1
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Chakrabarty JH, Glover J, Schmidt S, Phan M, Bycko M, Duong Q, Vesely SK, O’Neal C, Robertson C, Davis C, Kratochvil K, Yuen C, Khawandanah M, Selby G, Jassim R, Williams KM. Incidence and risk factors for graft failure in the modern era of cord blood transplantation. Vox Sang 2022; 117:1405-1410. [PMID: 36250288 PMCID: PMC9772075 DOI: 10.1111/vox.13368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Graft failure (GF) after cord blood transplant (CBT) has decreased with improved supportive care and cord selection strategies. We aimed to evaluate cord blood selection and factors associated with retransplantation on the incidence of GF, determine risk factors for GF including host antibodies to Kell antigen and evaluate survival after GF. MATERIALS AND METHODS We retrospectively reviewed 84 patients who underwent CBT at the University of Oklahoma between 2000 and 2016 and compared outcomes in patients with/without engraftment by Day 28. The nonengraftment cohort was further divided into patients who underwent retransplantation. Kaplan-Meier curves with log-rank tests were calculated to assess the association between mortality and engraftment. RESULTS Engraftment following CBT was high at 81%, with 52% engrafting by Day 28 and an additional 29% engrafting by a median of 36 days. Retransplantation led to 88% engraftment at a median of 53 days. Overall, 75% of the 40 patients who did not engraft by Day 28 died. Female sex and total nucleated cell count < 3.5/kg were significantly associated with lack of engraftment and higher mortality. Antibodies to Kell fetal antigen were not identified. Retransplantation by Day 28 for primary GF conferred a survival advantage. CONCLUSION This study demonstrates that failure to engraft by 28 days was associated with increased mortality, and risk was mitigated with early retransplantation. Female sex and low total cell dose were associated with increased mortality. Early identification of GF coupled with early retransplantation can reduce mortality in CBT.
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Affiliation(s)
| | - Joshua Glover
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sara Schmidt
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Minh Phan
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Michele Bycko
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Quyen Duong
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sara K. Vesely
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Caroline O’Neal
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Chelsie Robertson
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Christina Davis
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Kristen Kratochvil
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Carrie Yuen
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Mohamad Khawandanah
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - George Selby
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rami Jassim
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Kirsten M. Williams
- Aflac Cancer and Blood Disorders, Children’s Healthcare of Atlanta, Emory University, Atlanta GA
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2
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Non-relapse cytopenias following allogeneic stem cell transplantation, a case based review. Bone Marrow Transplant 2022; 57:1489-1499. [DOI: 10.1038/s41409-022-01761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/08/2022]
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3
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Albert MH, Sirin M, Hoenig M, Hauck F, Schuetz C, Bhattacharyya R, Stepensky P, Jacoby E, Güngör T, Beier R, Schulz A. Salvage HLA-haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide for graft failure in non-malignant disorders. Bone Marrow Transplant 2021; 56:2248-2258. [PMID: 33967276 PMCID: PMC8106764 DOI: 10.1038/s41409-021-01323-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 02/05/2023]
Abstract
Graft failure requires urgent salvage HSCT, but there is no universally accepted approach for this situation. We investigated T-cell replete haploidentical HSCT with post-transplantation cyclophosphamide following serotherapy-based, radiation-free, reduced intensity conditioning in children with non-malignant disorders who had rejected their primary graft. Twelve patients with primary or secondary graft failure received T-cell replete bone marrow grafts from haploidentical donors and post-transplantation cyclophosphamide. The recommended conditioning regimen comprised rituximab 375 mg/m2, alemtuzumab 0.4 mg/kg, fludarabine 150 mg/m2, treosulfan 20-24 g/m2 and cyclophosphamide 29 mg/kg. After a median follow-up of 26 months (7-95), eleven of twelve patients (92%) are alive and well with complete donor chimerism in ten. Neutrophil and platelet engraftment were observed in all patients after a median of 18 days (15-61) and 39 days (15-191), respectively. Acute GVHD grade I was observed in 1/12 patients (8%) and mild chronic GVHD in 1/12 patients (8%). Viral reactivations and disease were frequent complications at 75% and 42%, respectively, but no death from infectious causes occurred. In summary, this retrospective analysis demonstrates that a post-transplantation cyclophosphamide-based HLA-haploidentical salvage HSCT after irradiation-free conditioning results in excellent engraftment and overall survival in children with non-malignant diseases.
