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Zhao W, Wang R, Chen M. Clinical analysis of air-leak syndrome following allogeneic hematopoietic stem cell transplantation in pediatric patients. Pediatr Blood Cancer 2024; 71:e31008. [PMID: 38676303 DOI: 10.1002/pbc.31008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Air-leak syndrome (ALS) is considered as an independent risk factor for poor prognosis in adult patients who had received hematopoietic stem cell transplantation (HSCT), and the 5-year overall survival (OS) of ALS is less than 30%. However, the clinical features of ALS among post-transplant pediatric patients have rarely been explored. PROCEDURES We retrospectively reviewed 2206 pediatric patients who had received an allo-HSCT between January 2013 and December 2019 at the Hebei Yanda Lu Daopei Hospital, and analyzed the role of ALS in prognosis following HSCT. RESULTS In our research, ALS was divided into two categories: 15 cases of bronchiolitis obliterans syndrome (BOS) and 13 cases of idiopathic pneumonia syndrome (IPS). Following treatment of the ALS, 18 patients survived (18/28, 64.3%), and 10 patients died of respiratory failure or infection (10/28, 35.7%). CONCLUSIONS The OS of ALS in Hebei Yanda Lu Daopei Hospital is significantly higher than others, and they were cited to be related to early diagnosis and timely FAM treatment in previous reports.
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Affiliation(s)
- Wei Zhao
- Department of Stem Cell Transplantation, Beijing Ludaopei Hospital, Beijing, China
| | - Rong Wang
- Department of Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China
| | - Man Chen
- Department of Laboratory Medicine, Hebei Yanda Ludaopei Hospital, Langfang, China
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Balakrishnan B, Kulkarni UP, Pai AA, Illangeswaran RSS, Mohanan E, Mathews V, George B, Balasubramanian P. Biomarkers for early complications post hematopoietic cell transplantation: Insights and challenges. Front Immunol 2023; 14:1100306. [PMID: 36817455 PMCID: PMC9932777 DOI: 10.3389/fimmu.2023.1100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Hematopoietic cell transplantation is an established curative treatment option for various hematological malignant, and non-malignant diseases. However, the success of HCT is still limited by life-threatening early complications post-HCT, such as Graft Versus Host Disease (GVHD), Sinusoidal Obstruction Syndrome (SOS), and transplant-associated microangiopathy, to name a few. A decade of research in the discovery and validation of novel blood-based biomarkers aims to manage these early complications by using them for diagnosis or prognosis. Advances in this field have also led to predictive biomarkers to identify patients' likelihood of response to therapy. Although biomarkers have been extensively evaluated for different complications, these are yet to be used in routine clinical practice. This review provides a detailed summary of various biomarkers for individual early complications post-HCT, their discovery, validation, ongoing clinical trials, and their limitations. Furthermore, this review also provides insights into the biology of biomarkers and the challenge of obtaining a universal cut-off value for biomarkers.
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Affiliation(s)
- Balaji Balakrishnan
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, India
| | | | - Aswin Anand Pai
- Department of Haematology, Christian Medical College, Vellore, India
| | | | | | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
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Khanolkar RA, Tripathi G, Dharmani-Khan P, Dabas R, Kinzel M, Kalra A, Puckrin R, Jimenez-Zepeda V, Jamani K, Duggan PR, Chaudhry A, Bryant A, Stewart DA, Khan FM, Storek J. Incomplete chimerism following myeloablative and anti-thymocyte globulin-conditioned hematopoietic cell transplantation is a risk factor for relapse and chronic graft-versus-host disease. Cytotherapy 2022; 24:1225-1231. [PMID: 36057497 DOI: 10.1016/j.jcyt.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/16/2022] [Accepted: 07/31/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AIMS The value of routine chimerism determination after myeloablative hematopoietic cell transplantation (HCT) is unclear, particularly in the setting of anti-thymocyte globulin (ATG)-based graft-versus-host disease (GVHD) prophylaxis. METHODS Blood samples were collected at 3 months post-HCT from 558 patients who received myeloablative conditioning and ATG-based GVHD prophylaxis. Chimerism was assessed using multiplex polymerase chain reaction of short tandem repeats in sorted T cells (CD3+) and leukemia lineage cells (CD13+CD33+ for myeloid malignancies and CD19+ for B-lymphoid malignancies). ATG exposure was determined using a flow cytometry-based assay. The primary outcomes of interest were relapse and chronic GVHD (cGVHD). RESULTS Incomplete (<95%) T-cell chimerism and leukemia lineage chimerism were present in 17% and 4% of patients, respectively. Patients with incomplete T-cell chimerism had a significantly greater incidence of relapse (36% versus 22%, subhazard ratio [SHR] = 2.03, P = 0.001) and lower incidence of cGVHD (8% versus 25%, SHR = 0.29, P < 0.001) compared with patients with complete chimerism. In multivariate modeling, patients with high post-transplant ATG area under the curve and any cytomegalovirus (CMV) serostatus other than donor/recipient seropositivity (non-D+R+) had an increased likelihood of incomplete T-cell chimerism. Patients with incomplete leukemia lineage chimerism had a significantly greater incidence of relapse (50% versus 23%, SHR = 2.70, P = 0.011) and, surprisingly, a greater incidence of cGVHD (45% versus 20%, SHR = 2.64, P = 0.003). CONCLUSIONS High post-transplant ATG exposure and non-D+R+ CMV serostatus predispose patients to incomplete T-cell chimerism, which is associated with an increased risk of relapse. The increased risk of cGVHD with incomplete B-cell/myeloid chimerism is a novel finding that suggests an important role for recipient antigen-presenting cells in cGVHD pathogenesis.
