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HLA-haploidentical TCRαβ+/CD19+-depleted stem cell transplantation in children and young adults with Fanconi anemia. Blood Adv 2021; 5:1333-1339. [PMID: 33656536 DOI: 10.1182/bloodadvances.2020003707] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
We report on the outcome of 24 patients with Fanconi anemia (FA) lacking an HLA matched related or unrelated donor, given an HLA-haploidentical T-cell receptor αβ (TCRαβ+) and CD19+ cell-depleted hematopoietic stem cell transplantation (HSCT) in the context of a prospective, single-center phase 2 trial. Sustained primary engraftment was achieved in 22 (91.6%) of 24 patients, with median time to neutrophil recovery of 12 days (range, 9-15 days) and platelet recovery of 10 days (range, 7-14 days). Cumulative incidences of grade 1 to 2 acute graft-versus-host disease (GVHD) and chronic GVHD were 17.4% (95% confidence interval [CI], 5.5%-35.5%) and 5.5% (95% CI, 0.8%-33.4%), respectively. The conditioning regimen, which included fludarabine, low-dose cyclophosphamide and, in most patients, single-dose irradiation was well tolerated; no fatal transplant-related toxicity was observed. With a median follow-up of 5.2 years (range, 0.3-8.7 years), the overall and event-free survival probabilities were 100% and 86.3% (95% CI, 62.8%-95.4%), respectively (2 graft failures and 1 case of poor graft function were considered as events). The 2 patients who experienced primary graft failure underwent a subsequent successful HSCT from the other parent. This is the first report of FA patients given TCRαβ+/CD19+-depleted haplo-HSCT in the context of a prospective trial, and the largest series of T-cell-depleted haplo-HSCT in FA reported to date. This trial was registered at www.clinicaltrials.gov as #NCT01810120.
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2
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Gorin NC, Labopin M, Blaise D, de Groot M, Socié G, Bourhis JH, Ciceri F, Polge E, Nagler A, Mohty M. Stem cell transplantation from a haploidentical donor versus a genoidentical sister for adult male patients with acute myelogenous leukemia in first remission: A retrospective study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation. Cancer 2019; 126:1004-1015. [PMID: 31774557 DOI: 10.1002/cncr.32629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND In adult patients with acute myeloid leukemia (AML), a matched sibling donor (MSD) is considered the first choice for an allogeneic transplantation. However, a female donor for a male recipient is a poor prognostic factor. The authors compared haploidentical (HAPLO) donors with female MSDs. METHODS In total, 834 men underwent allogenic transplantation from a female MSD, and 232 men underwent allogenic transplantation from a HAPLO donor. Of these, 86% of HAPLO recipients and 3% of MSD recipients received graft-versus-host disease (GVHD) prophylaxis posttransplantation with high-dose cyclophosphamide. A significant qualitative interaction was observed between donor type and cytogenetics, Therefore, the analyses were stratified on cytogenetics. RESULTS Of the men with intermediate-risk AML, 638 received transplantation from a female MSD, and 160 received transplantation from a HAPLO donor. In multivariate analysis, poor risk factors were a HAPLO donor versus an MSD for nonrelapse mortality (hazard ratio [HR], 1.7; P = .02) and patient age for nonrelapse mortality and overall survival (HR, 1.22 [P = .02] and 1.15 [P = .02], respectively). HAPLO transplantation resulted in less chronic GVHD (HR, 0.43; P < 10-4 ) but lower leukemia-free survival (HR, 1.7; P = .04). The GVHD/relapse-free survival (GRFS) was not different. Of the men with high-risk AML, 196 received transplantation from a female MSD, and 72 received transplantation from a HAPLO donor. By multivariate analysis, HAPLO recipients had a lower incidence of relapse (HR, 0.40; P = .004), better leukemia-free survival (HR, 0.46; P = .003), better overall survival (HR, 0.43; P = .003), and better GRFS (HR, 0.54; P = .006). CONCLUSIONS In men who have intermediate-risk AML, allogenic transplantation from a sister MSD or a HAPLO donor produces similar GRFS. However, in men who have high-risk AML, a HAPLO donor combined with prophylactic high-dose cyclophosphamide posttransplantation may be a better choice.
