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Nagler A, Labopin M, Kröger N, Schroeder T, Gedde-Dahl T, Eder M, Franke GN, Blau IW, Salmenniemi U, Socie G, Schetelig J, Stelljes M, Ciceri F, Mohty M. The role of anti-thymocyte globulin in allogeneic stem cell transplantation (HSCT) from HLA-matched unrelated donors (MUD) for secondary AML in remission: a study from the ALWP /EBMT. Bone Marrow Transplant 2023; 58:1339-1347. [PMID: 37660157 DOI: 10.1038/s41409-023-02095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
We compared outcomes, of 1609 patients with secondary acute myeloid leukemia (sAML) undergoing allogeneic transplantation (HSCT) in first complete remission (CR1) from matched unrelated donors (MUD) from 2010 to 2021, receiving or not receiving anti-thymocyte globulin (ATG) (ATG-1308, no ATG-301). Median age was 60.9 (range, 18.5-77.8) and 61.1 (range, 21.8-75.7) years, (p = 0.3). Graft versus host disease (GVHD) prophylaxis was cyclosporin-A with methotrexate (41%) or mycophenolate mofetil (38.2%), without significant differences between groups. Day 28, engraftment (ANC > 0.5 × 109/L) was 92.3% vs 95.3% (p = 0.17), respectively. On multivariate analysis, ATG was associated with lower incidence of grade II-IV and grade III-IV acute GVHD (p = 0.002 and p = 0.015), total and extensive chronic GVHD (p = 0.008 and p < 0.0001), and relapse incidence (RI) (p = 0.039), while non-relapse mortality (NRM) did not differ (p = 0.51). Overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were significantly higher in the ATG vs no ATG group, HR = 0.76 (95% CI 0.61-0.95, p = 0.014) and HR = 0.68 (95% CI 0.57-0.8, p < 0.0001), with a tendency for better leukemia-free survival (LFS), HR = 0.82 (95% CI 0.67-1, p = 0.051). The main causes of death were the original disease, infection, and GVHD. In conclusion, ATG reduces GVHD and improves LFS, OS, and GRFS in sAML patients without increasing the RI, despite sAML being a high-risk disease.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Myriam Labopin
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR 938, Paris, France
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
| | - Thomas Schroeder
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - Tobias Gedde-Dahl
- Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Hematology Department, Section for Stem Cell Transplantation, Oslo, Norway
| | - Matthias Eder
- Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy University hospital Leipzig, Leipzig, Germany
| | - Igor Wolfgang Blau
- Charité, University medicine Berlin, Department of Hematology, BMT Unit, Berlin, Germany
| | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Gerard Socie
- Hopital St. Louis, Department of Hematology-BMT, Paris, France
| | - Johannes Schetelig
- Universitaetsklinikum Dresden Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Matthias Stelljes
- University of Muenster Department of Hematol. /Oncol., Muenster, Germany
| | - Fabio Ciceri
- Hematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris study office; Department of Haematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR 938, Paris, France
- Sorbonne University, Department of Haematology, Saint Antoine Hospital; INSERM UMR 938, Paris, France
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2
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Pourmontaseri H, Habibzadeh N, Entezari S, Samadian F, Kiyani S, Taheri M, Ahmadi A, Fallahi MS, Sheikhzadeh F, Ansari A, Tamimi A, Deravi N. Monoclonal antibodies for the treatment of acute lymphocytic leukemia: A literature review. Hum Antibodies 2022; 30:117-130. [PMID: 35662114 DOI: 10.3233/hab-211511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute lymphocytic leukemia (ALL) is a type of blood cancer that is more prevalent in children. Several treatment methods are available for ALL, including chemotherapy, upfront treatment regimens, and pediatric-inspired regimens for adults. Monoclonal antibodies (Mabs) are the novel Food and Drug Administration (FDA) approved remedies for the relapsed/refractory (R/R) adult ALL. In this article, we aimed to review studies that investigated the efficacy and safety of Mabs on ALL. METHODS We gathered studies through a complete search with all proper related keywords in ISI Web of Science, SID, Scopus, Google Scholar, Science Direct, and PubMed for English language publications up to 2020. RESULTS The most commonly studied Mabs for ALL therapies are CD-19, CD-20, CD-22, and CD-52. The best results have been reported in the administration of blinatumomab, rituximab, ofatumumab, and inotuzumab with acceptable low side effects. CONCLUSION Appling personalized approach for achieving higher efficacy is one of the most important aspects of treatment. Moreover, we recommend that the wide use of these Mabs depends on designing further cost-effectiveness trials in this field.
