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Friend BD, Schiller GJ. Beyond steroids: A systematic review and proposed solutions to managing acute graft-versus-host disease in adolescents and young adults. Blood Rev 2021; 52:100886. [PMID: 34509319 DOI: 10.1016/j.blre.2021.100886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
The outcomes of allogeneic hematopoietic cell transplantation (HCT) in adolescents and young adults (AYAs) with hematologic malignancies have been shown to be poorer when compared to results in children, due to a combination of higher relapse rates and greater treatment-related mortality (TRM). Although differences in relapse risk have been studied extensively, toxicity has been examined and reported less often. In this systematic review, we summarize recently published studies that have examined the differences in rates of TRM and acute graft-versus-host disease (GVHD) in AYAs and children with hematologic malignancies, and attempt to explain why these disparities exist and how they impact outcomes. In addition, we present best practices for management of steroid-refractory GVHD that are likely to improve survival in this patient population. Further, we propose the development of personalized, risk-based approaches for the prevention and treatment of GVHD that incorporate novel platforms and interventions. We believe this individualized approach is likely to reduce toxicity and greatly improve outcomes for this vulnerable population.
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Affiliation(s)
- Brian D Friend
- Department of Pediatrics, Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, 1102 Bates Ave, Suite 1630, Houston, TX 77030, USA.
| | - Gary J Schiller
- Department of Medicine, Division of Hematology-Oncology, University of California Los Angeles, 10833 Le Conte Ave, 42-121 CHS, Los Angeles, CA 90095, USA.
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Vignon M, Andreoli A, Dhédin N, Lengliné E, Masson E, Robin M, Granier C, Larghero J, Schlageter MH, de Latour RP, Socié G, Boissel N. Graft-Versus-Host Disease in Adolescents and Young Adults (15–24 Years Old) After Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia in First Complete Remission. J Adolesc Young Adult Oncol 2017; 6:299-306. [DOI: 10.1089/jayao.2016.0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marguerite Vignon
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Annalisa Andreoli
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Nathalie Dhédin
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Etienne Lengliné
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
| | - Emeline Masson
- Laboratoire d'Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Marie Robin
- Service d'Hématologie–Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Clémence Granier
- Laboratoire d'Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Jérôme Larghero
- Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CIC-BT501, Hôpital Saint-Louis, Paris, France
| | | | - Régis Peffault de Latour
- Service d'Hématologie–Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Gérard Socié
- Service d'Hématologie–Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Nicolas Boissel
- Unité d'Hématologie–Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot, Paris, France
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Reduced-intensity conditioning followed by allogeneic transplantation in pediatric malignancies: a report from the Société Française des Cancers de l'Enfant and the Société Française de Greffe de Moelle et de Thérapie Cellulaire. Bone Marrow Transplant 2013; 48:1401-8. [PMID: 23749103 DOI: 10.1038/bmt.2013.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/18/2013] [Accepted: 04/23/2013] [Indexed: 01/15/2023]
Abstract
We report French prospective experience with reduced-intensity conditioning-allo-SCT in 46 patients (median age: 15.5 years, 4.8-20.2) presenting high-risk AL (n=11), Hodgkin's lymphoma (n=15) or solid tumors (n=20). Graft sources were BM (n=21), PBSC (n=20) and cord blood (CB; n=5) from related (n=20) or unrelated (n=26) donors. For CB grafts, only one patient out of five achieved sustained engraftment. For PBSC/BM grafts, engraftment rate was 95%, hematopoietic recovery times were not significantly different between BM, PBSC, sibling or unrelated grafts, day+100. Full donor chimerism was achieved in 94% of patients, and incidences of primary acute GVHD and chronic GVHD were 49% and 14%, respectively. Underlying disease was fatal in 39% of patients. TRM was 6.9%. Three-year OS was 49.15%. OS and EFS were not significantly different between patients transplanted with different grafts and with or without primary GVHD. Patients with solid tumor or measurable disease at transplant had poorer outcomes. Three-year EFS: 33.3% for ALL, 75.0% for AML, 51.8% for Hodgkin's lymphoma, 28.6% for neuroblastoma and 22.2% for sarcoma patients. This multicentre study concluded that Bu/fludarabine/anti-thymocyte globulin conditioning with PB or BM, related or unrelated grafts in patients with various malignancies at high-risk for transplantation toxicity results in high engraftment rates, low TRM and acceptable survival.
