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Saini M, Khadwal AR, Roy SS, Pandiarajan V, Malhotra P. Haploidentical Transplant in Radiosensitive Severe Combined Immunodeficiency Disease. Cureus 2023; 15:e45159. [PMID: 37842439 PMCID: PMC10572685 DOI: 10.7759/cureus.45159] [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: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Severe combined immunodeficiency (SCID) is an inborn error of immunity invariably resulting in mortality in infancy until managed by hematopoietic stem cell transplant (HSCT). We present an unusual case of SCID with a rare mutation involving the non-homologous end-joining 1 (NHEJ1) gene, where a haploidentical HSCT was carried out with modified conditioning and graft versus host prophylaxis regimen using proteasome inhibitor bortezomib with a successful outcome.
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Affiliation(s)
- Manpreet Saini
- Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Alka R Khadwal
- Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sayan S Roy
- Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Vignesh Pandiarajan
- Pediatric Allergy and Immunology, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Pankaj Malhotra
- Clinical Hematology & Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
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2
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Bourgeois AL, Jullien M, Garnier A, Peterlin P, Béné MC, Guillaume T, Chevallier P. Post-transplant cyclophosphamide as sole GHVD prophylaxis after matched reduced-intensity conditioning allotransplant. Clin Transl Med 2023; 13:e1242. [PMID: 37140099 PMCID: PMC10131294 DOI: 10.1002/ctm2.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/01/2023] [Accepted: 04/07/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Post-transplant cyclophosphamide (PTCY) alone as graft-versus-host disease (GVHD) prophylaxis may avoid/reduce short- and mid-term toxicities of drugs commonly used for GVHD prophylaxis, accelerate immune reconstitution after the graft to decrease infections and facilitate the early integration of adjunct maintenance therapies to prevent relapse. OBJECTIVE A prospective phase 2 study was designed in order to assess the feasibility and safety of PTCY as a sole GVHD prophylaxis in adult patients receiving a Baltimore-based reduced-intensity conditioning (RIC) peripheral blood (PB) allogeneic hematopoietic stem cell transplantation (Allo-HSCT) with a matched donor. STUDY DESIGN Patients were planned to be included stepwise up to 59 evaluable PTCY recipients, in order to be able to stop the protocol in case of excessive corticosteroid resistant grade 3-4 severe acute GVHD (aGVHD). Because a high incidence of grade 2-4 aGVHD was observed after analysis of the first 27 patients, the protocol was amended to test the addition of 1 day of anti-thymoglobulin to PTCY. In spite of this, the trial had to be stopped after 38 treated patients, because of an unacceptable rate of grade 3-4 aGVHD. Donors were matched related to 12 patients and unrelated to 26. RESULTS With a median follow-up of 29.6 months, 2-year overall, disease-free and GVHD-free relapse-free (GRFS) survivals were respectively 65.4%, 62.1% and 46.9%. Cumulative incidences of grade 2-4 and 3-4 aGVHD at day 100 were 52.6% and 21.1%, respectively, while that of moderate/severe chronic(c) GVHD was 15.7% at 2 years. Addition of ATG to PTCY did influence neither aGVHD, cGVHD nor GRFS. CONCLUSION Despite paradoxically good survivals, especially GRFS, this study failed to demonstrate that PTCY (± ATG) alone can be used for Baltimore-based RIC PB Allo-HSCT with matched donors. Other combinations should be tested to try and avoid long-term use of immunosuppressive drugs following Allo-HSCT in this setting.
