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Nagler A, Labopin M, Swoboda R, Kulagin A, Velardi A, Sanz J, Labussière-Wallet H, Potter V, Kuball J, Sica S, Parovichnikova E, Bethge W, Maillard N, Platzbecker U, Stölzel F, Ciceri F, Mohty M. Long-term outcome of second allogeneic hematopoietic stem cell transplantation (HSCT2) for primary graft failure in patients with acute leukemia in remission: A study on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2023; 58:1008-1016. [PMID: 37253804 DOI: 10.1038/s41409-023-02012-5] [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: 03/13/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023]
Abstract
Second transplantation (HSCT2) is a potential treatment for primary graft failure (pGF). We assessed the outcome of HSCT2, performed between 2000 and 2021, for pGF in 243 patients with acute leukemia. Median age was 44.8 years. Conditioning at first HSCT (HSCT1) was myeloablative (MAC) in 58.4%. Median time from HSCT1 to HSCT2 was 48 days. Donors for HSCT2 were the same as for HSCT1 in 49%. Engraftment post HSCT2 was achieved by 73.7% of patients. The incidence of acute (a) graft versus host disease (GVHD) grades II-IV and III-IV was 23.2 and 8.1%. 5-year total and extensive chronic (c) GVHD was 22.3 and 10.1%. 5-year nonrelapse mortality (NRM), relapse incidence (RI), leukemia-free survival (LFS), overall survival (OS) and GVHD free, relapse-free survival (GRFS) was 51.6, 18.8, 29.6, 30.7 and 22.4%, respectively. Infections were the main cause of death. In multivariable analysis, being transplanted at second vs. first remission, lower Karnofsky performance status (KPS; <90) and receiving MAC at HSCT1 were adverse prognostic factors for NRM, LFS, OS, and GRFS, as was increased age for NRM, LFS, OS. We conclude that HSCT2 can rescue about a third of the patients who experienced pGF, but NRM is as high as 50%.
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Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
| | - Ryszard Swoboda
- Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Alexander Kulagin
- First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Paediatric Oncology, Hematology, and Transplantation, St Petersburg, Russia
| | - Andrea Velardi
- Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Ospedale Santa Maria della, Perugia, Italy
| | - Jaime Sanz
- Hematology Department, University Hospital La Fe, Valencia, Spain
| | | | - Victoria Potter
- Dept. of Haematological Medicine, Kings College Hospital, London, United Kingdom
| | - Jürgen Kuball
- University Medical Centre Dept. of Haematology, Utrecht, The Netherlands
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elena Parovichnikova
- National Research Center for Hematology, Bone Marrow Transplantation, Moscow, Russia
| | - Wolfgang Bethge
- Universitaet Tuebingen, Medizinische Klinik, Tuebingen, Germany
| | - Natacha Maillard
- Hopital La Miletrie Bone Marrow TransplantUnit, Clinical Hematology, Poitiers, France
| | - Uwe Platzbecker
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany
| | - Friedrich Stölzel
- Department of Hematology and Oncology, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
- Department of Medicine II, Division for Stem Cell Transplantation and Cellular Immunotherapy, University Hospital Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l. Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- EBMT Paris study office; Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Hospital Saint Antoine, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
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2
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Ionete A, Varady Z, Szegedi O, Coriu D. Case Series Using Salvage Haplo-Identical Stem Cells for Secondary Transplantation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1077. [PMID: 37374281 DOI: 10.3390/medicina59061077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
In order to expand the donor pool and accessibility of the transplant procedure, it was necessary to introduce haplo-identical stem cell transplants in the Fundeni Clinical Institute from 2015. Even if the Romanian population is an ethnically compact white population, many of the patients referred for bone marrow transplant lack a suitable donor. Hematopoietic stem cell transplant from a haplo-identical donor is an alternative option for those patients without an HLA (Human Leucocyte Antigen)-matched donor (sibling or matched unrelated). This procedure was used also as a salvage option for those who experienced engraftment failure or the rejection of the first stem cell graft. In this case series, we present three such cases, with a haplo-transplant used as a salvage protocol (after an engraftment failure or rejection of the first transplanted cells). The patients we present were diagnosed with AML (acute myeloid leukemia) with MDS (myelodysplastic syndrome), MDS-RAEB 2 (myelodysplastic syndrome-refractory anemia with excess blasts 2), and SAA (severe aplastic anemia). In two of the three cases, the engraftment failure may have been due to the conditioning Fludarabine/Busulfan/Cyclophosphamide (Flu/Bu/CFA) used, combined with marrow grafts. In all three cases, the second transplant was of haplo-identical peripheral blood stem cells using Melphalan/Fludarabine (Mel/Flu) conditioning, the cells engrafted properly and the patients experienced complete chimerism, and two of them are alive with an excellent quality of life.
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Affiliation(s)
- Alexandra Ionete
- Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
| | - Zsofia Varady
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Orsolya Szegedi
- Faculty of General Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
| | - Daniel Coriu
- Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
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3
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Giardino S, Bagnasco F, Falco M, Miano M, Pierri F, Risso M, Terranova P, Martino DD, Massaccesi E, Ricci M, Chianucci B, Dell'Orso G, Sabatini F, Podestà M, Lanino E, Faraci M. HAPLOIDENTICAL STEM CELL TRANSPLANTATION AFTER TCR αβ +AND CD19 + CELLS DEPLETION IN CHILDREN WITH CONGENITAL NON-MALIGNANT DISEASE. Transplant Cell Ther 2022; 28:394.e1-394.e9. [PMID: 35405368 DOI: 10.1016/j.jtct.2022.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND . Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) represents a valuable alternative for children with non-malignant disease and ex-vivo negative selection of TCR αβ+-cells is an emerging graft manipulation option that carries several potential advantages in terms of reduced risk of Graft versus Host Disease (GvHD) and improved immune reconstitution. METHODS . We reported all consecutive patients with a diagnosis of non-malignant disease who received a TCR-αβ+ and CD19+depleted haplo-HSCT at "IRCCS Istituto Giannina Gaslini" from 2013 to 2019; the conditioning regimen was myeloablative or non-myeloablative, depending on underlying disease; all patients received anti-thymocyte globulin and rituximab. No post-transplant GvHD prophylaxis was given in presence of a TCR-αβ+ cell-dose in the graft lower than the threshold of 1 × 105/kg of the recipient's weight. RESULTS . Among 20 HSCTs, engraftment occurred in 17 (85%) after a median of 14 and 12 days from graft infusion for neutrophils and platelets respectively. Primary graft failure was diagnosed in 3 (15%) patients, two (10%) experienced secondary rejection; all of these underwent a second HSCT. The cumulative incidence of a-GvHD and c-GvHD was 15% (2 grade 1, 1 grade 4) at 90 days and 5% (1 grade 1) at 7 months, respectively. Cytomegalovirus reactivation requiring pre-emptive treatment was observed in 9 patients (45%). One patient developed a JC virus-related progressive multifocal leukoencephalopathy, successfully managed with donor-derived virus-specific T-cell infusions. A complete immunological recovery was reached in most patients within 6 months. After a median follow-up of 4 years, 18 patients are alive, with a cumulative survival probability of 90%. CONCLUSION . Haplo-HSCT after ex-vivo TCR-αβ+/CD19+ negative selection may be considered a good option for children with non-malignant diseases since it ensures a high engraftment rate with an acceptable risk of graft failure, very low incidence of significant GvHD, and good immune reconstitution with low frequency of severe virus-related disease. However, the control of viral infection/reactivation should be kept high in order to promptly provide pre-emptive treatments and approaches of antiviral adoptive immunotherapy.
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Affiliation(s)
- Stefano Giardino
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy.
| | - Francesca Bagnasco
- Epidemiology and Biostatistics Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Falco
- Laboratory of Clinical and Experimental Immunology, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Miano
- Hematology Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Filomena Pierri
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Risso
- Immunohematology and Transfusional Department, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Terranova
- Laboratory of Hematology, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Margherita Ricci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
| | - Benedetta Chianucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Liguria, Italy
| | - Gianluca Dell'Orso
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Sabatini
- Stem Cells and Cell Therapies Laboratory, IRCSS IstitutoGianninaGaslini, Genoa, Italy
| | - Marina Podestà
- Stem Cells and Cell Therapies Laboratory, IRCSS IstitutoGianninaGaslini, Genoa, Italy
| | - Edoardo Lanino
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
| | - Maura Faraci
- Hematopoietic stem cell transplantation Unit, IRCSS Istituto Giannina Gaslini, Genoa, Italy
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4
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de Almeida GP, Lichtner P, Eckstein G, Brinkschmidt T, Chu CF, Sun S, Reinhard J, Mädler SC, Kloeppel M, Verbeek M, Zielinski CE. Human skin-resident host T cells can persist long term after allogeneic stem cell transplantation and maintain recirculation potential. Sci Immunol 2022; 7:eabe2634. [PMID: 35089814 DOI: 10.1126/sciimmunol.abe2634] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Tissue-resident memory T cells (TRM) have recently emerged as crucial cellular players for host defense in a wide variety of tissues and barrier sites. Insights into the maintenance and regulatory checkpoints of human TRM cells remain scarce, especially due to the difficulties associated with tracking T cells through time and space in humans. We therefore sought to identify and characterize skin-resident T cells in humans defined by their long-term in situ lodgment. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) preceded by myeloablative chemotherapy unmasked long-term sequestration of host T cell subsets in human skin despite complete donor T cell chimerism in the blood. Single-cell chimerism analysis paired with single-cell transcriptional profiling comprehensively characterized these bona fide long-term skin-resident T cells and revealed differential tissue maintenance for distinct T cell subsets, specific TRM cell markers such as galectin-3, but also tissue exit potential with retention of the transcriptomic TRM cell identity. Analysis of 26 allo-HSCT patients revealed profound interindividual variation in the tissue maintenance of host skin T cells. The long-term persistence of host skin T cells in a subset of these patients did not correlate with the development of chronic GvHD. Our data exemplify the power of exploiting a clinical situation as a proof of concept for the existence of bona fide human skin TRM cells and reveal long-term persistence of host T cells in a peripheral tissue but not in the circulation or bone marrow in a subset of allo-HSCT patients.