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Affiliation(s)
- Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.
| | - Mehtap Sirin
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Manfred Hoenig
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Munich, Germany
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rajat Bhattacharyya
- Haematology Oncology Service, Department of Paediatric subspecialties, KK Women's and Children's Hospital, Bukit Timah, Singapore
| | - Polina Stepensky
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Department of Bone Marrow Transplantation, Hadassah Medical Center, Jerusalem, Israel
| | - Elad Jacoby
- Division of Pediatric Hematology Oncology and BMT, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tayfun Güngör
- Department of Hematology/Oncology/Immunology, Gene-therapy, and Stem Cell Transplantation, University Children's Hospital Zürich - Eleonore Foundation & Children's Research Center (CRC), Zürich, Switzerland
| | - Rita Beier
- Department of Pediatric Hematology and Oncology, University Duisburg-Essen, Essen, Germany
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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4
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Sun YQ, Wang Y, Wang FR, Yan CH, Cheng YF, Chen YH, Zhang YY, Han TT, Han W, Suo P, Xu LP, Zhang XH, Liu KY, Huang XJ. Graft Failure in Patients With Hematological Malignancies: A Successful Salvage With a Second Transplantation From a Different Haploidentical Donor. Front Med (Lausanne) 2021; 8:604085. [PMID: 34150785 PMCID: PMC8212968 DOI: 10.3389/fmed.2021.604085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Graft failure (GF) is a fatal complication of allogeneic stem cell transplantation, especially after haploidentical transplantation. The mortality of GF is nearly 100% without an effective salvage method. A second transplantation is usually necessary to save the patient's life. However, there is no standardized regimen, and the outcome is usually disappointing. We report on a prospective single-center study using a reduced-intensity conditioning regimen with different haploidentical donors (HIDs). Patients with GF after the first transplantation were enrolled in a prospective single-arm clinical trial (ClinicalTrials.Gov ID: NCT03717545) at the Peking University Institute of Hematology. The conditioning regimen consisted of fludarabine (30 mg/m2) (days-6 to-2) and cyclophosphamide (1,000 mg/m2/day) (days-5 to-4). Patients underwent a second transplant from a different HID using a granulocyte colony-stimulating factor primed bone marrow and peripheral blood stem cells. The primary outcome was neutrophil engraftment at day 28. The secondary outcomes included platelet engraftment at day 100, transplant-related mortality (TRM) at day 30, TRM at day 100, and overall survival (OS) at 1 year. From March 2018 to June 2020, 13 patients were enrolled in this clinical trial. Of the 13 patients, five had acute myeloid leukemia, five had acute lymphoblastic leukemia, two had myelodysplastic syndromes, and one had a non-Hodgkin lymphoma. The median age at first transplantation was 38 years (range, 8-55 years). As for the first transplantation, 11 patients underwent haploidentical transplantations and two underwent unrelated donor transplantations. At the time of GF, three patients had complete donor chimerism, five had mixed chimerism, and five had complete recipient chimerism. The median time from the first transplantation to the second transplantation was 49 (range 35-120) days. The medians of infused cell doses were as follows: mononuclear cells 7.93 (5.95-12.51) × 108/kg and CD34 + cells 2.28 (0.75-5.57) × 106/kg. All 13 patients achieved neutrophil engraftment after the second transplantation, with a median engraftment time of 11 (range 10-20) days after transplantation. The platelet engraftment rate on day 100 after transplantation was 76.9%. The TRMs at day 30, day 100, and 1-year were 0, 0, and 23.1%, respectively. The OS and disease-free survival at 1-year were 56.6 and 48.4%, respectively. For patients with GF after first transplantation, a second transplantation using a fludarabine/cyclophosphamide regimen from a different HID was a promising salvage option. Further investigation is needed to confirm the suitability of this method.
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Affiliation(s)
- Yu-Qian Sun
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Feng-Rong Wang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Hua Yan
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yi-Fei Cheng
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Hong Chen
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yuan-Yuan Zhang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ting-Ting Han
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Wei Han
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Pan Suo
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Lan-Ping Xu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Hui Zhang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Kai-Yan Liu
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, National Clinical Research Center for Hematologic Disease, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
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5
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Harada K, Fuji S, Seo S, Kanda J, Ueki T, Kimura F, Kato K, Uchida N, Ikegame K, Onizuka M, Matsuoka KI, Doki N, Kawakita T, Onishi Y, Yano S, Fukuda T, Takanashi M, Kanda Y, Atsuta Y, Ogata M. Comparison of the outcomes after haploidentical and cord blood salvage transplantations for graft failure following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2020; 55:1784-1795. [PMID: 32051535 DOI: 10.1038/s41409-020-0821-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 01/28/2023]
Abstract
Graft failure (GF) is a life-threatening complication after allogeneic stem cell transplantation (SCT). Although salvage SCTs can be performed with haploidentical donor (HID) or cord blood (CB), no study has compared the performances of these two sources. Using nationwide registration data, we compared the transplant outcomes of patients who developed GF and underwent salvage transplantation from HID (n = 129) and CB (n = 570) from 2007 to 2016. The HID group demonstrated better neutrophil recovery (79.7 vs. 52.5% at 30 days, P < 0.001). With a median follow-up of 3 years, both groups demonstrated similar overall survival (OS) and nonrelapse mortality (NRM; 1-year OS, 33.1 vs. 34.6% and 1-year NRM, 45.1 vs. 49.8% for the HID and CB groups). After adjustments for other covariates, OS did not differ in both groups. However, HID was associated with a lower NRM (hazard ratio, 0.71; P = 0.038) than CB. The incidence of acute graft-versus-host disease (GVHD)-related deaths was significantly higher in the HID group, although infection-related deaths were observed more frequently in the CB group. HID may be a promising salvage SCT option after GF due to its faster engraftment and low NRM.
