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de Koning C, Tao W, Lacna A, van Veghel K, Horwitz ME, Sanz G, Jagasia MH, Wagner JE, Stiff PJ, Hanna R, Cilloni D, Valcárcel D, Peled T, Galamidi Cohen E, Goshen U, Pandit A, Lindemans CA, Jan Boelens J, Nierkens S. Lymphoid and myeloid immune cell reconstitution after nicotinamide-expanded cord blood transplantation. Bone Marrow Transplant 2021; 56:2826-2833. [PMID: 34312498 PMCID: PMC8563413 DOI: 10.1038/s41409-021-01417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Omidubicel (nicotinamide-expanded cord blood) is a potential alternative source for allogeneic hematopoietic cell transplantation (HCT) when an HLA-identical donor is lacking. A phase I/II trial with standalone omidubicel HCT showed rapid and robust neutrophil and platelet engraftment. In this study, we evaluated the immune reconstitution (IR) of patients receiving omidubicel grafts during the first 6 months post-transplant, as IR is critical for favorable outcomes of the procedure. Data was collected from the omidubicel phase I-II international, multicenter trial. The primary endpoint was the probability of achieving adequate CD4+ T-cell IR (CD4IR: > 50 × 106/L within 100 days). Secondary endpoints were the recovery of T-cells, natural killer (NK)-cells, B-cells, dendritic cells (DC), and monocytes as determined with multicolor flow cytometry. LOESS-regression curves and cumulative incidence plots were used for data description. Thirty-six omidubicel recipients (median 44; 13-63 years) were included, and IR data was available from 28 recipients. Of these patients, 90% achieved adequate CD4IR. Overall, IR was complete and consisted of T-cell, monocyte, DC, and notably fast NK- and B-cell reconstitution, compared to conventional grafts. Our data show that transplantation of adolescent and adult patients with omidubicel results in full and broad IR, which is comparable with IR after HCT with conventional graft sources.
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Affiliation(s)
- Coco de Koning
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Weiyang Tao
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amelia Lacna
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Guillermo Sanz
- Hospital Universitario y Politécnico la Fe, València, Spain
- Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Caroline A Lindemans
- University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jaap Jan Boelens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stefan Nierkens
- University Medical Center Utrecht, Utrecht, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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Primary graft failure, but not relapse, may be identified by early chimerism following double cord unit transplantation. Blood Adv 2021; 6:2414-2426. [PMID: 34700343 PMCID: PMC9006284 DOI: 10.1182/bloodadvances.2021005106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022] Open
Abstract
Primary graft failure may be identified by early chimerism analysis after DUCBT with RIC. Chimerism does not appear to be useful in predicting relapse.
Umbilical cord blood transplantation (UCBT) has increased access to potentially curative therapy for patients with life-threatening disorders of the bone marrow and immune system. The introduction of reduced intensity conditioning (RIC) regimens and double umbilical cord unit infusions (DUCBT) has broadened the applicability of UCBT to more frail or larger recipients. The kinetics of chimerism after RIC DUCBT and their clinical utility are poorly understood. The RIC CBT trial reported here sought to prospectively evaluate the role of lineage-specific chimerism after DUCBT in adult patients with hematologic malignancies in the United Kingdom. Fifty-eight patients with a median age of 52 years were recruited, with overall and progression-free survivals of 59% (95% confidence interval [CI], 45%-71%) and 52% (95% CI, 39%-64%), respectively, at 2 years. Nonrelapse mortality was 4% (95% CI, 1%-13%) at day 100, and the relapse rate was 31% (95% CI, 21%-45%) at 1 year. Peripheral blood lineage-specific chimerism was feasible from day 7 after transplant onward. Five patterns of chimerism were observed including (1) complete single unit dominance (39 patients), (2) sustained donor-donor mixed chimerism (3 patients), (3) sustained donor-recipient mixed chimerism (5 patients), (4) dominance reversion (1 patient), and (5) primary graft failure (4 patients). The RIC CBT trial enabled adult patients with high-risk hematologic malignancies to safely access UCBT in the United Kingdom and provided novel insights into the kinetics of donor and recipient chimerism after RIC DUCBT that are clinically relevant. This trial was registered at https://www.clinicaltrialsregister.eu/ctr-search/trial/2004-003845-41/GB as #NCT00959231 and EudraCT 2004-003845-41.
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3
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Double Umbilical Cord Blood Transplantation in High-Risk Hematological Patients: A Phase II Study Focusing on the Mechanism of Graft Predominance. Hemasphere 2019; 3:e285. [PMID: 31942540 PMCID: PMC6919462 DOI: 10.1097/hs9.0000000000000285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/18/2022] Open
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Abstract
Three decades of research in hematopoietic stem cell transplantation and HIV/AIDS fields have shaped a picture of immune restoration disorders. This manuscript overviews the molecular biology of interferon networks, the molecular pathogenesis of immune reconstitution inflammatory syndrome, and post-hematopoietic stem cell transplantation immune restoration disorders (IRD). It also summarizes the effects of thymic involution on T cell diversity, and the results of the assessment of diagnostic biomarkers of IRD, and tested targeted immunomodulatory treatments.
