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Mishra K, Naithani R. Haploidentical Hematopoietic Stem Cell Transplantation in India-Bridging the Gap. Indian J Hematol Blood Transfus 2024; 40:371-374. [PMID: 39011256 PMCID: PMC11246363 DOI: 10.1007/s12288-024-01812-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024] Open
Affiliation(s)
- Kundan Mishra
- Hematology and Bone Marrow Transplant Division, Command Hospital, Lucknow, India
| | - Rahul Naithani
- Hematology and Bone Marrow Transplant Division, Paras Health, Gurugram, India
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Ashouri K, Ginosyan AA, Chu M, Hom B, Hwang J, Resnick K, Rahimi Y, Chaudhary P, Woan K, Siddiqi I, Ladha A, Ali A, Tam EL, Yaghmour G. Donor matters: Donor selection impact on hematopoietic stem cell transplantation outcomes in Hispanic patients with B-cell acute lymphocytic leukemia: Insights from a myeloablative HSCT study. Leuk Res 2024; 141:107501. [PMID: 38631149 DOI: 10.1016/j.leukres.2024.107501] [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: 01/17/2024] [Revised: 03/17/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a pivotal treatment for high-risk acute lymphocytic leukemia (ALL), although limited by suitable human leukocyte antigen (HLA)-matched sibling donors (MSD). This study evaluates the impact of donor selection on outcomes in post-HSCT Hispanic B-cell ALL patients. METHODOLOGY This single-center retrospective study evaluates outcomes in 88 adult Hispanic B-cell ALL patients who underwent haploidentical, MSD, or MUD myeloablative HSCT between 2013 and 2023. RESULTS Compared to Haploidentical transplants, MSD exhibited worse cumulative incidence of relapse (CIR) (HR = 3.39; P = 0.014) and disease-free survival (DFS) (HR = 2.44; P = 0.048) whereas MUD outcomes did not differ. This effect persisted even when controlling for pre-HSCT stage and Minimal residual disease (MRD) status. In addition, Ph-like was a significant predictor of worse DFS (HR = 3.60; P=0.014) and CIR (HR = 2.97; P=0.035) on multivariate analysis. Older donor age correlated with worse GVHD-free, relapse-free survival (GRFS) in haploidentical transplants (HR = 1.05; P=0.036). CONCLUSION Our data highlights improved outcomes with younger, haploidentical donors among Hispanic B-cell ALL patients undergoing myeloablative HSCT. This underscores the importance of donor selection in optimizing outcomes for ALL patients.
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Affiliation(s)
- Karam Ashouri
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anush A Ginosyan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mollee Chu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Hom
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hwang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Karen Resnick
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yekta Rahimi
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Preet Chaudhary
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Karrune Woan
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Imran Siddiqi
- Division of Pathology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Abdullah Ladha
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Amir Ali
- Department of Pharmacy, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Eric Leon Tam
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
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Shyr D, Davis KL, Bertaina A. Stem cell transplantation for ALL: you've always got a donor, why not always use it? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:84-90. [PMID: 38066901 PMCID: PMC10726989 DOI: 10.1182/hematology.2023000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) represents a consolidated therapeutic strategy for high-risk pediatric acute lymphoblastic leukemia (ALL), offering the potential for curative treatment. This manuscript delves into the debate around the more universal application of HSCT for pediatric ALL in the modern era, considering the ubiquitous availability of suitable donors. In fact, despite significant advancements in chemotherapy, targeted therapy, and immunotherapy, a subset of pediatric patients with ALL with high-risk features or relapse continue to encounter poor prognostic outcomes. For this subgroup of patients, HSCT often remains the only potentially curative measure, leveraging the graft-versus- leukemia effect for long-term disease control. Nevertheless, the procedure's complexity and associated risks have traditionally curtailed its widespread use. However, the scenario is shifting with improvements in HLA matching, availability of alternative donor sources, less toxic conditioning regimens, and improved supportive care protocols. Concurrently, emerging therapies like CD19+ CAR T cells present new considerations for definitive therapy selection in relapsed/ refractory ALL. This article reviews critical current evidence and debates the potential of HSCT as a more universal treatment for ALL, reevaluating traditional treatment stratification in light of the constant availability of stem cell donors.
