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Mondesir J, Ghisi M, Poillet L, Bossong RA, Kepp O, Kroemer G, Sarry JE, Tamburini J, Lane AA. AMPK activation induces immunogenic cell death in AML. Blood Adv 2023; 7:7585-7596. [PMID: 37903311 PMCID: PMC10733104 DOI: 10.1182/bloodadvances.2022009444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 11/01/2023] Open
Abstract
Survival of patients with acute myeloid leukemia (AML) can be improved by allogeneic hematopoietic stem cell transplantation (allo-HSCT) because of the antileukemic activity of T and natural killer cells from the donor. However, the use of allo-HSCT is limited by donor availability, recipient age, and potential severe side effects. Similarly, the efficacy of immunotherapies directing autologous T cells against tumor cells, including T-cell recruiting antibodies, chimeric antigen receptor T-cell therapy, and immune checkpoint inhibitors are limited in AML because of multiple mechanisms of leukemia immune escape. This has prompted a search for novel immunostimulatory approaches. Here, we show that activation of adenosine 5'-monophosphate-activated protein kinase (AMPK), a master regulator of cellular energy balance, by the small molecule GSK621 induces calreticulin (CALR) membrane exposure in murine and human AML cells. When CALR is exposed on the cell surface, it serves as a damage-associated molecular pattern that stimulates immune responses. We found that GSK621-treated murine leukemia cells promote the activation and maturation of bone marrow-derived dendritic cells. Moreover, vaccination with GSK621-treated leukemia cells had a protective effect in syngeneic immunocompetent recipients bearing transplanted AMLs. This effect was lost in recipients depleted of CD4/CD8 T cells. Together, these results demonstrate that AMPK activation by GSK621 elicits traits of immunogenic cell death and promotes a robust immune response against leukemia. Pharmacologic AMPK activation thus represents a new potential target for improving the activity of immunotherapy in AML.
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Affiliation(s)
- Johanna Mondesir
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Université Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Équipe labellisée Ligue contre le cancer, Paris, France
| | - Margherita Ghisi
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm U1037, CNRS U5077, Université de Toulouse, Équipe labellisée Ligue contre le cancer, Toulouse, France
- LabEx Toucan, Toulouse, France
| | - Laura Poillet
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm U1037, CNRS U5077, Université de Toulouse, Équipe labellisée Ligue contre le cancer, Toulouse, France
- LabEx Toucan, Toulouse, France
| | - Robert A. Bossong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Oliver Kepp
- Université de Paris Cité, Sorbonne Université, INSERM UMR1138, Centre de Recherche des Cordeliers, Équipe labellisée Ligue contre le cancer, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy, Villejuif, France
| | - Guido Kroemer
- Université de Paris Cité, Sorbonne Université, INSERM UMR1138, Centre de Recherche des Cordeliers, Équipe labellisée Ligue contre le cancer, Paris, France
- Metabolomics and Cell Biology Platforms, Gustave Roussy, Villejuif, France
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Jean-Emmanuel Sarry
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Inserm U1037, CNRS U5077, Université de Toulouse, Équipe labellisée Ligue contre le cancer, Toulouse, France
- LabEx Toucan, Toulouse, France
| | - Jérôme Tamburini
- Université Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Équipe labellisée Ligue contre le cancer, Paris, France
- Translational Research Centre in Onco-hematology, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- Swiss Cancer Center Leman, Lausanne, Switzerland
| | - Andrew A. Lane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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2
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Novitzky-Basso I, Lam W, Chiarello C, Pasic I, Law AD, Michelis FV, Gerbitz A, Viswabandya A, Lipton JH, Kumar R, Mattsson J, Messner HA, Marras TK, Mittoo S, Kim DDH. Prognostic implication of pre-transplant FEV 1 on long-term outcomes following allogeneic hematopoietic stem cell transplantation. Eur J Haematol 2023; 111:687-696. [PMID: 37491877 DOI: 10.1111/ejh.14062] [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: 05/05/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Pre-transplant pulmonary function testing (PFT) is essential before allogeneic hematopoietic stem cell transplant (HCT), yet the optimal cutoff value for affecting transplant outcomes remains poorly defined. STUDY DESIGN Retrospective analysis of pre-HCT PFT data from 605 consecutive patients at the Princess Margaret Cancer Centre between January 1, 2004 and December 31, 2013 used binary recursive partitioning to identify cutoff values for overall survival (OS) as an endpoint of transplant outcomes. These values were compared to HCT comorbidity index (HCT-CI) FEV1 cutoffs for OS, cumulative incidence of relapse and non-relapse mortality. RESULTS FEV1 ≥ 81% was the identified cutoff point. The OS rate at 3 years showed 49.8% (FEV1 ≥ 81%) vs. 36.6% (<81%, p < .001). For HCT-CI cutoffs, the OS rate at 3 years for FEV1 ≥ 80%, 66%-80% and ≤65% were 49.0%, 38.1% and 37.6% (p = .011), respectively. Multivariate analysis confirmed that FEV1 ≥ 81% predicted reduced mortality (HR 0.682, p = .001). Subgroup analysis showed both FEV1 ≥ 81% and FEV1 by HCT-CI cutoffs may stratify patients according to OS and NRM risk in subgroups receiving myeloablative, but not reduced intensity conditioning. CONCLUSION FEV1 ≥ 81% can predict OS and NRM in our cohort and is potentially simpler when risk stratifying patients undergoing allogeneic HCT, particularly those receiving myeloablative conditioning.
