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Li Q, Meng F, Zhou M, Yu B, Mo W, Du Q, Jiang X, Wei Y. Clinical Comparison of Non-Myeloablative Conditioning with Anti-Thymocyte Globulin and Fludarabine for Patients with Hematologic Malignancies. Med Sci Monit 2015; 21:2257-65. [PMID: 26238068 PMCID: PMC4530985 DOI: 10.12659/msm.893846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The influence of different non-myeloablative conditioning regimens on clinical outcome remains undefined. Material/Methods We retrospectively analyzed the hematopoietic reconstitution, graft-versus-host disease (GVHD), and quality of life (QOL) in 56 patients with hematologic malignancies who underwent non-myeloablative stem cell transplantation (NST) with a conditioning regimen based on anti-thymocyte globulin (ATG), followed by donor lymphocyte infusion (n=24), or Fludarabine (FLU) (n=32). Hematopoietic stem cells were derived from low-resolution HLA-matched identical sibling donors. Results The blood type transformation and platelet reconstitution presented significantly earlier in the FLU group than the ATG group (P<0.05). Within 100 days post-transplantation, the incidence of grade I–IV acute GVHD was significantly lower in the ATG group than the FLU group (P<0.05). After 100 days post-transplant, extensive chronic GVHD (cGVHD) was more prevalent in the ATG group than the FLU group (P<0.05). There were lower cumulative risk of relapse and higher non-relapse-related mortality in the ATG group, but better QOL in the FLU group within 24 months, and no difference in 3-year disease-free survival (DFS) or overall survival (OS) between the 2 groups (P>0.05). Conclusions The FLU-based conditioning regimen improved hematopoietic reconstitution and decreased extensive cGVHD, but there was no difference in 3-year DFS or OS between the 2 groups.
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Affiliation(s)
- Qingshan Li
- Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Fanyi Meng
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Ming Zhou
- Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Bizhen Yu
- Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Wenjian Mo
- Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Qinghua Du
- Department of Hematology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China (mainland)
| | - Xuejie Jiang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangzhou, Guangdong, China (mainland)
| | - Yaming Wei
- Department of Blood Transfusion, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
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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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Lu Y, Waller EK. Dichotomous role of interferon-gamma in allogeneic bone marrow transplant. Biol Blood Marrow Transplant 2009; 15:1347-53. [PMID: 19822293 DOI: 10.1016/j.bbmt.2009.07.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 07/16/2009] [Indexed: 01/14/2023]
Abstract
Interferon (IFN)-gamma is a pleiotropic cytokine with a central role in innate and adaptive immunity. As a potent pro-inflammatory and antitumor cytokine, IFN-gamma is conventionally thought to be responsible for driving cellular immune response. On the other hand, accumulating evidence suggests that IFN-gamma also has immunosuppressive activity. An important role for IFN-gamma in inhibiting graft-versus-host disease (GVHD) has been demonstrated in murine models, despite IFN-gamma being one of the key factors amplifying T cell activation during the process of acute GVHD (aGVHD), the major complication and cause of post-transplant mortality in allogeneic bone marrow transplantation (BMT). At the same time, IFN-gamma facilitates graft-versus-leukemia (GVL) activity. Dissociation of GVL effects from GVHD has been the ultimate goal of allogeneic BMT in the treatment of hematologic malignancies. This paradoxic role of IFN-gamma makes modulating its activity a promising strategy to maximize GVL while minimizing GVHD and improve clinical outcomes in BMT. In this review, the effects of IFN-gamma on GVHD and GVL are discussed with consideration of the mechanism of IFN-gamma action.
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Affiliation(s)
- Ying Lu
- Department of Hematology/Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA
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Li JM, Giver CR, Lu Y, Hossain MS, Akhtari M, Waller EK. Separating graft-versus-leukemia from graft-versus-host disease in allogeneic hematopoietic stem cell transplantation. Immunotherapy 2009; 1:599-621. [PMID: 20191089 PMCID: PMC2827928 DOI: 10.2217/imt.09.32] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Routine methods to maximize the graft-versus-leukemia (GvL) activity of allogeneic hematopoietic stem cell transplantation (HSCT) without the detrimental effects of graft-versus-host disease (GvHD) are lacking. Depletion or inhibition of alloreactive T cells is partially effective in preventing GvHD, but usually leads to decreased GvL activity. The current model for the pathophysiology of acute GvHD describes a series of immune pathways that lead to activation of donor T cells and inflammatory cytokines responsible for tissue damage in acute GvHD. This model does not account for how allotransplant can lead to GvL effects without GvHD, or how the initial activation of donor immune cells may lead to counter-regulatory effects that limit GvHD. In this review, we will summarize new findings that support a more complex model for the initiation of GvHD and GvL activities in allogeneic HSCT, and discuss the potential of novel strategies to enhance GvL activity of the transplant.