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Affiliation(s)
- Norbert-Claude Gorin
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Institut national de la santé et de la recherche médicale (INSERM) Unit 938, Assistance Publique-Hopitaux de Paris APHP, Sorbonne University, Paris, France.,European Society for Blood and Marrow Transplantation Paris Office, Paris, France
| | - Myriam Labopin
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Institut national de la santé et de la recherche médicale (INSERM) Unit 938, Assistance Publique-Hopitaux de Paris APHP, Sorbonne University, Paris, France.,European Society for Blood and Marrow Transplantation Paris Office, Paris, France
| | - Didier Blaise
- Paoli Calmettes Institute, Aix Marseille University, Centre National de la Recherche scientifique, INSERM, CRCM, Marseille, France
| | - Marco de Groot
- Department of Hematology, University of Groningen, Groningen, the Netherlands
| | - Gerard Socié
- Department of Hematology and Stem Cell Transplantation, Saint Louis Hospital, Paris, France
| | - Jean Henri Bourhis
- Department of Hematology and Stem Cell Transplantation, Gustave Roussy Institute, Villejuif, France
| | - Fabio Ciceri
- Department of Hematology and Stem Cell Transplantation, San Raffaele Hospital, Milan, Italy
| | - Emmanuelle Polge
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Institut national de la santé et de la recherche médicale (INSERM) Unit 938, Assistance Publique-Hopitaux de Paris APHP, Sorbonne University, Paris, France.,European Society for Blood and Marrow Transplantation Paris Office, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Institut national de la santé et de la recherche médicale (INSERM) Unit 938, Assistance Publique-Hopitaux de Paris APHP, Sorbonne University, Paris, France.,European Society for Blood and Marrow Transplantation Paris Office, Paris, France
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3
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Prezioso L, Manfra I, Bonomini S, Schifano C, Segreto R, Monti A, Sammarelli G, Todaro G, Sassi M, Bertaggia I, Pelagatti L, Cambò B, Spolzino A, Follini E, Re F, Crugnola M, Craviotto L, Russo F, Plenteda C, Roti G, Giuliani N, Aversa F. Haploidentical hematopoietic stem cell transplantation in adults using the αβTCR/CD19-based depletion of G-CSF-mobilized peripheral blood progenitor cells. Bone Marrow Transplant 2019; 54:698-702. [DOI: 10.1038/s41409-019-0608-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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4
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Busca A, Aversa F. In-vivo or ex-vivo T cell depletion or both to prevent graft-versus-host disease after hematopoietic stem cell transplantation. Expert Opin Biol Ther 2017; 17:1401-1415. [PMID: 28846051 DOI: 10.1080/14712598.2017.1369949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation (HSCT) represents a widely accepted therapeutic strategy for the treatment of hematologic disorders which are otherwise considered incurable. Alloreactive T cells infused with the stem cell inoculum may generate graft-versus-host disease (GVHD) representing one the most relevant obstacles to the successful outcome of patients receiving allogeneic HSCT. Areas covered: In this review, the authors provide an overview of the most recent approaches of T-cell depletion (TCD) including ex-vivo αβ+ TCD and in-vivo TCD with anti-thymocyte globulin (ATG). Expert opinion: Ex vivo depletion of donor T-cells prevents both acute and chronic GVHD without the need for any additional posttransplant immunological prophylaxis either in haploidentical HSCT and HLA matched transplants. Three prospective trials evaluating the efficacy of ATG in matched unrelated donor transplant recipients demonstrated that ATG reduces the incidence of both acute and chronic GVHD without a significant increase of relapse rate, and similar results have been reported in the setting of blood stem cell grafts from matched sibling donors.
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Affiliation(s)
- Alessandro Busca
- a SSD Trapianto di Cellule Staminali , AOU Citta' della Salute e della Scienza , Torino , Italy
| | - Franco Aversa
- b Hematology and BMT Unit , University of Parma , Parma , Italy
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5
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Abstract
Allogeneic haematopoietic stem cell transplantation (HSCT) from an human leukocyte antigen (HLA)-identical donor can be curative for eligible patients with non-malignant and malignant haematological disorders. HSCT from alternative donor sources, such as HLA-mismatched haploidentical donors, is increasingly considered as a viable therapeutic option for patients lacking HLA-matched donors. Initial attempts at haploidentical HSCT were associated with vigorous bidirectional alloreactivity, leading to unacceptably high rates of graft rejection and graft-versus-host disease (GVHD). More recently, new approaches for mitigating harmful T-cell alloreactivity that mediates GVHD, while preserving the function of tumour-reactive natural killer (NK) cells and γδ T cells, have led to markedly improved clinical outcomes, and are successfully being implemented in the clinic. This article will provide an update on in vitro strategies and in vivo approaches aimed at preventing GVHD by selectively manipulating key components of the adaptive immune response, such as T-cell receptor (TCR)-αβ T cells and CD45RA-expressing naive T cells.
