1
|
Solh M, Bashey A, Zhang X, Holland HK, Bachier-Rdriguez L, Morris LE, Solomon SR. Immunosuppression-Free Status at 1 Year after Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide. Transplant Cell Ther 2024; 30:607.e1-607.e8. [PMID: 38552844 DOI: 10.1016/j.jtct.2024.03.025] [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: 01/30/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
The development of chronic graft-versus-host disease (GVHD) in 1-year survivors after matched related or unrelated hematopoietic cell transplantation was shown to be associated with higher nonrelapse mortality (NRM) and worse overall survival (OS). The impact of chronic GVHD requiring immunosuppression (IS) for recipients of haploidentical transplantation (HIDT) with post-transplantation cyclophosphamide (PTCy) who have survived to 1 year post-transplantation has not been studied previously and was investigated for this analysis. A total of 322 adult patients who underwent HIDT at our center were included in this study. The effect of IS-free status on post-transplantation outcomes was assessed. The median follow-up for survivors was 63.9 months (range, 18.3 to 165 months). A total of 163 patients (65%) were IS-free at 1 year post-HIDT. Baseline characteristics of this group were similar to those of patients still requiring IS, except for higher percentages of female donor-male recipient pairs (28% versus 15%; P =.03) and female donors (48% versus 30%; P =.008). Logistic regression to identify patients more likely to be on IS at 1 year post-HIDT identified the use of a female donor as a significant risk factor (odds ratio, 2.11; P = .009). In a Cox regression analysis, patients requiring IS at 1 year post-transplantation had higher NRM (hazard ratio [HR], 4.18; 95% confidence interval [CI], 1.80 to 6.72; P < .001) and showed a trend toward worse disease-free survival (DFS) (HR, 1.59; 95% CI, .95 to 2.66; P =.08), with no impact on OS (HR, 1.44; 95% CI, .90 to 2.31; P = .13) or relapse (HR, .77; 95% CI, .37 to 1.61; P = .49). These results indicate that use of a female donor is a significant risk factor for requiring IS at 1 year post-HIDT. Additionally, chronic GVHD requiring IS at 1-year post-HIDT no significant effect on relapse but is associated with higher NRM and a trend toward worse DFS.
Collapse
Affiliation(s)
- Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia.
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Xu Zhang
- School of Public Health, University of Texas, Houston, Texas
| | - H Kent Holland
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | | | - Lawrence E Morris
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| | - Scott R Solomon
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia
| |
Collapse
|
2
|
Sanz J, Labopin M, Blaise D, Raiola AM, Busca A, Vydra J, Tischer J, Chevallier P, Bramanti S, Fanin R, Socié G, Forcade E, Kröger N, Koc Y, Itäla-Remes M, Zecca M, Nagler A, Brissot E, Spyridonidis A, Bazarbachi A, Giebel S, Piemontese S, Mohty M, Ciceri F. Haploidentical stem cell donor choice for patients with acute myeloid leukemia: a study from the ALWP of the EBMT. Blood Adv 2024; 8:2332-2341. [PMID: 38429091 PMCID: PMC11127221 DOI: 10.1182/bloodadvances.2023012133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024] Open
Abstract
ABSTRACT There is a paucity of information to guide the selection of the most suitable donor in haploidentical (Haplo) hematopoietic stem cell transplantation (HSCT). For this reason, from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we conducted a retrospective analysis to evaluate the impact of Haplo donor characteristics on outcomes in patients with acute myeloid leukemia (AML) who received graft-versus-host disease prophylaxis with posttransplant cyclophosphamide (PTCy). The primary end point was graft-versus-host disease (GVHD)-free and relapse-free survival (GRFS). Overall, 2200 patients were included. The median age of donors was 37 years (range, 8-71); 820 (37%) were females, including 458 (21%) who were used for male recipients. In addition, 1631 donors (74%) donated peripheral blood (PB). Multivariable analysis identified certain donor-related risk factors with a detrimental impact on transplant outcomes. The use of PB, older donors' ages (>37 years), and female donors to male recipients negatively affected GRFS. Donor's age and female donor-to-male recipient combination also affected nonrelapse mortality, leukemia-free survival, and overall survival. In conclusion, donor-related variables significantly influence outcomes in patients with AML after Haplo-HSCT with PTCy. When possible, younger donors and male donors for male recipients should be prioritized. The use of bone marrow can additionally prevent GVHD.
Collapse
Affiliation(s)
- Jaime Sanz
- Hematology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- CIBERONC, Carlos III Health Institute, Madrid, Spain
- Departament de Medicina, Universitat de València, València, Espanya
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Didier Blaise
- Transplantation and Cellular Therapy Program, Marseille, France
| | | | | | - Jan Vydra
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | | | | | - Renato Fanin
- Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - Gérard Socié
- Blood and Marrow Transplant Unit, Saint-Louis Hospital, Paris, France
| | - Edouard Forcade
- Department of Hematology and Cellular Therapy, CHU Bordeaux, Bordeaux, France
| | | | - Yener Koc
- Medicana International Hospital Istanbul, Istanbul, Turkey
| | | | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Arnon Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Eolia Brissot
- Hospital Saint Antoine, Sorbonne University, Paris, France
| | - Alexandros Spyridonidis
- Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras, Patras, Greece
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Simona Piemontese
- Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
| | - Mohamad Mohty
- Hospital Saint Antoine, Sorbonne University, Paris, France
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute IRCCS, Milano, Italy
| |
Collapse
|
3
|
Mushtaq MU, Shahzad M, Amin MK, Lutfi F, DeJarnette S, Al-Ramahi JS, Li K, Ahmed N, Bansal R, Abdelhakim H, Shune L, Abdallah AO, Abhyankar SH, McGuirk JP, Singh AK. Outcomes with HLA-matched unrelated donor versus haploidentical hematopoietic cell transplantation. Leuk Lymphoma 2024; 65:493-502. [PMID: 38164945 DOI: 10.1080/10428194.2023.2300708] [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: 07/10/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
We investigated the outcomes after adult haploidentical (haplo) and matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) in a single-center study (n = 452) including 276 MUD and 176 haplo transplants. Myeloablative (37%) and reduced-intensity conditioning (63%) were performed. Graft sources included peripheral blood (50%) and bone marrow (50%). GVHD prophylaxis included tacrolimus/methotrexate (53%) and post-transplant cyclophosphamide-based (47%). In MUD versus haplo HCT recipients, a similar incidence of neutrophil engraftment (18 vs 17 days, p = 0.895), grade II-IV acute GVHD (51% vs 50%, p = 0.773), relapse (26% vs 23%, p = 0.578), non-relapse mortality (22% vs 23%, p = 0.817), 1-year disease-free survival (62% vs 63%. p = 0.921), and 1-year overall survival (73% vs 74%, p = 0.744) were observed. Earlier platelet engraftment (22 vs 27 days, p < 0.001) and higher chronic GVHD (45% vs 35%, p = 0.040) were noted in MUD as compared to haplo HCT. Allogeneic transplantation should be done promptly whenever indicated, utilizing either matched unrelated or haploidentical donors.
