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Radujkovic A, Kordelas L, Bogdanov R, Müller-Tidow C, Beelen DW, Dreger P, Luft T. Interleukin-18 and Hematopoietic Recovery after Allogeneic Stem Cell Transplantation. Cancers (Basel) 2020; 12:cancers12102789. [PMID: 32998441 PMCID: PMC7601738 DOI: 10.3390/cancers12102789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022] Open
Abstract
Simple Summary We have previously shown that high pre-conditioning levels of Interleukin-18 were associated with worse survival after allogeneic stem cell transplantation due to increased non-relapse mortality. While no correlations with acute graft-versus-host disease were observed, interleukin-18-related excess mortality was mainly driven by fatal infectious complications. In multiple studies, delayed hematopoietic recovery and poor graft function following allogeneic stem cell transplantation has been demonstrated as a powerful predictor of non-relapse mortality. The present study links high interleukin-18 to delayed platelet recovery in allografted patients. Given the functions of interleukin-18 in regulating the quiescence of hematopoietic stem/progenitor cells, our findings may be explained by Interferon gamma-independent inhibitory effects of interleukin-18 on stem cell proliferation and hematopoietic reconstitution in allografted patients. Importantly, considering recent successful interleukin-18-neutralizing approaches in autoimmune disorders, our results provide a rationale to explore modulation of interleukin-18 for improving hematopoietic recovery and outcomes in allogeneic stem cell transplantation recipients. Abstract Interleukin-18 (IL-18) is an immunoregulatory cytokine and a context-dependent regulator of hematopoietic stem/progenitor cell (HSPC) quiescence in murine models. In a previous study, high pre-conditioning levels of IL-18 were associated with increased non-relapse mortality (NRM) after allogeneic stem cell transplantation (alloSCT). To investigate the clinical impact of IL-18 status on hematopoietic function, the associations of pre-conditioning and day 0–3 cytokine levels with platelet and neutrophil recovery were analyzed in a training cohort of 714 allografted patients. In adjusted logistic regression analyses, both increasing pre-conditioning and day 0–3 IL-18 levels had a significantly higher adjusted odds ratio (aOR) of delayed platelet and neutrophil recovery on day +28 post-transplant (aOR per two-fold increase: 1.6–2.0). The adverse impact of high pre-conditioning IL-18 on day +28 platelet recovery was verified in an independent cohort of 673 allografted patients (aOR per two-fold increase: 1.8 and 1.7 for total and free IL-18, respectively). In both cohorts, a platelet count ≤20/nL on day +28 was associated with a significantly increased hazard of NRM (hazard ratio 2.13 and 2.94, respectively). Our findings support the hypothesis that elevated peritransplant IL-18 levels affect post-transplant HSPC function and may provide a rationale to explore modulation of IL-18 for improving alloSCT outcomes.
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Affiliation(s)
- Aleksandar Radujkovic
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
- Correspondence:
| | - Lambros Kordelas
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.K.); (R.B.); (D.W.B.)
| | - Rashit Bogdanov
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.K.); (R.B.); (D.W.B.)
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
| | - Dietrich W. Beelen
- Department of Bone Marrow Transplantation, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (L.K.); (R.B.); (D.W.B.)
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, 69120 Heidelberg, Germany; (C.M.-T.); (P.D.); (T.L.)
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Wang R, Huang A, Chen Q, Wang L, Gao L, Qiu H, Ni X, Zhang W, Yang J, Wang J, Hu X. Pulmonary Infection Within 100 Days After Transplantation Impaired Platelet Recovery in Patients with Hematologic Malignancies: A Propensity-Score-Matched Analysis. Ann Transplant 2019; 24:541-552. [PMID: 31558694 PMCID: PMC6784627 DOI: 10.12659/aot.917802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Pulmonary infection is one of the life-threatening complications occurring during allogeneic hematopoietic stem cell transplantation (alloHSCT), even when prophylactic measures have been employed. Few studies have investigated whether pulmonary infection affects platelet recovery during alloHSCT. Material/Methods We retrospectively reviewed 253 consecutive patients with hematologic diseases who received alloHSCT in our institute. Among them, 62 patients (25%) had pulmonary infection within 100 days after alloHSCT. Using the one-to-two propensity-score matching logistic model, 50 patients with pulmonary infection and 100 patients without were included based on age, disease and stage, time from diagnosis to transplantation, infused CD34+ cells, and mononuclear cells. Results The incidences of prolonged thrombocytopenia in patients with pulmonary infection were 44% (22/50) and 9% (9/100) in the corresponding matched group (P<0.001). The mean time for platelet engraftment in patients with and without pulmonary infection were 19.29±13.96 days and 13.94±4.12 days (P=0.012), respectively. Multivariable logistic regression showed that pulmonary infection was an independent risk factor for impaired platelet recovery (OR: 5.335, 95% CI: 2.735–10.407, P<0.001). Impaired platelet recovery was associated with shorter survival and higher treatment-related mortality. Conclusions Our results indicate that patients with pulmonary infection within 100 days after alloHSCT are more likely to suffer from impaired platelet recovery and have inferior long-term survival.
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Affiliation(s)
- Roujia Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Aijie Huang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Qi Chen
- Department of Health Statistics, Second Military Medical University, Shanghai, China (mainland)
| | - Libing Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Lei Gao
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Huiying Qiu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Xiong Ni
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Weiping Zhang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Jianmin Yang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Jianmin Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
| | - Xiaoxia Hu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, China (mainland)
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