1
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Duléry R, Brissot E, Mohty M. Combining post-transplant cyclophosphamide with antithymocyte globulin for graft-versus-host disease prophylaxis in hematological malignancies. Blood Rev 2023; 62:101080. [PMID: 37085459 DOI: 10.1016/j.blre.2023.101080] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
In search of an ideal partner or alternative to conventional immunosuppressive agents, rabbit anti-thymocyte globulin (ATG) and, more recently, post-transplant cyclophosphamide (PT-Cy) have both emerged as valid and efficient options for preventing graft-versus-host disease (GvHD). To further reduce the risk of GvHD, strategies combining ATG and PT-Cy have recently been investigated. In a haploidentical setting, retrospective studies suggest that combining PT-Cy and ATG may result in a lower incidence of chronic GvHD without increasing the risks of infection or relapse, when compared to PT-Cy without ATG. In haploidentical or unrelated donor settings, adding reduced doses of PT-Cy to ATG may reduce the risk of acute and chronic GvHD and improve survival, particularly GvHD-free, relapse-free survival (GRFS), when compared to ATG without PT-Cy. Overall, the combination of PT-Cy and ATG is a safe and promising approach for patients with hematological malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Rémy Duléry
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Eolia Brissot
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Mohamad Mohty
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.
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2
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Piekarska A, Czyz A, Peczynski C, Ambron P, Polge E, Moiseev I, Schoemans H, Penack O, Peric Z, Basak GW. ATG or no ATG? - survey of clinical practice in EBMT centers on behalf of the Transplant Complications Working Party of EBMT. Bone Marrow Transplant 2023; 58:337-339. [PMID: 36471107 DOI: 10.1038/s41409-022-01889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Agnieszka Piekarska
- Department of Hematology and Transplantology, Medical University of Gdansk and University Clinical Center, Gdansk, Poland.
| | - Anna Czyz
- Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Christophe Peczynski
- EBMT- Transplant Complications Working Party; Saint Antoine Hospital, Sorbonne University, Paris, France
| | - Pascale Ambron
- EBMT- Transplant Complications Working Party; Saint Antoine Hospital, Sorbonne University, Paris, France
| | - Emmanuelle Polge
- EBMT- Transplant Complications Working Party; Saint Antoine Hospital, Sorbonne University, Paris, France
| | - Ivan Moiseev
- RM Gorbacheva Research Institute, Pavlov University, St Petersburg, Russian Federation
| | - Helene Schoemans
- Department of Hematology, University Hospitals Leuven and Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
| | - Olaf Penack
- Charité - Department of Hematology, Oncology and Tumorimmunology, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Zinaida Peric
- School of Medicine, University Hospital Centre Zagreb and University of Zagreb, Zagreb, Croatia
| | - Grzegorz W Basak
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
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Nakamura Y, Mori T, Kako S, Yamazaki H, Kanda Y, Uchida N, Tanaka M, Nawa Y, Fukuda T, Ichinohe T, Atsuta Y, Onishi Y. Outcome of peripheral blood stem cell transplantation from HLA-identical sibling donors for adult patients with aplastic anemia. Int J Hematol 2023; 117:356-365. [PMID: 36378405 DOI: 10.1007/s12185-022-03487-6] [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: 08/11/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
Although bone marrow transplantation is the recommended form of allogeneic hematopoietic stem cell transplantation for aplastic anemia, some patients undergo peripheral blood stem cell transplantation (PBSCT). Therefore, there is critical demand to identify factors affecting transplantation outcomes. Using the Japanese registry database, we retrospectively analyzed outcomes of 94 adult patients with aplastic anemia who underwent PBSCT from HLA-identical sibling donors. The cumulative incidence of neutrophil engraftment was 94% (95% confidence interval [CI] 86-97%), and was significantly higher in patients who received anti-thymocyte globulin (ATG) in conditioning. The cumulative incidence rate was 26% (95% CI 17-35%) in grades II-IV acute graft-versus-host disease (GVHD) and 20% (95% CI 13-29%) in extensive chronic GVHD, and tended to be lower in patients with chronic GVHD who received ATG-based conditioning. The 5-year overall survival (OS) rate was 70% (95% CI 59-78%). In multivariate analysis, patient age < 40 years, shorter period from diagnosis to transplantation, better performance status, and ATG-based conditioning were significantly correlated with favorable OS. In conclusion, PBSCT from HLA-identical sibling donors for aplastic anemia would result in acceptable outcomes. Several risk factors identified in our study should be considered when selecting a stem cell source.
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Affiliation(s)
- Yukinori Nakamura
- Third Department of Internal Medicine, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Takehiko Mori
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hirohito Yamazaki
- Division of Transfusion Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuichiro Nawa
- Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yasushi Onishi
- Department of Hematology, Tohoku University Hospital, Sendai, Japan
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4
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Li Y, Wang M, Fang X, Jiang Y, Sui X, Li Y, Liu X, Wang X, Lu D, Sun X, Xu H, Wang X. The impact of different doses of antithymocyte globulin conditioning on immune reconstitution upon hematopoietic stem cell transplantation. Transpl Immunol 2021; 69:101486. [PMID: 34678462 DOI: 10.1016/j.trim.2021.101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anti-thymocyte globulin (ATG) is used prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT) for graft-versus-host disease (GVHD) prophylaxis. Two different ATG doses (7.5 or 10 mg/kg) were evaluated in comparison with a group without ATG therapy. METHODS We retrospectively analyzed 132 patients who were transplanted with HSCT without ATG (non-ATG), or who received 7.5 mg/kg ATG (ATG-7.5) or 10 mg/kg ATG (ATG-10) prior to transplantation. The immune cells (CD3+CD4+ T cells, CD3+CD8+ T cells, CD19+ B cells and CD16+CD56+ NK cells) were examined in peripheral blood every three months post-HSCT for 12 months. RESULTS Compared with non-ATG group, combined ATG-7.5/ATG-10 groups had significantly lower CD3+CD4+ T cells and higher CD3+CD8+ T cells at 3, 6, 9, 12 months post-HSCT; thus, displaying a lower CD4/CD8 ratio in the ATG groups compared to non-ATG group. The ratio of CD19+ B cells was statistically lower (at 3rd month, p = .014; at 6th month, p = .025) in combined ATG-7.5/ATG-10 groups at 3 and 6 months post-HSCT, but not at 9 and 12 months after HSCT. The ratios of CD3+CD4+ T cells, CD3+CD8+ T cells, CD19+ B cells and CD16+CD56+ NK cells were similar between the ATG-7.5 and ATG-10 groups at all examined time points. The overall survival (OS), progression-free survival (PFS), relapse and acute GVHD (aGVHD) were comparable among recipients without ATG therapy and with ATG-7.5 or/and ATG-10 therapies. Multivariate analysis revealed that immune cells ratios were not independent factors affecting prognosis. CONCLUSION The ATG therapy at higher and lower doses led to a delayed reconstitution of T cells and the inversion of CD4/CD8 ratio for at least one year after HSCT.
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Affiliation(s)
- Yahan Li
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mingyang Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China..
| | - Yujie Jiang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaohui Sui
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ying Li
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xin Liu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xianghua Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Dongyue Lu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xue Sun
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.; Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.; School of Medicine, Shandong University, Jinan, Shandong, China
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5
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Shiratori S, Kurata M, Sugita J, Ota S, Kasahara S, Ishikawa J, Imada K, Onishi Y, Ishiyama K, Ashida T, Kanda Y, Ichinohe T, Fukuda T, Atsuta Y, Teshima T. Graft-Versus-Host Disease Prophylaxis Using Low-Dose Antithymocyte Globulin in Peripheral Blood Stem Cell Transplantation-A Matched-Pair Analysis. Transplant Cell Ther 2021; 27:995.e1-995.e6. [PMID: 34500126 DOI: 10.1016/j.jtct.2021.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Antithymocyte globulin (ATG) decreases chronic graft-versus-host disease (cGVHD) in peripheral blood stem cell transplantation (PBSCT); however, the optimal ATG dose has not been elucidated. We conducted a matched-pair analysis to evaluate whether low-dose ATG could inhibit cGVHD in HLA-matched PBSCT after myeloablative conditioning. A total of 70 patients who were enrolled in the JSCT-ATG15 study, a multicenter phase II clinical trial of 2 mg/kg of ATG (thymoglobulin) given on days -2 and -1, were compared with 210 patients not receiving ATG, who were matched for age, sex, disease, and calcineurin inhibitor selected from the database in Japan. The primary endpoint, cumulative incidence of extensive cGVHD at 2 years was significantly less in the ATG group than that in the non-ATG group (8.7% [95% CI, 3.5%-16.8%] versus 26.2% [95% CI, 20.3%-32.5%], P = .002). ATG significantly reduced the incidence of overall cGVHD and inhibited multiple organ involvement. The ATG group had favorable outcome compared to the non-ATG group in GVHD-free, and relapse-free survival at 2 years. In conclusion, low-dose ATG effectively inhibits chronic GVHD in PBSCT.
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Affiliation(s)
- Souichi Shiratori
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Mio Kurata
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Junichi Sugita
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Senji Kasahara
- Department of Hematology, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Kazunori Imada
- Department of Hematology, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Yasushi Onishi
- Department of Hematology, Tohoku University Hospital, Sendai, Japan
| | - Ken Ishiyama
- Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takashi Ashida
- Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University Hospital, Osakasayama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Shimotsuke, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Higashihiroshima, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan; Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan.
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6
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Modi D, Kondrat K, Kim S, Deol A, Ayash L, Ratanatharathorn V, Uberti JP. Post-transplant Cyclophosphamide Versus Thymoglobulin in HLA-Mismatched Unrelated Donor Transplant for Acute Myelogenous Leukemia and Myelodysplastic Syndrome. Transplant Cell Ther 2021; 27:760-767. [PMID: 34174469 DOI: 10.1016/j.jtct.2021.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/11/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Limited information is available on the efficacy of post-transplantation cyclophosphamide (PTcy) or thymoglobulin for graft-versus-host disease (GVHD) prophylaxis in mismatched unrelated donor (MMUD) transplants. We retrospectively compared outcomes of 76 adult patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) who underwent 7/8 HLA-MMUD transplantation and received either PTcy (50 mg/kg on day 3 and 4) or thymoglobulin (total dose 4.5 mg/kg) for GVHD prophylaxis. In addition, tacrolimus and mycophenolate were used in both groups. Propensity score-based multivariable analyses (PSCA) were performed to adjust confounding effects of patient characteristics between both groups. Between January 2006 and June 2019, 25 patients received PTcy, and 51 received thymoglobulin. Median age of the population was 57 years, 78% of patients had AML, most common graft source was peripheral blood (96%), and 46% received myeloablative conditioning regimens. Median time to neutrophil (15 versus 11 days, P < .001) and platelet engraftment (21 versus 15 days, P = .002) was prolonged in the PTcy group. The cumulative incidence of grade III-IV acute GVHD at day 100 was similar (12% versus 19.6%, P = .38), whereas chronic GVHD at 1 year was lower with PTcy compared to thymoglobulin (16% versus 49%, P = .006). Using PSCA, no difference in survival, relapse, relapse-free survival, and GVHD-free relapse-free survival was seen between groups. However, thymoglobulin was associated with higher incidence of acute (hazard ratio [HR] = 2.63, P = .01) and chronic GVHD (HR = 4.43, P = .03), and non-relapse mortality (HR 3.38, P = .04) compared to PTcy. Our study demonstrated that PTcy resulted in significantly lower rates of acute and chronic GVHD and non-relapse mortality compared to thymoglobulin in 7/8 HLA-MMUD transplants for AML and MDS.
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Affiliation(s)
- Dipenkumar Modi
- Department of Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
| | - Kyle Kondrat
- Department of Internal Medicine and Pediatrics, DMC and Children's Hospital of Michigan, Detroit, Michigan
| | - Seongho Kim
- Biostatistics Core, Barbara Ann Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, Michigan
| | - Abhinav Deol
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Lois Ayash
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Voravit Ratanatharathorn
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Joseph P Uberti
- Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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7
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Butera S, Cerrano M, Brunello L, Dellacasa CM, Faraci DG, Vassallo S, Mordini N, Sorasio R, Zallio F, Busca A, Bruno B, Giaccone L. Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience. Ann Hematol 2021; 100:1837-1847. [PMID: 33948721 PMCID: PMC8195753 DOI: 10.1007/s00277-021-04521-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
Despite the widespread use of rabbit anti-thymocyte globulin (ATG) to prevent acute and chronic graft-versus-host disease (aGVHD, cGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT), convincing evidence about an optimal dose is lacking. We retrospectively evaluated the clinical impact of two different ATG doses (5 vs 6-7.5 mg/kg) in 395 adult patients undergoing HSCT from matched unrelated donors (MUD) at 3 Italian centers. Cumulative incidence of aGVHD and moderate-severe cGVHD did not differ in the 2 groups. We observed a trend toward prolonged overall survival (OS) and disease-free survival (DFS) with lower ATG dose (5-year OS and DFS 56.6% vs. 46.3%, p=0.052, and 46.8% vs. 38.6%, p=0.051, respectively) and no differences in relapse incidence and non-relapse mortality. However, a significantly increased infection-related mortality (IRM) was observed in patients who received a higher ATG dose (16.7% vs. 8.8% in the lower ATG group, p=0.019). Besides, graft and relapse-free survival (GRFS) was superior in the lower ATG group (5-year GRFS 43.1% vs. 32.4%, p=0.014). The negative impact of higher ATG dose on IRM and GRFS was confirmed by multivariate analysis. Our results suggest that ATG doses higher than 5 mg/kg are not required for MUD allo-HCT and seem associated with worse outcomes.