Collapse
Affiliation(s)
- Muhammad Umair Mushtaq
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Moazzam Shahzad
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Muhammad K Amin
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Forat Lutfi
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shaun DeJarnette
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joe S Al-Ramahi
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kevin Li
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nausheen Ahmed
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rajat Bansal
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Haitham Abdelhakim
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Leyla Shune
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Al-Ola Abdallah
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sunil H Abhyankar
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joseph P McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Anurag K Singh
- Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
4
|
Avenoso D, Serpenti F, Slonim LB, Bouziana S, Dazzi F, Hannah G, Kenyon M, Mehra V, Kulasekararaj A, Krishamurthy P, Shah MN, Lionel S, Pagliuca A, Potter V. Haploidentical Transplant with Post-Transplant Cyclophosphamide for Acute Myeloid Leukaemia and Myelodysplastic Syndromes Patients: The Role of Previous Lines of Therapy. Mediterr J Hematol Infect Dis 2024; 16:e2024002. [PMID: 38223487 PMCID: PMC10786144 DOI: 10.4084/mjhid.2024.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
Background Allogeneic haematopoietic stem-cell transplant is an option, potentially curative, for high-risk acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients. Post-transplant cyclophosphamide administration allows for the selection of haploidentical donors in patients who are eligible for the procedure but do not have a fully matched donor since it can overcome the HLA barrier. There is still an active debate on whether intensifying the conditioning regimen is necessary with haploidentical donors when peripheral blood stem cells are used as the graft source. Herein, we report our decennial experience of haploidentical stem-cell transplant using peripheral blood stem cells (haplo-PBSC) at King's College Hospital. Objectives The primary objective was to evaluate overall survival (OS) following haplo-PBSC. Secondary objectives were total OS for patients with less than two previous lines of therapy, OS according to cytomegalovirus (CMV) reactivation, incidence of transplant-related mortality (TRM), graft-versus-host disease (GVHD) and GVHD-relapse-free survival (GRFS). Results One-year and three-year total OS were 62% and 43%, respectively, with a median OS of 22 months. One-year and three-year OS for patients with ≤2 and those with >2 previous lines of therapy were 72% and 55%, and 60% and 22%, respectively (p-value=0.04). The median OS in patients with >2 previous and ≤2 lines of therapy was 16 and 49 months, respectively. Cumulative incidence (CI) of relapse was 25% with a median time to relapse of 5 months (range 1 - 38 months). Conclusions Haploidentical haematopoietic stem-cell transplant is potentially curative in chemosensitive AML and MDS and offers a high rate of prolonged remission. Our cohort further confirms the role of consolidative haploidentical transplant in patients in complete remission and highlights that patients with heavily pre-treated disease may not benefit from this strategy.
Collapse
Affiliation(s)
- Daniele Avenoso
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Fabio Serpenti
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | | | - Styliani Bouziana
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Francesco Dazzi
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Guy Hannah
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Michelle Kenyon
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Varun Mehra
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Austin Kulasekararaj
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Pramila Krishamurthy
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Mili Naresh Shah
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Sharon Lionel
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Antonio Pagliuca
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| | - Victoria Potter
- King’s College Hospital NHS Foundation Trust, Department of haematological medicine, Denmark Hill, London
| |
Collapse
|
5
|
Franco AA, Lotero V, Rodríguez P, Beltran E, Manzi E, Devia-Zapata A, Medina-Valencia D. Outcomes and challenges treating pediatric acute myeloid leukemia: a retrospective analysis of patients treated at the Fundación Valle del Lili between 2011 and 2020. Hematol Transfus Cell Ther 2023:S2531-1379(23)02552-X. [PMID: 37872063 DOI: 10.1016/j.htct.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Acute myeloid leukemia is a challenging disease, due to a poor prognosis in developing countries. Herein, we aim to describe the clinical characteristics and outcomes after chemotherapy and transplantation. METHODS A retrospective analytic observational study was performed with patients under 18 years of age with newly diagnosed acute myeloid leukemia treated at a referral center in Colombia. Two groups were compared: induction therapy (IT) and induction therapy plus consolidation (IT + C). The survival analysis was performed using the Kaplan-Meier method. RESULTS We analyzed 34 patients diagnosed with acute myeloid leukemia; 20 received hematopoietic stem cell transplantation. Most were French-American-British (FAB) classification types M1, M5 and M0. The transplantation was haploidentical in 65%, conditioning was myeloablative in 67% and graft-versus-host disease prophylaxis was performed with post-transplant cyclophosphamide in 70%. Overall, the 5-year survival was 52% and the overall 5-year survival in the transplanted group was 80%. There were 16 deaths; in the IT group, n = 12, and in the IT + C group, n = 4. In the former, the main cause of death was septic shock and in the latter, it was relapse. CONCLUSION Transplantation is a safe option. Receiving treatment and supportive measures in hematopoietic stem cell transplantation units is necessary to avoid infections, especially during induction cycles.
Collapse
Affiliation(s)
- Alexis A Franco
- Fundación Valle del Lili, Departamento Materno infantil, servicio de hemato-oncología pediátrica, unidad de trasplante de médula ósea, Cra 98 No. 18-49, Cali 760032, Colombia; Universidad Icesi, Facultad de Ciencias de la Salud. Calle 18 No. 122-135, Cali 760031, Colombia
| | - Viviana Lotero
- Universidad Icesi, Facultad de Ciencias de la Salud. Calle 18 No. 122-135, Cali 760031, Colombia; Fundación Valle del Lili, Departamento Materno infantil, servicio de hemato-oncología pediátrica, Cra 98 No. 18-49, Cali 760032, Colombia
| | - Pamela Rodríguez
- Universidad Icesi, Facultad de Ciencias de la Salud. Calle 18 No. 122-135, Cali 760031, Colombia; Fundación Valle del Lili, Departamento Materno infantil, servicio de hemato-oncología pediátrica, Cra 98 No. 18-49, Cali 760032, Colombia
| | - Estefania Beltran
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali 760032, Colombia
| | - Eliana Manzi
- Universidad Icesi, Facultad de Ciencias de la Salud. Calle 18 No. 122-135, Cali 760031, Colombia; Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali 760032, Colombia
| | - Angela Devia-Zapata
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali 760032, Colombia
| | - Diego Medina-Valencia
- Fundación Valle del Lili, Departamento Materno infantil, servicio de hemato-oncología pediátrica, unidad de trasplante de médula ósea, Cra 98 No. 18-49, Cali 760032, Colombia; Universidad Icesi, Facultad de Ciencias de la Salud. Calle 18 No. 122-135, Cali 760031, Colombia.
| |
Collapse
|
6
|
Fleischhauer K, Hien Tran T, Meisel R, Mytilineos J, Dreger P, Kröger N. Donor Selection for Allogeneic Hematopoietic Cell Transplantation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:261-268. [PMID: 36949660 PMCID: PMC10366961 DOI: 10.3238/arztebl.m2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/19/2022] [Accepted: 02/01/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND In Germany, each year over 3000 patients with malignant and non-malignant hematologic and systemic diseases are treated by allo - geneic hematopoietic cell transplantation (HCT). Genetic donor-recipient disparities, especially those concerning variable human leukocyte antigens (HLA), mediate both an immunotherapeutic effect and the risk of damage to healthy tissues ("graft-versus-host disease"). The adoption of evidencebased strategies for donor selection has been crucial for the continuous improvement of survival rates after allogeneic HCT, with over 50% of patients transplanted for standard indications-such as early-stage acute myeloid leukemia-alive at three years post-transplant. METHODS The PubMed database was selectively searched for literature on immunogenetic and clinical factors relevant to allogeneic HCT, as part of the process of establishing a German consensus statement on HCT donor selection. RESULTS The most important factor in donor selection is a match for the five major HLA loci (HLA-A, -B, -C, -DR, -DQ), either in genetically HLAidentical siblings or in unrelated but fully HLA-compatible donors from international registries. Additional selection criteria for the latter include com - patibility for the HLA-DP locus, donor age and sex, cytomegalovirus serostatus, and blood group. Related donors identical for only 50% of the HLA genes (haploidentical donors) as well as unrelated donors with a single HLA mismatch are both valid alternatives although they are associated with an up to 10% higher risk of mortality. CONCLUSION The refinement of donor selection strategies has been instrumental for the continuous improvement of patient survival rates after allogeneic HCT witnessed over the past decades. An interdisciplinary approach to donor selection based on up-to-date scientific evidence is crucial for optimizing patient outcomes.