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Affiliation(s)
- Kaito Harada
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimitsu Ueki
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Fumihiko Kimura
- Division of Hematology, National Defense Medical College, Tokorozawa, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Shingo Yano
- Clinical oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Minoko Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masao Ogata
- Department of Hematology, Oita University Hospital, Yufu, Japan
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6
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Alcazer V, Peffault de Latour R, Ader F, Labussière-Wallet H. [Graft failure after allogeneic hematopoietic stem cell transplantation: Definition and risk factors]. Bull Cancer 2019; 106:574-583. [PMID: 31060736 DOI: 10.1016/j.bulcan.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/02/2019] [Accepted: 03/07/2019] [Indexed: 11/25/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation is the only curative therapy for numerous malignant and non-malignant haematological diseases. A sustained engraftment of the donor stem cells is essential for transplant success and overall outcome. Graft failure is a rare but severe event after allogeneic hematopoietic stem cell transplantation. While different risk factors such as underlying disease, graft source or HLA matching have been found to be consistently associated with graft failure, other factors such as ABO mismatch graft-versus-host disease prophylaxis or infections, particularly viral reactivations, are more controversial. In this article, we review the different factors associated with graft failure.
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Affiliation(s)
- Vincent Alcazer
- Hospices civils de Lyon, département d'hématologie clinique, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Centre de recherche en cancérologie de Lyon, Inserm U1052/CNRS 5286, 69008 Lyon, France.
| | - Régis Peffault de Latour
- Assistance publique-hôpitaux de Paris, hôpital Saint-Louis, service d'hématologie-greffe, 75006 Paris, France; Université Paris Diderot, 75007 Paris, France
| | - Florence Ader
- Hospices civils de Lyon, service des maladies infectieuses, 69004 Lyon, France; Centre international de recherche en infectiologie, Inserm U1111, CNRS 5308, 69008 Lyon, France
| | - Hélène Labussière-Wallet
- Hospices civils de Lyon, département d'hématologie clinique, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
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7
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Feasibility of salvage cord blood transplantation using a fludarabine, melphalan, and low-dose anti-thymocyte globulin conditioning regimen. Int J Hematol 2019; 109:463-469. [PMID: 30734904 DOI: 10.1007/s12185-019-02610-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
Primary graft failure (PGF) is a lethal complication that occurs early after allogeneic stem cell transplantation (allo-SCT). Cord blood transplantation (CBT) is a potential re-transplantation option. Total body irradiation (TBI) is often incorporated into the pre-salvage CBT conditioning regimen following PGF; however, patients experiencing PGF are not always amenable to TBI, and non-TBI regimens for salvage CBT should be established. Here, we report five patients with hematologic malignancies who received salvage CBT for PGF following a non-TBI regimen using fludarabine (Flu), melphalan (Mel), and low-dose anti-thymocyte globulin (ATG). The median intervals between the failed allo-SCT and salvage CBT, as well as between the diagnosis of PGF and salvage CBT, were 37 days and 8 days, respectively. The median neutrophil recovery period was 21 days (range 18-21 days). Four of five patients achieved neutrophil engraftment following salvage CBT; all four exhibited sustained engraftment with complete donor chimerism. Three of the five patients were alive after a median follow-up time of 907 days (range 315-909 days) post-salvage CBT; two patients died of causes unrelated to recurrence. These data suggest that CBT following the non-TBI regimen described here is feasible in patients with PGF.
