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Naik S, Li Y, Talleur AC, Selukar S, Ashcraft E, Cheng C, Madden RM, Mamcarz E, Qudeimat A, Sharma A, Srinivasan A, Suliman AY, Epperly R, Obeng EA, Velasquez MP, Langfitt D, Schell S, Métais JY, Arnold PY, Hijano DR, Maron G, Merchant TE, Akel S, Leung W, Gottschalk S, Triplett BM. Memory T-cell enriched haploidentical transplantation with NK cell addback results in promising long-term outcomes: a phase II trial. J Hematol Oncol 2024; 17:50. [PMID: 38937803 PMCID: PMC11212178 DOI: 10.1186/s13045-024-01567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Relapse remains a challenge after transplantation in pediatric patients with hematological malignancies. Myeloablative regimens used for disease control are associated with acute and long-term adverse effects. We used a CD45RA-depleted haploidentical graft for adoptive transfer of memory T cells combined with NK-cell addback and hypothesized that maximizing the graft-versus-leukemia (GVL) effect might allow for reduction in intensity of conditioning regimen. METHODS In this phase II clinical trial (NCT01807611), 72 patients with hematological malignancies (complete remission (CR)1: 25, ≥ CR2: 28, refractory disease: 19) received haploidentical CD34 + enriched and CD45RA-depleted hematopoietic progenitor cell grafts followed by NK-cell infusion. Conditioning included fludarabine, thiotepa, melphalan, cyclophosphamide, total lymphoid irradiation, and graft-versus-host disease (GVHD) prophylaxis consisted of a short-course sirolimus or mycophenolate mofetil without serotherapy. RESULTS The 3-year overall survival (OS) and event-free-survival (EFS) for patients in CR1 were 92% (95% CI:72-98) and 88% (95% CI: 67-96); ≥ CR2 were 81% (95% CI: 61-92) and 68% (95% CI: 47-82) and refractory disease were 32% (95% CI: 11-54) and 20% (95% CI: 6-40). The 3-year EFS for all patients in morphological CR was 77% (95% CI: 64-87) with no difference amongst recipients with or without minimal residual disease (P = 0.2992). Immune reconstitution was rapid, with mean CD3 and CD4 T-cell counts of 410/μL and 140/μL at day + 30. Cumulative incidence of acute GVHD and chronic GVHD was 36% and 26% but most patients with acute GVHD recovered rapidly with therapy. Lower rates of grade III-IV acute GVHD were observed with NK-cell alloreactive donors (P = 0.004), and higher rates of moderate/severe chronic GVHD occurred with maternal donors (P = 0.035). CONCLUSION The combination of a CD45RA-depleted graft and NK-cell addback led to robust immune reconstitution maximizing the GVL effect and allowed for use of a submyeloablative, TBI-free conditioning regimen that was associated with excellent EFS resulting in promising long-term outcomes in this high-risk population. The trial is registered at ClinicalTrials.gov (NCT01807611).
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Affiliation(s)
- Swati Naik
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Ying Li
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Aimee C Talleur
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Subodh Selukar
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Emily Ashcraft
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Renee M Madden
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ewelina Mamcarz
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Amr Qudeimat
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ashok Srinivasan
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ali Y Suliman
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca Epperly
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Esther A Obeng
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - M Paulina Velasquez
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Deanna Langfitt
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sarah Schell
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jean-Yves Métais
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Paula Y Arnold
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Diego R Hijano
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gabriela Maron
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Salem Akel
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Wing Leung
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephen Gottschalk
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Brandon M Triplett
- Department of Bone Marrow Transplantation & Cellular Therapy, St Jude Children's Research Hospital, Memphis, TN, USA.
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Nishikawa T. Human Leukocyte Antigen-Haploidentical Haematopoietic Stem Cell Transplantation Using Post-Transplant Cyclophosphamide for Paediatric Haematological Malignancies. Cancers (Basel) 2024; 16:600. [PMID: 38339351 PMCID: PMC10854899 DOI: 10.3390/cancers16030600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
The use of human leukocyte antigen (HLA)-haploidentical haematopoietic stem cell transplantation (HSCT) with post-transplant cyclophosphamide (PTCY), which markedly reduces the risk of graft-versus-host disease, has rapidly increased worldwide, even in children. It was initially developed for post-transplant relapse or non-remission at transplant for patients with high-risk haematologic malignancies. However, this strategy is currently used more frequently for standard-risk, transplant-eligible paediatric haematological malignancies. It has recently been recognised in adults that the transplant outcomes after PTCY-based HLA-haploidentical HSCT are comparable with those achieved after HLA-matched HSCT. Therefore, even in children, parental donors who are HLA-haploidentical donors and cord blood are currently considered the next donor candidates when an HLA-matched related or unrelated donor is unavailable. This review addresses the current status of the use of haplo-HSCT with PTCY for paediatric haematologic malignancies and future directions for donor selection (sex, age, ABO blood type, and HLA disparity), donor source, the dose of infused CD34+ cells, optimal conditioning, the concomitant graft-versus-host disease prophylaxis other than PTCY, and the pharmacokinetic study of CY and CY metabolites. These aspects present key solutions for further improvements in the outcomes of haplo-HSCT with PTCY for paediatric haematological malignancies.
