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Du J, Zhang H, Wang H, Luan S, Chen S, Li F, Wang L, Dou L, Liu D. Patients Beyond the Optimal Range of rATG-AUC Still Benefit from the Targeted Dosing Strategy in Unmanipulated Haplo-PBSCT. Transplant Cell Ther 2024; 30:1023.e1-1023.e12. [PMID: 39111369 DOI: 10.1016/j.jtct.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/04/2024] [Accepted: 07/28/2024] [Indexed: 08/25/2024]
Abstract
Rabbit antithymocyte globulin (rATG) is widely used in allogeneic hematopoietic stem cell transplantation to prevent graft failure and severe graft-versus-host disease (GVHD). We developed a rATG-targeted dosing strategy based on the optimal areas under the concentration-time curve (AUC) of active rATG. This study compared the outcomes of the optimal AUC arm with nonoptimal AUC arm to assess the effect of the rATG-targeted dosing strategy. Eighty patients (median age: 32 years) with hematological malignancies who received their first haplo-PBSCT were enrolled successively. With rATG-targeted dosing, the AUC values of 60 patients (75%, optimal AUC arm) fell within the optimal range (100-148.5 UE/mL/day) and 20 fell beyond this range (nonoptimal AUC arm). In the historical control group of 102 haplo-PBSCT patients who received a fixed dose of rATG (10 mg/kg), less patients fell within the optimal range (57.8%, P = .016). Looking at the nonoptimal AUC arms in both groups, lower cumulative incidence of CMV was noted in the targeted dosing group compared with the historical control group(50.0%, 95% CI, 30.8%-72.9% versus 81.4%, 95% CI, 68.6%-91.3%; P = .004). The cumulative incidences of EBV, relapse, overall survival and disease-free survival tended to be superior in the nonoptimal AUC arm in the targeted dosing group compared with the historical control. In the targeted dosing group, the cumulative incidence of cytomegalovirus (CMV) reactivation on day +180 tended to be lower in the optimal AUC arm (30.0%, 95% CI, 20.1%-43.3%) compared with the nonoptimal AUC arm (50.0%, 95% CI, 30.8%-72.9%, P = .199) without statistical difference. There were no significant differences of acute or chronic GVHD, relapse, nonrelapse mortality, overall survival, disease-free survival or lymphocyte reconstitution between the two arms. In conclusion, the rATG-targeted dosing strategy made the exposure of active rATG in more patients with the optimal AUC range. Even patients who fell beyond this range would still benefit from the strategy.
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Affiliation(s)
- Jishan Du
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haoyang Zhang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haitao Wang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Songhua Luan
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Sheng Chen
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Li
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lu Wang
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liping Dou
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Daihong Liu
- Department of Hematology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China.
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Yan L, Li J, Yang Y, Zhang X, Zhang C. Old drug, new use: Recent advances for G-CSF. Cytokine 2024; 184:156759. [PMID: 39293182 DOI: 10.1016/j.cyto.2024.156759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/08/2024] [Accepted: 09/10/2024] [Indexed: 09/20/2024]
Abstract
Granulocyte colony-stimulating factor (G-CSF), also known as colony-stimulating factor 3 (CSF3), is a proinflammatory cytokine that primarily stimulates the survival, proliferation, differentiation and function of neutrophil granulocyte progenitor cells and mature neutrophils. Over the past years, G-CSF has mainly been used to cure patients with neutropenia and as a part of chemotherapy to induct the remission for refractory/relapse leukemia. Recent studies showed that C-CSF can been used as condition regimens and as a part of preventive methods after allogeneic transplantation to improve the survival of patients and also has immunoregulation, and has promote or inhibit the proliferation of solid tumors. Therefore, in this review, we firstly describe the structure for G-CSF. Then its functions and mechanism were reviewed including the neutrophil mobilization, differentiation, migration, and inhibiting apoptosis of neutrophils, and its immunoregulation. Finally, the clinical applications were further discussed.
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Affiliation(s)
- Lun Yan
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing 400037 China; Chongqing Key Laboratory of Hematology and Microenvironment, Chongqing 400037 China; State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University, Chongqing 400037 China
| | - Jing Li
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing 400037 China; Chongqing Key Laboratory of Hematology and Microenvironment, Chongqing 400037 China; State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University, Chongqing 400037 China
| | - Yang Yang
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing 400037 China; Chongqing Key Laboratory of Hematology and Microenvironment, Chongqing 400037 China; State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University, Chongqing 400037 China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing 400037 China; Chongqing Key Laboratory of Hematology and Microenvironment, Chongqing 400037 China; State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University, Chongqing 400037 China.
| | - Cheng Zhang
- Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing 400037 China; Chongqing Key Laboratory of Hematology and Microenvironment, Chongqing 400037 China; State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University, Chongqing 400037 China.
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Wang H, Zhao Y, Fang S, Wang L, Peng B, Yang J, Wang N, Du J, Li F, Jin X, Luan S, Wu X, Dou L, Liu D. Optimal Active Anti-Thymocyte Globulin Exposure Associated with Minimum Risk of Virus Reactivation and Comparable Acute Graft-Versus-Host Disease Under Adult Myeloablative Haploidentical Peripheral Blood Stem Cell Transplantation. Transplant Cell Ther 2022; 28:332.e1-332.e10. [PMID: 35314377 DOI: 10.1016/j.jtct.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/15/2022]
Abstract
Anti-thymocyte globulin (ATG) is often included in the conditioning regimen to prevent graft-versus-host disease (GVHD) in allogeneic hematopoietic cell transplantation (allo-HCT). However, the risk of virus reactivation increases significantly. We conducted a single-center prospective study to identify the optimal ATG exposure that ensures engraftment, effectively prevents acute GVHD, and reduces the risk of virus reactivation without increasing relapse of malignant diseases in haploidentical peripheral blood stem cell transplantation (haplo-PBSCT). From September 2018 to June 2020, 106 patients (median age, 32 years) with malignant hematological diseases who received haplo-PBSCT for the first time were enrolled. All patients received 10 mg/kg rabbit ATG (thymoglobulin) divided for 4 days (days -5 to -2). Pre-transplant, post-transplant, and total areas under the concentration-time curve (AUCs) of active ATG were calculated. Total AUC of active ATG was shown to be the best predictor for virus reactivation and acute GVHD of grades II to IV or grades III and IV. The optimal total AUC range of active ATG was 100 to 148.5 UE/mL/day. The median time was 14 versus 13 days (P = .184) for myeloid engraftment and 13 versus 13 days (P = .263) for platelet engraftment in the optimal and non-optimal AUC groups, respectively. The optimal AUC group showed a lower cumulative incidence of cytomegalovirus (CMV) reactivation and persistent CMV viremia than the non-optimal AUC group: 60.6% (95% confidence interval [CI], 48.3%-73.1%) versus 77.1% (95% CI, 64.5%-87.7%; P = .016) and 31.5% (95% CI, 21.2%-45.3%) versus 56.3% (95% CI, 42.9%-70.4%; P = .007), respectively. The cumulative incidence of persistent Epstein-Barr virus (EBV) viremia in the optimal AUC group was significantly lower than the non-optimal total AUC group: 33.1% (95% CI, 22.5%-46.8%) versus 52.6% (95% CI, 39.3%-67.2%; P = .048). However, there was no difference in EBV reactivation (P = .752). Similar outcomes were observed for grade II to IV and grade III and IV acute GVHD between the two groups: 48.6% (95% CI, 36.8%-62.0%) versus 37.0% (95% CI, 24.8%-52.5%; P = .113) and 10.4% (95% CI, 4.8%-21.7%) versus 4.2% (95% CI, 1.0%-15.6%; P = .234, respectively. Relapse, non-relapse mortality, and disease-free survival demonstrated no significant differences between the two groups. But, overall survival at 2 years tended to increase in the optimal AUC group: 75.7% (95% CI, 62.4%-84.8%) versus 57.8% (95% CI, 42.4%-70.4%; P = .061). These data support an optimal active ATG exposure of 110 to 148.5 UE/mL/day in haplo-PBSCT. Individualized dosing of ATG in allo-HCT might reduce the risk of virus reactivation and effectively prevent acute GVHD simultaneously.