Collapse
Affiliation(s)
- Katharina Fleischhauer
- German Immunogenetics Society (DGI), Munich
- Institute for Experimental Cellular Therapy, University Hospital Essen
- German Consortium for Translational Cancer Research, Essen–Düsseldorf Site
- German Registry for Hematopoietic Cell Transplantation (DRST), Essen
| | - Thuong Hien Tran
- German Immunogenetics Society (DGI), Munich
- Institute for Immunology, University Hospital Heidelberg
| | - Roland Meisel
- German Consortium for Translational Cancer Research, Essen–Düsseldorf Site
| | - Joannis Mytilineos
- German Immunogenetics Society (DGI), Munich
- German Registry for Hematopoietic Cell Transplantation (DRST), Essen
| | - Peter Dreger
- German Registry for Hematopoietic Cell Transplantation (DRST), Essen
| | - Nicolaus Kröger
- German Registry for Hematopoietic Cell Transplantation (DRST), Essen
| |
Collapse
|
7
|
Racial disparities in access to alternative donor allografts persist in the era of "donors for all". Blood Adv 2022; 6:5625-5629. [PMID: 35675518 PMCID: PMC9642869 DOI: 10.1182/bloodadvances.2022007814] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
|
8
|
Fleischhauer K. Haplo-PtCy: adjusting the HLA barrier. Blood 2022; 139:1431-1433. [PMID: 35267004 DOI: 10.1182/blood.2021014532] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Katharina Fleischhauer
- University Hospital Essen-Institute for Experimental Cellular Therapy
- German Cancer Consortium
| |
Collapse
|
9
|
Fuchs EJ, McCurdy SR, Solomon SR, Wang T, Herr MM, Modi D, Grunwald MR, Nishihori T, Kuxhausen M, Fingerson S, McKallor C, Bashey A, Kasamon YL, Bolon YT, Saad A, McGuirk J, Paczesny S, Gadalla SM, Marsh SGE, Shaw BE, Spellman SR, Lee SJ, Petersdorf EW. HLA informs risk predictions after haploidentical stem cell transplantation with posttransplantation cyclophosphamide. Blood 2022; 139:1452-1468. [PMID: 34724567 PMCID: PMC8914182 DOI: 10.1182/blood.2021013443] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Hematopoietic cell transplantation from HLA-haploidentical related donors is increasingly used to treat hematologic cancers; however, characteristics of the optimal haploidentical donor have not been established. We studied the role of donor HLA mismatching in graft-versus-host disease (GVHD), disease recurrence, and survival after haploidentical donor transplantation with posttransplantation cyclophosphamide (PTCy) for 1434 acute leukemia or myelodysplastic syndrome patients reported to the Center for International Blood and Marrow Transplant Research. The impact of mismatching in the graft-versus-host vector for HLA-A, -B, -C, -DRB1, and -DQB1 alleles, the HLA-B leader, and HLA-DPB1 T-cell epitope (TCE) were studied using multivariable regression methods. Outcome was associated with HLA (mis)matches at individual loci rather than the total number of HLA mismatches. HLA-DRB1 mismatches were associated with lower risk of disease recurrence. HLA-DRB1 mismatching with HLA-DQB1 matching correlated with improved disease-free survival. HLA-B leader matching and HLA-DPB1 TCE-nonpermissive mismatching were each associated with improved overall survival. HLA-C matching lowered chronic GVHD risk, and the level of HLA-C expression correlated with transplant-related mortality. Matching status at the HLA-B leader and HLA-DRB1, -DQB1, and -DPB1 predicted disease-free survival, as did patient and donor cytomegalovirus serostatus, patient age, and comorbidity index. A web-based tool was developed to facilitate selection of the best haploidentical-related donor by calculating disease-free survival based on these characteristics. In conclusion, HLA factors influence the success of haploidentical transplantation with PTCy. HLA-DRB1 and -DPB1 mismatching and HLA-C, -B leader, and -DQB1 matching are favorable. Consideration of HLA factors may help to optimize the selection of haploidentical related donors.
Collapse
Affiliation(s)
- Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | | | - Scott R Solomon
- Northside Hospital Cancer Institute, Blood and Marrow Transplant Program, Atlanta, GA
| | - Tao Wang
- Department of Medicine, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy (BMT CI), Moffitt Cancer Center, Tampa, FL
| | - Michelle Kuxhausen
- CIBMTR, National Marrow Donor Program/Be The Match Foundation, Minneapolis, MN
| | - Stephanie Fingerson
- CIBMTR, National Marrow Donor Program/Be The Match Foundation, Minneapolis, MN
| | - Caroline McKallor
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Asad Bashey
- Northside Hospital Cancer Institute, Blood and Marrow Transplant Program, Atlanta, GA
| | - Yvette L Kasamon
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD
| | - Yung-Tsi Bolon
- CIBMTR, National Marrow Donor Program/Be The Match Foundation, Minneapolis, MN
| | - Ayman Saad
- Division of Hematology, Ohio State University, Columbus, OH
| | - Joseph McGuirk
- Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas Cancer Center, Kansas City, KS
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, National Cancer Institute, Clinical Genetics Branch, Rockville, MD
| | - Steven G E Marsh
- Anthony Nolan Research Institute-University College London Cancer Institute, Royal Free Campus, London, United Kingdom; and
| | - Bronwen E Shaw
- Department of Medicine, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI
| | - Stephen R Spellman
- CIBMTR, National Marrow Donor Program/Be The Match Foundation, Minneapolis, MN
| | - Stephanie J Lee
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, CIBMTR, Medical College of Wisconsin, Milwaukee, WI
| | - Effie W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
10
|
Wu Y, Lai X, Shi J, Tan Y, Zhao Y, Yu J, Liu L, Zhang W, Huang H, Luo Y. Effect of donor characteristics on T cell-replete haploidentical stem cell transplantation over the last 10 years at a single institution. Br J Haematol 2021; 196:1225-1238. [PMID: 34859418 DOI: 10.1111/bjh.17978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
One of the most complex issues with haploidentical stem cell transplantation (haplo-SCT) is donor selection, given that multiple haploidentical donors are often available for a given recipient. To develop evidence-based guidance for donor selection in the setting of anti-thymocyte globulin-based haplo-SCT, we performed a prospective cohort study of 512 patients with haematological malignancies who had haplo-SCT to determine which donor variables were most important in favouring transplant outcomes. Increasing donor age was associated with poorer overall survival (OS) [hazard ratio (HR) 1·08, P = 0·044]. Female donors to male recipients was significantly associated with higher non-relapse mortality (NRM; HR 2·05, P = 0·006). Furthermore, increasing donor age had a higher risk of Grades 3-4 acute graft-versus-host disease (aGVHD; HR 1·17, P = 0·005), female donors to male recipients was associated with a higher risk of Grades 2-4 aGVHD (HR 1·50, P = 0·022). Sibling donors had superior OS, disease-free survival, and NRM than parental donors in patients aged <35 years. However, sibling donors had higher NRM than offspring donors in patients aged ≥35 years. A younger donor, usually a young sibling in younger recipients (aged <35 years) or a young offspring in older patients (aged ≥35 years) and avoiding female donors to male recipients should be preferred when multiple haploidentical donors are available.