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Affiliation(s)
- Hesham Mohei
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Usha Kellampalli
- Department of Medicine, University of Minnesota, Minneapolis, USA
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5
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Delayed immune reconstitution after allogeneic transplantation increases the risks of mortality and chronic GVHD. Blood Adv 2019; 2:909-922. [PMID: 29678809 DOI: 10.1182/bloodadvances.2017014464] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Slow immune reconstitution is a major obstacle to the successful use of allogeneic hematopoietic cell transplantation (allo-HCT). As matched sibling donor (MSD) allo-HCT is regarded as the gold standard, we evaluated the pace of immune reconstitution in 157 adult recipients of reduced-intensity conditioning followed by MSD peripheral blood HCT (n = 68) and compared these to recipients of umbilical cord blood (UCB; n = 89). At day 28, UCB recipients had fewer natural killer (NK) cells than MSD recipients, but thereafter, NK cell numbers (and their subsets) were higher in UCB recipients. During the first 6 months to 1 year after transplant, UCB recipients had slower T-cell subset recovery, with lower numbers of CD3+, CD8+, CD8+ naive, CD4+ naive, CD4+ effector memory T, regulatory T, and CD3+CD56+ T cells than MSD recipients. Notably, B-cell numbers were higher in UCB recipients from day 60 to 1 year. Bacterial and viral infections were more frequent in UCB recipients, yet donor type had no influence on treatment-related mortality or survival. Considering all patients at day 28, lower numbers of total CD4+ T cells and naive CD4+ T cells were significantly associated with increased infection risk, treatment-related mortality, and chronic graft-versus-host disease (GVHD). Patients with these characteristics may benefit from enhanced or prolonged infection surveillance and prophylaxis as well as immune reconstitution-accelerating strategies.
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6
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Impaired thymopoiesis predicts for a high risk of severe infections after reduced intensity conditioning without anti-thymocyte globulin in double umbilical cord blood transplantation. Bone Marrow Transplant 2018; 53:673-682. [DOI: 10.1038/s41409-018-0103-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023]
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Mehta RS, Olson A, Ponce DM, Shpall EJ. Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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8
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Cornelissen JJ, Kalin B, Lamers CHJ. Graft predominance after double umbilical cord blood transplantation: a review. Stem Cell Investig 2017; 4:47. [PMID: 28607921 DOI: 10.21037/sci.2017.05.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022]
Abstract
Several parameters are involved in graft predominance after double umbilical cord blood transplantation (dUCBT), of which T-cell alloreactivity between the grafts is now considered to be the major denominator. We recently showed that alloreactive CD4+ T-cells originating from the predominant CBU recognize HLA-class II allele mismatches and can readily be detected in the majority of patients. In addition, it was shown that HLA-class II allele-specific CD4+ T-cells were able to recognize primary leukemic cells when the mismatched HLA-class II allele was shared between the rejected CBU and the patient. These results further underscored the role of alloreactive T-cells, notably class II specific CD4+ T-cells, in graft-versus-graft reactions and in graft-versus-leukemia after dUCBT.
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Affiliation(s)
- Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Burak Kalin
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cor H J Lamers
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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9
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van Walraven SM, Brand A, Bakker JNA, Heemskerk MBA, Nillesen S, Bierings MB, Bungener LB, Hepkema BG, Lankester A, van der Meer A, Sintnicolaas K, Somers JAE, Spierings E, Tilanus MGJ, Voorter CEM, Cornelissen JJ, Oudshoorn M. The increase of the global donor inventory is of limited benefit to patients of non-Northwestern European descent. Haematologica 2017; 102:176-183. [PMID: 27561721 PMCID: PMC5210248 DOI: 10.3324/haematol.2016.145730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/22/2016] [Indexed: 11/09/2022] Open
Abstract
Between 2001 and 2012, the number of unrelated donors registered worldwide increased from 7 to 21 million, and the number of public cord blood units increased to over 500,000. We addressed the question of whether this expansion resulted in higher percentages of patients reaching transplantation. Unrelated donor searches were evaluated for 3,124 eligible patients in the Netherlands in two cohorts (2001-2006, n=995; 2007-2012, n=2129), comparing results for patients of Northwestern European and non-Northwestern European origin. Endpoints were 'donor found' and 'transplantation reached'. The substantial growth of the donor inventory over the period studied did not increase the median number of potential unrelated donors (n=7) for non-Northwestern European patients, but almost doubled the number for Northwestern European patients from 42 to 71. Before and after 2007, an unrelated donor or cord blood was identified for 91% and 95%, respectively, of Northwestern European patients and for 65% and 82% of non-Northwestern European patients (P<0.0001). Non-Northwestern European patients more often needed a cord blood transplant. The degree of HLA matching was significantly lower for non-Northwestern European patients (P<0.0006). The time needed to identify a donor decreased for both populations. The percentage of Northwestern European patients reaching transplantation increased from 77% to 83% and for non-Northwestern European patients from 57% to 72% (P=0.0003). The increase of the global inventory resulted in more transplants for patients lacking a family donor, although the quality and quantity of (potential) haematopoietic cell grafts for patients of a non-Northwestern European descent remained inferior, indicating the need for adaptation of recruitment.
