1
|
Haugaard AK, Kofoed J, Masmas TN, Madsen HO, Marquart HV, Heilmann C, Müller KG, Ifversen M. Is microchimerism a sign of imminent disease recurrence after allogeneic hematopoietic stem cell transplantation? A systematic review of the literature. Blood Rev 2020; 44:100673. [DOI: 10.1016/j.blre.2020.100673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
|
2
|
Single- Versus Double-Unit Umbilical Cord Blood Transplantation for Hematologic Diseases: A Systematic Review. Transfus Med Rev 2018; 33:51-60. [PMID: 30482420 DOI: 10.1016/j.tmrv.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/11/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022]
Abstract
Controversial results exist regarding the clinical benefits of single- vs double-unit umbilical cord blood transplantation (UCBT) in patients with hematologic diseases. A systematic review was conducted to evaluate this issue. The PubMed, Embase, and Cochrane Library databases were searched up to May 2018. A total of 25 studies including 6571 recipients were identified. Although double-unit UCB contained higher doses of total nucleated cells and CD34+ cells, it offered no advantages over single-unit UCB in terms of hematologic recovery, including the rate and speed of neutrophil and platelet engraftment. Double-unit UCBT was associated with higher incidences of grades II-IV acute and extensive chronic graft-vs-host disease, accompanied by a lower relapse incidence, which may be attributed to a graft-vs-graft effect induced by double-unit UCB. However, transplant-related mortality, disease-free survival, and overall survival were comparable between single- and double-unit UCBT. Although double-unit UCBT confers no clinical advantages over single-unit UCBT, certain patients, such as those at high risk of relapse, might benefit from double-unit UCBT, a possibility that needs to be clarified in future randomized trials.
Collapse
|
3
|
Berglund S, Magalhaes I, Gaballa A, Vanherberghen B, Uhlin M. Advances in umbilical cord blood cell therapy: the present and the future. Expert Opin Biol Ther 2017; 17:691-699. [PMID: 28379044 DOI: 10.1080/14712598.2017.1316713] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Umbilical cord blood (UCB), previously seen as medical waste, is increasingly recognized as a valuable source of cells for therapeutic use. The best-known application is in hematopoietic stem cell transplantation (HSCT), where UCB has become an increasingly important graft source in the 28 years since the first umbilical cord blood transplantation (UCBT) was performed. Recently, UCB has been increasingly investigated as a putative source for adoptive cell therapy. Areas covered: This review covers the advances in umbilical cord blood transplantation (UCBT) to overcome the limitation regarding cellular dose, immunological naivety and additional cell doses such as DLI. It also provides an overview regarding the progress in adoptive cellular therapy using UCB. Expert opinion: UCB has been established as an important source of stem cells for HSCT. Successful strategies to overcome the limitations of UCBT, such as the limited cell numbers and naivety of the cells, are being developed, including novel methods to perform in vitro expansion of progenitor cells, and to improve their homing to the bone marrow. Promising early clinical trials of adoptive therapies with UCB cells, including non-immunological cells, are currently performed for viral infections, malignant diseases and in regenerative medicine.