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Affiliation(s)
| | - Maxime Jullien
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie C Béné
- INSERM UMR1232, CRCINA IRS-UN, University of Nantes, Nantes, France
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Thierry Guillaume
- Hematology Department, Nantes University Hospital, Nantes, France
- INSERM UMR1232, CRCINA IRS-UN, University of Nantes, Nantes, France
| | - Patrice Chevallier
- Hematology Department, Nantes University Hospital, Nantes, France
- INSERM UMR1232, CRCINA IRS-UN, University of Nantes, Nantes, France
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PTCY and Tacrolimus for GVHD Prevention for Older Adults Undergoing HLA-Matched Sibling and Unrelated Donor AlloHCT. Transplant Cell Ther 2022; 28:489.e1-489.e9. [PMID: 35577323 DOI: 10.1016/j.jtct.2022.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The use of PTCY for graft-versus-host disease (GHVD) prevention is becoming prevalent in the transplant community when HLA-identical sibling (MSD) and 10/10 HLA-matched (MUD) and 9/10 mismatched (MMUD) unrelated donors are selected for alloHSCT. However, reported evidence on outcomes from elderly receiving PTCY-containing GVHD prophylaxis remains limited. OBJECTIVES This study aims to compare the outcomes of PTCY-TK prophylaxis and conventional GVHD prophylaxis in patients aged >50 years undergoing peripheral blood alloHSCT from a single institution. STUDY DESIGN A total of 161 consecutive patients aged >50 years undergoing alloHSCT between Jan-2014 and Feb-2021 were included. Data was collected retrospectively and updated in December 2021. Patients received grafts from HLA-identical sibling (MSD), and from 10/10 and 9/10 HLA matched and mismatched unrelated donors (UD). RESULTS Overall, median age was 60 years and 91 (54.8%) received PTCY-TK for GVHD prevention. Time to neutrophil and platelet engraftment was longer in the PTCY-TK group (20 vs. 16 days and 19 vs. 11 days, P< 0.001). The cumulative incidences of grade II-IV and III-IV aGVHD at day +100 and moderate/severe cGVHD at 2 years were 18.2%, 5.7% and 9.5% for patients receiving PTCY-TK, and 26.0%, 9.6% and 39.5% for those that did not. The multivariate analysis showed that PTCY-TK reduced the probability of grade II-IV aGVHD (HR 0.41, p=0.035), of cGVHD [any grade: HR 0.43 (p=0.014), and of moderate/severe cGVHD (HR 0.15 (p<0.001)]. At 2-years, the overall survival (65.4% vs. 65.6%, p=0.472), non-relapse mortality (17.4% vs. 13.7%, p=0.967), and cumulative incidence of relapse rates (24.2% vs. 27.5%, p=0.712) were comparable between both cohorts; GVHD-Free/Relapse-free survival (GRFS) was higher in the PTCY-TK group (2-years: 50.2% vs. 21.8%; HR 0.42, p=0.001). In patients aged ≥50 years, Conclusion: PTCY-TK was safe and a more effective drug combination than non-PTCY containing GVHD prophylaxis, even with the use of matched and mismatched UD, and resulted in comparable relapse rates and better GRFS.
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Zhang W, Zhang Q, Wei X, Feng Y. Bortezomib-containing regiment in treating glomerulopathy with fibronectin deposits combined with monoclonal gammopathy of undetermined significance: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:379. [PMID: 35434028 PMCID: PMC9011310 DOI: 10.21037/atm-22-242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
Abstract
Background Glomerulopathy with fibronectin deposits (GFND) is a newly recognized rare glomerular disease. As its onset can be stably inherited in affected families without sex differences and fibronectin 1 (FN1) mutations can be detected in 40% of patients’ families, GFND is considered to be an autosomal dominant genetic disease. The main clinical manifestations are proteinuria, progressive renal failure, edema, hypertension, hematuria, and type 4 renal tubular acidosis. The diagnosis was confirmed by renal biopsy, and there was no specific treatment. Monoclonal gammopathy refers to the existence of monoclonal immunoglobulin (MIg) produced by monoclonal plasma cells in serum. When MIg damages the kidney by direct deposition or indirect mechanisms, it is defined as monoclonal gammopathy of renal significance (MGRS). The principle of treatment is to inhibit plasma cells from producing MIg. Case Description We report the efficacy of a case of GFND combined with monoclonal gammopathy of undetermined significance (MGUS) treated with a bortezomib-containing regimen. A 44-year-old female patient was admitted to the hospital for “edema of both lower extremities for 1 month and aggravation for 5 days”. In May 2018, after exertion, the patient developed edema of both lower extremities, accompanied by foamy urine with no obvious deepening of urine color or decreased output, no gross hematuria, and gradual aggravation with fatigue. Conclusions After treatment, the edema of patient subsided, urinary protein decreased significantly, and serum albumin increased near to normal. It is achieving a very good therapeutic effect and long-term event-free survival. The treatment is safety and there are no obvious toxic side effects. It provides a new idea for the treatment of GFND.