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Affiliation(s)
- Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.,Bitab knowledge enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Niloofar Habibzadeh
- Student Research Committee, School of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sarina Entezari
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Samadian
- Nursing Department, Shahid Beheshti University of Medical science, Tehran, Iran
| | - Shamim Kiyani
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Taheri
- Student Research Committee, School of Pharmacy Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Ahmadi
- Faculty of Biological Sciences and Technologies, Islamic Azad University Sari Branch, Sari, Iran
| | | | - Farzad Sheikhzadeh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arina Ansari
- Student Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Amirhossein Tamimi
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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A case of thymoma showing significant tumor reduction after anti-thymocyte globulin. Gen Thorac Cardiovasc Surg 2021; 70:96-99. [PMID: 34709554 DOI: 10.1007/s11748-021-01721-2] [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: 05/30/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
A 71-year-old female with type B3 thymoma developed severe aplastic anemia. Anti-thymocyte globulin was administered with glucocorticoids and cyclosporin A as the treatment for aplastic anemia. Computed tomography scan revealed that thymoma apparently shrank and remained without regrowth for at least 7 months. As previously reported, glucocorticoid has therapeutic effects on thymoma especially with abundant lymphocytes. Anti-thymocyte globulin also depletes peripheral lymphocytes, but its efficacy in the treatment of thymoma is unknown. Anti-thymocyte globulin and glucocorticoids may have cooperated with each other in reducing thymoma in our case. More cases should be accumulated to elucidate the effects of anti-thymocyte globulin on thymoma.
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Shichijo T, Fuji S, Nagler A, Bazarbachi A, Mohty M, Savani BN. Personalizing rabbit anti-thymocyte globulin therapy for prevention of graft-versus-host disease after allogeneic hematopoietic cell transplantation: is there an optimal dose? Bone Marrow Transplant 2019; 55:505-522. [PMID: 31435032 DOI: 10.1038/s41409-019-0643-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/04/2019] [Accepted: 07/05/2019] [Indexed: 11/09/2022]
Abstract
The efficacy of anti-thymocyte globulin (ATG) as prophylaxis for graft-versus-host disease (GVHD) has been investigated by many clinical studies over the past decade, including some randomized controlled trials. Intriguingly, although ATG is commonly used as prophylaxis for GVHD, there is still controversy about the optimal dose of ATG for prophylaxis of GVHD after allogeneic hematopoietic cell transplantation (allo-HCT). Indeed, the dose and formulation of ATG, as well as the degree of clinical benefit, has varied among studies, which makes it difficult to fully determine the clinical benefit of ATG. The aim of this review is to summarize the information regarding the optimal ATG dose of each formulation according to stem cell source, and to discuss how best to determine the personalized optimal dose of ATG in each allo-HCT recipient.
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Affiliation(s)
- Takafumi Shichijo
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University Faculty of life Sciences, Kumamoto, Japan.,Laboratory of Virus Control, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan.
