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Pugnet G. [The arguments favoring autologous haematopoietic stem cell transplantation in systemic scleroderma]. Rev Med Interne 2024; 45:104-108. [PMID: 38267322 DOI: 10.1016/j.revmed.2024.01.003] [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] [Indexed: 01/26/2024]
Abstract
Autologous haematopoietic stem cell transplantation for systemic scleroderma, developed over more than 25 years, has shown in three randomised controlled clinical trials a significant impact not only in event-free survival, overall survival, cutaneous and pulmonary involvement, but also in the quality of life of patients living with recent severe diffuse cutaneous systemic scleroderma, compared with IV cyclophosphamid despite a transplant-related mortality between 2.4 and 10%. No immunosuppressants or biologics have shown such an impact on mortality in this disease. The risk of relapse is estimated between 9 and 24%, two years after transplant. On the basis of these results, French and international guidelines now position autologous haematopoietic stem cell transplantation as a level 1A evidence-based therapeutic alternative in severe early and rapidly progressive systemic scleroderma.
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Affiliation(s)
- G Pugnet
- Service de médecine interne et immunologie clinique, CHU de Toulouse, 2, rue Viguerie, 31059 Toulouse, France.
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2
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Murugesan R, Karuppusamy KV, Marepally S, Thangavel S. Current approaches and potential challenges in the delivery of gene editing cargos into hematopoietic stem and progenitor cells. Front Genome Ed 2023; 5:1148693. [PMID: 37780116 PMCID: PMC10540692 DOI: 10.3389/fgeed.2023.1148693] [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] [Received: 01/20/2023] [Accepted: 08/17/2023] [Indexed: 10/03/2023] Open
Abstract
Advancements in gene delivery and editing have expanded the applications of autologous hematopoietic stem and progenitor cells (HSPCs) for the treatment of monogenic and acquired diseases. The gene editing toolbox is growing, and the ability to achieve gene editing with mRNA or protein delivered intracellularly by vehicles, such as electroporation and nanoparticles, has highlighted the potential of gene editing in HSPCs. Ongoing phase I/II clinical trials with gene-edited HSPCs for β-hemoglobinopathies provide hope for treating monogenic diseases. The development of safe and efficient gene editing reagents and their delivery into hard-to-transfect HSPCs have been critical drivers in the rapid translation of HSPC gene editing into clinical studies. This review article summarizes the available payloads and delivery vehicles for gene editing HSPCs and their potential impact on therapeutic applications.
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Affiliation(s)
- Ramya Murugesan
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Karthik V. Karuppusamy
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srujan Marepally
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu, India
| | - Saravanabhavan Thangavel
- Centre for Stem Cell Research (CSCR), A Unit of InStem Bengaluru, Christian Medical College Campus, Vellore, Tamil Nadu, India
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3
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Gorin NC. History and Development of Autologous Stem Cell Transplantation for Acute Myeloid Leukemia. Clin Hematol Int 2021; 3:83-95. [PMID: 34820613 PMCID: PMC8486970 DOI: 10.2991/chi.k.210703.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
This review describes the development of cryopreservation, the birth of autologous stem cell transplantation (ASCT) and its past and present use to consolidate adult patients with acute myelogenous leukemia (AML). It summarizes the first autografts in patients in relapse, the experience of autografting in complete remission (CR), using bone marrow unpurged or purged in vitro with cyclophosphamide-derivatives, and the important shift to peripheral blood stem cells. The review also discusses the results of recent studies in favor of the use of ASCT to consolidate good- and intermediate-risk patients who reach CR with no detectable minimal residual disease, and those which support the inclusion of maintenance therapy post autograft with hypomethylating agents, anti-BCL-2, and, possibly, in the future, anti AML chimeric antigen receptor-T cells. Carefully applied to well-selected patients, ASCT may regain interest, because of its simplicity, its reduced toxicity, lower non-relapse mortality and better quality of life.
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Affiliation(s)
- Norbert Claude Gorin
- Department of Hematology and Cell Therapy, and EBMT Global Committee, Hopital Saint-Antoine APHP, Paris Sorbonne University, Paris, France
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4
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Bekadja MA, Boumendil A, Blaise D, Chevallier P, Peggs KS, Salles G, Giebel S, Marks R, Arcese W, Milpied N, Finel H, Gorin NC. Non-cryopreserved hematopoietic stem cells in autograft patients with lymphoma: a matched-pair analysis comparing a single center experience with the use of cryopreserved stem cells reported to the European Society for Blood and Marrow Transplantation registry. Cytotherapy 2021; 23:483-487. [PMID: 33678598 DOI: 10.1016/j.jcyt.2020.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/02/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AIMS Around 50 000 autologous stem cell transplantations are done each year worldwide using cryopreserved peripheral blood stem cells (PBSCs). Cryopreservation is time-consuming and expensive. Since 2007, several retrospective studies have shown that PBSCs can be stored at 4°C for 2-3 days, allowing autologous stem cell transplantation in patients with multiple myeloma receiving high-dose melphalan. Data with non-cryopreserved PBSCs in patients autografted for lymphoma following longer pre-conditioning regimens are limited. In addition, no controlled comparison has been able to detect unforeseen differences. METHODS The authors compared outcomes of 94 consecutive adult patients with lymphoma (66 with Hodgkin lymphoma) autografted in our department in Oran (Algeria) using PBSCs stored at 4°C, from 2009 to 2018, with patients receiving cryopreserved stem cells reported to the European Society for Blood and Marrow Transplantation registry. Patients autografted in Oran were matched with patients receiving cryopreserved PBSCs in the registry (four controls per patient in Oran). RESULTS Neutrophil engraftment was significantly faster with cryopreserved PBSCs (P = 0.003). By day 10, only 17% of patients receiving non-cryopreserved PBSCs engrafted versus 48% for cryopreserved PBSCs. Likewise, platelet recovery to 20 000/mm3 was significantly faster in patients receiving cryopreserved PBSCs (P = 0.01). However, all patients in both groups had recovered by day 20. There were no significant differences in non-relapse mortality (9% versus 7%, P = 0.4), relapse incidence (22% versus 32%, P = 0.13), progression-free survival (70% versus 61%, P = 0.4) or overall survival (85% versus 75%, P = 0.3). CONCLUSIONS This analysis suggests that, in patients with lymphoma receiving pre-transplant regimens such as carmustine, etoposide, cytarabine and melphalan, PBSCs stored at 4°C for up to 6 days can be used safely in centers with no cryopreservation facility. However, the kinetics of hematopoietic recovery showed a significant, albeit small, delay in engraftment for both neutrophils and platelets, which favors the use of cryopreservation if available.