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Affiliation(s)
- Sara Butera
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Marco Cerrano
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Brunello
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Hematology, A.O. Santissimi Antonio e Biagio e C Arrigo, Alessandria, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| | - Danilo Giuseppe Faraci
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Sara Vassallo
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Nicola Mordini
- Division of Hematology, A.O. Santi Croce e Carle, Cuneo, Italy
| | - Roberto Sorasio
- Division of Hematology, A.O. Santi Croce e Carle, Cuneo, Italy
| | - Francesco Zallio
- Department of Hematology, A.O. Santissimi Antonio e Biagio e C Arrigo, Alessandria, Italy
| | - Alessandro Busca
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| | - Benedetto Bruno
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy
| | - Luisa Giaccone
- Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy.
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Torino, Italy.
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8
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Modi D, Singh V, Kim S, Ayash L, Deol A, Ratanatharathorn V, Uberti JP. Comparison of myeloablative and reduced intensity conditioning unrelated donor allogeneic peripheral blood stem cell transplant outcomes for AML using thymoglobulin for GVHD prophylaxis. Ann Hematol 2021; 100:969-978. [PMID: 33594448 DOI: 10.1007/s00277-021-04445-8] [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: 08/17/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
A head-to-head comparison of outcomes of unrelated donor allogeneic peripheral blood stem cell transplantation for AML between reduced intensity conditioning (RIC) and myeloablative conditioning (MAC) regimens using thymoglobulin for GVHD prophylaxis is limited. We evaluated outcomes of 122 AML patients who received either busulfan (Bu)/fludarabine (Flu)/low-dose total body irradiation (TBI) as RIC (n = 64, 52%) or Bu/Flu as MAC (n = 58, 48%), and thymoglobulin 4.5 mg/kg total dose between day - 3 to - 1 for GVHD prophylaxis. Grades III-IV acute GVHD (aGVHD) was lower with Bu/Flu/TBI compared with Bu/Flu (6.2% vs 26.1%, p = 0.009). At 1 year, Bu/Flu/TBI was associated with similar chronic GVHD (41.2% vs 44.8%, p = 0.75), OS (61.9% vs 56.9%, p = 0.69), relapse rate (29.9% vs 20.7%, p = 0.24), relapse-free survival (52.8% vs 50%, p = 0.80), non-relapse mortality (17.4% vs 29.3%, p = 0.41), and GVHD-free relapse-free survival (24.2% vs 27.5%, p = 0.80) compared with Bu/Flu. Multivariable analysis did not reveal any difference in outcomes between both regimens. In summary, thymoglobulin at 4.5 mg/kg did not have any adverse impact on survival when used with RIC regimen. Both Bu/Flu/TBI and Bu/Flu conditioning regimens yielded similar survival.
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Affiliation(s)
- Dipenkumar Modi
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
| | - Vijendra Singh
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA
| | - Seongho Kim
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA
| | - Lois Ayash
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA
| | - Abhinav Deol
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA
| | - Voravit Ratanatharathorn
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA
| | - Joseph P Uberti
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA
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9
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Song ZY, Ren HY, Dong YJ, Li Y, Yin Y, Sun YH, Wang Q, Xu WL, Liu W, Ou JP, Liang ZY. Impact of Low-Dose rATG Prior to Matched Sibling Donor Hematopoietic Stem Cell Transplantation for Hematologic Malignancies: Reduced Risk of Chronic Graft-versus-Host Disease and Improved Survival Outcomes. Cancer Manag Res 2020; 12:12287-12300. [PMID: 33311999 PMCID: PMC7725103 DOI: 10.2147/cmar.s283855] [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: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the efficacy of low-dose rabbit antithymocyte globulin (rATG) in matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) for patients with acute leukemia or myelodysplastic syndrome. Patients and Methods We performed a retrospective study of 79 patients with hematologic malignancies who received MSD-HSCT. All patients received standard graft-versus-host disease (GVHD) prophylaxis comprising cyclosporine, mycophenolate mofetil and short-term methotrexate. Among them, 38 were administered 5 mg/kg rATG as part of GVHD prophylaxis. Clinical outcomes including overall survival (OS), GVHD and relapse were analyzed. Results No graft failure occurred in the antithymocyte globulin (ATG) or non-ATG group. The cumulative incidences of grade 2-4 and 3-4 acute GVHD at day +100 were 13.3% versus 19.5% (p=0.507) and 5.7% versus 15.2% (p=0.196), respectively. The 2-year cumulative incidences of chronic GVHD (cGVHD) were 35.4% and 60.4% (p=0.039), and those of extensive cGVHD were 12.9% and 40.0% (p=0.015), respectively. In a multivariate analysis, the use of low-dose rATG was an independent protective factor for extensive cGVHD (hazard ratio [HR] 0.256; 95% confidence interval [CI], 0.080 to 0.822, p=0.022). The 2-year OS was 88.1% and 68.4% (p=0.038), respectively, and the use of low-dose rATG was the only protective factor in the multivariate analysis (HR 0.216; 95% CI, 0.059 to 0.792, p=0.021). There was no significant difference between the two groups in terms of the 2-year cumulative incidence of relapse, leukemia-free survival or GVHD-free and relapse-free survival. Conclusion Low-dose rATG used in MSD-HSCT as part of the conditioning regimen results in a reduced incidence of cGVHD and improves survival outcomes.
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Affiliation(s)
- Zheng-Yang Song
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Han-Yun Ren
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yu-Jun Dong
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yuan Li
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yue Yin
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yu-Hua Sun
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Qian Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Wei-Lin Xu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Wei Liu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Jin-Ping Ou
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Ze-Yin Liang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
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10
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Jullien M, Guillaume T, Peterlin P, Garnier A, Le Bourgeois A, Debord C, Mahe B, Dubruille V, Wuilleme S, Blin N, Touzeau C, Gastinne T, Tessoulin B, Le Bris Y, Eveillard M, Duquesne A, Moreau P, Le Gouill S, Bene MC, Chevallier P. Antithymocyte globulin administration in patients with profound lymphopenia receiving a PBSC purine analog/busulfan-based conditioning regimen allograft. Sci Rep 2020; 10:15399. [PMID: 32958816 PMCID: PMC7505958 DOI: 10.1038/s41598-020-72415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022] Open
Abstract
Graft-versus host disease (GVHD) remains one of the main causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (ASCT). Prophylactic T cell depletion via antithymocyte globulin (ATG) during ASCT conditioning is one of the standards of care for GVHD prophylaxis, although the optimal dosing strategy is still unclear. Recent studies have reported that absolute lymphocyte count at the time of ATG administration could predict survivals in ASCT from unrelated donors. Here this issue was examined in 116 patients receiving peripheral blood stem cells (PBSC) ASCT with purine analog/busulfan-based conditioning regimens between 2009 and 2019 in our department. The impact of lymphopenia at the time of ATG administration was evaluated in terms of overall survival, disease-free survival and GVHD-free/relapse-free survival. After a median follow-up of 4 years, no adverse effect of a profound lymphopenia was observed on patients' outcome. Notably, a reduced dose of ATG in patients with profound lymphopenia did not translate into better survivals. This study indicates that ATG can be administered whatever the recipient's lymphocyte counts in patients receiving a PBSC purine analog/busulfan-based conditioning regimen ASCT.
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Affiliation(s)
- Maxime Jullien
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France.
| | - Thierry Guillaume
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Pierre Peterlin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Alice Garnier
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Amandine Le Bourgeois
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Camille Debord
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Beatrice Mahe
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Viviane Dubruille
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Soraya Wuilleme
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Nicolas Blin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Cyrille Touzeau
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Thomas Gastinne
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Benoit Tessoulin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Yannick Le Bris
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | | | - Philippe Moreau
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Steven Le Gouill
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Marie C Bene
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
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11
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Heelan F, Mallick R, Bryant A, Radhwi O, Atkins H, Huebsch L, Bredeson C, Allan D, Kekre N. Does Lymphocyte Count Impact Dosing of Anti-Thymocyte Globulin in Unrelated Donor Stem Cell Transplantation? Biol Blood Marrow Transplant 2020; 26:1298-1302. [DOI: 10.1016/j.bbmt.2020.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 12/17/2022]
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12
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Bonifazi F, Rubio MT, Bacigalupo A, Boelens JJ, Finke J, Greinix H, Mohty M, Nagler A, Passweg J, Rambaldi A, Socie G, Solano C, Walker I, Barosi G, Kröger N. Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel. Bone Marrow Transplant 2020; 55:1093-1102. [PMID: 31969678 PMCID: PMC7269907 DOI: 10.1038/s41409-020-0792-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/04/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
This collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT.
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Affiliation(s)
- Francesca Bonifazi
- Institute of Hematology "Seragnoli", University Hospital "S. Orsola Malpighi", Bologna, Italy.
| | - Marie-Thérèse Rubio
- Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole del'Université del Lorraine, Vendoeuvre les Nancy, France
| | - Andrea Bacigalupo
- "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jürgen Finke
- Freiburg University Medical Faculty and Medical Center, Department for Medicine, Hematology, Oncology and Stem Cell Transplantation, Freiburg, Germany
| | - Hildegard Greinix
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036, Graz, Austria
| | - Mohamad Mohty
- Service d'Hématologie clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, INSERM UMRs 938, Paris, France
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Jakob Passweg
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Alessandro Rambaldi
- Department of Oncology, University of Milano and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Gérard Socie
- Service d' Hématologie-greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Inserm UMR 976, Paris, France
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario-INCLIVA; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Irwin Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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13
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Mountjoy L, Jain T, Kunze KL, Khera N, Sproat LZ, Jennifer W, McCallen M, Leis JF, Noel P, Slack JL, Palmer J. Clinical outcomes with low dose anti-thymocyte globulin in patients undergoing matched unrelated donor allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2020; 61:1996-2002. [PMID: 32281491 DOI: 10.1080/10428194.2020.1747067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Anti-thymocyte globulin (ATG) has been associated with decreased rates graft versus host disease (GVHD) but with a potential risk of increasing risk of infection and relapse. We retrospectively studied the impact of single dose low dose (2.5 mg/kg) ATG in patients undergoing allogenic hematopoietic cell transplantation (HCT) from 8/8 matched unrelated donors (MUD). Of the total 209 patients identified, 129 received ATG. At baseline, the ATG group had more intermediate and high disease risk index (DRI) (64.6% vs. 54.3%) (28.3% vs. 23.7%) p < .001, respectively, and who received reduced intensity or non-myeloablative conditioning (RIC) (69.0% vs. 47.5%, p .003). There was no significant difference in the overall survival (OS) HR = 1.3, 95% CI [0.99, 1.0], p = .350 or relapse-free survival (RFS) HR = 1.2, 95% CI [0.74, 1.8], p = .526 between the two groups. Patients receiving ATG had a lower incidence of chronic GVHD (cGVHD) (10.1% vs. 25%, p = .007) and less moderate to severe cGVHD (8.5% vs. 25%, p = .002). ATG was associated with a reduced incidence of moderate to severe cGVHD OR = 0.28, 95% CI [0.12, 0.61], p < .01. There was no difference in the incidence of Epstein-Barr Virus (EBV) or cytomegalovirus (CMV) reactivation, CMV disease, invasive fungal infection, or grade III-IV acute GVHD (aGVHD). Our study shows that low dose ATG results in similar OS and RFS with lower rates of cGVHD. Additional prospective studies are needed to confirm these findings.
