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Ma CKK, Clancy L, Simms R, Burgess J, Deo S, Blyth E, Micklethwaite KP, Gottlieb DJ. Adjuvant Peptide Pulsed Dendritic Cell Vaccination in Addition to T Cell Adoptive Immunotherapy for Cytomegalovirus Infection in Allogeneic Hematopoietic Stem Cell Transplantation Recipients. Biol Blood Marrow Transplant 2017; 24:71-77. [PMID: 28864137 DOI: 10.1016/j.bbmt.2017.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
Adoptive cellular immunotherapy has been shown to be effective in the management of cytomegalovirus (CMV) reactivation and disease. Whether adjuvant dendritic cell (DC) vaccination will provide additional benefit in prophylaxis or treatment of CMV in hematoietic cell transplantation (HSCT) recipients is unknown. In this study, we administered prophylactic CMV-peptide specific T cell infusions, followed by 2 doses of intradermal CMV peptide-pulsed DC vaccine, to 4 HSCT recipients. There were no immediate adverse events associated with T cell infusion or DC vaccinations. One of the 4 patients developed grade III acute gut graft-versus-host disease. Immune reconstitution against CMV was detected in all 4 patients. Patients receiving CMV peptide-specific T cells and DC vaccination had peak immune reconstitution at least 10 days after the second DC vaccination. In summary, combining DC vaccine with T cell infusion appears feasible, although further study is required to ascertain its safety and efficacy in augmenting the effects of infusing donor-derived CMV-specific T cells.
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Affiliation(s)
- Chun K K Ma
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Leighton Clancy
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, Sydney, Australia
| | - Renee Simms
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, Sydney, Australia
| | - Jane Burgess
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, Sydney, Australia
| | - Shivashni Deo
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Emily Blyth
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, Sydney, Australia
| | - Kenneth P Micklethwaite
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, Sydney, Australia
| | - David J Gottlieb
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; Blood and Marrow Transplant Unit, Westmead Hospital, Sydney, Australia; Sydney Cell and Gene Therapy Laboratory, Westmead Hospital, Sydney, Australia.
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2
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Tessoulin B, Ceballos P, Chevallier P, Blaise D, Tournilhac O, Gauthier J, Maillard N, Tabrizi R, Choquet S, Carras S, Ifrah N, Guillerm G, Mohty M, Tilly H, Socie G, Cornillon J, Hermine O, Daguindau É, Bachy E, Girault S, Marchand T, Oberic L, Reman O, Leux C, Le Gouill S. Allogeneic stem cell transplantation for patients with mantle cell lymphoma who failed autologous stem cell transplantation: a national survey of the SFGM-TC. Bone Marrow Transplant 2016; 51:1184-90. [PMID: 27111043 DOI: 10.1038/bmt.2016.102] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 11/09/2022]
Abstract
Poly-chemotherapy plus rituximab followed by autologous stem cell transplantation (auto-SCT) is standard care for untreated young patients with mantle cell lymphoma (MCL). Despite this intensive treatment, transplant patients remain highly susceptible to relapse over time. The French SFGM-TC performed a national survey on reduced-intensity conditioning allogeneic stem cell transplantation (RIC-allo-SCT) for fit relapsed/refractory patients who failed after auto-SCT (n=106). Median times of relapse after auto-SCT, and from auto-SCT to RIC-allo-SCT were 28 months and 3.6 years, respectively. Sixty per cent of patients received at least three lines of treatment before RIC-allo-SCT. Conditioning regimens for RIC-allo-SCT were heterogeneous. Twenty patients experienced grade III/IV aGvHD, extensive cGvHD was reported in 28 cases. Median follow-up after RIC-allo-SCT was 45 months. Median PFS after RIC-allo-SCT was 30.1 months and median overall survival was 62 months. Treatment-related mortality (TRM) at 1 year and 3 years were estimated at 28% and 32%, respectively. A total of 52 patients died; major causes of death were related to toxicity (n=34) and MCL (n=11). Patients in good response before RIC-allo-SCT experienced a better PFS and OS. Our work highlights the need for new RIC-allo-SCT MCL-tailored approaches to reduce TRM, and early and late relapse.