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Affiliation(s)
| | - Ariane Boumendil
- European Society for Blood and Marrow Transplantation Global Committee, Paris, France
| | - Didier Blaise
- Institut Paoli Calmettes, Cancer Research Center of Marseille, Aix Marseille University, Marseille, France
| | - Patrice Chevallier
- Department of Hematology and Cell Therapy, Centre Hospitalier Universitaire, Nantes, France
| | - Karl S Peggs
- University College London Cancer Institute, London, UK
| | - Gilles Salles
- Department of Hematology and Cell Therapy, Hospices Civils, Lyon, France
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | | | | | - Noel Milpied
- Department of Hematology and Stem Cell Transplantation, Centre Hospitalier Universitaire, Bordeaux, France
| | - Herve Finel
- European Society for Blood and Marrow Transplantation Global Committee, Paris, France
| | - Norbert Claude Gorin
- European Society for Blood and Marrow Transplantation Global Committee, Paris, France; Department of Hematology and Cell Therapy, Hôpital Saint-Antoine, Sorbonne University, Paris, France.
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5
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Hénon P, Lahlil R. CD34+ Stem Cells and Regenerative Medicine. Stem Cells 2021. [DOI: 10.1007/978-3-030-77052-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Lazarus HM, El Jurdi N. Autologous hematopoietic cell transplantation for adult acute myeloid leukemia: An obsolete or resurfacing concept? Best Pract Res Clin Haematol 2017; 30:327-332. [PMID: 29156204 DOI: 10.1016/j.beha.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Improving long-term outcomes of adult acute myeloid leukemia (AML) patients remains a challenge. Major scientific and clinical advances have led to a better understanding of the disease biology, and the majority of patients achieve a complete remission (CR) after induction therapy. Relapse risk, however, remains considerable and is the leading cause of death in this patient population. Significant efforts to improve outcomes emphasize use of post-remission therapies such as hematopoietic cell transplantation (HCT), an increasingly utilized modality. Improvement in transplantation techniques, understanding of donor:recipient histocompatibility, and increased availability of alternative donors have resulted in greater use of allogeneic HCT. Despite a graft-versus-leukemia effect and lower post-HCT relapse rates, allogeneic HCT continues to be plagued by treatment-related mortality (TRM) and chronic graft-versus-host disease. Better understanding of AML risk stratification and issues relating to minimal residual disease (MRD) as well as extremely low TRM rates with autografts have prompted clinicians to re-explore use of autologous HCT in subsets of favorable and intermediate-risk CR1 AML patients. Herein, we highlight the evolving literature and treatment outcomes for autologous HCT in AML. We provide recommendations for considering this therapeutic modality for treatment intensification in AML.