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Affiliation(s)
- Takuro Nishikawa
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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3
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Vigorito AC, Miranda ECM, Colturato VAR, Funke VAM, Fatobene G, Mariano L, Macedo MCMDA, Ribeiro LB, Daudt LE, Moreira MCR, Bonfim C, Colella MP, Seber A, Rodrigues M, Duarte FB, Martin PJ, Flowers MED. Chronic graft-versus-host-disease treatment in Brazil: analyses of failure-free survival. Transplant Cell Ther 2023; 29:276.e1-276.e7. [PMID: 36646321 DOI: 10.1016/j.jtct.2023.01.007] [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: 10/09/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
Failure-free survival (FFS), defined as the absence of new systemic treatment, recurrence of original malignancy and mortality not associated with recurrence after allogeneic hematopoietic stem cell transplantation (HCT), is a robust clinical measure to interpret results of initial systemic treatment of chronic graft-versus-host disease (cGVHD). We evaluate FFS after initial treatment of cGVHD in a mixed-race cohort from a resource-constrained country. This retrospective study included 354 consecutive patients after their first HCT between January 2014 and August 2020, who received initial systemic treatment for moderate or severe cGVHD at 13 Brazilian centers. Cox regression models were used to identify risk factors for treatment failure. The overall median follow-up among survivors was 28 months (range 1-71) after initial treatment. FFS was 89% at 6 months, 71% at 1 year and 52% at 2 years. New systemic treatment was the major cause of failure. In multivariable models, prior grades II-IV acute GVHD, a National Institutes of Health severity score of 3 in liver, gastrointestinal tract or lung involvement, and onset of initial treatment of cGVHD within 12 months after transplantation were all associated with an increased risk of treatment failure. Our results could serve as a benchmark for the design of future clinical trials evaluating initial treatment of cGVHD in resource-constrained locations.
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Affiliation(s)
- Afonso Celso Vigorito
- Hospital das Clínicas/Hemocentro da Universidade Estadual de Campinas, Campinas, SP, Brasil
| | | | | | | | | | - Livia Mariano
- Laboratório de Investigação Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Liane Esteves Daudt
- Hospital de Clínicas de Porto Alegre e Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Carmem Bonfim
- Instituto de Pesq0uisa Pele Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
| | - Marcos Paulo Colella
- Hospital das Clínicas/Hemocentro da Universidade Estadual de Campinas, Campinas, SP, Brasil
| | | | | | - Fernando Barroso Duarte
- Hospital Universitário Walter Cantidio, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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- Hospital das Clínicas/Hemocentro da Universidade Estadual de Campinas, Campinas, SP, Brasil
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Li T, He Q, Yang J, Cai Y, Huang C, Xu X, Qiu H, Niu J, Zhou K, Zhang Y, Xia X, Wei Y, Shen C, Ding X, Tong Y, Wan L, Song X. Low-Dose Anti-Thymocyte Globulin Plus Low-Dose Posttransplant Cyclophosphamide as an Effective Regimen for Prophylaxis of Graft Versus Host Disease After Haploidentical Peripheral Blood Stem Cell Transplantation With Maternal/Collateral Related Donors. Cell Transplant 2022; 31:9636897221139103. [PMID: 36433646 PMCID: PMC9706219 DOI: 10.1177/09636897221139103] [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] [Indexed: 11/27/2022] Open
Abstract
Maternal and collateral donors were associated with a higher incidence of graft-versus-host disease (GvHD) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT). A more effective regimen for GvHD prophylaxis after haplo-HSCT with maternal/collateral donors needed to be explored. A retrospective study was performed on 62 patients after haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with maternal/collateral donors, which included 35 patients with low-dose antithymocyte globulin (ATG) plus low-dose posttransplant cyclophosphamide-based (low-dose ATG/PTCy-based) and 27 with ATG-based regimens for GvHD prophylaxis. The 180-day cumulative incidences (CIs) of grades II-IV and III-IV acute GvHD (aGvHD) were 17.7% and 6.8% in low-dose ATG/PTCy-based group, which were significantly lower than that in ATG-based group (55.4% and 31.9%) (P = 0.003 for grade II-IV and P = 0.007 for III-IV aGvHD). In low-dose ATG/PTCy-based group, the 1-year overall survival (OS) and relapse-free survival (RFS) were 80.0%and 80.4%, which were higher than that in ATG-based group with OS of 59.4% and RFS of 62.0%. In multivariate analysis, the low-dose ATG/PTCy-based regimen significantly reduced the risk of grade II-IV (HR = 0.357; P = 0.049) and grade III-IV aGvHD (HR = 0.190; P = 0.046) as an independent risk factor. The results suggested that the low-dose ATG/PTCy-based regimen could effectively prevent the occurrence of aGvHD after haplo-PBSCT with maternal/collateral donors compared with the ATG-based regimen.
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Affiliation(s)
- Ting Li
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Qiaomei He
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Jun Yang
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Yu Cai
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Chongmei Huang
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Xiaowei Xu
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Huiying Qiu
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Jiahua Niu
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Kun Zhou
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Yin Zhang
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Xinxin Xia
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Yu Wei
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Chang Shen
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Xueying Ding
- Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Yin Tong
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Liping Wan
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China
| | - Xianmin Song
- Department of Hematology, Shanghai
General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai,
China,Engineering Technology Research Center
of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee,
Shanghai, China,Xianmin Song, Department of Hematology,
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.
100 Haining Road, Shanghai 200080, China.
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5
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[Chinese expert consensus of the allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia (not APL) (2022)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:802-809. [PMID: 36709193 PMCID: PMC9669633 DOI: 10.3760/cma.j.issn.0253-2727.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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