, Kim DY, Park HS, Choi EJ, Ko SH, Seol M, Lee YS, Kang YA, Jeon M, Baek S, Kang YL, Kim SH, Yun SC, Kim H, Jo JC, Choi Y, Joo YD, Lim SN. Reduced-Intensity Conditioning with Busulfan, Fludarabine, and Antithymocyte Globulin for Hematopoietic Cell Transplantation from Unrelated or Haploidentical Family Donors in Patients with Acute Myeloid Leukemia in Remission. Biol Blood Marrow Transplant 2017; 23:1555-1566. [PMID: 28552421 DOI: 10.1016/j.bbmt.2017.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Abstract
To investigate the role of antithymocyte globulin (ATG)-containing reduced-intensity conditioning (RIC) in hematopoietic cell transplantation (HCT) from unrelated (UD) or haploidentical family donors (HFD), we conducted a phase 2 trial of 237 patients (age range, 16 to 69 years) with acute myeloid leukemia (AML) in remission. Patients undergoing UD-HCT (n = 93) or HFD-HCT (n = 59) received RIC comprising busulfan, fludarabine, and ATG, 9 mg/kg, whereas those undergoing HCT from matched sibling donors (MSD, n = 85) received myeloablative busulfan and cyclophosphamide conditioning or aforementioned RIC with ATG, 4.5 mg/kg. For graft-versus-host disease (GVHD) prophylaxis, cyclosporine and methotrexate were administered. The median follow-up period was 44.7 months after HCT for 161 survivors. For UD-HCT versus HFD-HCT, there were no significant differences in leukemia recurrence, nonrelapse mortality, relapse-free survival, grades 2 to 4 acute GVHD, and moderate-to-severe chronic GVHD. Furthermore, when the outcomes of UD-HCT and HFD-HCT were combined and compared with those of MSD-HCT, there were no significant differences in leukemia recurrence (3-year cumulative incidence, 30% versus 29%), nonrelapse mortality (3-year cumulative incidence, 7% versus 8%), relapse-free survival (3-year estimate, 63% versus 63%), and grades 2 to 4 acute GVHD (120-day cumulative incidence, 16% versus 13%). Moderate-to-severe chronic GVHD, however, occurred less frequently in UD/HFD-HCT (2-year cumulative incidence, 22% versus 40%; P = .006). The addition of ATG to conditioning regimen was a significant predictor for less chronic GVHD (subdistribution hazard ratio, .59). In AML in remission, UD/HFD-HCT after ATG-containing RIC achieved leukemia control equivalent to that of MSD-HCT. Despite HLA disparity in UD/HFD-HCT, chronic GVHD occurred less frequently after ATG-containing RIC, suggesting a strong GVHD-modulating effect of ATG.
Collapse
Affiliation(s)
- Kyoo-Hyung Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
| | - Je-Hwan Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jung-Hee Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Dae-Young Kim
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Han-Seung Park
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Eun-Ji Choi
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sun-Hye Ko
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Miee Seol
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young-Shin Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young-A Kang
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Mijin Jeon
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Seunghyun Baek
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - You-Lee Kang
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Han Kim
- Section of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hawk Kim
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Jae-Cheol Jo
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Yunsuk Choi
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Young-Don Joo
- Hematology-Oncology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Sung-Nam Lim
- Hematology-Oncology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| |
Collapse
|
12
|
Magalhaes I, Uhlin M, Schaffer M, Sundin M, Hauzenberger D, Remberger M, Mattsson J. No effect of HLA-C mismatch after allogeneic hematopoietic stem cell transplantation with unrelated donors and T-cell depletion in patients with hematological malignancies. Clin Transplant 2017; 31. [PMID: 28510343 DOI: 10.1111/ctr.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 11/29/2022]
Abstract
HLA-C mismatch in unrelated donor's hematopoietic stem cell transplantation (HSCT) has been associated with poor patient outcome. However, the impact of HLA-C mismatch in the context of HSCT combined with in vivo T-cell depletion remains unclear. We therefore performed a single-center, retrospective analysis of the clinical outcome on patients with hematological malignancies treated with allo-HSCT, who underwent T-cell depletion. The majority of the patients (n=276) received a HLA-A, HLA-B, HLA-DRB1-matched graft that were either also HLA-C matched (n=260), or patients with the permissive HLA-C*03:03/03:04 mismatch (n=16), while the remaining patients (n=95) received a HLA-C-mismatched graft (excluding HLA-C*03:03/03:04 mismatches). We did not observe any significant differences between the HLA-C-matched patients (including the permissive HLA-C*03:03/03:04 mismatch) and the HLA-C-mismatched patients regarding cumulative proportion surviving, graft failure, relapse-free survival, relapse, or acute graft-versus-host disease. Our data suggest that in the context of high dose T lymphocyte-depleting agents, HLA-C matching is not essential for patients with hematological malignancies.