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Affiliation(s)
| | - Anneke Brand
- Sanquin, Amsterdam, the Netherlands
- Leiden University Medical Center, Immunohematology and Blood Transfusion, Leiden
| | | | | | - Suzan Nillesen
- Stem Cell Donor Bank Europdonor Nijmegen, University Medical Center Nijmegen St. Radboud, the Netherlands
| | - Marc B Bierings
- University Medical Center Utrecht / Wilhelmina Kinderziekenhuis, Pediatric Stem Cell Transplantation Team, Leiden, the Netherlands
| | - Laura B Bungener
- University Medical Center Groningen, Laboratory for Transplant Immunology, Leiden, the Netherlands
| | - Bouke G Hepkema
- University Medical Center Groningen, Laboratory for Transplant Immunology, Leiden, the Netherlands
| | - Arjan Lankester
- Leiden University Medical Center, Willem Alexander Kinderziekenhuis, Department for Pediatric Stem Cell Transplantation, Leiden, the Netherlands
| | - Arnold van der Meer
- Stem Cell Donor Bank Europdonor Nijmegen, University Medical Center Nijmegen St. Radboud, the Netherlands
- Radboud University Medical Center, Laboratory Medical Immunology, Nijmegen, the Netherlands
| | - Kees Sintnicolaas
- Sanquin, Department of Transfusion Medicine, Rotterdam, the Netherlands
| | - Judith A E Somers
- Sanquin, Department of Transfusion Medicine, Rotterdam, the Netherlands
| | - Eric Spierings
- University Medical Center Utrecht, Department of Immunology, HLA laboratory, Maastricht, the Netherlands
| | - Marcel G J Tilanus
- University Hospital Maastricht, Transplantation Immunology, Tissue Typing Laboratory, Maastricht, the Netherlands
| | - Christien E M Voorter
- University Hospital Maastricht, Transplantation Immunology, Tissue Typing Laboratory, Maastricht, the Netherlands
| | - Jan J Cornelissen
- Erasmus University Medical Center, Department of Hematology, Rotterdam, the Netherlands
| | - Machteld Oudshoorn
- Europdonor Foundation, Leiden, the Netherlands
- Leiden University Medical Center, Immunohematology and Blood Transfusion, Leiden
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Mehta RS, Rezvani K. Can we make a better match or mismatch with KIR genotyping? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:106-118. [PMID: 27913469 PMCID: PMC6142490 DOI: 10.1182/asheducation-2016.1.106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Natural killer (NK) cell function is regulated by a fine balance between numerous activating and inhibitory receptors, of which killer-cell immunoglobulin-like receptors (KIRs) are among the most polymorphic and comprehensively studied. KIRs allow NK cells to recognize downregulation or the absence of HLA class I molecules on target cells (known as missing-self), a phenomenon that is commonly observed in virally infected cells or cancer cells. Because KIR and HLA genes are located on different chromosomes, in an allogeneic environment such as after hematopoietic stem cell transplantation, donor NK cells that express an inhibitory KIR for an HLA class I molecule that is absent on recipient targets (KIR/KIR-ligand mismatch), can recognize and react to this missing self and mediate cytotoxicity. Accumulating data indicate that epistatic interactions between KIR and HLA influence outcomes in several clinical conditions. Herein, we discuss the genetic and functional features of KIR/KIR-ligand interactions in hematopoietic stem cell transplantation and how these data can guide donor selection. We will also review clinical studies of adoptive NK cell therapy in leukemia and emerging data on the use of genetically modified NK cells that could broaden the scope of cancer immunotherapy.
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Affiliation(s)
- Rohtesh S Mehta
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Strategies before, during, and after hematopoietic cell transplantation to improve T-cell immune reconstitution. Blood 2016; 128:2607-2615. [PMID: 27697775 DOI: 10.1182/blood-2016-06-724005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/28/2016] [Indexed: 12/11/2022] Open
Abstract
T-cell immune reconstitution (IR) after allogeneic hematopoietic cell transplantation (allo-HCT) is highly variable between patients and may take several months to even years. Patients with delayed or unbalanced T-cell IR have a higher probability of developing transplantation-related morbidity, mortality, and relapse of disease. Hence, there is a need for strategies to better predict and improve IR to reduce these limitations of allo-HCT. In this review, we provide an update of current and in-near-future clinically relevant strategies before, during, and after transplantation to achieve successful T-cell IR. Potent strategies are choosing the right HCT source (eg, donor-recipient matching, cell dose, graft manipulation), individualized conditioning and serotherapy (eg, antithymocyte globulin), nutritional status, exercise, home care, modulation of microbiota, enhancing homeostatic peripheral expansion, promoting thymopoiesis, and the use of adjuvant-targeted cellular immunotherapies. Strategies to prevent graft-versus-host disease are important as well because this complication and the subsequent need for immunosuppression affects T-cell IR and function. These options aim for personalized precision transplantation, where allo-HCT therapy is designed to boost a well-balanced T-cell IR and limit complications in individual patients, resulting in overall lower morbidity and higher survival chances.
