1
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Chu M, Hu S, Shen Y, Shen D, Zhan Y, Fan Y, Chen J, Tang X, Wu D, Xu Y. Comparison of clinical outcomes between peripheral blood stem cells and peripheral blood stem cells plus bone marrow in myelodysplastic syndrome patients with haploidentical transplantation. Bone Marrow Transplant 2023; 58:142-151. [PMID: 36335255 DOI: 10.1038/s41409-022-01862-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
The comparison of haploidentical G-CSF-mobilized peripheral blood and bone marrow transplantation (HBMT) for patients with myelodysplastic syndrome (MDS) and haploidentical G-CSF-primed peripheral blood stem cell transplantation (HPBSCT) remains unclear. We performed a retrospective analysis using a propensity score method on 140 MDS patients who received HPBSCT (n = 46) or HBMT (n = 94) with BU/CY as a conditioning regimen prior to transplantation at our center between June 2016 and June 2021. HBMT recipients were associated with a reduced incidence of grade III-IV acute GVHD (17.22% vs. 30.57%, p = 0.019) within 100 days, reduced 2-year transplant-related mortality (TRM) (14.29% vs. 28.94%, p = 0.045) and superior 2-year overall survival (OS) (81.6% vs. 66.0%, p = 0.027), progression-free survival (PFS) (80.9% vs. 61.2%, p = 0.015), and GVHD relapse-free survival (GRFS) (64.6% vs. 53.3%, p = 0.062) compared with HPBSCT, but 2-year relapse incidence (RI) (5.96% vs. 9.39%, p = 0.445) was not affected. Multivariate analysis revealed that a GPB/GBM mixture was the independent factor for a reduced incidence of grade III-IV acute GVHD (p = 0.018) and TRM (p = 0.048), improved OS (p = 0.029), PFS (p = 0.019) and GRFS (p = 0.072). Collectively, the use of a GPB/GBM mixture as stem cell grafts for haplo-HSCT in patients with MDS appears to be an optimal choice.
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Affiliation(s)
- Mengqian Chu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Shuhong Hu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, PR China
| | - Yifan Shen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Danya Shen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Yuchen Zhan
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Yi Fan
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, PR China
| | - Jia Chen
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, PR China
| | - Xiaowen Tang
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China
| | - Depei Wu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China. .,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, PR China.
| | - Yang Xu
- Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, PR China. .,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, PR China.
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2
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Malkan ÜY, Göker H, Demiroğlu H, Tekin F, Akdemir NB, Karakulak EA, Sayınalp N, Haznedaroğlu İC, Özcebe Oİ, Büyükaşık Y. A single-center experience of haploidentical stem cell transplantation in hematological malignancies. Turk J Med Sci 2023; 53:352-359. [PMID: 36945951 PMCID: PMC10388032 DOI: 10.55730/1300-0144.5591] [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: 08/05/2022] [Accepted: 11/22/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Since well-designed prospective comparative trials are lacking, haploidentical hematopoietic stem cell transplantations approach should be based on the expertise of a particular center. In this study, we aimed to report the results and outcomes of patients who underwent haploidentical hematopoietic stem cell transplantation. METHODS : Thirty-nine patients who underwent transplantation in our clinic between 2015 and 2022 were retrospectively analyzed. Primary end point of this study is to find out the survival rates of the patients. RESULTS The overall survival of patients was 29.9 ± 4.9 months. The disease-free survival of the patients was 37.8 ± 5.7 months. The 3-year overall survival rate of the patients was %50 and the 3-year disease-free survival rate of the patients was %53. Nineteen patients were nonsurvivors among a total of 39 patients. Busulfan-fludarabine-thiotepa was the most frequently used conditioning regimen for transplantation. Busulfan-fludarabin-antithymocyte globulin regimen is the second preferred conditioning regimen. Cyclosporine- cyclophosphamide-mycophenolate mofetil was the most widely used graft-versus-host disease prophylaxis regimen. Sixteen patients had graft-versus-host disease, 28% of the patients had acute graft-versus-host disease, and 13% had chronic graft-versus-host disease. Gastrointestinal system consists of the most involved organs in graft-versus-host disease since 15% of the patients had gastrointestinal graft-versus-host disease. First-degree relatives (parent/child) were the most frequent donor source for haploidentical hematopoietic stem cell transplantation. Sepsis was the most frequent reason of death among transplant patients. DISCUSSION In our center, we prefer to use high dose posttransplantation cyclophosphamide after haploidentical hematopoietic stem cell transplantation for graft-versus-host disease prophylaxis. With this approach, our center's overall survival and disease-free survival rates are comparable and compatible with the literature findings.