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8
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Kliman D, Bilmon I, Kwan J, Blyth E, Micklethwaite K, Panicker S, Bhattacharyya A, Deren S, Antonenas V, Huang G, Gottlieb D. Rescue haploidentical peripheral blood stem cell transplantation for engraftment failure: a single-centre case series. Intern Med J 2019; 48:988-991. [PMID: 30133987 DOI: 10.1111/imj.13979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/15/2018] [Accepted: 05/06/2018] [Indexed: 01/22/2023]
Abstract
Graft failure affects approximately 5% of allogeneic stem cell transplants, with a poor prognosis. Salvage second allogeneic stem cell transplantation (alloSCT2) is limited by high rates of transplant-related mortality from infection and graft-versus-host disease. We report on five adult patients receiving rescue alloSCT2 using haploidentical peripheral blood stem cells. All patients achieved neutrophil engraftment, two subsequently died from sepsis and disease relapse, respectively. Three patients remain alive up to 2 years post-transplant. We suggest consideration of haploidentical alloSCT2 for patients with graft failure.
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Affiliation(s)
- David Kliman
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Ian Bilmon
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - John Kwan
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Emily Blyth
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Cellular Therapies Laboratory, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Ken Micklethwaite
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Cellular Therapies Laboratory, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Shyam Panicker
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Abir Bhattacharyya
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Deren
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vicki Antonenas
- Sydney Cellular Therapies Laboratory, Sydney, New South Wales, Australia
| | - Gillian Huang
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - David Gottlieb
- Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Cellular Therapies Laboratory, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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9
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Tecchio C, Andreini A, Costantini C, Zamò A, de Sabata D, Aprili F, Galavotti R, Guardalben E, Benedetti F. Haploidentical hematopoietic stem cell transplantation in a myelofibrosis patient with primary graft failure. Hematol Rep 2017; 9:7091. [PMID: 29383224 PMCID: PMC5768082 DOI: 10.4081/hr.2017.7091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 11/22/2022] Open
Abstract
The prognosis of patients affected by myelofibrosis (MF) is usually dismal and allogeneic hematopoietic stem cell transplantation (HSCT) remains the only cure. The number of HSCTs in MF patients has recently increased. However, a major obstacle is still represented by primary graft failure (PGF). Currently there are no definitive guidelines for the treatment of PGF and a second HSCT can be performed only when an allogeneic donor is rapidly available. Herein we report on a MF patient with PGF after an unrelated HSCT, who was rescued by a non-myeloablative, unmanipulated, haploidentical HSCT that resulted in persistent engraftment and bone-marrow fibrosis regression, but not in a long-term disease control. Based on this experience we briefly review the role of different conditioning regimens and hematopoietic stem cell sources in the setting of HSCT for MF patients with PGF. The role of haploidentical donors in MF patients lacking HLAmatched relatives is also discussed.
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Affiliation(s)
- Cristina Tecchio
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine
| | - Angelo Andreini
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine
| | - Claudio Costantini
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine
| | - Alberto Zamò
- Section of Pathology and Diagnostics, Department of Pathology
| | - Donata de Sabata
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine
| | - Fiorenza Aprili
- Clinical Biochemistry Laboratory, Department of Life and Reproduction Sciences
| | - Roberta Galavotti
- Section of Biology and Genetics, Department of Mother and Child, University of Verona, Italy
| | - Emanuele Guardalben
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine
| | - Fabio Benedetti
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine
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10
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Mochizuki K, Sano H, Akaihata M, Kobayashi S, Waragai T, Ohara Y, Takahashi N, Ito M, Ikeda K, Ohto H, Kikuta A. T cell replete-haploidentical second hematopoietic stem cell transplantation for primary graft failure in pediatric patients with hematologic malignancies. Pediatr Transplant 2017; 21. [PMID: 28845543 DOI: 10.1111/petr.13043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Abstract
GF is one of the fatal complications of allogeneic HSCT. To rescue patients with primary GF, a second HSCT should be conducted as soon as possible, but the optimal donor source and technique have yet to be established. In this study, we retrospectively analyzed six children with hematologic malignancies who received TCR-haploidentical second HSCT for primary GF. The median interval between the prior HSCT and the second HSCT was 37.5 days. All patients received fludarabine and ATG containing reduced-intensity re-conditioning before the second HSCT. All patients, except one who died early, achieved both neutrophil and Plt engraftment at a median time of 15 and 33 days, respectively. Chimerism analysis showed that all engrafted patients achieved complete donor chimerism within 3 weeks. Four patients developed acute GVHD, and three patients developed chronic GVHD. TRM occurred in two patients. Median follow-up of the four survivors was 6.8 years, and all remained in sustained remission until the last follow-up. These results suggested that a TCR-haploidentical second HSCT for pediatric patients is feasible, and this approach may provide a potent option for children with primary GF.