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Affiliation(s)
- Wenjie Zhang
- Department of Hematology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Qike Zhang
- Department of Hematology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Xiaofang Wei
- Department of Hematology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Youfan Feng
- Department of Hematology, Gansu Provincial People's Hospital, Lanzhou, China
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Mossallam GI, Fattah RA, Bokhary M, Moneer M, Mahmoud HK. LMP7 polymorphism may modify the presentation and clinical impact of minor histocompatibility antigens in matched related hematopoietic stem cell transplantation. Cell Immunol 2021; 364:104329. [PMID: 33798908 DOI: 10.1016/j.cellimm.2021.104329] [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: 12/04/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Differential expression of minor histocompatibility antigens between the recipient and donor determines their disparity and can be modified by immunoproteasomes that regulate their processing and presentation. We examined the impact of HA-1 and HA-8 disparity, and immunoproteasome LMP7 polymorphism in 130 pairs. In multivariate analysis, HA-1 disparity showed a statistically significant association with an increased incidence of acute graft-versus-host disease (aGVHD) II-IV (p = 0.043, HR: 3.71, 95%CI = 1.04-13.26), while LMP7-Q/Q showed a trend toward increased incidence of aGVHD compared to LMP7-Q/K and K/K genotypes (p = 0.087, HR: 2.36, 95%CI = 0.88-6.31). All HA-1 and HA-8 disparate patients who developed aGVHD had the LMP7-Q/Q genotype. No significant association could be detected between HA-1, HA-8, or LMP7 and chronic GVHD, relapse-free survival (RFS), overall survival (OS), or transplant-related mortality (TRM). In conclusion, we suggested an association between the HA-1 disparity and the risk of developing aGVHD with a possible modifying effect of LMP7.
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Affiliation(s)
- Ghada I Mossallam
- Bone Marrow Transplantation Laboratory Unit, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Raafat Abdel Fattah
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Bone Marrow Transplantation Unit, Nasser Institute Hospital for Research and Treatment, Cairo, Egypt
| | - Mahmoud Bokhary
- Bone Marrow Transplantation Unit, Nasser Institute Hospital for Research and Treatment, Cairo, Egypt
| | - Manar Moneer
- Department of Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Egypt
| | - Hossam K Mahmoud
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Bone Marrow Transplantation Unit, Nasser Institute Hospital for Research and Treatment, Cairo, Egypt
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Kunacheewa C, Owattanapanish W, Jirabanditsakul C, Issaragrisil S. Post-Transplant Cyclophosphamide and Thymoglobulin, a Graft-Versus-Host Disease Prophylaxis in Matched Sibling Donor Peripheral Blood Stem Cell Transplantations. Cell Transplant 2020; 29:963689720965900. [PMID: 33035116 PMCID: PMC7784589 DOI: 10.1177/0963689720965900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Post-transplant cyclophosphamide (PTCy) has been explored in several types of stem cell transplantations (SCTs) and it proved highly effective in controlling graft-versus-host disease (GvHD) without aggravating relapsed disease. However, PTCy alone has resulted in inferior outcomes in matched sibling donor (MSD) employing peripheral blood (PB) SCTs. We hypothesized that adding thymoglobulin to PTCy would be able to control GvHD effectively. We retrospectively compared the use of standard GvHD prophylaxis encompassing a combination of PTCy and thymoglobulin (ATG) in patients with myeloid malignancies in a myeloablative conditioning MSD PBSCT. Forty-two patients underwent PBSCT using either methotrexate and cyclosporine (MTX/CSA, 21 patients) or PTCy and ATG (21 patients) as a GvHD prophylaxis. With median follow-ups of 71 months, the 1-year GvHD-free, relapse-free survival rates and chronic GvHD-free survival rate of the standard and PTCy/ATG groups were similar: 24% versus 37% (P = 0.251) and 29% versus 43% (P = 0.095), respectively. When focusing on chronic GvHD we observed that 17/35 patients (48.6%) suffered from this, 5/18 (27.8%) treated with MTX/CSA had extensive chronic GvHD, but 0/17 PTCy/ATG did. Twenty-one patients required additional GvHD treatment; 7/21 in the PTCy/ATG received only corticosteroid, while 8/14 MTX/CSA required at least 2 drugs. The 5-year overall survival rates were 52% and 52% (P = 0.859), and the 5-year disease-free survival rates were 52% and 52% (P = 0.862) for the MTX/CSA and PTCy/ATG groups, respectively. We conclude that PTCy in combination with ATG without immunosuppression of a calcineurin inhibitor can effectively control GvHD.
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Affiliation(s)
- Chutima Kunacheewa
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Owattanapanish
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chutirat Jirabanditsakul
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surapol Issaragrisil
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Lin J, Boon L, Bockermann R, Robertson A, Kjellman C, Anderson CC. Desensitization using imlifidase and EndoS enables chimerism induction in allosensitized recipient mice. Am J Transplant 2020; 20:2356-2365. [PMID: 32185855 PMCID: PMC7496317 DOI: 10.1111/ajt.15851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 01/25/2023]
Abstract
Mixed hematopoietic chimerism induction as a way to foster tolerance to donor organs in recipients who have been sensitized to donor antigens is challenging. Donor-specific antibodies (DSA) are a dominant barrier toward successful donor bone marrow engraftment. Although desensitization methods are routinely used in recipients with allosensitization for allogeneic bone marrow transplantation, engraftment is frequently unsuccessful. To overcome the barrier of prior sensitization we tested enzymatic desensitization of donor-specific IgG using imlifidase and endoglycosidase of Streptococcus pyogenes (EndoS), which both partially block the function of DSA in mice, as a novel approach to improve murine bone marrow engraftment in primed hosts. We found that EndoS was capable of inhibiting antibody-mediated killing of donor cells in vivo. Furthermore, the effect of EndoS depended on the titer of DSA and the genetic background of the recipients. In combination with imlifidase, EndoS improved the survival of donor bone marrow cells. Together with cyclophosphamide, bortezomib, T cell depletion, and nonlethal irradiation, imlifidase in combination with EndoS allowed allogeneic bone marrow engraftment in sensitized recipients. We conclude that enzymatic inactivation of DSA, using the combination of imlifidase and EndoS, can be used for inducing donor hematopoietic chimerism in allosensitized recipient mice in combination with other desensitization strategies.
