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Aladag E, Goker H, Demiroglu H, Aksu S, Sayinalp N, Haznedaroglu IC, Ozcebe OI, Buyukasik Y. Long-term results of allogeneic peripheral blood hematopoietic stem cell transplantation for severe aplastic anemia. Transfus Apher Sci 2021; 60:103050. [PMID: 33446450 DOI: 10.1016/j.transci.2020.103050] [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: 06/15/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Aplastic anemia (AA) is a life-threatening disorder and may be associated with significant morbidity and mortality Currently, the first treatment option is allogeneic hematopoietic stem cell transplant (allo-HSCT) for patients younger than 40 years. Bone marrow is recommended as the stem cell source due to less graft versus host disease (GVHD) risk and better outcomes than peripheral blood (PB)-derived stem cell. The aim of this study is to share the data of AA patients who have underwent PB-derived allo-HSCT in our bone marrow transplantation center. METHODS Twenty-seven patients who underwent PB-derived allo-HSCT from human leukocyte antigen matched sibling donors were analyzed retrospectively. RESULTS The median follow-up time was 95.2 months (range, 4.8-235 months). The 10-year survival was 89 %. The median neutrophil and platelet engraftment time was 11 days (range, 9-16 days) and 13 days (range, 11-29 days), respectively. Primary platelet engraftment failure was observed in 1 patient (3.7 %). Acute and chronic GVHD observed in 2 (7.4 %) and 3 (11.1 %) patients, respectively. Neutropenic fever was observed in 13 (44.8 %) of patients until the engraftment after allo-HSCT. One patient died due to CMV infections, two died due to septic shock secondary to fungal infection. CONCLUSION Although there is no prospective data directly comparing BM with PB as stem cell source in AA, observational studies indicates better OS with BM. PB can be used in certain situations such as higher risk for graft failure and donor preference. This study demonstrated that PB-derived stem cell seems to be a reasonable alternative to BM.
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Affiliation(s)
- Elifcan Aladag
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey
| | - Hakan Goker
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey.
| | - Haluk Demiroglu
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey
| | - Nilgun Sayinalp
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey
| | | | - Osman Ilhami Ozcebe
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey
| | - Yahya Buyukasik
- Hacettepe University Faculty of Medicine, Department of Hematology, 06100, Ankara, Turkey
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Similar outcomes of alemtuzumab-based hematopoietic cell transplantation for SAA patients older or younger than 50 years. Blood Adv 2020; 3:3070-3079. [PMID: 31648330 DOI: 10.1182/bloodadvances.2019000480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
Survival after allogeneic hematopoietic cell transplantation (HSCT) for severe aplastic anemia (SAA) among older patients remains poor and associated with increased risk for graft-versus-host disease (GVHD). In this retrospective study of 65 consecutive patients with acquired SAA who were transplanted using fludarabine, low-dose cyclophosphamide, and alemtuzumab (FCC), outcomes of 27 patients aged at least 50 years were compared with those of 38 patients younger than 50 years. The median age of the older cohort was 61 years (range, 51-71 years); 21 (78%) patients were transplanted from unrelated donors (3 of 21 from HLA 9/10 mismatch donors) and 6 from matched sibling donors. One-year GVHD-free, relapse-free survival (GRFS) was comparable to that of patients younger than 50 years (84% vs 94%, respectively; P = .23). Both groups showed low rates of acute (5% vs 4%) and chronic (18% vs 14%) GVHD, with no cases of severe GVHD among matched donor transplants, and similar 1-year transplant-related mortality (14% vs 5.4%, older vs younger; P = .23). HSCT comorbidity index (HTC-CI) scores were similar between the groups, but overall survival with an HCT-CI of at least 3 was lower compared with a score less than 3 (76% vs 98%; P = .005). Median donor T-cell chimerism among older patients was 64% and 60% at 1 and 3 years, respectively, and was similar to that of younger patients. Increased B regulatory cells potentially contributed to low alloreactivity and mutual donor-recipient tolerance in older patients. Effect of comorbidities rather than age alone may be a more important determinant of suitability for FCC HSCT in older patients.