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12
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CD4+ T-cell alloreactivity toward mismatched HLA class II alleles early after double umbilical cord blood transplantation. Blood 2016; 128:2165-2174. [PMID: 27531680 DOI: 10.1182/blood-2016-06-718619] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/09/2016] [Indexed: 11/20/2022] Open
Abstract
Although double umbilical cord blood transplantation (dUCBT) in adult patients may be associated with less graft failure compared with single UCBT, hematopoietic recovery generally originates from a single cord blood unit (CBU). CBU predominance is still incompletely understood. We recently showed that blood CD4+ T-cell numbers rapidly increase after dUCBT, and early CD4+ T-cell chimerism predicts for graft predominance. Given the frequent HLA class II allele mismatches between CBUs in dUCBT, we hypothesized that alloreactive HLA class II-specific CD4+ T cells from the "winning" CBU may contribute to rejection of the "loser" CBU. We evaluated whether CD4+ T cells originating from the predominant (PD)-CBU would recognize HLA class II allele mismatches, expressed by the nonengrafting (NE)-CBU. Alloreactive effector CD4+ T cells toward 1 or more mismatched HLA class II alleles of the NE-CBU were detected in 11 of 11 patients, with reactivity toward 29 of 33 (88%) tested mismatches, and the strongest reactivity toward DR and DQ alleles early after dUCBT. Mismatched HLA class II allele-specific CD4+ T cells recognized primary leukemic cells when the mismatched HLA class II allele was shared between NE-CBU and patient. Our results suggest that cytotoxicity exerted by CD4+ T cells from the PD-CBU drives the rapid rejection of the NE-CBU, whose alloreactive effect might also contribute to graft-versus-leukemia.
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Ishida T, Takahashi S, Lai CY, Nojima M, Yamamoto R, Takeuchi E, Takeuchi Y, Higashihara M, Nakauchi H, Otsu M. Multiple allogeneic progenitors in combination function as a unit to support early transient hematopoiesis in transplantation. J Exp Med 2016; 213:1865-80. [PMID: 27503070 PMCID: PMC4995077 DOI: 10.1084/jem.20151493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/06/2016] [Indexed: 12/23/2022] Open
Abstract
Cord blood (CB) is a valuable donor source in hematopoietic cell transplantation. However, the initial time to engraftment in CB transplantation (CBT) is often delayed because of low graft cell numbers. This limits the use of CB. To overcome this cell dose barrier, we modeled an insufficient dose CBT setting in lethally irradiated mice and then added hematopoietic stem/progenitor cells (HSCs/HPCs; HSPCs) derived from four mouse allogeneic strains. The mixture of HSPCs rescued recipients and significantly accelerated hematopoietic recovery. Including T cells from one strain favored single-donor chimerism through graft versus graft reactions, with early hematopoietic recovery unaffected. Furthermore, using clinically relevant procedures, we successfully isolated a mixture of CD34(+) cells from multiple frozen CB units at one time regardless of HLA-type disparities. These CD34(+) cells in combination proved transplantable into immunodeficient mice. This work provides proof of concept that when circumstances require support of hematopoiesis, combined multiple units of allogeneic HSPCs are capable of early hematopoietic reconstitution while allowing single-donor hematopoiesis by a principal graft.
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Affiliation(s)
- Takashi Ishida
- Department of Hematology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Satoshi Takahashi
- Division of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Chen-Yi Lai
- Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Masanori Nojima
- Division of Advanced Medicine Promotion, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Ryo Yamamoto
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Emiko Takeuchi
- Department of Immunology, Kitasato University Graduate School of Medical Science, Kanagawa 252-0374, Japan
| | - Yasuo Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Masaaki Higashihara
- Department of Hematology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Hiromitsu Nakauchi
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Makoto Otsu
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
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Mehta RS, Rezvani K. Immune reconstitution post allogeneic transplant and the impact of immune recovery on the risk of infection. Virulence 2016; 7:901-916. [PMID: 27385018 DOI: 10.1080/21505594.2016.1208866] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Infection is the leading cause of non-relapse mortality after allogeneic haematopoietic cell transplantation (HCT). This occurs as a result of dysfunction to the host immune system from the preparative regimen used prior to HCT, combined with a delay in reconstitution of the donor-derived immune system after HCT. In this article, we elaborate on the process of immune reconstitution post-HCT that begins with the innate system and is followed by recovery of adaptive immunity. Simultaneously, we describe how the tempo of immune reconstitution influences the risk of various infections. We explain some of the key differences in immune reconstitution and the consequent risk of infections in recipients of peripheral blood stem cell, bone marrow or umbilical cord blood grafts. Other factors that impact on immune recovery are also highlighted. Finally, we allude to various strategies that are being tested to enhance immune reconstitution post-HCT.