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Affiliation(s)
- HaiTao Wang
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China; Chinese PLA General Hospital, Beijing, China
| | | | - Shu Fang
- Chinese PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - LiLi Wang
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bo Peng
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Nan Wang
- Chinese PLA General Hospital, Beijing, China
| | - JiShan Du
- Chinese PLA General Hospital, Beijing, China
| | - Fei Li
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - XiangShu Jin
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - SongHua Luan
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - XiaoXiong Wu
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - LiPing Dou
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China; Chinese PLA General Hospital, Beijing, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - DaiHong Liu
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China; Chinese PLA General Hospital, Beijing, China.
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Li J, Wang S, Zhang Y, Lou S, Liu Y, Kong P, Zhang C, Gao L, Peng X, Wang P, Deng X, Gao L, Zhang X. Is It Better to Mobilize Hematopoietic Stem Cells With Pegfilgrastim in Healthy Donors During Allogeneic Hematopoietic Stem Cell Transplantation? Front Oncol 2020; 10:1598. [PMID: 33014813 PMCID: PMC7494731 DOI: 10.3389/fonc.2020.01598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Abstract
The mobilization of hematopoietic stem cells (HSCs) using granulocyte colony-stimulating factor is a classic method. Recently, a single injection of pegfilgrastim was used to mobilize CD34+ cells in some small-sample studies. To confirm the efficacy and safety of pegfilgrastim in the mobilization of CD34+ cells from healthy donors, we conducted a retrospective multicenter study. A total of 146 healthy donors who all received subcutaneous pegfilgrastim (12 mg) on day 1 were enrolled in our study. Donor HSC apheresis was conducted on day 5. The primary endpoint was the percentage of donors from whom ≥4 × 106 CD34+ cells/kg were collected in a single apheresis session. The median number of CD34+ cells in donors was significantly higher on day 5 than that on day 4 (82.26 μL vs. 51.65 μL, P ¡ 0.001). In 111 of the 146 donors, an optimal number of CD34+ cells (≥4 × 106 kg) were collected in a single apheresis procedure. Bone pain and headache were the main adverse events, but the side effects did not require treatment. The number of white blood cells in most donors dropped to normal levels within 1 week after apheresis. Nearly 97% of patients achieved neutrophil and platelet engraftment. Pegfilgrastim for mobilization could be used to obtain an optimal number of CD34+ cells in a single session. Pegfilgrastim-induced mobilization not only was effective and safe but also avoided the pain of multiple injections and apheresis procedures in donors. However, prospective randomized controlled trials should be conducted in the future.
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Affiliation(s)
- Jiali Li
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Sanbin Wang
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Yunnan, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shifeng Lou
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Peiyan Kong
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Cheng Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Lei Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Xiangui Peng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Ping Wang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Xiaojuan Deng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Li Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
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Kwon M, Bailén R, Díez-Martín JL. Evolution of the role of haploidentical stem cell transplantation: past, present, and future. Expert Rev Hematol 2020; 13:835-850. [PMID: 32749913 DOI: 10.1080/17474086.2020.1796621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The accessibility to haplo-donors has led to an increase in the number of haplo-HSCT worldwide. A systematic search of the PubMed database between 2000 to present was performed. AREAS COVERED In this review, the authors discussed the most used approaches to perform haplo-HSCT and its results: T-cell depletion (TCD, including Perugia platform and its modifications) and T-cell repleted haplo (TCR, including the high-dose post-transplant cyclophosphamide strategy (Baltimore protocol) and the Beijing protocol). The improvements and modifications made to the different strategies have increased the indications of haplo-HSCT, including both malignant and nonmalignant disorders. Focusing on the Baltimore protocol, the authors review the results of the retrospective studies that have compared it to other donor transplants. The limitations of this strategy in terms of toxicity, graft complications, and GVHD are also discussed in detail. Finally, possible approaches to improve the outcomes of TCR haplo-HSCT are presented. EXPERT OPINION The recent advances in the field of haplo-HSCT have allowed a large number of patients with incurable diseases to benefit from this procedure despite not having a matched donor. With all available strategies, virtually no patient who needs an allogeneic transplant should be excluded by the absence of a donor.
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Affiliation(s)
- Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón , Madrid, Spain.,Departement of Translational Oncology, Institute of Health Research Gregorio Marañón , Madrid, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañón , Madrid, Spain.,Departement of Translational Oncology, Institute of Health Research Gregorio Marañón , Madrid, Spain
| | - José Luis Díez-Martín
- Department of Hematology, Hospital General Universitario Gregorio Marañón , Madrid, Spain.,Departement of Translational Oncology, Institute of Health Research Gregorio Marañón , Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid , Madrid, Spain
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Donor-derived CAR-T Cells Serve as a Reduced-intensity Conditioning Regimen for Haploidentical Stem Cell Transplantation in Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia: Case Report and Review of the Literature. J Immunother 2019; 41:306-311. [PMID: 29864079 DOI: 10.1097/cji.0000000000000233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Reduced-intensity conditioning (RIC) regimens with low tolerable toxicities have been used for allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the relapse rate by this treatment is high. Treatment of CD19 B-cell relapsed/refractory acute lymphoblastic leukemia (r/r ALL) with allogeneic chimeric antigen receptor-modified T (CAR-T) cells is safe and effective. Use of allogeneic CD19-CAR-T cells as a part of RIC regimens for treatment of r/r ALL patients with haploidentical HSCT has not been investigated yet. CASE PRESENTATION A 12-year-old girl with CD19 r/r ALL underwent haploidentical HSCT. The patient received fludarabine, busulfan, and cyclophosphamide combined with haploidentical donor-derived CD19-CAR-T cells as the conditioning regimen. Granulocyte colony-stimulating factor-mobilized peripheral blood stem cells and granulocyte colony-stimulating factor-mobilized bone marrow were infused on days 1 and 2, respectively. Mycophenolate mofetil and tacrolimus were administered on day 1, antithymocyte globulin was administered on days +14 and +15, and a short course of methotrexate was administered to prevent graft-versus-host disease. The time of peak CAR-T cell proliferation was detected after the first infusion of CAR-T cells on day 7. The patient's engraftment and full-donor cell engraftment were established. The disease was in complete remission with minimal residual disease, which was undetectable by flow cytometry. No graft-versus-host disease or serious cytokine-release syndrome was found. CONCLUSIONS Treatment of r/r ALL with RIC including CD19-CAR-T cells followed by allo-HSCT was safe and effective, which suggest that CAR-T cells can be used as a part of RIC regimens in the treatment of r/r ALL in haploidentical HSCT.
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Trino S, Zoppoli P, Carella AM, Laurenzana I, Weisz A, Memoli D, Calice G, La Rocca F, Simeon V, Savino L, Del Vecchio L, Musto P, Caivano A, De Luca L. DNA methylation dynamic of bone marrow hematopoietic stem cells after allogeneic transplantation. Stem Cell Res Ther 2019; 10:138. [PMID: 31109375 PMCID: PMC6528331 DOI: 10.1186/s13287-019-1245-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (AHSCT) is a curative therapeutic approach for different hematological malignancies (HMs), and epigenetic modifications, including DNA methylation, play a role in the reconstitution of the hematopoietic system after AHSCT. This study aimed to explore global DNA methylation dynamic of bone marrow (BM) hematopoietic stem and progenitor cells (HSPCs) from donors and their respective recipients affected by acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and Hodgkin lymphoma (HL) during the first year after transplant. METHODS We measured DNA methylation profile by Illumina HumanMethylationEPIC in BM HSPC of 10 donors (t0) and their matched recipients at different time points after AHSCT, at day + 30 (t1), + 60 (t2), + 120 (t3), + 180 (t4), and + 365 (t5). Differential methylation analysis was performed by using R software and CRAN/Bioconductor packages. Gene set enrichment analysis was carried out on promoter area of significantly differentially methylated genes by clusterProfiler package and the mSigDB genes sets. RESULTS Results show significant differences in the global methylation profile between HL and acute leukemias, and between patients with mixed and complete chimerism, with a strong methylation change, with prevailing hyper-methylation, occurring 30 days after AHSCT. Functional analysis of promoter methylation changes identified genes involved in hematopoietic cell activation, differentiation, shaping, and movement. This could be a consequence of donor cell "adaptation" in recipient BM niche. Interestingly, this epigenetic remodeling was reversible, since methylation returns similar to that of donor HSPCs after 1 year. Only for a pool of genes, mainly involved in dynamic shaping and trafficking, the DNA methylation changes acquired after 30 days were maintained for up to 1 year post-transplant. Finally, preliminary data suggest that the methylation profile could be used as predictor of relapse in ALL. CONCLUSIONS Overall, these data provide insights into the DNA methylation changes of HSPCs after transplantation and a new framework to investigate epigenetics of AHSCT and its outcomes.