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Affiliation(s)
- Ümit Yavuz Malkan
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Göker
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haluk Demiroğlu
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatma Tekin
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nadire Buket Akdemir
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Nilgün Sayınalp
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Osman İlhami Özcebe
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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3
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Choi DW, Cho KA, Lee HJ, Kim YH, Woo KJ, Park JW, Ryu KH, Woo SY. Co‑transplantation of tonsil‑derived mesenchymal stromal cells in bone marrow transplantation promotes thymus regeneration and T cell diversity following cytotoxic conditioning. Int J Mol Med 2020; 46:1166-1174. [PMID: 32582998 PMCID: PMC7387097 DOI: 10.3892/ijmm.2020.4657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
Bone marrow (BM) transplantation (BMT) represents a curative treatment for various hematological disorders. Prior to BMT, a large amount of the relevant anticancer drug needed to be administered to eliminate cancer cells. However, during this pre-BMT cytotoxic conditioning regimen, hematopoietic stem cells in the BM and thymic epithelial cells were also destroyed. The T cell receptor (TCR) recognizes diverse pathogen, tumor and environmental antigens, and confers immunological memory and self-tolerance. Delayed thymus reconstitution following pre-BMT cytotoxic conditioning impedes de novo thymopoiesis and limits T cell-mediated immunity. Several cytokines, such as RANK ligand, interleukin (IL)-7, IL-22 and stem cell factor, were recently reported to improve thymopoiesis and immune function following BMT. In the present study, it was found that the co-transplantation of tonsil-derived mesenchymal stromal cells (T-MSCs) with BM-derived cells (BMCs) accelerated the recovery of involuted thymuses in mice following partial pre-BMT conditioning with busulfan-cyclophosphamide treatment, possibly by inducing FMS-like tyrosine kinase 3 ligand (FLT3L) and fibroblast growth factor 7 (FGF7) production in T-MSCs. The co-transplantation of T-MSCs with BMCs also replenished the CD3+ cell population by inhibiting thymocyte apoptosis following pre-BMT cytotoxic conditioning. Furthermore, T-MSC co-transplantation improved the recovery of the TCR repertoire and led to increased thymus-generated T cell diversity.
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Affiliation(s)
- Da-Won Choi
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Kyung-Ah Cho
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Hyun-Ji Lee
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Yu-Hee Kim
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Kyong-Je Woo
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Joo-Won Park
- Department of Biochemistry, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - Kyung-Ha Ryu
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
| | - So-Youn Woo
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
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4
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Gatwood KS, Labopin M, Savani BN, Finke J, Socie G, Beelen D, Yakoub-Agha I, Chevallier P, Ganser A, Blaise D, Milpied N, Bruno L, Mailhol A, Mohty M, Nagler A. Transplant outcomes for patients with therapy-related acute myeloid leukemia with prior lymphoid malignancy: an ALWP of EBMT study. Bone Marrow Transplant 2019; 55:224-232. [PMID: 31527819 DOI: 10.1038/s41409-019-0673-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 12/13/2022]
Abstract
Allogeneic hematopoietic cell transplant (HCT) is a curative therapy for patients with secondary acute myeloid leukemia (sAML), though the impact of conditioning regimens on HCT outcomes for patients with antecedent lymphoid malignancy is largely unknown. This multicenter, retrospective registry study of the ALWP of the EBMT assessed HCT outcomes in this population. In all, 549 patients ≥18 years with sAML following an antecedent lymphoid malignancy treated with first allograft between 2000-2016 were included. Myeloablative (MAC) and reduced intensity conditioning (RIC) was given in 258 (47%) and 291 (53%), respectively. At 2 years, leukemia-free survival (LFS) was 31.7% (95% CI, 27.5-35.9), overall survival (OS) was 37.4% (95% CI, 33-41.8), nonrelapse mortality (NRM) was 28.9% (95% CI, 25-33), and GVHD-free, relapse-free survival (GRFS) was 22.8% (95% CI, 19-26.6). In multivariate analysis, patients receiving RIC regimens had lower risk of NRM (HR: 0.58, CI: 0.40-0.83, p = 0.003), and improved LFS (HR: 0.67, CI: 0.52-0.85, p = 0.001). Patients with prior autologous HCT had inferior LFS (HR: 1.30, CI: 1.01-1.67, p = 0.01). This study demonstrates that sAML patients following prior lymphoid malignancy treated with RIC regimens have a lower risk of NRM and improved LFS, OS, and GFRS. Other variables associated with inferior outcomes include older age, active disease, adverse cytogenetics, and prior auto-HCT.