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Affiliation(s)
- Gustavo P de Almeida
- Institute of Virology, Technical University of Munich, Munich, Germany.,TranslaTUM, Technical University of Munich, Munich, Germany.,German Center for Infection Research partner site, Munich, Germany
| | - Peter Lichtner
- Genome Analysis Center, Helmholtz Zentrum Munich, Munich, Germany
| | - Gertrud Eckstein
- Genome Analysis Center, Helmholtz Zentrum Munich, Munich, Germany
| | - Tonio Brinkschmidt
- Institute of Virology, Technical University of Munich, Munich, Germany.,TranslaTUM, Technical University of Munich, Munich, Germany.,Department of Infection Immunology, Leibniz-Institute for Natural Product Research and Infection Biology, Jena, Germany
| | - Chang-Feng Chu
- TranslaTUM, Technical University of Munich, Munich, Germany.,Department of Infection Immunology, Leibniz-Institute for Natural Product Research and Infection Biology, Jena, Germany.,Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
| | - Shan Sun
- Institute of Virology, Technical University of Munich, Munich, Germany.,TranslaTUM, Technical University of Munich, Munich, Germany.,German Center for Infection Research partner site, Munich, Germany.,Department of Infection Immunology, Leibniz-Institute for Natural Product Research and Infection Biology, Jena, Germany
| | | | | | - Markus Kloeppel
- Klinikum rechts der Isar and Praxisklinik für Ästhetische Chirurgie und Medizin, Munich, Germany
| | - Mareike Verbeek
- Department of Medicine III, Klinikum rechts der Isar, Munich, Germany
| | - Christina E Zielinski
- Institute of Virology, Technical University of Munich, Munich, Germany.,TranslaTUM, Technical University of Munich, Munich, Germany.,German Center for Infection Research partner site, Munich, Germany.,Department of Infection Immunology, Leibniz-Institute for Natural Product Research and Infection Biology, Jena, Germany.,Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University, Jena, Germany
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5
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Falvo P, Orecchioni S, Roma S, Raveane A, Bertolini F. Drug Repurposing in Oncology, an Attractive Opportunity for Novel Combinatorial Regimens. Curr Med Chem 2021; 28:2114-2136. [PMID: 33109033 DOI: 10.2174/0929867327999200817104912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
The costs of developing, validating and buying new drugs are dramatically increasing. On the other hand, sobering economies have difficulties in sustaining their healthcare systems, particularly in countries with an elderly population requiring increasing welfare. This conundrum requires immediate action, and a possible option is to study the large, already present arsenal of drugs approved and to use them for innovative therapies. This possibility is particularly interesting in oncology, where the complexity of the cancer genome dictates in most patients a multistep therapeutic approach. In this review, we discuss a) Computational approaches; b) preclinical models; c) currently ongoing or already published clinical trials in the drug repurposing field in oncology; and d) drug repurposing to overcome resistance to previous therapies.
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Affiliation(s)
- Paolo Falvo
- Laboratory of Hematology-Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Stefania Orecchioni
- Laboratory of Hematology-Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Stefania Roma
- Laboratory of Hematology-Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Alessandro Raveane
- Laboratory of Hematology-Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesco Bertolini
- Laboratory of Hematology-Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy
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6
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Bremm M, Krastel T, Cappel C, Zimmermann O, Pfeffermann LM, Katzki V, Bonig H, Schäfer R, Rettinger E, Merker M, Bremm S, Schaefer K, Klingebiel T, Soerensen J, Bader P, Huenecke S. Depletion of CD45RA + T cells: Advantages and disadvantages of different purification methods. J Immunol Methods 2021; 492:112960. [PMID: 33417916 DOI: 10.1016/j.jim.2021.112960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, new advances were made regarding the depletion of CD45RA+ naïve T cells from haploidentical grafts as they are suspected to be the most alloreactive. METHODS Within this project we investigated CD45RA-depletion from G-CSF mobilized PBSC by two different purification strategies according to GMP, specifically direct depletion of CD45RA+ cells (one-step approach), or CD34-positive selection followed by CD45RA-depletion (two-step approach). RESULTS With log -3.9 and - 3.8 the depletion quality of CD45RA+ T cells was equally for both approaches together with a close to complete CD19+ B cell depletion. However, due to a high expression of CD45RA the majority of NK cells were lost within both CD45RA depletion strategies. Stem cell recovery after one-step CD45RA-depletion was at median 52.0% (range: 49.7-67.2%), which was comparable to previously published recovery data received from direct CD34 positive selection. Memory T cell recovery including CD4+ and CD8+ memory T cell subsets was statistically not differing between both purification approaches. The recovery of CD4+ and CD8+ T cells was as well similar, but overall a higher amount of cytotoxic than T-helper cells were lost as indicated by an increase of the CD4/CD8 ratio. CONCLUSIONS CD45RA-depletion from G-CSF mobilized PBSC is feasible as one- and two-step approach and results in sufficient reduction of CD45RA+ T cells as well as B cells, but also to a co-depletion of NK cells. However, by gaining two independent cell products, the two-step approach enables the highest clinical flexibility in regard to individual graft composition with precise dosage of stem cells and T cells.
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Affiliation(s)
- Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany.
| | - Theresa Krastel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Olga Zimmermann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Lisa-Marie Pfeffermann
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Verena Katzki
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Richard Schäfer
- Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, German Red Cross Blood Donor Service Baden-Württemberg-Hessen, Frankfurt/Main, Germany
| | - Eva Rettinger
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Michael Merker
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Sebastian Bremm
- Data Analytics & Visualization, Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Kirsten Schaefer
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Jan Soerensen
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
| | - Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine, University Hospital, Frankfurt/Main, Germany
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7
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Khan MA, Bashir Q, Chaudhry QUN, Ahmed P, Satti TM, Mahmood SK. Review of Haploidentical Hematopoietic Cell Transplantation. J Glob Oncol 2019; 4:1-13. [PMID: 30521413 PMCID: PMC7010419 DOI: 10.1200/jgo.18.00130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Use of haploidentical (haplo) donors for hematopoietic cell transplantation (HCT) has significantly increased in the last decade. The major advantage with this strategy is universal availability and faster acquisition of the donor, along with affordability and provision of immunotherapy in post-transplantation period. Historically, haplo-HCT was associated with compromised outcomes because of high rates of graft-versus-host disease and graft failure, but after the development of a post-transplantation high-dose cyclophosphamide strategy, which results in selective T-cell depletion, these issues have been addressed to a large extent. Nevertheless, graft failure, high treatment-related mortality due to graft-versus-host disease, infections, delayed immune reconstitution, and disease relapse remain significant concerns. As the experience with haplo-HCTs grows, the clinical outcomes are becoming more at par with those seen with fully matched unrelated donor allogeneic HCTs.