Collapse
Affiliation(s)
- Sofia Berglund
- a Centre for Allogeneic Stem Cell Transplantation , Karolinska University Hospital , Stockholm , Sweden
| | - Isabelle Magalhaes
- b Department of oncology and Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Ahmed Gaballa
- c Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden
| | - Bruno Vanherberghen
- d Department of Applied Physics , Royal Institute of Technology , Stockholm , Sweden
| | - Michael Uhlin
- c Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden.,d Department of Applied Physics , Royal Institute of Technology , Stockholm , Sweden.,e Department of Immunology/Transfusion Medicine , Karolinska University Hospital , Stockholm , Sweden
| |
Collapse
|
4
|
Yokohata E, Kuwatsuka Y, Ohashi H, Terakura S, Kawashima N, Seto A, Kurahashi S, Ozawa Y, Goto T, Imahashi N, Nishida T, Miyao K, Sakemura R, Kato T, Sawa M, Kohno A, Sao H, Iida H, Kiyoi H, Naoe T, Miyamura K, Murata M. Impact of T-cell chimerism on relapse after cord blood transplantation for hematological malignancies: Nagoya Blood and Marrow Transplantation Group study. Bone Marrow Transplant 2017; 52:612-614. [PMID: 28067879 DOI: 10.1038/bmt.2016.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- E Yokohata
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Y Kuwatsuka
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - H Ohashi
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Division of Hematology, Toyota Memorial Hospital, Toyota, Japan
| | - S Terakura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Kawashima
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - A Seto
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.,Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Kurahashi
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Y Ozawa
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - T Goto
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Imahashi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Nishida
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Miyao
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - R Sakemura
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - T Kato
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - M Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - A Kohno
- Department of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan
| | - H Sao
- Department of Hematology, Meitetsu Hospital, Nagoya, Japan
| | - H Iida
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - H Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Naoe
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Miyamura
- Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - M Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
5
|
Kudek MR, Shanley R, Zantek ND, McKenna DH, Smith AR, Miller WP. Impact of Graft-Recipient ABO Compatibility on Outcomes after Umbilical Cord Blood Transplant for Nonmalignant Disease. Biol Blood Marrow Transplant 2016; 22:2019-2024. [PMID: 27496217 PMCID: PMC5067229 DOI: 10.1016/j.bbmt.2016.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/23/2016] [Indexed: 01/05/2023]
Abstract
Existing literature shows mixed conclusions regarding the impact of ABO incompatibility on outcomes after hematopoietic stem cell transplantation. Because the future for umbilical cord blood (UCB) expansion technologies is bright, we assessed whether this typically overlooked graft characteristic impacted various outcomes after UCB transplantation (UCBT) for nonmalignant disorders (NMDs). A prospectively maintained institutional blood and marrow transplant program database was queried for all patients undergoing first UCBT for NMDs. UCB and recipient ABO compatibility was considered as matched, major mismatched, minor mismatched, or bidirectional mismatched. The impact of ABO incompatibility was assessed on overall survival, graft failure, acute and chronic graft-versus-host disease (GVHD), time to neutrophil and platelet recovery, day 0 to day 100 RBC transfusion burden, and donor hematopoietic chimerism. Through December 2014, 270 patients have undergone first UCBT for various NMDs. In both univariable and multivariable analyses, ABO compatibility status did not appear to impact any outcomes assessed, although a trend toward increased grades III to IV acute GVHD was seen in recipients of major mismatched units. When considering UCBT for treatment of NMDs, ABO compatibility between the donor unit and intended recipient does not appear to be an important consideration in the UCB unit choice.