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Affiliation(s)
- Luke Mountjoy
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Tania Jain
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA.,Hematologic Malignancies and Bone Marrow Transplantation Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie L Kunze
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Woodburn Jennifer
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Margaret McCallen
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jose F Leis
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Pierre Noel
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - James L Slack
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Jeanne Palmer
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
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14
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Is there an optimal conditioning for older patients with AML receiving allogeneic hematopoietic cell transplantation? Blood 2020; 135:449-452. [PMID: 31826244 PMCID: PMC8212356 DOI: 10.1182/blood.2019003662] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/28/2019] [Indexed: 02/03/2023] Open
Abstract
The optimal conditioning regimen for older patients with acute myeloid leukemia (AML) remains unclear. In this study, we compared outcomes of AML patients >60 years of age undergoing allogenic hematopoietic stem cell transplantation at our institution. All 404 consecutively treated patients received 1 of the following conditioning regimens: (1) fludarabine+melphalan 100 mg/m2 (FM100), (2) fludarabine+melphalan 140 mg/m2 (FM140), (3) fludarabine+IV busulfan AUC ≥ 5000/d × 4 d (Bu≥20000), and (4) fludarabine+IV busulfan AUC 4000/d × 4 d (Bu16000). A propensity score analysis (PSA) was used to compare outcomes between these 4 groups. Among the 4 conditioning regimens, the FM100 group had a significantly better long-term survival with 5-year progression-free survival of 49% vs 30%, 34%, and 23%, respectively. The benefit of the FM100 regimen resulted primarily from the lower nonrelapse mortality associated with this regimen, an effect more pronounced in patients with lower performance status. The PSA confirmed that FM100 was associated with better posttransplantation survival, whereas no significant differences were seen between the other regimen groups. In summary, older patients with AML benefited from a reduced-intensity conditioning regimen with lower melphalan doses (FM100), which was associated with better survival, even though it was primarily used in patients who could not receive a more intense conditioning regimen.
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15
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Shichijo T, Fuji S, Nagler A, Bazarbachi A, Mohty M, Savani BN. Personalizing rabbit anti-thymocyte globulin therapy for prevention of graft-versus-host disease after allogeneic hematopoietic cell transplantation: is there an optimal dose? Bone Marrow Transplant 2019; 55:505-522. [PMID: 31435032 DOI: 10.1038/s41409-019-0643-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/04/2019] [Accepted: 07/05/2019] [Indexed: 11/09/2022]
Abstract
The efficacy of anti-thymocyte globulin (ATG) as prophylaxis for graft-versus-host disease (GVHD) has been investigated by many clinical studies over the past decade, including some randomized controlled trials. Intriguingly, although ATG is commonly used as prophylaxis for GVHD, there is still controversy about the optimal dose of ATG for prophylaxis of GVHD after allogeneic hematopoietic cell transplantation (allo-HCT). Indeed, the dose and formulation of ATG, as well as the degree of clinical benefit, has varied among studies, which makes it difficult to fully determine the clinical benefit of ATG. The aim of this review is to summarize the information regarding the optimal ATG dose of each formulation according to stem cell source, and to discuss how best to determine the personalized optimal dose of ATG in each allo-HCT recipient.
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Affiliation(s)
- Takafumi Shichijo
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University Faculty of life Sciences, Kumamoto, Japan.,Laboratory of Virus Control, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan.
| | - Arnon Nagler
- Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Abdulhamid Bazarbachi
- Service d'Hématologie Clinique et thérapie cellulaire and EBMT Paris Study Office, Saint Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et thérapie cellulaire and EBMT Paris Study Office, Saint Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France
| | - Bipin N Savani
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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16
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Lin R, Wang Y, Huang F, Fan Z, Zhang S, Yang T, Xu Y, Xu N, Xuan L, Ye J, Sun J, Huang X, Liu Q. Two dose levels of rabbit antithymocyte globulin as graft-versus-host disease prophylaxis in haploidentical stem cell transplantation: a multicenter randomized study. BMC Med 2019; 17:156. [PMID: 31401973 PMCID: PMC6689871 DOI: 10.1186/s12916-019-1393-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal dose of rabbit antithymocyte globulin (ATG, ImtixSangstat) minimizing infections without increasing graft-versus-host disease (GVHD) is unknown in T cell-replete, G-CSF-primed haploidentical hematopoietic stem cell transplantation (haplo-HSCT). METHODS Four hundred and eight patients were enrolled in this multicenter study to evaluate the effect of 7.5 mg/kg and 10.0 mg/kg rabbit ATG on viral infections and GVHD prophylaxis after haplo-HSCT. The primary endpoint was EBV DNAemia within 1 year posttransplantation. RESULTS The 1-year incidence of EBV DNAemia was 20.7% (95% confidence interval, 15.4-26.5) and 40.0% (33.3-46.6) in the 7.5 mg/kg and 10.0 mg/kg groups, respectively (P < 0.001). The 100-day cumulative incidence of grade II to IV aGVHD was 27.1% (21.1-33.4) and 25.4% (19.6-31.5) in the 7.5 mg/kg and 10.0 mg/kg ATG groups, respectively (P = 0.548). The 2-year incidence of chronic GVHD was 34.6% (27.8-41.4) and 36.2% (29.1-43.2) in the 7.5 mg and 10.0 mg groups (P = 0.814). The 1-year incidence of CMV DNAemia was 73.4% (67.2-79.4) and 83.4% (77.5-87.9) in the 7.5 mg/kg and 10.0 mg/kg groups (P = 0.038). The 3-year overall survival posttransplantation was 69.5% (63.2-75.8) and 63.5% (56.2-70.8), and the disease-free survival was 62.2% (55.3-69.1) and 60.3% (53.0-67.6) in the 7.5 mg/kg and 10.0 mg/kg groups, respectively (OS: P = 0.308; DFS: P = 0.660). The counts of EBV- and CMV-specific cytotoxic T cells (CTLs) were higher in the 7.5 mg/kg group than in the 10.0 mg/kg group early posttransplantation. CONCLUSIONS Compared with 10.0 mg/kg, 7.5 mg/kg ATG for GVHD prophylaxis was associated with reduced EBV and CMV infections without increased incidence of GVHD in haplo-HSCT, probably by affecting EBV- and CMV-specific CTLs. TRIAL REGISTRATION clinicaltrials.gov, NCT01883180 . Registered 14 June 2013.
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Affiliation(s)
- Ren Lin
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Wang
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Fen Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiping Fan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shen Zhang
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ting Yang
- Department of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yajing Xu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, China
| | - Na Xu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li Xuan
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jieyu Ye
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Sun
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojun Huang
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China. .,Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China. .,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China. .,Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, Southern Medical University, Guangzhou, China.
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17
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Comparison of Two Doses of Antithymocyte Globulin in Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1993-2001. [PMID: 31229641 DOI: 10.1016/j.bbmt.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/04/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
The appropriate dose of antithymocyte globulin (ATG) to be used in reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) is yet to be determined. We retrospectively analyzed the outcomes of patients who underwent unrelated or mismatch related RIC allo-HSCT for hematologic malignancies and received r-ATG (4.5 mg/kg, 141 patients) versus R-ATG (6 mg/kg, 216 patients). There was a higher incidence of cytomegalovirus (P < .001) and Epstein-Barr virus viremia (P =.03) in the R-ATG group than in the r-ATG group. The cumulative incidences of acute graft-versus-host disease (aGVHD) grades II to IV at day 180 in the r-ATG and R-ATG groups were 59% and 44% (P = .006) and grades III to IV 20% and 12% (P = .029), respectively. In multivariable models adjusting for disease diagnosis, the risk of aGVHD grades III to IV did not reach statistical significance (P = .087). The respective cumulative incidences of chronic GVHD in the r-ATG and R-ATG groups were 26% and 15% (P = .10), respectively. There were no significant differences in relapse rate (P = .24), nonrelapse mortality (P = .96), progression-free survival (P = .24), overall survival (P = .70), and GVHD-free relapse-free survival (P = .24). In this retrospective analysis, aGVHD incidence was higher in those treated with r-ATG compared with R-ATG, but this did not translate into significant differences of clinical outcome. Given the increasing use of RIC allo-HSCT for treating malignant hematologic conditions, the correct dose and schedule of ATG administration should be defined by prospective randomized controlled trials.
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18
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Oostenbrink LVE, Jol-van der Zijde CM, Kielsen K, Jansen-Hoogendijk AM, Ifversen M, Müller KG, Lankester AC, van Halteren AGS, Bredius RGM, Schilham MW, van Tol MJD. Differential Elimination of Anti-Thymocyte Globulin of Fresenius and Genzyme Impacts T-Cell Reconstitution After Hematopoietic Stem Cell Transplantation. Front Immunol 2019; 10:315. [PMID: 30894854 PMCID: PMC6414431 DOI: 10.3389/fimmu.2019.00315] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/06/2019] [Indexed: 01/11/2023] Open
Abstract
Anti-thymocyte globulin (ATG) is a lymphocyte depleting agent applied in hematopoietic stem cell transplantation (HSCT) to prevent rejection and Graft-vs.-Host Disease (GvHD). In this study, we compared two rabbit ATG products, ATG-Genzyme (ATG-GENZ), and ATG-Fresenius (ATG-FRES), with respect to dosing, clearance of the active lymphocyte binding component, post-HSCT immune reconstitution and clinical outcome. Fifty-eigth pediatric acute leukemia patients (n = 42 ATG-GENZ, n = 16 ATG-FRES), who received a non-depleted bone marrow or peripheral blood stem cell graft from an unrelated donor were included. ATG-GENZ was given at a dosage of 6-10 mg/kg; ATG-FRES at 45-60 mg/kg. The active component of ATG from both products was cleared at different rates. Within the ATG-FRES dose range no differences were found in clearance of active ATG or T-cell re-appearance. However, the high dosage of ATG-GENZ (10 mg/kg), in contrast to the low dosage (6-8 mg/kg), correlated with prolonged persistence of active ATG and delayed T-cell reconstitution. Occurrence of serious acute GvHD (grade III-IV) was highest in the ATG-GENZ-low dosage group. These results imply that dosing of ATG-GENZ is more critical than dosing of ATG-FRES due to the difference in clearance of active ATG. This should be taken into account when designing clinical protocols.
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Affiliation(s)
| | | | - Katrine Kielsen
- Institute for Inflammation Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Marianne Ifversen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Klaus G Müller
- Institute for Inflammation Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Arjan C Lankester
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robbert G M Bredius
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Marco W Schilham
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Maarten J D van Tol
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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19
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Le Bourgeois A, Labopin M, Leclerc M, de Latour RP, Bourhis JH, Ceballos P, Orvain C, Wallet HL, Bilger K, Blaise D, Rubio MT, Guillaume T, Mohty M, Chevallier P. Clofarabine/busulfan-based reduced intensity conditioning regimens provides very good survivals in acute myeloid leukemia patients in complete remission at transplant: a retrospective study on behalf of the SFGM-TC. Oncotarget 2018; 9:36603-36612. [PMID: 30564300 PMCID: PMC6290956 DOI: 10.18632/oncotarget.26391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/01/2018] [Indexed: 11/25/2022] Open
Abstract
Background Clofarabine has been proved to have higher anti-leukemic myeloid activity compared to fludarabine, a drug extensively used as part of reduced intensity conditioning (RIC) for allogeneic stem cell transplantation (allo-SCT). Results Eighty-four patients were included. The majority of patients had acute myeloid leukemia (AML, n = 63). Sixty-one patients were in complete remission (AML n = 55). With a median follow up of 31 months (range: 5.7-74.1), 2-year overall (OS) and disease-free (DFS) survivals, relapse incidence (RI), non-relapse mortality (NRM) and graft-versus-host disease (GVHD)/relapse free survival (GRFS) were 64.5% (53.8-75.2); 57.2% (46.2-68.2); 27.7% (18.2-37.9); 15.1% (8.2-23.9) and 43.6% (32.5-54.7), respectively. Considering AML in remission, 2-year OS, DFS, RI, NRM and GRFS were 74.2% (62-86.5); 66.8% (53.6-79.9); 23.4% (12.7-36); 9.8% (3.5-19.9) and 50.9% (36.9-64.9), respectively. Two-year outcomes were similar between CloB2A1 and CloB2A2 sub-groups. In multivariate analysis, active disease at transplant was the only factor adversely impacting 2 years outcomes. Conclusions CloB2A2/A1 RIC regimen provides very good results for AML patients allografted in CR and could be retained as a new RIC platform for these patients. Materials and Methods This was a retrospective study including all patients who received a clofarabine/busulfan based RIC allo-SCT for myeloid malignancies and reported within the SFGM-TC registry. RIC regimen consisted of clofarabine 30 mg/m2/day 4 to 5 days (Clo), busulfan 3.2 mg/kg/day 2 days (B2) and 2.5 mg/kg/day of rabbit anti-thymocyte globulin 1 or 2 days (A1 or A2). The primary objective of the study was to report the main outcomes of the whole cohort at 2 years.