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Affiliation(s)
- Hillard M Lazarus
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Najla El Jurdi
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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7
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Saraceni F, Bruno B, Lemoli RM, Meloni G, Arcese W, Falda M, Ciceri F, Alessandrino EP, Specchia G, Scimè R, Raimondi R, Bacigalupo A, Bosi A, Onida F, Rambaldi A, Bonifazi F, Olivieri A. Autologous stem cell transplantation is still a valid option in good- and intermediate-risk AML: a GITMO survey on 809 patients autografted in first complete remission. Bone Marrow Transplant 2016; 52:163-166. [PMID: 27668760 DOI: 10.1038/bmt.2016.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- F Saraceni
- Hematology and Bone Marrow Transplantation, Polytechnic University of Marche-Ospedali Riuniti, Ancona, Italy
| | - B Bruno
- National Registry GITMO & Data Managing, Ospedale San Martino, Genova, Italy
| | - R M Lemoli
- Hematology Clinic, Department of Internal Medicine (DiMI), University of Genoa, IRCCS AOU S. Martino-IST, Genova, Italy
| | - G Meloni
- Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University of Rome, Rome, Italy
| | - W Arcese
- Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - M Falda
- Hematology 2 Unit, San Giovanni Battista Hospital and University, Turin, Italy
| | - F Ciceri
- Hematology and BMT Unit, Department of Oncology, San Raffaele Scientific Institute, Milano, Italy
| | - E P Alessandrino
- Department of Hematology, University of Pavia, Policlinico S Matteo-IRCCS, Pavia, Italy
| | - G Specchia
- Hematology Department, University of Bari, Bari, Italy
| | - R Scimè
- Department of Hematology and Bone Marrow Transplant Unit Ospedale Cervello, Palermo, Italy
| | - R Raimondi
- Department of Hematology, S Bortolo Hospital, Vicenza, Italy
| | - A Bacigalupo
- Institute of Haematology, Università Cattolica Sacro Cuore, Roma, Italy
| | - A Bosi
- Haematology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - F Onida
- Hematology - BMT Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Rambaldi
- Hematology and BMT Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F Bonifazi
- Hematology Clinic, Department of Internal Medicine (DiMI), University of Genoa, IRCCS AOU S. Martino-IST, Genova, Italy
| | - A Olivieri
- Hematology and Bone Marrow Transplantation, Polytechnic University of Marche-Ospedali Riuniti, Ancona, Italy
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8
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Saraceni F, Labopin M, Gorin NC, Blaise D, Tabrizi R, Volin L, Cornelissen J, Cahn JY, Chevallier P, Craddock C, Wu D, Huynh A, Arcese W, Mohty M, Nagler A. Matched and mismatched unrelated donor compared to autologous stem cell transplantation for acute myeloid leukemia in first complete remission: a retrospective, propensity score-weighted analysis from the ALWP of the EBMT. J Hematol Oncol 2016; 9:79. [PMID: 27589849 PMCID: PMC5009662 DOI: 10.1186/s13045-016-0314-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/26/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Optimal post-remission strategy for patients with acute myeloid leukemia (AML) is matter of intense debate. Recent reports have shown stronger anti-leukemic activity but similar survival for allogeneic stem cell transplantation (allo-HSCT) from matched sibling donor compared to autologous transplantation (auto-HSCT); however, there is scarcity of literature confronting auto-HSCT with allo-HSCT from unrelated donor (UD-HSCT), especially mismatched UD-HSCT. METHODS We retrospectively compared outcome of allogeneic transplantation from matched (10/10 UD-HSCT) or mismatched at a single HLA-locus unrelated donor (9/10 UD-HSCT) to autologous transplantation in patients with AML in first complete remission (CR1). A total of 2879 patients were included; 1202 patients received auto-HSCT, 1302 10/10 UD-HSCT, and 375 9/10 UD-HSCT. A propensity score-weighted analysis was conducted to control for disease risk imbalances between the groups. RESULTS Matched 10/10 UD-HSCT was associated with the best leukemia-free survival (10/10 UD-HSCT vs auto-HSCT: HR 0.7, p = 0.0016). Leukemia-free survival was not statistically different between auto-HSCT and 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 0.8, p = 0.2). Overall survival was similar across the groups (10/10 UD-HSCT vs auto-HSCT: HR 0.98, p = 0.84; 9/10 UD-HSCT vs auto-HSCT: HR 1.1, p = 0.49). Notably, in intermediate-risk patients, OS was significantly worse for 9/10 UD-HSCT (9/10 UD-HSCT vs auto-HSCT: HR 1.6, p = 0.049), while it did not differ between auto-HSCT and 10/10 UD-HSCT (HR 0.95, p = 0.88). In favorable risk patients, auto-HSCT resulted in 3-year LFS and OS rates of 59 and 78 %, respectively. CONCLUSIONS Our findings suggest that in AML patients in CR1 lacking an HLA-matched sibling donor, 10/10 UD-HSCT significantly improves LFS, but this advantage does not translate in better OS compared to auto-HSCT. In intermediate-risk patients lacking a fully HLA-matched donor, auto-HSCT should be considered as a valid option, as better survival appears to be provided by auto-HSCT compared to mismatched UD-HSCT. Finally, auto-HSCT provided an encouraging outcome in patients with favorable risk AML.
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Affiliation(s)
- Francesco Saraceni
- Hematology and Bone Marrow Transplantation, Polytechnic University of Marche—Ospedali Riuniti Ancona, Via Conca 71, 60126 Ancona, Italy
| | - Myriam Labopin
- ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France
| | - Norbert-Claude Gorin
- ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France
| | - Didier Blaise
- Programme de Transplantation et Therapie Cellulaire—Institut Paoli Calmettes, Marseille, France
| | - Reza Tabrizi
- CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France
| | - Liisa Volin
- HUH, Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | - Jan Cornelissen
- Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | - Jean-Yves Cahn
- Clinique Universitaire d’Hématologie CHU Grenoble, Grenoble, France
| | | | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Depei Wu
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Anne Huynh
- CHU Department Hématologie, Hôpital de Purpan, Toulouse, France
| | - William Arcese
- Rome Transplant Network, Stem Cell Transplant Unit, Tor Vergata University of Rome, Rome, Italy
| | - Mohamad Mohty
- ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
- ALWP-EBMT Office, Saint Antoine Hospital, Paris, France
| | - Acute Leukemia Working Party (ALWP) of the European society for Blood and Marrow Transplantation (EBMT)
- Hematology and Bone Marrow Transplantation, Polytechnic University of Marche—Ospedali Riuniti Ancona, Via Conca 71, 60126 Ancona, Italy
- ALWP-EBMT and Department of Hematology and Cell Therapy, Saint Antoine Hospital, Paris, France
- Programme de Transplantation et Therapie Cellulaire—Institut Paoli Calmettes, Marseille, France
- CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France
- HUH, Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
- Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
- Clinique Universitaire d’Hématologie CHU Grenoble, Grenoble, France
- Department D’Hématologie, CHU Nantes, Nantes, France
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
- CHU Department Hématologie, Hôpital de Purpan, Toulouse, France
- Rome Transplant Network, Stem Cell Transplant Unit, Tor Vergata University of Rome, Rome, Italy
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
- ALWP-EBMT Office, Saint Antoine Hospital, Paris, France
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Visani G, Malagola M, Guiducci B, Lucesole M, Loscocco F, Gabucci E, Paolini S, Piccaluga PP, Isidori A. Conditioning regimens in acute myeloid leukemia. Expert Rev Hematol 2014; 7:465-479. [PMID: 25025371 DOI: 10.1586/17474086.2014.939066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Current intensive consolidation chemotherapy for patients with acute myeloid leukemia (AML) produces median remission duration of 12-18 months, with less than 30% of patients surviving 5 years free of disease. Post-remission therapy is necessary to prevent relapse in most patients with AML; therefore, the aim of post-remission treatment is to eradicate the minimal residual disease. Nevertheless, the optimal form of treatment is still under debate. The choice among the possible approaches (intensive chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation) relies on two main factors: the expected risk of relapse, as determined by biological features, and expected morbidity and mortality associated with a specific option. In this review, we focus on the different preparative regimens before autologous and allogeneic hematopoietic stem cell transplantation in patients with AML, stressing the importance of an adequate conditioning regimen as a mandatory element of a successful AML therapy, in both the allogeneic and the autologous transplant setting.