Collapse
Affiliation(s)
- Isabelle Magalhaes
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Michael Uhlin
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Schaffer
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Sundin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Pediatric Blood Disorders, Immunodeficiency and Stem Cell Transplantation, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Dan Hauzenberger
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Remberger
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
13
|
Nishihori T, Al-Kadhimi Z, Hamadani M, Kharfan-Dabaja MA. Antithymocyte globulin in allogeneic hematopoietic cell transplantation: benefits and limitations. Immunotherapy 2016; 8:435-47. [DOI: 10.2217/imt.15.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Significant advances have been made in allogeneic hematopoietic cell transplantation by reducing toxicities and optimizing its efficacy. Antithymocyte globulin (ATG) is an important in vivo T-cell depletion strategy, which reduces the risk of graft-versus-host disease in HLA-matched or -mismatched donor allografting. ATG effectively targets alloreactive T cells at the expense of potentially increasing the risk of post-hematopoietic cell transplantation infections and delayed immune reconstitution. We summarize the targets, mechanisms, various preparations of ATG, the growing role of ATG in prevention of graft-versus-host disease in various transplant modalities as well as emerging data on pharmacokinetic modeling for individualized ATG dosing. Further research is needed to optimize the ATG administration while minimizing the toxicities.
Collapse
Affiliation(s)
- Taiga Nishihori
- Department of Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, Morsani College of Medicine, Moffitt Cancer Center/University of South Florida, Tampa, FL, USA
| | | | | | - Mohamed A Kharfan-Dabaja
- Department of Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, FOB-3, Tampa, FL 33612, USA
- Department of Oncologic Sciences, Morsani College of Medicine, Moffitt Cancer Center/University of South Florida, Tampa, FL, USA
| |
Collapse
|
14
|
Abstract
For the majority of hematologic malignancies allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment option. Sibling donors have been the standard for adult patients. Since there is not a suitable family donor for all patients, the need for alternative donors for HCT is great. Fortunately, the availability of unrelated volunteer donor registries has expanded over the years and the results of HCT with matched unrelated donors (MUD) are comparable to the results with matched related donors (MRD). Nevertheless, there are many patients lacking a well-matched donor. To increase the applicability of transplantation, alternative donors such as mismatched unrelated donors (MMURD), cord blood stem cell products and haploidentical related donors have been widely used. This review seeks to give insights into the use of MMUD donors for HCT and summarize the existing data.
Collapse
Affiliation(s)
- Henning Sebastian Schäfer
- Department of Hematology, Oncology and Stem Cell Transplantation, Albert-Ludwigs University Medical Center, Freiburg, Germany
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Albert-Ludwigs University Medical Center, Freiburg, Germany.
| |
Collapse
|
15
|
Liu J, Xu LP, Bian Z, Chang YJ, Wang Y, Zhang XH, Huang XJ. Differential impact of two doses of antithymocyte globulin conditioning on lymphocyte recovery upon haploidentical hematopoietic stem cell transplantation. J Transl Med 2015; 13:391. [PMID: 26715367 PMCID: PMC4696105 DOI: 10.1186/s12967-015-0748-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/04/2015] [Indexed: 12/26/2022] Open
Abstract
Background In vivo depletion of host T cells with antithymocyte globulin (ATG) is a common strategy for preventing graft-versus-host disease in allogeneic hematopoietic stem cell transplantation (HSCT). The total dose of ATG in conditioning regimens appears to be an important factor that influences the outcome in recipients of transplants. However, the optimal ATG dosage has not been established to date. It remains unclear whether, in the setting of haploidentical HSCT (haploHSCT), different doses of ATG might exert differential influences on the recovery of lymphocyte subpopulations. Methods This retrospective study analyzed lymphocyte recovery and its correlation to viral infection in two groups of patients that received different doses of ATG before haploHSCT. We performed flowcytometry to determine immunophenotypes of CD19+ B cells and CD3+, CD4+, CD8+, CD4+CD45RA+, CD4+CD45RO+, CD4+CD28+, CD8+CD28+, and CD4−CD8− T cells. Results We found that, compared to 6 mg/kg, 10 mg/kg ATG significantly hampered the recoveries of CD4+, CD4+CD45RA+, and CD4+CD45RO+ T cells in the first 2 months following haploHSCT. Similarly, compared to 6 mg/kg, the 10 mg/kg dose of ATG negatively influenced the recoveries of CD4−CD8− and CD8+CD28+ T cells; recovery was delayed for 6 and 12 months after transplantation, respectively. Moreover, we showed that an increase in Epstein-Barr virus (EBV) infections, associated with the higher dose of ATG, was correlated with the delayed recovery of CD4−CD8− double negative T cells. Conclusions The present study revealed a differential impact of different ATG conditioning doses on the recoveries of T cell subpopulations post-haploHSCT. This study was the first to connect the recovery of CD4−CD8− T cells to the risk of EBV infection after HSCT. These findings will facilitate optimization of the ATG conditioning dosage and improve the outcome of patients with leukemia that receive haploHSCT.