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Affiliation(s)
- Igor Novitzky-Basso
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wilson Lam
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Caden Chiarello
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ivan Pasic
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arjun D Law
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fotios V Michelis
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Armin Gerbitz
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Auro Viswabandya
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey H Lipton
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rajat Kumar
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonas Mattsson
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation, University of Toronto, Toronto, Ontario, Canada
| | - Hans A Messner
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Theodore K Marras
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shikha Mittoo
- University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada
- Involved Medicine, Toronto, Ontario, Canada
| | - Dennis Dong Hwan Kim
- Messner Allogeneic Blood and Marrow Transplantation Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Shouval R, Fein JA, Cho C, Avecilla ST, Ruiz J, Tomas AA, Sanchez-Escamilla M, Flores NC, Yáñez L, Barker JN, Dahi P, Giralt SA, Geyer AI, Gyurkocza B, Jakubowski AA, Lin RJ, O’Reilly RJ, Papadopoulos EB, Politikos I, Ponce DM, Sauter CS, Scordo M, Shaffer B, Shah GL, Sullivan JP, Tamari R, van den Brink MRM, Young JW, Nagler A, Devlin S, Shimoni A, Perales MA. The Simplified Comorbidity Index: a new tool for prediction of nonrelapse mortality in allo-HCT. Blood Adv 2022; 6:1525-1535. [PMID: 34507354 PMCID: PMC8905694 DOI: 10.1182/bloodadvances.2021004319] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/10/2021] [Indexed: 11/20/2022] Open
Abstract
Individual comorbidities have distinct contributions to nonrelapse mortality (NRM) following allogeneic hematopoietic cell transplantation (allo-HCT). We studied the impact of comorbidities individually and in combination in a single-center cohort of 573 adult patients who underwent CD34-selected allo-HCT following myeloablative conditioning. Pulmonary disease, moderate to severe hepatic comorbidity, cardiac disease of any type, and renal dysfunction were associated with increased NRM in multivariable Cox regression models. A Simplified Comorbidity Index (SCI) composed of the 4 comorbidities predictive of NRM, as well as age >60 years, stratified patients into 5 groups with a stepwise increase in NRM. NRM rates ranged from 11.4% to 49.9% by stratum, with adjusted hazard ratios of 1.84, 2.59, 3.57, and 5.38. The SCI was also applicable in an external cohort of 230 patients who underwent allo-HCT with unmanipulated grafts following intermediate-intensity conditioning. The area under the receiver operating characteristic curve (AUC) of the SCI for 1-year NRM was 70.3 and 72.0 over the development and external-validation cohorts, respectively; corresponding AUCs of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) were 61.7 and 65.7. In summary, a small set of comorbidities, aggregated into the SCI, is highly predictive of NRM. The new index stratifies patients into distinct risk groups, was validated in an external cohort, and provides higher discrimination than does the HCT-CI.
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Affiliation(s)
- Roni Shouval
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Joshua A. Fein
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT
| | - Christina Cho
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Josel Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ana Alarcon Tomas
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Miriam Sanchez-Escamilla
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nerea Castillo Flores
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lucrecia Yáñez
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juliet N. Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Parastoo Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sergio A. Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Alexander I. Geyer
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Pulmonary Service, Department of Medicine
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ann A. Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Richard J. Lin
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Richard J. O’Reilly
- Department of Medicine, Weill Cornell Medical College, New York, NY
- Bone Marrow Transplant Service, Department of Pediatrics, and
| | - Esperanza B. Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Doris M. Ponce
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Craig S. Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Gunjan L. Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Roni Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Marcel R. M. van den Brink
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - James W. Young
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - Sean Devlin
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Avichai Shimoni
- Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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4
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Yegin ZA, Özkurt ZN, Dikyar A, Kaynar LA, Karacaoğlu Ö, Yağcı M. Hematopoietic Cell Transplant-Composite Risk (HCT-CR): A Novel Predictor of Prognosis in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Proc 2021; 53:2013-2020. [PMID: 34246474 DOI: 10.1016/j.transproceed.2021.06.017] [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: 12/29/2020] [Revised: 05/05/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a curable treatment modality for hematologic disorders. Transplant-related mortality remains high despite prominent scientific and technologic improvements. In consideration with the potential impact of patient- and disease-related factors on transplant outcome, this retrospective study was performed to investigate the predictive role of pretransplant HCT-composite risk (HCT-CR) score in allo-HCT recipients. METHODS A total of 313 patients with acute leukemia (male/female: 192/121; median age, 36 [18-71] years) were included in this study. The study cohort was divided into 2 subgroups based on pretransplant HCT-CR categories. The HCT-CRlo group included low-risk patients, and the HCT-CRint-hi group consisted of intermediate-, high-, and very high-risk patients. RESULTS In the whole cohort, overall survival (OS) and 5-year OS were found to be 32.2% and 45.1%, respectively. Probability of OS was significantly better in the HCT-CRlo group compared with the HCT-CRint-hi group (P < .001). Leukemia-free survival (LFS) and 3-year LFS were 59.5% and 65.1%, respectively. Probability of LFS was better in the HCT-CRlo group compared with the HCT-CRint-hi group (P = .001). Nonrelapse mortality (NRM) and 3-year NRM were estimated to be 38.1% and 27.5%, respectively. Probability of NRM was significantly higher in the HCT-CRint-hi group compared with the HCT-CRlo group (P = .012). In multivariate analysis, HCT-CR was shown to have significant prognostic impact in acute lymphoblastic leukemia patients (P = .023; hazard ratio, 2.613; 95% CI, 1.142-5.982). CONCLUSION Pretransplant evaluation of patient- and disease-related factors is essential for the accurate prediction of posttransplant survival. Further efforts to evolve current criteria for pretransplant risk assessment would eventuate in better transplant outcomes.
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Affiliation(s)
- Zeynep Arzu Yegin
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey.
| | - Zübeyde Nur Özkurt
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Asena Dikyar
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Lale Aydın Kaynar
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Özlem Karacaoğlu
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Münci Yağcı
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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5
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Versluis J, Cornelissen JJ. Risks and benefits in a personalized application of allogeneic transplantation in patients with AML in first CR. Semin Hematol 2019; 56:164-170. [DOI: 10.1053/j.seminhematol.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 11/11/2022]
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6
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Tay J, Daly A, Jamani K, Labelle L, Savoie L, Stewart D, Storek J, Beattie S. Patient eligibility for hematopoietic stem cell transplantation: a review of patient-associated variables. Bone Marrow Transplant 2018; 54:368-382. [PMID: 29988063 DOI: 10.1038/s41409-018-0265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/30/2018] [Accepted: 06/06/2018] [Indexed: 02/07/2023]
Abstract
Assessing patient eligibility for hematopoietic stem cell transplantation (HSCT) remains a complex, multifaceted challenge. Among these challenges, the paucity of comprehensive clinical data to guide decision making remains problematic coupled with unclear trade-offs between patient, disease and local HSCT center factors. Moreover, it is unclear that the modification of poor patient characteristics will improve post-HSCT outcomes. However, the use of Comorbidity Indices and Comprehensive Geriatric Assessments helps meet this challenge, but may be limited by overlapping patient characteristics. The increasing consideration for pre-HSCT psychosocial assessments and interventions remains to be studied. Ultimately, the decision to proceed with a HSCT remains interdisciplinary while considering the available evidence discussed in this review.