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10
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Abstract
Hematology Oncology has a rich history including few crucial therapeutic innovations. These were possible because of the evolution of the cell and molecular biology allowing a better understanding of basic mechanisms of cancerogenesis. We propose here to summarize the most important therapeutic innovations since the beginning of Hematology/Oncology history. We also describe evolution of therapeutic strategies themselves. New insights and therapeutic perspectives for next future are also discussed.
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11
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von Grünigen I, Raschle J, Rüsges-Wolter I, Taleghani BM, Mueller BU, Pabst T. The relapse risk of AML patients undergoing autologous transplantation correlates with the stem cell mobilizing potential. Leuk Res 2012; 36:1325-9. [PMID: 22727508 DOI: 10.1016/j.leukres.2012.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
Autologous stem cell transplantation (ASCT) is widely used to consolidate first remission in AML. We determined the significance of circulating CD34+ cells at the day of blood stem cell collection in 78 AML patients. Patients mobilizing more than 60,000 CD34+ cells/ml had shorter overall survival (OS; P=0.0274), shorter time to progression (TTP; P=0.0014), and a higher relapse rate (P=0.0177). High levels of CD34+ cells were an independent marker for shorter OS and TTP in a multivariate analysis. These data suggest that ASCT is associated with unfavorable outcome in AML patients with high levels of mobilized peripheral CD34+ cells.
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Affiliation(s)
- Isabelle von Grünigen
- Department of Medical Oncology, University Hospital and University of Berne, Berne, Switzerland
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12
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Gorin NC, Labopin M, Reiffers J, Milpied N, Blaise D, Witz F, de Witte T, Meloni G, Attal M, Bernal T, Rocha V. Higher incidence of relapse in patients with acute myelocytic leukemia infused with higher doses of CD34+ cells from leukapheresis products autografted during the first remission. Blood 2010; 116:3157-62. [PMID: 20479285 DOI: 10.1182/blood-2009-11-252197] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The stem cell source for autologous transplantation has shifted from bone marrow to peripheral blood (PB). We previously showed that relapse incidence in patients with acute myelocytic leukemia autografted in first remission (CR1) was greater with PB than bone marrow, and a poorer outcome was associated with a shorter CR1 to PB transplantation interval (≤ 80 days). Leukemic and normal progenitors are CD34(+) and can be concomitantly mobilized; we assessed whether an association exists between the infused CD34(+) cell dose and outcome. The infused CD34(+) cell doses were available for 772 patients autografted more than 80 days after CR1 and were categorized by percentiles. We selected the highest quintile (> 7.16 × 10(6)/kg) as the cutoff point. By multivariate analysis, relapse was more probable in patients who received the highest dose (hazard ratio = 1.48; 95% confidence interval, 1.12-1.95; P = .005), and leukemia-free survival was worse (hazard ratio = 0.72; 95% confidence interval, 0.55-0.93; P = .01). In conclusion, in patients autografted in first remission, relapse was higher and leukemia-free survival lower for those who received the highest CD34(+) PB doses.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antigens, CD34/adverse effects
- Disease-Free Survival
- Humans
- Leukapheresis
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/prevention & control
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Multivariate Analysis
- Prognosis
- Recurrence
- Remission Induction
- Transplantation, Autologous
- Young Adult
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Affiliation(s)
- Norbert-Claude Gorin
- Department of Hematology, Hôpital Saint Antoine, 184 rue du Faubourg Saint-Antoine, Paris, France.