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Affiliation(s)
| | | | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jürgen Finke
- University of Freiburg Department of Medicine-Hematology, Oncology, Freiburg, Germany
| | - Gerard Socie
- Department of Hematology-BMT, Hospital St. Louis, Paris, France
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | | | | | - Arnold Ganser
- Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, Germany
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Noel Milpied
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Lioure Bruno
- Techniciens d'Etude Clinique suivi de patients greffes, Nouvel Hopital Civil, Strasbourg, France
| | | | - Mohamad Mohty
- Department of Hematology, Hopital Saint Antoine, Paris, France
| | - Arnon Nagler
- Department of Hematology, Hopital Saint Antoine, Paris, France.,Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
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5
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Simons L, Cavazzana M, André I. Concise Review: Boosting T-Cell Reconstitution Following Allogeneic Transplantation-Current Concepts and Future Perspectives. Stem Cells Transl Med 2019; 8:650-657. [PMID: 30887712 PMCID: PMC6591542 DOI: 10.1002/sctm.18-0248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/06/2019] [Indexed: 12/14/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for a large number of malignant and nonmalignant (inherited) diseases of the hematopoietic system. Nevertheless, non‐HLA identical transplantations are complicated by a severe T‐cell immunodeficiency associated with a high rate of infection, relapse and graft‐versus‐host disease. Initial recovery of T‐cell immunity following HSCT relies on peripheral expansion of memory T cells mostly driven by cytokines. The reconstitution of a diverse, self‐tolerant, and naive T‐cell repertoire, however, may take up to 2 years and crucially relies on the interaction of T‐cell progenitors with the host thymic epithelium, which may be altered by GvHD, age or transplant‐related toxicities. In this review, we summarize current concepts to stimulate reconstitution of a peripheral and polyclonal T‐cell compartment following allogeneic transplantation such as graft manipulation (i.e., T‐cell depletion), transfusion of ex vivo manipulated donor T cells or the exogenous administration of cytokines and growth factors to stimulate host‐thymopoiesis with emphasis on approaches which have led to clinical trials. Particular attention will be given to the development of cellular therapies such as the ex vivo generation of T‐cell precursors to fasten generation of a polyclonal and functional host‐derived T‐cell repertoire. Having been tested so far only in preclinical mouse models, clinical studies are now on the way to validate the efficacy of such T‐cell progenitors in enhancing immune reconstitution following HSCT in various clinical settings. stem cells translational medicine2019;00:1–8
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Affiliation(s)
- Laura Simons
- Laboratory of Human Lymphohematopoiesis, INSERM UMR 1163, Imagine Institute, Paris, France.,Paris Descartes University-Sorbonne Paris Cité, Imagine Institute, Paris, France.,Department of Biotherapy, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marina Cavazzana
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM CIC, Paris, France.,Laboratory of Human Lymphohematopoiesis, INSERM UMR 1163, Imagine Institute, Paris, France.,Paris Descartes University-Sorbonne Paris Cité, Imagine Institute, Paris, France.,Department of Biotherapy, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle André
- Laboratory of Human Lymphohematopoiesis, INSERM UMR 1163, Imagine Institute, Paris, France.,Paris Descartes University-Sorbonne Paris Cité, Imagine Institute, Paris, France
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6
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Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients. Am J Clin Dermatol 2019; 20:55-73. [PMID: 30298481 DOI: 10.1007/s40257-018-0391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.
