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Qayed M, Kapoor U, Gillespie S, Westbrook A, Aguayo-Hiraldo P, Ayuk FA, Aziz M, Baez J, Choe H, DeFilipp Z, Etra A, Grupp SA, Hexner E, Holler E, Hogan WJ, Kowalyk S, Merli P, Morales G, Nakamura R, Pulsipher MA, Schechter T, Shah J, Spyrou N, Srinagesh HK, Wölfl M, Yanik G, Young R, Kitko CL, Ferrara JL, Levine JE. A Validated Risk Stratification That Incorporates MAGIC Biomarkers Predicts Long-Term Outcomes in Pediatric Patients with Acute GVHD. Transplant Cell Ther 2024; 30:603.e1-603.e11. [PMID: 38548227 PMCID: PMC11139591 DOI: 10.1016/j.jtct.2024.03.022] [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: 01/29/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
Acute graft versus host disease (GVHD) is a common and serious complication of allogeneic hematopoietic cell transplantation (HCT) in children but overall clinical grade at onset only modestly predicts response to treatment and survival outcomes. Two tools to assess risk at initiation of treatment were recently developed. The Minnesota risk system stratifies children for risk of nonrelapse mortality (NRM) according to the pattern of GVHD target organ severity. The Mount Sinai Acute GVHD International Consortium (MAGIC) algorithm of 2 serum biomarkers (ST2 and REG3α) predicts NRM in adult patients but has not been validated in a pediatric population. We aimed to develop and validate a system that stratifies children at the onset of GVHD for risk of 6-month NRM. We determined the MAGIC algorithm probabilities (MAPs) and Minnesota risk for a multicenter cohort of 315 pediatric patients who developed GVHD requiring treatment with systemic corticosteroids. MAPs created 3 risk groups with distinct outcomes at the start of treatment and were more accurate than Minnesota risk stratification for prediction of NRM (area under the receiver operating curve (AUC), .79 versus .62, P = .001). A novel model that combined Minnesota risk and biomarker scores created from a training cohort was more accurate than either biomarkers or clinical systems in a validation cohort (AUC .87) and stratified patients into 2 groups with highly different 6-month NRM (5% versus 38%, P < .001). In summary, we validated the MAP as a prognostic biomarker in pediatric patients with GVHD, and a novel risk stratification that combines Minnesota risk and biomarker risk performed best. Biomarker-based risk stratification can be used in clinical trials to develop more tailored approaches for children who require treatment for GVHD.
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Affiliation(s)
- Muna Qayed
- Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Urvi Kapoor
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA
| | - Adrianna Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA
| | - Paibel Aguayo-Hiraldo
- Division of Hematology, Oncology, and BMT, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Francis A. Ayuk
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mina Aziz
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Janna Baez
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hannah Choe
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - Aaron Etra
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephan A. Grupp
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth Hexner
- Blood and Marrow Transplantation Program, Abramson Cancer Center and the Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ernst Holler
- Department of Hematology and Oncology, Internal Medicine III, University of Regensburg, Regensburg, Germany
| | | | - Steven Kowalyk
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pietro Merli
- Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy
| | - George Morales
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryotaro Nakamura
- Hematology/Hematopoietic Cell Transplant, City of Hope National Medical Center, Duarte, CA
| | - Michael A. Pulsipher
- Division of Hematology, Oncology, and BMT, Children’s Hospital Los Angeles, Los Angeles, CA
- Division of Hematology and Oncology, Intermountain Primary Children’s Hospital, Huntsman Cancer Institute at the Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT
| | - Tal Schechter
- Division of Hematology / Oncology / BMT, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jay Shah
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikolaos Spyrou
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hrishikesh K. Srinagesh