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Affiliation(s)
- Mehreen A Khan
- Mehreen A. Khan, Qamar-un-Nisa Chaudhry, Tariq M. Satti, and Syed K. Mahmood, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi; Parvez Ahmed, Quaid-e-Azam International Hospital, Islamabad, Pakistan; and Qaiser Bashir, MD Anderson Cancer Centre, Houston, TX
| | - Qaiser Bashir
- Mehreen A. Khan, Qamar-un-Nisa Chaudhry, Tariq M. Satti, and Syed K. Mahmood, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi; Parvez Ahmed, Quaid-e-Azam International Hospital, Islamabad, Pakistan; and Qaiser Bashir, MD Anderson Cancer Centre, Houston, TX
| | - Qamar-Un-Nisa Chaudhry
- Mehreen A. Khan, Qamar-un-Nisa Chaudhry, Tariq M. Satti, and Syed K. Mahmood, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi; Parvez Ahmed, Quaid-e-Azam International Hospital, Islamabad, Pakistan; and Qaiser Bashir, MD Anderson Cancer Centre, Houston, TX
| | - Parvez Ahmed
- Mehreen A. Khan, Qamar-un-Nisa Chaudhry, Tariq M. Satti, and Syed K. Mahmood, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi; Parvez Ahmed, Quaid-e-Azam International Hospital, Islamabad, Pakistan; and Qaiser Bashir, MD Anderson Cancer Centre, Houston, TX
| | - Tariq M Satti
- Mehreen A. Khan, Qamar-un-Nisa Chaudhry, Tariq M. Satti, and Syed K. Mahmood, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi; Parvez Ahmed, Quaid-e-Azam International Hospital, Islamabad, Pakistan; and Qaiser Bashir, MD Anderson Cancer Centre, Houston, TX
| | - Syed K Mahmood
- Mehreen A. Khan, Qamar-un-Nisa Chaudhry, Tariq M. Satti, and Syed K. Mahmood, Armed Forces Bone Marrow Transplant Centre/National Institute of Blood and Marrow Transplant, Rawalpindi; Parvez Ahmed, Quaid-e-Azam International Hospital, Islamabad, Pakistan; and Qaiser Bashir, MD Anderson Cancer Centre, Houston, TX
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8
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Merker M, Salzmann-Manrique E, Katzki V, Huenecke S, Bremm M, Bakhtiar S, Willasch A, Jarisch A, Soerensen J, Schulz A, Meisel R, Bug G, Bonig H, Klingebiel T, Bader P, Rettinger E. Clearance of Hematologic Malignancies by Allogeneic Cytokine-Induced Killer Cell or Donor Lymphocyte Infusions. Biol Blood Marrow Transplant 2019; 25:1281-1292. [PMID: 30878607 DOI: 10.1016/j.bbmt.2019.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/06/2019] [Indexed: 11/18/2022]
Abstract
Well-established donor lymphocyte infusion (DLI) and novel cytokine-induced killer (CIK) cell therapy for the treatment of relapsing hematologic malignancies after allogeneic hematopoietic stem cell transplantation (HSCT) were compared with respect to feasibility, safety, and efficacy. Altogether, a total of 221 infusions were given to 91 patients (DLI, n = 55; CIK, n = 36). T cell recovery was significantly improved after CIK cell therapy (P < .0001). Although patients with CIK cell treatment showed a significantly worse prognosis at the time of HSCT (risk score, 1.7 versus 2.1; P < .0001), DLI and CIK cell therapy induced complete remission (CR) in 29% and 53% patients, respectively, whereas relapse occurred in 71% and 47%. In both groups, all patients with overt hematologic relapse at the time of immunotherapy (DLI, n = 11; CIK, n = 8) succumbed to their disease, while 36% and 68% patients with DLI or CIK cell therapy applied due to molecular relapse or active disease at the time of transplantation achieved CR. The 6-month overall survival rate in the latter patients was 57% and 77%, respectively, with a median follow-up of 27.9 months (range, .9 to 149.2 months). The 6-month cumulative incidence of relapse was 55% and 22% in patients who received DLI and CIK cell therapy, respectively (P = .012). Acute graft-versus-host disease developed in 35% of the patients who received DLI and in 25% of those who received CIK. No transfusion-related deaths occurred. These data, while underscoring the therapeutic value of conventional DLI, suggest the improved safety and to a certain extent efficacy of CIK cell therapy for patients at high risk for post-transplantation relapse of various hematologic malignancies.
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Affiliation(s)
- Michael Merker
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Emilia Salzmann-Manrique
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Verena Katzki
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sabine Huenecke
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Melanie Bremm
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Shahrzad Bakhtiar
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andre Willasch
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrea Jarisch
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jan Soerensen
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Ansgar Schulz
- Pediatric Oncology, Department of Pediatric and Adolescent Medicine, University Hospital Ulm, Ulm, Germany
| | - Roland Meisel
- Clinic of Pediatric Oncology, Hematology and Immunology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Gesine Bug
- Hematology/Oncology, Department of Internal Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Donor Service Baden-Württemberg-Hessen and Institute for Transfusion Medicine and Immunohematology, Department of Cellular Therapeutics/Cell Processing, Goethe University Frankfurt, Frankfurt am Main, Germany; Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | - Thomas Klingebiel
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Peter Bader
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Eva Rettinger
- Division of Stem Cell Transplantation and Immunology, Department of Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Salzmann-Manrique E, Bremm M, Huenecke S, Stech M, Orth A, Eyrich M, Schulz A, Esser R, Klingebiel T, Bader P, Herrmann E, Koehl U. Joint Modeling of Immune Reconstitution Post Haploidentical Stem Cell Transplantation in Pediatric Patients With Acute Leukemia Comparing CD34 +-Selected to CD3/CD19-Depleted Grafts in a Retrospective Multicenter Study. Front Immunol 2018; 9:1841. [PMID: 30154788 PMCID: PMC6102342 DOI: 10.3389/fimmu.2018.01841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/26/2018] [Indexed: 12/25/2022] Open
Abstract
Rapid immune reconstitution (IR) following stem cell transplantation (SCT) is essential for a favorable outcome. The optimization of graft composition should not only enable a sufficient IR but also improve graft vs. leukemia/tumor effects, overcome infectious complications and, finally, improve patient survival. Especially in haploidentical SCT, the optimization of graft composition is controversial. Therefore, we analyzed the influence of graft manipulation on IR in 40 patients with acute leukemia in remission. We examined the cell recovery post haploidentical SCT in patients receiving a CD34+-selected or CD3/CD19-depleted graft, considering the applied conditioning regimen. We used joint model analysis for overall survival (OS) and analyzed the dynamics of age-adjusted leukocytes; lymphocytes; monocytes; CD3+, CD3+CD4+, and CD3+CD8+ T cells; natural killer (NK) cells; and B cells over the course of time after SCT. Lymphocytes, NK cells, and B cells expanded more rapidly after SCT with CD34+-selected grafts (P = 0.036, P = 0.002, and P < 0.001, respectively). Contrarily, CD3+CD4+ helper T cells recovered delayer in the CD34 selected group (P = 0.026). Furthermore, reduced intensity conditioning facilitated faster immune recovery of lymphocytes and T cells and their subsets (P < 0.001). However, the immune recovery for NK cells and B cells was comparable for patients who received reduced-intensity or full preparative regimens. Dynamics of all cell types had a significant influence on OS, which did not differ between patients receiving CD34+-selected and those receiving CD3/CD19-depleted grafts. In conclusion, cell reconstitution dynamics showed complex diversity with regard to the graft manufacturing procedure and conditioning regimen.
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Affiliation(s)
- Emilia Salzmann-Manrique
- Department of Medicine, Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University, Frankfurt, Germany.,Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Melanie Bremm
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Sabine Huenecke
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Milena Stech
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Andreas Orth
- University of Applied Sciences Frankfurt, Frankfurt, Germany
| | - Matthias Eyrich
- Pediatric Hematology and Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Ansgar Schulz
- Pediatric Hematology and Oncology, University of Ulm, Ulm, Germany
| | - Ruth Esser
- Institute of Cellular Therapeutics Hannover Medical School, Hannover, Germany
| | - Thomas Klingebiel
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Peter Bader
- Pediatric Hematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ulrike Koehl
- Institute of Cellular Therapeutics Hannover Medical School, Hannover, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany.,Fraunhofer Institute of Cellular Therapy and Immunology, Leipzig, Germany
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Atilla E, Atilla PA, Bozdağ SC, Demirer T. A review of infectious complications after haploidentical hematopoietic stem cell transplantations. Infection 2017; 45:403-411. [PMID: 28417421 DOI: 10.1007/s15010-017-1016-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/05/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation from haploidentical donor is a feasible option for patients with hematological diseases who lack a suitable HLA-matched donor, but viral and fungal infections are still the most common causes of morbidity and mortality in haploidentical transplantation setting because of delayed immune reconstitution, increased risk of graft vs host disease (GvHD) or systemic steroid use. Therefore, this review will focus on the infectious complications after haploidentical hematopoietic stem cell transplantation (HSCT). MATERIALS AND METHODS Electronic publications were searched until February 2017 throughout databases, including Pubmed, Cochrane, and Embase. The following keywords were used 'haploidentical transplantation', 'infection', 'T cell replete', and 'T cell deplete'. RESULTS An increased incidence of bacterial, fungal, or viral infections is detected in haplo-HSCT compared to related, unrelated, or cord blood transplantations. Neutropenia and use of systemic steroid for GvHD and delayed immune reconstitution are important risk factors for infection after haplo-HSCT. CONCLUSION A shift towards T cell repletes haplo-HSCT with post-transplant cyclophosphamide (CY) for GvHD has been emerged in recent years, in which the incidence of viral and fungal infections is detected to be lower. Prophylaxis and pre-emptive treatment strategies should be applied according to patient status.
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Affiliation(s)
- Erden Atilla
- Department of Hematology, Ankara University Medical School, Cebeci, 06590, Ankara, Turkey
| | - Pinar Ataca Atilla
- Department of Hematology, Ankara University Medical School, Cebeci, 06590, Ankara, Turkey
| | - Sinem Civriz Bozdağ
- Department of Hematology, Ankara University Medical School, Cebeci, 06590, Ankara, Turkey
| | - Taner Demirer
- Department of Hematology, Ankara University Medical School, Cebeci, 06590, Ankara, Turkey.
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11
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Farhadfar N, Hogan WJ. Overview of the progress on haploidentical hematopoietic transplantation. World J Transplant 2016; 6:665-674. [PMID: 28058216 PMCID: PMC5175224 DOI: 10.5500/wjt.v6.i4.665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplant (HSCT) remains the only potentially curative option for variety of hematologic disorders. Lack of a suitable fully HLA-matched donor limits this option for many patients. Without a suitable related or unrelated HLA-matched donor, umbilical cord blood and haploidentical family members provide a potential source of stem cells. Timely donor availability makes haploidentical donors an attractive alternative donor source. Initial attempts at haploidentical HSCT was associated with significantly increased mortality owing to high rates of graft rejection and severe graft-versus-host disease caused by major donor-recipient HLA-disparity. However, over the past decade, outcomes of haploidentical HSCT have improved significantly. Here, we review the advantages and challenges of haploidentical transplantation. We also discuss new developments to attempt to overcome the challenges to a successful haploidentical transplantation.