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13
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Gorin NC, Labopin M, Blaise D, Reiffers J, Meloni G, Michallet M, de Witte T, Attal M, Rio B, Witz F, Fouillard L, Willemze R, Rocha V. Higher incidence of relapse with peripheral blood rather than marrow as a source of stem cells in adults with acute myelocytic leukemia autografted during the first remission. J Clin Oncol 2009; 27:3987-93. [PMID: 19597030 DOI: 10.1200/jco.2008.20.1400] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The cell source for autologous stem cell transplantation has shifted from bone marrow (BM) to peripheral blood (PB). In acute myelocytic leukemia (AML), for patients who receive transplants during first complete remission (CR1), no prospective randomized study has compared relapse incidence (RI) to cell source. PATIENTS AND METHODS We analyzed 2,165 patients who received autografts (1,607 PB and 558 BM) from 1994 to 2006 and were reported to the European Cooperative Group for Blood and Marrow Transplantation with complete research data. Relative to the time of CR1, PB transplants were performed earlier than BM transplants. Because a poorer outcome was associated with a shorter interval from CR1 to transplantation, patients were divided into three groups: BM, early PB (< or = 80 days after CR1), and late PB (> 80 days after CR1) transplantation. RESULTS In a multivariate analysis adjusted for differences between groups and center, RI was higher with both early PB (56% +/- 3%; hazard ratio [HR], 1.45; 95% CI, 1.11 to 1.9; P = .006) and late PB transplantation (46% +/- 2%; HR, 1.3; 95% CI, 1.06 to 1.59; P = .01) as compared with BM transplantation (39% +/- 2%). This translated into a significantly worse leukemia-free survival (LFS) for early PB transplantation (36% +/- 3%; HR, 0.75; 95% CI, 0.58 to 0.96; P = .02) and a trend for a poorer LFS for late PB (46% +/- 2%; HR, 0.84; 95% CI, 0.7 to 1.01; P = .06) as compared with BM (52% +/- 2%). CONCLUSION For patients with AML in CR1, risk of relapse is greater with PB transplantation rather than BM, independent of the interval from CR1 to transplantation.
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14
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Gorin NC. Autologous stem cell transplantation in hematological malignancies. ACTA ACUST UNITED AC 2004; 26:3-30. [PMID: 15480668 DOI: 10.1007/s00281-004-0172-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Accepted: 07/30/2004] [Indexed: 12/22/2022]
Affiliation(s)
- Norbert-Claude Gorin
- Department of Hematology and Cell Therapy, and EBMT Paris office, Hôpital Saint-Antoine and Université Pierre et Marie Curie, 75012 Paris, France.
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Nabhan C, Mehta J, Tallman MS. The role of bone marrow transplantation in acute promyelocytic leukemia. Bone Marrow Transplant 2001; 28:219-26. [PMID: 11535988 DOI: 10.1038/sj.bmt.1703119] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Acute promyelocytic leukemia (APL) is characterized by a specific gene rearrangement and the generation of the PML-RARalpha fusion transcript which results from a translocation between chromosomes 15 and 17. Targeted therapy with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy results in an apparent cure in 70-80% of patients. Both allogeneic (ALLO) and autologous (AUTO) hematopoietic stem cell transplantation (HSCT) are effective in acute myeloid leukemia (AML), but their role in APL is not clear given the excellent outcome with ATRA and chemotherapy. Several retrospective studies have analyzed the outcome of patients undergoing AUTO or ALLO-HSCT in first (CR1) or second (CR2) complete remission. Most of these studies have shown significant transplant-related mortality (TRM) with ALLO-HSCT, but a reduction in relapse rate compared with AUTO-HSCT. The high TRM with ALLO-HSCT and the excellent outcome with ATRA and chemotherapy do not justify recommending this procedure for the majority of patients in CR1. The role of AUTO-HSCT in CR1 also is unclear. A small subset of patients at high risk of relapse, possibly identifiable by a high white blood cell count at presentation may benefit from HSCT. Most patients with relapsed disease achieve CR2 with ATRA, arsenic trioxide, or combination therapy. However, it is not known if these responses are sustained or if consolidation with HSCT has a place in this setting. The outcome of AUTO-HSCT in CR2 using stem cells that are negative for PML-RARalpha is excellent. It is unclear whether ALLO-HSCT from an HLA-identical sibling is superior to AUTO-HSCT with PML-RARalpha-negative cells in CR2 since the former would be associated with graft-versus-leukemia effects and the latter with lower TRM. Alternatively, arsenic trioxide or re-treatment with ATRA, followed by intensive chemotherapy may also be effective. A randomized prospective clinical trial, or a retrospective analysis of the available data would be useful in answering this critical question.