Collapse
Affiliation(s)
- Yibo Wu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Xiaoyu Lai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Jimin Shi
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Yamin Tan
- Department of Hematology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Yanmin Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Jian Yu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Lizhen Liu
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Wei Zhang
- HLA Typing Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Yi Luo
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Hematology, Zhejiang University, Hangzhou, China.,Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.,Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| |
Collapse
|
11
|
Parody R, Sánchez-Ortega I, Mussetti A, Patiño B, Arnan M, Pomares H, González-Barca E, Mercadal S, Boqué C, Maluquer C, Carro I, Peña M, Clapés V, Verdesoto S, Bustamante G, Oliveira AC, Baca C, Cabezudo E, Talarn C, Escoda L, Ortega S, García N, Isabel González-Medina M, Sánchez-Salmerón M, Fusté C, Villa J, Carreras E, Domingo-Domènech E, Sureda A. A real-life overview of a hematopoietic cell transplant program throughout a four-year period, including prospective registry, exclusion causes and final donor selection. Bone Marrow Transplant 2021; 57:176-182. [PMID: 34711917 DOI: 10.1038/s41409-021-01506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022]
Abstract
Traceability of patients who are candidates for Hematopoietic cell transplant (HCT) is crucial to ensure HCT program quality. Continuous knowledge of both a detailed registry from a HCT program and final exclusion causes can contribute to promoting a real-life vision and optimizing patient and donor selection. We analyzed epidemiological data reported in a 4 year-monocentric prospective registry, which included all patients presented as candidates for autologous (Auto) and/or allogeneic (Allo) HCT. A total of 543 patients were considered for HCT: 252 (42.4%) for Allo and 291 (57.6%) for Auto. A total of 98 (38.9%) patients were excluded from AlloHCT due to basal disease progression more commonly (18.2%). Seventy-six (30.2%) patients had an HLA identical sibling, whereas 147 (58.3%) patients had only Haplo. UD research was performed in 106 (42%) cases, significantly more often in myeloid than lymphoid malignancies (57% vs 28.7%, p < 0.001) but 61.3% were finally canceled, due to donor or disease causes in 72.4%. With respect to Auto candidates, a total of 60 (20.6%) patients were finally excluded; progression was the most common cause (12%). Currently, Haplo is the most frequent donor type. The high cancellation rate of UD research should be revised to optimize further donor algorithms.
Collapse
Affiliation(s)
- R Parody
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain. .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain.
| | - I Sánchez-Ortega
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - A Mussetti
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - B Patiño
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - M Arnan
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - H Pomares
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - E González-Barca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - S Mercadal
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - C Boqué
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - C Maluquer
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - I Carro
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - M Peña
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - V Clapés
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,H. Comarcal d'Alt Penedés, Vilafranca del Penedés, Barcelona, Spain
| | - S Verdesoto
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - G Bustamante
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - A C Oliveira
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Hospital Sant Camil - St. Pere de Ribes, Barcelona, Spain
| | - C Baca
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,H General de Igualada, Barcelona, Spain
| | - E Cabezudo
- EBMT medical Office; 3. Hospital Moisès Broggi, S.Joan d'Espí, Barcelona, Spain
| | - C Talarn
- Institut Català d'Oncologia-Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - L Escoda
- Institut Català d'Oncologia-Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - S Ortega
- Banc de Sang i Teixits, Barcelona, Barcelona, Spain
| | - N García
- Banc de Sang i Teixits, Barcelona, Barcelona, Spain
| | | | - Mar Sánchez-Salmerón
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain
| | - C Fusté
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - J Villa
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - E Carreras
- REDMO, Fundació Josep Carreras, Barcelona, Spain
| | - E Domingo-Domènech
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| | - A Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Relationship of donor age and relationship to outcomes of haploidentical transplantation with posttransplant cyclophosphamide. Blood Adv 2021; 5:1360-1368. [PMID: 33661299 DOI: 10.1182/bloodadvances.2020003922] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 02/08/2023] Open
Abstract
Allogeneic blood or marrow transplantation (BMT) physicians seek to optimize all possible variables to improve outcomes. Selectable factors include conditioning, graft-versus-host disease (GVHD) prophylaxis, graft source, and donor. Many patients, especially those with eligible haploidentical (haplo) donors, will have multiple donor options. We seek to identify factors to optimize the choice of haplo donors when using posttransplantation cyclophosphamide (PTCy) GVHD prophylaxis. We evaluated the effect of modifiable donor characteristics (donor age and relationship) on outcomes following haplo BMT with a uniform nonmyeloablative conditioning and PTCy. From 2002 to 2017, 889 consecutive adult patients underwent nonmyeloablative haplo BMT with PTCy. Median follow-up among survivors was 2.5 years after BMT. Median recipient age was 59 (range: 18 to 76) years and median donor age was 40 (range: 13 to 79) years. Multivariable analyses demonstrated that increasing donor age by decade was associated with poorer overall survival (hazard ratio [HR], 1.13 [1.05, 1.22; P = .0015]), worse progression-free survival (HR, 1.09 [1.02, 1.16; P = .015]), and a higher risk for grade 2 to 4 and grade 3 to 4 GVHD (1.3 [1.06, 1.61; P = .013]), but not for chronic GVHD (HR, 1.06 [0.94, 1.2]; P = .37). These less-favorable results with older donors were attributable to worse nonrelapse mortality (HR, 1.19 [1.05, 1.34]; P = .006), not relapse. Parents were associated with inferior outcomes compared with sibling donors, whereas no significant differences were observed between parental donors. These data suggest that the youngest, adult-sized donors should be preferred when multiple haplo donors are available.
Collapse
|
13
|
Impact of donor age and kinship on clinical outcomes after T-cell-replete haploidentical transplantation with PT-Cy. Blood Adv 2021; 4:3900-3912. [PMID: 32813875 DOI: 10.1182/bloodadvances.2020001620] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/11/2020] [Indexed: 12/22/2022] Open
Abstract
Donor selection contributes to improve clinical outcomes of T-cell-replete haploidentical stem cell transplantation (haplo-SCT) with posttransplant cyclophosphamide (PT-Cy). The impact of donor age and other non-HLA donor characteristics remains a matter of debate. We performed a multicenter retrospective analysis on 990 haplo-SCTs with PT-Cy. By multivariable analysis, after adjusting for donor/recipient kinship, increasing donor age and peripheral blood stem cell graft were associated with a higher risk of grade 2 to 4 acute graft-versus-host-disease (aGVHD), whereas 2-year cumulative incidence of moderate-to-severe chronic GVHD was higher for transplants from female donors into male recipients and after myeloablative conditioning. Increasing donor age was associated with a trend for higher nonrelapse mortality (NRM) (hazard ratio [HR], 1.05; P = .057) but with a significant reduced risk of disease relapse (HR, 0.92; P = .001) and improved progression-free survival (PFS) (HR, 0.97; P = .036). Increasing recipient age was a predictor of worse overall survival (OS). Risk of relapse was higher (HR, 1.39; P < .001) in patients aged ≤40 years receiving a transplant from a parent as compared with a sibling. Moreover, OS and PFS were lower when the donor was the mother rather than the father. Pretransplant active disease status was an invariably independent predictor of worse clinical outcomes, while recipient positive cytomegalovirus serostatus and hematopoietic cell transplant comorbidity index >3 were associated with worse OS and PFS. Our results suggest that younger donors may reduce the incidence of aGVHD and NRM, though at higher risk of relapse. A parent donor, particularly the mother, is not recommended in recipients ≤40 years.
Collapse
|
14
|
Myeloablative haploidentical BMT with posttransplant cyclophosphamide for hematologic malignancies in children and adults. Blood Adv 2021; 4:3913-3925. [PMID: 32813874 DOI: 10.1182/bloodadvances.2020001648] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/06/2020] [Indexed: 01/19/2023] Open
Abstract
Promising results have been reported for patients with high-risk hematologic malignancies undergoing HLA-haploidentical bone marrow transplantation (haploBMT) with posttransplantation cyclophosphamide (PTCy), but there are few data on outcomes with myeloablative conditioning in this context. We report the results of a single-institution, prospective phase 2 trial of myeloablative haploBMT using busulfan-based or total body irradiation-based conditioning in 96 children or adults (median age, 42 years; range, 1-65 years) with high-risk hematologic malignancies. Recovery of neutrophils and platelets occurred at a median of 24 and 29 days. Engraftment of donor cells with chimerism >95% was achieved in 91%. The cumulative incidence of acute graft-versus-host disease (GVHD) grades II to IV and grades III to IV at day 100 was 11% and 4%, and of chronic GVHD at 6 and 12 months was 4% and 15%, with 6% moderate to severe. The cumulative incidence of nonrelapse mortality was 6% at 100 days and 11% at 1 year (19% in those aged >55 years). The cumulative incidence of relapse at 1 year was 35%; at 3 years, it was 43%. In multivariable analysis, relapse was associated with increased age (P = .02 for age 20-55 years and P = .02 for age >55 years) and with minimal residual disease before transplantation (P = .05). The overall survival at 1 and 3 years is 73% and 54%, and event-free survival at 1 and 3 years is 57% and 49%. We show that haploBMT with PTCy after myeloablative conditioning is safe and efficacious for adult and pediatric patients with hematologic malignancies. Careful consideration must be given to using myeloablative conditioning in patients age >55 years. This trial was registered at www.clinicaltrials.gov as #NCT00796562.