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12
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Selective Depletion of αβ T Cells and B Cells for Human Leukocyte Antigen–Haploidentical Hematopoietic Stem Cell Transplantation. A Three-Year Follow-Up of Procedure Efficiency. Biol Blood Marrow Transplant 2016; 22:2056-2064. [DOI: 10.1016/j.bbmt.2016.08.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
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13
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Little AM, Green A, Harvey J, Hemmatpour S, Latham K, Marsh SGE, Poulton K, Sage D. BSHI Guideline: HLA matching and donor selection for haematopoietic progenitor cell transplantation. Int J Immunogenet 2016; 43:263-86. [DOI: 10.1111/iji.12282] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/06/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022]
Affiliation(s)
- A-M. Little
- Histocompatibility and Immunogenetics Laboratory; Gartnavel General Hospital; Glasgow UK
- Institute of Infection, Immunity and Inflammation; College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow UK
| | - A. Green
- Histocompatibility and Immunogenetics Laboratory; NHS Blood and Transplant; Filton UK
| | - J. Harvey
- Histocompatibility and Immunogenetics Laboratory; NHS Blood and Transplant; Filton UK
| | - S. Hemmatpour
- Histocompatibility and Immunogenetics Laboratory; NHS Blood and Transplant; London Tooting UK
| | - K. Latham
- Anthony Nolan Research Institute; Royal Free Hospital; London UK
| | - S. G. E. Marsh
- Anthony Nolan Research Institute; Royal Free Hospital; London UK
- Cancer Institute; University College London; London UK
| | - K. Poulton
- Transplantation Laboratory; Manchester Royal Infirmary; Manchester UK
- British Society for Histocompatibility & Immunogenetics
| | - D. Sage
- Histocompatibility and Immunogenetics Laboratory; NHS Blood and Transplant; London Tooting UK
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14
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Bremm M, Cappel C, Erben S, Jarisch A, Schumm M, Arendt A, Bonig H, Klingebiel T, Koehl U, Bader P, Huenecke S. Generation and flow cytometric quality control of clinical-scale TCRαβ/CD19-depleted grafts. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 92:126-135. [DOI: 10.1002/cyto.b.21328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/16/2015] [Accepted: 09/17/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Melanie Bremm
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Claudia Cappel
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Stephanie Erben
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Andrea Jarisch
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Michael Schumm
- Department of Hematology/Oncology; Children's University Hospital; Tübingen Germany
| | | | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology, Goethe-University Frankfurt/Main, Division for Cell Processing, German Red Cross Blood Donor Service Baden-Württemberg-Hessen; Frankfurt/Main Germany
| | - Thomas Klingebiel
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Ulrike Koehl
- Institute of Cellular Therapeutics, GMP Development Unit; IFB-TX; Hannover Medical School; Hannover Germany
| | - Peter Bader
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
| | - Sabine Huenecke
- Clinic for Pediatric and Adolescent Medicine; University Hospital; Frankfurt Germany
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15
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Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation. BONE MARROW RESEARCH 2013; 2013:565824. [PMID: 24416593 PMCID: PMC3876681 DOI: 10.1155/2013/565824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 01/26/2023]
Abstract
Background. Allogeneic hematopoietic stem cell transplantation (HSCT) is still associated with a high transplant-related mortality rate. In 2009, the EBMT risk score was validated as a simple tool to predict the outcome after allogeneic HSCT for acquired hematological disorders. Objectives. The aim of this study was to validate the applicability of the EBMT risk score for allogeneic HSCT on South Brazilian patients. Methods. A retrospective observational study was performed based on patients' records and data base at Hospital de Clínicas de Porto Alegre, including all allogeneic transplants for malignant and severe aplastic anemia from 1994 to 2010. Patients were categorized according to EBMT risk score and overall survival (OS). Nonrelapse mortality (NRM) and relapse rate (RR) were analyzed. Results. There were 278 evaluable patients. OS, NRM, and RR at five years median followup were 48.7%, 40.7%, and 30.7%, respectively. The OS was 81.8% for risk score 0 and 0% for score 6 (P < 0.001), and NRM was 13.6% and 80% for risk scores 0 and 6, respectively (P = 0.001). Conclusion. The EBMT risk score can be utilized as a tool for clinical decision making before allogeneic HSCT for malignant hematological diseases and severe aplastic anemia at a single center in Brazil.
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16
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El-Cheikh J, Venton G, Crocchiolo R, Fürst S, Faucher C, Granata A, Oudin C, Coso D, Bouabdallah R, Vey N, Duran S, Fougereau E, Berger P, Chabannon C, Blaise D. Efficacy and safety of micafungin for prophylaxis of invasive fungal infections in patients undergoing haplo-identical hematopoietic SCT. Bone Marrow Transplant 2013; 48:1472-7. [DOI: 10.1038/bmt.2013.87] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/06/2013] [Accepted: 03/10/2013] [Indexed: 11/09/2022]
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17
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Abstract
The feasibility of stem cell transplantation across the major histocompatibility barrier-as in haploidentical stem cell transplantation-has been proved for some time in several studies. The main limitations include a higher graft failure rate, delayed immune reconstitution after transplantation with high rates of life-threatening infections, a higher incidence of post-transplant lymphoproliferative disease, and severe acute and chronic graft-versus-host disease. In an attempt to reduce the transplant-related morbidity/mortality, several techniques had been evaluated involving conditioning regimen intensity, graft engineering, post-transplant cellular therapy and immunosuppression. This review will describe the current situation. It will also discuss initiatives and strategies to overcome the limitations associated with transplant across the MHC barrier.
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Affiliation(s)
- Amr Ahmed Nassar
- King Abdullah Medical City, Mecca, Western Province, Saudi Arabia.
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18
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Natural killer cell activity influences outcome after T cell depleted stem cell transplantation from matched unrelated and haploidentical donors. Best Pract Res Clin Haematol 2011; 24:403-11. [DOI: 10.1016/j.beha.2011.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Bouchlaka MN, Redelman D, Murphy WJ. Immunotherapy following hematopoietic stem cell transplantation: potential for synergistic effects. Immunotherapy 2010; 2:399-418. [PMID: 20635904 DOI: 10.2217/imt.10.20] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a particularly important treatment for hematologic malignancies. Unfortunately, following allogeneic HSCT, graft-versus-host disease, immunosuppression and susceptibility to opportunistic infections remain among the most substantial problems restricting the efficacy and use of this procedure, particularly for cancer. Adoptive immunotherapy and/or manipulation of the graft offer ways to attack residual cancer as well as other transplant-related complications. Recent exciting discoveries have demonstrated that HSCT could be expanded to solid tissue cancers with profound effects on the effectiveness of adoptive immunotherapy. This review will provide a background regarding HSCT, discuss the complications that make it such a complex treatment procedure following up with current immunotherapeutic strategies and discuss emerging approaches in applying immunotherapy in HSCT for cancer.
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Affiliation(s)
- Myriam N Bouchlaka
- Department of Microbiology & Immunology, University of Nevada, Reno, NV, USA
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20
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Cheng FWT, Chan PKS, Lee V, Leung WK, Shing MK, Li CK, Leung TF. Lymphoproliferative response to herpes simplex virus type 1, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, human herpes virus 6, 7, and 8 antigen stimulation in pediatric allogeneic stem cell transplant recipients. Pediatr Transplant 2010; 14:761-9. [PMID: 20534025 DOI: 10.1111/j.1399-3046.2010.01333.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We evaluate the recovery of CMI to various herpes viruses by measuring in vitro LPR to specific recall antigens. CMI was evaluated by the in vitro LPR of PBMC to specific purified HSV-1, VZV, CMV, EBV, HHV-6, -7, -8, antigens. Results were expressed as SI. SI > or = 3 was regarded as positive LPR. Serial measurements were taken prospectively from pretransplant till 12-month post-transplant. Thirty-six patients (M = 19; F = 17) with median age 10.5 yr old were recruited. Most transplants were from MSD with PBSC as the stem cell source. Altogether 50% of subjects started to show positive LPR to HSV-1, CMV, and VZV antigens at two-month post-transplant, major upsurges were noted until 6-month post-transplant. Subjects showed positive LPR to EBV, HHV-6, HHV-7, and HHV-8 antigens were all along <50% throughout the study period. The antibody status of donor and recipient for HSV-1, CMV, and VZV were associated with the timing of recovery of CMI. Choice of donor and stem cell source were important determinants of eventual LPR to various herpes viruses at 3-month post-transplant. At 12-month post-transplant, there was no statistical difference in any parameters in affecting LPR to different herpes viruses.