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Affiliation(s)
- J Tay
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
| | - A Daly
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - K Jamani
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Labelle
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - L Savoie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - D Stewart
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - J Storek
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - S Beattie
- Alberta Blood and Marrow Transplant Program, University of Calgary and Alberta Health Services, Calgary, AB, Canada
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7
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Mohammad AA. Myelodysplastic syndrome from theoretical review to clinical application view. Oncol Rev 2018; 12:397. [PMID: 30607219 PMCID: PMC6291758 DOI: 10.4081/oncol.2018.397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023] Open
Abstract
Myelodysplastic syndromes (MDS), called ineffective hematopoiesis is indicated by bone marrow failure and tendency to acute myeloid leukemia transformation. Since the disease is more common in elderly with non- hematology co-morbidities, the research for less toxic and curative novel agents is essential. More than 12 years without new Food and Drug Administration approved drugs in MDS management through the whole course, only 5 drugs. We summarized the basic data in diagnosis, treatment guidelines and future direction.
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Affiliation(s)
- Amrallah A. Mohammad
- Medical Oncology, Department of Medical Oncology, Faculty of Medicine, Zagazig University, Egypt
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8
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Shouval R, de Jong CN, Fein J, Broers AEC, Danylesko I, Shimoni A, Reurs MR, Baars AE, van der Schaft N, Nagler A, Cornelissen JJ. Baseline Renal Function and Albumin are Powerful Predictors for Allogeneic Transplantation-Related Mortality. Biol Blood Marrow Transplant 2018; 24:1685-1691. [PMID: 29753163 DOI: 10.1016/j.bbmt.2018.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
Biomarkers measured in blood chemistry before allogeneic hematopoietic stem cell transplantation (HSCT) may reflect patients' physiological status. We hypothesized that selected markers are predictive for nonrelapse mortality (NRM) following transplantation and could contribute to risk assessment. We investigated the value of pre-HSCT albumin, estimated glomerular filtration rate (eGFR), and alkaline phosphatase (AlkP) in predicting NRM. We retrospectively analyzed clinical and laboratory data from 1217 patients receiving a first HSCT in 2 European centers between 2003 and 2015. Transplantation indications and conditioning regimens were diverse. Patients had a median age of 55 years and hematopoietic cell transplantation comorbidity index (HCT-CI) scores of 0 (24%), 1 to 2 (39%), and ≥3 (37%). Cutoffs of eGFR <60 mL/min, albumin <3.5 g/dL, and AlkP >180 IU/L corresponded with 8.8%, 8.3%, and 6.5% of the patients, respectively. eGFR and albumin were associated with increased risk and higher cumulative incidence of day-100, 1-year, and 2-year NRM, both as continuous or categorized variables. A similar pattern was observed for AlkP, except for day-100 NRM. In multivariable analyses, eGFR and albumin were consistently among the top risk factors for early and late-term NRM, abrogating the role of age. Prediction models for day-100, 1-year, and 2-year NRM based only on HCT-CI resulted in c-statistics of .565, .575, and .577, respectively. Addition of both biomarkers increased c-statistics for day-100, 1-year, and 2-year NRM to .651, .633, and .624, respectively. Albumin and eGFR are prognostic biomarkers for NRM after HSCT and improve the discriminative power of the HCT-CI.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Cornelis N de Jong
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Joshua Fein
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Annoek E C Broers
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ivetta Danylesko
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avichai Shimoni
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marloes R Reurs
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Adája E Baars
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Niels van der Schaft
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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9
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Fox TA, Chakraverty R, Burns S, Carpenter B, Thomson K, Lowe D, Fielding A, Peggs K, Kottaridis P, Uttenthal B, Bigley V, Buckland M, Grandage V, Denovan S, Grace S, Dahlstrom J, Workman S, Symes A, Mackinnon S, Hough R, Morris E. Successful outcome following allogeneic hematopoietic stem cell transplantation in adults with primary immunodeficiency. Blood 2018; 131:917-931. [PMID: 29279357 PMCID: PMC6225386 DOI: 10.1182/blood-2017-09-807487] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/14/2017] [Indexed: 12/14/2022] Open
Abstract
The primary immunodeficiencies (PIDs), rare inherited diseases characterized by severe dysfunction of immunity, have been successfully treated by allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in childhood. Controversy exists regarding optimal timing and use of Allo-HSCT in adults, due to lack of experience and previous poor outcomes. Twenty-nine consecutive adult patients, with a mean age at transplant of 24 years (range, 17-50 years), underwent Allo-HSCT. Reduced-intensity conditioning (RIC) included fludarabine (Flu)/melphalan/alemtuzumab (n = 20), Flu/busulfan (Bu)/alemtuzumab (n = 8), and Flu/Bu/antithymocyte globulin (n = 1). Stem cell donors were matched unrelated donors or mismatched unrelated donors (n = 18) and matched related donors (n = 11). Overall survival (OS), event-free survival, transplant-related mortality (TRM), acute and chronic graft-versus-host disease incidence and severity, time to engraftment, lineage-specific chimerism, immune reconstitution, and discontinuation of immunoglobulin replacement therapy were recorded. OS at 3 years for the whole cohort was 85.2%. The rarer PID patients without chronic granulomatous disease (CGD) achieved an OS at 3 years of 88.9% (n = 18), compared with 81.8% for CGD patients (n = 11). TRM was low with only 4 deaths observed at a median follow-up of 3.5 years. There were no cases of early or late rejection. In all surviving patients, either stable mixed chimerism or full donor chimerism were observed. At last follow-up, 87% of the surviving patients had no evidence of persistent or recurrent infections. Allo-HSCT is safe and effective in young adult patients with severe PID and should be considered the treatment of choice where an appropriate donor is available.