Collapse
|
15
|
Peripheral Blood Stem Cell Mobilization and Collection in Pediatric Healthy Sibling Donors Weighing 20 Kilograms or Less; Algerian Experience. Transfus Apher Sci 2020; 59:102987. [DOI: 10.1016/j.transci.2020.102987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
16
|
Prevalence and risk factors of having antibodies to class I and II human leukocyte antigens in older haploidentical allograft candidates. Sci Rep 2020; 10:2367. [PMID: 32047235 PMCID: PMC7012824 DOI: 10.1038/s41598-020-59417-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/29/2020] [Indexed: 02/04/2023] Open
Abstract
The effect of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) has been recognized as a factor in graft failure (GF) in patients who underwent umbilical cord blood transplantation (UBT), matched unrelated donor transplantation (MUDT), or haploidentical stem cell transplantation (haplo-SCT). Presently, we know little about the prevalence of and risk factors for having anti-HLA antibodies among older transplant candidates. Therefore, we analyzed 273 older patients with hematologic disease who were waiting for haplo-SCT. Among all patients, 73 (26.7%) patients had a positive panel-reactive antibody (PRA) result for class I, 38 (13.9%) for class II, and 32 (11.7%) for both. Multivariate analysis showed that females were at a higher risk for having a PRA result for class II (P = 0.001) and for having antibodies against HLA-C and HLA-DQ. Prior pregnancy was a risk factor for having a PRA result for class I (P < 0.001) and for having antibodies against HLA-A, HLA-B and HLA-DQ. Platelet transfusions were risk factors for the following: having a positive PRA result for class I (P = 0.014) and class II (P < 0.001); having antibodies against HLA-A, HLA-B, HLA-C, HLA-DP, HLA-DQ, and HLA-DR; and having higher mean fluorescence intensity (MFI) of PRA for class I (P = 0.042). In addition, previous total transfusions were at high risk for having higher numbers of antibodies to specific HLA loci (P = 0.005), and disease course (7.5 months or more) (P = 0.020) were related to higher MFI of PRAs for class I. Our findings indicated that female sex, prior pregnancy, platelet transfusions and disease courses are independent risk factors for older patients with hematologic disease for having anti-HLA antibodies, which could guide anti-HLA antibody monitoring and be helpful for donor selection.
Collapse
|
17
|
Yoshimitsu M, Fuji S, Utsunomiya A, Nakano N, Ito A, Ito Y, Miyamoto T, Suehiro Y, Kawakita T, Moriuchi Y, Nakamae H, Kanda Y, Ichinohe T, Fukuda T, Atsuta Y, Kato K. Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation for ATL with HTLV-1 Antibody-Positive Donors. Biol Blood Marrow Transplant 2019; 26:718-722. [PMID: 31821886 DOI: 10.1016/j.bbmt.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/25/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HCT) is the only available curative treatment option for patients with aggressive adult T cell leukemia-lymphoma (ATL). Donor human T cell leukemia virus (HTLV) 1 seropositivity is a critical concern when choosing relative donors, as they are not usually recommended due solely to the occurrence of donor-derived ATL. A previous report suggested that allo-HCT with an HTLV-1-seropositive donor increased ATL-related mortality. We updated the risk assessment for choosing an HTLV-1-seropositive allo-HCT donor for ATL. Our current registry data, which include larger numbers of HTLV-1-seropositive donors and longer observation periods, revealed no significant difference in overall survival (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.70-1.24; P = .61) or cumulative incidence of either ATL-related (HR, 0.96; 95% CI, 0.64 to 1.45; P = .80) or non-ATL-related mortality (HR, 0.91; 95% CI, 0.61 to 1.37; P = .66). Similarly, when considering only patients with ATL in complete remission, there was no significant difference in overall survival (HR, 1.02; 95% CI, 0.70 to 1.49; P = .91) or cumulative incidence of either ATL-related (HR, 1.20; 95% CI, 0.66 to 2.20; P=0.54) or non-ATL-related mortality (HR, 0.86; 95% CI, 0.52-1.42; P = .66). These data indicate that selecting HTLV-1-seropositive donors might not be contraindicated for patients with ATL receiving allo-HCT if alternative donors are unavailable. Further risk assessment remains to be performed.
Collapse
Affiliation(s)
- Makoto Yoshimitsu
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan.
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Center, Osaka, Japan
| | - Atae Utsunomiya
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Nobuaki Nakano
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Ayumu Ito
- Department of Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshikiyo Ito
- Department of Hematology, Imamura General Hospital, Kagoshima, Japan
| | - Toshihiro Miyamoto
- Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | | | - Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Tochigi, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takahiro Fukuda
- Department of Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Koji Kato
- Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | |
Collapse
|
18
|
McCurdy SR, Luznik L. How we perform haploidentical stem cell transplantation with posttransplant cyclophosphamide. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:513-521. [PMID: 31808908 PMCID: PMC6913422 DOI: 10.1182/hematology.2019001323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
HLA-haploidentical hematopoietic stem cell transplantation is now one of the most commonly employed alternative donor techniques, with most centers applying T-cell-replete strategies such as that developed by the Baltimore group using high-dose posttransplant cyclophosphamide. HLA-haploidentical hematopoietic stem cell transplantation using posttransplant cyclophosphamide is associated with low rates of severe graft-versus-host disease and nonrelapse mortality and does not require graft manipulation or storage, which results in a low graft acquisition cost. Its remarkable safety when used with reduced-intensity conditioning has been demonstrated in patients up to 75 years old with outcomes similar to those of patients in their 50s. Several large, registry-based retrospective studies have confirmed the efficacy of HLA-haploidentical hematopoietic stem cell transplantation with posttransplant cyclophosphamide, achieving results comparable to those of HLA-matched hematopoietic stem cell transplantation. In this article, we describe our approach to this rapidly available and clinically simple platform and address some of the key clinical questions associated with its use.
Collapse
Affiliation(s)
- Shannon R McCurdy
- Abramson Cancer Center and
- Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA; and
| | - Leo Luznik
- Department of Oncology and
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW We briefly address the advances in genetics, pathophysiology, and phenotypes of chronic granulomatous disease (CGD). This is one of the most studied primary immunodeficiencies, which comprise mutations in genes encoding the different subunits of the NADPH oxidase system. Those mutations lead to defective reactive oxygen species production, and consequently a failure to eliminate pathogens. RECENT FINDINGS Patients with CGD are susceptible to fungal, bacterial, and parasitic infections. Other symptoms, as systemic adverse effects to BCG vaccine and hyperinflammation, are also important clinical conditions in this disease. This wide-ranging clinical spectrum of CGD comes from heterogeneity of mutations, X-linked-CGD or autosomal recessive inheritance, and diverse environmental pressure factors. Early accurate diagnosis and prompt treatment are necessary to diminish the consequences of the disease. The most used diagnostic tests are dihydrorhodamine, cytochrome c reduction, and luminol-enhanced chemiluminescence assay. SUMMARY The determination of mutations is essential for diagnosis confirmation and genetic counseling. CGD treatment usually includes prophylactic antibiotics and antifungals. Prophylactic recombinant human interferon-γ, immunosuppressors or immune modulators may be, respectively, indicated for preventing infections or inflammatory manifestations. Hematopoietic stem cell transplantation and gene therapy are currently the available options for curative treatment of CGD.