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthias Wölfl
- Pediatric Blood and Marrow Transplantation Program, Children’s Hospital, University of Würzburg, Würzburg, Germany
| | - Gregory Yanik
- Pediatric Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI
| | - Rachel Young
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carrie L. Kitko
- Pediatric Blood and Marrow Transplant Program, Vanderbilt University Medical Center, Nashville, TN
| | - James L.M. Ferrara
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John E. Levine
- The Tisch Cancer Institute and Division of Hematology / Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
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Gao L, Yang L, Zhou S, Zhu W, Han Y, Chen S, Xue S, Wang Y, Qiu H, Wu D, Wu X. Allogenic hematopoietic stem cell transplantation outcomes of patients aged ≥ 55 years with acute myeloid leukemia or myelodysplastic syndromes in China: a retrospective study. Stem Cell Res Ther 2024; 15:24. [PMID: 38282037 PMCID: PMC10823660 DOI: 10.1186/s13287-024-03640-4] [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: 10/02/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Elderly patients with acute myeloid leukemia or myelodysplastic syndromes (AML/MDS) have historically had poor prognoses. However, there has been a recent increase in the use of allogenic hematopoietic stem cell transplantation (allo-HSCT) are in this patient population. Nevertheless, the optimal choice of donor type for the patients remains an unmet need. Limited data exist on the use of allo-HSCT in elderly patients with AML/MDS from China. To better understand and optimize the selection of donor type for the elderly patients, particularly for those with refractory or relapsed disease, in comparison with the previous studies in the US and Europe. METHODS Our retrospective study enrolled 259 patients aged over 55 years who underwent their first allo-HSCT between April 2015 and August 2022. These patients were divided into three groups based on donor type: haploidentical related donor group (haploidentical related donor transplantation [HID], n = 184), matched sibling donor group (matched sibling donor transplantation [MSD], n = 39), and matched unrelated donor group (matched unrelated donor transplantation [MUD], n = 36). Statistics were performed with the chi-square test, the log-rank and Fine-Gray tests. RESULTS The median age of the cohort was 57 years (range: 55-75) and 26.25% of patients were over 60 years old. Younger patients had a higher incidence of acute graft-versus-host disease (HR = 1.942, P = 0.035), faster neutrophil recovery (HR = 1.387, P = 0.012), and better overall survival (HR = 0.567, P = 0.043) than patients aged ≥ 60 years across the entire cohort. Patients with refractory or relapsed (R/R) diseases had delayed neutrophil engraftment (P = 0.010, HR = 0.752) and platelet engraftment (P < 0.001, HR = 0.596), higher incidence of relapses (HR = 2.300, P = 0.013), and inferior relapse-free survival (RFS) (HR = 1.740, HR = 0.016) regardless of donor type. When it came to graft-versus-host-disease-free, relapse-free survival (GRFS), MUDs turned out to be superior to HIDs (HR = 0.472, P = 0.026) according to the multivariable analysis. In contrast, we found MSDs had an inferior GRFS to HIDs in parallel (HR = 1.621, P = 0.043). CONCLUSION The choice of donor type did not significantly affect the outcomes of allo-HSCT. However, when considering the quality of post-transplant life, MUDs or HIDs from younger donors may be the optimal choice for elderly patients.
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Affiliation(s)
- Lu Gao
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Li Yang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Tongren Hospital Shanghai Jiao Tong University School of Medicine, 111 Xianxia Road, Shanghai, China
| | - Shiyuan Zhou
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Wenjuan Zhu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Yue Han
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Suning Chen
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Shengli Xue
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Ying Wang
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China
| | - Huiying Qiu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China.
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China.
| | - Xiaojin Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China.