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6
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Immunity to Infections after Haploidentical Hematopoietic Stem Cell Transplantation. Mediterr J Hematol Infect Dis 2016; 8:e2016057. [PMID: 27872737 PMCID: PMC5111540 DOI: 10.4084/mjhid.2016.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/21/2016] [Indexed: 02/06/2023] Open
Abstract
The advantage of using a Human Leukocyte Antigen (HLA)-mismatched related donor is that almost every patient who does not have an HLA-identical donor or who urgently needs hematopoietic stem cell transplantation (HSCT) has at least one family member with whom shares one haplotype (haploidentical) and who is promptly available as a donor. The major challenge of haplo-HSCT is intense bi-directional alloreactivity leading to high incidences of graft rejection and graft-versus-host disease (GVHD). Advances in graft processing and pharmacologic prophylaxis of GVHD have reduced these risks and have made haplo-HSCT a viable alternative for patients lacking a matched donor. Indeed, the haplo-HSCT has spread to centers worldwide even though some centers have preferred an approach based on T cell depletion of G-CSF-mobilized peripheral blood progenitor cells (PBPCs), others have focused on new strategies for GvHD prevention, such as G-CSF priming of bone marrow and robust post-transplant immune suppression or post-transplant cyclophosphamide (PTCY). Today, the graft can be a megadose of T-cell depleted PBPCs or a standard dose of unmanipulated bone marrow and/or PBPCs. Although haplo-HSCT modalities are based mainly on high intensity conditioning regimens, recently introduced reduced intensity regimens (RIC) showed promise in decreasing early transplant-related mortality (TRM), and extending the opportunity of HSCT to an elderly population with more comorbidities. Infections are still mostly responsible for toxicity and non-relapse mortality due to prolonged immunosuppression related, or not, to GVHD. Future challenges lie in determining the safest preparative conditioning regimen, minimizing GvHD and promoting rapid and more robust immune reconstitution.
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7
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Wiles K, Fishman JM, De Coppi P, Birchall MA. The Host Immune Response to Tissue-Engineered Organs: Current Problems and Future Directions. TISSUE ENGINEERING PART B-REVIEWS 2016; 22:208-19. [DOI: 10.1089/ten.teb.2015.0376] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Martin A. Birchall
- UCL Ear Institute & Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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8
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Lakshmikanth T, Heuts F, Muvva SSVJR, Wallin RPA, Persson AK, Fauriat C, Applequist SE, Ljunggren HG, Höglund P, Kärre K, Svensson M, Juarez JG. In vivo engineering of mobilized stem cell grafts with the immunomodulatory drug FTY720 for allogeneic transplantation. Eur J Immunol 2016; 46:1758-69. [PMID: 27119199 DOI: 10.1002/eji.201545991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 03/02/2016] [Accepted: 04/20/2016] [Indexed: 01/16/2023]
Abstract
The immunological attributes of stem cell grafts play an important role in the outcome of allogeneic stem cell transplants. Currently, ex vivo manipulation techniques such as bulk T-cell depletion or positive selection of CD34(+) cells are utilized to improve the immunological attributes of grafts and minimize the potential for graft-versus-host disease (GvHD). Here, we demonstrate a novel graft engineering technique, which utilizes the immunomodulatory drug FTY720 for in vivo depletion of naïve T (TN ) cells from donor G-CSF-mobilized grafts without ex vivo manipulation. We show that treatment of donor mice with FTY720 during mobilization depletes grafts of TN cells and prevents lethal GvHD following transplantation in a major mismatch setting. Importantly, both stem cells and NK cells are retained in the FTY720-treated grafts. FTY720 treatment does not negatively affect the engraftment potential of stem cells as demonstrated in our congenic transplants or the functionality of NK cells. In addition, potentially useful memory T cells may be retained in the graft. These findings suggest that FTY720 may be used to optimize the immunological attributes of G-CSF-mobilized grafts by removing potentially deleterious TN cells which can contribute to GvHD, and by retaining useful cells which can promote immunity in the recipient.