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Affiliation(s)
- Stefania Trino
- Laboratory of Preclinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Pietro Zoppoli
- Laboratory of Preclinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Angelo Michele Carella
- SSD Unità di terapia intensiva ematologica e terapie cellulari, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilaria Laurenzana
- Laboratory of Preclinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Alessandro Weisz
- Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, Baronissi, SA Italy
| | - Domenico Memoli
- Laboratory of Molecular Medicine and Genomics, Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, Baronissi, SA Italy
| | - Giovanni Calice
- Laboratory of Preclinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Francesco La Rocca
- Laboratory of Clinical Research and Advanced Diagnostics, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lucia Savino
- SSD Unità di terapia intensiva ematologica e terapie cellulari, Fondazione IRCCS-Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luigi Del Vecchio
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80138 Naples, Italy
| | - Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Antonella Caivano
- Laboratory of Preclinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Luciana De Luca
- Laboratory of Preclinical and Translational Research, IRCCS - Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
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Xia J, Chen SN, Chen J, Fan Y, Chen F, Ma X, Miao M, Wu DP. [Efficacy and safety of haploidentical hematopoietic stem cell transplantation for 17 patients with paroxysmal nocturnal hemamoglobinuria]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:904-907. [PMID: 30486585 PMCID: PMC7342361 DOI: 10.3760/cma.j.issn.0253-2727.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Indexed: 01/07/2023]
Abstract
Objective: To explore the efficacy and safety of haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) for paroxysmal nocturnal hemoglobinuria (PNH). Methods: A total of 17 patients with PNH who received Haplo-HSCT from January 2013 to September 2017 were analyzed retrospectively. Results: Of them, 4 patients had de novo PNH, 13 patients had aplastic anemia-PNH syndrome (AA-PNH). All patients received modified busulfan and Cytoxan (BuCy)-based regimens combined with anti-thymocyte globulin (ATG). Granulocyte colony-stimulating factor-mobilized bone marrow and peripheral blood stem cells were transplanted as graft. Prophylaxis for graft-versus-host disease (GVHD) was ciclosporin A+ mycophenolate mofetil (MMF)+short-term methotrexate (MTX). All patients were engrafted successfully. The median time of neutrophils to 0.5×10(9)/L and platelets to 20×10(9)/L was 12(10-15) days and 14(11-45) days, respectively. All of the 17 patients achieved full donor chimerism at 30 d after Haplo-HSCT. Seven patients developed grade Ⅱ-Ⅳ acute GVHD, and 4 chronic GVHD. Median follow-up time was 27.1 (8.6-60.4) months. Of the 17 patients, 15 survived and 2 died of severe pulmonary infection and transplant associated thrombotic microangiopathy. Three-year overall survival was (77.8±15.2)%. Conclusion: Haplo-HSCT may be effective and safe for PNH patients who did not have matched donor.
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Affiliation(s)
- J Xia
- Jiangsu Institute of Hematology, Department of Hematology, the First Affiliated Hospital of Soochow University, Key Lab of Thrombosis and Hemostasis of Ministry of Health, Suzhou 215006, China
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Park H, Lee YJ, Shin SJ, Lee J, Park S, Kim I, Moon JH, Lee H, Jang JH, Yoon SS, Koh Y. Which donor is better when a matched donor is not available domestically? Comparison of outcomes of allogeneic stem cell transplantation with haploidentical and international donors in a homogenous ethnic population. Leuk Res 2018; 69:31-38. [DOI: 10.1016/j.leukres.2018.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 11/16/2022]
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10
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Zeng Y, Wang S, Wang J, Liu L, Su Y, Lu Z, Zhang X, Zhang Y, Zhong JF, Peng L, Liu Q, Lu Y, Gao L, Zhang X. Optimal donor for severe aplastic anemia patient requiring allogeneic hematopoietic stem cell transplantation: A large-sample study from China. Sci Rep 2018; 8:2479. [PMID: 29410500 PMCID: PMC5802708 DOI: 10.1038/s41598-018-20853-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 01/23/2018] [Indexed: 11/09/2022] Open
Abstract
HLA-haploidentical hematopoietic stem cell transplantation (HSCT) may be an option for severe aplastic anemia (SAA) patients. However, to date, no large-sample studies have been performed to determine which types of SAA patients are suitable for HLA-haploidentical HSCT. We retrospectively studied 189 consecutive patients with SAA who underwent HLA-identical or HLA-haploidentical HSCT at seven transplant centers in China. Propensity score matching (PSM) was applied in this study to reduce the influence of potential confounders. The 5-year overall survival (OS) rate was 72.0% in the HLA-haploidentical group and 76.5% in the HLA-identical group. The median time to achieve engraftment and the incidence of acute GVHD/chronic GVHD were not significantly different between the two groups. In the subgroup analysis, the outcome of patients older than 40 years in the HLA-haploidentical group was significantly poorer than that of patients younger than 40 years in the same group and that of patients older than 40 years in the HLA-identical group. Based on the above results, we suggest that HLA-haploidentical relative HSCT should be considered as a valid alternative option for patients younger than 40 years with SAA for whom no matched sibling donor is available.
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Affiliation(s)
- Yunjing Zeng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Sanbin Wang
- Department of Hematology, General Hospital of Kunming Military Region of PLA, Kunming, China
| | - Jishi Wang
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Li Liu
- Department of Hematology, Tangdu Hospital, Forth Military Medical University, Xi'an, China
| | - Yi Su
- Department of Hematology, General Hospital of Chengdu Military Region of PLA, Chengdu, Sichuan, China
| | - Zhixiang Lu
- Department of Hematology, First Yunnan Provincial People's Hospital, Kunming, China
| | - Xuemei Zhang
- Department of Hematology, Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Yanqi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Jiang Fan Zhong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lihui Peng
- Department of Hematology, General Hospital of Kunming Military Region of PLA, Kunming, China
| | - Qiang Liu
- Department of Hematology, Tangdu Hospital, Forth Military Medical University, Xi'an, China
| | - Yinghao Lu
- Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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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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Lee CJ, Savani BN, Mohty M, Labopin M, Ruggeri A, Schmid C, Baron F, Esteve J, Gorin NC, Giebel S, Ciceri F, Nagler A. Haploidentical hematopoietic cell transplantation for adult acute myeloid leukemia: a position statement from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica 2017; 102:1810-1822. [PMID: 28883081 PMCID: PMC5664385 DOI: 10.3324/haematol.2017.176107] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022] Open
Abstract
Allogeneic blood or marrow hematopoietic cell transplantation continues to be the most potent anti-leukemic treatment for adult patients with standard, high-risk, or chemo-refractory acute myeloid leukemia. Until recently, this procedure was generally limited to those recipients who had an available matched-sibling donor or matched-unrelated donor. Technical advances in graft cell processing and manipulation, control of bidirectional T cell alloreactivity, graft-versus-host disease prophylaxis, and other supportive measures in haploidentical transplantation now enable nearly all patients with acute myeloid leukemia to benefit from the graft-versus-leukemia effect with substantial reduction in procedure-related mortality. Over recent years, haploidentical donors have been increasingly adopted as a valid donor source in allogeneic hematopoietic cell transplantation for acute myeloid leukemia in the absence of an HLA-matched donor. Among centers of the European Society for Blood and Marrow Transplantation, the use of haploidentical related donor transplantation has increased by 250% since 2010, and 291% since 2005. On behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we summarize recent utilization trends in haploidentical transplantation for acute myeloid leukemia and describe the transformative changes in haploidentical hematopoietic cell transplantation techniques over the past decade, which have led to the current widespread use of this procedure. Furthermore, we review the efficacy of haploidentical hematopoietic cell transplantation for acute myeloid leukemia from available studies, including preliminary comparative studies, and bring attention to remaining unanswered questions and directions for future research. We conclude this report with our recommendations for the role of haploidentical hematopoietic cell transplantation in acute myeloid leukemia.