Collapse
Affiliation(s)
- Jiangying Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Zhilei Bian
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Ying-Jun Chang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, 11 Xizhimen South Street, Beijing, 100044, China.
| |
Collapse
|
16
|
Nelson R, Shapiro JF, Perkins JB, Kim J, Nishihori T, Pidala J, Ayala E, Locke FL, Field T, Mishra A, Riches M, Betts B, Perez L, Yue B, Ochoa-Bayona JL, Alsina M, Fernandez H, Anasetti C, Kharfan-Dabaja MA. Sirolimus, tacrolimus and antithymocyte globulin as GVHD prophylaxis in HLA-mismatched unrelated donor hematopoietic cell transplantation: a single institution experience. Bone Marrow Transplant 2015; 50:1487-9. [PMID: 26301969 DOI: 10.1038/bmt.2015.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R Nelson
- Department of Pharmacy, Moffitt Cancer Center, Tampa, FL, USA
| | - J F Shapiro
- Department of Pharmacy, Moffitt Cancer Center, Tampa, FL, USA
| | - J B Perkins
- Department of Pharmacotherapy and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
| | - J Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA
| | - T Nishihori
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - J Pidala
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - E Ayala
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - F L Locke
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - T Field
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - A Mishra
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - M Riches
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - B Betts
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - L Perez
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - B Yue
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - J L Ochoa-Bayona
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - M Alsina
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - H Fernandez
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - C Anasetti
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - M A Kharfan-Dabaja
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
17
|
Comparable outcome after single-antigen-mismatched versus matched unrelated donor haematopoietic cell transplantation. J Cancer Res Clin Oncol 2015; 141:2193-203. [DOI: 10.1007/s00432-015-2003-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/14/2015] [Indexed: 11/28/2022]
|
18
|
Zheng C, Luan Z, Fang J, Sun X, Chen J, Li CK, Hu S, Zhu Y, Sun Z. Comparison of conditioning regimens with or without antithymocyte globulin for unrelated cord blood transplantation in children with high-risk or advanced hematological malignancies. Biol Blood Marrow Transplant 2015; 21:707-12. [PMID: 25598277 DOI: 10.1016/j.bbmt.2014.12.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022]
Abstract
The role and potential efficacy of antithymocyte globulin (ATG) in patients receiving cord blood transplantation (CBT) remain controversial. We retrospectively evaluated the effect of ATG on patient outcomes in 207 children with high-risk or advanced hematological malignancies at 8 child blood disease centers in China. The cumulative incidence of platelet recovery on day 100 was significantly lower in the ATG cohort compared with the non-ATG cohort (77.3% versus 89.8%) (P = .046). There was no significant difference in the incidence of grade II to IV acute and chronic graft-versus-host disease (GVHD), and transplantation-related mortality (TRM) between the 2 groups (P = .76, P = .57, and P = .46, respectively). The incidence of CMV infection was significantly higher among the ATG group compared with that among the non-ATG group (P = .003). The 5-year cumulative incidence of relapse was significantly higher in the ATG cohort (30.7% versus 15.4%) (P = .009). Overall survival in the non-ATG group was slightly higher than that of the ATG cohort (64.1% versus 52.1%, P = .093) and leukemia-free survival in the non-ATG cohort was significantly higher than in the ATG cohort (56.6% versus 37.7%, P = .015). Our study demonstrated that, for high-risk or advanced childhood hematological malignancies receiving unrelated CBT, patients who received conditioning that omitted ATG had a faster platelet recovery, a comparable GVHD and TRM, a significantly lower relapse risk, and an improved long-term survival compared with those patients who received ATG in the conditioning.
Collapse
Affiliation(s)
- Changcheng Zheng
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Zuo Luan
- Department of Pediatrics, Navy General Hospital of People's Liberation Army, Beijing, China.