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Affiliation(s)
| | - Myriam Labopin
- Department of Hematology, Hôpital Saint Antoine, Paris, France
| | - Mathieu Leclerc
- Department of Hematology, Hôpital Henri Mondor, Créteil, France
| | | | | | - Patrice Ceballos
- Department of Hematology, CHU de Montpellier, Montpellier, France
| | | | | | - Karin Bilger
- Department of Hematology, CHU Strasbourg, Strasbourg, France
| | - Didier Blaise
- Department of Hematology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | | | - Mohamad Mohty
- Department of Hematology, Hôpital Saint Antoine, Paris, France
| | | | - on behalf of Société Francophone de Greffe de Moelle et de Thérapie Cellulaire
- Department of Hematology, CHU Hôtel Dieu, Nantes, France
- Department of Hematology, Hôpital Saint Antoine, Paris, France
- Department of Hematology, Hôpital Henri Mondor, Créteil, France
- Department of Hematology, Hôpital Saint Louis, Université Paris 7, Denis Diderot, Paris, France
- Department of Hematology, Hôpital Gustave Roussy, Paris, France
- Department of Hematology, CHU de Montpellier, Montpellier, France
- Department of Hematology, CHU d’Angers, Angers, France
- Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France
- Department of Hematology, CHU Strasbourg, Strasbourg, France
- Department of Hematology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
- Department of Hematology, CHU Nancy, Nancy, France
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20
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Effects of two doses of anti-T lymphocyte globulin-Fresenius given after full-match sibling stem cell transplantation in acute myeloblastic leukemia patients who underwent myeloablative fludarabine/busulfan conditioning. Hematol Oncol Stem Cell Ther 2018; 11:149-157. [DOI: 10.1016/j.hemonc.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/18/2017] [Accepted: 01/21/2018] [Indexed: 01/15/2023] Open
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21
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Devillier R, Legrand F, Rey J, Castagna L, Fürst S, Granata A, Charbonnier A, Harbi S, d'Incan E, Pagliardini T, Faucher C, Lemarie C, Saillard C, Calmels B, Mohty B, Maisano V, Weiller PJ, Chabannon C, Vey N, Blaise D. HLA-Matched Sibling versus Unrelated versus Haploidentical Related Donor Allogeneic Hematopoietic Stem Cell Transplantation for Patients Aged Over 60 Years with Acute Myeloid Leukemia: A Single-Center Donor Comparison. Biol Blood Marrow Transplant 2018; 24:1449-1454. [DOI: 10.1016/j.bbmt.2018.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
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22
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Afram G, Simón JAP, Remberger M, Caballero-Velázquez T, Martino R, Piñana JL, Ringden O, Esquirol A, Lopez-Corral L, Garcia I, López-Godino O, Sierra J, Caballero D, Ljungman P, Vazquez L, Hägglund H. Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting. Med Oncol 2018; 35:79. [PMID: 29696461 PMCID: PMC5918523 DOI: 10.1007/s12032-018-1127-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/05/2018] [Indexed: 01/09/2023]
Abstract
Chronic graft-versus-host disease (cGVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Aim is to identify risk factors for the development of cGVHD in a multicenter setting. Patients transplanted between 2000 and 2006 were analyzed (n = 820). Donors were HLA-identical siblings (57%), matched unrelated donors (30%), and HLA-A, B or DR antigen mismatched (13%). Reduced intensity conditioning (RIC) was given to 65% of patients. Overall incidence of cGVHD was 46% for patients surviving more than 100 days after HSCT (n = 747). Older patient age [HR 1.15, p < 0.001], prior acute GVHD [1.30, p = 0.024], and RIC [1.36, p = 0.028] increased overall cGVHD. In addition, RIC [4.85, p < 0.001], prior aGVHD [2.14, p = 0.001] and female donor to male recipient [1.80, p = 0.008] increased the risk of severe cGVHD. ATG had a protective effect for both overall [0.41, p < 0.001] and severe cGVHD [0.20, p < 0.001]. Relapse-free survival (RFS) was impaired in patients with severe cGVHD. RIC, prior aGVHD, and female-to-male donation increase the risk of severe cGVHD. ATG reduces the risk of all grades of cGVHD without hampering RFS. GVHD prophylaxis may be tailored according to the risk profile of patients.
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Affiliation(s)
- Gabriel Afram
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
| | - Jose Antonio Pérez Simón
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Mats Remberger
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Teresa Caballero-Velázquez
- Department of Hematology, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Rodrigo Martino
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Luis Piñana
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Hematology, Hospital Clinico Universitario, Valencia, Spain
| | - Olle Ringden
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Albert Esquirol
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lucia Lopez-Corral
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Irene Garcia
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriana López-Godino
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Jordi Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Dolores Caballero
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Per Ljungman
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lourdes Vazquez
- Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Hans Hägglund
- Division of Hematology, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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23
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Shichijo T, Fuji S, Tajima K, Kubo H, Nozaki K, Honda T, Yamaguchi J, Kawashima I, Kawajiri A, Takemura T, Onishi A, Ito A, Tanaka T, Inamoto Y, Kurosawa S, Kim SW, Fukuda T. Beneficial impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation: focusing on difference between stem cell sources. Bone Marrow Transplant 2018; 53:634-639. [DOI: 10.1038/s41409-017-0045-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/26/2017] [Accepted: 11/14/2017] [Indexed: 01/05/2023]
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24
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Impact of antithymocyte globulin doses in reduced intensity conditioning before allogeneic transplantation from matched sibling donor for patients with acute myeloid leukemia: a report from the acute leukemia working party of European group of Bone Marrow Transplantation. Bone Marrow Transplant 2018; 53:431-437. [DOI: 10.1038/s41409-017-0043-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 11/12/2022]
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25
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CD34 + Cell Selection versus Reduced-Intensity Conditioning and Unmodified Grafts for Allogeneic Hematopoietic Cell Transplantation in Patients Age >50 Years with Acute Myelogenous Leukemia and Myelodysplastic Syndrome . Biol Blood Marrow Transplant 2018; 24:964-972. [PMID: 29305194 DOI: 10.1016/j.bbmt.2017.12.804] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022]
Abstract
Reduced-intensity conditioning (RIC) and T cell depletion (TCD) through CD34+ cell selection without the use of post-transplantation immunosuppression are 2 strategies used to reduce nonrelapse mortality (NRM) in older patients after allogeneic hematopoietic cell transplantation (allo-HCT). To compare the efficacy of the RIC and TCD approaches, we evaluated the outcomes of patients age >50 years with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) who underwent allo-HCT from an HLA-matched donor with one of these strategies. Baseline characteristics were comparable in the patients receiving TCD (n = 204) and those receiving RIC (n = 151), except for a higher proportion of unrelated donors (68% versus 40%; P < .001) and a higher comorbidity burden (Hematopoietic Cell Transplantation Comorbidity Index [HCT-CI] ≥3: 51% versus 38%; P < .001) in the TCD cohort. Analysis of outcomes at 3 years showed a higher chronic graft-versus-host disease (GVHD)/relapse-free survival (CRFS) (51% versus 7%; P < .001), lower incidences of grade II-IV acute GVHD (18% versus 46% at day +180) and chronic GVHD (6% versus 55% at 3 years; P < .001), and a lower incidence of relapse (19% versus 33% at 3 years; P = .001) in the TCD group compared with the RIC group. Relapse-free survival (RFS), overall survival (OS), and NRM were similar in the 2 groups. Combining transplantation approach (RIC versus TCD) and comorbidity burden (HCT-CI 0-2 versus ≥3), patients with an HCT-CI score of 0-2 seemed to benefit from the TCD approach. In conclusion, in this retrospective study, the use of a CD34+ cell-selected graft and a myeloablative conditioning regimen was associated with higher CRFS and similar RFS and OS compared with unmodified allo-RIC in patients age >50 years with AML and MDS.
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26
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Busca A, Aversa F. In-vivo or ex-vivo T cell depletion or both to prevent graft-versus-host disease after hematopoietic stem cell transplantation. Expert Opin Biol Ther 2017; 17:1401-1415. [PMID: 28846051 DOI: 10.1080/14712598.2017.1369949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation (HSCT) represents a widely accepted therapeutic strategy for the treatment of hematologic disorders which are otherwise considered incurable. Alloreactive T cells infused with the stem cell inoculum may generate graft-versus-host disease (GVHD) representing one the most relevant obstacles to the successful outcome of patients receiving allogeneic HSCT. Areas covered: In this review, the authors provide an overview of the most recent approaches of T-cell depletion (TCD) including ex-vivo αβ+ TCD and in-vivo TCD with anti-thymocyte globulin (ATG). Expert opinion: Ex vivo depletion of donor T-cells prevents both acute and chronic GVHD without the need for any additional posttransplant immunological prophylaxis either in haploidentical HSCT and HLA matched transplants. Three prospective trials evaluating the efficacy of ATG in matched unrelated donor transplant recipients demonstrated that ATG reduces the incidence of both acute and chronic GVHD without a significant increase of relapse rate, and similar results have been reported in the setting of blood stem cell grafts from matched sibling donors.
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Affiliation(s)
- Alessandro Busca
- a SSD Trapianto di Cellule Staminali , AOU Citta' della Salute e della Scienza , Torino , Italy
| | - Franco Aversa
- b Hematology and BMT Unit , University of Parma , Parma , Italy
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27
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Zhang R, Shi W, Wang HF, You Y, Zhong ZD, Li WM, Zhang C, Lu X, Wang YD, Zheng P, Fang J, Hong M, Wu QL, Xia LH. Idarubicin-intensified haploidentical HSCT with GvHD prophylaxis of ATG and basiliximab provides comparable results to sibling donors in high-risk acute leukemia. Bone Marrow Transplant 2017; 52:1253-1260. [PMID: 28581464 DOI: 10.1038/bmt.2017.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022]
Abstract
We designed a novel haploidentical hematopoietic stem cell transplantation (haplo-HSCT) system using idarubicin (IDA) intensified conditioning regimens and combination of antithymocyte globulin and basiliximab for GvHD prophylaxis. The outcomes of 110 high-risk acute leukemia patients undergoing haplo-HSCT were compared with 69 contemporaneous high-risk patients receiving HLA-matched sibling transplantation using uniform IDA-intensified regimens. The relapse incidence of haplo-HSCT was 23.4%, and 3-year overall survival (OS) and disease-free survival (DFS) achieved 62.9%, 59.1%, respectively. The cumulative incidences of II-IV and III-IV aGvHD were 28.6 and 14.3%, while limited and extensive cGvHD were 19.4, 13.8%. All these results were equivalent to those of concurrent identical sibling transplantation. Three-year OS and DFS for patients in advance stage reached 48.5, 47.3%. Furthermore, the relapse, 3-year OS of positive minimal residual disease (MRD) patients did not differ from negative MRD patients (18.9% vs 11.5%, 63.6% vs 69.6%), indicating our intensified haplo-HSCT technique could circumvent the dismal prognosis of MRD. These data provide reinforcing evidence that our haplo-HSCT system could dramatically improve the survival of high-risk acute leukemia with low relapse and acceptable transplantation-related mortality, and might be a promising therapeutic option for high-risk patients.