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Affiliation(s)
- Jiaxin Lin
- Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada,Alberta Diabetes and Transplant InstitutesUniversity of AlbertaEdmontonAlbertaCanada
| | | | | | | | | | - Colin C. Anderson
- Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada,Department of Medical Microbiology and ImmunologyUniversity of AlbertaEdmontonAlbertaCanada,Alberta Diabetes and Transplant InstitutesUniversity of AlbertaEdmontonAlbertaCanada
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8
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Yokoyama E, Hashimoto D, Hayase E, Ara T, Ogasawara R, Takahashi S, Ohigashi H, Tateno T, Hasegawa Y, Chen X, Teshima T. Short-term KRP203 and posttransplant cyclophosphamide for graft-versus-host disease prophylaxis. Bone Marrow Transplant 2019; 55:787-795. [PMID: 31685933 DOI: 10.1038/s41409-019-0733-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/23/2022]
Abstract
Posttransplant high-dose cyclophosphamide (PTCY) has been increasingly used as graft-versus-host disease (GVHD) prophylaxis after HLA-haploidentical or matched hematopoietic stem cell transplantation (SCT). However, PTCY alone is insufficient and requires additional immunosuppressants such as calcineurin inhibitors. In the current study, we evaluated effects of a novel GVHD prophylaxis with PTCY in combination with short-term KRP203, a selective agonist of sphingosine-1-phosphate receptor 1 that regulates egress of lymphocytes from the secondary lymphoid organs (SLOs) in mice. Short-term oral administration of KRP203 alone induced apoptosis of donor T cells in the SLOs and ameliorated GVHD. Administration of KRP203 significantly preserved graft-versus-leukemia effects compared to cyclosporin. A combination of KRP203 on days 0 to +4 and PTCY on day +3 synergistically suppressed donor T-cell migration into the intestine and skin, and ameliorated GVHD more potently than PTCY alone. A combination of short-term KRP203 and PTCY is a promising novel calcineurin-free GVHD prophylaxis in HLA-haploidentical SCT.
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Affiliation(s)
- Emi Yokoyama
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Daigo Hashimoto
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
| | - Eiko Hayase
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Takahide Ara
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Reiki Ogasawara
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Shuichiro Takahashi
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Hiroyuki Ohigashi
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Takahiro Tateno
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Yuta Hasegawa
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Xuanzhong Chen
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, 060-8638, Japan.
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Caballero-Velázquez T, Calderón-Cabrera C, López-Corral L, Puig N, Marquez-Malaver F, Pérez-López E, García-Calderón C, Rosso-Fernández CM, Caballero Barrigón D, Martín J, Mateos MV, San Miguel J, Pérez-Simón JA. Efficacy of bortezomib to intensify the conditioning regimen and the graft-versus-host disease prophylaxis for high-risk myeloma patients undergoing transplantation. Bone Marrow Transplant 2019; 55:419-430. [PMID: 31551517 DOI: 10.1038/s41409-019-0670-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/15/2019] [Accepted: 07/22/2019] [Indexed: 11/09/2022]
Abstract
This multicenter phase I trial was designed to evaluate the safety and efficacy of bortezomib (Bz) as part of both the conditioning regimen and the graft-versus-host disease (GvHD) prophylaxis. Patients received fludarabine, melphalan and Bz (days -9 and -2). GVHD prophylaxis consisted of Bz (days +1, +4, and +7), sirolimus (Siro) from day -5 and tacrolimus (Tk) from -3 (except the first five patients that did not receive Tk). Twenty-five patients with poor prognostic multiple myeloma were included. Eleven out of the 19 patients had high-risk features. Out of the 21 patients evaluable at day +100, 14 were in CR (67%) and 7 (33%) in PR. Cumulative incidence (CI) of nonrelapse mortality at 1 year was 24%. CI of grades 2-4 and 3-4 acute GvHD was 35% and 10%, respectively; CI of chronic GvHD was 35% and 55% at 1 and 2 years, respectively. Overall and event free survival at 2 years were 64% and 31%, respectively. Bz as part of the conditioning regimen and in the combination with Siro/tacrolimus for GvHD prophylaxis is safe and effective allowing an optimal disease control early after transplant and reducing the risk of GvHD.