| | - Jianpei Fang
- Department of Pediatrics, Sun Yet-sen Memorial Hospital, Sun Yet-sen University, Guangzhou, China
| | - Xin Sun
- Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jing Chen
- Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Chi Kong Li
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Shaoyan Hu
- Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, China
| | - Yiping Zhu
- Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Zimin Sun
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| |
Collapse
|
19
|
Michallet M, Sobh M, Serrier C, Morisset S, Labussière H, Ducastelle S, Barraco F, Gilis L, Thomas X, Nicolini FE. Allogeneic hematopoietic stem cell transplant for hematological malignancies from mismatched 9/10 human leukocyte antigen unrelated donors: comparison with transplants from 10/10 unrelated donors and human leukocyte antigen identical siblings. Leuk Lymphoma 2014; 56:999-1003. [PMID: 25029640 DOI: 10.3109/10428194.2014.944518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We studied the outcome of 213 patients who received allo-HSCT for hematological malignancies, 121 (57%) from HLA identical siblings, 63 (29%) from 10/10 HLA identical unrelated donors and 29 (14%) from 9/10 HLA mismatched unrelated donors. Engraftment was lower in the 9/10 HLA group (90%) than in the 10/10 HLA group (95%) than in the sibling group (99%); 3 months CI of aGVHD ≥ 2 was 32% (23-41), 20% (15-26) and 27% (23-32) respectively; the one year CI of extensive cGVHD was 21% (13-30), 9% (5-13) and 17% (14-21) respectively. The median OS was 10 months (5-21), 18 months (11-NR) and 60 months (31-NR) respectively with 2-years probability of 19% (8-44), 43% (31-59) and 63% (54-74) respectively. TRM was significantly higher in the 9/10 HLA group with 1 year CI of 45% (35-55), compared to 33% (27-39) in the unrelated 10/10 HLA group and 12% (9-15) in the identical siblings group (p < 0.001).
Collapse
Affiliation(s)
- Mauricette Michallet
- Hospices Civils de Lyon, Blood and Marrow Transplant Unit, Department of Hematology 1G, Centre Hospitalier Lyon Sud , Pierre Benite , France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Devillier R, Fürst S, Crocchiolo R, El-Cheikh J, Castagna L, Harbi S, Granata A, D'Incan E, Coso D, Chabannon C, Picard C, Etienne A, Calmels B, Schiano JM, Lemarie C, Stoppa AM, Bouabdallah R, Vey N, Blaise D. A conditioning platform based on fludarabine, busulfan, and 2 days of rabbit antithymocyte globulin results in promising results in patients undergoing allogeneic transplantation from both matched and mismatched unrelated donor. Am J Hematol 2014; 89:83-7. [PMID: 24108528 DOI: 10.1002/ajh.23592] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/23/2013] [Accepted: 09/06/2013] [Indexed: 11/09/2022]
Abstract
Conditioning regimen including fludarabine, intravenous busulfan (Bx), and 5 mg/kg total dose of rabbit antithymocyte globulin (r-ATG) (FBx-ATG) results in low incidence of graft-versus-host disease (GVHD) and non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT) from HLA-matched related or unrelated donors (MUD). However, whether this platform produces similar results in the setting of one mismatch unrelated donor (MMUD) Allo-HSCT is not known. We retrospectively analyzed patients aged less than 65 years who were diagnosed with hematological malignancies and received FBx-ATG regimen prior to Allo-HSCT from MUD (N = 74) or MMUD (N = 40). We compared outcome of MUD versus MMUD patients. There was no difference in the cumulative incidence of grades II-IV acute GVHD (MUD: 34% vs. MMUD: 35%, P = 0.918), but MMUD patients developed more grade III-IV acute GVHD (MUD: 5% vs. MMUD: 15%, P = 0.016). The cumulative incidences of overall chronic GVHD (MUD: 33% vs. MMUD: 22%, P = 0.088) and extensive chronic GVHD (MUD: 20% vs. MMUD: 19%, P = 0.594) were comparable. One-year NRM was similar in both groups (MUD: 16% vs. MMUD: 14%, P = 0.292); similarly, progression-free survival (MUD: 59% vs. MMUD: 55%, P = 0.476) and overall survival (MUD: 63% vs. MMUD: 61%, P = 0.762) were not different between both groups. With a median follow up of 24 months, 35 of 74 MUD patients (47%) and 19 of 40 MMUD patients (48%) were free of both disease progression and immunosuppressive treatment. We conclude that the FBx-ATG regimen results in low incidences of NRM and GVHD in both MUD and the MMUD recipients.