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Abdulhamid Bazarbachi
- Service d'Hématologie Clinique et thérapie cellulaire and EBMT Paris Study Office, Saint Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et thérapie cellulaire and EBMT Paris Study Office, Saint Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
| | - Bipin N Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Bonifazi F, Solano C, Wolschke C, Sessa M, Patriarca F, Zallio F, Nagler A, Selleri C, Risitano AM, Messina G, Bethge W, Herrera P, Sureda A, Carella AM, Cimminiello M, Guidi S, Finke J, Sorasio R, Ferra C, Sierra J, Russo D, Benedetti E, Milone G, Benedetti F, Heinzelmann M, Pastore D, Jurado M, Terruzzi E, Narni F, Völp A, Ayuk F, Ruutu T, Kröger N. GVHD prophylaxis plus ATLG after myeloablative allogeneic haemopoietic peripheral blood stem-cell transplantation from HLA-identical siblings in patients with acute leukaemia in remission: final results of quality of life and long-term outcome analysis of a phase 3 randomised study. LANCET HAEMATOLOGY 2019; 6:e89-e99. [DOI: 10.1016/s2352-3026(18)30214-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022]
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Filgrastim enhances T-cell clearance by antithymocyte globulin exposure after unrelated cord blood transplantation. Blood Adv 2019. [PMID: 29535105 DOI: 10.1182/bloodadvances.2017015487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Residual antithymocyte globulin (ATG; Thymoglobulin) exposure after allogeneic hematopoietic (stem) cell transplantation (HCT) delays CD4+ T-cell immune reconstitution (CD4+ IR), subsequently increasing morbidity and mortality. This effect seems particularly present after cord blood transplantation (CBT) compared to bone marrow transplantation (BMT). The reason for this is currently unknown. We investigated the effect of active-ATG exposure on CD4+ IR after BMT and CBT in 275 patients (CBT n = 155, BMT n = 120; median age, 7.8 years; range, 0.16-19.2 years) receiving their first allogeneic HCT between January 2008 and September 2016. Multivariate log-rank tests (with correction for covariates) revealed that CD4+ IR was faster after CBT than after BMT with <10 active-ATG × day/mL (P = .018) residual exposure. In contrast, >10 active-ATG × day/mL exposure severely impaired CD4+ IR after CBT (P < .001), but not after BMT (P = .74). To decipher these differences, we performed ATG-binding and ATG-cytotoxicity experiments using cord blood- and bone marrow graft-derived T-cell subsets, B cells, natural killer cells, and monocytes. No differences were observed. Nevertheless, a major covariate in our cohort was Filgrastim treatment (only given after CBT). We found that Filgrastim (granulocyte colony-stimulating factor [G-CSF]) exposure highly increased neutrophil-mediated ATG cytotoxicity (by 40-fold [0.5 vs 20%; P = .002]), which explained the enhanced T-cell clearance after CBT. These findings imply revision of the use (and/or timing) of G-CSF in patients with residual ATG exposure.
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The putative anti-leukemic effects of anti-thymocyte globulins in patients with CD7-positive acute myeloid leukemia. Bone Marrow Transplant 2018; 53:1019-1029. [PMID: 29459664 DOI: 10.1038/s41409-018-0115-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/09/2022]
Abstract
Polyclonal anti-thymocyte globulins (ATGs) are widely used in allogeneic stem cell transplantation (allo-SCT) for GvHD prophylaxis. ATGs exerted anti-tumor effects in in vitro experiments, but in vivo studies are lacking. We experienced a case of relapsed AML with cells positive for CD7 who underwent haploidentical SCT and unexpectedly achieved a significant reduction of AML cells in the peripheral blood after receiving ATGs before the administration of other drugs in the conditioning regimen. This patient achieved long-term survival after haploidentical SCT. To assess the impact of ATGs on clinical outcomes in patients with AML, we performed a retrospective analysis of allo-SCT for relapsed/refractory AML and divided 132 patients into four groups according to the expression of CD7 in AML cells and use of ATGs as part of the conditioning regimen, as follows: CD7-positive ATG group (n = 15), CD7-positive no-ATG group (n = 32), CD7-negative ATG group (n = 19), and CD7-negative no-ATG group (n = 66). The overall survival rates in the CD7-positive ATG group were significantly higher than those in the CD7-positive no-ATG group, whereas these rates did not differ statistically between the CD7-negative ATG and CD7-negative no-ATG groups. Our results indicate a possible anti-leukemic effect of ATGs against CD7-positive AML in humans.