Collapse
Affiliation(s)
- Matthew R Kudek
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Ryan Shanley
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - David H McKenna
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Angela R Smith
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Weston P Miller
- Division of Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
6
|
Solves P, Carpio N, Carretero C, Lorenzo JI, Sanz J, Gómez I, López-Chuliá F, Arilla MJ, Regadera AI, Montesinos P, Sanz GF, Sanz MÁ. ABO incompatibility does not influence transfusion requirements in patients undergoing single-unit umbilical cord blood transplantation. Bone Marrow Transplant 2016; 52:394-399. [DOI: 10.1038/bmt.2016.264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 11/09/2022]
|
7
|
Tsang KS, Leung AWK, Lee V, Cheng FWT, Shing MMK, Pong HNH, Leung TF, Yuen PMP, Li CK. Indiscernible Benefit of Double-Unit Umbilical Cord Blood Transplantation in Children: A Single-Center Experience from Hong Kong. Cell Transplant 2016; 25:1277-86. [DOI: 10.3727/096368915x689631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Double-unit umbilical cord blood (DU-UCB) may extend the use of UCB transplantation and improve clinical outcomes. Data in the literature show that single-unit dominance happened in a vast majority of recipients, and the mechanism is unknown. We examined the clinical relevance and engraftment kinetics of DU-UCB transplant in 65 consecutive children who underwent unrelated single-unit ( n = 25) and double-unit ( n = 40) UCB transplantation for various hematological malignancies ( n = 45) and nonmalignant disorders ( n = 20). Our result showed no discernible benefit to children receiving double-unit transplant over those receiving single-unit transplant when the total nucleated cell (TNC) doses are ≥2.5 × 107/kg, in terms of the hastening of the engraftment of neutrophils and platelets, reduction of nonengraftment, disease recurrence, early mortality, and graft-versus-host disease, despite significantly higher numbers of TNCs in double units. Further analyses demonstrated that the phenomena were not associated with underlying disease, duration of UCB storage, postthaw viability, HLA disparity, ABO incompatibility, gender, or doses of TNCs, CD34+ cells, CD3+ cells, or colony-forming units. Engrafting units in DU-UCB transplants were notably associated with higher CD34+ cell dose. Chimerism studies demonstrated that single-unit dominance started before neutrophil engraftment in DU-UCB transplants. Data from the study suggested no advantage of infusing double-unit UCB, if an adequately dosed single-unit UCB is available. Successful prediction of the dominant graft would optimize algorithms of UCB selection and maximize the long-term engraftment of chosen units.
Collapse
Affiliation(s)
- Kam Sze Tsang
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex Wing Kwan Leung
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Vincent Lee
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Frankie Wai Tsoi Cheng
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Matthew Ming Kong Shing
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Henry Nga Hin Pong
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ting Fan Leung
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Man Pan Yuen
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chi Kong Li
- Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
8
|
Konuma T, Kato S, Oiwa-Monna M, Ishii H, Tojo A, Takahashi S. Early phase mixed chimerism in bone marrow does not affect long-term outcomes of myeloablative single-unit cord blood transplantation for adult patients with hematological malignancies. Leuk Lymphoma 2016; 57:2848-2854. [PMID: 27124418 DOI: 10.3109/10428194.2016.1171860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Coexisting hematopoiesis from donor and recipient origin, called a mixed chimerism status, can occur in patients after myeloablative allogeneic hematopoietic stem cell transplantation. However, its impact on the outcomes of cord blood transplantation (CBT) has yet to be clarified. We retrospectively analyzed 150 adult patients who received myeloablative single-unit CBT for hematological malignancies in our institute. At the median time of first bone marrow analysis of 41 days after CBT, mixed chimerism was observed in 16 of the 150 patients. Among patients with mixed chimerism, 4 patients relapsed. The remaining 12 patients were alive and in remission at a median follow-up of 50 months. Bone marrow-mixed chimerism did not have a significant impact on the incidences of disease-free survival, relapse, or transplant-related mortality after CBT. These data show that early phase mixed chimerism did not have a significant impact on long-term outcomes after myeloablative single-unit CBT for hematological malignancies.