Collapse
Affiliation(s)
- Raynier Devillier
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
| | - Sabine Fürst
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Roberto Crocchiolo
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Jean El-Cheikh
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Luca Castagna
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Humanitas Cancer Center, Hematology Unit; Instituto Clinico Humanitas; Rozzano Milano Italy
| | - Samia Harbi
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Angela Granata
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Evelyne D'Incan
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Diane Coso
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Christian Chabannon
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
- Institut Paoli-Calmettes, Centre de Thérapie Cellulaire (Cell Therapy Facility); F-13273 Marseille France
- Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie; F-13009 Marseille France
| | - Christophe Picard
- Laboratory of Histocompatibility; EFS Alpes Mediterrannée; Marseille France
| | - Anne Etienne
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Boris Calmels
- Institut Paoli-Calmettes, Centre de Thérapie Cellulaire (Cell Therapy Facility); F-13273 Marseille France
- Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie; F-13009 Marseille France
| | - Jean-Marc Schiano
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Claude Lemarie
- Institut Paoli-Calmettes, Centre de Thérapie Cellulaire (Cell Therapy Facility); F-13273 Marseille France
- Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie; F-13009 Marseille France
| | - Anne-Marie Stoppa
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Reda Bouabdallah
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Norbert Vey
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
| | - Didier Blaise
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
| |
Collapse
|
21
|
Wang L, Wang Y, Tang W, Dou HB, Shan JH, Hu J. The superiority of allogeneic hematopoietic stem cell transplantation from unrelated donor over chemotherapy for adult patients with high-risk acute lymphoblastic leukemia in first remission. Int J Hematol 2013; 98:569-77. [DOI: 10.1007/s12185-013-1442-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
|
22
|
Effective prevention of GVHD using in vivo T-cell depletion with anti-lymphocyte globulin in HLA-identical or -mismatched sibling peripheral blood stem cell transplantation. Bone Marrow Transplant 2013; 49:126-30. [PMID: 24037022 DOI: 10.1038/bmt.2013.143] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 07/17/2013] [Accepted: 07/29/2013] [Indexed: 11/08/2022]
Abstract
To investigate the impact of anti-lymphocyte globulin (ATG-Fresenius) as part of the HLA-sibling transplantation, we evaluated 238 patients (median age 48 years) with different diagnoses (AML, ALL, CML and lymphoproliferative disorders). A total of 79 patients received ATG and 159 patients did not. In the ATG group, there were more HLA-mismatched donors (6% vs 1%, p=0.02), bad risk patients (70% vs 55%, P=0.04), reduced intensity conditioning (RIC) regimens (65% vs 34%, P=<0.001) and older patients (median age 51 vs 48 years, P=0.002). The median time to leukocyte engraftment was significantly faster in the non-ATG group (13 vs 15 days, P < 0.001). EBV reactivation was more often seen in the ATG group (9% vs 2%, P=0.05). Cumulative incidence of acute and chronic GVHD was less observed in the ATG group (27% vs 40%, P=0.004, and 33% vs 54%, P=0.002). The cumulative incidence rates of non-relapse mortality and of relapse at 5 years were 20 and 34%, respectively, for ATG and 34 and 29%, respectively, for non-ATG (P=0.06 and P=0.3). ATG can prevent GVHD without an obvious risk of relapse but should be confirmed in a randomized study.
Collapse
|
23
|
Kim HJ, Kim SY, Lee MH, Min WS. Peripheral blood stem cell transplantation from human leukocyte antigen-matched sibling donors and unrelated donors in acute myeloid leukemia patients. Acta Haematol 2013; 130:206-16. [PMID: 23816761 DOI: 10.1159/000350481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/24/2013] [Indexed: 11/19/2022]
Abstract
There have been rare comparative studies of hematopoietic stem cell transplantation from matched sibling donors (MSDs) and unrelated donors (URDs) with regard to peripheral blood stem cell transplantation (PBSCT). We performed a retrospective study of 104 consecutive acute myeloid leukemia (AML) patients who had received an allogeneic PBSCT from an MSD or a URD in order to compare transplant outcomes and posttransplant complications between the 2 groups of patients. The cumulative incidence of grade 2-4 acute graft-versus-host disease (aGVHD) at 100 days (22.6% with MSD vs. 35.3% with URD; p = 0.107) and that of chronic GVHD (cGVHD) at 2 years (72.9% with MSD vs. 56.1% with URD; p = 0.153) was not significantly different between the 2 groups. Multivariate analysis also indicated that a URD was not an independent predictor of grade 2-4 aGVHD or cGVHD. No statistically significant differences were observed in terms of relapse incidence (p = 0.371), nonrelapse mortality (p = 0.473), disease-free survival (p = 0.925) or overall survival (p = 0.534) at 2 years. URDs are comparable with MSDs as a donor type for PBSCT in AML patients if risk-stratified GVHD prophylaxis is adopted.