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Affiliation(s)
- Thomas A Fox
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
| | - Ronjon Chakraverty
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Siobhan Burns
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
| | - Benjamin Carpenter
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Kirsty Thomson
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - David Lowe
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Adele Fielding
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Karl Peggs
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Panagiotis Kottaridis
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
| | - Benjamin Uttenthal
- Department of Haematology, Addenbrookes' Hospital, Cambridge, United Kingdom; and
| | - Venetia Bigley
- Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom
| | - Matthew Buckland
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Victoria Grandage
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Shari Denovan
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Sarah Grace
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Julia Dahlstrom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Sarita Workman
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Andrew Symes
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
| | - Stephen Mackinnon
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Haematology, Royal Free London NHS FT, London, United Kingdom
- Department of Haematology, Cancer Institute, UCL, London, United Kingdom
| | - Rachael Hough
- Teenage and Young Adult BMT Programme, UCL Hospital NHS FT, London, United Kingdom
| | - Emma Morris
- Institute of Immunity and Transplantation, University College London (UCL), London, United Kingdom
- Bone Marrow Transplant (BMT) Programme, UCL Hospital National Health Service Foundation Trust (NHS FT), London, United Kingdom
- Department of Immunology, Royal Free London NHS FT, London, United Kingdom
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10
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Potdar R, Varadi G, Fein J, Labopin M, Nagler A, Shouval R. Prognostic Scoring Systems in Allogeneic Hematopoietic Stem Cell Transplantation: Where Do We Stand? Biol Blood Marrow Transplant 2017; 23:1839-1846. [PMID: 28797781 DOI: 10.1016/j.bbmt.2017.07.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/22/2017] [Indexed: 01/19/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation is a potentially curative treatment for many hematologic disorders. Maximizing the benefit of transplantation for disease control while minimizing the risk for associated complications remains the field's leading challenge. This challenge has prompted the development of multiple prognostic scoring systems over the last 2 decades. Prognostic scores can be used for informed decision making, better patient counseling, design of interventional trials, and analysis of prospective and retrospective data. They are also helpful in treatment allocation and personalization according to predicted risk. A better understanding of the molecular and cytogenetic features of the disease, along with the advent of novel therapies, has increased the need for reliable prognostication of which patients will benefit most from transplantation. Here we review the clinical role of the prognostic systems currently in clinical use, examining both their strengths and their limitations.
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Affiliation(s)
- Rashmika Potdar
- Division of Hematology and Oncology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Gabor Varadi
- Division of Hematology and Oncology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Joshua Fein
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Myriam Labopin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France; Acute Leukemia Working Party, EBMT Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Acute Leukemia Working Party, EBMT Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Roni Shouval
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat-Gan, Israel.
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11
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Salit RB, Oliver DC, Delaney C, Sorror ML, Milano F. Prognostic Value of the Hematopoietic Cell Transplantation Comorbidity Index for Patients Undergoing Reduced-Intensity Conditioning Cord Blood Transplantation. Biol Blood Marrow Transplant 2017; 23:654-658. [DOI: 10.1016/j.bbmt.2017.01.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/20/2017] [Indexed: 01/15/2023]
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12
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Elsawy M, Sorror ML. Up-to-date tools for risk assessment before allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2016; 51:1283-1300. [PMID: 27272454 DOI: 10.1038/bmt.2016.141] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/13/2016] [Accepted: 04/11/2016] [Indexed: 12/13/2022]
Abstract
Cure of malignant and non-malignant hematological diseases is potentially possible after allogeneic hematopoietic stem cell transplantation (HCT). Accurate evaluation of the risk-benefit ratio for an individual patient could improve the decision-making process about transplant, which ultimately would increase the likelihood of success. Several transplant-related models were designed in an effort to optimize decision-making about suitable candidates for allogeneic HCT. In 1998, The European Society for Blood and Marrow Transplantation (EBMT) developed a five-component pretransplantation risk scoring system for patients with CML. The EBMT score was later tested in patients with various hematological disorders, and it was shown to stratify risks of mortality after allogeneic HCT. More recent research efforts focused on models that assess health status before HCT. A HCT-specific comorbidity index was designed to assign weights to 17 relevant comorbidities that were shown to independently predict non-relapse mortality. Performance status scales and comprehensive geriatric assessment tools might uncover additional overall health limitations that affect long-term survival among older recipients of allogeneic HCT. Other models include the pretransplantation assessment of mortality score that summarizes the impacts of eight different pretransplantation patient- and disease-specific variables into a 50-point model that predicts survival. The disease-risk index captures the impact of primary diagnoses and disease status on relapse and survival following allogeneic HCT. The values and limitations of each model are discussed herein. We also provide insight on how to use these models in the clinic to decide about offering allogeneic HCT with the most suitable conditioning regimen intensity.
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Affiliation(s)
- M Elsawy
- Transplantation Biology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - M L Sorror
- Transplantation Biology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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13
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Mohammadi M, Cao Y, Glimelius I, Bottai M, Eloranta S, Smedby KE. The impact of comorbid disease history on all-cause and cancer-specific mortality in myeloid leukemia and myeloma - a Swedish population-based study. BMC Cancer 2015; 15:850. [PMID: 26537111 PMCID: PMC4634819 DOI: 10.1186/s12885-015-1857-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/27/2015] [Indexed: 11/20/2022] Open
Abstract
Background Comorbidity increases overall mortality in patients diagnosed with hematological malignancies. The impact of comorbidity on cancer-specific mortality, taking competing risks into account, has not been evaluated. Methods Using the Swedish Cancer Register, we identified patients aged >18 years with a first diagnosis of acute myeloid leukemia (AML, N = 2,550), chronic myeloid leukemia (CML, N = 1,000) or myeloma (N = 4,584) 2002–2009. Comorbid disease history was assessed through in- and out-patient care as defined in the Charlson comorbidity index. Mortality rate ratios (MRR) were estimated through 2012 using Poisson regression. Probabilities of cancer-specific death were computed using flexible parametric survival models. Results Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15–1.40; CML = 1.28, 0.96–1.70; myeloma = 1.17, 1.08–1.28) compared with patients without comorbidity. Disorders associated with higher cancer-specific mortality were renal disease (in patients with AML, CML and myeloma), cerebrovascular conditions, dementia, psychiatric disease (AML, myeloma), liver and rheumatic disease (AML), cardiovascular and pulmonary disease (myeloma). The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly. The probability of cancer-specific death was generally higher than other-cause death even in older age groups, irrespective of comorbidity. Conclusion Comorbidities associated with organ failure or cognitive function are associated with poorer prognosis in several hematological malignancies, likely due to lower treatment tolerability. The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1857-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Mohammadi
- Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Yang Cao
- Institute of Environmental Medicine, Unit of Biostatistics, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Ingrid Glimelius
- Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. .,Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden.