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Affiliation(s)
- David Shyr
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Center for Definitive and Curative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Kara L Davis
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Center for Cancer Cellular Therapy, Stanford University School of Medicine, Palo Alto, CA
| | - Alice Bertaina
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Center for Definitive and Curative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Ekpa QL, Akahara PC, Anderson AM, Adekoya OO, Ajayi OO, Alabi PO, Okobi OE, Jaiyeola O, Ekanem MS. A Review of Acute Lymphocytic Leukemia (ALL) in the Pediatric Population: Evaluating Current Trends and Changes in Guidelines in the Past Decade. Cureus 2023; 15:e49930. [PMID: 38179374 PMCID: PMC10766210 DOI: 10.7759/cureus.49930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Acute lymphocytic leukemia (ALL) is a commonly diagnosed cancer in children. Despite technological advancements to improve treatment and survival rates, there has been a steady increase in the incidence of ALL and treatment failures. This paper discusses the pathogenic interaction between genetic and environmental factors leading to childhood ALL. It evaluates the current treatment guidelines and notable obstacles leading to resistance, relapse, and treatment toxicities. The review evaluates a 10-year trend in the management guidelines of pediatric ALL through a systematic literature review of records from 2012 to 2023. Findings show that improvement in the five-year survival rates, notwithstanding rates of relapse and incurable diseases, is still high. Furthermore, several risk factors, including an interplay between genetic and environmental factors, are largely contributory to the outcome of ALL treatments and its overall incidence. Moreover, huge financial costs have remained a significant challenge in outcomes. There remains a need to provide individualized treatment plans, shared decision-making, and goals of care as parts of the management guidelines for the best possible outcomes. We expect that future advancements will increase overall survival rates and disease-free years.
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Affiliation(s)
- Queen L Ekpa
- General Practice, Conestoga College, Kitchener, CAN
| | | | - Alexis M Anderson
- Pediatric Medicine, St. George's University, School of Medicine, St. George's, GRD
| | | | - Olamide O Ajayi
- Pediatrics, Medway Maritime Hospital, Kent, GBR
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Peace O Alabi
- Pediatrics, University of Abuja Teaching Hospital, Abuja, NGA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Medara S Ekanem
- General Medicine, Babcock University Teaching Hospital, Ilishan-Remo, NGA
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Nagler A. In 2022, which is preferred: haploidentical or cord transplant? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:64-73. [PMID: 36485156 PMCID: PMC9820258 DOI: 10.1182/hematology.2022000327] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation is the treatment of choice for high-risk hematological malignancies such as acute myeloid and lymphocytic leukemia, myelodysplastic syndrome, and myeloproliferative disorders. Alternative donor transplantation from either haploidentical (haplo-SCT) or cord blood donor (CBT) is an established therapeutic alternative for patients who need transplants but lack a human leukocyte antigen-matched donor. Although haplo-SCT (mainly non-T-cell-depleted haplo-SCT with posttransplant cyclophosphamide) is increasing while CBT is decreasing worldwide (Figure 1), recent developments in CBT, especially cord blood expansion and other strategies to improve engraftment and immune reconstitution post-CBT, make CBT still a valuable option. This article discusses the 2 options based on the currently available data, focusing on adults, and tries to give some clues to help the transplant physician choose a haploidentical vs a cord blood donor. Given the limited numbers of published or ongoing well-designed randomized controlled trials comparing haplo-SCT to CBT and the overall similar clinical results in the available, mostly registry-based, and single-center studies, with substantial heterogeneity and variability, the decision to perform haplo-SCT or CBT in a given patient depends not only on the patient, disease, and donor characteristics and donor availability (although most if not all patients should have in principle an alternative donor) but also on the transplant physician's discretion and, most importantly, the center's experience and preference and ongoing protocols and strategies.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Bone Marrow Transplantation, and Hemato-Oncology Center, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation, Paris, France
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Ma R, Liu XT, Chang YJ. Allogeneic haematopoietic stem cell transplantation for acute lymphoblastic leukaemia: current status and future directions mainly focusing on a Chinese perspective. Expert Rev Hematol 2022; 15:789-803. [DOI: 10.1080/17474086.2022.2125375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rui Ma
- Peking University People’s Hospital & Peking University Institute of Hematology
- National Clinical Research Center for Hematologic Disease
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xin-Tong Liu
- Peking University People’s Hospital & Peking University Institute of Hematology
- National Clinical Research Center for Hematologic Disease
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Ying-Jun Chang
- Peking University People’s Hospital & Peking University Institute of Hematology
- National Clinical Research Center for Hematologic Disease
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
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