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Affiliation(s)
- B Tessoulin
- Department of Hematology, University Hospital, Nantes, France.,INSERM team 10 UMR 892, CRCNA, Nantes, France
| | - P Ceballos
- Department of Hematology, University Hospital, Montpellier, France
| | - P Chevallier
- Department of Hematology, University Hospital, Nantes, France
| | - D Blaise
- Department of Hematology, Paoli Calmettes, Marseille, France
| | - O Tournilhac
- Department of Hematology, University Hospital, Clermont-Ferrand, France
| | - J Gauthier
- Department of Hematology, University Hospital, Lille, France
| | - N Maillard
- Department of Hematology, University Hospital, Poitiers, France
| | - R Tabrizi
- Department of Hematology, University Hospital, Bordeaux, France
| | - S Choquet
- Department of Hematology, Pitie Salpetriere, Paris, France
| | - S Carras
- Department of Hematology, University Hospital, Grenoble, France
| | - N Ifrah
- Department of Hematology, University Hospital, Angers, France
| | - G Guillerm
- Department of Hematology, University Hospital, Brest, France
| | - M Mohty
- Department of Hematology, University Hospital-Saint Antoine, Paris, France
| | - H Tilly
- Department of Hematology, Centre Henri-Becquerel, Rouen, France
| | - G Socie
- Department of Hematology, Saint Louis Hospital, Paris, France
| | - J Cornillon
- Department of Hematology, Institut de Cancerologie de la Loire, Saint Etienne, France
| | - O Hermine
- Department of Hematology, Necker Hospital, Paris, France
| | - É Daguindau
- Department of Hematology, University Hospital, Besancon, France
| | - E Bachy
- Department of Hematology, University hospital, Lyon, France
| | - S Girault
- Department of Hematology, University Hospital, Limoges, France
| | - T Marchand
- Department of Hematology, University Hospital, Rennes, France
| | - L Oberic
- University Cancer Institute, Toulouse, France
| | - O Reman
- Department of Hematology, University Hospital, Caen, France
| | - C Leux
- Department of Epidemiology, University Hospital of Nantes, Nantes, France
| | - S Le Gouill
- Department of Hematology, University Hospital, Nantes, France.,INSERM team 10 UMR 892, CRCNA, Nantes, France.,Centre d'Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, Nantes, France
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3
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Vaughn JE, Sorror ML, Storer BE, Chauncey TR, Pulsipher MA, Maziarz RT, Maris MB, Hari P, Laport GG, Franke GN, Agura ED, Langston AA, Rezvani AR, Storb R, Sandmaier BM, Maloney DG. Long-term sustained disease control in patients with mantle cell lymphoma with or without active disease after treatment with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. Cancer 2015. [PMID: 26207349 DOI: 10.1002/cncr.29498] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previously, early results were reported for allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning with 2 Gy of total body irradiation with or without fludarabine and/or rituximab in 33 patients with mantle cell lymphoma (MCL). METHODS This study examined the outcomes of 70 patients with MCL and included extended follow-up (median, 10 years) for the 33 initial patients. Grafts were obtained from human leukocyte antigen (HLA)-matched, related donors (47%), unrelated donors (41%), and HLA antigen-mismatched donors (11%). RESULTS The 5-year incidence of nonrelapse mortality was 28%. The relapse rate was 26%. The 5-year rates of overall survival (OS) and progression-free survival (PFS) were 55% and 46%, respectively. The 10-year rates of OS and PFS were 44% and 41%, respectively. Eighty percent of surviving patients were off immunosuppression at the last follow-up. The presence of relapsed or refractory disease at the time of HCT predicted a higher rate of relapse (hazard ratio [HR], 2.94; P = .05). Despite this, OS rates at 5 (51% vs 58%) and 10 years (43% vs 45%) were comparable between those with relapsed/refractory disease and those undergoing transplantation with partial or complete remission. A high-risk cytomegalovirus (CMV) status was the only independent predictor of worse OS (HR, 2.32; P = .02). A high-risk CMV status and a low CD3 dose predicted PFS (HR, 2.22; P = .03). CONCLUSIONS Nonmyeloablative allogeneic HCT provides a long-term survival benefit for patients with relapsed MCL, including those with refractory disease or multiple relapses.