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Affiliation(s)
- Rohtesh S Mehta
- a Division of Hematology, Oncology and Transplantation, University of Minnesota , Minneapolis , MN , USA
| | - Katayoun Rezvani
- b Department of Stem Cell Transplantation and Cellular Therapy , MD Anderson Cancer Center , Houston , TX , USA
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15
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Castillo N, García-Cadenas I, Díaz-Heredia C, Martino R, Barba P, Ferrà C, Canals C, Elorza I, Olivé T, Badell I, Sierra J, Valcárcel D, Querol S. Cord Blood Units with High CD3(+) Cell Counts Predict Early Lymphocyte Recovery After In Vivo T Cell-Depleted Single Cord Blood Transplantation. Biol Blood Marrow Transplant 2016; 22:1073-1079. [PMID: 27038860 DOI: 10.1016/j.bbmt.2016.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/07/2016] [Indexed: 11/29/2022]
Abstract
Although high absolute lymphocyte count (ALC) early after transplantation is a simple surrogate for immune reconstitution, few studies to date have established the predictive factors for ALC after umbilical cord blood transplantation (UCBT). We retrospectively studied the factors associated with early lymphocyte recovery and the impact of the ALC on day +42 (ALC42) of ≥300 × 10(6)/L on outcomes in 210 consecutive pediatric and adult patients (112 males; median age, 15 years; range, 0.3 to 60 years; interquartile range, 4 to 36 years) who underwent myeloablative in vivo T cell-depleted single UCBT between 2005 and 2014 for malignant and nonmalignant disorders. In a logistic multivariate regression model, factors favoring a higher ALC42 were higher infused CD3(+) cell dose (odds ratio [OR], 2.7; 95% CI, 1.4 to 5.2; P = .004), lower antithymocyte globulin dose (OR, 2.3; 95% CI, 1.2 to 4.5; P = .01), and better HLA match (OR, 2.1; 95% CI, 1.1 to 4.1; P = .03). In multivariate analysis, lower ALC42 was associated with higher nonrelapse mortality (hazard ratio [HR], 1.76; 95% CI, 1.34 to 2.32; P = .001), whereas a higher ALC42 was associated with better disease-free survival (HR, 2.03; 95% CI, 1.15 to 3.6; P < .001) and overall survival (HR, 2.03; 95% CI, 1.17 to 3.6; P < .001). Our study suggests that the selection of better HLA-matched cord blood units containing higher CD3(+) cell counts and the use of conditioning regimens with lower ATG doses could improve immune reconstitution after UCBT.
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Affiliation(s)
| | - Irene García-Cadenas
- Adult Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Díaz-Heredia
- Pediatric Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rodrigo Martino
- Adult Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Barba
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Izaskun Elorza
- Pediatric Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Teresa Olivé
- Pediatric Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Isabel Badell
- Pediatric Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jorge Sierra
- Adult Hematology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Valcárcel
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Guillaume N, Loiseau P, Gagne K, Teissserenc HM, Cayuela JM, Henry G, Robin M, Peffault de Latour R, Gluckman E, Socié G, Retiere C, Dulphy N, Toubert A. Natural killer cell licensing after double cord blood transplantation is driven by the self-HLA class I molecules from the dominant cord blood. Haematologica 2016; 101:e209-12. [PMID: 26819052 DOI: 10.3324/haematol.2015.138883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Nicolas Guillaume
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Amiens, France Laboratoire d'Hématologie et d' Histocompatibilité, EA 4666 «Lymphocyte Normal - Pathologique et Cancers», Centre Hospitalier Universitaire, Amiens, France
| | - Pascale Loiseau
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Amiens, France Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France Inserm, UMRS-1160, Institut Universitaire d'Hématologie, Paris
| | - Katia Gagne
- Etablissement Français du Sang (EFS), Laboratoire d'Histocompatibilité, Nantes, France EFS, Laboratoire de Recherche EA4271, Nantes, France LabEx Transplantex, University of Strasbourg, Paris, France
| | - Hélène Moins Teissserenc
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Amiens, France Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France Inserm, UMRS-1160, Institut Universitaire d'Hématologie, Paris Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, EA3518, Paris, France
| | - Jean-Michel Cayuela
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, EA3518, Paris, France AP-HP, Laboratoire d'Hématologie, Hôpital Saint-Louis, Paris, France
| | - Guylaine Henry
- Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France
| | - Marie Robin
- AP-HP, Hématologie -Transplantation; Hôpital Saint Louis, Paris, France
| | | | | | - Gérard Socié
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Amiens, France AP-HP, Hématologie -Transplantation; Hôpital Saint Louis, Paris, France
| | - Christelle Retiere
- EFS, Laboratoire de Recherche EA4271, Nantes, France LabEx Transplantex, University of Strasbourg, Paris, France
| | - Nicolas Dulphy
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Amiens, France Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France Inserm, UMRS-1160, Institut Universitaire d'Hématologie, Paris LabEx Transplantex, University of Strasbourg, Paris, France
| | - Antoine Toubert
- Université Paris-Diderot, Sorbonne Paris Cité, Institut Universitaire d'Hématologie, Amiens, France Assistance Publique-Hopitaux de Paris (AP-HP), Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatibilité, Paris, France Inserm, UMRS-1160, Institut Universitaire d'Hématologie, Paris LabEx Transplantex, University of Strasbourg, Paris, France
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17
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Mehta RS, Shpall EJ, Rezvani K. Cord Blood as a Source of Natural Killer Cells. Front Med (Lausanne) 2016; 2:93. [PMID: 26779484 PMCID: PMC4700256 DOI: 10.3389/fmed.2015.00093] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/10/2015] [Indexed: 12/11/2022] Open
Abstract
Cord blood (CB) offers several unique advantages as a graft source for hematopoietic stem cell transplantation (HSCT). The risk of relapse and graft vs. host disease after cord blood transplantation (CBT) is lower than what is typically observed after other graft sources with a similar degree of human leukocyte antigen mismatch. Natural killer (NK) cells have a well-defined role in both innate and adaptive immunity and as the first lymphocytes to reconstitute after HSCT and CBT, and they play a significant role in protection against early relapse. In this article, we highlight the uses of CB NK cells in transplantation and adoptive immunotherapy. First, we will describe differences in the phenotype and functional characteristics of NK cells in CB as compared with peripheral blood. Then, we will review some of the obstacles we face in using resting CB NK cells for adoptive immunotherapy, and discuss methods to overcome them. We will review the current literature on killer-cell immunoglobulin-like receptors ligand mismatch and outcomes after CBT. Finally, we will touch on current strategies for the use of CB NK cells in cellular immunotherapy.