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Affiliation(s)
- Kazuhiro Mochizuki
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideki Sano
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mitsuko Akaihata
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Shogo Kobayashi
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tomoko Waragai
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yoshihiro Ohara
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Nobuhisa Takahashi
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masaki Ito
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
| | - Kazuhiko Ikeda
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Kikuta
- Department of Pediatric Oncology, Fukushima Medical University Hospital, Fukushima, Japan
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11
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A Successful Second Stem Cell Transplantation in Fanconi Anemia: A Case Report. Transplant Proc 2016; 47:2298-300. [PMID: 26361704 DOI: 10.1016/j.transproceed.2015.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/27/2015] [Accepted: 06/16/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim was to describe a case of successful second stem cell transplantation in Fanconi anemia (FA). METHODS A 7.5-year-old boy with FA was admitted for stem cell transplantation. The first matched sibling allogeneic bone marrow transplantation was done in January 2005. Until August 2008, the patient's blood count had been decreasing and the patient depended on transfusions, and anti-A Ab was detected (donor blood GP is A RH+). Therefore, the second matched sibling allogeneic peripheral blood stem cell transplantation was performed on November 27, 2008 with anti-thymocyte globulin alone as a second transplant conditioning. RESULT The child has been disease-free for 5 years. CONCLUSION Anti-thymocyte globulin alone as a second transplant conditioning may give first transplant failure FA patients the opportunity for a long-term disease-free survival.
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12
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Im HJ, Koh KN, Seo JJ. Recent advances in haploidentical hematopoietic stem cell transplantation using ex vivo T cell-depleted graft in children and adolescents. Blood Res 2016; 51:8-16. [PMID: 27104186 PMCID: PMC4828537 DOI: 10.5045/br.2016.51.1.8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 12/21/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for children and adolescents with various malignant and non-malignant diseases. While human leukocyte antigen (HLA)-identical sibling donor is the preferred choice, matched unrelated volunteer donor is another realistic option for successful HSCT. Unfortunately, it is not always possible to find a HLA-matched donor for patients requiring HSCT, leading to a considerable number of deaths of patients without undergoing transplantation. Alternatively, allogeneic HSCT from haploidentical family members could provide donors for virtually all patients who need HSCT. Although the early attempts at allogeneic HSCT from haploidentical family donor (HFD) were disappointing, recent advances in the effective ex vivo depletion of T cells or unmanipulated in vivo regulation of T cells, better supportive care, and optimal conditioning regimens have significantly improved the outcomes of haploidentical HSCT. The ex vivo techniques used to remove T cells have evolved from the selection of CD34+ hematopoietic stem cell progenitors to the depletion of CD3+ cells, and more recently to the depletion of αβ+ T cells. The recent emerging evidence for ex vivo T cell-depleted haploidentical HSCT has provided additional therapeutic options for pediatric patients with diseases curable by HSCT but has not found a suitable related or unrelated donor. This review discusses recent advances in haploidentical HSCT, focusing on transplant using ex vivo T cell-depleted grafts. In addition, our experiences with this novel approach for the treatment of pediatric patients with malignant and non-malignant diseases are described.
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Affiliation(s)
- Ho Joon Im
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Jong Jin Seo
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
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13
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Abstract
Alternative donor hematopoietic cell transplantation (HCT) using umbilical cord blood, haploidentical or mismatched unrelated donors is a viable option for patients without human leukocyte antigen (HLA)-identical sibling or matched unrelated donors. The same principles of supportive care as conventional graft sources apply to alternative donor HCT recipients. However, there are some unique supportive care issues related to post-transplant complications, engraftment, graft-versus-host disease, immune reconstitution, and infections that are unique to each of the three alternative graft sources, both in the early and late post-transplant periods. This review discusses the supportive care issues relevant to this population and their management.
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Affiliation(s)
- Shuang Fu
- Department of Hematology-Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
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14
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Takahashi S, Tsumanuma R, Aizawa K, Osakabe M, Maeda K, Omoto E. Early Improvement in Marrow Fibrosis Following Haploidentical Stem Cell Transplantation for a Patient with Myelodysplastic Syndrome with Bone Marrow Fibrosis. Intern Med 2016; 55:3351-3356. [PMID: 27853082 PMCID: PMC5173507 DOI: 10.2169/internalmedicine.55.6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The prognosis for myelodysplastic syndrome with bone marrow fibrosis (MDS-F) is worse than the prognosis of MDS without fibrosis. Hematopoietic stem cell transplantation (HSCT) is the only curative therapy; however, the indications and the procedures involved in HSCT remain unclear. We herein describe a 69-year-old Japanese man with MDS-F who received haploidentical HSCT and post-transplantation cyclophosphamide. Although the first HSCT resulted in secondary graft failure, the second HSCT using PTCy led to successful engraftment after early improvement in fibrosis. Since the incidence of graft failure is high in myelofibrosis patients, a secondary HSCT using PTCy may be successful if employed.