Collapse
Affiliation(s)
- Takaaki Konuma
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Seiko Kato
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Maki Oiwa-Monna
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Hiroto Ishii
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Arinobu Tojo
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Satoshi Takahashi
- a Department of Hematology/Oncology , The Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| |
Collapse
|
9
|
Mellgren K, Arvidson J, Toporski J, Winiarski J. Chimerism analysis in clinical practice and its relevance for the detection of graft rejection and malignant relapse in pediatric hematopoietic stem cell transplant patients. Pediatr Transplant 2015; 19:758-66. [PMID: 26290161 DOI: 10.1111/petr.12580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 11/29/2022]
Abstract
Chimerism and clinical outcome data from 244 hematopoietic stem cell transplants in 218 children were retrospectively analyzed to assess their relevance for the detection of graft rejection and malignant relapse. Patients transplanted for a non-malignant disease had significantly higher proportions of residual recipient T cells in peripheral blood at one, three, and six months compared with patients transplanted for malignant disease. Recipient T-cell levels were below 50% at one month after transplantation in most patients (129 of 152 transplants). Graft rejection occurred more frequently in the group of patients with high levels of recipient cells at one month (10 graft rejections in the 23 patients with recipient T cells >50% at one month as compared to seven graft rejections occurred in 129 patients with recipient T cells <50% (p < 0.001). Multilineage chimerism data in 87 children with leukemia at one, three, and six months after transplantation were not correlated with subsequent relapse of malignant disease. In conclusion, early analysis of lineage-specific chimerism in peripheral blood can be used to identify patients who are at high risk of graft rejection. However, the efficacy of early chimerism analysis for predicting leukemia relapse was limited.
Collapse
Affiliation(s)
- Karin Mellgren
- Department of Pediatrics, Institution for Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Johan Arvidson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jacek Toporski
- Section of Pediatric Oncology/Hematology, Department of Pediatrics, Skåne University Hospital, Lund, Sweden
| | - Jacek Winiarski
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| |
Collapse
|
10
|
Rio B, Chevret S, Vigouroux S, Chevallier P, Fürst S, Sirvent A, Bay JO, Socié G, Ceballos P, Huynh A, Cornillon J, Françoise S, Legrand F, Yakoub-Agha I, Michel G, Maillard N, Margueritte G, Maury S, Uzunov M, Bulabois CE, Michallet M, Clement L, Dauriac C, Bilger K, Gluckman E, Ruggeri A, Buzyn A, Nguyen S, Simon T, Milpied N, Rocha V. Decreased nonrelapse mortality after unrelated cord blood transplantation for acute myeloid leukemia using reduced-intensity conditioning: a prospective phase II multicenter trial. Biol Blood Marrow Transplant 2014; 21:445-53. [PMID: 25460357 DOI: 10.1016/j.bbmt.2014.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/07/2014] [Indexed: 01/27/2023]
Abstract
A prospective phase II multicenter trial was performed with the aim to obtain less than 25% nonrelapse mortality (NRM) after unrelated cord blood transplantation (UCBT) for adults with acute myeloid leukemia (AML) using a reduced-intensity conditioning regimen (RIC) consisting of total body irradiation (2 Gy), cyclophosphamide (50 mg/kg), and fludarabine (200 mg/m(2)). From 2007 to 2009, 79 UCBT recipients were enrolled. Patients who underwent transplantation in first complete remission (CR1) (n = 48) had a higher frequency of unfavorable cytogenetics and secondary AML and required more induction courses of chemotherapy to achieve CR1 compared with the others. The median infused total nucleated cells (TNC) was 3.4 × 10(7)/kg, 60% received double UCBT, 77% were HLA mismatched (4/6), and 40% had major ABO incompatibility. Cumulative incidence of neutrophil recovery at day 60 was 87% and the cumulative incidence of 100-day acute graft-versus-host disease (II to IV) was 50%. At 2 years, the cumulative incidence of NRM and relapse was 20% and 46%, respectively. In multivariate analysis, major ABO incompatibility (P = .001) and TNC (<3.4 × 10(7)/kg; P = .001) were associated with increased NRM, and use of 2 or more induction courses to obtain CR1 was associated with increased relapse incidence (P = .04). Leukemia-free survival (LFS) at 2 years was 35%, and the only factor associated with decreased LFS was secondary AML (P = .04). In conclusion, despite the decreased NRM observed, other RIC regimens with higher myelosuppression should be evaluated to decrease relapse in high-risk AML. (EUDRACT 2006-005901-67).