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Affiliation(s)
- C Nabhan
- Division of Hematology-Oncology, Department of Medicine, Northwestern University Medical School, Robert H Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
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Kröger N, Zabelina T, Sonnenberg S, Krüger W, Renges H, Stute N, Finkenstein F, Mayer U, Holstein K, Fiedler W, Colberg H, Sonnen R, Kuse R, Braumann D, Metzner B, del Valle F, Erttmann R, Kabisch H, Zander AR. Dose-dependent effect of etoposide in combination with busulfan plus cyclophosphamide as conditioning for stem cell transplantation in patients with acute myeloid leukemia. Bone Marrow Transplant 2000; 26:711-6. [PMID: 11042650 DOI: 10.1038/sj.bmt.1702598] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To evaluate the efficacy and toxicity of two different etoposide (VP-16) dosages (30 or 45 mg/kg) in combination with busulfan/cyclophosphamide as conditioning therapy followed by stem cell transplantation in acute myeloid leukemia (AML), 90 patients with AML received either 30 mg/kg (n = 60) or 45 mg/kg (n = 30) etoposide in combination with busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg). The stem cell source was allogeneic related bone marrow (BM) (n = 53), allogeneic unrelated BM (n = 5), allogeneic unrelated peripheral blood (PBSC) (n = 2), syngeneic BM (n = 2), autologous BM purged (n = 9) or unpurged (n = 9), autologous PBSC (n = 10). Fifty-six patients (62%) were in first CR, 26 (29%) were > first CR, and eight (9%) were transplanted in relapse. Principal toxicities in both groups were mucositis and hepatotoxicity. Forty-five mg/kg etoposide resulted in greater hepatic toxicity (P = 0.03), and a higher incidence of VOD (23 vs 12%, P = 0.04) and acute GVHD grade III/IV (13 vs 5%, NS). The treatment-related mortality was 17% in the 30 mg/kg group and 33% in the 45 mg/kg group, mainly due to infections, intestinal pneumonia and GVHD. Hematological recovery of leukocytes 1/nl was comparable in both groups (17 vs 16 days). After a median follow-up of 16 months 19% in the 30 mg/kg group and 23% in the 45 mg/kg group relapsed. In patients who had undergone allogeneic related bone marrow transplantation in first CR no relapses occurred after a median follow-up of 3 years. For all patients the 3-year estimated disease-free survival was 62% in the 30 mg/kg group and 40% in the 45 mg/kg group (P = 0.03). For patients in first CR who underwent allogeneic related stem cell transplantation the 3 year disease-free survivals were 80% and 66%, respectively (P = 0.4). We conclude that etoposide 30 mg/kg or 45 mg/kg in combination with busulfan/cyclophosphamide is a highly active regimen for bone marrow transplantation of patients with AML with a low relapse rate. However, conditioning with 30 mg/kg rather than 45 mg/kg etoposide resulted in less toxicity and a better overall survival due to a lower transplant-related mortality. Bone Marrow Transplantation (2000) 26, 711-716.
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Affiliation(s)
- N Kröger
- Bone Marrow Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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17
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Gorin NC, Labopin M, Laporte JP, Douay L, Lopez M, Lesage S, Fouillard L, Isnard F, Jouet JP, Bellal N, Perot C, Van Den Akker J, Bauters F, Najman A. Importance of marrow dose on posttransplant outcome in acute leukemia: models derived from patients autografted with mafosfamide-purged marrow at a single institution. Exp Hematol 1999; 27:1822-30. [PMID: 10641600 DOI: 10.1016/s0301-472x(99)00121-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Several prospective randomized trials in acute myelocytic leukemia (AML) documented a lower relapse rate with autologous bone marrow transplantation (ABMT) than with conventional chemotherapy. However, they also identified some transplant difficulties, such as failure to collect sufficient numbers of stem cells, slow kinetics of engraftment, and a high transplant-related mortality that diminished or negated positive impact on overall survival. Data for ABMT are inconclusive in acute lymphocytic leukemia (ALL) in adults. We retrospectively analyzed patients with acute leukemia autografted with marrow purged with mafosfamide after January 1983 in our institution. The population comprised 229 consecutive patients; 165 with AML [123 in first remission (CR1), 32 in second remission (CR2)]; 61 with ALL (46 in CR1, 4 in CR2); and 3 with undifferentiated acute leukemia. All patients were autografted with marrow purged with mafosfamide. Mafosfamide was given at a constant dose of 50 microg/mL in 103 and adjusted individually to produce a CFU-GM LD 95 (5% residual CFU-GM post purging) in 126. The outcome was analyzed for correlation with patient characteristics, the disease including cytogenetics, and the graft itself. Prognostic factors identified by multivariate analysis were used to derive a prognostic classification. Patients receiving higher doses of marrow submitted to purging (>5.46 x 10(4) CFU-GM/kg) experienced a lower treatment-related mortality (RR = 0.11, p = 0.005) and a higher leukemia-free (RR = 0.5, p = 0.005) and overall survival (RR = 0.4, p = 0.001). Patients receiving <0.004% CFU-GM of marrow actually infused post purging had a lower relapse rate (RR = 0.51, p = 0.003). Modeling of prognostic groups identified good-, intermediate-, and poor-risk categories. Patients receiving a stem cell dose evaluated before purging of >5.46 x 10(4) CFU-GM/kg and doses actually infused post purging of < or =0.02 x 10(4)/kg had a treatment-related mortality of only 2+/-2%, a leukemia-free survival of 70%, and an overall survival of 77+/-7% at 10 years. In this study of autotransplantation for acute leukemia using mafosfamide-purged marrow, the stem cell dose used for purging and the intensity of purging were the most important factors predicting outcome.
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Affiliation(s)
- N C Gorin
- Department of Hematology, Hôpital Saint-Antoine AP-HP, Centre de Recherche Claude-Bernard, Université Paris VI et Fontenay-aux-Roses, France.
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20
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Imrie K, Dicke KA, Keating A. Autologous bone marrow transplantation for acute myeloid leukemia. Stem Cells 1996; 14:69-78. [PMID: 8820953 DOI: 10.1002/stem.140069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite progress over the past three decades, most patients with acute myeloid leukemia (AML) treated with conventional chemotherapy alone relapse and die of recurrent leukemia. Treatments used to improve outcome include allogeneic (alloBMT) and autologous bone marrow transplantation (ABMT). Indications for transplantation and the relative merits of alloBMT and ABMT remain unclear. In this review, we evaluate evidence supporting a role of ABMT in AML and compare the results with outcomes after alloBMT. In addition, we discuss areas of controversy including the optimal timing for ABMT, the role of bone marrow purging, the place of peripheral blood stem cell collection, the high dose regimen, and post-transplant immunotherapy to reduce relapse.