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Bernasconi P, Borsani O. Immune Escape after Hematopoietic Stem Cell Transplantation (HSCT): From Mechanisms to Novel Therapies. Cancers (Basel) 2019; 12:cancers12010069. [PMID: 31881776 PMCID: PMC7016529 DOI: 10.3390/cancers12010069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 12/21/2022] Open
Abstract
Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Recent advances in understanding its molecular basis have opened the way to new therapeutic strategies, including targeted therapies. However, despite an improvement in prognosis it has been documented in recent years (especially in younger patients) that allogenic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment in AML and the first therapeutic option for high-risk patients. After allo-HSCT, relapse is still a major complication, and is observed in about 50% of patients. Current evidence suggests that relapse is not due to clonal evolution, but instead to the ability of the AML cell population to escape immune control by a variety of mechanisms including the altered expression of HLA-molecules, production of anti-inflammatory cytokines, relevant metabolic changes and expression of immune checkpoint (ICP) inhibitors capable of “switching-off” the immune response against leukemic cells. Here, we review the main mechanisms of immune escape and identify potential strategies to overcome these mechanisms.
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Affiliation(s)
- Paolo Bernasconi
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
- Hematology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Oscar Borsani
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-340-656-3988
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Transplant outcome for patients with acquired aplastic anemia over the age of 40: has the outcome improved? Blood 2018; 131:1989-1992. [DOI: 10.1182/blood-2017-09-807859] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Xu L, Liu Z, Wu Y, Yang X, Cao Y, Li X, Yan B, Li S, Da W, Wu X. Clinical evaluation of haploidentical hematopoietic combined with human umbilical cord-derived mesenchymal stem cells in severe aplastic anemia. Eur J Med Res 2018; 23:12. [PMID: 29490698 PMCID: PMC5831581 DOI: 10.1186/s40001-018-0311-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 02/20/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND This study not only evaluated the clinical effects of treatment using haploidentical hematopoietic stem cells (haplo-HSCs) combined with human umbilical cord mesenchymal stem cells (UC-MSCs) in patients with severe aplastic anemia (SAA), but also investigated the factors related to graft versus host disease (GVHD). METHODS Cotransplantation of haplo-HSCs and UC-MSCs was performed in 24 SAA patients. The conditioning regimens consisted of rabbit anti-human T-lymphocyte immunoglobulin (ATG), cyclophosphamide, and fludarabine with or without busulfan. GVHD was prevented using cyclosporine A, ATG, anti-CD25 monoclonal antibody, and mycophenolate material. RESULTS The incidence of acute GVHD was 50%. The incidence of severe acute GVHD was not related to gender, age, donor-recipient relations, and patient/donor pair, while patient/donor pair (r = 0.541, P = 0.022) was significantly correlated with incidence of chronic GVHD. Upon follow-up for a median of 13 months, 5 of the 24 patients (20.8%) were dead. The survival rates at 3 and 6 months in all patients were 87.5% (21/24) and 83.3% (20/24), respectively. CONCLUSION Cotransplantation of haplo-HSCs combined with UC-MSCs was an effective and safe approach for the treatment of patients with SAA. The appropriate conditioning regimen and early treatment for infection also played a critical role in the success of HSCT.
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Affiliation(s)
- Lixin Xu
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Zhouyang Liu
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Yamei Wu
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Xueliang Yang
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Yongbin Cao
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Xiaohong Li
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Bei Yan
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Songwei Li
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Wanming Da
- Department of Hematology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaoxiong Wu
- Department of Hematology, The First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100048, China.
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Purev E, Tian X, Aue G, Pantin J, Vo P, Shalabi R, Reger RN, Cook L, Ramos C, Cho E, Worthy T, Khuu H, Stroncek D, Young NS, Childs RW. Allogeneic transplantation using CD34 + selected peripheral blood progenitor cells combined with non-mobilized donor T cells for refractory severe aplastic anaemia. Br J Haematol 2017; 176:950-960. [PMID: 28169418 DOI: 10.1111/bjh.14448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
Allogeneic haematopoietic stem cell transplantation is curative for severe aplastic anaemia (SAA) unresponsive to immunosuppressive therapy. To reduce chronic graft-versus-host disease (GVHD), which occurs more frequently after peripheral blood stem cell (PBSC) transplantation compared to bone-marrow transplantation (BMT), and to prevent graft rejection, we developed a novel partial T-cell depleted transplant that infuses high numbers of granulocyte colony-stimulating factor-mobilized CD34+ selected PBSCs combined with a BMT-equivalent dose of non-mobilized donor T-cells. Fifteen patients with refractory SAA received cyclophosphamide, anti-thymocyte globulin and fludarabine conditioning, and were transplanted with a median 8 × 106 CD34+ cells/kg and 2 × 107 non-mobilized CD3+ T-cells/kg from human leucocyte antigen-matched sibling donors. All achieved sustained engraftment with only two developing acute and two developing chronic GVHD. With a 3·5-year median follow-up, 86% of patients survived and were transfusion-independent. When compared to a retrospective cohort of 56 bone-marrow failure patients that received the identical transplant preparative regimen and GVHD prophylaxis with the exception that the allograft contained unmanipulated PBSCs, partial T-cell depleted transplant recipients had delayed donor T-cell chimerism and relative reduction of 75% in the incidence of acute grade II-IV GVHD (13% vs. 52%; P = 0·010) and of 82% in chronic GVHD (13% vs. 72%; P = 0·0004). In multivariate analysis, partial T-cell depleted transplants remained significantly associated with a reduced risk of GVHD. In conclusion, for patients with refractory SAA, this novel transplant strategy achieves excellent engraftment and survival when compared to unmanipulated PBSC transplants and dramatically reduces the incidence of both acute and chronic GVHD.