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7
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Li Z, Labopin M, Ciceri F, Blaise D, Tischer J, Ehninger G, Van Lint MT, Koc Y, Santarone S, Forcade E, Castagna L, Polge E, Mailhol A, Ruggeri A, Mohty M, Savani BN, Nagler A. Haploidentical transplantation outcomes for secondary acute myeloid leukemia: Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) study. Am J Hematol 2018. [PMID: 29536560 DOI: 10.1002/ajh.25087] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Secondary acute myeloid leukemia (sAML) traditionally has inferior outcomes compared to de novo AML. Allogeneic hematopoietic cell transplantation (HCT) is the sole potentially curative therapy. This study analyzes the outcomes for unmanipulated haploidentical HCT (haploHCT) for sAML using the Acute Leukemia Working Party (ALWP) registry of the European Society for Blood and Marrow Transplantation (EBMT). We identified 154 patients with sAML who underwent haploHCT from 2006 to 2016. Median age at HCT was 60 years with time from diagnosis to HCT 5 months. At transplantation, 69 patients were in first CR and 85 had active disease. Fifty-seven (38.0%) patients underwent myeloablative conditioning and 97 (62.0%) reduced intensity conditioning (RIC) conditioning. Multivariate analysis showed that there was no difference in RI, nonrelapse mortality (NRM), leukemia free survival (LFS), overall survival (OS), or GVHD-free/relapse free survival (GRFS) for conditioning intensity, age, performance status, or graft source. Active disease was associated with higher RI and inferior LFS, OS, and GRFS compared with patients in CR at time of transplant. T-cell depletion with anti-thymoglobulin resulted in higher NRM and inferior LFS, OS, and GRFS compared to post-transplant cyclophosphamide (PTCy) (HR 2.25, 2.01, 2.16, and 1.73, respectively with P values <.05). Our data shows that haploHCT is a feasible alternative for sAML when matched transplantation is unavailable.
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Affiliation(s)
- Zhuoyan Li
- Vanderbilt University Medical CenterNashville Tennessee
| | - Myriam Labopin
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938Université Pierre et Marie CurieParis France
| | | | - Didier Blaise
- Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli CalmettesMarseille France
| | - Johanna Tischer
- Department of Medicine IIIUniversity Hospital, LMU Munich Germany
| | - Gerhard Ehninger
- Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik IDresden Germany
| | - MT Van Lint
- Department of Haematology IIOspedale San MartinoGenova Italy
| | - Yener Koc
- Medical Park HospitalsStem Cell Transplant UnitAntalya Turkey
| | - Stella Santarone
- Ospedale Civile, Dipartimento di EmatologiaMedicina Trasfusionale e BiotecnologiePescara Italy
| | | | - Luca Castagna
- Istituto Clinico Humanitas, Transplantation Unit, Department of Oncology and HaematologyMilano Italy
| | - Emmanuelle Polge
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938Université Pierre et Marie CurieParis France
| | - Audrey Mailhol
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938Université Pierre et Marie CurieParis France
| | - Annalisa Ruggeri
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938Université Pierre et Marie CurieParis France
| | - Mohamad Mohty
- Hôpital Saint‐Antoine, Universite Pierre & Marie Curie and INSERM, Centre de Recherche Saint‐Antoine, UMRs U938Paris France
| | | | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical CenterTel Hashomer, Israel and the ALWP office of the EBMT Hôpital Saint‐AntoineParis France
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8
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Goldsmith SR, Slade M, DiPersio JF, Westervelt P, Schroeder MA, Gao F, Romee R. Donor-lymphocyte infusion following haploidentical hematopoietic cell transplantation with peripheral blood stem cell grafts and PTCy. Bone Marrow Transplant 2017; 52:1623-1628. [PMID: 29035393 DOI: 10.1038/bmt.2017.193] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/17/2017] [Accepted: 07/28/2017] [Indexed: 11/09/2022]
Abstract
Donor-lymphocyte infusion (DLI) for relapse following haploidentical hematopoietic cell transplantation (haploHCT) with post-transplant cyclophosphamide (PTCy) has been described in recipients of bone marrow grafts, but not recipients of G-CSF mobilized peripheral blood (PB) grafts. We retrospectively identified patients who underwent DLI following PB-haploHCT with PTCy for relapse, or loss of chimerism (LOC). Twelve patients (57%) received DLI for hematologic relapse/persistent disease, seven (33%) for extramedullary relapse and two (10%) for LOC. Sixteen (76%) received chemotherapy prior to DLI, which did not correlate with response. The most common first dose was 1 × 106 CD3+ cells/kg. Two patients developed grade I aGvHD post DLI, one had grade II and two had grade III. One developed mild skin cGvHD 1361 days post DLI. Pre-DLI aGvHD predicted post-DLI aGvHD (P=0.025). Six patients achieved CR after DLI for overt relapse, one achieved full donor chimerism after LOC. Patients with LOC or EM relapse had superior relapse-free survival following DLI (P=0.029). DLI following PB-haploHCT with PTCy is a viable salvage therapy for overt relapse or LOC without a substantial increase in GvHD, and donor lymphocytes may be collected simultaneously with graft collection to facilitate availability in patients at high risk of relapse.