| | - Matteo Bottai
- Institute of Environmental Medicine, Unit of Biostatistics, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Sandra Eloranta
- Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Karin E Smedby
- Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. .,Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
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14
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Assessing the Influence of Different Comorbidities Indexes on the Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in a Developing Country. PLoS One 2015; 10:e0137390. [PMID: 26394228 PMCID: PMC4578937 DOI: 10.1371/journal.pone.0137390] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/17/2015] [Indexed: 01/05/2023] Open
Abstract
Although the application of Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) has enabled better prediction of transplant-related mortality (TRM) in allogeneic hematopoietic stem cell transplants (AHSCT), data from developing countries are scarce. This study prospectively evaluated the HCT-CI and the Adult Comorbidity Evaluation (ACE-27), in its original and in a modified version, as predictors of post-transplant complications in adults undergoing a first related or unrelated AHSCT in Brazil. Both bone marrow (BM) and peripheral blood stem cells (PBSC) as graft sources were included. We analyzed the cumulative incidence of granulocyte and platelet recovery, sinusoidal obstructive syndrome, acute and chronic graft-versus-host disease, relapse and transplant-related mortality, and rates of event-free survival and overall survival. Ninety-nine patients were assessed. Median age was 38 years (18–65 years); HCT-CI ≥ 3 accounted for only 8% of cases; hematologic malignancies comprised 75.8% of the indications for AHSCT. There was no association between the HCT-CI or the original or modified ACE-27 with TRM or any other studied outcomes after AHSCT. These results show that, in the population studied, none of the comorbidity indexes seem to be associated with AHSCT outcomes. A significantly low frequency of high-risk (HCT-CI ≥ 3) in this Brazilian population might justify these results.
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15
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Brissot E, Mohty M. Which Acute Myeloid Leukemia Patients Should Be Offered Transplantation? Semin Hematol 2015; 52:223-31. [DOI: 10.1053/j.seminhematol.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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ElSawy M, Storer BE, Pulsipher MA, Maziarz RT, Bhatia S, Maris MB, Syrjala KL, Martin PJ, Maloney DG, Sandmaier BM, Storb R, Sorror ML. Multi-centre validation of the prognostic value of the haematopoietic cell transplantation- specific comorbidity index among recipient of allogeneic haematopoietic cell transplantation. Br J Haematol 2015; 170:574-83. [PMID: 25945807 DOI: 10.1111/bjh.13476] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/24/2015] [Indexed: 11/27/2022]
Abstract
The haematopoietic cell transplantation-specific comorbidity index (HCT-CI) was developed in a single centre as a weighted scoring system to predict risks of non-relapse mortality (NRM) following allogeneic haematopoietic cell transplantation. Information on the performance of the HCT-CI in multi-centre studies is lacking in the literature. To that end, a collaborative multicentre retrospective study was initiated. Comorbidity data from 2523 consecutive recipients of human leucocyte antigen-matched grafts from five different US institutions were analysed. Among all patients, HCT-CI scores of 0 vs. 1-2 vs. ≥3 were associated with 2-year NRM rates of 14%, 23% and 39% (P < 0·0001), respectively, and 2-year overall survival (OS) rates of 74%, 61% and 39%, respectively (P < 0·0001). Using regression models, increasing HCT-CI scores were independently associated with increases in hazard ratios for NRM and worse survival within individual institutions. The HCT-CI retained independent capacity for association with outcomes within different age as well as conditioning intensity groups. C-statistic estimates for the prognostic power of the HCT-CI for NRM and OS were 0·66 and 0·64, respectively. The estimates within each institution were overall similar. The HCT-CI is a valid tool for capturing comorbidities and predicting mortality after haematopoietic cell transplantation across different institutions.
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Affiliation(s)
- Mahmoud ElSawy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,National Cancer Institute, Cairo University, Cairo, Egypt
| | - Barry E Storer
- Clinical Statistics Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Michael A Pulsipher
- Division of Hematology/Blood and Marrow Transplantation, University of Utah School of Medicine, Logan, UT, USA.,Pediatric Blood and Marrow Transplant Program, Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Richard T Maziarz
- Center for Hematologic Malignancies, OHSU Knight Cancer Institute, Portland, OR, USA.,Division of Hematology and Medical Oncology, Oregon Health & Science University School of Medicine, Portland, OR, USA
| | - Smita Bhatia
- Department of Population Sciences, Center for Cancer Survivorship, City of Hope School of Medicine, Duarte, CA, USA
| | - Michael B Maris
- Colorado Blood Cancer Institute School of Medicine, Denver, CO, USA
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine Seattle, Seattle, WA, USA
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Rainer Storb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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17
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Interpreting outcome data in hematopoietic cell transplantation for leukemia: tackling common biases. Bone Marrow Transplant 2015; 50:324-33. [DOI: 10.1038/bmt.2014.270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/15/2014] [Accepted: 07/03/2014] [Indexed: 11/08/2022]
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18
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Odenike O, Onida F, Padron E. Myelodysplastic syndromes and myelodysplastic/myeloproliferative neoplasms: an update on risk stratification, molecular genetics, and therapeutic approaches including allogeneic hematopoietic stem cell transplantation. Am Soc Clin Oncol Educ Book 2015:e398-e412. [PMID: 25993202 DOI: 10.14694/edbook_am.2015.35.e398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Myelodysplastic syndromes are a heterogeneous group of clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis, peripheral cytopenias, and a variable propensity for leukemic transformation. In recent years there has been an explosion of information on the molecular genetic changes underlying these disorders. This information has substantial prognostic implications, and the influence on therapeutic approaches and the treatment of patients is evolving. Allogeneic hematopoietic stem cell transplantation (alloSCT) is the only known cure for these diseases, but appropriate patient selection is of utmost importance from a risk-benefit perspective. This review focuses on the factors influencing risk stratification in MDS and optimal choice of front-line therapy in the current era, including the interplay of clinical factors and molecular genetic factors, and factors that determine eligibility for alloSCT. The myelodysplastic/myeloproliferative diseases also will be discussed, including the increasing effort to understand the molecular genetics and natural history of these disorders and treatment approaches.