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Affiliation(s)
- Rohtesh S Mehta
- Division of Hematology, Oncology and Transplantation, University of Minnesota Medical Center , Minneapolis, MN , USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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18
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van der Garde M, van Hensbergen Y, Brand A, Slot MC, de Graaf-Dijkstra A, Mulder A, Watt SM, Zwaginga JJ. Thrombopoietin treatment of one graft in a double cord blood transplant provides early platelet recovery while contributing to long-term engraftment in NSG mice. Stem Cells Dev 2015; 24:67-76. [PMID: 25137252 DOI: 10.1089/scd.2014.0294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Human cord blood (CB) hematopoietic stem cell (HSC) transplants demonstrate delayed early neutrophil and platelet recovery and delayed longer term immune reconstitution compared to bone marrow and mobilized peripheral blood transplants. Despite advances in enhancing early neutrophil engraftment, platelet recovery after CB transplantation is not significantly altered when compared to contemporaneous controls. Recent studies have identified a platelet-biased murine HSC subset, maintained by thrombopoietin (TPO), which has enhanced capacity for short- and long-term platelet reconstitution, can self-renew, and can give rise to myeloid- and lymphoid-biased HSCs. In previous studies, we have shown that transplantation of human CB CD34(+) cells precultured in TPO as a single graft accelerates early platelet recovery as well as yielding long-term repopulation in immune-deficient mice. In this study, using a double CB murine transplant model, we investigated whether TPO cultured human CB CD34(+) cells have a competitive advantage or disadvantage over untreated human CB CD34(+) cells in terms of (1) short-term and longer term platelet recovery and (2) longer term hematological recovery. Our studies demonstrate that the TPO treated graft shows accelerated early platelet recovery without impairing the platelet engraftment of untreated CD34(+) cells. Notably, this was followed by a dominant contribution to platelet production through the untreated CD34(+) cell graft over the intermediate to longer term. Furthermore, although the contribution of the TPO treated graft to long-term hematological engraftment was reduced, the TPO treated and untreated grafts both contributed significantly to long-term chimerism in vivo.
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Affiliation(s)
- Mark van der Garde
- 1 Jon J. van Rood Center for Clinical Transfusion Research , Sanquin Blood Supply Foundation, Leiden, The Netherlands
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19
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Beije N, Versluis J, Kraan J, Gratama JW, Sleijfer S, Cornelissen JJ. Circulating endothelial cell enumeration demonstrates prolonged endothelial damage in recipients of myeloablative allogeneic stem cell transplantation. Haematologica 2015; 100:e246-9. [PMID: 25710454 DOI: 10.3324/haematol.2014.121731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nick Beije
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology and Cancer Genomics Netherlands
| | - Jurjen Versluis
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, The Netherlands
| | - Jaco Kraan
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology and Cancer Genomics Netherlands
| | - Jan W Gratama
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology and Cancer Genomics Netherlands
| | - Stefan Sleijfer
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Medical Oncology and Cancer Genomics Netherlands
| | - Jan J Cornelissen
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, The Netherlands
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20
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Saliba RM, Rezvani K, Leen A, Jorgensen J, Shah N, Hosing C, Parmar S, Oran B, Olson A, Rondon G, Chen J, Martinez C, Hamdi A, Mehta RS, Chemaly RF, Saunders IM, Bollard CM, Shpall EJ. General and Virus-Specific Immune Cell Reconstitution after Double Cord Blood Transplantation. Biol Blood Marrow Transplant 2015; 21:1284-90. [PMID: 25708219 DOI: 10.1016/j.bbmt.2015.02.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 02/16/2015] [Indexed: 01/09/2023]
Abstract
Cord blood transplantation (CBT) is curative for many patients with hematologic malignancies but is associated with delayed immune recovery and an increased risk of viral infections compared with HLA-matched bone marrow or peripheral blood progenitor cell transplantation. In this study we evaluated the significance of lymphocyte recovery in 125 consecutive patients with hematologic malignancies who underwent double-unit CBT (DUCBT) with an antithymocyte globulin-containing regimen at our institution. A subset of 65 patients was prospectively evaluated for recovery of T, natural killer (NK), and B cells, and in 46 patients we also examined viral-specific T cell recovery against adenovirus, Epstein-Barr virus, cytomegalovirus, BK virus, respiratory syncytial virus, and influenza antigen. Our results indicate that in recipients of DUCBT, the day 30 absolute lymphocyte count is highly predictive of nonrelapse mortality and overall survival. Immune recovery post-DUCBT was characterized by prolonged CD8+ and CD4+ T lymphopenia associated with preferential expansion of B and NK cells. We also observed profound delays in quantitative and functional recovery of viral-specific CD4+ and CD8+ T cell responses for the first year post-CBT. Taken together, our data support efforts aimed at optimizing viral-specific T cell recovery to improve outcomes post-CBT.