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Affiliation(s)
- Jennifer E Vaughn
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Barry E Storer
- Clinical Statistics Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Thomas R Chauncey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Marrow Transplant Unit, VA Puget Sound Health Care System, Seattle, Washington
| | - Michael A Pulsipher
- Pediatric Blood and Marrow Transplant Program, Primary Children's Hospital, Salt Lake City, Utah.,Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Parameswaran Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ginna G Laport
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Georg N Franke
- Division of Hematology, Oncology, and Hemostaseology, Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Edward D Agura
- Hematopoietic Stem Cell Program, Baylor University School of Medicine, Dallas, Texas
| | - Amelia A Langston
- Division of Hematology-Oncology, Emory University School of Medicine, Atlanta, Georgia.,Bone Marrow & Stem Cell Transplant Center, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Rainer Storb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - David G Maloney
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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4
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Abstract
Mantle cell lymphoma as a rare non-Hodgkin B-cell lymphoma can present in different clinical presentations such as an aggressive form or a more indolent picture. Treatment modality is based on multiple factors including age, presence or absence of symptoms, and comorbidities. Watchful waiting is a reasonable approach for asymptomatic patients especially in elderly. In symptomatic patients, treatment is chemo-immunotherapy followed by maintenance immunotherapy or autologous bone marrow transplant. Allogeneic bone marrow transplant has a potential benefit of cure for relapsed/refractory cases, but it has a high mortality rate. Novel treatment with agents such as ibrutinib, a Bruton tyrosine kinase inhibitor, has shown promising results in relapse/refractory cases. We extensively review the most recent data on diagnostic and therapeutic management of mantle cell lymphoma through presenting two extreme clinical scenarios.
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Affiliation(s)
- Babak Rajabi
- University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV 89102, USA
| | - John W Sweetenham
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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5
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Cassaday RD, Gopal AK. Allogeneic hematopoietic cell transplantation in mantle cell lymphoma. Best Pract Res Clin Haematol 2012; 25:165-74. [PMID: 22687452 DOI: 10.1016/j.beha.2012.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mantle cell lymphoma (MCL) is a high-risk non-Hodgkin lymphoma that is considered incurable with standard chemotherapy. While autologous hematopoietic cell transplantation (autoHCT) can provide lengthy disease-free survival in select patients, cure generally is not an expected outcome with this approach. Allogeneic hematopoietic cell transplantation (alloHCT), which can exploit the potential benefits of graft-versus-lymphoma (GVL) effect, has been shown in multiple studies to yield a small but reproducible portion of patients with long-term remission more suggestive of cure. Historically, alloHCT for MCL was administered after myeloablative conditioning, but this approach was limited by early non-relapse mortality. Development of reduced-intensity (RI)-alloHCT has abrogated some of the early post-transplant risks, allowing this potentially effective therapy to be offered to a larger number of affected individuals. The trends in published data reflect a preference toward using RI-alloHCT for MCL, often because patients in whom alloHCT is being considered have relapsed disease following myeloablative autoHCT. Further efforts to spare the effects of graft-versus-host disease (GVHD) while still evoking GVL remain a focus of investigation in this area. In this review, we will discuss the application of alloHCT in the management of MCL, the factors associated with outcome, the different methods in which it can be performed, and the strategies that can be employed in post-alloHCT relapse.
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Affiliation(s)
- Ryan D Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109, USA
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6
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Hallam S, Gribben JG. Stem cell transplantation in chronic lymphocytic leukaemia - steering a safe course over shifting sands. Best Pract Res Clin Haematol 2011; 23:109-19. [PMID: 20620975 DOI: 10.1016/j.beha.2009.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is no clear consensus regarding the optimal management of chronic lymphocytic leukaemia. Many patients are diagnosed at an advanced age and will die with chronic lymphocytic leukaemia, but of other unrelated causes. A significant minority are diagnosed at an earlier age, or with more aggressive disease, and despite chemotherapy, are likely to die of chronic lymphocytic leukaemia. The infusion of autologous or allogeneic haemopoietic stem cells, following a variety of conditioning regimes, offers the possibility of longer remissions or even cure. We explore the key questions facing clinicians in this field: Who is it best to transplant? When is it best to transplant? How is it best to transplant?