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Affiliation(s)
- S R Goldsmith
- Bone Marrow Transplantation and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - M Slade
- Bone Marrow Transplantation and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - J F DiPersio
- Bone Marrow Transplantation and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - P Westervelt
- Bone Marrow Transplantation and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - M A Schroeder
- Bone Marrow Transplantation and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - F Gao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R Romee
- Bone Marrow Transplantation and Leukemia Program, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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9
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Yoshimi A, Kato K, Hosaka S, Suzuki R, Fukushima H, Nakao T, Kobayashi C, Fukushima T, Koike K, Sumazaki R, Tsuchida M. Haploidentical peripheral blood stem cell transplantation without irradiation or busulfan after reduced-intensity conditioning for KMT2A(MLL)-rearranged infant B-cell precursor acute lymphoblastic leukemia: Report of two cases. Pediatr Transplant 2017; 21. [PMID: 28332262 DOI: 10.1111/petr.12918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/29/2022]
Abstract
We present two infants with KMT2A(MLL)-gene-R-associated BCP-ALL, who received HLA haploidentical PBSCT after RIC. The patients developed ALL at age 6 months and 3 months, respectively. Case 1 underwent PBSCT at the second CR with detectable KMT2A-AFF1(MLL-AF4) fusion gene transcript at 11 months of age, and Case 2 at the first CR without KMT2A-MLLT1(MLL-ENL) fusion gene transcript at 8 months of age. Both patients received G-CSF-mobilized unmanipulated peripheral blood mononuclear cells from their HLA haploidentical mothers after administration of FLU, MEL, and ATG. Tacrolimus, methotrexate, and mPSL were administered as prophylaxis against GVHD. Engraftment was rapidly obtained with complete chimerism in both patients. Acute adverse events included acute GVHD in Case 1 and bacterial sepsis in Case 2. At last clinical check at age 5 years and 4 years, respectively, both patients were recurrence-free and attained normal growth and development. We conclude that PBSCT from an HLA haploidentical mother with non-TBI and non-BU regimen seems feasible and efficacious, offering favorable life quality for infants.
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Affiliation(s)
- Ai Yoshimi
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Keisuke Kato
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Sho Hosaka
- Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryoko Suzuki
- Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomohei Nakao
- Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chie Kobayashi
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Takashi Fukushima
- Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutoshi Koike
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Ryo Sumazaki
- Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Tsuchida
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
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Panch SR, Szymanski J, Savani BN, Stroncek DF. Sources of Hematopoietic Stem and Progenitor Cells and Methods to Optimize Yields for Clinical Cell Therapy. Biol Blood Marrow Transplant 2017; 23:1241-1249. [PMID: 28495640 DOI: 10.1016/j.bbmt.2017.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
Bone marrow (BM) aspirates, mobilized peripheral blood, and umbilical cord blood (UCB) have developed as graft sources for hematopoietic stem and progenitor cells (HSPCs) for stem cell transplantation and other cellular therapeutics. Individualized techniques are necessary to enhance graft HSPC yields and cell quality from each graft source. BM aspirates yield adequate CD34+ cells but can result in relative delays in engraftment. Granulocyte colony-stimulating factor (G-CSF)-primed BM HSPCs may facilitate faster engraftment while minimizing graft-versus-host disease in certain patient subsets. The levels of circulating HSPCs are enhanced using mobilizing agents, such as G-CSF and/or plerixafor, which act via the stromal cell-derived factor 1/C-X-C chemokine receptor type 4 axis. Alternate niche pathway mediators, including very late antigen-4/vascular cell adhesion molecule-1, heparan sulfate proteoglycans, parathyroid hormone, and coagulation cascade intermediates, may offer promising alternatives for graft enhancement. UCB grafts have been expanded ex vivo with cytokines, notch-ligand, or mesenchymal stromal cells, and most studies demonstrated greater quantities of CD34+ cells ex vivo and improved short-term engraftment. No significant changes were observed in long-term repopulating potential or in patient survival. Early phase clinical trials using nicotinamide and StemReginin1 may offer improved short- and long-term repopulating ability. Breakthroughs in genome editing and stem cell reprogramming technologies may hasten the generation of pooled, third-party HSPC grafts. This review elucidates past, present, and potential future approaches to HSPC graft optimization.