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Affiliation(s)
- Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Ann Leen
- Department of Pediatrics, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Jeffrey Jorgensen
- Department of Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Charles Martinez
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Amir Hamdi
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Rohtesh S Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Roy F Chemaly
- Department of Infectious Diseases, MD Anderson Cancer Center, Houston, Texas
| | - Ila M Saunders
- Hematology/Oncology and Bone Marrow Transplant, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California San Diego, La Jolla, California
| | - Catherine M Bollard
- Division of Blood and Marrow Transplantation, Children's National Hospital System and George Washington University, Washington, DC
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas.
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Abstract
The use of umbilical cord blood (UCB) as an alternative haematopoietic cell source in lieu of bone marrow for haematopoietic reconstitution is increasingly becoming a mainstay treatment for both malignant and nonmalignant diseases, as most individuals will have at least one available, suitably HLA-matched unit of blood. The principal limitation of UCB is the low and finite number of haematopoietic stem and progenitor cells (HSPC) relative to the number found in a typical bone marrow or mobilized peripheral blood allograft, which leads to prolonged engraftment times. In an attempt to overcome this obstacle, strategies that are often based on native processes occurring in the bone marrow microenvironment or 'niche' have been developed with the goal of accelerating UCB engraftment. In broad terms, the two main approaches have been either to expand UCB HSPC ex vivo before transplantation, or to modulate HSPC functionality to increase the efficiency of HSPC homing to the bone marrow niche after transplant both of which enhance the biological activities of the engrafted HSPC. Several early phase clinical trials of these approaches have reported promising results.
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22
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Somers JAE, Braakman E, van der Holt B, Petersen EJ, Marijt EWA, Huisman C, Sintnicolaas K, Oudshoorn M, Groenendijk-Sijnke ME, Brand A, Cornelissen JJ. Rapid induction of single donor chimerism after double umbilical cord blood transplantation preceded by reduced intensity conditioning: results of the HOVON 106 phase II study. Haematologica 2014; 99:1753-61. [PMID: 25107890 DOI: 10.3324/haematol.2014.106690] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Double umbilical cord blood transplantation is increasingly applied in the treatment of adult patients with high-risk hematological malignancies and has been associated with improved engraftment as compared to that provided by single unit cord blood transplantation. The mechanism of improved engraftment is, however, still incompletely understood as only one unit survives. In this multicenter phase II study we evaluated engraftment, early chimerism, recovery of different cell lineages and transplant outcome in 53 patients who underwent double cord blood transplantation preceded by a reduced intensity conditioning regimen. Primary graft failure occurred in one patient. Engraftment was observed in 92% of patients with a median time to neutrophil recovery of 36 days (range, 15-102). Ultimate single donor chimerism was established in 94% of patients. Unit predominance occurred by day 11 after transplantation and early CD4(+) T-cell chimerism predicted for unit survival. Total nucleated cell viability was also associated with unit survival. With a median follow up of 35 months (range, 10-51), the cumulative incidence of relapse and non-relapse mortality rate at 2 years were 39% and 19%, respectively. Progressionfree survival and overall survival rates at 2 years were 42% (95% confidence interval, 28-56) and 57% (95% confidence interval, 43-70), respectively. Double umbilical cord blood transplantation preceded by a reduced intensity conditioning regimen using cyclophosphamide/fludarabine/4 Gy total body irradiation results in a high engraftment rate with low non-relapse mortality. Moreover, prediction of unit survival by early CD4(+) lymphocyte chimerism might suggest a role for CD4(+) lymphocyte mediated unit-versus-unit alloreactivity. www.trialregister.nl NTR1573.