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Affiliation(s)
- Frankie Wai Tsoi Cheng
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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21
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Turner BE, Collin M, Rice AM. Reduced intensity conditioning for hematopoietic stem cell transplantation: has it achieved all it set out to? Cytotherapy 2010; 12:440-54. [DOI: 10.3109/14653241003709678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Chen XH, Zhang C, Zhang X, Gao L, Gao L, Kong PY, Peng XG, Sun AH, Zeng DF, Wang QY. Cost and outcome in stem cell collections in HLA-haplo identical/mismatched related transplantation with combined granulocyte-colony stimulating factor-mobilized blood and bone marrow for patients with hematologic malignancies. Transfus Apher Sci 2010; 43:23-8. [PMID: 20554478 DOI: 10.1016/j.transci.2010.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Unmanipulated HLA-haplo identical/mismatched related transplantation with combined granulocyte-colony stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) and granulocyte-colony stimulating factor-mobilized bone marrow (G-BM) has been developed as an alternative transplantation strategy for patients without an HLA-matched related or unrelated donor. In this transplantation setting, the cost and outcome of stem cell collections have not been defined completely. The aim of this study was to compare the cost and outcome of stem cell collection in HLA-haplo identical/mismatched related transplantation with combined G-PBSCs and G-BM to the HLA-identical/matched transplantation with G-PBSCs alone for patients with hematologic malignancies. Hundred and fifty-two healthy donors received twice-daily granulocyte-colony stimulating factor (G-CSF) subcutaneously for 5 days. The PBSCs were collected on day 4 and 5 of G-CSF treatment for HLA-identical/matched transplantation from unrelated/related donors. The PBSC collections and BM harvests was performed on day 4 and 5 of G-CSF treatment for HLA-haplo identical/mismatched related transplantation from related donors, respectively. There was no difference in the major characteristics between groups. More stem cells were harvested in HLA-haplo identical/mismatched related donors than that of HLA-identical/matched donors and a lower cost was seen in the former. The HLA-haplo identical/mismatched related transplantation with combined G-PBSCs and G-BM was a feasible approach with high cell harvest and low cost of stem cell collection for patients with hematologic malignancies.
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Affiliation(s)
- Xing-Hua Chen
- Department of Hematology, Xinqiao Hospital, The Third Military Medical University, Chongqing 400037, People's Republic of China.
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Perruccio K, Bonifazi P, Topini F, Tosti A, Bozza S, Aloisi T, Carotti A, Aversa F, Martelli MF, Romani L, Velardi A. Thymosin α1 to harness immunity to pathogens after haploidentical hematopoietic transplantation. Ann N Y Acad Sci 2010; 1194:153-61. [DOI: 10.1111/j.1749-6632.2010.05486.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Unmanipulated HLA-mismatched/haploidentical blood and marrow hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2010; 17:197-204. [PMID: 20302961 DOI: 10.1016/j.bbmt.2010.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 03/07/2010] [Indexed: 02/06/2023]
Abstract
Extensive ex vivo T cell-depleted or unmanipulated haploidentical transplantation provides benefits of rapid and near universal donor availability for patients without HLA-identical sibling donors or those who urgently need transplant. However, CD34 selected haplotype mismatched transplantation was limited by delayed immune reconstitution (IR), although this protocol has now been an acceptable approach. Recently, Peking University researchers developed a novel approach to HLA-mismatched/haploidentical blood and marrow transplantation without in vitro T cell depletion (GIAC protocol). This review summarizes transplant outcomes, and factors correlating with transplant outcomes following the GIAC protocol. Moreover, future challenges in improving posttransplant IR and finding the best approach reducing the incidence and severity of GVHD, whereas preserving graft-versus-leukemia effect to prevent the recurrence of underlying malignancy, are also discussed.
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25
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Patil S, Schwarer T. Natural killer cells - new understanding of basic biology may lead to more effective allogeneic haematopoietic stem cell transplantation. Intern Med J 2009; 39:639-47. [DOI: 10.1111/j.1445-5994.2009.02024.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Cytokine-induced killer cells are terminally differentiated activated CD8 cytotoxic T-EMRA lymphocytes. Exp Hematol 2009; 37:616-628.e2. [PMID: 19375652 DOI: 10.1016/j.exphem.2009.01.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Revised: 01/19/2009] [Accepted: 01/30/2009] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cytokine-induced killer cells (CIK) are CD3(+)CD56(+) T cells with natural killer (NK)-like cytotoxic activity used for the immunotherapy of tumors. We aimed to fully characterize CIK cells and define their ontogeny. MATERIALS AND METHODS CIK were generated in vitro by stimulation of peripheral blood mononuclear cells or T-cell subsets with interferon-gamma, anti-CD3 and interleukin-2. They were fully characterized in terms of phenotype, cytotoxic activity, and gene expression with respect to circulating CD3(+)CD56(+) cells, NK cells, and CD56(-) T cells present in CIK cultures. RESULTS We demonstrate that CIK are terminally differentiated CD8 T cells that derive from proliferating CD3(+)CD56(-)CD8(+) T cells. They express polyclonal T-cell receptor Vbeta chains and have acquired CD56, NKG2D, and large granular lymphocyte morphology, but lack expression of most NK-specific activating (NKp30, NKp44, NKp46) and inhibitory (KIR2DL1, KIR2DL2, KIR3DL1, NKG2A, CD94) receptors, and can kill K562 targets. Circulating CD3(+)CD56(+) cells are also CD8(+)CD16(-), but are oligoclonal, poorly cytotoxic for K562, and express lower levels of CD56 and NKG2D. Gene profiling of CIK, CD56(-) T and NK cells present at the end of culture shows that differences are much more limited between CIK and CD56(-) T compared to CIK and NK cells. Most of the genes upregulated in CIK cells compared to CD56(-) T cells are part of the tumor necrosis factor gene network. CONCLUSIONS The CIK phenotype, that is CD45RA(+), CCR7(-), CD62L-weakly positive, CD11a(+), CD27(+), CD28(-), macrophage inflammatory protein 1alpha(+), perforin(+), Fas ligand(+) coincides almost exactly with that described for the T RA(+) effector memory CD27 single positive subset of terminally differentiated human memory T cells.
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27
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Wang HX, Yan HM, Duan LN, Wang ZD, Zhu L, Xue M, Liu J, Hu LD, Guo ZK. Haploidentical hematopoietic stem cell transplantation in child hematologic malignancies with G-CSF-mobilized marrow grafts without T-cell depletion: a single-center report of 45 cases. Pediatr Hematol Oncol 2009; 26:119-28. [PMID: 19382033 DOI: 10.1080/08880010902772208] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this report, the authors describe a protocol for haploidentical bone marrow transplantation in children who received G-CSF-mobilized bone marrow grafts without T-cell depletion from HLA-mismatched parents. Forty-two of 45 patients achieved complete donor hematopoietic engraftment; the medium time for neutrophil and platelet recovery was 17 and 19 days, respectively. Three died of early transplantation-associated complications; other causes of death included relapse (11 cases), fungal pneumonia (5), and acute graft-versus-host disease (2). The total disease-free survival rate longer than 2 years was 53.3%. These data suggest that haploidentical hematopoietic transplantation is an alterative strategy for children who lack immediate access to HLA-matched sources.
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Affiliation(s)
- Heng-Xiang Wang
- Department of Hematology, The General Hospital of the Air Force, PLA, Beijing, China
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Lang P, Handgretinger R. Haploidentical SCT in children: an update and future perspectives. Bone Marrow Transplant 2009; 42 Suppl 2:S54-9. [PMID: 18978746 DOI: 10.1038/bmt.2008.285] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Transplantation of haploidentical stem cells has become a well-established approach, which makes a potential donor available for almost all patients. This review focuses on current results and new strategies, especially in pediatric patients with malignant diseases. CD34(+) positive selection was the most common procedure for graft manipulation in the past years, whereas T and B cell depletion is a promising new method. GVHD could herewith be effectively reduced and primary engraftment was reported in 83-100% of patients after transplantation of high stem cell doses. For patients with ALL in remission, disease-free survival at 3 years ranged between 22 and 48%. TRM, mainly because of viral infections, was improved by the use of reduced-intensity conditioning (which helped to speed up T cell recovery) and by close monitoring of viral loads and prophylactic/preemptive therapy. The role of donor-derived Ag-specific T cells against viral and fungal antigens is currently under investigation. Patients with active disease at the time of transplantation had a poor outcome and several attempts to improve these results are currently evaluated, such as co-infusion of natural killer cells, co-transplantation of MSC, use of new antileukemic drugs and post-transplant immunotherapy.
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Affiliation(s)
- P Lang
- Department of Haematology/Oncology, Children's University Hospital, University of Tuebingen, Tuebingen, Germany.
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29
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Natural killer cell activity and killer immunoglobulin-like receptors in hematopoietic stem cell transplantation. Cancer Treat Res 2009; 144:47-69. [PMID: 19779874 DOI: 10.1007/978-0-387-78580-6_3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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30
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Huang XJ. Current status of haploidentical stem cell transplantation for leukemia. J Hematol Oncol 2008; 1:27. [PMID: 19117511 PMCID: PMC2637880 DOI: 10.1186/1756-8722-1-27] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 12/31/2008] [Indexed: 12/16/2022] Open
Abstract
Haploidentical hematopoietic stem cell transplantation has made tremendous progress over the past 20 years and has become a feasible option for leukemia patients without a HLA identical sibling donor. The early complications of severe graft-versus-host disease (GVHD), graft failure and delayed engraftment, as well as disease recurrence have limited the use of this approach. Newer strategies have been applied and overcome some of the problems, including the use of T-cell depleted graft, "mega" dose of stem cells, intensive post-transplant immunosuppression and manipulation of the graft. These have decreased the transplant related mortality and GVHD associated with haploidentical transplantation, however, the major problems of disease relapse and infection, which related to late immune reconstitution, limit the development of haploidentical HSCT. Future challenges remain in improving post-transplant immune reconstitution and finding the best approach to reduce the incidence and severity of GVHD, while preserving graft-versus-leukemia effect to prevent the recurrence of underlying malignancy.