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Affiliation(s)
- Catherine J Lee
- Utah Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- Department of Hematology, Saint-Antoine Hospital, INSERM, Paris, France
| | - Myriam Labopin
- Department of Hematology, Saint-Antoine Hospital, INSERM, Paris, France
| | - Annalisa Ruggeri
- Department of Hematology, Saint-Antoine Hospital, INSERM, Paris, France
| | - Christoph Schmid
- Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany
| | - Frédéric Baron
- Department of Medicine, Division of Hematology, University of Liège, Belgium
| | - Jordi Esteve
- Department of Hematology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Norbert C Gorin
- Department of Hematology, Saint-Antoine Hospital, APHP and University UPMC, Paris, France
| | - Sebastian Giebel
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Fabio Ciceri
- Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arnon Nagler
- Department of Hematology, Saint-Antoine Hospital, INSERM, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
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13
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Yuan J, Pei R, Su W, Cao J, Lu Y. Meta-analysis of the actions of antithymocyte globulin in patients undergoing allogeneic hematopoietic cell transplantation. Oncotarget 2017; 8:10871-10882. [PMID: 28107198 PMCID: PMC5355230 DOI: 10.18632/oncotarget.14719] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/20/2016] [Indexed: 12/26/2022] Open
Abstract
Graft-versus-host disease (GVHD) is a serious complication associated with allogeneic hematopoietic cell transplantation (allo-HCT). Antithymocyte globulin (ATG) is widely used prior to allo-HCT for GVHD prevention, though evidence of its efficacy remains unclear. We therefore identified nine randomized controlled trials (RCTs), enrolling 1089 patients (554 in the ATG group and 535 in the non-ATG group) to conduct a meta-analysis of the actions of ATG in allo-HCT. A relative risk or risk ratio (RR) and 95% confidence interval (CI) were calculated for each outcome. Rabbit ATG reduced overall acute (a) GVHD (RR 0.77, 95% CI 0.67-0.89, P = 0.0004), grade III-IV aGVHD (RR 0.53, 95% CI 0.32-0.88, P = 0.01), overall chronic (c) GVHD (RR 0.52, 95% CI 0.42-0.64, P < 0.00001) and extensive cGVHD (RR 0.28, 95% CI 0.18-0.43, P < 0.00001), without increased risk of relapse (RR 1.17, 95% CI 0.91-1.49, P = 0.23). By contrast, horse ATG did not reduce overall aGVHD (RR 1.25, 95% CI 0.88-1.79, P = 0.22) or cGVHD (RR 1.67, 95% CI 0.96-2.91, P = 0.07). ATG marginally reduced 100-day transplant related mortality (RR 0.75, 95% CI 0.56-1.00, P = 0.05) without compromising overall survival or increased risk of infections. Further studies are required to evaluate the optimal dosage and formulation of ATG in different conditioning regimens of transplantation with varied sources of graft and donor.
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Affiliation(s)
- Jiaojiao Yuan
- Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China
| | - Renzhi Pei
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China
| | - Wensi Su
- Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China
| | - Junjie Cao
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China
| | - Ying Lu
- Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China
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Gao L, Liu J, Zhang Y, Chen X, Gao L, Zhang C, Liu Y, Kong P, Zhong J, Sun A, Du X, Su Y, Li H, Liu H, Peng X, Zhang X. Low incidence of acute graft-versus-host disease with short-term tacrolimus in haploidentical hematopoietic stem cell transplantation. Leuk Res 2017; 57:27-36. [PMID: 28273549 DOI: 10.1016/j.leukres.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/22/2017] [Accepted: 02/22/2017] [Indexed: 01/29/2023]
Abstract
Although tacrolimus (Tac) has immunosuppressive properties and exhibits promising efficacy against graft-versus-host disease (GVHD), little is known about Tac in the prophylaxis of GVHD after HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT). In a multicenter randomized controlled trial, 174 patients received haplo-HSCT with GVHD prophylaxis involving short-term Tac (from -8days to +30days) or cyclosporine (CsA). The 100day cumulative incidences of acute GVHD (aGVHD) and grade III-IV aGVHD with the short-term Tac regimen and CsA regimen were 29.1 (19.5-38.7)% vs. 50.0(39.6-60.4)% (p=0.005) and 3.6(0.0-7.5)% vs. 13.5(6.1-20.9)% (p=0.027), respectively. There were no significant differences in the incidences of chronic GVHD (cGVHD), relapse and cytomegalovirus infection. Lymphocyte subset analysis showed that T cells decreased to lower levels on the short-term Tac regimen within 3 months of transplantation. The disease-free survival and overall survival on the short-term Tac and CsA regimens were 59.3 (48.9-69.7)% vs. 55.7 (45.3-66.1)% (p=0.696) and 65.1 (55.1-75.1)% vs. 61.4 (51.2-71.6)% (p=0.075), respectively. Our findings indicate that the short-term Tac regimen for GVHD prophylaxis in patients undergoing haplo-HSCT is associated with a low incidence and slight severity of aGVHD and did not increase the incidence of relapse and cytomegalovirus infection.
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Affiliation(s)
- Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
| | - Jia Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yanqi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Xinghua Chen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yao Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Peiyan Kong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jiangfan Zhong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Aihua Sun
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xin Du
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yi Su
- Department of Hematology, General Hospital of Chengdu Military Region of PLA, Chengdu, China
| | - Huimin Li
- Department of Hematology, Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Hong Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiangui Peng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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15
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Gao L, Zhang Y, Hu B, Liu J, Kong P, Lou S, Su Y, Yang T, Li H, Liu Y, Zhang C, Gao L, Zhu L, Wen Q, Wang P, Chen X, Zhong J, Zhang X. Phase II Multicenter, Randomized, Double-Blind Controlled Study of Efficacy and Safety of Umbilical Cord-Derived Mesenchymal Stromal Cells in the Prophylaxis of Chronic Graft-Versus-Host Disease After HLA-Haploidentical Stem-Cell Transplantation. J Clin Oncol 2016; 34:2843-50. [PMID: 27400949 DOI: 10.1200/jco.2015.65.3642] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Although mesenchymal stromal cells (MSCs) possess immunomodulatory properties and exhibit promising efficacy against chronic graft-versus-host disease (cGVHD), little is known about the efficacy of MSCs in the prophylaxis of cGVHD after HLA-haploidentical hematopoietic stem-cell transplantation (HLA-haplo HSCT). PATIENTS AND METHODS In this multicenter, double-blind, randomized controlled trial, we investigated the incidence and severity of cGVHD among patients, and the changes in T, B, and natural killer (NK) cells after the repeated infusion of MSCs. RESULTS The 2-year cumulative incidence of cGVHD in the MSCs group was 27.4% (95% CI, 16.2% to 38.6%), compared with 49.0% (95% CI, 36.5% to 61.5%) in the non-MSCs control group (P = .021). Seven patients in the non-MSCs control group had severe lung cGVHD, but no patients in the MSCs group developed typical lung cGVHD (P = .047). After the MSC infusions, increasing memory B lymphocytes and regulatory T cells, as well as the ratio of type 1 T helper to type 2 T helper cells, were observed, whereas the number of NK cells decreased. CONCLUSION Our findings suggest that the repeated infusion of MSCs might inhibit cGVHD symptoms in patients after HLA-haplo HSCT, accompanied by changes in the numbers and subtypes of T, B, and NK cells, leading to the acquisition of immune tolerance.
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Affiliation(s)
- Lei Gao
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Yanqi Zhang
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Baoyang Hu
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Jia Liu
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Peiyan Kong
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Shifeng Lou
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Yi Su
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Tonghua Yang
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Huimin Li
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Yao Liu
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Cheng Zhang
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Li Gao
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Lidan Zhu
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Qin Wen
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Ping Wang
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Xinghua Chen
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Jiangfan Zhong
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA
| | - Xi Zhang
- Lei Gao, Yanqi Zhang, Jia Liu, Peiyan Kong, Yao Liu, Li Gao, Cheng Zhang, Lidan Zhu, Qin Wen, Ping Wang, Xinghua Chen, Jiangfan Zhong, and Xi Zhang, Third Military Medical University, Chongqing; Baoyang Hu, Chinese Academy of Sciences, Beijing; Shifeng Lou, Second Affiliated Hospital of Chongqing Medical University, Chongqing; Yi Su, General Hospital of Chengdu Military Region of People's Liberation Army, Chengdu; Tonghua Yang, Yunnan Provincial People's Hospital; Huimin Li, Affiliated Hospital of Kunming Medical College, Kunming, China; and Jiangfan Zhong, University of Southern California, Los Angeles, CA.