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Affiliation(s)
- Rutvij A Khanolkar
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1.
| | - Gaurav Tripathi
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Precision Laboratories, Calgary, Canada, T2N 4N1
| | - Poonam Dharmani-Khan
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Precision Laboratories, Calgary, Canada, T2N 4N1
| | - Rosy Dabas
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1
| | - Megan Kinzel
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1
| | - Amit Kalra
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1
| | - Robert Puckrin
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Victor Jimenez-Zepeda
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Kareem Jamani
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Peter R Duggan
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Ahsan Chaudhry
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Adam Bryant
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Douglas A Stewart
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
| | - Faisal M Khan
- Department of Laboratory Medicine and Pathology, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Precision Laboratories, Calgary, Canada, T2N 4N1
| | - Jan Storek
- Department of Medicine, University of Calgary, Calgary, Canada, T2N 4N1; Alberta Health Services, Calgary, Canada, T2N 4N1
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Xue E, Lorentino F, Lupo Stanghellini MT, Giglio F, Piemontese S, Clerici DT, Farina F, Mastaglio S, Bruno A, Campodonico E, Nitti R, Marcatti M, Assanelli A, Corti C, Ciceri F, Peccatori J, Greco R. Addition of a Single Low Dose of Anti T-Lymphocyte Globulin to Post-Transplant Cyclophosphamide after Allogeneic Hematopoietic Stem Cell Transplant: A Pilot Study. J Clin Med 2022; 11:jcm11041106. [PMID: 35207379 PMCID: PMC8879643 DOI: 10.3390/jcm11041106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023] Open
Abstract
Correlation between risk of graft-versus-host disease (GvHD) and CD3+ counts within the peripheral blood stem cell graft has recently been reported in the setting of post-transplant cyclophosphamide (PT-Cy). We aimed to investigate the benefit of the addition of a single dose of anti-T lymphocyte globulin (ATLG 5 mg/kg) to PT-Cy in this setting. Starting in 2019, all patients receiving PBSC transplant containing CD3+ counts above 300 × 106/kg (study group) received a post-transplant dose of ATLG in addition to standard PT-Cy. The study was designed as a real-life analysis and included all consecutive Hematopoietic Stem Cell Transplantation (HSCT) recipients according to the above-mentioned inclusion criterion (n = 21), excluding cord blood and bone marrow donors. Using a 1:2 matched-pair analysis, we compared the outcomes with a historical population who received PT-Cy only (control group). We found a delayed platelet engraftment (29% vs. 45% at 30 days, p = 0.03) and a non-significant trend toward higher risk of poor graft function (29% vs. 19%, p = 0.52). The addition of ATLG impacted long-term immune reconstitution on the CD4+ subsets, but this did not translate into higher rate of relapse or viral infection. Acute GvHD was not significantly impacted, but 1-year cumulative incidence of chronic GvHD was significantly lower in the study group (15% vs. 41%, p = 0.04). Survival outcomes were comparable. In conclusion PT-Cy and ATLG was overall safe and translated into a low rate of chronic GvHD incidence.
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Affiliation(s)
- Elisabetta Xue
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Francesca Lorentino
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
- PhD Program in Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Maria Teresa Lupo Stanghellini
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Fabio Giglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Simona Piemontese
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Daniela Teresa Clerici
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Francesca Farina
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Sara Mastaglio
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Alessandro Bruno
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Edoardo Campodonico
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Rosamaria Nitti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Magda Marcatti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Andrea Assanelli
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Consuelo Corti
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
| | - Jacopo Peccatori
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
- Correspondence: (J.P.); (R.G.)
| | - Raffaella Greco
- Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (E.X.); (F.L.); (M.T.L.S.); (F.G.); (S.P.); (D.T.C.); (F.F.); (S.M.); (A.B.); (E.C.); (R.N.); (M.M.); (A.A.); (C.C.); (F.C.)
- Correspondence: (J.P.); (R.G.)
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