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Affiliation(s)
- Tadepally Lakshmikanth
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Frank Heuts
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - S S V Jagadeeswara Rao Muvva
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Robert P A Wallin
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Persson
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Cyril Fauriat
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Centre de Recherche en Cancerologie de Marseille, Inserm, Marseille, France.,Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France.,CNRS, Marseille, France
| | - Steven E Applequist
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Hans-Gustaf Ljunggren
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Petter Höglund
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Klas Kärre
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Svensson
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Julius G Juarez
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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9
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Sun Y, Beohou E, Labopin M, Volin L, Milpied N, Yakoub-Agha I, Piemontese S, Polge E, Houhou M, Huang XJ, Mohty M, Nagler A, Gorin NC. Unmanipulated haploidentical versus matched unrelated donor allogeneic stem cell transplantation in adult patients with acute myelogenous leukemia in first remission: a retrospective pair-matched comparative study of the Beijing approach with the EBMT database. Haematologica 2016; 101:e352-4. [PMID: 27081180 DOI: 10.3324/haematol.2015.140509] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Yuqian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China
| | - Eric Beohou
- Acute Leukemia Working Party of the EBMT, Paris, France
| | - Myriam Labopin
- Acute Leukemia Working Party of the EBMT, Paris, France Hospital Saint-Antoine, Paris University UPMC, INSERM U938, France
| | | | - Noel Milpied
- Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France
| | | | - Simona Piemontese
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Mohamad Mohty
- Acute Leukemia Working Party of the EBMT, Paris, France Department of Hematology and Cell therapy, Hospital Saint-Antoine APHP, Paris University UPMC, INSERM U938, Paris, France
| | - Arnon Nagler
- EBMT Acute Leukemia Working Party and Registry, Hematology Division, BMT and Cord Blood Bank, Tel-Aviv University, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Norbert-Claude Gorin
- Acute Leukemia Working Party of the EBMT, Paris, France Department of Hematology and Cell therapy, Hospital Saint-Antoine APHP, Paris University UPMC, INSERM U938, Paris, France
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10
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Selection and expansion of natural killer cells for NK cell-based immunotherapy. Cancer Immunol Immunother 2016; 65:477-84. [PMID: 26810567 PMCID: PMC4826432 DOI: 10.1007/s00262-016-1792-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 01/01/2016] [Indexed: 01/19/2023]
Abstract
Natural killer (NK) cells have been used in several clinical trials as adaptive immunotherapy. The low numbers of these cells in peripheral blood mononuclear cells (PBMC) have resulted in various approaches to preferentially expand primary NK cells from PBMC. While some clinical trials have used the addition of interleukin 2 (IL-2) to co-stimulate the expansion of purified NK cells from allogeneic donors, recent studies have shown promising results in achieving in vitro expansion of NK cells to large numbers for adoptive immunotherapy. NK cell expansion requires multiple cell signals for survival, proliferation and activation. Thus, expansion strategies have been focused either to substitute these factors using autologous feeder cells or to use genetically modified allogeneic feeder cells. Recent developments in the clinical use of genetically modified NK cell lines with chimeric antigen receptors, the development of expansion protocols for the clinical use of NK cell from human embryonic stem cells and induced pluripotent stem cells are challenging improvements for NK cell-based immunotherapy. Transfer of several of these protocols to clinical-grade production of NK cells necessitates adaptation of good manufacturing practice conditions, and the development of freezing conditions to establish NK cell stocks will require some effort and, however, should enhance the therapeutic options of NK cells in clinical medicine.