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Affiliation(s)
- Olatoyosi Odenike
- From the Section of Hematology/Oncology, and the Comprehensive Cancer Center, The University of Chicago, Chicago, IL; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Moffitt Cancer Center, Tampa, FL
| | - Francesco Onida
- From the Section of Hematology/Oncology, and the Comprehensive Cancer Center, The University of Chicago, Chicago, IL; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Moffitt Cancer Center, Tampa, FL
| | - Eric Padron
- From the Section of Hematology/Oncology, and the Comprehensive Cancer Center, The University of Chicago, Chicago, IL; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Moffitt Cancer Center, Tampa, FL
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19
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Impact of pre-transplant co-morbidities on outcome after alemtuzumab-based reduced intensity conditioning allo-SCT in elderly patients: a British Society of Blood and Marrow Transplantation study. Bone Marrow Transplant 2014; 50:82-6. [PMID: 25285801 DOI: 10.1038/bmt.2014.215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/12/2022]
Abstract
The advent of reduced intensity conditioning (RIC) regimens has permitted the extension of allo-SCT to selected patients into their eighth decade but GVHD remains a major cause of morbidity and mortality. Alemtuzumab is increasingly used to reduce the risk of severe GVHD, but there are concerns that T-cell depletion may compromise outcome particularly in older patients. We therefore studied the impact of pre-transplant factors on the outcome of 187 patients with a haematological malignancy over the age of 60 transplanted using an alemtuzumab-based RIC regimen of whom co-morbidity scoring was possible in 169. Of the patients, 120 had a haematopoietic cell transplantation co-morbidity index (HCT-CI) of 0 or 1 and 49 had a score of 2 or more. The 5-year OS was 33%. In multivariable analysis, OS was determined by co-morbidity score (P=0.001) and disease status at transplant (P=0.004) but not by patient age. Non-relapse mortality was determined by co-morbidity score (P=0.001). Two-year OS for patients with a HCT-CI of 0-1 was 59 versus 6% for patients with a higher score. Alemtuzumab-based RIC allografts can be delivered safely in patients aged over 60 but co-morbidity scoring is mandatory to identify patients who will benefit.
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20
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Nakaya A, Mori T, Tanaka M, Tomita N, Nakaseko C, Yano S, Fujisawa S, Sakamaki H, Aotsuka N, Yokota A, Kanda Y, Sakura T, Nanya Y, Saitoh T, Kanamori H, Takahashi S, Okamoto S. Does the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) Predict Transplantation Outcomes? A Prospective Multicenter Validation Study of the Kanto Study Group for Cell Therapy. Biol Blood Marrow Transplant 2014; 20:1553-9. [DOI: 10.1016/j.bbmt.2014.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 06/02/2014] [Indexed: 12/21/2022]
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21
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Ofran Y. Genetic stratification in myeloid diseases: from risk assessment to clinical decision support tool. Rambam Maimonides Med J 2014; 5:e0025. [PMID: 25386341 PMCID: PMC4222414 DOI: 10.5041/rmmj.10159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Genetic aberrations have become a dominant factor in the stratification of myeloid malignancies. Cytogenetic and a few mutation studies are the backbone of risk assessment models of myeloid malignancies which are a major consideration in clinical decisions, especially patient assignment for allogeneic stem cell transplantation. Progress in our understanding of the genetic basis of the pathogenesis of myeloid malignancies and the growing capabilities of mass sequencing may add new roles for the clinical usage of genetic data. A few recently identified mutations recognized to be associated with specific diseases or clinical scenarios may soon become part of the diagnostic criteria of such conditions. Mutational studies may also advance our capabilities for a more efficient patient selection process, assigning the most effective therapy at the best timing for each patient. The clinical utility of genetic data is anticipated to advance further with the adoption of deep sequencing and next-generation sequencing techniques. We herein suggest some future potential applications of sequential genetic data to identify pending deteriorations at time points which are the best for aggressive interventions such as allogeneic stem cell transplantation. Genetics is moving from being mostly a prognostic factor to becoming a multitasking decision support tool for hematologists. Physicians must pay attention to advances in molecular hematology as it will soon be accessible and influential for most of our patients.
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Affiliation(s)
- Yishai Ofran
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel and ; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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22
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Outcomes of stem cell transplant patients with acute respiratory failure requiring mechanical ventilation in the United States. Bone Marrow Transplant 2014; 49:1278-86. [DOI: 10.1038/bmt.2014.130] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/02/2014] [Accepted: 05/12/2014] [Indexed: 11/09/2022]
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23
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Versluis J, Labopin M, Niederwieser D, Socie G, Schlenk RF, Milpied N, Nagler A, Blaise D, Rocha V, Cornelissen JJ, Mohty M. Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission. Leukemia 2014; 29:51-7. [PMID: 24913728 DOI: 10.1038/leu.2014.164] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/13/2014] [Accepted: 04/28/2014] [Indexed: 01/21/2023]
Abstract
Non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (alloHSCT) can be predicted by the hematopoietic cell transplantation comorbidity index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score, which are composed of different parameters. We set out to integrate the parameters of both scores in patients with acute myeloid leukemia (AML) in first complete remission (CR1) receiving reduced intensity conditioning (RIC) alloHSCT. All parameters from the HCT-CI and the EBMT-score with the addition of patient and donor cytomegalovirus serology were evaluated in 812 patients by multivariable analysis with end-point NRM at 2 years. Subsequently, 16 parameters were selected based on hazard ratio >1.2, and were incorporated into a novel score, which was further internally validated by bootstrapping. Both the HCT-CI and the EBMT-score showed relatively weak predictive value, whereas the integrated score allowed to identify three clearly distinct risk groups with 2-year NRM estimates of 8±2% (low-risk), 17±2% (intermediate-risk) and 38±4% (high-risk), which also translated in prediction of overall survival. Collectively, integration of the most dominant parameters from the HCT-CI and the EBMT-score allowed to develop a simple and robust, integrated score with improved prediction of NRM for AML patients proceeding to RIC alloHSCT in CR1.