Collapse
Affiliation(s)
- Hee-Je Kim
- Catholic Blood and Marrow Transplantation Center, The Catholic University of Korea, Seoul, Republic of Korea
| | | | | | | |
Collapse
|
24
|
Ayuk F, Zabelina T, Wortmann F, Alchalby H, Wolschke C, Lellek H, Bacher U, Zander A, Kröger N. Donor choice according to age for allo-SCT for AML in complete remission. Bone Marrow Transplant 2013; 48:1028-32. [PMID: 23419435 DOI: 10.1038/bmt.2013.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/30/2012] [Accepted: 01/15/2013] [Indexed: 11/09/2022]
Abstract
In a retrospective study of 168 patients with AML in CR who underwent allo-SCT, we compare the impact of young unrelated donors (UD) vs older matched related donors (MRD) on 5-year OS (5-yr OS). Median follow-up was 59 months and median donor age was 39 years, which was used as cutoff for young vs older donors. Kaplan-Meier-estimated 5-yr OS was better with UD ≤39 years vs MRD >39 years (66% vs 34%, P=0.001). In multivariate analysis, only donor age and cytogenetic risk impacted 5-yr OS. Compared with UD ≤39 years, both MRD >39 years (relative risk (RR): 4.31, P=0.001) and UD >39 years (RR: 2.14, P=0.03) were associated with poorer 5-yr OS. Standard-risk cytogenetics was associated with better 5-yr OS compared with bad-risk cytogenetics, (RR: 0.53, P=0.02). Subgroup analyses of patients ≥50 years (n=76) revealed similar results, with 5-yr OS of 62% for UD ≤39 yrs and 26% for MRD >39 yrs (P=0.022). In patients undergoing allo-HSCT for AML, young UD may improve outcome as compared with older MRD.
Collapse
Affiliation(s)
- F Ayuk
- Clinic for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Filosto M, Scarpelli M, Tonin P, Lucchini G, Pavan F, Santus F, Parini R, Donati MA, Cotelli MS, Vielmi V, Todeschini A, Canonico F, Tomelleri G, Padovani A, Rovelli A. Course and management of allogeneic stem cell transplantation in patients with mitochondrial neurogastrointestinal encephalomyopathy. J Neurol 2012; 259:2699-706. [PMID: 22711161 DOI: 10.1007/s00415-012-6572-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 05/25/2012] [Accepted: 05/28/2012] [Indexed: 11/27/2022]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder caused by mutations in the gene encoding thymidine phosphorylase (TP). Allogeneic hematopoietic stem cell transplantation (HSCT) has been proposed as a treatment for patients with MNGIE and a standardized approach to HSCT in this condition has recently been developed. We report on the transplant course, management and short-term follow-up in two MNGIE patients who underwent HSCT. The source of stem cells was bone marrow taken from an HLA 9/10 allele-matched unrelated donor in the first patient and from an HLA 10/10 allele-matched sibling donor in the second. Both patients achieved full donor chimerism, and we observed restoration of buffy coat TP activity and lowered urine nucleoside concentrations in both of them. The post-transplant clinical follow-up showed improvement in gastrointestinal dysmotility, abdominal cramps and diarrhea. Neurological assessment remained unchanged. However, the first patient died 15 months after HSCT due to gastrointestinal obstruction and shock; the second patient died 8 months after the procedure due to respiratory distress following septic shock. Although HSCT corrects biochemical abnormalities and improves gastrointestinal symptoms, the procedure can be risky in subjects already in poor medical condition as are many MNGIE patients. Since transplant-related morbidity and mortality increases with progression of the disease and number of comorbidities, MNGIE patients should be submitted to HSCT when they are still relatively healthy, in order to minimize the complications of the procedure. Anyway, there is still incomplete knowledge on the natural history of the disease in many affected patients and it is not yet clear when the best time to do a transplant is. Further clues to the therapeutic potential of HSCT could result from a prolonged observation in a greater number of non-transplanted and transplanted patients, which would allow us to answer the questions of if, how and when MNGIE patients require HSCT treatment.
Collapse
Affiliation(s)
- Massimiliano Filosto
- Clinical Neurology, Section for Neuromuscular Diseases and Neuropathies, University Hospital "Spedali Civili", Pz.le Spedali Civili 1, 25100 Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Selection of optimal alternative graft source: mismatched unrelated donor, umbilical cord blood, or haploidentical transplant. Blood 2011; 119:1972-80. [PMID: 22210876 DOI: 10.1182/blood-2011-11-354563] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Only 30% of patients who require an allogeneic hematopoietic cell transplant will have an HLA-matched sibling donor. A search for an unrelated donor will be undertaken for patients without a matched family donor. However, many patients, particularly patients of diverse racial and ethnic backgrounds, may not be able to rapidly identify a suitably matched unrelated donor. Three alternative graft sources, umbilical cord blood (UCB), haploidentical (haplo)-related donor, and mismatched unrelated donor (MMUD) are available. UCB is associated with decreased GVHD, but hematologic recovery and immune reconstitution are slow. Haplo-HCT is characterized by donor availability for transplantation and after transplantation adoptive cellular immunotherapy but may be complicated by a high risk of graft failure and relapse. A MMUD transplant may also be an option, but GVHD may be of greater concern. Phase 2 studies have documented advances in HLA typing, GVHD prophylaxis, and infection prevention, which have improved survival. The same patient evaluated in different transplant centers may be offered MMUD, UCB, or haplo-HCT depending on center preference. In this review, we discuss the rationale for donor choice and the need of phase 3 studies to help answer this important question.