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Affiliation(s)
- R Zhang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - W Shi
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - H-F Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y You
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Z-D Zhong
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - W-M Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - C Zhang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - X Lu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Y-D Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - P Zheng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - J Fang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - M Hong
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Q-L Wu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - L-H Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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28
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Lee KH, Lee JH, Lee JH, Kim DY, Park HS, Choi EJ, Ko SH, Seol M, Lee YS, Kang YA, Jeon M, Baek S, Kang YL, Kim SH, Yun SC, Kim H, Jo JC, Choi Y, Joo YD, Lim SN. Reduced-Intensity Conditioning with Busulfan, Fludarabine, and Antithymocyte Globulin for Hematopoietic Cell Transplantation from Unrelated or Haploidentical Family Donors in Patients with Acute Myeloid Leukemia in Remission. Biol Blood Marrow Transplant 2017; 23:1555-1566. [PMID: 28552421 DOI: 10.1016/j.bbmt.2017.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Abstract
To investigate the role of antithymocyte globulin (ATG)-containing reduced-intensity conditioning (RIC) in hematopoietic cell transplantation (HCT) from unrelated (UD) or haploidentical family donors (HFD), we conducted a phase 2 trial of 237 patients (age range, 16 to 69 years) with acute myeloid leukemia (AML) in remission. Patients undergoing UD-HCT (n = 93) or HFD-HCT (n = 59) received RIC comprising busulfan, fludarabine, and ATG, 9 mg/kg, whereas those undergoing HCT from matched sibling donors (MSD, n = 85) received myeloablative busulfan and cyclophosphamide conditioning or aforementioned RIC with ATG, 4.5 mg/kg. For graft-versus-host disease (GVHD) prophylaxis, cyclosporine and methotrexate were administered. The median follow-up period was 44.7 months after HCT for 161 survivors. For UD-HCT versus HFD-HCT, there were no significant differences in leukemia recurrence, nonrelapse mortality, relapse-free survival, grades 2 to 4 acute GVHD, and moderate-to-severe chronic GVHD. Furthermore, when the outcomes of UD-HCT and HFD-HCT were combined and compared with those of MSD-HCT, there were no significant differences in leukemia recurrence (3-year cumulative incidence, 30% versus 29%), nonrelapse mortality (3-year cumulative incidence, 7% versus 8%), relapse-free survival (3-year estimate, 63% versus 63%), and grades 2 to 4 acute GVHD (120-day cumulative incidence, 16% versus 13%). Moderate-to-severe chronic GVHD, however, occurred less frequently in UD/HFD-HCT (2-year cumulative incidence, 22% versus 40%; P = .006). The addition of ATG to conditioning regimen was a significant predictor for less chronic GVHD (subdistribution hazard ratio, .59). In AML in remission, UD/HFD-HCT after ATG-containing RIC achieved leukemia control equivalent to that of MSD-HCT. Despite HLA disparity in UD/HFD-HCT, chronic GVHD occurred less frequently after ATG-containing RIC, suggesting a strong GVHD-modulating effect of ATG.
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Affiliation(s)
- Kyoo-Hyung Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
| | - Je-Hwan Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jung-Hee Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Dae-Young Kim
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Han-Seung Park
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Eun-Ji Choi
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sun-Hye Ko
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Miee Seol
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young-Shin Lee
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young-A Kang
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Mijin Jeon
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Seunghyun Baek
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - You-Lee Kang
- Section of Hematology, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Han Kim
- Section of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hawk Kim
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Jae-Cheol Jo
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Yunsuk Choi
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Republic of Korea
| | - Young-Don Joo
- Hematology-Oncology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Sung-Nam Lim
- Hematology-Oncology, Department of Internal Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
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Wang H, Liu H, Zhou JY, Zhang TT, Jin S, Zhang X, Chen SN, Li WY, Xu Y, Miao M, Wu DP. Antithymocyte globulin improves the survival of patients with myelodysplastic syndrome undergoing HLA-matched unrelated donor and haplo-identical donor transplants. Sci Rep 2017; 7:43488. [PMID: 28262717 PMCID: PMC5337979 DOI: 10.1038/srep43488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/24/2017] [Indexed: 01/02/2023] Open
Abstract
Significant advances have been achieved in the outcomes of patients with myelodysplastic syndromes (MDS) after both HLA-matched sibling donor transplants (MSDT) and non-MSDT, the latter including HLA-matched unrelated donor (MUDT) and haplo-identical donor transplants (HIDT). In this retrospective study, we analyzed the data of 85 consecutive patients with MDS who received allogeneic HSCT between Dec 2007 and Apr 2014 in our center. These patients comprised 38 (44.7%) who received MSDT, 29 (34.1%) MUDT, and 18 (21.2%) HIDT. The median overall survival (OS) was 60.2 months, the probabilities of OS being 63%, 57%, and 48%, at the first, second, and fifth year, respectively. Median OS post-transplant (OSPT) was 57.2 months, the probabilities of OSPT being 58%, 55%, and 48% at the first, second, and fifth year, respectively. The survival of patients receiving non-MSDT was superior to that of MSDT, median OSPT being 84.0 months and 23.6 months, respectively (P = 0.042); the findings for OS were similar (P = 0.028). We also found that using ATG in conditioning regimens significantly improved survival after non-MSDT, with better OS and OSPT (P = 0.016 and P = 0.025). These data suggest that using ATG in conditioning regimens may improve the survival of MDS patients after non-MSDT.
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Affiliation(s)
- Hong Wang
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Hong Liu
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Jin-Yi Zhou
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Tong-Tong Zhang
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Song Jin
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Xiang Zhang
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Su-Ning Chen
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Wei-Yang Li
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Yang Xu
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - Miao Miao
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
| | - De-Pei Wu
- Jiangsu Institute of Haematology, The First Affiliated Hospital of Soochow University; Institute of Blood and Marrow Transplantation; Collaborative Innovation of Haematology; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, 215000, China
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30
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Rubio MT, D'Aveni-Piney M, Labopin M, Hamladji RM, Sanz MA, Blaise D, Ozdogu H, Daguindeau E, Richard C, Santarone S, Irrera G, Yakoub-Agha I, Yeshurun M, Diez-Martin JL, Mohty M, Savani BN, Nagler A. Impact of in vivo T cell depletion in HLA-identical allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission conditioned with a fludarabine iv-busulfan myeloablative regimen: a report from the EBMT Acute Leukemia Working Party. J Hematol Oncol 2017; 10:31. [PMID: 28118857 PMCID: PMC5259921 DOI: 10.1186/s13045-016-0389-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/31/2016] [Indexed: 01/15/2023] Open
Abstract
Background The impact of the use of anti-thymocyte globulin (ATG) in allogeneic stem cell transplantation performed with HLA-identical sibling donors following fludarabine and 4 days intravenous busulfan myeloablative conditioning regimen has been poorly explored. Methods We retrospectively analyzed 566 patients who underwent a first HLA-identical allogeneic stem cell transplantation with this conditioning regimen for acute myeloid leukemia in first complete remission between 2006 and 2013 and compared the outcomes of 145 (25.6%) patients who received ATG (ATG group) to 421 (74.4%) who did not (no-ATG group). The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. Results Patients in the ATG group were older, received more frequently peripheral blood stem cell grafts from older donors, and were transplanted more recently. With a median follow-up of 19 months, patients in the ATG group had reduced 2-year cumulative incidence of chronic graft-versus-host disease (GVHD) (31 vs. 52%, p = 0.0002) and of its extensive form (8 vs. 26%, p < 0.0001) but similar relapse incidence (22 vs. 27%, p = 0.23) leading to improved GVHD and relapse-free survival (GRFS) (60 vs. 40%, p = 0.0001). In multivariate analyses, the addition of ATG was independently associated with lower chronic GVHD (HR = 0.46, p = 0.0001), improved leukemia-free survival (HR = 0.67, p = 0.027), overall survival (HR = 0.65, p = 0.027), and GRFS (HR = 0.51, p = 4 × 10−5). Recipient age above 50 years was the only other factor associated with worse survivals. Conclusions These results suggest that the use of ATG with fludarabine and 4 days intravenous busulfan followed by HLA-identical sibling donor allogeneic stem cell transplantation for acute myeloid leukemia improves overall transplant outcomes due to reduced incidence of chronic GVHD without increased relapse risk. Electronic supplementary material The online version of this article (doi:10.1186/s13045-016-0389-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Thérèse Rubio
- Service d'Hématologie et de Médecine interne, Hôpital Brabois, CHRU Nancy, Nancy, France. .,IMoPA, CNRS UMR 7365, Nancy, France. .,Université de Lorraine, Nancy, France.
| | - Maud D'Aveni-Piney
- Service d'Hématologie et de Médecine interne, Hôpital Brabois, CHRU Nancy, Nancy, France. .,IMoPA, CNRS UMR 7365, Nancy, France. .,Université de Lorraine, Nancy, France.
| | - Myriam Labopin
- ALWP Office, Hôpital Saint Antoine, Paris, France.,Service d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Rose-Marie Hamladji
- Service Hématologie Greffe de Moëlle, Centre Pierre et Marie Curie, Alger, Algeria
| | - Miguel A Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Hakan Ozdogu
- Hematology Division, BMT Unit, Hematology Reserach Laboratory, Training and Medical, Baskent University Hospital, Adana, Turkey
| | | | - Carlos Richard
- Servicio de Hematología-Hemoterapia, Hospital U. Marqués de Valdecilla, Santander, Spain
| | - Stella Santarone
- Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Civile, Pescara, Italy
| | - Giuseppe Irrera
- Azienda Ospedaliera, Centro Unico Regionale Trapianti, Reggio, Calabria, Italy
| | | | - Moshe Yeshurun
- Hematology and BMT Department, Beilinson Hospital, Petach-Tikva, Israel
| | - Jose L Diez-Martin
- Sección de Transplante de Medula Osea, Hospital Gregorio Marañón, Madrid, Spain
| | - Mohamad Mohty
- ALWP Office, Hôpital Saint Antoine, Paris, France.,Service d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Bipin N Savani
- ALWP Office, Hôpital Saint Antoine, Paris, France.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arnon Nagler
- ALWP Office, Hôpital Saint Antoine, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Division of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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31
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Baron F, Mohty M, Blaise D, Socié G, Labopin M, Esteve J, Ciceri F, Giebel S, Gorin NC, Savani BN, Schmid C, Nagler A. Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica 2016; 102:224-234. [PMID: 27927772 DOI: 10.3324/haematol.2016.148510] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation is increasingly used as treatment for patients with life-threatening blood diseases. Its curative potential is largely based on immune-mediated graft-versus-leukemia effects caused by donor T cells contained in the graft. Unfortunately, donor T cells are also the cause of graft-versus-host disease. The vast majority of human leukocyte antigen-matched allogeneic hematopoietic stem cell transplants are nowadays carried out with peripheral blood stem cells as the stem cell source. In comparison with bone marrows, peripheral blood stem cells contain more hematopoietic stem/progenitor cells but also one log more T cells. Consequently, the use of peripheral blood stem cells instead of bone marrow has been associated with faster hematologic recovery and a lower risk of relapse in patients with advanced disease, but also with a higher incidence of chronic graft-versus-host disease. These observations have been the basis for several studies aimed at assessing the impact of immunoregulation with anti-thymocyte globulin on transplantation outcomes in patients given human leukocyte antigen-matched peripheral blood stem cells from related or unrelated donors. After a brief introduction on anti-thymocyte globulin, this article reviews recent studies assessing the impact of anti-thymocyte globulin on transplantation outcomes in patients given peripheral blood stem cells from human leukocyte antigen-matched related or unrelated donors as well as in recipients of grafts from human leukocyte antigen haploidentical donors.
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Affiliation(s)
| | - Mohamad Mohty
- Hopital Saint-Antoine, AP-HP, Paris, France.,Université Pierre & Marie Curie, Paris, France.,INSERM UMRs U938, Paris, France
| | - Didier Blaise
- Aix Marseille Univ, CNRS, INSERM, CRCM, Institut Paoli-Calmettes, Marseille, France
| | - Gérard Socié
- AP-HP, Hematology Transplantation, Hospital Saint-Louis, Paris, France
| | - Myriam Labopin
- Hopital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRs U938, Paris, France
| | - Jordi Esteve
- Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - Fabio Ciceri
- Department of Hematology, Ospedale San Raffaele, Università degli Studi, Milano, Italy
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | - Bipin N Savani
- Long term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christoph Schmid
- Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,EBMT Paris Office, Hospital Saint Antoine, Paris, France
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32
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Chevallier P, Labopin M, de La Tour RP, Lioure B, Bulabois C, Huynh A, Blaise D, Turlure P, Daguindau E, Maillard N, Yakoub‐Agha I, Guillerm G, Delage J, Contentin N, Bay J, Beckerich F, Bourhis J, Detrait M, Vigouroux S, François S, Legrand F, Guillaume T, Mohty M. Clofarabine versus fludarabine-based reduced-intensity conditioning regimen prior to allogeneic transplantation in adults with AML/MDS. Cancer Med 2016; 5:3068-3076. [PMID: 27748046 PMCID: PMC5119961 DOI: 10.1002/cam4.880] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022] Open
Abstract
We have retrospectively compared survivals between acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) patients who received either a clofarabine/busulfan (CloB2A2) or a fludarabine/busulfan (FB2A2) RIC regimen for allogeneic stem cell transplantation. Between 2009 and 2014, 355 allotransplanted cases were identified from the SFGM-TC registry as having received either the FB2A2 (n = 316, 56% males, median age: 59.2 years, AML 78.5%, first complete remission [CR1] 72%, median follow-up: 20 months) or the CloB2A2 (n = 39, 62% males, median age: 60.8 years, AML 62%, CR1 69%, median follow-up: 22.4 months) RIC regimen. In multivariate analysis, FB2A2 was associated with significant lower overall survival (OS, HR: 2.14; 95%CI: 1.05-4.35, P = 0.04) and higher relapse incidence (RI, HR: 2.17; 95%CI: 1.02-4.61, P = 0.04) and a trend for lower leukemia-free survival (LFS, HR: 1.75; 95%CI: 0.94-3.26, P = 0.08). These results were confirmed using a propensity score-matching strategy. However, when considering AML and MDS patients separately, the benefit of the CLOB2A2 regimen was restricted to AML patients (2-year OS FB2A2: 38% [14.5-61.6] vs. CloB2A2: 79.2% [62.9-95.4], P = 0.01; 2-year LFS FB2A2: 38% [16-59.9] vs. CloB2A2: 70.8% [52.6-89], P = 0.03). The better survivals were due to the lower risk of relapse in this CloB2A2 AML subgroup (2-year RI FB2A2: 41.2% [19-62.4] vs. CloB2A2: 16.7% [5-34.2], P = 0.05). This retrospective comparison suggests that the CloB2A2 RIC regimen can likely provide longer survival than that awarded by a FB2A2 RIC regimen and may become a new standard of care RIC regimen for allotransplanted AML patients. A prospective phase 3 randomized study is warranted.