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Affiliation(s)
- Xiao-jun Huang
- Institute of Hematology, People's Hospital, Peking University, No 11, Xi Zhi Men South Street, Beijing, 10044, PR China.
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31
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Velardi A, Ruggeri L, Mancusi A, Burchielli E, Perruccio K, Aversa F, Martelli MF. Clinical impact of natural killer cell reconstitution after allogeneic hematopoietic transplantation. Semin Immunopathol 2008; 30:489-503. [DOI: 10.1007/s00281-008-0136-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 09/30/2008] [Indexed: 12/01/2022]
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Abstract
Haploidentical hematopoietic stem cell transplantation (HSCT) provides an opportunity for nearly all patients to benefit from HCT when a HLA genotypically matched sibling is not available. Initial results with the use of mismatched allografts led to limited enthusiasm due to GVHD and infectious complications resulting in unacceptable treatment-related morbidity and mortality. Recent advances with effective T-cell depletion, the use of 'megadoses' of stem cells, better antimicrobial therapy and reduced intensity conditioning has significantly decreased the early transplant-related mortality and GVHD. These modifications also enabled robust and prompt engraftment and led to enhancing the therapeutic benefits of haploidentical transplantation. However, the cardinal problems related to delayed immune reconstitution causing post-transplant infectious complications and relapse remain, limiting the efficacy of haploidentical transplant. Preliminary data have demonstrated the great potential in the use of adoptive cellular immunity and selective allodepletion in rapidly reconstituting immunity without GVHD. The encouraging reports from haploidentical transplant using noninherited maternal antigen (NIMA)-mismatched donors or natural killer (NK) alloreactive donors may greatly increase the donor availability and open a way to more appropriate donor selection in HLA-haploidentical HSCT. Future challenges remain in determining the safest approach for haploidentical transplant with minimal risk of GVHD, while preserving effective GVL activity and promoting prompt immune reconstitution.
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Temporal, quantitative, and functional characteristics of single-KIR-positive alloreactive natural killer cell recovery account for impaired graft-versus-leukemia activity after haploidentical hematopoietic stem cell transplantation. Blood 2008; 112:3488-99. [PMID: 18645039 DOI: 10.1182/blood-2007-07-103325] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In this study, we have characterized reconstitution of the natural killer (NK) cell repertoire after haploidentical CD34(+) selected hematopoietic stem cell transplantation (HSCT) for high-risk hematologic malignancies. Analysis focused on alloreactive single-KIR(+) NK cells, which reportedly are potent antileukemic effectors. One month after HSCT, CD56(bright)/CD56(dim) NK-cell subsets showed inverted ratio and phenotypic features. CD25 and CD117 down-regulation on CD56(bright), and NKG2A and CD62L up-regulation on CD56(dim), suggest sequential CD56(bright)-to-CD56(dim) NK-cell maturation in vivo. Consistently, the functional potential of these maturation intermediates against leukemic blasts was impaired. Mature receptor repertoire reconstitution took at least 3 months. Importantly, at this time point, supposedly alloreactive, single-KIR(+) NK cells were not yet fully functional. Frequency of these cells was highly variable, independently from predicted NK alloreactivity, and below 1% of NK cells in 3 of 6 alloreactive patients studied. In line with these observations, no clinical benefit of predicted NK alloreactivity was observed in the total cohort of 56 patients. Our findings unravel the kinetics, and limits, of NK-cell differentiation from purified haploidentical hematopoietic stem cells in vivo, and suggest that NK-cell antileukemic potential could be best exploited by infusion of mature single-KIR(+) NK cells selected from an alloreactive donor.
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35
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Arpaci F, Tezcan I, Kuzhan O, Yalman N, Uckan D, Kürekci AE, Ikincioğullari A, Ozet A, Tanyeli A. G-CSF-mobilized haploidentical peripheral blood stem cell transplantation in children with poor prognostic nonmalignant disorders. Am J Hematol 2008; 83:133-6. [PMID: 17722073 DOI: 10.1002/ajh.21017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Haploidentical hematopoietic stem cell transplantation (HSCT) is currently one of the alternative curative treatment options for some nonmalignant but also for malignant diseases. However, concerns regarding its safety cause delays in time and a successful outcome. Between 2000 and 2005, twenty-one children with poor prognostic nonmalignant disorders, 13 boys and 8 girls, with a median age of 12 months, underwent 28 haploidentical peripheral HSCT. Immunomagnetic bead depletion device (CliniMACS) was used for indirect T-cell depletion. Indications for transplant were severe combined immunodeficiency (n=16), osteopetrosis (n=2), MDS (n=1), amegakaryocytic thrombocytopenia (n=1), and aplastic anemia (n=1). Five patients (24%) had lung infection at the time of transplantation. The patients received a median of 25.67 x 10(6) G-CSF-mobilized peripheral CD34(+) progenitor cells and a median of 4.19 x 10(4) T-lymphocytes per kilogram of body weight with a T-cell depletion rate of median 4.59 logs. The rate of total engraftment was 66.6%. Median times for leukocyte and platelet engraftment were 14 and 16 days, respectively. The 6-year projected survival was 32% for all patients and 29.76% for patients with severe combined immunodeficiency (SCID). The rates of transplant-related mortality, graft failure, and severe GvHD were 14.2, 33.4%, and 8.3%, respectively. Infection was the main cause of death. The poor outcome may be explained with the poor prognostic factors of our patients such as the type of SCID in most cases (T-B- SCID), the median age over 6 months and the presence of lung infection in some children at the time of transplantation.
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Affiliation(s)
- Fikret Arpaci
- Department of Medical Oncology, Faculty of Medicine, Gulhane Military Medical Academy, Ankara, Turkey.
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36
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Management of the Bone Marrow Transplant Patient. Oncology 2007. [DOI: 10.1007/0-387-31056-8_88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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37
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Allogeneic Hematopoietic Stem Cell Transplant Using Mismatched/Haploidentical Donors. Biol Blood Marrow Transplant 2007; 13:1249-67. [DOI: 10.1016/j.bbmt.2007.08.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 08/13/2007] [Indexed: 01/16/2023]
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38
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Koh LP, Chao NJ. Nonmyeloablative allogeneic hematopoietic stem cell transplant using mismatched/haploidentical donors: a review. Blood Cells Mol Dis 2007; 40:20-4. [PMID: 17884641 PMCID: PMC2330277 DOI: 10.1016/j.bcmd.2007.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 06/30/2007] [Accepted: 06/30/2007] [Indexed: 11/17/2022]
Abstract
Haploidentical hematopoietic stem cell transplantation (HSCT) provides an opportunity for patients to benefit from HCT when a human leukocyte antigen (HLA) genotypically matched sibling is not available. Initial results with the use of mismatched allograft has been disappointing due to the high incidence of graft-versus-host disease (GVHD) and infectious complications resulting in an unacceptable treatment-related morbidity and mortality. Recent advances with effective T-cell depletion, the use of 'megadose' of stem cells and reduced intensity conditioning has significantly decreased the early transplant related mortality and GvHD, while enabling robust and prompt engraftment, and hence enhancing the therapeutic benefits of haploidentical transplantation. However, the cardinal problems related to delayed immune reconstitution causing posttransplant infectious complications and relapse remain, limiting the efficacy of haploidentical transplant. Preliminary data have demonstrated the great potential in the use of adoptive cellular immunity and selective allodepletion in rapidly reconstituting immunity without GvHD. The encouraging reports from haploidentical transplant using noninherited maternal antigen (NIMA)-mismatched donors or natural killer alloreactive donors may greatly increase the donor availability and open a way to more appropriate donor selection in HLA-haploidentical HSCT. Future challenges remain in determining the safest approach for haploidentical transplant to be performed with minimal risk of GvHD, while preserving effective graft-versus-leukemia activity and promoting prompt immune reconstitution.
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Affiliation(s)
- Liang-Pniu Koh
- Adult Bone Marrow and Stem Cell Transplantation Program, Duke University Medical Center, Durham, North Carolina
- Stem Cell Transplant Program, Department of Hematology-Oncology, National University Hospital, Singapore
| | - Nelson J. Chao
- Adult Bone Marrow and Stem Cell Transplantation Program, Duke University Medical Center, Durham, North Carolina
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39
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Abdul-Hai A, Weiss L, Ben-Yehuda A, Ergas D, Shapira MY, Slavin S. Interleukin-7 induced facilitation of immunological reconstitution of sublethally irradiated mice following treatment with alloreactive spleen cells in a murine model of B-cell leukemia/lymphoma (BCL1). Bone Marrow Transplant 2007; 40:881-9. [PMID: 17704792 DOI: 10.1038/sj.bmt.1705819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Interleukin-7 (IL-7) plays a key role in maturation and function of both T and B cells. We investigate the potential use of recombinant human IL-7 for facilitation of graft-versus-leukemia (GVL) effects mediated by T cells following transplantation in a murine model. Administration of IL-7 in vivo to allogeneic-transplanted mice improved disease-free survival: 67% of mice treated with IL-7 remained alive and disease free for more than 60 days, in comparison to 17% of the controls (P<0.05). Similar results were obtained when C57BL/6 spleen cells sensitized against irradiated B-cell leukemia (BCL(1)) cells in the presence of IL-7 were transplanted to F(1) mice, followed by IL-7 treatment in vivo. Of the BALB/c mice that received spleen cells from F(1) mice treated with IL-7 following transplantation of C57BL/6 spleen cells sensitized with irradiated BCL(1) in the presence of IL-7, only 29% developed leukemia, as compared to 79% in the control group (P<0.05). Mice treated with IL-7 showed increased splenic and thymic cellularity and improved T cell-dependent proliferative responses compared to the controls (P<0.05). IL-7 may provide a novel tool to enhance immune reconstitution following transplantation of mismatched stem cells and for enhancement of GVL effects mediated by alloreactive lymphocytes.