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Affiliation(s)
- K Imrie
- University of Toronto Autologous Blood and Marrow Transplant Program, Ontario, Canada
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21
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Abstract
Autologous bone marrow transplantation (ABMT) has considerably developed in the past 20 years. In AML, the beneficial role of purging the graft with cyclophosphamide derivatives (4-HC or mafosfamide) has been strongly suggested by retrospective studies from the European Cooperative Group for Blood and Marrow Transplantation and by single institution studies. Also, gene marking experiments have clearly shown that tumour cells infused with unpurged marrow indeed recirculate and in some instances, induce or contribute to tumour recurrence. Amifostine protects normal progenitor cells without concomitantly protecting colony forming unit leukaemic progenitors (CFUL). In comparative in vitro studies, we have shown that pre-incubation of normal marrow contaminated by leukaemic progenitors with amifostine followed by mafosfamide, results not only in a protection of the more mature progenitors (CFUGM, BFUE), but also sensitises leukaemic progenitors, so that in the end, the therapeutic index of mafosfamide is increasing by 6 logarithms. In the clinical field, it has been shown in patients with breast cancer autografted with protection by amifostine results in a shortening of the duration of aplasia of about 10 days. A European randomised study evaluating amifostine in the context of autografting for acute leukaemia has just started.
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Affiliation(s)
- N C Gorin
- Service des Maladies du Sang, Hôpital Saint-Antoine, Paris, France
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22
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Affiliation(s)
- N C Gorin
- Bone Marrow Transplant Unit, Hôpital Saint-Antoine, Paris, France
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23
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Lopez M, Bardinet D, Bouchet S, Texier V, Douay L, Gorin NC. [Towards a standardization of the culture of hematopoietic progenitor cells CFU-GM applied to the transplantation of hematopoietic stem cells in France]. Transfus Clin Biol 1995; 2:101-7. [PMID: 7767478 DOI: 10.1016/s1246-7820(05)80004-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The CFU-GM (granulo-macrophagic colony forming unit) content of 130 bone marrow samples and 105 cytapheresis blood samples was evaluated by two culture techniques, one in agar with human placenta conditioned medium as stimulating factor, the second in methyl cellulose with a cocktail of recombinant G-CSF, GM-CSF, IL-3 and erythropoietin as stimulating factors. The aim of the study was to evaluate in methyl cellulose the CFU-GM threshold doses necessary to ensure hemopoietic reconstitution in autologous transplantation that we previously determined in the agar technique. Thirty-one out of the 130 BM samples were also tested after incubation with mafosfamide, and 33 after freezing and thawing. Results showed that the numbers of CFU-GM in the 2 techniques were significantly correlated (p < 0.0001). The strongest correlation was found with the formula "log CFU-GM methyl = a log CFU-GM agar + b" with a slight variation in the values of a and b among the 4 settings, i.e. unmanipulated BM, mafosfamide-treated BM, frozen-thawed BM and unmanipulated blood samples. According to the formulas, the threshold doses of CFU-GM for BM and blood, previously determined in the agar technique (respectively 10(4)/kg and 5 x 10(4)/kg) were calculated for CFU-GM grown in methyl and corresponded respectively to 2.3 x 10(4)/kg and 2.1 x 10(5)/kg.
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Affiliation(s)
- M Lopez
- INSERM U76, Centre National de Transfusion Sanguine, Paris
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24
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Gorin NC, Dicke K, Löwenberg B. High dose therapy for acute myelocytic leukemia treatment strategy: what is the choice? Ann Oncol 1993; 4 Suppl 1:59-80. [PMID: 8338796 DOI: 10.1093/annonc/4.suppl_1.s59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- N C Gorin
- Department of Hematology, Hôpital Saint-Antoine, Paris, France
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25
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Gorin NC, Muller JY, Salmon C, Duhamel G. Immunological studies in patients submitted to autologous bone marrow transplantation. HAEMATOLOGY AND BLOOD TRANSFUSION 1980; 25:263-73. [PMID: 7021344 DOI: 10.1007/978-3-642-67319-1_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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26
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Dicke KA, Zander AR, Spitzer G, Verma DS, Peters L, Vellekoop L, Thomson S, Stewart D, McCredie KB. Autologous bone marrow transplantation in relapsed adult acute leukemia. HAEMATOLOGY AND BLOOD TRANSFUSION 1980; 25:309-20. [PMID: 7021348 DOI: 10.1007/978-3-642-67319-1_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
From March, 1976 to February, 1979, 28 cases of adult acute leukemia of which 24 were evaluable were treated in irreversible relapse with high dose chemotherapy (piperazinedione) and supra-lethal total body irradiation (TBI) in conjunction with autologous bone marrow transplantation (ABMT). The marrow cells grafted were collected and stored in liquid nitrogen at the time of remission. In 12 patients the marrow cells were fractionated using discontinuous albumin gradients in an attempt to separate normal cells from residual leukemic cells. Twelve patients achieved complete remission (CR); in 9 additional patients signs of engraftment were evident but death occurred before achievement of CR. Seven of 12 AML patients, which were treated with bone marrow transplantation as first treatment of their relapse, achieved CR. Four of 5 patients with ALL, whose bone marrows were collected during first remission, reached CR. The median CR duration was 4+ months and the median survival of the patients reaching CR was 6+ months. Autologous bone marrow transplantation offers a good chance of CR (66%) when marrow is collected during first remission and used as first treatment for AML in third relapse and ALL in second relapse.