Collapse
|
27
|
Predictive impact of allele-matching and EBMT risk score for outcome after T-cell depleted unrelated donor transplantation in poor-risk acute leukemia and myelodysplasia. Leukemia 2011; 25:1548-54. [PMID: 21606965 DOI: 10.1038/leu.2011.123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many parameters predict for outcome after unrelated donor (URD) allogeneic hematopoietic stem cell transplantation (alloSCT). High-resolution HLA-matching significantly impacts outcome and also the European Group of Blood and Marrow Transplantation (EBMT) risk score, based on patient age, disease stage, donor type, time from diagnosis to SCT and gender combination, may predict for non-relapse mortality and overall survival (OS). We evaluated the individual and combined effects of allele-matching and the EBMT risk score in 327 patients with poor-risk acute leukemia or myelodysplasia, who received a T-cell depleted URD alloSCT. Matching for HLA-A, -B, -C and -DRB1 alleles (8/8 match) was associated with a 5-year OS of 40% compared with 30% for mismatched (≤7/8) pairs (P=0.02). Patients with EBMT risk scores of 1-2, 3, 4 and 5-7 had 5-year OS estimates of 53, 43, 30 and 20%, respectively (P<0.001). The favorable prognostic impact of an 8/8 donor was most pronounced if the EBMT risk score was low (1-2). Five-year OS was 74±8% vs 39±11% for fully matched patients with a low-risk EBMT score as compared with EBMT low-risk patients with ≤7/8 donors. These data underscore the importance of incorporating both the EBMT risk score and the degree of high-resolution HLA-matching in the risk assessment prior to URD alloSCT.
Collapse
|
28
|
Pidala J, Tomblyn M, Nishihori T, Ayala E, Field T, Fernandez H, Perez L, Locke F, Alsina M, Ochoa JL, Perkins J, Tate C, Shapiro J, Conwell M, Bookout R, Anasetti C. ATG prevents severe acute graft-versus-host disease in mismatched unrelated donor hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011; 17:1237-44. [PMID: 21215811 DOI: 10.1016/j.bbmt.2010.12.705] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 12/29/2010] [Indexed: 12/22/2022]
Abstract
Severe acute graft-versus-host disease (aGVHD) remains a major source of morbidity and mortality following mismatched unrelated donor hematopoietic cell transplantation (HCT). Through a retrospective analysis, we investigated the efficacy of GVHD prophylaxis with rabbit anti-thymocyte globulin (ATG) 7.5 mg/kg (1 mg/kg given on day -3, then 3.25 mg/kg/day on days -2 and -1 before stem cell infusion) followed by standard tacrolimus plus methotrexate in a consecutive series of 45 HLA partially matched unrelated donor HCT recipients. The cumulative incidence of grade III-IV aGVHD was 11% by 100 days (95% confidence interval [CI] 5%-25%). Moderate to severe chronic GVHD (per NIH consensus criteria) was 19% (95% CI 10%-36%) at 1 year, and 28% (95% CI 16%-48%) at 2 years. With a median follow-up time for surviving patients of 12 months (range: 5-39 months), overall survival was 55% (95% CI 39%-71%) at 1 year, and 45% (95% CI 27%-63%) at 2 years. Nonrelapse mortality was 11% (95% CI 5%-25%) by 100 days post-HCT, 26% (95% CI 16%-44%) by 1 year, and 30% (95% CI 18%-50%) by 2 years. The cumulative incidence of primary disease relapse was 23% (95% CI 13%-41%) at 1 year, and 33% (95% CI 20%-56%) by 2 years after HCT. Cytomegalovirus (CMV) infection or reactivation varied according to recipient and donor CMV serostatus. Epstein-Barr Virus (EBV) reactivation occurred in 54% (95% CI 40%-71%) of patients. Preemptive rituximab therapy was administered for EBV reactivation, however, posttransplant lymphoproliferative disorder was diagnosed in 5 (11%) cases, and was fatal in 1. A regimen of ATG 7.5 mg/kg total ending on day -1 effectively decreased the occurrence of grade III-IV aGVHD and severe chronic GVHD.