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
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Huo WX, Wen Q, Zhang XH, Xu LP, Wang Y, Yan CH, Chen H, Chen YH, Han W, Wang FR, Wang JZ, Huang XJ, Mo XD. Outcomes of haploidentical haematopoietic stem cell transplantation for adolescent and young adults with acute myeloid leukaemia. Br J Haematol 2023; 202:856-865. [PMID: 37365147 DOI: 10.1111/bjh.18937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
We aimed to identify the efficacy of haploidentical related donor (HID) haematopoietic stem cell transplantation (HSCT) in adolescent and young adults (AYAs) with acute myeloid leukaemia (AML) in a large cohort. Consecutive AML AYAs (15-39 years old, n = 599) receiving HID HSCT in complete remission (CR) were included. The 3-year cumulative incidence of measurable residual disease occurrence, relapse and non-relapse mortality after HID HSCT was 28.6% (95% CI: 25.0-32.2), 11.6% (95% CI: 9.0-14.2) and 6.7% (95% CI: 4.7-8.7) respectively. The 3-year probability of event-free survival, leukaemia-free survival (LFS) and overall survival (OS) after HID HSCT was 60.7% (95% CI: 56.9-64.8), 81.7% (95% CI: 78.7-84.9) and 85.6% (95% CI: 82.8-88.4) respectively. In multivariable analysis, AML risk category at diagnosis and comorbidity burdens before HID HSCT were independently associated with LFS and OS. Compared to the older adults (≥ 40 years, n = 355) with AML receiving HID HSCT in CR during the same time period, AYAs have a lower incidence of non-relapse mortality and higher probabilities of LFS and OS. Thus, we firstly confirmed the safety and efficacy of HID HSCT in AYAs with AML-CR.
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Affiliation(s)
- Wen-Xuan Huo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Qi Wen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies (2019RU029), Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
- Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies (2019RU029), Chinese Academy of Medical Sciences, Beijing, China
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4
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Levitte S, Ganguly A, Frolik S, Guevara-Tique AA, Patel S, Tadas A, Klein O, Shyr D, Agarwal-Hashmi R, Beach L, Callard E, Weinacht K, Bertaina A, Thakor AS. Precision Delivery of Steroids as a Rescue Therapy for Gastrointestinal Graft-versus-Host Disease in Pediatric Stem Cell Transplant Recipients. J Clin Med 2023; 12:4229. [PMID: 37445274 DOI: 10.3390/jcm12134229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Graft versus host disease (GVHD) is one of the most serious complications following stem cell transplant in children and is a major cause of morbidity and mortality. Corticosteroids remain the mainstay of treatment, and although a majority of children respond to systemic steroids, those refractory to or dependent upon corticosteroids suffer from complications secondary to long-term steroid administration. This problem has prompted consideration of steroid-sparing treatment strategies, although the time to clinical remission can be variable. Intraarterial corticosteroid delivery has been used in adults as a rescue therapy in steroid-resistant patients, but its use in children has been limited. We investigated the feasibility of intraarterial steroid administration into the bowel and/or liver in a cohort of six pediatric patients with acute GVHD. All patients successfully underwent treatment with no serious adverse effects. Five of five (100%) patients with gastrointestinal bleeding due to GVHD had rapid symptom improvement by 48 h, which was durable up to three weeks. Three of four (75%) patients with hepatic GVHD had improved cholestasis following intraarterial steroid administration. Our experience with this small cohort preliminarily demonstrated the feasibility and safety of intraarterial steroid administration in children with acute GVHD. This approach warrants consideration as a rescue therapy in steroid-refractory cases and as a "bridge" therapy for children with severe acute GVHD who are transitioning to steroid-sparing regimens.
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Affiliation(s)
- Steven Levitte
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, Palo Alto, CA 94304, USA
| | - Abantika Ganguly
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Sophie Frolik
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Alix A Guevara-Tique
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Shaini Patel
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
| | - Ann Tadas
- Department of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USA
| | - Orly Klein
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - David Shyr
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Rajni Agarwal-Hashmi
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Lynn Beach
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Elizabeth Callard
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Katja Weinacht
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Alice Bertaina
- Division of Pediatric Hematology/Oncology, Stem Cell Transplantation, and Regenerative Medicine, Stanford University, Palo Alto, CA 94304, USA
| | - Avnesh S Thakor
- Interventional Radiology Innovation at Stanford (IRIS), 3155 Porter Drive, Palo Alto, CA 94304, USA
- Department of Pediatric Radiology, Interventional Radiology, Stanford University, Palo Alto, CA 94304, USA
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