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11
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Chen Y, Huang XJ, Liu KY, Chen H, Chen YH, Zhang XH, Wang FR, Han W, Wang JZ, Wang Y, Yan CH, Zhang YY, Sun YQ, Xu LP. Infusion-related febrile reaction after haploidentical stem cell transplantation in children is associated with higher rates of engraftment syndrome and acute graft-versus-host disease. Pediatr Transplant 2015; 19:918-24. [PMID: 26332180 DOI: 10.1111/petr.12586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 12/23/2022]
Abstract
The clinical significance and prognostic impact of IRFR in pediatric recipients of haploidentical SCT are not clearly understood. Therefore, we attempted to determine how IRFR affects clinical outcomes in children. Clinical data from 100 consecutive pediatric patients (60 boys and 40 girls; median age, 12 yr [range, 2-18 yr] after haploidentical SCT between January 2010 and December 2012 were collected retrospectively. IRFR was described as unexplained fever (>38 °C) within 24 h after the infusion of haploidentical PBSCs. Thirty-eight (38.0%) cases met the criteria for IRFR. ES was found in 24 (63.2%) of the 38 children with IRFR, with the median time of developing ES of +9 (7-16) days, while only 15 (25.4%) of the 59 children without IRFR were found with ES (p < 0.001). Similarly, the cumulative incidence rates of grade II-IV aGVHD were 50.0% in the IRFR group and 29.3% (p = 0.012) in the non-febrile group. Multivariate analysis identified IRFR as the risk factor for ES and aGVHD. In the haploidentical setting, IRFR is associated with the development of ES and aGVHD. We attempted to determine how IRFR affects clinical outcomes in children after haploidentical SCT. Thirty-eight children comprised the IRFR group, and 59 were in the control (non-IRFR) group. High incidence of ES was observed in children with the occurrence of IRFR. Similarly, the incidence of stage I-IV and II-IV aGVHD was significantly higher in the febrile group. Multivariate analysis showed IRFR to be the risk factor for ES and aGVHD.
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Affiliation(s)
- Yao Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
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12
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T-cell depletion: from positive selection to negative depletion in adult patients. Bone Marrow Transplant 2015; 50 Suppl 2:S11-3. [DOI: 10.1038/bmt.2015.88] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Chen Y, Wang Y, Xu LP, Liu KY, Chen H, Chen YH, Zhang XH, Wang FR, Han W, Wang JZ, Yan CH, Zhang YY, Sun YQ, Huang XJ. Haploidentical stem cell transplantation in patients aged 50 yr and older with leukemia: similar outcomes compared to younger adults. Clin Transplant 2015; 29:523-30. [PMID: 25809115 DOI: 10.1111/ctr.12545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 01/21/2023]
Abstract
AIM We aimed to analyze the complications and survival associated with myeloablative haploidentical SCT in patients aged ≥ 50 yr and compare these results with a younger group population. DESIGN AND METHODS In this case-control study, enrolled patients with leukemia were identified from 1262 patients between May 2002 and May 2013 at a single institution. RESULTS Thirty-one patients were aged ≥ 50 yr (the older group) and 165 patients were aged 18-49 yr (the younger group). Of the older group, 20 of 31 (64.5%) had a hematopoietic cell transplantation comorbidity index (HCT-CI) of 0 or 2. Statistical analysis showed no significant differences in the incidences of grades II to IV acute GVHD, extensive chronic GVHD, and non-relapse mortality (NRM), or probability of relapse between the two groups. Furthermore, the 3-yr overall survival (OS) and leukemia-free survival (LFS) were not significantly different between the older and younger groups: 67.0 ± 9.3% vs. 75.3 ± 3.4% (p = 0.406) and 60.5 ± 9.6% vs. 72.5 ± 3.5% (p = 0.183), respectively. CONCLUSION Selected older patients aged ≥ 50 yr with low HCT-CI and good performance status could safely undergo haploidentical SCT.
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Affiliation(s)
- Yao Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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14
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Morishita S, Kaida K, Yamauchi S, Wakasugi T, Ikegame K, Kodama N, Ogawa H, Domen K. Early-phase differences in health-related quality of life, psychological status, and physical function between human leucocyte antigen-haploidentical and other allogeneic haematopoietic stem cell transplantation recipients. Eur J Oncol Nurs 2015; 19:443-50. [PMID: 25911269 DOI: 10.1016/j.ejon.2015.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This study investigated the differences between allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients receiving HSC from human leucocyte antigen (HLA)-haploidentical donors (HID) and other donors that included HLA-matched sibling, matched unrelated, and unrelated umbilical cord blood donors in the 6 weeks after HSCT with respect to quality of life (QOL), psychological status, and physical function. METHODS The study included 126 patients (HID group, n = 100; other donor group, n = 26) who underwent allo-HSCT between July 2007 and December 2012. Patients were evaluated for health-related QOL using the Medical Outcome Study 36-item Short Form Health Survey. Psychological status was measured by Hospital Anxiety and Depression Scale. Physical function was assessed using tests for handgrip strength, knee extensor strength, and the 6-min walk test. RESULTS After HSCT, the HID group showed significantly greater improvements in the general health subscale and Mental Component Summary (MCS) of QOL than the other donor group (P < 0.01). Multivariate analysis confirmed that complete remission and age were associated with changes in the general health subscale before and after HSCT (P < 0.05). With regard to physical function, the HID group showed significantly more decline than the other donor group with respect to handgrip strength and knee extensor muscle strength after HSCT (P < 0.05). Total corticosteroid dose was associated with decreased handgrip strength before and after HSCT (P < 0.05). CONCLUSIONS The donor type affects QOL, psychological status, and physical function in allo-HSCT recipients; these findings may provide insights for customised rehabilitation strategies for HSCT recipients.