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27
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Gorin NC, Najman A, Salmon C, Muller JY, Petit JC, David R, Stachowiak J, Marie FH, Parlier Y, Duhamel G. High dose combination chemotherapy (TACC) with and without autologous bone marrow transplantation for the treatment of acute leukaemia and other malignant diseases: kinetics of recovery of haemopoiesis. A preliminary study of 12 cases. Eur J Cancer 1979; 15:1113-9. [PMID: 393517 DOI: 10.1016/0014-2964(79)90127-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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28
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Hill RS, Mackinder CA, Postlewaight BF, Blacklock HA. The survival of cryopreserved human bone marrow stem cells. Pathology 1979; 11:361-7. [PMID: 392422 DOI: 10.3109/00313027909059012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Two methods for cryopreservation of bone marrow stem cells were compared using bone marrow obtained from 36 patients. Included in this group were 21 persons with the diagnosis of leukaemia including 14 either with acute myeloid or lymphoblastic leukaemia in remission following intensive remission induction chemotherapy. After freeze-preservation and reconstitution, all marrow samples were tested for nucleated cell (NC) recovery and grown on agar to assess colony forming units (CFUC) and cluster forming units in culture (CluFUc). A slow dilution reconstitution method using freezing media containing AB negative plasma resulted in recovery of 85% of the CFUc activity of fresh marrow. This result was significantly better than the 47% CFUc recovery obtained when freezing media without plasma and a rapid dilution reconstitution technique were used. NC recoveries following slow dilution (51%) and rapid dilution (44%) were not significantly different. CluFUc were disproportionately reduced compared with CFUc although yielding similar results with both methods (26% and 32%). No correlation was found for either method between CFUc and NC recovery or between CFUc and CluFUc recovery in cryopreserved bone marrow.
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Dicke KA, Zander A, Spitzer G, Verma DS, Peters L, Vellekoop L, McCredie KB, Hester J. Autologous bone-marrow transplantation in relapsed adult acute leukaemia. Lancet 1979; 1:514-7. [PMID: 85105 DOI: 10.1016/s0140-6736(79)90943-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
24 cases of adult acute leukaemia, of which 21 were evaluable, were treated in irreversible relapse with high-dose piperazinedione and supralethal total-body irradiation (T.B.I.) in conjunction with autologous marrow transplantation (A.B.M.T.). The grafted marrow cells had been collected and stored in liquid nitrogen at the time of remission. In 12 patients the marrow cells were fractionated on discontinuous albumin gradients in an attempt to separate normal cells from residual leukaemic cells. 11 patients achieved complete remission (C.R.); 7 other patients had signs of engraftment but died before C.R. The median remission duration was 4 months (2-14). 6 of 9 acute myeloblastic leukaemia patients, in whom bone-marrow transplantation was the first treatment of relapse, achieved C.R. 4 of 5 patients with acute lymphoblastic leukaemia, whose bone-marrow cells were collected during first remission, reached C.R. Autologous bone-marrow transplantation is a valuable first treatment for acute myeloblastic leukaemia in relapse and acute lymphoblastic leukaemia in second relapse.
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MESH Headings
- Adolescent
- Adult
- Antibiotics, Antineoplastic/administration & dosage
- Cell Fractionation/methods
- Follow-Up Studies
- Hematopoietic Stem Cell Transplantation
- Humans
- In Vitro Techniques
- Injections, Intravenous
- Leukemia, Lymphoid/blood
- Leukemia, Lymphoid/mortality
- Leukemia, Lymphoid/therapy
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/therapy
- Middle Aged
- Neoplasm Recurrence, Local/therapy
- Piperazines/administration & dosage
- Preoperative Care
- Radiotherapy Dosage
- Remission, Spontaneous
- Tissue Preservation/methods
- Transplantation, Autologous
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Goldman JM, Th'ng KH, Park DS, Spiers AS, Lowenthal RM, Ruutu T. Collection, cryopreservation and subsequent viability of haemopoietic stem cells intended for treatment of chronic granulocytic leukaemia in blast-cell transformation. Br J Haematol 1978; 40:185-95. [PMID: 30469 DOI: 10.1111/j.1365-2141.1978.tb03656.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We have stored at -196 degrees C peripheral blood buffy coat (BC) and bone marrow (BM) cells collected from 47 patients with chronic granulocytic leukaemia in the chronic phase. Dimethyl sulphoxide (DMSO) 10% was used as cryoprotective agent. As these cells include CFUc and probably pluripotential stem cells they may be transfused as part of the management of patients who enter blast cell transformation. The mean numbers of nucleated cells collected and stored per procedure was about 9 times greater for BC collections than for BM harvests (106 +/- 49 (SD) X 10(9) versus 11.9 +/- 6.6 X 10(9) respectively). Agar CFUc assay showed that stored cells may remain viable for up to 5 years. Since in vitro studies showed that CFUc proliferation is not inhibited by low concentrations of DMSO the removal of all DMSO during cell reconstitution before transfusion may not be necessary. If autologous BC cells are capable of repopulating the BM of patients treated for CGL in blast cell transformation the routine collection and storage of BC rather than BM cells may be desirable for all newly diagnosed patients.
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