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Affiliation(s)
| | - Myriam Labopin
- Université Pierre & Marie CurieParisFrance
- INSERM, UMRs 938ParisFrance
- Hôpital Saint‐Antoine, AP‐HPParisFrance
| | | | - Bruno Lioure
- Hematology DepartmentCHRU HautepierreStrasbourgFrance
| | | | - Anne Huynh
- Hematology DepartmentCentre Anti‐cancéreuxToulouseFrance
| | - Didier Blaise
- Hematology DepartmentInstitut Paoli‐CalmetteMarseilleFrance
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mohamad Mohty
- Université Pierre & Marie CurieParisFrance
- INSERM, UMRs 938ParisFrance
- Hôpital Saint‐Antoine, AP‐HPParisFrance
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Cornillon J, Balsat M, Cabrespine A, Tavernier-Tardy E, Hermet E, Mulliez A, Augeul-Meunier K, Guyotat D, Bay JO. Impact of ATG Dose on the Outcome of Patients Undergoing Reduced Intensity Conditioning Followed by Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Malignancies. Acta Haematol 2016; 136:193-200. [PMID: 27623172 DOI: 10.1159/000446835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/14/2016] [Indexed: 01/07/2023]
Abstract
Reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often proposed for patients with comorbidities. To enhance engraftment and limit graft-versus-host disease (GVHD), antithymoglobulin (ATG) is usually used. However, the dose needed remains unclear unlike myeloablative conditioning. In order to clarify this point, we conducted a retrospective study on patients who received a reduced intensity conditioning allo-HSCT based on a 2-day fludarabine and busulfan treatment with either 1 or 2 days of ATG treatment. One hundred and eight patients received 2.5 mg/kg (ATG2.5) and another 60 patients 5 mg/kg (ATG5). The median follow-up was 36 months. The median overall survival was 39 months and the median disease-free survival 45 months. In multivariate analysis, overall nonrelapse mortality (NRM) was independently influenced by the acute GVHD grade III-IV (p < 0.001) and ATG dose (30 vs. 21% for ATG5; p = 0.008). Despite heterogeneity of populations, using proportional-hazard assumptions, we have been able to observe in multivariate analysis a lower NRM in the ATG5 group. This leads to a statistically higher overall survival for the ATG5 group. In conclusion, 2 days of ATG decrease NRM independently without increasing the risk of relapse or infectious disease.
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Affiliation(s)
- Jérôme Cornillon
- Department of Hematology, Institut de Cancérologie Lucien-Neuwirth, St-Etienne, France
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34
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Blaise D, Fürst S, Crocchiolo R, El-Cheikh J, Granata A, Harbi S, Bouabdallah R, Devillier R, Bramanti S, Lemarie C, Picard C, Chabannon C, Weiller PJ, Faucher C, Mohty B, Vey N, Castagna L. Haploidentical T Cell–Replete Transplantation with Post-Transplantation Cyclophosphamide for Patients in or above the Sixth Decade of Age Compared with Allogeneic Hematopoietic Stem Cell Transplantation from an Human Leukocyte Antigen–Matched Related or Unrelated Donor. Biol Blood Marrow Transplant 2016; 22:119-24. [DOI: 10.1016/j.bbmt.2015.08.029] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/20/2015] [Indexed: 11/26/2022]
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35
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Castagna L, Bramanti S, Furst S, Giordano L, Sarina B, Crocchiolo R, El-Cheikh J, Cheikh JE, Granata A, Morabito L, Mauro E, Faucher C, Mohty B, Harbi S, Devillier R, Chabannon C, Carlo-Stella C, Santoro A, Blaise D. Tacrolimus compared with cyclosporine A after haploidentical T-cell replete transplantation with post-infusion cyclophosphamide. Bone Marrow Transplant 2015; 51:462-5. [PMID: 26595078 DOI: 10.1038/bmt.2015.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- L Castagna
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - S Bramanti
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - S Furst
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - L Giordano
- Statistic Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - B Sarina
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - R Crocchiolo
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | | | - J El Cheikh
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - A Granata
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - L Morabito
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - E Mauro
- Department of Hematology, Ospedale Ferrarotto, Catania, Italy
| | - C Faucher
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - B Mohty
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - S Harbi
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - R Devillier
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France
| | - C Chabannon
- Cell Therapy Unit Institut Paoli Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | - C Carlo-Stella
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - A Santoro
- Department of Hematology, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - D Blaise
- Department of Hematology, Transplantation Program Institut Paoli Calmettes, Marseille, France.,Aix-Marseille Université, Marseille, France.,Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
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36
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Devillier R, Bramanti S, Fürst S, Sarina B, El-Cheikh J, Crocchiolo R, Granata A, Chabannon C, Morabito L, Harbi S, Faucher C, Santoro A, Weiller PJ, Vey N, Carlo-Stella C, Castagna L, Blaise D. T-replete haploidentical allogeneic transplantation using post-transplantation cyclophosphamide in advanced AML and myelodysplastic syndromes. Bone Marrow Transplant 2015; 51:194-8. [PMID: 26551778 DOI: 10.1038/bmt.2015.270] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 11/12/2022]
Abstract
Unmanipulated haploidentical transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy) represents an alternative for patients with high-risk diseases lacking HLA-identical donor. Although it provides low incidences of GVHD, the efficacy of Haplo-SCT is still questioned, especially for patients with myeloid malignancies. Thus, we analyzed 60 consecutive patients with refractory (n=30) or high-risk CR (n=30) AML or myelodysplastic syndromes (MDSs) who underwent PT-Cy Haplo-SCT. The median age was 57 years (22-73 years), hematopoietic cell transplantation comorbidity index was ⩾3 in 38 patients (63%) and Haplo-SCT was the second allogeneic transplantation for 10 patients (17%). Although most of patients received PBSC as graft source (n=48, 80%), we found low incidences of grade 3-4 acute (2%) and severe chronic GVHD (4%). Among patients with high-risk CR diseases, 1-year non-relapse mortality, cumulative incidence of relapse, progression-free and overall survivals were 20%, 32%, 47% and 62%, respectively. In patients with refractory disease, corresponding results were 34%, 35%, 32% and 37%, respectively. We conclude that PT-Cy Haplo-SCT could provide promising anti-leukemic effect even in the setting of very advanced diseases. Thus, it represents a viable alternative for high-risk AML/MDS patients without HLA-identical donor.
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Affiliation(s)
- R Devillier
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
| | - S Bramanti
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - S Fürst
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - B Sarina
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - J El-Cheikh
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - R Crocchiolo
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - A Granata
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - C Chabannon
- Aix-Marseille University, Medicine Faculty, Marseille, France.,Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France
| | - L Morabito
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - S Harbi
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - C Faucher
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - A Santoro
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - P-J Weiller
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
| | - N Vey
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
| | - C Carlo-Stella
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - L Castagna
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - D Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France.,Aix-Marseille University, Medicine Faculty, Marseille, France
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37
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Allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning regimen: Outcomes of patients admitted to intensive care unit. J Crit Care 2015; 30:1107-13. [DOI: 10.1016/j.jcrc.2015.06.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/08/2015] [Accepted: 06/20/2015] [Indexed: 11/18/2022]
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38
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Peffault de Latour R, Labopin M, Cornelissen J, Vigouroux S, Craddock C, Blaise D, Huyn A, Vindelov L, Maertens J, Chevallier P, Fegueux N, Socié G, Cahn JY, Petersen E, Schouten H, Lioure B, Russell N, Corral LL, Ciceri F, Nagler A, Mohty M. In patients older than 55 years with AML in first CR, should we search for a matched unrelated donor when an old sibling donor is available? Bone Marrow Transplant 2015; 50:1411-5. [PMID: 26367237 DOI: 10.1038/bmt.2015.180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/05/2015] [Accepted: 07/08/2015] [Indexed: 01/08/2023]
Abstract
Allogeneic hematopoietic transplantation is increasingly used in patients aged 55 years or more with AML. The question of whether outcomes can be improved with an allele-level 8/8 HLA-matched unrelated donor (MUD) rather than an older HLA-matched sibling (MSD, more than 55 years) is still unanswered. We thus analyzed outcomes in 714 patients aged 55 years and older with AML in first CR (CR1) who received PBSCs after a reduced-intensity conditioning hematopoietic cell transplant from a MUD (n=310) or a MSD (n=404) in a recent period (2005-2010). The 3-year cumulative incidences (CIs) of non-relapse mortality were 17% and 23% with MSD and MUD, respectively (P=0.17). The 3-year CIs of relapse were 37% and 30%, respectively (P=0.12), resulting in a 3-year CI of leukemia-free survival of 46% and 47%, respectively (P=0.51). The 3-year overall survival was 49% with both MSD and MUD. In conclusion, HLA-identical sibling donors aged 55 years or more should not be excluded because of age for patients aged 55 years and older with AML in CR1.
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Affiliation(s)
- R Peffault de Latour
- Service d'Hématologie Greffe, AP-HP-Hôpital Saint Louis, Paris, France.,Paris Diderot University, EA 3518, Paris, France
| | - M Labopin
- ALWP-EBMT, AP-HP-Hôpital Saint Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, AP-HP-Hôpital Saint Antoine, Paris, France.,Universite Pierre et Marie Curie, Paris, France.,INSERM, UMRs 938, Paris, France
| | - J Cornelissen
- Hematology Department, Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | - S Vigouroux
- CHU Bordeaux-Hôpital Haut-levêque, Pessac, France
| | - C Craddock
- BMT unit, Centre for Clinical Haematology-Queen Elizabeth Hospital, Birmingham, UK
| | - D Blaise
- Institut Paoli Calmettes-Unité de Transplantation et de Thérapie Cellulaire-Inserm UMR 891, Marseille, France
| | - A Huyn
- Department of Hematology, Hopital de Purpan-CHU, Toulouse, France
| | - L Vindelov
- Bone Marrow Transplant Unit L 4043, Rigshospitalet, Copenhagen, Denmark
| | - J Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - P Chevallier
- Department of Hematology, Hopital Hotel Dieu-CHU, Nantes, France
| | - N Fegueux
- CHU Lapeyronie-Service d'Hématologie et Oncologie, Montpellier, France
| | - G Socié
- Service d'Hématologie Greffe, AP-HP-Hôpital Saint Louis, Paris, France.,Université Paris Diderot, Paris, France.,INSERM 1160, Paris, France
| | - J Y Cahn
- Department of Hematology, University Hospital, Grenoble, France.,University Medical Centre UMR 525 CNRS, Grenoble, France
| | - E Petersen
- Department of Hematology, Utrecht, The Netherlands
| | - H Schouten
- Department Internal Medicine Hematology/Oncology, University Hospital Maastricht, Maastricht, The Netherlands
| | - B Lioure
- Department of Onco-Hematologiy, CHU Hautepierre, Strasbourg, France
| | - N Russell
- Division of Hematology and BMT, Nottingham City Hospital, Nottingham, UK
| | - L L Corral
- Hospital Clínico-Servicio de Hematología, Salamanca, Spain
| | - F Ciceri
- Hematology and BMT Unit, EBMT CIC 813, San Raffaele Scientific Institute, Milano, Italy
| | - A Nagler
- ALWP-EBMT, AP-HP-Hôpital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - M Mohty
- ALWP-EBMT, AP-HP-Hôpital Saint Antoine, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, AP-HP-Hôpital Saint Antoine, Paris, France.,Universite Pierre et Marie Curie, Paris, France.,INSERM, UMRs 938, Paris, France
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39
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Rubio MT, Labopin M, Blaise D, Socié G, Contreras RR, Chevallier P, Sanz MA, Vigouroux S, Huynh A, Shimoni A, Bulabois CE, Caminos N, López-Corral L, Nagler A, Mohty M. The impact of graft-versus-host disease prophylaxis in reduced-intensity conditioning allogeneic stem cell transplant in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2015; 100:683-9. [PMID: 25769546 DOI: 10.3324/haematol.2014.119339] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 03/06/2015] [Indexed: 12/14/2022] Open
Abstract
The impact of the intensity of graft-versus-host-disease immunoprophylaxis on transplantation outcomes in patients undergoing transplantation following reduced-intensity conditioning is unclear. This study addresses this issue in 228 adult patients above 50 years of age with acute myeloid leukemia in first complete remission given peripheral blood stem cells from HLA-identical siblings after fludarabine and 2 days of intravenous busulfan reduced-intensity conditioning. A total of 152 patients received anti-thymocyte globulin, either in combination with cyclosporine A in 86 patients (group 1), or with cyclosporine A and mycophenolate mofetil or short course methotrexate in 66 patients (group 2). The remaining 76 patients did not receive anti-thymocyte globulin but were given cyclosporine A and methotrexate or mycophenolate mofetil (group 3). Incidences of grade II-IV acute graft-versus-host-disease were comparable in the three groups (16.5%, 29.5% and 19.5% in groups 1, 2 and 3, respectively, P=0.15). In multivariate analysis, the absence of anti-thymocyte globulin was the only factor associated with a higher risk of chronic graft-versus-host-disease (P=0.005), while the use of triple immunosuppression (group 3) was associated with an increased risk of relapse (P=0.003). In comparison to anti-thymocyte globulin and cyclosporine A alone, the other two strategies of graft-versus-host-disease prophylaxis were associated with reduced leukemia-free survival and overall survival (P=0.001 for each parameter), independently of the dose of anti-thymocyte globulin. These data suggest that fine tuning of the intensity of this prophylaxis can affect the outcome of transplantation and that anti-thymocyte globulin and cyclosporine A alone should be the preferred combination with the fludarabine-busulfan reduced-intensity conditioning regimen and sibling donors.