Collapse
Affiliation(s)
- Bernard Rio
- Service d'Hématologie, Hôtel-Dieu Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvie Chevret
- Department de Bioinformatique et Statistique Médicale, Hopital Saint-Louis, Paris, France
| | - Stéphane Vigouroux
- Service d'Hématologie, Service d'Hématologie clinique et de thérapie cellulaire, CHU de Bordeaux Hopital du Haut-Lévèque, Pessac, France
| | - Patrice Chevallier
- Service d'Hématologie, Hematology Department, CHU de Nantes, Nantes, France
| | - Sabine Fürst
- Service d'Hématologie, Service de Greffe de Moelle, Institut Paoli Calmettes, Marseille, France
| | - Anne Sirvent
- Service d'Hématologie, Hematologie Clinique, Hopital de l'Archet I, Nice, France
| | - Jacques-Olivier Bay
- Service d'Hématologie, Service d'Hématologie Clinique, CHU Estaing, Clermont-Ferrand, France
| | - Gérard Socié
- Service d'Hématologie, Hematology-Bone Marrow Transplantation, Hopital Saint-Louis, Paris, France
| | | | - Anne Huynh
- Service d'Hématologie, Hématologie Clinique, CHU, Toulouse, France
| | - Jérôme Cornillon
- Service d'Hématologie, Hematology, Institut de Cancérologie de la Loire, Loire, France
| | | | - Faezeh Legrand
- Service d'Hématologie, Hematology, CHU Besançon, Besancon, France
| | | | - Gérard Michel
- Department of Hematology, Hôpital La Timone, Marseille, France
| | | | | | - Sébastien Maury
- Service d'Hématologie, Service d'Hematologie, Hôpital Henri Mondor, Creteil, France
| | - Madalina Uzunov
- Service d'Hématologie, Pitié-Salpêtrière (AP-HP), Paris, France
| | | | | | | | | | - Karin Bilger
- Service d'Hématologie, CHRU Strasbourg, Strasbourg, France
| | - Eliane Gluckman
- Service d'Hématologie, Eurocord Office, Hôpital Saint-Louis, Paris, France
| | - Annalisa Ruggeri
- Service d'Hématologie, Eurocord Office, Hôpital Saint-Louis, Paris, France; Service d'Hématologie, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Agnès Buzyn
- Service d'Hématologie, Comité Scientifique, SFGM-TC, Hôpital Necker (AP-HP), Paris, France
| | - Stéphanie Nguyen
- Service d'Hématologie, Hôpital Pitié Salpêtrière (AP-HP), Paris, France
| | - Tabassome Simon
- Service d'Hématologie, URC Est Saint Antoine (AP-HP), Paris, France
| | - Nöel Milpied
- Service d'Hématologie, Service d'Hématologie clinique et de thérapie cellulaire, CHU de Bordeaux Hopital du Haut-Lévèque, Pessac, France
| | - Vanderson Rocha
- Service d'Hématologie, Eurocord Office, Hôpital Saint-Louis, Paris, France; Department of Haematology, Churchill Hospital, Oxford, United Kingdom.
| | | |
Collapse
|
11
|
Bergkvist K, Winterling J, Johansson E, Johansson UB, Svahn BM, Remberger M, Mattsson J, Larsen J. General health, symptom occurrence, and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation: a cross-sectional comparison between hospital care and home care. Support Care Cancer 2014; 23:1273-83. [PMID: 25322970 DOI: 10.1007/s00520-014-2476-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/06/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Earlier studies have shown that home care during the neutropenic phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is medically safe, with positive outcomes. However, there have been few results on long-term outcomes after home care. The aims of this study were to compare general health, symptom occurrence, and self-efficacy in adult survivors who received either home care or hospital care during the early neutropenic phase after allo-HSCT and to investigate whether demographic or medical variables were associated with general health or symptom occurrence in this patient population. METHODS In a cross-sectional survey, 117 patients (hospital care: n = 78; home care: n = 39) rated their general health (SF-36), symptom occurrence (SFID-SCT, HADS), and self-efficacy (GSE) at a median of 5 (1-11) years post-HSCT. RESULTS No differences were found regarding general health, symptom occurrence, or self-efficacy between groups. The majority of patients in both hospital care (77 %) and home care (78 %) rated their general health as "good" with a median of 14 (0-36) current symptoms. Symptoms of fatigue and sexual problems were among the most common. Poor general health was associated with acute graft-versus-host disease (GVHD), low self-efficacy, and cord blood stem cells. A high symptom occurrence was associated with female gender, acute GVHD, and low self-efficacy. CONCLUSIONS No long-term differences in general health and symptom occurrence were observed between home care and hospital care. Thus, home care is an alternative treatment method for patients who for various reasons prefer this treatment option. We therefore encourage other centers to offer home care to patients.