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Affiliation(s)
- Enkhtsetseg Purev
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xin Tian
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Georg Aue
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy Pantin
- Hematology and Oncology, Department of Medicine, Augusta University, Augusta, GA, USA
| | - Phuong Vo
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Reem Shalabi
- Clinical Center, Pharmacy Department, National Institutes of Health, Bethesda, MD, USA
| | - Robert N Reger
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Cook
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Catalina Ramos
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elena Cho
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tat'yana Worthy
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hanh Khuu
- Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD, USA
| | - David Stroncek
- Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Neal S Young
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard W Childs
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Xu L, Liu Z, Wu Y, Yang X, Cao Y, Li X, Yan B, Li S, Da W, Wu X. RETRACTED ARTICLE: Cotransplantation of human umbilical cord mesenchymal and haplo-hematopoietic stem cells in patients with severe aplastic anemia. Cytotechnology 2015; 68:177. [PMID: 25407730 DOI: 10.1007/s10616-014-9793-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/27/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lixin Xu
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Zhouyang Liu
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Yamei Wu
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Xueliang Yang
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Yongbin Cao
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Xiaohong Li
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Bei Yan
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Songwei Li
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China
| | - Wanming Da
- Department of Hematology, Chinese PLA General Hospital, Beijing, 100048, China
| | - Xiaoxiong Wu
- Department of Hematology, the First Affiliated Hospital of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.
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Bacigalupo A. Bone Marrow Transplantation for Acquired Severe Aplastic Anemia. Hematol Oncol Clin North Am 2014; 28:1145-55. [DOI: 10.1016/j.hoc.2014.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Marotta S, Pagliuca S, Risitano AM. Hematopoietic stem cell transplantation for aplastic anemia and paroxysmal nocturnal hemoglobinuria: current evidence and recommendations. Expert Rev Hematol 2014; 7:775-89. [DOI: 10.1586/17474086.2014.967678] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Reduced intensity conditioning and co-transplantation of unrelated peripheral stem cells combined with umbilical cord mesenchymal stem/stroma cells for young patients with refractory severe aplastic anemia. Int J Hematol 2013; 98:658-63. [DOI: 10.1007/s12185-013-1425-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/24/2013] [Accepted: 08/27/2013] [Indexed: 01/14/2023]
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Socié G. Allogeneic BM transplantation for the treatment of aplastic anemia: current results and expanding donor possibilities. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2013; 2013:82-86. [PMID: 24319167 DOI: 10.1182/asheducation-2013.1.82] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Allogeneic BM transplantation from an HLA-identical sibling donor leads to long-term survival in the majority of patients (>80%). Therefore, survival is no longer the sole concern and attention has to be paid to decreasing the incidence and severity of long-term complications. For patients without a sibling donor, transplantation from a well-matched unrelated donor can be considered after failure of a previous course of immunosuppressive therapy. After transplantation from an HLA-identical sibling donor or from an unrelated one, the use of peripheral blood stem cells must be strongly discouraged because they have been systematically associated with an increased incidence of chronic GVHD compared with the use of BM as a stem cell source, leading to an unacceptably higher risk of treatment-related mortality in this setting. For as yet unknown reasons, the age limit after which transplantation results are less satisfactory remains 40 years of age.
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Affiliation(s)
- Gérard Socié
- 1Hematology/Transplantation and French Reference Center for Rare Disease, Aplastic Anemia, Hospital Saint Louis, Paris, France
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