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Affiliation(s)
- Simon Hallam
- Institute of Cancer, Bart's and the London School of Medicine, Charterhouse Square, London, EC1M 6BQ, UK
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7
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Grigg AP, Stone J, Milner AD, Schwarer AP, Wolf M, Prince HM, Seymour J, Gill D, Ellis D, Bashford J. Phase II study of autologous stem cell transplant using busulfan-melphalan chemotherapy-only conditioning followed by interferon for relapsed poor prognosis follicular non-Hodgkin lymphoma. Leuk Lymphoma 2010; 51:641-9. [PMID: 20218809 DOI: 10.3109/10428191003611428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Alpha interferon has proven efficacy in prolonging remissions in patients with follicular non-Hodgkin lymphoma (NHL) when given concurrently with or after conventional-dose anthracycline-based chemotherapy, but there are limited data on its use after myeloablative conditioning. We prospectively evaluated the toxicity and efficacy of interferon given thrice weekly for up to 5 years post-engraftment in patients with relapsed follicular NHL undergoing autologous stem cell transplant using busulfan-melphalan conditioning. Thirty-seven patients were enrolled in this Australasian Leukaemia & Lymphoma Group study and transplanted between 1995 and 1999. Only one patient had received prior rituximab. Two patients died of transplant-related toxicity; 28 of the remainder commenced interferon, but it was discontinued prematurely in most patients due to toxicity (mainly fatigue and depression) or relapse. While the majority of patients (29/36 evaluable: 81%) achieved a complete remission based on clinical and CT scan criteria post-transplant, most relapsed relatively early, with a median progression-free survival of 2.4 years. The overall survival at 7 years was 49%. Eight patients (22%), however, remain alive a median of 9.3 years post-transplant, having never relapsed, and another six patients (16%) remain alive in durable remission after salvage therapy. These results demonstrate that interferon is poorly tolerated post-autograft and hence is unlikely to positively contribute to patient outcome. Long-term follow-up demonstrates that autografting may result in durable remissions in a meaningful minority of patients with relapsed follicular NHL.
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Affiliation(s)
- Andrew P Grigg
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia.
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8
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Hallam S, Gribben JG. Transplantation in chronic lymphocytic leukemia: timing and expectations. ACTA ACUST UNITED AC 2010; 9 Suppl 3:S186-93. [PMID: 19778839 DOI: 10.3816/clm.2009.s.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Stem cell transplantation in chronic lymphocytic leukemia (CLL) is an evolving field. Younger patients with high-risk disease might derive the greatest benefit from this approach and the availability of reduced-intensity conditioning regimens has made allogeneic stem cell transplantation more relevant to patients with CLL. Patient selection, timing of transplantation, and method of conditioning, stem cell delivery and immunosuppression appear to influence outcomes. We collect and review the available data to assist clinical decision-making in this field.
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Affiliation(s)
- Simon Hallam
- Institute of Cancer, Bart's and the London School of Medicine, Charterhouse Square, London, EC1M 6BQ, UK
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9
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Patil S, Spencer A, Schwarer A, Lewis I, Hertzberg M, Avery S, Wei A, Noutsos T, Paul E, Taouk Y, Muirhead J. Reduced-intensity conditioned allogeneic haematopoietic stem cell transplantation results in durable disease-free and overall survival in patients with poor prognosis myeloid and lymphoid malignancies: eighty-month follow-up. Bone Marrow Transplant 2009; 45:1154-60. [PMID: 19898502 DOI: 10.1038/bmt.2009.322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The long-term outcome of patients with haematological malignancies treated with reduced-intensity conditioned allogeneic peripheral blood stem cell transplantation is not known. We report the outcome of 79 patients with poor-risk myeloid and lymphoid malignancies transplanted with reduced-intensity conditioning (RIC) regimens. The diagnoses include AML/myelodysplastic syndrome (n=43), non Hodgkin's lymphoma (n=30), Hodgkin's lymphoma (n=3), ALL (n=2) and CML (n=1). For the entire cohort, the disease-free survival (DFS) and OS were 61.2 and 35.7%, respectively. Twenty patients relapsed, 18 within the first three years, and 14 patients succumbed to progressive disease. Overall, 31 patients died from transplant-related complications within the first three years. Day 100 non-relapse mortality correlated with a higher total nucleated cell dose in the graft (odds ratio: 3.9). For those in CR at 3 years, the DFS and OS were 84.2 and 81.1%, respectively. Furthermore, of 43 patients with active disease at the time of transplantation, 16 remained in CR after 3 years. The majority of the long-term survivors were functioning independently. One patient died from a second malignancy. No post-transplant lymphoproliferative disorder was seen. In conclusion, durable disease control was achieved after RIC allogeneic stem cell transplantation for patients with advanced myeloid and lymphoid malignancies.
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Affiliation(s)
- S Patil
- Department of Malignant Haematology and Stem Cell Transplantation, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia.