Collapse
|
20
|
McCurdy SR, Luznik L. How we perform haploidentical stem cell transplantation with posttransplant cyclophosphamide. Blood 2019; 134:1802-1810. [PMID: 31751485 PMCID: PMC6872960 DOI: 10.1182/blood.2019001323] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022] Open
Abstract
HLA-haploidentical hematopoietic stem cell transplantation is now one of the most commonly employed alternative donor techniques, with most centers applying T-cell-replete strategies such as that developed by the Baltimore group using high-dose posttransplant cyclophosphamide. HLA-haploidentical hematopoietic stem cell transplantation using posttransplant cyclophosphamide is associated with low rates of severe graft-versus-host disease and nonrelapse mortality and does not require graft manipulation or storage, which results in a low graft acquisition cost. Its remarkable safety when used with reduced-intensity conditioning has been demonstrated in patients up to 75 years old with outcomes similar to those of patients in their 50s. Several large, registry-based retrospective studies have confirmed the efficacy of HLA-haploidentical hematopoietic stem cell transplantation with posttransplant cyclophosphamide, achieving results comparable to those of HLA-matched hematopoietic stem cell transplantation. In this article, we describe our approach to this rapidly available and clinically simple platform and address some of the key clinical questions associated with its use.
Collapse
Affiliation(s)
- Shannon R McCurdy
- Abramson Cancer Center and
- Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA; and
| | - Leo Luznik
- Department of Oncology and
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
21
|
Simpson E, Dazzi F. Bone Marrow Transplantation 1957-2019. Front Immunol 2019; 10:1246. [PMID: 31231381 PMCID: PMC6560153 DOI: 10.3389/fimmu.2019.01246] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/16/2019] [Indexed: 12/22/2022] Open
Abstract
Clinical bone marrow transplantation started in 1957 at a time when remarkably little was known about hematopoietic stems cells, immune responses to transplants or the identity of transplant antigens. This review will delineate the substantial increase in knowledge about these three areas gained between then and 1992 when the Ceppellini School course on Bone Marrow Transplantation was held, along with the progress made in clinical application, as well as the stumbling blocks that remained to be overcome by further research to advance knowledge. It will outline the significant progress made between 1992 and the present year, 2019, and the remaining problems.
Collapse
Affiliation(s)
- Elizabeth Simpson
- Division of Immunology & Inflammation, Department of Medicine, Imperial College London, London, United Kingdom
| | - Francesco Dazzi
- Division of Cancer Studies, King's College London, London, United Kingdom
| |
Collapse
|
22
|
High-resolution HLA phased haplotype frequencies to predict the success of unrelated donor searches and clinical outcome following hematopoietic stem cell transplantation. Bone Marrow Transplant 2019; 54:1701-1709. [PMID: 30953025 PMCID: PMC7198472 DOI: 10.1038/s41409-019-0520-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
HLA matching is a critical factor for successful allogeneic hematopoietic stem cell transplantation. For unrelated donor searches, matching is usually based on high-resolution typing at five HLA loci, looking for a 10/10 match. Some studies have proposed that further matching at the haplotype level could be beneficial for clinical outcome. In this study, we determined the phased haplotypes of 291 patients using family members and segregation analysis. The sum of ranks of the haplotypes carried by patients was used as a surrogate predictor of a successful unrelated donor search. The putative impact of haplotypes was then analyzed in a cohort of 211 recipients transplanted with 10/10 matched unrelated donors. A logistic regression analysis showed a highly significant effect of the haplotypes in the outcome of a search, but we did not find any significant effect on overall survival, graft versus host disease or relapse/progression following HSCT. This study provides useful data for the optimization of unrelated bone marrow donor searches, but does not confirm previous reports that matching at the haplotype level has a clinical impact following HSCT. Due to the extreme polymorphism of HLA genes, further studies are warranted to better understand the many factors at play.
Collapse
|
23
|
Effect of donor characteristics on haploidentical transplantation with posttransplantation cyclophosphamide. Blood Adv 2019; 2:299-307. [PMID: 29440002 DOI: 10.1182/bloodadvances.2017014829] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 01/06/2018] [Indexed: 01/23/2023] Open
Abstract
We studied the association between non-HLA donor characteristics (age, sex, donor-recipient relationship, blood group [ABO] match, and cytomegalovirus [CMV] serostatus) and transplant outcomes after T-cell-replete HLA-haploidentical transplantation using posttransplantation cyclophosphamide (PT-Cy) in 928 adults with hematologic malignancy transplanted between 2008 and 2015. Siblings (n = 358) and offspring (n = 450) were the predominant donors, with only 120 patients having received grafts from parents. Although mortality risks were higher with donors aged 30 years or older (hazard ratio, 1.39; P < .0001), the introduction of patient age to the Cox regression model negated the effect of donor age. Two-year survival adjusted for CMV seropositivity, disease, and disease risk index was lower in patients aged 55 to 78 years after transplantation of grafts from donors younger than 30 years (53%) or aged at least 30 years (46%) compared with younger patients who received grafts from donors younger than 30 years (61%) and at least 30 years (60%; P < .0001). Similarly, 2-year survival in patients aged 55 to 78 years was lower after transplantation of grafts from siblings (45%) or offspring (48%) compared with patients aged 18 to 54 years after transplantation of grafts from siblings (62%), offspring (58%), and parents (61%; P < .0001). Graft failure was higher after transplantation of grafts from parents (14%) compared with siblings (6%) or offspring (7%; P = .02). Other non-HLA donor characteristics were not associated with survival or graft failure. The current analyses suggest patient and disease, rather than non-HLA donor characteristics, predominantly influence survival in adults.
Collapse
|
24
|
Lv M, Zhai SZ, Wang Y, Xu LP, Zhang XH, Chen H, Chen YH, Wang FR, Han W, Sun YQ, Cheng YF, Yan CH, Mo XD, Liu KY, Chang YJ, Huang XJ, Zhao XY. Class I and II human leukocyte antibodies in pediatric haploidentical allograft candidates: prevalence and risk factors. Bone Marrow Transplant 2019; 54:1287-1294. [DOI: 10.1038/s41409-018-0427-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 12/13/2022]
|
25
|
Fleischhauer K, Hsu KC, Shaw BE. Prevention of relapse after allogeneic hematopoietic cell transplantation by donor and cell source selection. Bone Marrow Transplant 2018; 53:1498-1507. [PMID: 29795435 PMCID: PMC7286200 DOI: 10.1038/s41409-018-0218-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/16/2018] [Accepted: 03/24/2018] [Indexed: 01/27/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the most established form of cancer immunotherapy and has been successfully applied for the treatment and cure of otherwise lethal neoplastic blood disorders. Cancer immune surveillance is mediated to a large extent by alloreactive T and natural killer (NK) cells recognizing genetic differences between patient and donor. Profound insights into the biology of these effector cells has been obtained over recent years and used for the development of innovative strategies for intelligent donor selection, aiming for improved graft-versus-leukemia effect without unmanageable graft-versus-host disease. The cellular composition of the stem cell source plays a major role in modulating these effects. This review summarizes the current state-of the-art of donor selection according to HLA, NK alloreactivity and stem cell source.
Collapse
Affiliation(s)
- Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany.
- German Cancer Consortium, Heidelberg, Germany.
| | - Katharine C Hsu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Immunology Program, Sloan Kettering Institute, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
26
|
Abstract
Apheresis procedures are standard of care for a wide range of indications in children, collection of hematopoietic stem cells being the most frequent one. With increasing numbers of hematopoietic stem cell transplants, advances in graft manipulation techniques and the development of innovative therapies using immune effector cells and gene therapy, apheresis within the pediatric population is growing in demand. While young children have higher circulating white blood cell counts and robustly mobilize hematopoietic stem cells, apheresis machines were designed for use within the adult population and apheresis procedures in children, particularly small children, can be more challenging as vascular access, collection techniques and impact of extracorporeal volumes increase the rate of adverse events. In this article we review topics of particular relevance to hematopoietic stem cell and immune effector cell collections in small children.