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16
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Mu Y, Qin M, Wang B, Li S, Zhu G, Zhou X, Yang J, Wang K, Lin W, Zheng H. Haploidentical hematopoietic stem cell transplantation without total body irradiation for pediatric acute leukemia: a single-center experience. Onco Targets Ther 2016; 9:2557-63. [PMID: 27217774 PMCID: PMC4860998 DOI: 10.2147/ott.s102286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a promising method for therapy of pediatric patients with acute leukemia. However, less availability of matched donors limited its wide application. Recently, haploidentical HSCT has become a great resource. Here, we have retrospectively reported our experience of 20 pediatric patients with acute leukemia who underwent haploidentical HSCT without total body irradiation (TBI) myeloablative regimen in our center from November 2007 to June 2014. All the patients attained successful HSCT engraftment in terms of myeloid and platelet recovery. Thirteen patients developed grade I–IV acute graft-versus-host disease (a-GVHD). The incidence of grade I–II a-GVHD, grade III–IV a-GVHD, and chronic GVHD (c-GVHD) was 45%, 20%, and 25%, respectively. The mean myeloid and platelet recovery time was 13.20±2.41 and 19.10±8.37 days. The median follow-up time was 43.95±29.26 months. During the follow-up, three patients died. The overall survival (OS) rate was 85%. The present study indicated that haploidentical HSCT without TBI myeloablative regimen significantly improved the OS rate of pediatric patients with acute leukemia.
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Affiliation(s)
- Yanshun Mu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Maoquan Qin
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bin Wang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Sidan Li
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guanghua Zhu
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xuan Zhou
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun Yang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kai Wang
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Lin
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Huyong Zheng
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Ministry of Education, Key Laboratory of Major Diseases in Children, Ministry of Education, Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
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Sengsayadeth S, Savani BN, Blaise D, Mohty M. Haploidentical transplantation: selecting optimal conditioning regimen and stem cell source. Semin Hematol 2016; 53:111-4. [DOI: 10.1053/j.seminhematol.2016.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Chang YJ, Huang XJ. Haploidentical stem cell transplantation: anti-thymocyte globulin-based experience. Semin Hematol 2016; 53:82-9. [DOI: 10.1053/j.seminhematol.2016.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Choice of Unmanipulated T Cell Replete Graft for Haploidentical Stem Cell Transplant and Posttransplant Cyclophosphamide in Hematologic Malignancies in Adults: Peripheral Blood or Bone Marrow-Review of Published Literature. Adv Hematol 2016; 2016:6950346. [PMID: 27118973 PMCID: PMC4826912 DOI: 10.1155/2016/6950346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/23/2016] [Accepted: 03/06/2016] [Indexed: 11/18/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (SCT) is often the only curative option for many patients with malignant and benign hematological stem cell disorders. However, some issues are still of concern regarding finding a donor like shrinking family sizes in many societies, underrepresentation of the ethnic minorities in the registries, genetic variability for some races, and significant delays in obtaining stem cells after starting the search. So there is a considerable need to develop alternate donor stem cell sources. The rapid and near universal availability of the haploidentical donor is an advantage of the haploidentical SCT and an opportunity that is being explored currently in many centers especially using T cell replete graft and posttransplant cyclophosphamide. This is probably because it does not require expertise in graft manipulation and because of the lower costs. However, there are still lots of unanswered questions, like the effect of use of bone marrow versus peripheral blood as the source of stem cells on graft-versus-host disease, graft versus tumor, overall survival, immune reconstitution, and quality of life. Here we review the available publications on bone marrow and peripheral blood experience in the haploidentical SCT setting.
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Abstract
Allogeneic blood or bone-marrow transplantation (alloBMT) is a potentially curative treatment for a variety of haematological malignancies and nonmalignant diseases. Historically, human leukocyte antigen (HLA)-matched siblings have been the preferred source of donor cells owing to superior outcomes compared with alloBMT using other donors. Although only approximately one-third of patients have an HLA-matched sibling, nearly all patients have HLA-haploidentical related donors. Early studies using HLA-haploidentical alloBMT resulted in unacceptably high rates of graft rejection and graft-versus-host disease (GVHD), leading to high nonrelapse mortality and consequently poor survival. Several novel approaches to HLA-haploidentical alloBMT have yielded encouraging results with high rates of successful engraftment, effective GVHD control and favourable outcomes. In fact, outcomes of several retrospective comparative studies seem similar to those seen using other allograft sources, including those of HLA-matched-sibling alloBMT. In this Review, we provide an overview of the three most-developed approaches to HLA-haploidentical alloBMT: T-cell depletion with 'megadose' CD34(+) cells; granulocyte colony-stimulating factor-primed allografts combined with intensive pharmacological immunosuppression, including antithymocyte globulin; and high-dose, post-transplantation cyclophosphamide. We review the preclinical and biological data supporting each approach, results from major clinical studies, and completed or ongoing clinical studies comparing these approaches with other alloBMT platforms.
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Gao L, Zhang C, Gao L, Liu Y, Su Y, Wang S, Li B, Yang T, Yuan Z, Zhang X. Favorable outcome of haploidentical hematopoietic stem cell transplantation in Philadelphia chromosome-positive acute lymphoblastic leukemia: a multicenter study in Southwest China. J Hematol Oncol 2015. [PMID: 26208715 PMCID: PMC4515001 DOI: 10.1186/s13045-015-0186-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Since the introduction of tyrosine kinase inhibitors (TKIs) into combination chemotherapy regimens, the majority of newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) patients have achieved complete remission (CR). However, without allogeneic hematopoietic stem cell transplantation (HSCT), long-term outcomes in adults remain unsatisfactory. Indeed, haploidentical HSCT has become a common treatment for adult patients who lack an HLA-matched donor, though limited data are available on the efficacy of haploidentical HSCT in Ph+ ALL patients. Methods We analyzed the clinical outcomes of 82 Ph+ ALL patients who underwent haploidentical HSCT (n = 47) or HLA-matched HSCT (n = 35). Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed to assess BCR-ABL expression. All of the patients were treated with an imatinib-based regimen before undergoing HSCT. Imatinib treatment was resumed in the patients’ posttransplantation following detection of BCR-ABL transcripts. Results All of the patients achieved neutrophil and platelet engraftment, with the exception of five patients who died prior to engraftment. Haploidentical HSCT was associated with higher incidences of acute graft-versus-host disease (GVHD) (51.1 vs. 25.7 %, p < 0.05) and chronic GVHD (48.9 vs. 25.7 %, p < 0.05) compared with HLA-matched HSCT, but there was no difference in the incidence of either grades III–IV acute GVHD or extensive chronic GVHD. The incidence of cytomegalovirus (CMV) infection was significantly higher in the patients treated with haploidentical HSCT than in those treated with HLA-matched HSCT (38.3 vs. 14.3 %, p < 0.05). Haploidentical HSCT was associated with a significantly lower relapse rate compared with HLA-matched HSCT (44.8 vs. 19.1 %, p < 0.05). There were no differences in non-relapse mortality (NRM), leukemia-free survival (LFS), or overall survival (OS) between the patients who received HLA-matched HSCT and those who underwent haploidentical HSCT. Conclusions Our data indicate that the incidence of NRM after HSCT is similar between the patients who receive HLA-matched donor cells and those who receive haploidentical donor cells and that haploidentical HSCT reduces the relapse rate. Haploidentical HSCT represents an encouraging treatment option for Ph+ ALL patients who lack a suitable HLA-matched donor.
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Affiliation(s)
- Li Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China.
| | - Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China.
| | - Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China.
| | - Yao Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China.
| | - Yi Su
- Department of Hematology, General Hospital of Chengdu Military Region of PLA, Sichuan, China.
| | - Sanbin Wang
- Department of Hematology, General Hospital of Kunming Military Region of PLA, Yunnan, China.
| | - Bin Li
- Department of Hematology, Yunnan Provincial Peoples Hospital, Yunnan, China.
| | - Tonghua Yang
- Department of Hematology, Second Yunnan Provincial Peoples Hospital, Yunnan, China.
| | - Zhong Yuan
- Department of Hematology, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China.