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Affiliation(s)
- Shinichiro Morishita
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
| | - Katsuji Kaida
- Division of Haematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Shinya Yamauchi
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
| | - Tatsushi Wakasugi
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
| | - Kazuhiro Ikegame
- Division of Haematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Hiroyasu Ogawa
- Division of Haematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
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15
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Gorin NC, Labopin M, Piemontese S, Arcese W, Santarone S, Huang H, Meloni G, Ferrara F, Beelen D, Sanz M, Bacigalupo A, Ciceri F, Mailhol A, Nagler A, Mohty M. T-cell-replete haploidentical transplantation versus autologous stem cell transplantation in adult acute leukemia: a matched pair analysis. Haematologica 2015; 100:558-64. [PMID: 25637051 DOI: 10.3324/haematol.2014.111450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Adult patients with acute leukemia in need of a transplant but without a genoidentical donor are usually considered upfront for transplantation with stem cells from any other allogeneic source, rather than autologous stem cell transplantation. We used data from the European Society for Blood and Marrow Transplantation and performed a matched pair analysis on 188 T-cell-replete haploidentical and 356 autologous transplants done from January 2007 to December 2012, using age, diagnosis, disease status, cytogenetics, and interval from diagnosis to transplant as matching factors. "Haploidentical expert" centers were defined as having reported more than five haploidentical transplants for acute leukemia (median value for the study period). The median follow-up was 28 months. Multivariate analyses, including type of transplant categorized into three classes ("haploidentical regular", "haploidentical expert" and autologous), conditioning intensity (reduced intensity versus myeloablative conditioning) and the random effect taking into account associations related to matching, showed that non-relapse mortality was higher following haploidentical transplants in expert (HR: 4.7; P=0.00004) and regular (HR: 8.98; P<10(-5)) centers. Relapse incidence for haploidentical transplants was lower in expert centers (HR:0.39; P=0.0003) but in regular centers was similar to that for autologous transplants. Leukemia-free survival and overall survival rates were higher following autologous transplantation than haploidentical transplants in regular centers (HR: 1.63; P=0.008 and HR: 2.31; P=0.0002 respectively) but similar to those following haploidentical transplants in expert centers. We conclude that autologous stem cell transplantation should presently be considered as a possible alternative to haploidentical transplantation in regular centers that have not developed a specific expert program.
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Affiliation(s)
- Norbert-Claude Gorin
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
| | - Myriam Labopin
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
| | - Simona Piemontese
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy
| | - William Arcese
- Rome Transplant Network, Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Stella Santarone
- Ospedale Civile, Department of Hematology, Fonte Romana 8, Pescara, Italy
| | - He Huang
- First Affiliated Hospital, Zhejiang University, Bone Marrow Transplantation Center, Hangzhou Zhejiang, China
| | | | | | - Dietrich Beelen
- University Hospital, Dept. of Bone Marrow Transplantation, Essen, Germany
| | - Miguel Sanz
- Hospital Universitario La Fe, University of Valencia, Spain
| | | | - Fabio Ciceri
- Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy
| | - Audrey Mailhol
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
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16
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Yahng SA, Kim JH, Jeon YW, Yoon JH, Shin SH, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS, Park CW, Kim HJ. A well-tolerated regimen of 800 cGy TBI-fludarabine-busulfan-ATG for reliable engraftment after unmanipulated haploidentical peripheral blood stem cell transplantation in adult patients with acute myeloid leukemia. Biol Blood Marrow Transplant 2014; 21:119-29. [PMID: 25300871 DOI: 10.1016/j.bbmt.2014.09.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/30/2014] [Indexed: 01/07/2023]
Abstract