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Paillard C, Salmon A, Curtillet C, David A, Halle P, Cachin F, Bordigoni P, Michel G, Rousseau R, Dore E, Isfan F, Merlin E, Rochette E, Demeocq F, Kanold J. Evidence of a clinical response at one yr after reduced-intensity allogeneic hematopoietic stem cell transplantation in heavily pretreated adolescents with aggressive refractory Hodgkin's lymphoma. Pediatr Transplant 2010; 14:109-14. [PMID: 19490483 DOI: 10.1111/j.1399-3046.2009.01140.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report results of RIC AHSCT in four adolescents with aggressive refractory HL. They all received three or four lines of therapy prior to RIC-AHSCT including autografts. At the time of RIC, they were in partial response except for one patient who had progressive chemoresistant disease. The conditioning regimen consisted of fludarabin, busulfan and ATG. They all had a matched related donor. The median follow-up was 12-16-month post-allograft. All patient transplants engrafted rapidly. The median time of hospitalization was 35 days. The median time to neutrophil recovery (>or=500/muL) was 19 days. All the patients were in complete donor chimerism at day 60. Four patients developed skin (grade <or= II) acute GvHD. All responded and all are alive. Two patients are in CR, one in PR and one relapsed six months after grafting after a PR. Each of the patients in PR received two DLI. These observations, together with the responses after DLI, suggest the presence of a graft vs. lymphoma effect in patients with advanced active HL. Prospective studies are needed to identify the patients likely to benefit most from this treatment approach.
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Affiliation(s)
- C Paillard
- Centre Hospitalier et Universitaire de Clermont-Ferrand, Service de Pédiatrie B et Unité Bioclinique de Thérapie Cellulaire, Clermont-Ferrand, France.
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Druley TE, Hayashi R, Mansur DB, Zhang QJ, Barnes Y, Trinkaus K, Witty S, Thomas T, Klein EE, DiPersio JF, Adkins D, Shenoy S. Early outcomes after allogeneic hematopoietic SCT in pediatric patients with hematologic malignancies following single fraction TBI. Bone Marrow Transplant 2008; 43:307-14. [PMID: 19011666 DOI: 10.1038/bmt.2008.327] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fractionated TBI (FTBI) followed by allogeneic hematopoietic SCT results in donor engraftment and improves survival in children with high-risk hematologic malignancies. However, acute toxicities (skin, lung and mucosa) are common after FTBI. Late complications include cataracts, endocrine dysfunction, sterility and impaired neurodevelopment. Instead of FTBI, we used low-dose single fraction TBI (550 cGy) with CY as transplant conditioning for pediatric hematologic malignancies. GVHD prophylaxis included CYA and short-course MTX; methylprednisolone was added for unrelated donor transplants. A total of 55 children in first (40%) or second remission and beyond (60%) underwent transplantation from BM (65%) or peripheral blood; 62% from unrelated donors; 22% were mismatched. Median follow-up was 18.5 months (1-68). Overall survival and disease-free survival at 1 year were 60 and 47%, respectively. Acute toxicities included grade 3-4 mucositis (18%), invasive infections (11%), multiorgan failure/shock (11%), hemolytic anemia (7%), veno-occlusive disease (4%) and renal failure (4%). TRM was 11% at 100 days. Non-relapse mortality was 6% thereafter. Graft rejection occurred in 2%. Three patients (5%) died of GVHD. The regimen was well tolerated even in heavily pretreated children and supported donor cell engraftment; long-term follow up is in progress.
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Affiliation(s)
- T E Druley
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Bone Marrow Transplantation and Leukemia Section, Washington University School of Medicine, One Children's Place, Saint Louis, MO 63110, USA
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