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Affiliation(s)
- J Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M Labopin
- 1] Sorbonne Universités, Paris, France [2] Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France [3] AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - D Niederwieser
- Department of Hematology and Oncology, University Leipzig, Leipzig, Germany
| | - G Socie
- 1] Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France [2] Department of Hematology/Transplantation, Hopital Saint-Louis, Sorbonne University, Paris, France
| | - R F Schlenk
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - N Milpied
- Department of Hematology, CHU de Bordeaux, Bordeaux, France
| | - A Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - D Blaise
- Department of Hematology and Transplant Program, Institut Paoli Calmettes, Marseille, France
| | - V Rocha
- Eurocord International Registry, Hopital Saint Louis, Sorbonne University, Paris, France
| | - J J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M Mohty
- 1] Sorbonne Universités, Paris, France [2] Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France [3] AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
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24
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Potter VT, Krishnamurthy P, Barber LD, Lim Z, Kenyon M, Ireland RM, de Lavallade H, Dhouri A, Marsh JCW, Marcus R, Devereux S, Ho A, Pagliuca A, Mufti GJ. Long-term outcomes of alemtuzumab-based reduced-intensity conditioned hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myelogenous leukemia secondary to myelodysplastic syndrome. Biol Blood Marrow Transplant 2013; 20:111-7. [PMID: 24216184 DOI: 10.1016/j.bbmt.2013.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 10/22/2013] [Indexed: 12/01/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) with reduced-intensity conditioning (RIC) offers a potential cure for patients with myelodysplastic syndrome (MDS) who are ineligible for standard-intensity regimens. Previously published data from our institution suggest excellent outcomes at 1 yr using a uniform fludarabine, busulfan, and alemtuzumab-based regimen. Here we report long-term follow-up of 192 patients with MDS and acute myelogenous leukemia (AML) secondary to MDS (MDS-AML) transplanted with this protocol, using sibling (n = 45) or matched unrelated (n = 147) donors. The median age of the cohort was 57 yr (range, 21 to 72 yr), and median follow-up was 4.5 yr (range, 0.1 to 10.6 yr). The 5-yr overall survival (OS), event-free survival, and nonrelapse mortality were 44%, 33%, and 26% respectively. The incidence of de novo chronic graft-versus-host disease (GVHD) was low at 19%, illustrating the efficacy of alemtuzumab for GVHD prophylaxis. Conversely, the 5-yr relapse rate was 51%. For younger patients (age <50 yr), the 5-yr OS and relapse rates were 58% and 39%, respectively. On multivariate analysis, advanced age predicted significantly worse outcomes, with patients age >60 yr having a 5-yr OS of 15% and relapse rate of 66%. Patients receiving preemptive donor lymphocyte infusions had an impressive 5-yr OS of 67%, suggesting that this protocol may lend itself to the incorporation of immunotherapeutic strategies. Overall, these data demonstrate good 5-yr OS for patients with MDS and MDS-AML undergoing alemtuzumab-based RIC-HSCT. The low rate of chronic GVHD is encouraging, and comparative studies with other RIC protocols are warranted.
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Affiliation(s)
- Victoria T Potter
- Department of Haematological Medicine, King's College Hospital, London, UK
| | | | - Linda D Barber
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Ziyi Lim
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Michelle Kenyon
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Robin M Ireland
- Department of Haematological Medicine, King's College Hospital, London, UK
| | | | - Abdel Dhouri
- Department of Statistics, King's College, London, UK
| | - Judith C W Marsh
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Robert Marcus
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Stephen Devereux
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Aloysius Ho
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Ghulam J Mufti
- Department of Haematological Medicine, King's College Hospital, London, UK.
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25
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Busca A, Pecoraro C, Giaccone L, Bruno B, Allione B, Corsetti MT, Pini M, Marmont F, Audisio E, D’Ardia S, Frairia C, Castiglione A, Ciccone G, Levis A, Vitolo U, Falda M. Allogeneic stem cell transplant for adults with myelodysplastic syndromes: relevance of pre-transplant disease status. Leuk Lymphoma 2013; 55:863-9. [DOI: 10.3109/10428194.2013.816422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Indications and outcomes of reduced-toxicity hematopoietic stem cell transplantation in adult patients with hematological malignancies. Int J Hematol 2013; 97:581-98. [PMID: 23585244 DOI: 10.1007/s12185-013-1313-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 02/05/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) utilizing non-myeloablative (NMA) and reduced-intensity conditioning (RIC) regimens (collectively referred to as reduced-toxicity HCT, RT-HCT) has become a viable therapeutic option for patients with hematological malignancies who are ineligible for standard myeloablative conditioning transplantation (MA-HCT). RT-HCT has been shown to induce stable engraftment with low toxicity, and to produce similar overall and progression-free survival (PFS) when compared to MA-HCT in acute myeloid leukemia and myelodysplastic syndrome. The best results for RT-HCT have been reported for patients with disease that is in remission, indolent and chemosensitive, and with a strong graft-versus-malignancy effect. Chronic graft-versus-host disease seems to correlate with a lower relapse rate and better PFS. RT-HCT is inferior when performed in poor risk or advanced disease, due to high relapse rates. A search for novel strategies that includes the most appropriate conditioning regimens and post-transplant immunomodulation protocols with more intensive anti-malignancy activity but limited toxicity is in progress. This review provides an update on the results of clinical studies of RT-HCT, and discusses possible indications and investigative strategies for improving the clinical outcomes of RT-HCT for the major hematological malignancies.
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27
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Current world literature. Curr Opin Infect Dis 2012; 25:718-28. [PMID: 23147811 DOI: 10.1097/qco.0b013e32835af239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Cornelissen JJ, Gratwohl A, Schlenk RF, Sierra J, Bornhäuser M, Juliusson G, Råcil Z, Rowe JM, Russell N, Mohty M, Löwenberg B, Socié G, Niederwieser D, Ossenkoppele GJ. The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach. Nat Rev Clin Oncol 2012; 9:579-90. [PMID: 22949046 DOI: 10.1038/nrclinonc.2012.150] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic haematopoietic stem-cell transplantation (HSCT) is frequently applied as part of the treatment in patients with acute myeloid leukaemia (AML) in their first or subsequent remission. Allogeneic HSCT reduces relapse, but nonrelapse mortality and morbidity might counterbalance this beneficial effect. Here, we review recent studies reporting new disease-specific prognostic markers, in addition to allogeneic-HSCT-related risk factors, which can be assessed at specific time points during treatment. We propose risk assessment as a dynamic process during treatment, incorporating both disease-related and transplant-related factors for the decision to proceed either to allogeneic HSCT or to apply a nontransplant strategy. We suggest that allogeneic HSCT might be favoured if the projected disease-free survival is expected to improve by at least 10% based on an individual's risk assessment. The approach requires initial disease risk assessment, identifying a sibling or unrelated donor soon after diagnosis and the incorporation of time-dependent risk factors, all within the context of an integrated therapeutic management approach.