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Kanakry CG, de Lima MJ, Luznik L. Alternative Donor Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia. Semin Hematol 2015; 52:232-42. [PMID: 26111471 DOI: 10.1053/j.seminhematol.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) provides a potentially curative therapy for patients with high-risk or chemorefractory acute myeloid leukemia (AML). Historically, the applicability of alloHCT has been limited as only 30%-35% of patients have human leukocyte antigen (HLA)-matched siblings and outcomes using other donor types have been markedly inferior due to excess toxicity, graft failure, graft-versus-host disease (GVHD), and consequently non-relapse mortality. Advances in HLA typing, GVHD prophylactic approaches, and other transplantation techniques have successfully addressed these historical challenges. Herein, we review recent alloHCT studies using volunteer unrelated donors, umbilical cord blood units, or HLA-haploidentical donors, specifically focusing on studies that compared outcomes between donor sources. Although none are randomized and most are retrospective, these analyses suggest that current outcomes for AML patients using most alternative donor types are comparable to those seen using HLA-matched siblings.
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Affiliation(s)
- Christopher G Kanakry
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Marcos J de Lima
- University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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Gao L, Zhang X. Haploidentical hematopoietic transplantation without T-cell depletion: current status and future perspectives. Stem Cell Investig 2015; 2:20. [PMID: 27358888 DOI: 10.3978/j.issn.2306-9759.2015.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023]
Abstract
Human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (HLA-haplo HSCT) without T-cell depletion has tremendously progressed over the past 20 years and has become a feasible treatment option for leukemia patients without an HLA-identical sibling donor. Advances in conditioning regimens, graft manipulation, and pharmacological graft-versus-host disease (GVHD) prophylaxis have reduced the risk of fatal graft failure and severe GVHD, two of the most serious complications of traversing the HLA barrier. According to clinical observations, killer immunoglobulin-like receptor (KIR) mismatch and donor-specific anti-HLA (DSA) antibodies-negative status play potential roles in reducing the risk of GVHD and graft failure following HLA-haploidentical SCT. New strategies to improve transplant outcomes include donor lymphocyte, NK cell and selected T-cell subset infusion, mesenchymal stem cell (MSC) co-transplantation and interleukin-2 (IL-2) application. Future challenges remain in improving post-transplant immune reconstitution and finding the best approach to reduce the incidence and severity of GVHD while simultaneously preserving the graft-versus leukemia effect to prevent the recurrence of underlying malignancy.
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Affiliation(s)
- Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing 40037, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing 40037, China
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24
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Gao L, Wen Q, Chen X, Liu Y, Zhang C, Gao L, Kong P, Zhang Y, Li Y, Liu J, Wang Q, Su Y, Wang C, Wang S, Zeng Y, Sun A, Du X, Zeng D, Liu H, Peng X, Zhang X. Effects of priming with recombinant human granulocyte colony-stimulating factor on conditioning regimen for high-risk acute myeloid leukemia patients undergoing human leukocyte antigen-haploidentical hematopoietic stem cell transplantation: a multicenter randomized controlled study in southwest China. Biol Blood Marrow Transplant 2014; 20:1932-9. [PMID: 25109850 DOI: 10.1016/j.bbmt.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
HLA-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is an effective and immediate treatment for high-risk acute myeloid leukemia (HR-AML) patients lacking matched donors. Relapse remains the leading cause of death for HR-AML patients after haplo-HSCT. Accordingly, the prevention of relapse remains a challenge in the treatment of HR-AML. In a multicenter randomized controlled trial in southwestern China, 178 HR-AML patients received haplo-HSCT with conditioning regimens involving recombinant human granulocyte colony-stimulating factor (rhG-CSF) or non-rhG-CSF. The cumulative incidences of relapse and graft-versus-host disease (GVHD), 2-year leukemia-free survival (LFS), and overall survival (OS) were evaluated. HR-AML patients who underwent the priming conditioning regimen with rhG-CSF had a lower relapse rate than those who were treated with non-rhG-CSF (38.2%; 95% confidence interval [CI], 28.1% to 48.3% versus 60.7%, 95% CI, 50.5% to 70.8%; P < .01). The cumulative incidences of acute GVHD, chronic GVHD, transplantation-related toxicity, and infectious complications appeared to be equivalent. In total, 53 patients in the rhG-CSF-priming group and 31 patients in the non-rhG-CSF-priming group were still alive at the median follow-up time of 42 months (range, 24 to 80 months). The 2-year probabilities of LFS and OS in the rhG-CSF-priming and non-rhG-CSF-priming groups were 55.1% (95% CI, 44.7% to 65.4%) versus 32.6% (95% CI, 22.8% to 42.3%) (P < .01) and 59.6% (95% CI, 49.4% to 69.7%) versus 34.8% (95% CI, 24.9% to 44.7%) (P < .01), respectively. Multivariate analyses indicated that the 2-year probability of LFS of patients who achieved complete remission (CR) before transplantation was better than that of patients who did not achieve CR. The 2-year probability of LFS of patients with no M4/M5/M6 subtype was better than that of patients with the M4/M5/M6 subtype in the G-CSF-priming group (67.4%; 95% CI, 53.8% to 80.9% versus 41.9%; 95% CI, 27.1% to 56.6%; P < .05). This study suggests that the rhG-CSF-priming conditioning regimen is an acceptable choice for HR-AML patients, especially for the patients with no M4/M5/M6 subtype who achieved CR before transplantation.
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Affiliation(s)
- Lei Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qin Wen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xinghua Chen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yao Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Peiyan Kong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yanqi Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yunlong Li
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jia Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Qingyu Wang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yi Su
- Department of Hematology, General Hospital of Chengdu Military Region of PLA, Chengdu, China
| | - Chunsen Wang
- Department of Hematology, Sichuan Provincial Peoples Hospital, Chengdu, China
| | - Sanbin Wang
- Department of Hematology, General Hospital of Kunming Military Region of PLA, Kunming, China
| | - Yun Zeng
- Department of Hematology, Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Aihua Sun
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xin Du
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Dongfeng Zeng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Hong Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xiangui Peng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
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25
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Gao L, Li Y, Zhang Y, Chen X, Gao L, Zhang C, Liu Y, Kong P, Wang Q, Su Y, Wang C, Wang S, Li B, Sun A, Du X, Zeng D, Li J, Liu H, Zhang X. Long-term outcome of HLA-haploidentical hematopoietic SCT without in vitro T-cell depletion for adult severe aplastic anemia after modified conditioning and supportive therapy. Bone Marrow Transplant 2014; 49:519-24. [PMID: 24464145 DOI: 10.1038/bmt.2013.224] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/22/2013] [Accepted: 12/01/2013] [Indexed: 11/09/2022]
Abstract
HLA-haploidentical hematopoietic SCT (HSCT) is an option for severe aplastic anemia (SAA) patients. Here, we evaluated the outcomes of 26 adult-SAA patients who received HLA-haploidentical HSCT in five transplant centers in southwestern China. Most of the patients in this study failed prior therapy and were transfused heavily before the transplantation. The patients received fludarabine+cyclophosphamide+antithymocyte globulin as conditioning regimens and then unmanipulated peripheral blood plus marrow transplantation. Micafungin, i.v. Ig and recombinant human TPO were used for post-grafting infection prevention and supportive care. Of 26 patients, 25 achieved engraftment at a median of 13 days (range, 11-19 days) after HSCT. One of 25 patients experienced graft rejection and did not achieve sustained engraftment after second HSCT. Therefore, the final engraftment rate was 92.3%. Three of 25 (12%) patients developed acute GVHD, 10 of 25 (40%) patients developed chronic GVHD (9 with limited whereas the other with extensive). The OS rate was 84.6% and the average follow-up time was 1313.2 (738-2005) days for surviving patients. This encouraging result suggests that HLA-haploidentical HSCT is an effective therapeutic option for adults with acquired SAA if an HLA-identical donor is not available.