Eighty adult patients with acute myeloid leukemia (AML) received peripheral blood T cell-replete HLA haploidentical hematopoietic stem cell transplantation (haplo-HSCT). Disease status at transplantation was either first or second complete remission (CR, n = 69) or relapse/refractory (n = 11). Identical transplant-related procedures with conditioning regimen consisting of fractionated 800 cGy total body irradiation (TBI), fludarabine (30 mg/m(2)/day for 5 days), busulfan (3.2 mg/kg/day for 2 days), and antithymocyte globulin (1.25 mg/kg/day on days -4 to -1) and graft-versus-host disease (GVHD) prophylaxis with tacrolimus and methotrexate were used in all patients. Recovery of neutrophil (median, 11 days) and platelet (median, 10 days) counts was achieved in all patients with full donor chimerism (≥ 99%), and no delayed engraftment failure was observed. The cumulative incidence of grades III to IV acute GVHD and moderate to severe chronic GVHD was 11.2% and 26.3%, respectively. A donor CD8(+) and CD4(+) T cell dose above the median value was significantly associated with the incidences of grades II to IV acute GHVD and moderate to severe chronic GVHD, respectively. After a median follow-up of 28 months for survivors, the 2-year cumulative incidences of relapse (n = 20) and nonrelapse mortality (n = 10) were 26.6% and 12.2%, respectively. Although all but 1 patient in relapse/refractory status died, the 2-year overall and progression-free survival of patients in first CR was 82.5% and 75.1%, respectively. We suggest the strategy of fractionated 800 cGy TBI-based conditioning with unmanipulated peripheral blood stem cell grafts seems feasible with favorable outcomes for adult patients with AML undergoing haplo-HSCT in CR.
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Affiliation(s)
- Seung-Ah Yahng
- Department of Hematology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Ho Kim
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Woo Jeon
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Hwan Shin
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Seong Eom
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Wook Kim
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Wook Lee
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo-Sung Min
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chong-Won Park
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Catholic Blood and Marrow Transplantation Center, Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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17
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Al-Homsi AS, Roy TS, Cole K, Feng Y, Duffner U. Post-transplant high-dose cyclophosphamide for the prevention of graft-versus-host disease. Biol Blood Marrow Transplant 2014; 21:604-11. [PMID: 25240817 DOI: 10.1016/j.bbmt.2014.08.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/19/2014] [Indexed: 12/18/2022]
Abstract
Cyclophosphamide's lack of hematopoietic stem cell toxicity and its unique effects on the immune system have prompted several investigators to explore its potential for the prevention of graft-versus-host disease (GVHD). In haploidentical hematopoietic stem cell transplants, post-transplant cyclophosphamide together with standard prophylaxis reduces the incidence of GVHD to acceptable rates without the need for T cell depletion. In matched related and unrelated donor settings, cyclophosphamide alone has produced encouraging results. In particular, the low incidence of chronic GVHD is noteworthy. Here, we present a review of the current understanding of the mechanism of action of post-transplant cyclophosphamide and summarize the clinical data on its use for the prevention of GVHD.
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Affiliation(s)
- Ahmad Samer Al-Homsi
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan; Department of Medicine, Michigan State University, College of Human Medicine, Grand Rapids, Michigan.
| | - Tara S Roy
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan
| | - Kelli Cole
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan
| | - Yuxin Feng
- Blood and Marrow Transplantation Program, Spectrum Health, Grand Rapids, Michigan
| | - Ulrich Duffner
- Department of Medicine, Michigan State University, College of Human Medicine, Grand Rapids, Michigan; Helen DeVos Children Hospital, Grand Rapids, Michigan
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18
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Kanakry CG, Luznik L. Are alternative donors really still "alternative?". Biol Blood Marrow Transplant 2014; 20:1463-4. [PMID: 25087900 DOI: 10.1016/j.bbmt.2014.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Christopher G Kanakry
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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19
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Momburg F, Watzl C, Cerwenka A. NK cells--versatile tools for viral defense and cancer treatment. Eur J Immunol 2013; 43:860-3. [PMID: 23592381 DOI: 10.1002/eji.201370044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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Di Giacomo A. The EFIS-EJI Ruggero Ceppellini Advanced School of Immunology Innate Immunity 2012: from evolution to revolution. Eur J Immunol 2013; 43:13-4. [PMID: 23441330 DOI: 10.1002/eji.201370017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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