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Affiliation(s)
- Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
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29
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Takasaki H, Tanaka M, Tachibana T, Numata A, Fujimaki K, Sakai R, Fujisawa S, Tomita N, Fujita H, Maruta A, Ishigatsubo Y, Kanamori H. Prognostic factors in patients aged 50 years or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancy. Int J Hematol 2012; 95:291-8. [PMID: 22302471 DOI: 10.1007/s12185-012-1009-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 11/28/2022]
Abstract
We retrospectively analyzed patients aged C 50 years with hematologic malignancies who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) to identify preoperative variables predicting the outcome. There were 71 patients with a median age of 57 years (range: 50-63 years) who had acute leukemia (n = 53) or myelodysplastic syndrome (n = 18). Myeloablative conditioning was done in 35 patients and 36 patients had reduced-intensity conditioning. The 5-year overall survival rate (OS), cumulative relapse rate, and non-relapse mortality rate (NRM) were 45, 24, and 33%, respectively. According to multivariate analysis, high-risk disease (HR 3.50, 95% CI 1.43-8.56, P = 0.006), a hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥ 3 (HR 4.41, 95% CI 1.31-14.77, P = 0.016), and an HLA-mismatched unrelated donor (HR 4.03, 95% CI 1.46-11.10, P = 0.007) were significant predictors of worse OS. Highrisk disease was also significantly associated with a higher cumulative relapse rate (HR 4.59, 95% CI 0.94-6.92, P = 0.065). Furthermore, an HCT-CI score ≥ 3 (HR 3.02, 95% CI 1.01-20.78, P = 0.048) and an HLA-mismatched unrelated donor (HR 3.02, 95% CI 1.04-8.74, P = 0.042) were risk factors for NRM. These results suggest that the disease risk, HCT-CI score, and donor type/histocompatibility are prognostic factors for elderly patients, while the conditioning regimen and age are not predictors.
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Affiliation(s)
- Hirotaka Takasaki
- Department of Hematology, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama 241-0815, Japan.
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30
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Validation of the Hematopoietic Cell Transplantation-Specific Comorbidity Index: a prospective, multicenter GITMO study. Blood 2012; 120:1327-33. [PMID: 22740454 DOI: 10.1182/blood-2012-03-414573] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The development of tools for the prediction of nonrelapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (HSCT) would offer a major guidance in the therapeutic decision. Recently, the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) has been associated with increased NRM risk in several retrospective studies, but its clinical utility has never been demonstrated prospectively in an adequately sized cohort. To this aim, we prospectively evaluated a consecutive cohort of 1937 patients receiving HSCT in Italy over 2 years. HCT-CI was strongly correlated with both 2-year NRM (14.7%, 21.3%, and 27.3% in patients having an HCT-CI score of 0, 1-2, and ≥ 3, respectively) and overall survival (56.4%, 54.5%, and 41.3%, respectively). There was an excellent calibration between the predicted and observed 2-year NRM in patients having an HCT-CI score of 0 and 1-2, whereas in the ≥ 3 group the predicted NRM overestimated the observed NRM (41% vs 27.3%). HCT-CI alone was the strongest predictor of NRM in patients with lymphoma, myelodysplastic syndrome, and acute myeloid leukemia in first remission (c-statistics 0.66, 064, and 0.59, respectively). We confirm the clinical utility of the HCT-CI score that could also identify patients at low NRM risk possibly benefiting from an HSCT-based treatment strategy.
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31
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The challenge of individualised risk assessment and therapy planning in elderly high-risk myelodysplastic syndromes (MDS) patients. Ann Hematol 2012; 91:1333-43. [PMID: 22547053 PMCID: PMC3411309 DOI: 10.1007/s00277-012-1472-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
Myelodysplastic syndromes (MDS) represent one of the most frequent and serious haematologic diseases of the elderly. Effective therapies exist ranging from best supportive care to haematologic stem cell transplantation (HSCT). Decision making, however, is rather complex in this group of patients because ageing is a multidimensional process involving not only physiological changes but also changes in functional, social, emotional and cognitive capacities. All these factors can have a significant impact on the efficacy and tolerability of a potential therapy and therefore have to be thoroughly assessed before deciding on individual treatment regimens. Risk assessment tools are available both to classify the stage and prognosis of MDS and to meet the needs of elderly patients. A tool explicitly focussing on elderly MDS patients, however, is still missing. The current report approached this issue by combining the well established MDS-risk score 'International Prognostic Scoring System' (IPSS) with the 'Multidimensional Geriatric Assessment' (MGA). As decision making is most complex in high-risk MDS patients, the new algorithm is presented exemplarily for this group of patients. In a first step, MDS-related risk is identified using IPSS, in a second step, patients are assigned to one of three risk categories of the MGA (go-go/fit, slow-go/vulnerable, no-go/frail). While go-go patients might be subjected to therapies comparable to those given to younger patients, in no-go patients, a palliative therapy combined with best supportive care will probably be most appropriate. In slow-go patients, age-related life expectancy taken from public age statistics should be compared to the MDS-related life expectancy. Based on this combined assessment procedure and also on treatment tolerance in terms of the expectations/wishes of the patient and his/her family, an individualised therapeutic approach should be developed. Specific treatment recommendations for these three groups of patients are given, including HSCT, azanucleosides and best supportive care. To illustrate its practicability, i.e. the implementation of the novel algorithm in clinical practice, the case of an elderly high-risk MDS patient is presented and discussed in detail. This new algorithm will facilitate the identification of the very particular needs and conditions of elderly MDS patients in clinical practice. Based on this, individually tailored therapeutic approaches can be developed--the prerequisite for the best possible clinical outcome.
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