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Affiliation(s)
- A Abdul-Hai
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Cell Therapy and Transplantation Research Center, Hadassah University Hospital, Jerusalem, Israel
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40
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Ruggeri L, Aversa F, Martelli MF, Velardi A. Allogeneic hematopoietic transplantation and natural killer cell recognition of missing self. Immunol Rev 2006; 214:202-18. [PMID: 17100886 DOI: 10.1111/j.1600-065x.2006.00455.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the optimal donor for allogeneic hematopoietic stem cell transplantation (HSCT) is a human leukocyte antigen-matched sibling, 75% of patients do not have a match, and alternatives are matched unrelated volunteers, unrelated umbilical cord blood units, and full-haplotype-mismatched family members. To cure leukemia, allogeneic HSCT relies on donor T cells in the allograft, which promote engraftment, eradicate malignant cells, and reconstitute immunity. Here, we focus on the open issues of rejection, graft-versus-host disease (GVHD), and infections and the benefits of natural killer (NK) cell alloreactivity and its underlying mechanisms. Donor-versus-recipient NK cell alloreactivity derives from a mismatch between inhibitory receptors for self-major histocompatibility complex (MHC) class I molecules on donor NK clones and the MHC class I ligands on recipient cells. These NK clones sense the missing expression of the self-MHC class I allele on the allogeneic targets and mediate alloreactions. HSCT from 'NK alloreactive' donors controls acute myeloid relapse without causing GVHD. We review the translation of NK cell recognition of missing self into the clinical practice of allogeneic hematopoietic transplantation and discuss how it has opened innovative perspectives in the cure of leukemia.
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Affiliation(s)
- Loredana Ruggeri
- Division of Hematology and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Perugia, Italy
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41
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Abstract
AbstractAlthough improvement in outcomes has occurred in younger adults with acute myeloid leukemia (AML) during the past 4 decades, progress in older adults has been much less conspicuous, if at all. Approximately 50% to 75% of adults with AML achieve complete remission (CR) with cytarabine and an anthracycline such as daunorubicin or idarubicin or the anthracenedione mitoxantrone. However, only approximately 20% to 30% of the patients enjoy long-term disease survival. Various postremission strategies have been explored to eliminate minimal residual disease. The optimal dose, schedule, and number of cycles of postremission chemotherapy for most patients are not known. A variety of prognostic factors can predict outcome and include the karyotype of the leukemic cells and the presence of transmembrane transporter proteins, which extrude certain chemotherapy agents from the cell and confer multidrug resistance and mutations in or over expressions of specific genes such as WT1, CEBPA, BAX and the ratio of BCL2 to BAX, BAALC, EVI1, KIT, and FLT3. Most recently, insights into the molecular pathogenesis of AML have led to the development of more specific targeted agents and have ushered in an exciting new era of antileukemia therapy. Such agents include the immunoconjugate gemtuzumab ozogamicin, multidrug resistance inhibitors, farnesyl transferase inhibitors, histone deacetylase and proteosome inhibitors, antiangiogenesis agents, Fms-like tyrosine kinase 3 (FLT3) inhibitors, and apoptosis inhibitors.
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Affiliation(s)
- Martin S Tallman
- Northwestern University Feinberg School of Medicine, Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, 676 N St Clair St, Ste 850, Chicago, IL 60611, USA.
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42
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Lang P, Greil J, Bader P, Handgretinger R, Klingebiel T, Schumm M, Schlegel PG, Feuchtinger T, Pfeiffer M, Scheel-Walter H, Führer M, Martin D, Niethammer D. Long-term outcome after haploidentical stem cell transplantation in children. Blood Cells Mol Dis 2005; 33:281-7. [PMID: 15528145 DOI: 10.1016/j.bcmd.2004.08.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present an update of our results with transplantation of highly purified stem cells from one to three loci mismatched parental donors. Sixty-three pediatric patients with acute lymphoblastic leukemias (n = 32), acute myeloid, chronic myeloid and myelomonocytic leukemias (n = 13), myelodysplastic syndromes (n = 4), lymphomas (n = 4), and various nonmalignant diseases (n = 10) underwent transplantation. Mobilized peripheral-blood stem cells were selected with either anti-CD34- or anti-CD133-coated microbeads. Patients received a median of 19.5 x 10(6) purified cells and <25,000 CD3+ T lymphocytes per kilogram, with no regular posttransplant pharmacological immunosuppression. Engraftment occurred in 98% of patients (primary sustained engraftment, 83%; engraftment after reconditioning/stem cell boosts, 15%). Moreover, all survivors but one had a stable three-lineage engraftment with a median follow up of 4.1 years (range 0.6-8 years). Primary acute graft-versus-host disease (GvHD) grade II was seen in only 7% of patients. No severe primary acute GvHD grades III-IV occurred. Thirteen percent of the patients developed transient chronic GvHD. Probability of disease-free survival (DFS) at 3 years was 60% for patients with nonmalignant diseases and 48% for patients with acute lymphatic leukemia (ALL)/non-Hodgkin lymphoma (NHL) in complete remission (CR)1-3. None of the ALL/NHL patients with active disease survived. Children with acute and chronic myeloid leukemias had a poorer outcome (3-year DFS = 18%), whereas two of four patients with myelodysplastic syndrome (MDS) are alive. Relapse probability of the whole group was not significantly increased when compared to a historical control group. The incidence of lethal viral infections was 18% between 1995 and 2002 and has since been reduced to 8% by the introduction of new therapeutic strategies. In summary, the use of stem cells from haploidentical parental donors should be strongly considered in all children who need transplantation but lack an identical donor.
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Affiliation(s)
- Peter Lang
- Children's University Hospital, University of Tuebingen, Germany.
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43
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Klingebiel T, Lang P, Schumm M, Koehl U, Bader P, Schwabe D, Schlegel PG, Eyrich M, Greil J, Beck JF, Niethammer D, Handgretinger R. Experiences with haploidentical stem cell transplantation in children with acute lymphoblastic leukemia. ACTA ACUST UNITED AC 2005; 53:159-61. [DOI: 10.1016/j.patbio.2004.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Accepted: 03/05/2004] [Indexed: 11/26/2022]
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44
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Klingebiel T, Handgretinger R, Lang P, Bader P, Niethammer D. Haploidentical transplantation for acute lymphoblastic leukemia in childhood. Blood Rev 2004; 18:181-92. [PMID: 15183902 DOI: 10.1016/s0268-960x(03)00063-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Haploidentical transplantation in childhood acute lymphoblastic leukemia (ALL) is a promising option for children lacking a suitable donor. We have updated our series of patients with ALL and report the results. Additionally, we reviewed the literature and try to embed our own experiences in the published results. We performed HLA-mismatched stem cell transplantations with megadoses of purified positively selected mobilized peripheral blood CD34+ progenitor cells (PBPC) from adult donors in 27 children with acute lymphoblastic leukemia (ALL) in first (CR1 n = 7), second (CR2 n = 10), or third (CR3 n = 4) complete remission, and in refractory state (NR n = 6). The patients received a mean number of 19.1+/-11.3 x 10(6)/kg purified CD34+ and a mean number of 15.5+/-24.2 x 10(3)/kg CD3+ T-cells. No additional graft-versus-host disease (GVHD) prophylaxis was used, except as short-term CSA in the first 3 patients. The myeloablative treatment was based on busulfan in 12 and on TBI in 14 patients. One patient was grafted with a non-myeloablative approach. Engraftment was rapid in 26 patients, with two patients suffering from a rejection. These two and one patient with initial non-engraftment had been successfully regrafted. The probability of survival of the total group is 0.34+/-0.09; the 12 patients transplanted in remission showed a probability of survival of 0.44+/-0.11. None of the patients transplanted in non-remission survived. There was no statistical difference in survival for patients with a 1, 2 or 3 antigen mismatched donor (out of 6 HLA antigens) or for patients in 1st, 2nd or 3rd remission. Causes of death were relapses in 10 patients, veno-occlusive disease (VOD) in 1, multi-organ failure (MOF) in 2 and infections in 4 patients. 3/24 evaluable patients without any additional GVHD-prophylaxis developed grade 1 or 2 GVHD. Ten patients were treated with additional donor lymphocyte infusion (DLI), from which 4 developed a maximum grade 3 GVHD. We conclude that the HLA barrier can be overcome by transplantation of megadoses of highly purified CD34+ PBPC and GVHD can effectively be prevented. This approach offers a promising treatment option for patients with acute lymphoblastic leukemia needing urgently transplantation but lacking a suitable donor.
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Affiliation(s)
- Thomas Klingebiel
- Klinik für Kinderheilkunde III, Zentrum für Kinderheilkunde und Jugendmedizin der Universität Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany.