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Affiliation(s)
| | | | | | | | | | - Edmund K Waller
- Author for correspondence: Department of Hematology/Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Road NE, Room C4002, Atlanta, GA 3032, USA Tel.: +1 404 727 4995 Fax: +1 404 778 5530
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Morecki S, Yacovlev E, Gelfand Y, Shabat Y, Slavin S. Induction of graft-versus-leukemia (GVL) effect without graft-versus-host disease (GVHD) by pretransplant donor treatment with immunomodulators. Biol Blood Marrow Transplant 2009; 15:406-15. [PMID: 19285627 DOI: 10.1016/j.bbmt.2008.12.504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 12/24/2008] [Indexed: 02/03/2023]
Abstract
Pretransplant donor treatment with immunomodulators such as complete Freund's adjuvant (CFA) or oligodeoxynucleotide sequences expressing CpG motifs (CpG), was applied in sublethally irradiated host mice inoculated with murine models of mammary carcinoma (4T1) or B cell leukemia (BCL1). Spleen cells or IL-2 activated splenocytes (lymphokine activated killer [LAK]) derived from donor mice treated with CpG emulsified in incomplete Freund's adjuvant (IFA), (CpG + IFA) did not cause graft-versus-host disease (GVHD), but were not efficient enough to induce a significant graft-versus-tumor (GVT) response against 4T1 cells. In contrast, an efficient graft-versus-leukemia (GVL) effect was evident in BCL1-bearing mice inoculated with spleen cells from donors pretreated with CFA or CpG + IFA. Pretransplant donor treatment with CFA prolonged survival to a median of 62 days with 3 of 27 mice remaining GVHD- and leukemia-free for >200 days, compared to GVHD-related death of all mice inoculated with naïve cells (median 17 days), or leukemia-related death of all mice inoculated with leukemia cells (median of 27 days). Pretransplant donor treatment with CpG + IFA exerted a more efficient GVL effect with reduced GVHD resulting in 12 of 26 GVHD- and leukemia-free survivors for >200 days. Our results suggest that it may be possible to prevent GVHD while sparing an efficient GVL effect by using pretransplant donor treatment with immunomodulators prior to allogeneic stem cell transplantation and/or donor lymphocyte infusions in hematologic malignancies.
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Affiliation(s)
- Shoshana Morecki
- Department of Bone Marrow Transplantation & Cancer Immunotherapy, Cell Therapy & Transplantation Research Laboratory, Hadassah University Hospital, Jerusalem, Israel.
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Li JM, Gorechlad J, Larsen CP, Waller EK. Apoptotic donor leukocytes limit mixed-chimerism induced by CD40-CD154 blockade in allogeneic bone marrow transplantation. Biol Blood Marrow Transplant 2007; 12:1239-49. [PMID: 17162205 DOI: 10.1016/j.bbmt.2006.08.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Accepted: 08/24/2006] [Indexed: 11/26/2022]
Abstract
"Mini" allogeneic bone marrow transplants using non-myeloablative conditioning have reduced early treatment-related mortalities, but graft-versus-host disease (GVHD) and graft rejection remain clinical problems. Our preliminary studies indicated that low-dose busulfan conditioning and costimulatory blockade using anti-CD154 monoclonal antibody (mAb) in combination with a pretransplantation "tolerating" dose of bone marrow (BM) cells were sufficient to establish stable mixed-chimerism without GVHD when transplanting moderate doses of T cell depleted (TCD)-BM from major histocompatibility complex (MHC) fully-mismatched donors (Adams AB, Durham MM, Kean L, et al. J Immunol. 2001;167:1103-1111). In this study, donor splenocytes were administered before transplantation as a tolerating cell infusion with a conditioning regimen consisting of low-dose busulfan and anti-CD154 mAb. We compared the ability of viable and apoptotic donor cells of different ex vivo treatments and purified different donor cell populations (CD3(+), CD3(-), CD11b(+), and CD11b(-) splenocytes) to induce tolerance and enhance donor chimerism in a MHC mismatched model of murine bone marrow transplantation. We found that mixed chimerism without GVHD was enhanced by pretransplantation administration of viable allogeneic splenocytes and diminished in mice with prior exposure to apoptotic/necrotic donor splenocytes. CD11b(+)-enriched splenocytes more potently enhanced donor chimerism compared to unfractionated splenocytes or other splenocyte subsets. Mixed lymphocyte cultures demonstrated that apoptotic stimulators overcame the immune-tolerating activity of anti-CD154 mAb and led to increased interferon gamma and tumor necrosis factor alpha synthesis, increased proliferation of responder T cells, and decreased production of interleukin-10. In conclusion, viable donor splenocytes administered before transplantation in combination with costimulatory blockade induced tolerance and enhanced donor chimerism, whereas pretransplantation administration of apoptotic/necrotic donor cells led to host T cell activation and decreased overall donor engraftment.
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Affiliation(s)
- Jian-ming Li
- Division of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA
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