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10
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Ritchie DS. Is allogeneic stem cell transplantation for transformed follicular lymphoma anti-lymphoma stem cell therapy? Leuk Lymphoma 2009; 49:1852-3. [DOI: 10.1080/10428190802491714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Inwards DJ, Fishkin PAS, Hillman DW, Brown DW, Ansell SM, Kurtin PJ, Fonseca R, Morton RF, Veeder MH, Witzig TE. Long-term results of the treatment of patients with mantle cell lymphoma with cladribine (2-CDA) alone (95-80-53) or 2-CDA and rituximab (N0189) in the North Central Cancer Treatment Group. Cancer 2008; 113:108-16. [PMID: 18470909 DOI: 10.1002/cncr.23537] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to test cladribine (2-CDA) alone and in combination with rituximab in patients with mantle cell lymphoma (MCL). METHODS Patients with MCL were treated on 2 sequential trials. In Trial 95-80-53, patients received 2-CDA as initial therapy or at relapse. In Trial N0189, patients received combination 2-CDA and rituximab as initial therapy. In both trials, 2-CDA was administered at a dose of 5 mg/m2 intravenously on Days 1 through 5 every 4 weeks for 2 to 6 cycles, depending on response. In Trial N0189, rituximab 375 mg/m2 was administered on Day 1 of each cycle. RESULTS Results were reported for 80 patients. Twenty-six previously untreated patients and 25 patients who had recurrent disease with a median age of 68 years received single-agent 2-CDA. The overall response rate (ORR) was 81% with 42% complete responses (CRs) in the previously untreated group. The median progression-free survival (PFS) was 13.6 months (95% confidence interval [95% CI], 7.2-22.1 months), and 81% of patients remained alive at 2 years. The ORR was 46% with a 21% CR rate in the recurrent disease group. The median PFS was 5.4 months (95% CI, 4.6-13.1 months), and 36% of patients remained alive at 2 years. Twenty-nine eligible patients with a median age of 70 years received 2-CDA plus rituximab. The ORR was 66% (19 of 29 patient), and the CR rate was 52% (15 of 29 patients). The median duration of response for patients who achieved a CR had not been reached at the time of the current report, and only 3 of the patients who achieved a CR developed recurrent disease at a median follow-up of 21.5 months. CONCLUSIONS 2-CDA had substantial single-agent activity in both recurrent and untreated MCL, and the results indicated that it may be administered safely to elderly patients. The addition of rituximab to 2-CDA may increase the duration of response.
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Affiliation(s)
- David J Inwards
- Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
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12
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Gill S, Grigg A, Grigg A, Szer J, Ritchie D. Long-term toxicity of allogeneic stem cell transplantation in fludarabine-refractory chronic lymphocytic leukemia. Leuk Lymphoma 2008; 49:896-901. [PMID: 18464108 DOI: 10.1080/10428190801975550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Allogeneic stem cell transplantation (AlloSCT) is the only potentially curative therapy for chronic lymphocytic leukemia (CLL), but high transplant-related morbidity and mortality rates limit its widespread use. Data on the long-term toxicity of alloSCT in this group of patients are lacking. We evaluated response and survival rates as well as measures of quality of life (QOL) in 13 patients with CLL, selected for high-risk progressive disease from the transplant database at the Royal Melbourne Hospital. Seven of 13 patients (54%) achieved a complete remission (CR), of whom four remained in continuous CR at 30-77 months post-transplant. The event-free and overall survival rates were 31% and 38% respectively at 5 years. The transplant-related mortality was 31% at 2 years. Three of 5 patients still alive at last follow-up have resumed part- or full-time employment. AlloSCT is a feasible salvage therapeutic strategy and can provide meaningful disease-free survival and quality of life for some patients with high-risk refractory CLL.