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Affiliation(s)
- Marie Thérèse Rubio
- Hôpital Saint Antoine, Service d'Hématologie et de Thérapie Cellulaire, Paris, France Université Pierre et Marie Curie, Paris, France INSERM UMRs938, CDR Saint Antoine, Paris, France
| | - Myriam Labopin
- Hôpital Saint Antoine, Service d'Hématologie et de Thérapie Cellulaire, Paris, France EBMT Data Office, Hôpital Saint Antoine, Paris, France
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Gerard Socié
- Hôpital St. Louis, Dept. of Hematology - BMT, Paris, France
| | | | | | - Miguel A Sanz
- Hospital Universidad La Fe, Servicio de Hematologia y Oncologia, Valencia, Spain
| | | | - Anne Huynh
- Hôpital Purpan, CHU de Toulouse, Dept. Hematologie, France
| | - Avichai Shimoni
- Department of Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel
| | | | | | - Lucía López-Corral
- Hospital Clinico, Servicio de Hematologia, Instituto Biosanitario de Salamanca (IBSAL), Spain
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Israel EBMT Data Office, Hôpital Saint Antoine, Paris, France
| | - Mohamad Mohty
- Hôpital Saint Antoine, Service d'Hématologie et de Thérapie Cellulaire, Paris, France Université Pierre et Marie Curie, Paris, France INSERM UMRs938, CDR Saint Antoine, Paris, France EBMT Data Office, Hôpital Saint Antoine, Paris, France
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40
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Garciaz S, Castagna L, Bouabdallah R, Fürst S, Bramanti S, Coso D, Crocchiolo R, El-Cheikh J, Broussais F, Chabannon C, Santoro A, Blaise D. Familial haploidentical challenging unrelated donor Allo-SCT in advanced non-Hodgkin lymphomas when matched related donor is not available. Bone Marrow Transplant 2015; 50:865-7. [PMID: 25730187 DOI: 10.1038/bmt.2015.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- S Garciaz
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - L Castagna
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - R Bouabdallah
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - S Fürst
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - S Bramanti
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - D Coso
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - R Crocchiolo
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - J El-Cheikh
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - F Broussais
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - C Chabannon
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - A Santoro
- Department of Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - D Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
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41
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Reduced-intensity conditioned allogeneic SCT in adults with AML. Bone Marrow Transplant 2015; 50:759-69. [PMID: 25730186 DOI: 10.1038/bmt.2015.7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 02/08/2023]
Abstract
AML is currently the most common indication for reduced-intensity conditioned (RIC) allo-SCT. Reduced-intensity regimens allow a potent GVL response to occur with minimized treatment-related toxicity in patients of older age or with comorbidities that preclude the use of myeloablative conditioning. Whether RIC SCT is appropriate for younger and more standard risk patients is not well defined and the field is changing rapidly; a prospective randomized trial of myeloablative vs RIC (BMT-CTN 0901) was recently closed when early results indicated better outcomes for myeloablative regimens. However, detailed results are not available, and all patients in that study were eligible for myeloablative conditioning. RIC transplants will likely remain the standard of care as many patients with AML are not eligible for myeloablative conditioning. Recent publication of mature results from retrospective and prospective cohorts provide contemporary efficacy and toxicity data for these attenuated regimens. In addition, recent studies explore the use of alternative donors, introduce regimens that attempt to reduce toxicity without reducing intensity, and identify predictive factors that pave the way to personalized approaches. These studies paint a picture of the future of RIC transplants. Here we review the current status of RIC allogeneic SCT in AML.
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42
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Blaise D, Devillier R, Lecoroller-Sorriano AG, Boher JM, Boyer-Chammard A, Tabrizi R, Chevallier P, Fegueux N, Sirvent A, Michallet M, Bay JO, Fürst S, El-Cheikh J, Vincent L, Guillaume T, Regny C, Milpied N, Castagna L, Mohty M. Low non-relapse mortality and long-term preserved quality of life in older patients undergoing matched related donor allogeneic stem cell transplantation: a prospective multicenter phase II trial. Haematologica 2014; 100:269-74. [PMID: 25425691 DOI: 10.3324/haematol.2014.113571] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Allogeneic transplantation is a challenge in patients of advanced age because of a high risk of non-relapse mortality and potential long-lasting impairment of health-related quality of life. The development of reduced-intensity conditioning regimens has allowed the use of allogeneic transplantation in this population, but the optimal regimen remains undefined. We conducted a multicenter phase II trial evaluating the safety and efficacy of a reduced-intensity conditioning regimen combining fludarabine, intravenous busulfan, and rabbit antithymocyte globulins in patients older than 55 years of age transplanted from matched-related donor. In addition, health-related quality of life was prospectively measured. Seventy-five patients with a median age of 60 years (range 55-70) were analyzed. Grade III-IV acute and extensive chronic graft-versus-host diseases were found in 3% and 27% of patients, respectively. The day 100 and 1-year non-relapse mortality incidences were 1% and 9%, respectively. The cumulative incidences of relapse, progression-free survival and overall survival at two years were 36%, 51% and 67%, respectively, with a median follow up of 49 months. Global health-related quality of life, physical functioning, emotional functioning, and social functioning were not impaired compared to baseline for more than 75% of the patients (75%, 81.4%, 82.3%, and 75%, respectively). Thirty-four of the 46 (74%) progression-free patients at one year were living without persistent extensive chronic graft-versus-host disease. We conclude that the reduced-intensity conditioning regimen combining fludarabine, intravenous busulfan, and rabbit antithymocyte globulins is well tolerated in patients older than 55 years with low non-relapse mortality and long-term preserved quality of life.
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Affiliation(s)
- Didier Blaise
- Hematology Department, Transplantation Unit, Paoli Calmettes Institute, Marseille Centre de Recherche sur le Cancer de Marseille (CRCM), Inserm U 1068, Marseille Aix-Marseille University, Marseille
| | - Raynier Devillier
- Hematology Department, Transplantation Unit, Paoli Calmettes Institute, Marseille Centre de Recherche sur le Cancer de Marseille (CRCM), Inserm U 1068, Marseille Aix-Marseille University, Marseille
| | - Anne-Gaëlle Lecoroller-Sorriano
- Mixed Research Unit 912, Institute of Research and Development, National Institute of Health and Medical Research, Paoli Calmettes Institute, Aix-Marseille University, Marseille
| | - Jean-Marie Boher
- Clinical Trial Office and Biostatistics Unit, Paoli Calmettes Institute, Marseille
| | - Agnès Boyer-Chammard
- Clinical Trial Office and Biostatistics Unit, Paoli Calmettes Institute, Marseille
| | - Reza Tabrizi
- Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital Center, Pessac
| | | | | | - Anne Sirvent
- Hematology Department, University Hospital Center, Montpellier
| | | | | | - Sabine Fürst
- Hematology Department, Transplantation Unit, Paoli Calmettes Institute, Marseille
| | - Jean El-Cheikh
- Hematology Department, Transplantation Unit, Paoli Calmettes Institute, Marseille
| | - Laure Vincent
- Hematology Department, University Hospital Center, Montpellier
| | | | - Caroline Regny
- Hematology Department, University Hospital Center, Grenoble
| | - Noël Milpied
- Hematology Department, Haut-Leveque Hospital and Bordeaux University Hospital Center, Pessac
| | - Luca Castagna
- Hematology Department, Transplantation Unit, Paoli Calmettes Institute, Marseille
| | - Mohamad Mohty
- Hematology Department, University Hospital Center, Nantes CRNCA, UMR 892 INSERM - 6299 CNRS, and Université de Nantes, Faculté de Médecine, Nantes, France Hematology and Cellular Therapy Unit, AP-HP, Université Paris 6, Hôpital Saint Antoine, Paris, France
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43
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Ratanatharathorn V, Deol A, Ayash L, Cronin S, Bhutani D, Lum LG, Abidi M, Ventimiglia M, Mellert K, Uberti JP. Low-dose antithymocyte globulin enhanced the efficacy of tacrolimus and mycophenolate for GVHD prophylaxis in recipients of unrelated SCT. Bone Marrow Transplant 2014; 50:106-12. [PMID: 25285804 DOI: 10.1038/bmt.2014.203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/03/2014] [Accepted: 07/29/2014] [Indexed: 11/12/2022]
Abstract
We performed a retrospective analysis of the outcome of 197 consecutive unrelated donor transplant recipients who received GVHD prophylaxis either TM regimen (tacrolimus and mycophenolate) (121 patients) or TM/ATG-G regimen (TM with low-dose antithymocyte globulin (ATG) of 4.5 mg/kg, ATG-G, Genzyme) (76 patients). Cumulative incidences of grade II-IV acute GVHD for the TM and TM/ATG-G cohorts were 49% and 61% (P=0.11) and grade III-IV acute GVHD for the TM and TM/ATG-G cohorts were 27% and 14% (P=0.02), respectively. There was no difference in the incidence of relapse or disease progression between TM and TM/ATG-G-16% and 23% (P=0.64). TM/ATG-G cohort had lower incidence of non-relapse mortality (NRM; 37% vs 20%, P=0.01), chronic GVHD (56% vs 43%, P<0.001) and more favorable global chronic GVHD severity (P<0.001). Univariate analyses showed improved OS and PFS of patients who received TM/ATG-G. Multivariate analysis confirmed TM/ATG-G had a favorable influence on OS (P=0.05) but not on PFS (P=0.07). We concluded that low-dose ATG of 4.5 mg/kg given in conjunction with TM improved GVHD prophylaxis without increased risk of relapse. Lower NRM, lower incidence and severity of chronic GVHD could potentially improve survival.