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45
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Lewalle P, Delforge A, Aoun M, Crombez P, de Wilde V, Theunissen K, Lagneaux L, Nowak B, Misplon V, Bron D, Martiat P. Growth factors and DLI in adult haploidentical transplant: a three-step pilot study towards patient and disease status adjusted management. Blood Cells Mol Dis 2004; 33:256-60. [PMID: 15528140 DOI: 10.1016/j.bcmd.2004.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Indexed: 10/26/2022]
Abstract
Haploidentical transplant is now established as a procedure of choice for patients who lack a compatible donor. However, they are still referred too late, heavily pretreated, at very advanced stages. We initiated a three-step phase I study trying improve transplant-related mortality, relapse rate, and immunity: G-CSF + DLI, GM-CSF + DLI, patient- and disease-adapted strategy. Thirty-three consecutive leukemia patients, aged 18-55, were investigated (20 very poor risk, 11 poor risk, and 2 better risk). GvH type NK alloreactivity was chosen when possible (18/33) and balanced across the three groups. In the first nine patients, G-CSF was used and escalated prophylactic DLI started at month 1. Thus, G-CSF and 1-3 DLI (10(4) CD3/kg) is safe. It results in faster CD4 recovery and a low rate of infections. However, it was insufficient to induce a GVL effect. In the next 12 patients, GM-CSF was used plus 1 DLI (10(4) CD3/kg) at day 30 unless aGVHD (3 patients). The comparison between the two first groups can be summarized as follows: G-CSF + DLI: TRM at day 100: 0, RR: 6/9, severe aGVHD: 0. GM-CSF + 1 DLI group: RR: 1/12, TRM at day 100: 3, aGVHD > 1: 9/12, price to pay: GVHD resulting in five deaths in total. Step 3 (13 patients) consists of a patient-adapted strategy: no more aspecific DLI (selected anti-CMV and aspergillus DLI planned in all patients); in myeloid disorders with NK alloreactivity: no GF. In the other cases, GM-CSF (at a reduced total dose of 500 mug) is given the follow-up of these 13 patients, although promising is currently short (median 5 months). Overall, TRM at day 100 is 3/29, reflecting the good tolerance of the conditioning in a heavily pretreated population (median age: 43). NRR mortality (8/26) at 1 year is greater in the GM-CSF + DLI group, reflecting the impact of severe aGVHD. We conclude that the third strategy might improve the outcome without exposing patients to unnecessary severe GVHD.
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Affiliation(s)
- P Lewalle
- Department of Hematology, Institut Jules Bordet, University of Brussels (ULB), Brussels, Belgium
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46
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Aversa F, Reisner Y, Martelli MF. Hematopoietic stem cell transplantation from alternative sources in adults with high-risk acute leukemia. Blood Cells Mol Dis 2004; 33:294-302. [PMID: 15528148 DOI: 10.1016/j.bcmd.2004.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Indexed: 11/25/2022]
Abstract
Since 75% of patients with high-risk acute leukemia do not have a human leukocyte antigen (HLA)-identical sibling, alternative sources for hematopoietic stem cell transplantation (HSCT) are matched unrelated donors (MUD), unrelated umbilical cord blood (UD-UCB) and one HLA haplotype mismatched family members (haploidentical). The chance of finding a suitable donor in the international voluntary donor registries is limited by frequency of the HLA phenotype and the time required to identify the right donor from a potential panel, to establish eligibility and to harvest the cells. In adult MUD recipients, event-free survival ranges up to 50% and refers only to patients who undergo transplant, without taking into account those who do not find a donor. Umbilical cord blood offers the advantages of easy procurement, the absence of risks to donors, the reduced risk of transmitting infections, immediate availability of cryopreserved samples and acceptance of mismatches at two of the six antigens. Although UD-UCB transplantation is a viable option for children, it is seldom considered for adults. The great divergency between body weight and the number of hematopoietic cells in a standard cord blood unit, particularly if associated with a two-antigen mismatch, increases the risk of graft failure and delays hematopoietic reconstitution. Work on full-haplotype mismatched transplants has been proceeding for over 20 years. Originally, outcome in leukemia patients was disappointing because of high incidence of severe graft-vs.-host disease in T-replete transplants and high rejection rates in T-cell-depleted transplants. The breakthrough came with the use of a megadose of T-cell-depleted progenitor cells after a high-intensity conditioning regimen. Treating end-stage patients inevitably confounded clinical outcome in the early pilot studies. Today, high-risk acute leukemia patients are treated at less advanced stages of disease, receive a reasonably well tolerated conditioning regimen, and benefit from advances in post-transplant immunological reconstitution. All these factors contribute to markedly reduce transplant-related mortality. Overall, event-free survival and transplant-related mortality compare favorably with reports from unrelated matched transplants. T-cell-depleted megadose stem cell transplant from a mismatched family member, who is immediately available, can be offered as a viable option to candidates with high-risk acute leukemias.
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Affiliation(s)
- Franco Aversa
- Department of Hematology, University of Perugia, Perugia, Italy.
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47
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Rauser G, Einsele H, Sinzger C, Wernet D, Kuntz G, Assenmacher M, Campbell JDM, Topp MS. Rapid generation of combined CMV-specific CD4+ and CD8+ T-cell lines for adoptive transfer into recipients of allogeneic stem cell transplants. Blood 2004; 103:3565-72. [PMID: 14670917 DOI: 10.1182/blood-2003-09-3056] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Adoptive transfer of cytomegalovirus (CMV)-specific T cells can restore long-lasting, virus-specific immunity and clear CMV viremia in recipients of allogeneic stem cell transplants if CD4+ and CD8+ CMV-specific T cells are detected in the recipient after transfer. Current protocols for generating virus-specific T cells use live virus, require leukapheresis of the donor, and are time consuming. To circumvent these limitations, a clinical-scale protocol was developed to generate CMV-specific T cells by using autologous cellular and serum components derived from a single 500-mL blood draw. CMV-specific T cells were stimulated simultaneously with CMV-specific major histocompatibility complex class I (MHC I)- restricted peptides and CMV antigen. Activated T cells were isolated with the interferon-γ (IFN-γ) secretion assay and expanded for 10 days. In 8 randomly selected, CMV-seropositive donors, 1.34 × 108 combined CD4+ and CD8+ CMV-specific T cells, on average, were generated, as determined by antigen-triggered IFN-γ production. CMV-infected fibroblasts were efficiently lysed by the generated T cells, and CMV-specific CD4+ and CD8+ T cells expanded if they were stimulated with natural processed antigen. On the other hand, CD4+ and CD8+ T cell-mediated alloreactivity of generated CMV-specific T-cell lines was reduced compared with that of the starting population. In conclusion, the culture system developed allowed the rapid generation of allodepleted, highly enriched, combined CD4+ and CD8+ CMV-specific T cells under conditions mimicking good manufacturing practice. (Blood. 2004; 103:3565-3572)
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Affiliation(s)
- Georg Rauser
- Medizinische Klinik II, Eberhard-Karls-Universität, Tuebingen, Germany
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Ringdén O. Novel treatment for refractory acute myeloid leukemia. Pediatr Transplant 2003; 7:422-5. [PMID: 14870888 DOI: 10.1046/j.1397-3142.2003.00106.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Veys P, Amrolia P, Rao K. The role of haploidentical stem cell transplantation in the management of children with haematological disorders. Br J Haematol 2003; 123:193-206. [PMID: 14531901 DOI: 10.1046/j.1365-2141.2003.04655.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The broader application of stem cell transplantation (SCT) for paediatric diseases has been limited by a lack of human leucocyte antigen (HLA)-matched donors. Virtually all children, however have at least one haploidentical parent who could serve as a donor. Such a donor is immediately available and the considerable costs of additional HLA typing, registry and banking expenditures that are necessary to procure an unrelated donor, could be reduced. Recent technological advances appear to have overcome the historical problems of graft rejection and severe graft versus host disease in the haploidentical setting, and in the latest studies the overall survival for children undergoing haploidentical SCT for leukaemia is now comparable with that following unrelated donor bone marrow or cord blood transplantation. Post-transplant infectious complications and leukaemia relapse remain the most important barriers yet to overcome, and new directions in the use of adoptive cellular immunity appear to be promising in this respect. Haploidentical SCT is now a viable option for those children who do not have an HLA compatible sibling or fully matched unrelated donor. The relative merits of a haploidentical family donor versus mismatched unrelated bone marrow or cord blood donation needs to be assessed in prospective, randomized clinical trials.
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Affiliation(s)
- Paul Veys
- Department of Blood and Marrow Transplantation, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Jones DC, Young NT. Natural killer receptor repertoires in transplantation. EUROPEAN JOURNAL OF IMMUNOGENETICS : OFFICIAL JOURNAL OF THE BRITISH SOCIETY FOR HISTOCOMPATIBILITY AND IMMUNOGENETICS 2003; 30:169-76. [PMID: 12786992 DOI: 10.1046/j.1365-2370.2003.00385.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Natural killer (NK) lymphocytes are potent effector cells that are controlled by the expression of a variety of cell surface receptors with either inhibitory or activating functions. The genetic and functional diversity of this receptor repertoire and the role of HLA class I molecules as a major group of NK receptor ligands create an innate alloreactive capacity in this cell type. Both animal models and in vitro studies have implicated NK cells as contributors to the pathology of clinical transplantation. However, recent clinical studies have indicated the potential benefit of exploiting NK cell alloreactivity in mismatched haematopoietic stem cell transplantation. Further investigations of NK cell alloreactivity will undoubtedly reveal additional applications of this fundamental cell type in clinical transplantation.
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Affiliation(s)
- D C Jones
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
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