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Affiliation(s)
- Sarr Gill
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Australia
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13
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Witzig TE. Standard Approaches to Relapsed Indolent Non-Hodgkin’s Lymphoma. Semin Hematol 2007. [DOI: 10.1053/j.seminhematol.2007.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Cohen JM, Sebire NJ, Harvey J, Gaspar HB, Cathy C, Jones A, Rao K, Cubitt D, Amrolia PJ, Davies EG, Veys P. Successful treatment of lymphoproliferative disease complicating primary immunodeficiency/immunodysregulatory disorders with reduced-intensity allogeneic stem-cell transplantation. Blood 2007; 110:2209-14. [PMID: 17502458 DOI: 10.1182/blood-2006-12-062174] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lymphoproliferative disease (LPD) is a recognized complication of primary immunodeficiency (PID) and immunodysregulatory syndromes. Historically, it has a very poor outcome. For patients surviving LPD, myeloablative hematopoietic stem cell transplantation (SCT) was the only cure for the underlying PID, with a high risk of developing posttransplantation complications, including recurrent lymphoproliferative disease. We describe 8 patients with a range of PID and immunodysregulatory syndromes complicated by LPD. After initial treatment of the LPD (including the use of anti-CD20 monoclonal antibody, rituximab, in 6 of the patients), all patients underwent reduced-intensity conditioning (RIC) SCT with prospective monitoring for Epstein-Barr virus (EBV) viremia. After transplantation, 3 patients received rituximab, and 3 patients received prophylactic EBV-specific cytotoxic T-lymphocytes. Only 1 patient developed recurrent LPD posttransplantation, which responded to rituximab. All patients who underwent transplantation survive free of LPD and are cured of their PID at a median follow-up of 4 years (range, 1-7 years). With careful monitoring and pre-emptive therapy, we advocate this RIC SCT approach to patients with PID who have pre-existing EBV-LPD.
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Affiliation(s)
- Jonathan M Cohen
- Department of Clinical Immunology, Great Ormond Street Hospital, London, United Kingdom
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Micklethwaite K, Hansen A, Foster A, Snape E, Antonenas V, Sartor M, Shaw P, Bradstock K, Gottlieb D. Ex vivo expansion and prophylactic infusion of CMV-pp65 peptide-specific cytotoxic T-lymphocytes following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2007; 13:707-14. [PMID: 17531781 DOI: 10.1016/j.bbmt.2007.02.004] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 02/12/2007] [Indexed: 10/23/2022]
Abstract
Cytomegalovirus reactivation and infection post-allogeneic hematopoietic stem cell transplant continue to cause morbidity and mortality. Current pharmacologic therapies are limited by side effects. Adoptive transfer of ex vivo generated cytomegalovirus-specific T cells has the potential to restore immunity, prevent cytomegalovirus, and circumvent the need for pharmacologic therapies. We have generated donor-derived cytomegalovirus-specific cytotoxic T cells using dendritic cells pulsed with the HLA-A2 restricted nonapeptide NLVPMVATV (NLV) derived from the cytomegalovirus-pp65 protein. These cytotoxic T cells have been given prophylactically to 9 recipients aged 4 to 65 years on or after day 28 post-allogeneic hematopoietic stem cell transplant. Only 2 of 9 recipients received T cell depletion in vivo or in vitro. There were no immediate adverse reactions to the infusions. During 97-798 days of follow-up, 2 recipients developed cytomegalovirus reactivation; neither developed cytomegalovirus disease or required pharmacotherapy. Three recipients developed acute graft versus host disease after infusion. Two recipients died, 1 from thrombotic thrombocytopenia purpura secondary to cyclosporine, 1 from complications of graft versus host disease. A transient increase in numbers of cytomegalovirus-specific T cells demonstrated by NLV-tetramer binding was seen in 6 recipients. Prophylactic adoptive transfer of NLV-specific T cells is safe and may be effective in preventing cytomegalovirus reactivation.
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Affiliation(s)
- Kenneth Micklethwaite
- Westmead Millennium Institute, University of Sydney at Westmead Hospital, Sydney, Australia
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Le Dieu R, Gribben JG. Transplantation in chronic lymphocytic leukemia. Curr Hematol Malig Rep 2007; 2:56-63. [PMID: 20425389 DOI: 10.1007/s11899-007-0008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although there have been no randomized trials comparing the outcome of stem cell transplantation (SCT) with standard chemotherapy for patients with chronic lymphocytic leukemia (CLL), increasingly, both autologous and allogeneic SCT approaches are being explored in this disease. Clinical trials have demonstrated that these approaches are feasible, but current data suggest that autologous transplantation is not curative and myeloablative SCT, although offering the potential for cure, is associated with high treatment-related mortality. There is a clear demonstration of a graft-versus-leukemia effect in CLL, with encouraging results seen after SCT with reduced-intensity conditioning. Because no other treatment modalities are currently capable of improving survival in this disease, the treatment of choice for younger patients with poor-risk CLL may well be SCT, but continued enrollment of appropriate patients into well-designed clinical trials is vital to compare advances in SCT with the advances occurring in chemoimmunotherapy in CLL.
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Affiliation(s)
- Rifca Le Dieu
- Institute of Cancer, Barts and the London School of Medicine, Charterhouse Square, London, EC1M 6BQ, United Kingdom
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Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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