Collapse
|
27
|
Huo MR, Xu YJ, Zhai SZ, Lv M, Wang Y, Cao LQ, Xu LP, Zhang XH, Chen H, Chen YH, Wang FR, Han W, Sun YQ, Yan CH, Tang FF, Mo XD, Zhao MF, Liu KY, Huang XJ, Chang YJ. Prevalence and risk factors of antibodies to human leukocyte antigens in haploidentical stem cell transplantation candidates: A multi-center study. Hum Immunol 2018; 79:672-677. [DOI: 10.1016/j.humimm.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 12/30/2022]
|
28
|
Pei X, Huang X. New approaches in allogenic transplantation in AML. Semin Hematol 2018; 56:147-154. [PMID: 30926091 DOI: 10.1053/j.seminhematol.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/19/2018] [Accepted: 08/24/2018] [Indexed: 12/14/2022]
Abstract
Acute myeloid leukemia (AML) is a heterogeneous disorder with high morbidity and mortality. Allogeneic stem cell transplantation (allo-SCT) is an effective, and sometimes the only, curative postremission therapy for AML patients. Based on genetic risk classification, the published data have suggested that allo-SCT be recommended for high- and most intermediate-risk AML but not for low-risk AML in first complete remission (CR1). Recently, the role of allo-SCT in low-risk AML in CR1 is being established with the development of a risk-directed, minimal residual disease-based strategy. Though human leukocyte antigen-matched sibling transplantation remains the preferred therapeutic option for AML, modern approaches and developments pre-, peri- and post-transplant have facilitated other transplant modalities, especially haploidentical SCT, as promising valid alternative choices. In this paper, we review recent advances in allo-SCT for AML, weigh the benefits of allo-SCT for high-, intermediate-, and even low-risk AML in CR1, discuss the best choice of allo-SCT donor for the treatment of AML, and summarize new approaches for refractory and relapsed AML pre- or post-allo-SCT.
Collapse
Affiliation(s)
- Xuying Pei
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiaojun Huang
- Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Peking-Tsinghua Center for Life Sciences, Beijing, China.
| |
Collapse
|
29
|
DeZern AE, Brodsky RA. Haploidentical Donor Bone Marrow Transplantation for Severe Aplastic Anemia. Hematol Oncol Clin North Am 2018; 32:629-642. [PMID: 30047416 PMCID: PMC6063510 DOI: 10.1016/j.hoc.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hematopoietic stem cell transplantation (bone marrow transplantation [BMT]) is the only curative treatment of severe aplastic anemia. BMT from an human leukocyte antigen (HLA)-matched sibling donor is the standard of care for young patients; immunosuppressive therapy is used for older patients or those lacking matched sibling donors. Patients with refractory or relapsed disease are increasingly treated with HLA haploidentical BMT. Historically, haploidentical BMT led to high rates of graft rejection and graft-versus-host disease. High-dose post transplant cyclophosphamide, which mitigates the risk of graft-versus-host disease, is a major advance. This article provides an overview of the haploidentical BMT approach in severe aplastic anemia.
Collapse
Affiliation(s)
- Amy E DeZern
- Division of Hematologic Malignancies, The Johns Hopkins University School of Medicine, 1650 Orleans Street, CRBI Room 3M87, Baltimore, MD 21287-0013, USA.
| | - Robert A Brodsky
- Division of Hematology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross 1025, Baltimore, MD 21205, USA
| |
Collapse
|
30
|
Killer cell immunoglobulin-like receptor ligand mismatching and outcome after haploidentical transplantation with post-transplant cyclophosphamide. Leukemia 2018; 33:230-239. [PMID: 29907809 DOI: 10.1038/s41375-018-0170-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/11/2018] [Indexed: 11/08/2022]
Abstract
Haploidentical stem cell transplantation with T cell-replete grafts and post-transplant cyclophosphamide (PTCy) is increasingly used with encouraging outcome. Natural killer (NK) cell alloreactivity, predicted by missing killer cell immunoglobulin-like receptor (KIR) ligands in the recipient that are present in their donor improves outcome of T cell-depleted haploidentical transplants. We explored the role of KIR ligand mismatching in 444 acute leukemia patients after T cell-replete transplants with PTCy. Thirty-seven percent of all patients had KIR ligand mismatching. Patients were in first remission (CR1) (39%), second remission (CR2) (26%), or active disease (35%). Stem cell source was peripheral blood (PBSC, 46%) or bone marrow (54%). The 2-year relapse, non-relapse mortality (NRM), and survival rates were 36.0% (95% confidence interval (CI), 31.4-40.7), 23.9% (20.0-28.0), and 45.9% (40.8-51.0), respectively. Multivariate analysis identified acute myeloid leukemia compared with acute lymphoblastic leukemia (hazard ratio (HR) 0.55, P = 0.002), female gender (HR 0.72, P = 0.04), and good performance status (HR 0.71, P = 0.04) as factors associated with better survival, while advanced age (HR 1.13, P = 0.04), active disease (HR 3.38, P < 0.0001), and KIR ligand mismatching (HR 1.41, P = 0.03) as associated with worse survival. KIR ligand mismatching was associated with a trend for higher relapse but not with graft-versus-host disease or NRM. The KIR ligand-mismatching effect was more prominent in patients given PBSC. In conclusion, there is no evidence that KIR ligand mismatching results in better outcome in the PTCy setting.
Collapse
|
31
|
Connelly JA, Marsh R, Parikh S, Talano JA. Allogeneic Hematopoietic Cell Transplantation for Chronic Granulomatous Disease: Controversies and State of the Art. J Pediatric Infect Dis Soc 2018; 7:S31-S39. [PMID: 29746680 PMCID: PMC5946867 DOI: 10.1093/jpids/piy015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic granulomatous disease (CGD) is a congenital disorder characterized by recurrent life-threatening bacterial and fungal infections and development of severe inflammation secondary to a congenital defect in 1 of the 5 phagocyte oxidase (phox) subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. Hematopoietic cell transplant (HCT) is a curative treatment for patients with CGD that provides donor neutrophils with functional NADPH and superoxide anion production. Many characteristics of CGD, including preexisting infection and inflammation and the potential for cure with mixed-donor chimerism, influence the transplant approach and patient outcome. Because of the dangers of short-term death, graft-versus-host disease, and late effects from chemotherapy, HCT historically has been reserved for patients with high-risk disease and a matched donor. However, as advances in CGD and HCT treatments have evolved, recommendations on transplant eligibility also must be amended, but the development of modern guidelines has proven difficult. In this review, we provide an overview of HCT in patients with CGD, including the debate over HCT indications in them, the unique aspects of CGD that can complicate HCT, and a summary of transplant outcomes.
Collapse
Affiliation(s)
- James A Connelly
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital, Ohio
| | - Suhag Parikh
- Division of Pediatric Blood and Marrow Transplantation, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Julie-An Talano
- Division of Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin and Children’s Hospital of Wisconsin, Milwaukee,Correspondence: J. A. Connelly, MD, Division of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, 397 PRB, 2220 Pierce Ave, Nashville, TN 37232-6310 ()
| |
Collapse
|
32
|
Sun YQ, Chang YJ, Huang XJ. Update on current research into haploidentical hematopoietic stem cell transplantation. Expert Rev Hematol 2018; 11:273-284. [PMID: 29493370 DOI: 10.1080/17474086.2018.1447379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Haploidentical stem cell transplantation (Haplo-SCT) is currently a suitable alternative worldwide for patients with hematological diseases, who lack human leukocyte antigen (HLA)-matched siblings or unrelated donors. Areas covered: This review summarizes the advancements in Haplo-SCT in recent years, primarily focusing on the global trends of haploidentical allograft, the comparison of outcomes between Haplo-SCT and other transplantation modalities, strategies for improving clinical outcomes, including donor selection, hematopoietic reconstitution promotion, and graft-versus-host disease, and relapse prevention/management, as well as the expanded indications of Haplo-SCT, such as severe aplastic anemia, myeloma and lymphoma. Expert commentary: Haploidentical allografts, including granulocyte colony-stimulating factor-based protocol and a post-transplant cyclophosphamide-based protocol, have been the mainstream strategy for Haplo-SCT. However, there are many unanswered questions in this field.