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Affiliation(s)
- Sandhya R Panch
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| | - James Szymanski
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bipin N Savani
- Department of Hematology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David F Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Lv J, Xiao Q, Chen Y, Fan X, Liu X, Liu F, Luo G, Zhang B, Wang S. Effects of magnesium isoglycyrrhizinate on AST, ALT, and serum levels of Th1 cytokines in patients with allo-HSCT. Int Immunopharmacol 2017; 46:56-61. [PMID: 28259001 DOI: 10.1016/j.intimp.2017.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 01/01/2023]
Abstract
This study aimed to investigate the protective effects of magnesium isoglycyrrhizinate (MGL) on aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum levels of T helper 1 (Th1) cytokines in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT). The study included 42 patients prepared for allo-HSCT, who were divided equally into MGL and reduced glutathione groups. The ALT and AST levels were detected 1day before pretreatment and transplantation, and 7, 14, and 21days after transplantation. The total days and times of fever, treatment time of patients in the laminar flow room, white blood cell (WBC) count, platelet (PTL) implantation time, and success rate of transplantation were recorded. The serum levels of Th1/Th2 cytokines were detected. MGL had a significant protective effect on AST 1day before transplantation and 7, 14, and 21days after transplantation, while ALT had a statistical difference only 7days after transplantation. MGL could shorten the duration of fever during transplantation and advance the WBC and PTL implantation time. Significant differences in Th1-like cytokines (P<0.05) and higher levels of Th2-like cytokines but with no statistical significance (P>0.05) were found in the MGL group compared with the control group. MGL had significant protective effects on AST after transplantation. MGL could reduce the duration of fever during transplantation, help the reconstruction and recovery of WBCs and PTLs, and regulate Th1 cytokines, revealing its protective effects on hepatic transaminases and graft versus host disease in allo-HSCT patients.
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Affiliation(s)
- Jinglong Lv
- Department of Hematology, Chongqing Three Gorges Center Hospital, Chongqing, China
| | - Qing Xiao
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongping Chen
- Department of Hematology, Chongqing Three Gorges Center Hospital, Chongqing, China.
| | - Xuegong Fan
- Department of Infectious Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Liu
- Department of Occupational Medicine, The Sixth People's Hospital of Chongqing, Chongqing, China
| | - Fen Liu
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guoping Luo
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bangshuo Zhang
- Department of Hematology, Chongqing Three Gorges Center Hospital, Chongqing, China
| | - Sheng Wang
- Department of Hematology, Chongqing Three Gorges Center Hospital, Chongqing, China
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Sahin U, Demirer T. Future Perspectives for Haploidentical SCT. STEM CELL BIOLOGY AND REGENERATIVE MEDICINE 2017. [DOI: 10.1007/978-3-319-65319-8_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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13
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Slade M, Fakhri B, Savani BN, Romee R. Halfway there: the past, present and future of haploidentical transplantation. Bone Marrow Transplant 2016; 52:1-6. [DOI: 10.1038/bmt.2016.190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 02/03/2023]
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Savani BN, Mohty M. Introduction: Why alternative donor transplantation and what are the different options and current challenges? Semin Hematol 2016; 53:55-6. [DOI: 10.1053/j.seminhematol.2016.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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