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Affiliation(s)
- Shuichiro Takahashi
- Department of Hematology, Hokkaido University Graduate School of Medicine, Japan
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15
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Tachibana T, Yamamoto E, Kawasaki R, Koharazawa H, Ishibashi D, Nakajima Y, Tanaka M, Matsumoto K, Ishigatsubo Y, Fujisawa S. Successful Engraftment and Durable Graft-versus-host Disease Control with Haploidentical Peripheral Blood and a Short-term Conditioning Regimen for Primary Graft Failure. Intern Med 2015; 54:2749-52. [PMID: 26521905 DOI: 10.2169/internalmedicine.54.4809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary graft failure occurred after cord blood transplantation for a patient with acute lymphoblastic leukemia. The second transplantation was performed using haploidentical peripheral blood. The conditioning regimen consisted of fludarabine (day -1; 30 mg/m(2)), cyclophosphamide (day -1; 2,000 mg/m(2)), and total body irradiation (day -1; 2 Gy). The immunosuppressants contained tacrolimus, prednisolone, and rabbit anti-thymocyte globulin (day -3 to -2; total dose: 3.75 mg/kg). The engraftment was confirmed on day 9. Both acute and chronic graft-versus-host disease were controllable. The present regimen appears to be suitable for immediate management, fast engraftment, and the durable control of complications.
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16
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Tang BL, Zhu XY, Zheng CC, Liu HL, Geng LQ, Wang XB, Ding KY, Yao W, Tong J, Song KD, Zhang L, Qiang P, Sun ZM. Successful early unmanipulated haploidentical transplantation with reduced-intensity conditioning for primary graft failure after cord blood transplantation in hematologic malignancy patients. Bone Marrow Transplant 2014; 50:248-52. [PMID: 25365067 DOI: 10.1038/bmt.2014.250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/01/2014] [Accepted: 09/17/2014] [Indexed: 11/09/2022]
Abstract
Primary graft failure (pGF) is a frequent complication following cord blood transplantation (CBT). For those patients who will not experience autologous recovery, salvage transplantation should be performed as early as possible. However, standardized treatment protocols for pGF, such as the optimal stem cell source, preparative regimen and the ideal time for salvage transplantation, have yet to be determined. Therefore, we analyzed 17 hematologic malignancy patients who received unmanipulated haploidentical peripheral blood (PB) and BM transplantation with reduced-intensity conditioning (RIC) as a salvage therapy for pGF after CBT. The median interval between the two transplantations was 38 days. The RIC regimen for salvage transplantation consisted of fludarabine, antithymocyte globulin, CY and low-dose TBI. The neutrophil and plt engraftments were achieved in 14 (82.4%) and 13 (76.4%) patients, respectively. The cumulative incidences of grades II-IV and grades III-IV aGVHD were 35.3% and 17.6%, respectively. The cumulative incidence of chronic GVHD was 29.4%. After a median follow-up of 43 months, 10 of 17 patients remained alive in CR. The cumulative incidence of TRM at 180 days was 29.4%. The probability of 3-year OS and leukemia-free survival was 57.5%. Our results show that unmanipulated haploidentical PB and BM transplantation under a RIC regimen is an effective treatment for pGF after CBT.
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Affiliation(s)
- B L Tang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - X Y Zhu
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - C C Zheng
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - H L Liu
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - L Q Geng
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - X B Wang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - K Y Ding
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - W Yao
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - J Tong
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - K D Song
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - L Zhang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - P Qiang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Z M Sun
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
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17
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Hematopoietic stem cell transplantation donor sources in the 21st century: choosing the ideal donor when a perfect match does not exist. Blood 2014; 124:334-43. [DOI: 10.1182/blood-2014-02-514760] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Most patients who require allogeneic stem cell transplantation do not have a matched sibling donor, and many patients do not have a matched unrelated donor. In an effort to increase the applicability of transplantation, alternative donors such as mismatched adult unrelated donors, haploidentical related donors, and umbilical cord blood stem cell products are frequently used when a well matched donor is unavailable. We do not yet have the benefit of randomized trials comparing alternative donor stem cell sources to inform the choice of donor; however, the existing data allow some inferences to be made on the basis of existing observational and phase 2 studies. All 3 alternative donor sources can provide effective lymphohematopoietic reconstitution, but time to engraftment, graft failure rate, graft-versus-host disease, transplant-related mortality, and relapse risk vary by donor source. These factors all contribute to survival outcomes and an understanding of them should help guide clinicians when choosing among alternative donor sources when a matched related or matched unrelated donor is not available.