Collapse
Affiliation(s)
- Yu-Qian Sun
- a Peking University People's Hospital , Peking University Institute of Hematology , Beijing , China.,b Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases , Beijing , P.R. China
| | - Ying-Jun Chang
- a Peking University People's Hospital , Peking University Institute of Hematology , Beijing , China.,b Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases , Beijing , P.R. China
| | - Xiao-Jun Huang
- a Peking University People's Hospital , Peking University Institute of Hematology , Beijing , China.,b Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases , Beijing , P.R. China.,c Peking-Tsinghua Center for Life Sciences , Beijing , China
| |
Collapse
|
33
|
Canaani J, Savani BN, Labopin M, Huang XJ, Ciceri F, Arcese W, Koc Y, Tischer J, Blaise D, Gülbas Z, Van Lint MT, Bruno B, Mohty M, Nagler A. Donor age determines outcome in acute leukemia patients over 40 undergoing haploidentical hematopoietic cell transplantation. Am J Hematol 2018; 93:246-253. [PMID: 29114918 DOI: 10.1002/ajh.24963] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/25/2017] [Accepted: 11/03/2017] [Indexed: 01/11/2023]
Abstract
Haploidentical hematopoietic cell transplantation (haplo-HCT) is being increasingly used in acute leukemia patients as an alternative transplant modality when matched sibling or matched unrelated donors are unavailable. As several potential haploidentical relative donors are typically available for a given patient, optimizing donor selection to improve clinical outcome is crucial. The impact of donor age and kinship on the outcome of acute leukemia patients is not clearly established in this setting. Using the multinational registry of the acute leukemia working party of the European society for blood and marrow transplantation we retrospective analyzed the clinical outcome of 1270 acute myeloid leukemia and acute lymphoblastic leukemia patients who underwent haplo-HCT between 2005 and 2015. Patients over the age of 40 were significantly affected by increasing donor age resulting in higher non-relapse mortality (NRM) [Hazard ratio (HR)=1.86, confidence interval (CI) 95%, 1.18-2.94; P = .007], inferior leukemia-free survival (LFS) (HR = 1.59, CI 95%, 1.13-2.24; P = .007), and overall survival (OS) (HR = 1.74, CI 95%, 1.22-2.47; P = .002) when donors were over the age of 40. Additionally, kinship was found to be prognostically significant as patients transplanted from children donors over the age of 35 experienced an increased rate of NRM (HR = 1.82, CI 95%, 1.13-2.9; P = .01), inferior LFS (HR = 1.5, CI 95%, 1.05-2.13; P = .03), and OS (HR = 1.5, CI 95%, 1.04-2.15; P = .03). For patients younger than 40 years, donor age and kinship were mostly not clinically impactful. Our data establish donor age and kinship as significant determinants of outcome following haplo-HCT for acute leukemia patients.
Collapse
Affiliation(s)
- Jonathan Canaani
- Chaim Sheba Medical Center, Hematology Division; Tel Aviv University; Tel-Hashomer Israel
| | | | - Myriam Labopin
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy; Hȏpital Saint-Antoine; Paris
- INSERM UMRs 938, CEREST-TC EBMT; Paris France
| | - Xiao-Jun Huang
- Peking University Peoplés Hospital, Institute of Haematology; Xicheng District Beijing China
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT; Milano Italy
| | - William Arcese
- “Tor Vergata” University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata; Rome Italy
| | - Yener Koc
- Medical Park Hospitals, Stem Cell Transplant Unit; Antalya Turkey
| | | | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes; Marseille France
| | - Zafer Gülbas
- Bone Marrow Transplantation Department; Anadolu Medical Center Hospital; Kocaeli Turkey
| | | | - Benedetto Bruno
- S.S.D. Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di Torino, and Department of Molecular Biotechnology and Health Sciences; University of Torino; Torino Italy
| | - Mohamad Mohty
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy; Hȏpital Saint-Antoine; Paris
- INSERM UMRs 938, CEREST-TC EBMT; Paris France
| | - Arnon Nagler
- Chaim Sheba Medical Center, Hematology Division; Tel Aviv University; Tel-Hashomer Israel
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy; Hȏpital Saint-Antoine; Paris
| |
Collapse
|
34
|
The importance of natural killer cell killer immunoglobulin-like receptor-mismatch in transplant outcomes. Curr Opin Hematol 2017; 24:489-495. [DOI: 10.1097/moh.0000000000000384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
NK cell recovery after haploidentical HSCT with posttransplant cyclophosphamide: dynamics and clinical implications. Blood 2017; 131:247-262. [PMID: 28986344 DOI: 10.1182/blood-2017-05-780668] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/30/2017] [Indexed: 12/15/2022] Open
Abstract
The use of posttransplant cyclophosphamide (PT-Cy) as graft-versus-host disease (GVHD) prophylaxis has revolutionized haploidentical hematopoietic stem cell transplantation (HSCT), allowing safe infusion of unmanipulated T cell-replete grafts. PT-Cy selectively eliminates proliferating alloreactive T cells, but whether and how it affects natural killer (NK) cells and their alloreactivity is largely unknown. Here we characterized NK cell dynamics in 17 patients who received unmanipulated haploidentical grafts, containing high numbers of mature NK cells, according to PT-Cy-based protocols in 2 independent centers. In both series, we documented robust proliferation of donor-derived NK cells immediately after HSCT. After infusion of Cy, a marked reduction of proliferating NK cells was evident, suggesting selective purging of dividing cells. Supporting this hypothesis, proliferating NK cells did not express aldehyde dehydrogenase and were killed by Cy in vitro. After ablation of mature NK cells, starting from day 15 after HSCT and favored by the high levels of interleukin-15 present in patients' sera, immature NK cells (CD62L+NKG2A+KIR-) became highly prevalent, possibly directly stemming from infused hematopoietic stem cells. Importantly, also putatively alloreactive single KIR+ NK cells were eliminated by PT-Cy and were thus decreased in numbers and antileukemic potential at day 30 after HSCT. As a consequence, in an extended series of 99 haplo-HSCT with PT-Cy, we found no significant difference in progression-free survival between patients with or without predicted NK alloreactivity (42% vs 52% at 1 year, P = NS). Our data suggest that the majority of mature NK cells infused with unmanipulated grafts are lost upon PT-Cy administration, blunting NK cell alloreactivity in this transplantation setting.
Collapse
|
36
|
Petersdorf EW. Role of major histocompatibility complex variation in graft-versus-host disease after hematopoietic cell transplantation. F1000Res 2017; 6:617. [PMID: 28529723 PMCID: PMC5419254 DOI: 10.12688/f1000research.10990.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 01/01/2023] Open
Abstract
Graft-versus-host disease (GVHD) remains a significant potentially life-threatening complication of allogeneic hematopoietic cell transplantation (HCT). Since the discovery of the human leukocyte antigen (HLA) system over 50 years ago, significant advances have clarified the nature of HLA variation between transplant recipients and donors as a chief etiology of GVHD. New information on coding and non-coding gene variation and GVHD risk provides clinicians with options to consider selected mismatched donors when matched donors are not available. These advances have increased the availability of unrelated donors for patients in need of a transplant and have lowered the overall morbidity and mortality of HCT.
Collapse
|
37
|
Related haploidentical donors are a better choice than matched unrelated donors: Counterpoint. Blood Adv 2017; 1:401-406. [PMID: 29296955 DOI: 10.1182/bloodadvances.2016002188] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 01/18/2023] Open
Abstract
Publisher's Note: This article has a companion Point by Fuchs. Publisher's Note: Join in the discussion of these articles at Blood Advances Community Conversations.
Collapse
|
38
|
Yüksel MK, Demirer T. Toxicity of Conditioning Regimens in Haploidentical SCT. STEM CELL BIOLOGY AND REGENERATIVE MEDICINE 2017. [DOI: 10.1007/978-3-319-65319-8_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|