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Affiliation(s)
- V Ratanatharathorn
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - A Deol
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - L Ayash
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - S Cronin
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - D Bhutani
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - L G Lum
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Abidi
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - M Ventimiglia
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - K Mellert
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - J P Uberti
- Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA
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Oudin C, Chevallier P, Furst S, Guillaume T, El Cheikh J, Delaunay J, Castagna L, Faucher C, Granata A, Devillier R, Chabannon C, Esterni B, Vey N, Mohty M, Blaise D. Reduced-toxicity conditioning prior to allogeneic stem cell transplantation improves outcome in patients with myeloid malignancies. Haematologica 2014; 99:1762-8. [PMID: 25085356 DOI: 10.3324/haematol.2014.105981] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The introduction of reduced intensity/toxicity conditioning regimens has allowed allogeneic hematopoietic cell transplantation to be performed in patients who were previously considered too old or otherwise unfit. Although it led to a reduction in non-relapse mortality, disease control remains a major challenge. We studied the outcome of 165 patients with acute myeloid leukemia (n=124) or myelodysplastic syndrome (n=41) transplanted after conditioning with fludarabine (30 mg/m(2)/day for 5 days), intravenous busulfan (either 260 mg/m(2): reduced intensity conditioning, or 390-520 mg/m(2): reduced toxicity conditioning), and rabbit anti-thymoglobulin (2.5 mg/kg/day for 2 days). The median age of the patients at transplantation was 56.8 years. The 2-year relapse incidence was 29% (23% versus 39% for patients transplanted in first complete remission and those transplanted beyond first complete remission, respectively; P=0.008). The 2-year progression-free survival rate was 57% (95% CI: 49.9-65). It was higher in the groups with favorable or intermediate cytogenetics than in the group with unfavorable cytogenetics (72.7%, 60.5%, and 45.7%, respectively; P=0.03). The cumulative incidence of grades 2-4 and 3-4 acute graft-versus-host disease at day 100 was 19.3% and 7.9%, respectively. The cumulative incidence of chronic graft-versus-host disease at 1 year was 21.6% (severe forms: 7.8%). Non-relapse mortality at 1 year reached 11%. The 2-year overall survival rate was 61.8% (95% CI: 54.8-69.7). Unfavorable karyotype and disease status beyond first complete remission were associated with a poorer survival. This well-tolerated conditioning platform can lead to long-term disease control and offers possibilities of modulation according to disease stage or further development.
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Affiliation(s)
- Claire Oudin
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France
| | - Patrice Chevallier
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France
| | - Sabine Furst
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Thierry Guillaume
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France
| | - Jean El Cheikh
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Jacques Delaunay
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France
| | - Luca Castagna
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Humanitas Cancer Center, Hematology Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | - Catherine Faucher
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Angela Granata
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Raynier Devillier
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | - Christian Chabannon
- Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France
| | - Benjamin Esterni
- Unité de Biostatistiques, Institut Paoli Calmettes, Marseille, France
| | - Norbert Vey
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | - Mohamad Mohty
- Centre Hospitalier Universitaire de Nantes, Service d'Hématologie Clinique, France Université de Nantes, Faculté de Médecine, France INSERM CRNCA UMR 892, Nantes, France Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France Université Pierre et Marie Curie, Paris, France INSERM, UMRs 938, Paris, France
| | - Didier Blaise
- Département d'Hématologie, Institut Paoli Calmettes, Marseille, France Aix-Marseille University, Marseille, France Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
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45
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Chantepie S, Gac A, Reman O. Feasibility of the fludarabine busulfan 3 days and ATG 2 days reduced toxicity conditioning in 51 allogeneic hematopoietic stem cell transplantation: A single-center experience. Leuk Res 2014; 38:569-74. [DOI: 10.1016/j.leukres.2014.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
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46
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Hamadani M. Antithymocyte Globulin in Reduced-Intensity Conditioning Allografting: Is the Benefit Simply in the Eyes of the Transplanter? Biol Blood Marrow Transplant 2014; 20:292-4. [DOI: 10.1016/j.bbmt.2013.12.571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 01/09/2023]
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47
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Saillard C, Crocchiolo R, Furst S, El-Cheikh J, Castagna L, Signori A, Oudin C, Faucher C, Lemarie C, Chabannon C, Granata A, Blaise D. National Institutes of Health classification for chronic graft-versus-host disease predicts outcome of allo-hematopoietic stem cell transplant after fludarabine-busulfan-antithymocyte globulin conditioning regimen. Leuk Lymphoma 2014; 55:1106-12. [PMID: 23822538 DOI: 10.3109/10428194.2013.820285] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract In 2005, the National Institutes of Health (NIH) proposed standard criteria for diagnosis, organ scoring and global assessment of chronic graft-versus-host disease (cGvHD) severity. We retrospectively reclassified cGvHD with NIH criteria in a monocentric cohort of 130 consecutive adult patients with hematological malignancies presenting cGvHD after receiving allo-hematopoietic stem cell transplant (HSCT) with a fludarabine-busulfan-antithymocyte globulin (ATG) conditioning regimen, among 313 consecutive HSCT recipients. We compared NIH and Seattle classifications to correlate severity and outcome. The follow up range was effectively 2-120 months. Forty-four percent developed Seattle-defined cGvHD (22% limited, 78% extensive forms). Using NIH criteria, there were 23%, 40% and 37% mild, moderate and severe forms, respectively, and 58%, 32% and 8% classic cGvHD, late acute GvHD and overlap syndrome. Five-year overall survival was 55% (49-61), and cumulative incidences of non-relapse mortality (NRM) and relapse/progression at 2 years were 19% (14-23) and 19% (14-24). NIH mild and moderate forms were associated with better survival compared to severe cGvHD (hazard ratio [HR] = 3.28, 95% confidence interval [CI]: 1.38-7.82, p = 0.007), due to higher NRM among patients with severe cGvHD (HR = 3.04, 95% CI: 1.05-8.78, p = 0.04) but comparable relapse risk (p = NS). In conclusion, the NIH classification appears to be more accurate in predicting outcome mostly by the reclassification of old-defined extensive forms into NIH-defined moderate or severe.
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Affiliation(s)
- Colombe Saillard
- Hematology Department, Institut Paoli-Calmettes , Marseille , France
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48
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Venton G, Crocchiolo R, Fürst S, Granata A, Oudin C, Faucher C, Coso D, Bouabdallah R, Berger P, Vey N, Ladaique P, Chabannon C, Merlin ML, Blaise D, El-Cheikh J. Risk factors of Ganciclovir-related neutropenia after allogeneic stem cell transplantation: a retrospective monocentre study on 547 patients. Clin Microbiol Infect 2014; 20:160-6. [DOI: 10.1111/1469-0691.12222] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/04/2013] [Accepted: 03/13/2013] [Indexed: 11/27/2022]
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49
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Baron F, Labopin M, Blaise D, Lopez-Corral L, Vigouroux S, Craddock C, Attal M, Jindra P, Goker H, Socié G, Chevallier P, Browne P, Sandstedt A, Duarte RF, Nagler A, Mohty M. Impact of in vivo T-cell depletion on outcome of AML patients in first CR given peripheral blood stem cells and reduced-intensity conditioning allo-SCT from a HLA-identical sibling donor: a report from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2014; 49:389-96. [PMID: 24419525 DOI: 10.1038/bmt.2013.204] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 12/16/2022]
Abstract
The impact of in vivo T-cell depletion on transplantation outcomes in patients transplanted with reduced-intensity conditioning (RIC) remains controversial. This study assessed the outcome of 1250 adult patients with de novo AML in first CR (CR1) given PBSC from HLA-identical siblings after chemotherapy-based RIC. A total of 554 patients did not receive any form of in vivo T-cell depletion (control group), whereas antithymocyte globulin (ATG) and alemtuzumab were given in 444 and 252 patients, respectively. The incidences of grade II-IV acute GVHD were 21.4, 17.6 and 10.2% in control, ATG and alemtuzumab patients, respectively (P<0.001). In multivariate analysis, the use of ATG and the use of alemtuzumab were each associated with a lower risk of chronic GVHD (P<0.001 each), but a similar risk of relapse, and of nonrelapse mortality, and similar leukemia-free survival and OS. Further, among patients given BU-based RIC, the use of <6 mg/kg ATG did not increase the risk of relapse (hazard ratio, HR=1.1), whereas there was a suggestion for higher relapse risk in patients given 6 mg/kg ATG (HR=1.4, P=0.08). In summary, these data suggest that a certain amount of in vivo T-cell depletion can be safely used in the conditioning of AML patients in CR1 given PBSC after chemotherapy-based RIC.
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Affiliation(s)
- F Baron
- Department of Hematology, University of Liège, Liège, Belgium
| | - M Labopin
- 1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France
| | - D Blaise
- Hematology, CHU de Marseille, Marseille, France
| | | | - S Vigouroux
- Hematology, CHU de Bordeaux, Bordeaux, France
| | - C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital and School of Cancer Studies, University of Birmingham, Birmingham, UK
| | - M Attal
- Hematology, CHU de Toulouse, Toulouse, France
| | - P Jindra
- Charles University Medical School and Teaching Hospital, Pilsen, Czech Republic
| | - H Goker
- BMT Unit, Department of Hematology, Hacettepe University, Ankara, Turkey
| | - G Socié
- Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France
| | | | - P Browne
- Hope Directorate, St James's Hospital, Dublin, Ireland, UK
| | - A Sandstedt
- Department of Hematology, University Hospital, Linköping, Sweden
| | - R F Duarte
- ICO-Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain
| | - A Nagler
- Hematology Division, Sheba medical Center, Tel-Aviv University, Tel-Hashomer, Israel
| | - M Mohty
- 1] Clinical Hematology and Cellular Therapy Department, Hospital Saint Antoine, APHP, Paris, France [2] EBMT ALWP Office, Hospital Saint Antoine, Paris, France [3] Universite Pierre et Marie Curie, Paris, France [4] INSERM UMRs 938, Paris, France
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50
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Devillier R, Fürst S, Crocchiolo R, El-Cheikh J, Castagna L, Harbi S, Granata A, D'Incan E, Coso D, Chabannon C, Picard C, Etienne A, Calmels B, Schiano JM, Lemarie C, Stoppa AM, Bouabdallah R, Vey N, Blaise D. A conditioning platform based on fludarabine, busulfan, and 2 days of rabbit antithymocyte globulin results in promising results in patients undergoing allogeneic transplantation from both matched and mismatched unrelated donor. Am J Hematol 2014; 89:83-7. [PMID: 24108528 DOI: 10.1002/ajh.23592] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/23/2013] [Accepted: 09/06/2013] [Indexed: 11/09/2022]
Abstract
Conditioning regimen including fludarabine, intravenous busulfan (Bx), and 5 mg/kg total dose of rabbit antithymocyte globulin (r-ATG) (FBx-ATG) results in low incidence of graft-versus-host disease (GVHD) and non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT) from HLA-matched related or unrelated donors (MUD). However, whether this platform produces similar results in the setting of one mismatch unrelated donor (MMUD) Allo-HSCT is not known. We retrospectively analyzed patients aged less than 65 years who were diagnosed with hematological malignancies and received FBx-ATG regimen prior to Allo-HSCT from MUD (N = 74) or MMUD (N = 40). We compared outcome of MUD versus MMUD patients. There was no difference in the cumulative incidence of grades II-IV acute GVHD (MUD: 34% vs. MMUD: 35%, P = 0.918), but MMUD patients developed more grade III-IV acute GVHD (MUD: 5% vs. MMUD: 15%, P = 0.016). The cumulative incidences of overall chronic GVHD (MUD: 33% vs. MMUD: 22%, P = 0.088) and extensive chronic GVHD (MUD: 20% vs. MMUD: 19%, P = 0.594) were comparable. One-year NRM was similar in both groups (MUD: 16% vs. MMUD: 14%, P = 0.292); similarly, progression-free survival (MUD: 59% vs. MMUD: 55%, P = 0.476) and overall survival (MUD: 63% vs. MMUD: 61%, P = 0.762) were not different between both groups. With a median follow up of 24 months, 35 of 74 MUD patients (47%) and 19 of 40 MMUD patients (48%) were free of both disease progression and immunosuppressive treatment. We conclude that the FBx-ATG regimen results in low incidences of NRM and GVHD in both MUD and the MMUD recipients.
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Affiliation(s)
- Raynier Devillier
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
| | - Sabine Fürst
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Roberto Crocchiolo
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Jean El-Cheikh
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Luca Castagna
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Humanitas Cancer Center, Hematology Unit; Instituto Clinico Humanitas; Rozzano Milano Italy
| | - Samia Harbi
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Angela Granata
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Evelyne D'Incan
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Diane Coso
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Christian Chabannon
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
- Institut Paoli-Calmettes, Centre de Thérapie Cellulaire (Cell Therapy Facility); F-13273 Marseille France
- Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie; F-13009 Marseille France
| | - Christophe Picard
- Laboratory of Histocompatibility; EFS Alpes Mediterrannée; Marseille France
| | - Anne Etienne
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Boris Calmels
- Institut Paoli-Calmettes, Centre de Thérapie Cellulaire (Cell Therapy Facility); F-13273 Marseille France
- Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie; F-13009 Marseille France
| | - Jean-Marc Schiano
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Claude Lemarie
- Institut Paoli-Calmettes, Centre de Thérapie Cellulaire (Cell Therapy Facility); F-13273 Marseille France
- Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie; F-13009 Marseille France
| | - Anne-Marie Stoppa
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Reda Bouabdallah
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
| | - Norbert Vey
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
| | - Didier Blaise
- Département d'Onco-Hématologie; Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire; F-13273 Marseille France
- Aix-Marseille Université; F-13007 Marseille France
- Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM); F-13009 Marseille France
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