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The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:658-666. [DOI: 10.1016/j.clml.2017.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/04/2017] [Accepted: 06/08/2017] [Indexed: 01/22/2023]
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9
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Li XY, Wu L, Li SW, Zhou WB, Wang MY, Zuo GQ, Liu CA, Ding X. Effect of CD16a, the surface receptor of Kupffer cells, on the growth of hepatocellular carcinoma cells. Int J Mol Med 2016; 37:1465-74. [PMID: 27082928 PMCID: PMC4866971 DOI: 10.3892/ijmm.2016.2561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/18/2016] [Indexed: 12/16/2022] Open
Abstract
FcγRIIIa (CD16) is a low-affinity Fc receptor of IgG. As the idio-binding receptor of IgG Fc, it plays an important role in the antibody-dependent cellular cytotoxicity of natural killer cells. The aim of the present study was to investigate the distribution of Kupffer cells (KCs) and the expression of their surface receptor FcγRIIIa in hepatocellular carcinoma. Furthermore, we also aimed to observe the functional mechanism of FcγRIIIa. Immunohistochemical analysis was employed to study KCs and FcγRIIIa. In order to explore the role of FcγRIIIa in the growth of cancer cells, KCs and H22 tumor cells were co-cultured in different serum. The mRNA expression levels of tumor necrosis factor (TNF)-α and FcγRIIIa were analyzed by RT-qPCR; the TNF-α and FcγRIIIa protein expression levels were examined by enzyme-linked immunosorbent assay and western blot analysis, respectively. Our results showed that the number of Kuppfer cells in cancerous tissues (21.6±7.8) was lower than those in para-cancerous (68.8±9.1) tissues and adjacent normal hepatic tissues (62.0±1.9) (P<0.01); this decreased with the reduction in the differentiation degree of cancer (P<0.05). FcγRIIIa-positive cells were similar in morphology to KCs, and their distributive tendency was coincident (P<0.05). The increase in CD16a mRNA levels in the group treated with immune serum was 3.9-, 4.9- and 3.9-fold greater than that in the ordinary serum group at different time points, and CD16a protein expression also markedly increased (P<0.05). However, these effects were inhibited by the addition of anti-IgG Fc serum (P<0.05). The results of the present study suggested that FcγRIIIa resided in KCs, and it contributed to the inhibition of the growth of liver tumor cells.
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Affiliation(s)
- Xiu-Yun Li
- Department of Hepatobiliary Surgery, Traditional Chinese Medicine Hospital of Dianjiang, Dianjiang, Chongqing, P.R. China
| | - Lun Wu
- Institute of Liver Surgery, DongFeng Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Sheng-Wei Li
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Wen-Bo Zhou
- Institute of Liver Surgery, DongFeng Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Meng-Yuan Wang
- Department of Hepatobiliary Surgery, Chongqing Three Gorges Central Hospital, Wanzhou, Chongqing, P.R. China
| | - Guo-Qing Zuo
- Department of Gastroenterology, Hospital of Traditional Chinese Medicine, Yubei, Chongqing, P.R. China
| | - Chang-An Liu
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xiong Ding
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
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Anti-thymocyte globulin could improve the outcome of allogeneic hematopoietic stem cell transplantation in patients with highly aggressive T-cell tumors. Blood Cancer J 2015; 5:e332. [PMID: 26230956 PMCID: PMC4526780 DOI: 10.1038/bcj.2015.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 06/12/2015] [Indexed: 12/05/2022] Open
Abstract
The early experiment result in our hospital showed that anti-thymocyte globulin (ATG) inhibited the proliferation of lymphoid tumor cells in the T-cell tumors. We used the ATG as the part of the conditioning regimen and to evaluate the long-term anti-leukemia effect, the safety and complication in the patients with highly aggressive T-cell lymphomas. Twenty-three patients were enrolled into this study. At the time of transplant, six patients reached first or subsequent complete response, three patients had a partial remission and 14 patients had relapsed or primary refractory disease. The conditioning regimen consisted of ATG, total body irradiation, toposide and cyclophosphamide. The complete remission rate after transplant was 95.7%. At a median follow-up time of 25 months, 16 (69.6%) patients are alive and free from diseases, including nine patients in refractory and progressive disease. Seven patients died after transplant, five from relapse and two from treatment-related complications. The incidence of grades II–IV acute graft-vs-host disease (GvHD) was 39.1%. The maximum cumulative incidence of chronic GvHD was 30%. The most frequent and severe conditioning-related toxicities observed in 8 out of 23 patients were grades III/IV infections during cytopenia. Thus, ATG-based conditioning is a feasible and effective alternative for patients with highly aggressive T-cell tumors.
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