Collapse
Affiliation(s)
- Joseph Pidala
- Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida 33612, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Antithymocyte globulins and chronic graft-vs-host disease after myeloablative allogeneic stem cell transplantation from HLA-matched unrelated donors: a report from the Sociéte Française de Greffe de Moelle et de Thérapie Cellulaire. Leukemia 2010; 24:1867-74. [PMID: 20882046 DOI: 10.1038/leu.2010.200] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This retrospective report assessed the impact of rabbit antithymocyte globulins (ATG), incorporated within a standard myeloablative conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT) using human leukocyte antigen-matched unrelated donors (HLA-MUD), on the incidence of acute and chronic graft-vs-host disease (GVHD). In this series of leukemia patients, 120 patients (70%) did not receive ATG ('no-ATG' group), whereas 51 patients received ATG ('ATG' group). With a median follow-up of 30.3 months, the cumulative incidence of grade 3-4 acute GVHD was 36% in the no-ATG group and 20% in the ATG group (P = 0.11). The cumulative incidence of extensive chronic GVHD was significantly lower in the ATG group as compared to the no-ATG group (4 vs 32%, respectively; P = 0.0017). In multivariate analysis, the absence of use of ATG was the strongest parameter associated with an increased risk of extensive chronic GVHD (relative risk) = 7.14, 95% CI: 1.7-33.3, P = 0.008). At 2 years, the probability of nonrelapse mortality, relapse, overall and leukemia-free survivals was not significantly different between the no-ATG and ATG groups. We conclude that the addition of ATG to GVHD prophylaxis resulted in decreased incidence of extensive chronic GVHD without an increase in relapse or nonrelapse mortality, and without compromising survival after myeloablative allo-SCT from HLA-MUD.
Collapse
|
30
|
Mastaglio S, Stanghellini MTL, Bordignon C, Bondanza A, Ciceri F, Bonini C. Progress and prospects: graft-versus-host disease. Gene Ther 2010; 17:1309-17. [PMID: 20508597 DOI: 10.1038/gt.2010.83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Graft-versus-host disease (GvHD) is one of the major complications of allogeneic hematopoietic stem cell transplantation, an otherwise highly effective therapeutic modality for patients affected by hematological diseases. The main inducers of GvHD are alloreactive donor T cells, which recognize host antigens presented by recipient cells. The critical role of lymphocytes in GvHD is well documented by the observation that T-cell depletion from the graft prevents GvHD. Unfortunately, the removal of donor lymphocytes from the graft increases the incidence of disease relapse and life-threatening infectious complications. Gene transfer technologies are promising tools to manipulate donor T-cell immunity to enforce graft-versus-tumor/graft-versus-infection while preventing or controlling GvHD. For this purpose, several cell and gene transfer approaches have been investigated at the preclinical level and implemented in clinical trials.
Collapse
Affiliation(s)
- S Mastaglio
- Hematology and BMT Unit, Department of Oncology, San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | | | | |
Collapse
|
31
|
HLA-mismatched unrelated donors are a viable alternate graft source for allogeneic transplantation following alemtuzumab-based reduced-intensity conditioning. Blood 2010; 115:5147-53. [PMID: 20371745 DOI: 10.1182/blood-2010-01-265413] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The impact of human leukocyte antigen (HLA) mismatch after reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation (RIT) using unrelated donors (UD) is unclear, and may be modulated by T-cell depletion. We therefore examined outcomes of 157 consecutive patients undergoing RIT after uniform conditioning with fludarabine, melphalan, and alemtuzumab (FMC). Donors were 10/10 HLA-matched (MUDs, n = 107) and 6 to 9/10 HLA-matched (MMUDs, n = 50), with no significant differences in baseline characteristics other than increased cytomegalovirus seropositivity in MMUDs. Rates of durable engraftment were high. Graft failure rates (persistent cytopenias with donor chimerism) were similar (8% vs 3%, P = .21), though rejection (recipient chimerism) was more frequent in MMUDs (8% vs 0%, P < .01). There were no significant differences between donors in the incidences of acute graft-versus-host disease (GVHD; 20% vs 22% grade 2-4, respectively, P = .83), chronic extensive GVHD (3-year cumulative incidence [CI] 23% vs 24%, P = .56), or treatment-related mortality (1-year CI 27% vs 27%, P = .96). Furthermore, there was no difference in 3-year overall survival (OS; 53% vs 49%, P = .44). Mismatch occurred at the antigenic level in 40 cases. The outcome in these cases did not differ significantly from the rest of the cohort. We conclude that RIT using HLA-mismatched grafts is a viable option using FMC conditioning.
Collapse
|
32
|
Kröger N, Shimoni A, Schilling G, Schwerdtfeger R, Bornhäuser M, Nagler A, Zander AR, Heinzelmann M, Brand R, Gahrton GÃ, Morris C, Niederwieser D, de Witte T. Unrelated stem cell transplantation after reduced intensity conditioning for patients with multiple myeloma relapsing after autologous transplantation. Br J Haematol 2010; 148:323-31. [DOI: 10.1111/j.1365-2141.2009.07984.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|