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Affiliation(s)
- L Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Y Li
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Y Zhang
- Department of Health Statistics, College of Military Preventive Medicine, Third Military Medical University, Chongqing, China
| | - X Chen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - L Gao
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - C Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Y Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - P Kong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Q Wang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Y Su
- Department of Hematology, General Hospital of Chengdu Military Region of PLA, Sichuan, China
| | - C Wang
- Department of Hematology, Sichuan Provincial Peoples Hospital, Sichuan, China
| | - S Wang
- Department of Hematology, General Hospital of Kunming Military Region of PLA, Yunnan, China
| | - B Li
- Department of Hematology, Second Yunnan Provincial peoples hospital, Yunnan, China
| | - A Sun
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - X Du
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - D Zeng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - J Li
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - H Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - X Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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26
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González-Llano O, Rodríguez-Romo LN, Mancías-Guerra MDC, Tarín-Arzaga L, Jaime-Pérez JC, Herrera-Garza JL, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, García-Sepúlveda RD, García-Marín AY, Villarreal-Martínez L, Salazar-Riojas MDR, Gómez-Almaguer D. Feasibility of an outpatient HLA haploidentical stem cell transplantation program in children using a reduced-intensity conditioning regimen and CD3–CD19 depletion. Hematology 2013; 19:10-7. [DOI: 10.1179/1607845413y.0000000088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Oscar González-Llano
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Laura Nelly Rodríguez-Romo
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | | | - Luz Tarín-Arzaga
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Carlos Jaime-Pérez
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Luis Herrera-Garza
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Olga Graciela Cantú-Rodríguez
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - César Homero Gutiérrez-Aguirre
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ricardo Daniel García-Sepúlveda
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ana Yuritzen García-Marín
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Laura Villarreal-Martínez
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - María del Rosario Salazar-Riojas
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - David Gómez-Almaguer
- Hematology ServiceHospital Universitario ‘Dr. Jose E. Gonzalez’, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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27
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Nonmalignant Late Effects in Survivors of Partially Matched Donor Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2013; 19:777-83. [DOI: 10.1016/j.bbmt.2013.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/30/2013] [Indexed: 02/03/2023]
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Zhang C, Zhang X, Chen XH. Cellular mechanism for granulocyte-colony stimulating factor in the prevention of graft-versus-host disease in combined bone marrow and peripheral blood transplantation for hematological malignancies: the composition in collection. Transfus Apher Sci 2012; 48:3-9. [PMID: 23279971 DOI: 10.1016/j.transci.2012.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 08/16/2012] [Indexed: 01/29/2023]
Abstract
Despite improvements in transplant immunology and clinical and supportive care, acute graft-versus-host disease (aGVHD) remains a clinical challenge and a major cause of morbidity and mortality for patients after allogeneic hematopoietic stem cell transplantation (HSCT). Many ways have been used to prevent and treat aGVHD, however, long-term survival remains poor. The key to improve aGVHD outcomes may, in fact, rest upon successful initial therapy. The HLA-matched HSCT was limited by the shortage of suitable donors. Unmanipulated haploidentical/mismatched related transplantation with combined granulocyte-colony stimulating factor (G-CSF)-mobilized peripheral blood stem cells and G-CSF-mobilized bone marrow as a stronger aGVHD inhibition and graft-versus-leukemia effect, has been developed as an alternative transplantation strategy for patients with hematologic malignancies for the advantage of immediate donor availability, ability to select the best of many relatives, controlled graft composition and immediate access to donor-derived cellular therapies if required after transplantation. G-CSF is a potent hematopoietic cytokine, which is produced by fibroblasts, monocytes, and endothelial cells. G-CSF regulates production of neutrophils within the bone marrow and affects neutrophil progenitor proliferation, maturation and is also involved in mobilization of granulocytes, stem and progenitor cells, which has an important role in this transplantation. In this article, we review the possible mechanism for this combined G-CSF-mobilized HSCT in the prevention of aGVHD. Monocytes, T cells, Tregs cells, DC, adhesive molecule, NK cell/KIR ligand mismatching and mesenchymal stem cells may be involved in this transplantation.
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Affiliation(s)
- Cheng Zhang
- Department of Hematology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, People's Republic of China
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29
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Développement des greffes haplo-identiques chez l’adulte atteint d’une hémopathie maligne. Bull Cancer 2012; 99:1141-51. [DOI: 10.1684/bdc.2012.1665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Luo XH, Huang XJ, Li D, Liu KY, Xu LP, Liu DH. Immune reconstitution to cytomegalovirus following partially matched-related donor transplantation: impact ofin vivoT-cell depletion and granulocyte colony-stimulating factor-primed peripheral blood/bone marrow mixed grafts. Transpl Infect Dis 2012; 15:22-33. [PMID: 22372613 DOI: 10.1111/j.1399-3062.2012.00722.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/15/2011] [Accepted: 11/25/2011] [Indexed: 01/24/2023]
Affiliation(s)
- X.-H. Luo
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - X.-J. Huang
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - D. Li
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - K.-Y. Liu
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - L.-P. Xu
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
| | - D.-H. Liu
- Peking University; People's Hospital; Peking University Institute of Hematology, Peking University; Beijing; China
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31
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Mo XD, Xu LP, Liu DH, Chen YH, Han W, Zhang XH, Chen H, Wang Y, Wang JZ, Liu KY, Huang XJ. Patients receiving HLA-haploidentical/partially matched related allo-HSCT can achieve desirable health-related QoL that is comparable to that of patients receiving HLA-identical sibling allo-HSCT. Bone Marrow Transplant 2012; 47:1201-5. [PMID: 22231459 DOI: 10.1038/bmt.2011.250] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To investigate the health-related quality of life (HRQoL) of patients receiving allogeneic hematopoietic SCT (allo-HSCT) from HLA-haploidentical/partially matched related donors (HID/PMRD) and to compare this value with that of patients receiving allo-HSCT from HLA-identical sibling donor (ISD), a total of 350 patients receiving allo-HSCT were enrolled in a study (ISD: 173; HID/PMRD: 177). HRQoL post transplantation was evaluated by an SF-36 questionnaire. The effect of various factors on the HRQoL was analyzed through COX regression. Compared with the ISD group, patients in the HID/PMRD group had higher scores in physical functioning, general health, bodily pain, vitality and emotional role functioning, and these patients functioned significantly better on the physical and mental component summaries. Also, long-term survivors exhibit better HRQoL. Measured by multivariate analysis, extensive chronic GVHD was observed to have a strongly negative impact on patients' HRQoL, while male gender status, lower age when receiving allo-HSCT and returning to work or school were associated with positive impacts on at least one subscale. These results showed that the HRQoL of patients receiving HID/PMRD hematopoietic SCT (HSCT) is comparable to that of patients receiving ISD HSCT, and HLA disparity is not the factor affecting the HRQoL.
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Affiliation(s)
- X-D Mo
- Peking University People's Hospital, Institute of Hematology, Beijing, PR China
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32
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Wang HX, Yan HM, Wang ZD, Xue M, Liu J, Guo ZK. Haploidentical hematopoietic stem cell transplantation in hematologic malignancies with G-CSF mobilized bone marrow plus peripheral blood stem cells grafts without T cell depletion: a single center report of 29 cases. Leuk Lymphoma 2011; 53:654-9. [PMID: 21929286 DOI: 10.3109/10428194.2011.624225] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Haploidentical Hematopoietic stem cell transplantation (Haplo-HSCT) has provided an alternative option since virtually all patients have an immediately available donor. Here, we report the results of Haplo-HSCT with granulocyte-colony-stimulating factor (G-CSF) mobilized bone marrow grafts plus peripheral blood stem cells as the grafts without T-cell depletion. Twenty-nine patients with the mean age of 27.27 years (ranging from 15 to 51 years) were enrolled in this study, and 10 cases were in high risk status. The patients received myeloablative preconditioning with or without total body irradiation and acute graft-versus-host disease (GVHD) prophylaxis consisting of basiliximab, cyclosporine A, methotrexate, mycophenolate mofetil and a rabbit anti-thymocyte globulin. All the patients attained successful neutrophil and platelet recovery. The mean times for neutrophil and platelet recovery were 17.1 and 20.9 days, respectively. During the follow-up at a median time of 30.69 months (ranging from 3 to 76 months), nine patients developed aGVHD grade II-IV, including two developed grade III-IV GVHD after donor lymphocyte infusion. The incidence of cGVHD was 48.3%. 13 patients died within the first two years after transplantation, and the total disease-free survival rate longer than 2 years was 55.2%. These results suggest that G-CSF-primed bone marrow plus peripheral blood stem cell grafts are an appropriate stem cell source for Haplo-HSCT and large scale investigations are needed to confirm this protocol.
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Affiliation(s)
- Heng-Xiang Wang
- Department of Hematology, The General Hospital of Air Force, Beijing, China.