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18
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Moscardó F, Romero S, Sanz J, Sanz MA, Montesinos P, Lorenzo I, Solves P, Carpio N, Sanz GF. T Cell–Depleted Related HLA-Mismatched Peripheral Blood Stem Cell Transplantation as Salvage Therapy for Graft Failure after Single Unit Unrelated Donor Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2014; 20:1060-3. [DOI: 10.1016/j.bbmt.2014.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 03/19/2014] [Indexed: 11/15/2022]
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19
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Liu HL, Sun ZM, Geng LQ, Wang XB, Ding KY, Tong J, Tang BL, Zhou CY, Yao W, Zheng CC, Song KD, Zhu XY, Wei W, Wang Y. Similar survival, but better quality of life after myeloablative transplantation using unrelated cord blood vs matched sibling donors in adults with hematologic malignancies. Bone Marrow Transplant 2014; 49:1063-9. [PMID: 24842525 DOI: 10.1038/bmt.2014.102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/03/2014] [Accepted: 03/25/2014] [Indexed: 11/09/2022]
Abstract
This study included data from 185 consecutively treated patients, 16 years of age or older, who underwent myeloablative transplantation using unrelated umbilical cord blood (UCB) (UCB transplantation (UCBT), n=70) or HLA-identical sibling donor peripheral blood stem cells alone or combined with bone marrow (BMT/PBSCT, n=115) from October 2001 to December 2012. All patients received myeloablative regimens, cyclosporin A plus mycophenolate mofetil as prophylaxis for GVHD, and similar supportive care. Although hematopoietic recovery was significantly delayed after UCBT, the rate of neutrophil engraftment was comparable. The median follow-up was 53 months (range, 15-136 months) for BMT/peripheral blood SCT (PBSCT) recipients and 35 months (range, 10-123 months) for UCBT recipients. There were no significant differences in the cumulative incidence of grades III to IV acute GVHD, relapse rate, or 3-year probabilities of disease-free survival between patients receiving UCBT and those receiving BMT/PBSCT. However, the cumulative incidence of chronic and extensive chronic GVHD was lower in UCBT recipients. The rates of long-term survivors returning to school or work and off immunosuppressive therapy were significantly higher after UCBT, which indicated that long-term survivors who underwent UCBT had a higher quality of life.
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Affiliation(s)
- H-L Liu
- 1] Institute of Clinical Pharmacology, Anhui Medical University, Anhui, China [2] Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - Z-M Sun
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - L-Q Geng
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - X-B Wang
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - K-Y Ding
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - J Tong
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - B-L Tang
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - C-Y Zhou
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - W Yao
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - C-C Zheng
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - K-D Song
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - X-Y Zhu
- Department of Hematology of Anhui Provincial Hospital, Anhui Medical University, Anhui, China
| | - W Wei
- Institute of Clinical Pharmacology, Anhui Medical University, Anhui, China
| | - Y Wang
- 1] Institute of Clinical Pharmacology, Anhui Medical University, Anhui, China [2] Laboratory of Molecular Biology and Department of Biochemistry; Anhui Medical University, Anhui, China [3] Key Laboratory of Anti-inflammatory and Immunological Pharmacology, Ministry of Education, Anhui Medical University, Anhui, China [4] Key Laboratory of Gene Resource Utilization for Severe Diseases of Anhui Province, Anhui Medical University, Anhui, China
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20
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Yang K, Si Y, Chen H, He X, Lou J, Bai X, Du J, Guo Z, Chen P. Comparative study of the efficacy of allogeneic hematopoietic stem cell transplantation from human leukocyte antigen-haploidentical related and unrelated donors in the treatment of leukemia. Acta Haematol 2014; 131:37-44. [PMID: 24029046 DOI: 10.1159/000353776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 06/17/2013] [Indexed: 11/19/2022]
Abstract
AIMS To compare the efficacy of hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA)-haploidentical related donors (RD) and unrelated donors (URD) in the treatment of leukemia. METHODS Ninety-three leukemia patients underwent allogeneic HSCT were divided into two groups: 51 cases of RD-HSCT and 42 cases of URD-HSCT. In the RD-HSCT group, a preconditioning regimen with fludarabine (Flu) + busulfan (Bu) + cytosine arabinoside (Ara-C) was used in 42 patients and total body irradiation (TBI) + Flu + Ara-C was used in the remaining 9. RESULTS In the URD-HSCT group, a modified preconditioning regimen with Bu + cyclophosphamide was used in 35 patients, while the other 7 patients underwent treatment with TBI + Flu. After transplantation, the occurrence rate of grade II-IV acute graft-versus-host disease (GVHD) was 46.0 and 51.2% in the two groups. Likewise, the rate of chronic GVHD was 46.0 and 63.4%, respectively. No significant differences in the occurrence of acute and chronic GVHD were detected between the two groups. The differences in early-stage infection rate after transplantation, recurrence rate, 3-year survival rate, and disease-free survival rate between the two groups were not significant. CONCLUSION HLA-haploidentical RD-HSCT with enhanced preconditioning and administration of immunosuppressants showed a clinical efficacy similar to that of URD-HSCT against leukemia, without the risk of increased infection and GVHD.