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Affiliation(s)
- T Caballero-Velázquez
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - C Calderón-Cabrera
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - L López-Corral
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - N Puig
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - F Marquez-Malaver
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - E Pérez-López
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - C García-Calderón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - C M Rosso-Fernández
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - D Caballero Barrigón
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - J Martín
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain
| | - M V Mateos
- Department of Hematology, Complejo Asistencial Universitario de Salamanca-IBSAL-CIBERONC, Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | - J San Miguel
- Clínica Universidad de Navarra, Centro Investigación Médica Aplicada (CIMA), IDISNA, CIBERONC, Pamplona, Spain
| | - J A Pérez-Simón
- Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), Universidad de Sevilla, Seville, Spain.
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10
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On the role of the immunoproteasome in transplant rejection. Immunogenetics 2018; 71:263-271. [PMID: 30220008 DOI: 10.1007/s00251-018-1084-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022]
Abstract
The immunoproteasome is expressed in cells of hematopoietic origin and is induced during inflammation by IFN-γ. Targeting the immunoproteasome with selective inhibitors has been shown to be therapeutically effective in pre-clinical models for autoimmune diseases, colitis-associated cancer formation, and transplantation. Immunoproteasome inhibition prevents activation and proliferation of lymphocytes, lowers MHC class I cell surface expression, reduces the expression of cytokines of activated immune cells, and curtails T helper 1 and 17 cell differentiation. This might explain the in vivo efficacy of immunoproteasome inhibition in different pre-clinical disease models for autoimmunity, cancer, and transplantation. In this review, we summarize the effect of immunoproteasome inhibition in different animal models for transplantation.
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11
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Fuchs E. Haploidentical Hematopoietic Cell Transplantation. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Al-Homsi AS, Cole K, Muilenburg M, Goodyke A, Abidi M, Duffner U, Williams S, Parker J, Abdel-Mageed A. Calcineurin and mTOR Inhibitor-Free Post-Transplantation Cyclophosphamide and Bortezomib Combination for Graft-versus-Host Disease Prevention after Peripheral Blood Allogeneic Hematopoietic Stem Cell Transplantation: A Phase I/II Study. Biol Blood Marrow Transplant 2017; 23:1651-1657. [PMID: 28549771 DOI: 10.1016/j.bbmt.2017.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022]
Abstract
Graft-versus-host disease (GVHD) hampers the utility of allogeneic hematopoietic stem cell transplantation (AHSCT). The purpose of this study was to determine the feasibility, safety, and efficacy of a novel combination of post-transplantation cyclophosphamide (PTC) and bortezomib for the prevention of GVHD. Patients undergoing peripheral blood AHSCT for hematological malignancies after reduced-intensity conditioning with grafts from HLA-matched related or unrelated donors were enrolled in a phase I/II clinical trial. Patients received a fixed dose of PTC and an increasing dose of bortezomib in 3 cohorts, from .7 to 1 and then to 1.3 mg/m2, administered 6 hours after graft infusion and 72 hours thereafter, during phase I. The study was then extended at the higher dose in phase II for a total of 28 patients. No graft failure and no unexpected grade ≥3 nonhematologic toxicities were encountered. The median times to neutrophil and platelet engraftment were 16 and 27 days, respectively. Day +100 treatment-related mortality was 3.6% (95% confidence interval [CI], .2% to 15.7%). The cumulative incidences of grades II to IV and grades III and IV acute GVHD were 35.9% (95% CI, 18.6% to 53.6%) and 11.7% (95% CI, 2.8% to 27.5%), respectively. The incidence of chronic GVHD was 27% (95% CI, 11.4% to 45.3%). Progression-free survival, overall survival, and GVHD and relapse-free survival rates were 50% (95% CI, 30.6% to 66.6%), 50.8% (95% CI, 30.1% to 68.2%), and 37.7% (95% CI, 20.1% to 55.3%), respectively. Immune reconstitution, measured by CD3, CD4, and CD8 recovery, was prompt. The combination of PTC and bortezomib for the prevention of GVHD is feasible, safe, and yields promising results. The combination warrants further examination in a multi-institutional trial.