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33
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Hu YX, Cui Q, Liang B, Huang H. Relapsing Hematologic Malignancies after Haploidentical Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2011; 17:1099-111. [DOI: 10.1016/j.bbmt.2011.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/11/2011] [Indexed: 11/16/2022]
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34
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Factors influencing engraftment in HLA-haploidentical/mismatch related transplantation with combined granulocyte-colony stimulating factor-mobilized peripheral blood and bone marrow for patients with leukemia. Transfus Apher Sci 2011; 44:249-55. [DOI: 10.1016/j.transci.2011.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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35
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Zhang C, Chen XH, Zhang X, Gao L, Kong PY, Peng XG, Liang X, Gao L, Gong Y, Wang QY. Human umbilical cord blood-derived stromal cells, a new resource in the suppression of acute graft-versus-host disease in haploidentical stem cell transplantation in sublethally irradiated mice. J Biol Chem 2011; 286:13723-32. [PMID: 21349838 DOI: 10.1074/jbc.m110.144691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Human umbilical cord blood-derived stromal cells (hUCBDSCs), a novel population isolated from CD34(+) cells by our laboratory, exerted an immunosuppressive effect on xenogenic T cells. This study aimed to investigate whether hUCBDSCs play a critical role in the suppression of acute graft-versus-host disease (aGVHD). The hUCBDSCs were co-cultured with splenocytes (SPCs) of donor C57BL/6 mice. The aGVHD in the recipient (B6×BALB/c) F1 mice was induced by the infusion of bone marrow cells and SPCs from donor mice following sublethal irradiation. The shift in vivo for hUCBDSCs was detected. The proliferation and cell cycle of SPCs were tested by cell counting kit-8 and flow cytometry, respectively. The expression of CD49b natural killer (NK) cells and CD3 T cells was detected by flow cytometry in co-culture and post-transplantation. IL-4, and IFN-γ were detected by ELISA in the serum of co-culture and post-transplantation. The survival time, body weight, clinical score, and histopathological score were recorded for mice post-transplantation. The hUCBDSCs promoted the proliferation of SPCs and significantly increased the ratio of the S and G(2)/M phase (p < 0.05). The hUCBDSCs significantly increased the expression of CD49b NK cells and IL-4 protein and decreased the expression of CD3 T cells and IFN-γ protein both in vitro and in vivo. The survival time of mice with co-transplantation of hUCBDSCs was significantly prolonged, and decreased clinical and histopathological scores were also observed. The hUCBDSCs were continually detected in the target organs of GVHD. These results suggest that hUCBDSCs possess the capability of suppressing aGVHD, possibly via their influence on CD3 T cells, NK cells, and cytokines.
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Affiliation(s)
- Cheng Zhang
- Department of Hematology, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China.
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36
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Zhang C, Zhang X, Chen XH. Granulocyte-colony stimulating factor-mobilized mesenchymal stem cells: A new resource for rapid engraftment in hematopoietic stem cell transplantation. Med Hypotheses 2010; 76:241-3. [PMID: 21050671 DOI: 10.1016/j.mehy.2010.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/07/2010] [Accepted: 10/09/2010] [Indexed: 02/02/2023]
Abstract
The bone marrow (BM) microenvironment plays an important role in regulating hematopoietic stem cell self-renewal and differentiation. Mesenchymal stem cells (MSCs), which constitute approximately 0.01-0.0001% of the nucleated cells in the adult human BM, are an important component of the BM stroma that supports hematopoiesis. The BM stroma system is often damaged in patients who have undergone high-dose chemotherapy and/or radiation treatment. Thus, the BM stroma should be reconstructed during hematopoietic stem cell transplantation (HSCT). Granulocyte-colony stimulating factor (G-CSF) is a potent hematopoietic cytokine that regulates neutrophil generation within the BM by modulating the mobility, proliferation and maturation of neutrophil progenitor cells. The results from our study here show that G-CSF markedly increased the number of donor-derived MSCs in the BM and the peripheral blood. Engraftment was faster in HSCTs with bone marrow that was treated with G-CSF (G-BM) or with G-BM- and G-CSF-treated peripheral blood stem cells compared to stead-state bone marrow (SS-BM). Based on these findings, we hypothesize that G-CSF-mobilized treatment of MSCs may accelerate engraftment in HSCT.
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Affiliation(s)
- Cheng Zhang
- Department of Hematology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, People's Republic of China
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37
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Chen XH, Zhang C, Zhang X, Gao L, Gao L, Kong PY, Peng XG, Sun AH, Zeng DF, Wang QY. Cost and outcome in stem cell collections in HLA-haplo identical/mismatched related transplantation with combined granulocyte-colony stimulating factor-mobilized blood and bone marrow for patients with hematologic malignancies. Transfus Apher Sci 2010; 43:23-8. [PMID: 20554478 DOI: 10.1016/j.transci.2010.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Unmanipulated HLA-haplo identical/mismatched related transplantation with combined granulocyte-colony stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) and granulocyte-colony stimulating factor-mobilized bone marrow (G-BM) has been developed as an alternative transplantation strategy for patients without an HLA-matched related or unrelated donor. In this transplantation setting, the cost and outcome of stem cell collections have not been defined completely. The aim of this study was to compare the cost and outcome of stem cell collection in HLA-haplo identical/mismatched related transplantation with combined G-PBSCs and G-BM to the HLA-identical/matched transplantation with G-PBSCs alone for patients with hematologic malignancies. Hundred and fifty-two healthy donors received twice-daily granulocyte-colony stimulating factor (G-CSF) subcutaneously for 5 days. The PBSCs were collected on day 4 and 5 of G-CSF treatment for HLA-identical/matched transplantation from unrelated/related donors. The PBSC collections and BM harvests was performed on day 4 and 5 of G-CSF treatment for HLA-haplo identical/mismatched related transplantation from related donors, respectively. There was no difference in the major characteristics between groups. More stem cells were harvested in HLA-haplo identical/mismatched related donors than that of HLA-identical/matched donors and a lower cost was seen in the former. The HLA-haplo identical/mismatched related transplantation with combined G-PBSCs and G-BM was a feasible approach with high cell harvest and low cost of stem cell collection for patients with hematologic malignancies.
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Affiliation(s)
- Xing-Hua Chen
- Department of Hematology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, People's Republic of China.
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38
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Abstract
Currently, it is possible to find a hematopoietic stem cell (HSC) donor for virtually all patients with acute leukemia who have an indication to receive an allogeneic hematopoietic stem cell transplant (HSCT) and lack a human leukocyte antigen (HLA)-identical sibling or a well-matched HLA unrelated donor (URD). According to the ethnicity of the patients and the donor registry, approximately 25% to 60% of patients will not find an 8/8 HLA-matched unrelated donor. Other alternative donors, such as HLA-mismatched related donor or unrelated donor umbilical cord blood (UCB), have emerged to solve the lack of a sibling or well-matched URD. In the haploidentical HSCT setting, new techniques of T-cell depletion, new approaches using combinations of immunosuppressive drugs or different conditioning regimens, and developments on immunotherapy have focused attention on this option. Therefore, any physician has to carefully evaluate, for each patient in need of an allograft, all of the possible alternatives in order to choose the best HSC donor, taking into account type of disease to be transplanted, urgency of transplantation, donor characteristics, and center experience. This review evaluates the current status of haploidentical HSCT in acute leukemia, its advantages and remaining limitations compared to other stem cell sources, and how these data may be used in the development of donor selection algorithms.
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39
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Unmanipulated HLA-mismatched/haploidentical blood and marrow hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2010; 17:197-204. [PMID: 20302961 DOI: 10.1016/j.bbmt.2010.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 03/07/2010] [Indexed: 02/06/2023]
Abstract
Extensive ex vivo T cell-depleted or unmanipulated haploidentical transplantation provides benefits of rapid and near universal donor availability for patients without HLA-identical sibling donors or those who urgently need transplant. However, CD34 selected haplotype mismatched transplantation was limited by delayed immune reconstitution (IR), although this protocol has now been an acceptable approach. Recently, Peking University researchers developed a novel approach to HLA-mismatched/haploidentical blood and marrow transplantation without in vitro T cell depletion (GIAC protocol). This review summarizes transplant outcomes, and factors correlating with transplant outcomes following the GIAC protocol. Moreover, future challenges in improving posttransplant IR and finding the best approach reducing the incidence and severity of GVHD, whereas preserving graft-versus-leukemia effect to prevent the recurrence of underlying malignancy, are also discussed.
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