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Affiliation(s)
- Kai Yang
- Department of Hematology, Beijing Military General Hospital, Beijing, China
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21
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Park JA, Koh KN, Choi ES, Jang S, Kwon SW, Park CJ, Seo JJ, Im HJ. Successful rescue of early graft failure in pediatric patients using T-cell-depleted haploidentical hematopoietic SCT. Bone Marrow Transplant 2013; 49:270-5. [PMID: 24141651 DOI: 10.1038/bmt.2013.163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/21/2013] [Accepted: 08/30/2013] [Indexed: 11/09/2022]
Abstract
Graft failure (GF) is a significant complication after allogeneic hematopoietic stem cell transplantation (HCT) and is associated with a high mortality rate. We performed re-transplantation using haploidentical-related donors to rescue children with early GF. Between 2008 and 2013, 10 patients received re-transplantation from haploidentical family donors. The median age at HCT was 13.5 years and the median time between transplantations was 52.5 days. Conditioning regimen with fludarabine and CY was used in seven patients, and TBI was added in three patients. All 10 patients received T-cell-depleted grafts using CD3 or CD3/CD19 MoAb. The median numbers of CD34(+) and CD3(+) cells were 5.52 × 10(6)/kg and 1.08 × 10(6)/kg, respectively. For GVHD prophylaxis, mycophenolate mofetil (MMF) and tacrolimus or MMF and CYA were used. All 10 patients achieved a sustained neutrophil engraftment and maintained a complete donor chimerism at the time of analysis (median 23 months, range 6-62 months). Nine of 10 patients were alive, and one patient with moyamoya disease with AML died of encephalopathy 7 months post transplant. This study suggests that fludarabine- and CY-based conditioning with T-cell-depleted haploidentical HCT is a feasible option to rescue pediatric patients with primary GF.
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Affiliation(s)
- J A Park
- Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - K N Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - E S Choi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - S Jang
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - S W Kwon
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - C-J Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - J J Seo
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - H J Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
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22
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Salvage allogeneic hematopoietic SCT for primary graft failure in children. Bone Marrow Transplant 2013; 48:1173-8. [DOI: 10.1038/bmt.2013.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/14/2012] [Accepted: 02/18/2013] [Indexed: 11/08/2022]
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23
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Kanda J, Horwitz ME, Long GD, Gasparetto C, Sullivan KM, Chute JP, Morris A, Hennig T, Li Z, Chao NJ, Rizzieri DA. Outcomes of a 1-day nonmyeloablative salvage regimen for patients with primary graft failure after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2011; 47:700-5. [PMID: 21804612 PMCID: PMC3214602 DOI: 10.1038/bmt.2011.158] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Primary graft failure after allogeneic hematopoietic cell transplantation is a life-threatening complication. A shortened conditioning regimen may reduce the risk of infection and increase the chance of survival. Here, we report the outcome of 11 patients with hematologic diseases (median age, 44; range, 25–67 years, 7 males) who received a 1-day reduced-intensity preparative regimen given as a re-transplantation for primary graft failure. The salvage regimen consisted of fludarabine, cyclophosphamide, alemtuzumab, and total-body irradiation, all administered 1 day before re-transplantation. All patients received T-cell replete peripheral blood stem cells from the same or different haploidentical donor (n = 10) or from the same matched sibling donor (n = 1). Neutrophil counts promptly increased to >500/µL for 10 of the 11 patients at a median of 13 days. Of these, none developed Grade III/IV acute graft-versus-host disease. At present, 8 of the 11 patients are alive with a median follow-up of 11.2 months from re-transplantation and 5 of the 8 are in remission. In conclusion, this series suggests that our 1-day preparative regimen is feasible, leads to successful engraftment in a high proportion of patients, and is appropriate for patients requiring immediate re-transplantation after primary graft failure following reduced-intensity transplantation.
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Affiliation(s)
- J Kanda
- Division of Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA
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