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Affiliation(s)
- A Samer Al-Homsi
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Kelli Cole
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan
| | - Marlee Muilenburg
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan
| | - Austin Goodyke
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan
| | - Muneer Abidi
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Ulrich Duffner
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Stephanie Williams
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Jessica Parker
- Office of Research Administration, Spectrum Health, Grand Rapids, Michigan
| | - Aly Abdel-Mageed
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan
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13
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Al-Homsi AS, Goodyke A, McLane M, Abdel-Mageed S, Cole K, Muilenburg M, Feng Y. Post-Transplantation Cyclophosphamide and Ixazomib Combination Rescues Mice Subjected to Experimental Graft-versus-Host Disease and Is Superior to Either Agent Alone. Biol Blood Marrow Transplant 2016; 23:255-261. [PMID: 27888016 DOI: 10.1016/j.bbmt.2016.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/16/2016] [Indexed: 01/13/2023]
Abstract
Lapses in the prevention of graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) warrant novel approaches. Such approaches include, among others, the use of post-transplantation cyclophosphamide (PTC) and proteasome inhibitors. Although PTC alone consistently produces low rates of chronic GVHD, the incidence of acute GVHD remains significant. Inversely, prolonged post-transplantation administration of proteasome inhibitors carries a risk of paradoxical aggravation of GVHD. We examined whether the combination of cyclophosphamide and ixazomib addresses the limitations of each of these agents when used alone to prevent GVHD in mice subjected to allogeneic HSCT across MHC barriers. We chose ixazomib, an orally bioavailable proteasome inhibitor, because of its favorable physiochemical characteristics. The combination of cyclophosphamide and ixazomib improved overall survival of mice in comparison to an untreated control group and to groups receiving either cyclophosphamide alone or ixazomib alone. Furthermore, cyclophosphamide prevented the surge of IL-1β, GVHD aggravation, and sudden death associated with prolonged administration of ixazomib after HSCT. Finally, we demonstrated that although ixazomib was administered before cyclophosphamide, it did not impair the preferential depletion of proliferating as opposed to resting donor T cells. Our data suggest that the combination of cyclophosphamide and ixazomib for the prevention of GVHD after allogeneic HSCT is promising and merits further investigation in clinical trials.
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Affiliation(s)
- Ahmad Samer Al-Homsi
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan; Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Austin Goodyke
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan
| | - Michael McLane
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan
| | - Sarah Abdel-Mageed
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan
| | - Kelli Cole
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan
| | - Marlee Muilenburg
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan
| | - Yuxin Feng
- Adult Blood and Marrow Transplantation, Spectrum Health, Grand Rapids, Michigan
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14
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Citrin R, Foster JB, Teachey DT. The role of proteasome inhibition in the treatment of malignant and non-malignant hematologic disorders. Expert Rev Hematol 2016; 9:873-89. [DOI: 10.1080/17474086.2016.1216311] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Al-Homsi AS, Feng Y, Duffner U, Al Malki MM, Goodyke A, Cole K, Muilenburg M, Abdel-Mageed A. Bortezomib for the prevention and treatment of graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Exp Hematol 2016; 44:771-777. [PMID: 27224851 DOI: 10.1016/j.exphem.2016.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/06/2016] [Indexed: 01/13/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation is the standard treatment for a variety of benign and malignant conditions. However, graft-versus-host disease (GvHD) continues to present a major barrier to the success and wide applicability of this procedure. Although current GvHD prevention and treatment regimens exclusively target T cells, bortezomib, a reversible proteasome inhibitor, possesses unique immune regulatory activities that span a wide variety of cellular processes of T and dendritic cells essential for the development of GvHD. Herein, we review the current understanding of the effects of bortezomib in vitro and in animal models and summarize the clinical data relevant to its use in the prevention and treatment of GvHD. We conclude with an outline of the remaining challenges and opportunities to optimize bortezomib's potential role in this setting.