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Affiliation(s)
- Judith A E Somers
- Erasmus MC-Daniel Den Hoed Cancer Center, Dept. of Hematology, Rotterdam Sanquin Blood Supply, Dept. of Transfusion Medicine, Rotterdam/Leiden
| | - Eric Braakman
- Erasmus MC-Daniel Den Hoed Cancer Center, Dept. of Hematology, Rotterdam
| | - Bronno van der Holt
- Erasmus MC-Daniel Den Hoed Cancer Center, Clinical Trial Center, HOVON Data Center, Rotterdam
| | | | | | | | - Kees Sintnicolaas
- Sanquin Blood Supply, Dept. of Transfusion Medicine, Rotterdam/Leiden
| | - Machteld Oudshoorn
- Europdonor Foundation, Leiden Leiden University Medical Center, Dept. of Immunohematology and Blood Transfusion, the Netherlands
| | | | - Anneke Brand
- Sanquin Blood Supply, Dept. of Transfusion Medicine, Rotterdam/Leiden Europdonor Foundation, Leiden Leiden University Medical Center, Dept. of Immunohematology and Blood Transfusion, the Netherlands
| | - Jan J Cornelissen
- Erasmus MC-Daniel Den Hoed Cancer Center, Dept. of Hematology, Rotterdam
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23
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Danby R, Rocha V. Improving engraftment and immune reconstitution in umbilical cord blood transplantation. Front Immunol 2014; 5:68. [PMID: 24605111 PMCID: PMC3932655 DOI: 10.3389/fimmu.2014.00068] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/07/2014] [Indexed: 12/31/2022] Open
Abstract
Umbilical cord blood (UCB) is an important source of hematopoietic stem cells (HSC) for allogeneic transplantation when HLA-matched sibling and unrelated donors (MUD) are unavailable. Although the overall survival results for UCB transplantation are comparable to the results with MUD, UCB transplants are associated with slow engraftment, delayed immune reconstitution, and increased opportunistic infections. While this may be a consequence of the lower cell dose in UCB grafts, it also reflects the relative immaturity of cord blood. Furthermore, limited cell numbers and the non-availability of donor lymphocyte infusions currently prevent the use of post-transplant cellular immunotherapy to boost donor-derived immunity to treat infections, mixed chimerism, and disease relapse. To further develop UCB transplantation, many strategies to enhance engraftment and immune reconstitution are currently under investigation. This review summarizes our current understanding of engraftment and immune recovery following UCB transplantation and why this differs from allogeneic transplants using other sources of HSC. It also provides a comprehensive overview of promising techniques being used to improve myeloid and lymphoid recovery, including expansion, homing, and delivery of UCB HSC; combined use of UCB with third-party donors; isolation and expansion of natural killer cells, pathogen-specific T cells, and regulatory T cells; methods to protect and/or improve thymopoiesis. As many of these strategies are now in clinical trials, it is anticipated that UCB transplantation will continue to advance, further expanding our understanding of UCB biology and HSC transplantation.
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Affiliation(s)
- Robert Danby
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Trust , Oxford , UK ; NHS Blood and Transplant, John Radcliffe Hospital , Oxford , UK ; Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH , Paris , France
| | - Vanderson Rocha
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Trust , Oxford , UK ; NHS Blood and Transplant, John Radcliffe Hospital , Oxford , UK ; Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH , Paris , France
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24
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Li L, Kim HT, Nellore A, Patsoukis N, Petkova V, McDonough S, Politikos I, Nikiforow S, Soiffer R, Antin JH, Ballen K, Cutler C, Ritz J, Boussiotis VA. Prostaglandin E2 promotes survival of naive UCB T cells via the Wnt/β-catenin pathway and alters immune reconstitution after UCBT. Blood Cancer J 2014; 4:e178. [PMID: 24442207 PMCID: PMC3913944 DOI: 10.1038/bcj.2013.75] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/06/2013] [Indexed: 01/22/2023] Open
Abstract
The outcome of umbilical cord blood transplantation (UCBT) is compromised by low hematopoietic stem cell (HSC) doses leading to prolonged time to engraftment, delayed immunological reconstitution and late memory T-cell skewing. Exposure of UCB to dimethyl-prostaglandin E2 (dmPGE2) increases HSC in vivo. We determined that exposure of UCB T lymphocytes to dmPGE2 modified Wnt signaling resulting in T cell factor (TCF)-mediated transcription. Wnt signaling upregulated interleukin (IL)-7R and IL-2Rβ, resulting in enhanced survival mediated by the homeostatic cytokines IL-7 and IL-15. dmPGE2 also induced components of the Wnt pathway and Wnt receptors, thereby priming UCB T cells to receive signals via Wnt ligands in vivo. We observed that the Wnt transcription factor TCF7 and its target EOMES were elevated in the T cells of patients who received PGE2-treated UCBs. Consistent with the role of Wnt/β-catenin signaling to induce and maintain naive, memory precursors and long-lived central memory CD8(+) cells, these patients also had increased fractions of CD8(+)CD45RO(-)CD62L(+) plus CD8(+)CD45RO(+)CD62L(+) subsets encompassing these T-cell populations. These effects of the PGE2/Wnt/β-catenin axis may have significant implications for harnessing immunity in the context of UCBT, where impaired immune reconstitution is associated with late memory T-cell skewing.
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Affiliation(s)
- L Li
- Department of Medicine, Division of Hematology/Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - H T Kim
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - A Nellore
- Department of Medicine, Division of Hematology/Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - N Patsoukis
- Department of Medicine, Division of Hematology/Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - V Petkova
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S McDonough
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - I Politikos
- Department of Medicine, Division of Hematology/Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S Nikiforow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - R Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J H Antin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - K Ballen
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - C Cutler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - V A Boussiotis
- Department of Medicine, Division of Hematology/Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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25
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Mesenchymal stromal cell supported umbilical cord blood ex vivo expansion enhances regulatory T cells and reduces graft versus host disease. Cytotherapy 2013; 15:610-9. [DOI: 10.1016/j.jcyt.2012.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/26/2012] [Accepted: 12/27/2012] [Indexed: 01/11/2023]
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