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Affiliation(s)
- Ahmad Samer Al-Homsi
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Yuxin Feng
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA
| | - Ulrich Duffner
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Austin Goodyke
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA
| | - Kelli Cole
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA
| | - Marlee Muilenburg
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA
| | - Aly Abdel-Mageed
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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16
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Gatza E, Choi SW. Approaches for the prevention of graft-versus-host disease following hematopoietic cell transplantation. Int J Hematol Oncol 2015; 4:113-126. [PMID: 27182433 DOI: 10.2217/ijh.15.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic option for malignant and non-malignant diseases, but the more widespread application of the therapy remains limited by the occurrence of graft versus host disease (GVHD). GVHD results from immune-mediated injury by donor immune cells against tissues in the HCT recipient, and can be characterized as acute or chronic depending on the time of onset and site of organ involvement. The majority of efforts have focused on GVHD prevention. Calcineurin inhibitors are the most widely used agents and are included in almost all regimens. Despite current prophylaxis strategies, 40-70% of patients remain at risk for developing GVHD. Herein, we review standard and emerging therapies used in GVHD management.
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Affiliation(s)
- Erin Gatza
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, United States
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17
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Fenske TS, Shah NM, Kim KM, Saha S, Zhang C, Baim AE, Farnen JP, Onitilo AA, Blank JH, Ahuja H, Wassenaar T, Qamar R, Mansky P, Traynor AM, Mattison RJ, Kahl BS. A phase 2 study of weekly temsirolimus and bortezomib for relapsed or refractory B-cell non-Hodgkin lymphoma: A Wisconsin Oncology Network study. Cancer 2015; 121:3465-71. [PMID: 26079295 DOI: 10.1002/cncr.29502] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/17/2015] [Accepted: 04/30/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proteasome inhibitors and mammalian target of rapamycin inhibitors each have activity in various B-cell malignancies and affect distinct cellular pathways. Their combination has demonstrated synergy in vitro and in mouse models. METHODS The authors conducted a single-arm, phase 2 trial of combined temsirolimus and bortezomib in patients with relapsed and refractory B-cell non-Hodgkin lymphoma (NHL) using a dosing scheme that was previously tested in multiple myeloma. The patients received bortezomib and temsirolimus weekly on days 1, 8, 15, and 22 of a 35-day cycle. RESULTS Of 39 patients who received treatment, 3 achieved a complete response (7.7%; 95% confidence interval [CI], 1.6%-21%), and 9 had a partial response (PR) (23%; 95% CI, 11%-39%). Thus, the overall response rate (12 of 39 patients) was 31% (95% CI, 17%-48%), and the median progression-free survival was 4.7 months (95% CI, 2.1-7.8 months; 2 months for patients with diffuse large B-cell lymphoma [n = 18], 7.5 months for those with mantle cell lymphoma [n = 7], and 16.5 months for those with follicular lymphoma [n = 9]). Two extensively treated patients with diffuse large B-cell lymphoma achieved a complete response. There were no unexpected toxicities from the combination. CONCLUSIONS The current results demonstrate that the combination of a mammalian target of rapamycin inhibitor and a proteasome inhibitor is safe and has activity in patients with heavily pretreated B-cell NHL. Further studies with this combination are warranted in specific subtypes of NHL.
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Affiliation(s)
- Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Namrata M Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kyung Mann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Sandeep Saha
- Department of Biostatistics and Medical Informatics, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Chong Zhang
- Department of Biostatistics and Medical Informatics, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Arielle E Baim
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John P Farnen
- Gundersen Lutheran Health System, La Crosse, Wisconsin
| | | | - Jules H Blank
- St. Vincent Regional Cancer Center, Green Bay, Wisconsin
| | - Harish Ahuja
- Aspirus Regional Cancer Center, Wausau, Wisconsin
| | | | | | | | - Anne M Traynor
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Ryan J Mattison
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Brad S Kahl
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
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