Collapse
Affiliation(s)
- Karin Bergkvist
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden,
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Berglund S, Gertow J, Uhlin M, Mattsson J. Expanded umbilical cord blood T cells used as donor lymphocyte infusions after umbilical cord blood transplantation. Cytotherapy 2014; 16:1528-1536. [PMID: 25231890 DOI: 10.1016/j.jcyt.2014.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Umbilical cord blood (UCB) is an alternative graft source for hematopoietic stem cell transplantation and has been shown to give results comparable to transplantation with other stem cell sources. Donor lymphocyte infusion (DLI) is an effective treatment for relapsed malignancies after hematopoietic stem cell transplantation. However, DLI is not available after UCB transplantation. METHODS In this study, in vitro-cultured T cells from the UCB graft were explored as an alternative to conventional DLI. The main aim was to study the safety of the cultured UCB T cells used as DLI because such cell preparations have not been used in this context previously. We also assessed potential benefits of the treatment. RESULTS The cultured UCB T cells (UCB DLI) were given to 4 patients with mixed chimerism (n = 2), minimal residual disease (n = 1) and graft failure (n = 1). No adverse reactions were seen at transfusion. Three of the patients did not show any signs of graft-versus-host disease (GVHD) after UCB DLI, but GVHD could not be excluded in the last patient. In the patient with minimal residual disease treated with UCB DLI, the malignant cell clone was detectable shortly before infusion but undetectable at treatment and for 3 months after infusion. In 1 patient with mixed chimerism, the percentage of recipient cells decreased in temporal association with UCB DLI treatment. CONCLUSIONS We saw no certain adverse effects of treatment with UCB DLI. Events that could indicate possible benefits were seen but with no certain causal association with the treatment.
Collapse
Affiliation(s)
- Sofia Berglund
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden.
| | - Jens Gertow
- Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Michael Uhlin
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
13
|
Elkaim E, Picard C, Galambrun C, Barlogis V, Loundou A, Curtillet C, Oudin C, Thuret I, Chambost H, Michel G. Peripheral blood cells chimerism after unrelated cord blood transplantation in children: kinetics, predictive factors and impact on post-transplant outcome. Br J Haematol 2014; 166:557-65. [PMID: 24779895 DOI: 10.1111/bjh.12918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
This study aimed to describe kinetics of complete donor chimerism occurrence (cDC, >99·9% donor) after unrelated cord blood transplantation (UCBT), to identify its predictive factors and its impact on post-transplant outcome. Ninety-four children who received single UCBT after a myeloablative conditioning regimen had blood chimerism evaluation at predefined post-transplant dates, using a real-time polymerase chain reaction method with 0·1% sensitivity. Cumulative incidence of cDC at 1 year post-transplantation was 61·8%. Three predictive factors were identified in multivariate analysis: history of malignant disease (P = 0·03), older age (above 2·16 years, the first quartile of age, P = 0·0055) and higher level of cord/recipient human leucocyte antigen mismatch (4/6 vs. 5-6/6, P < 0·001) increased the probability of post-transplant cDC. Although graft cell dose had a strong impact on haematological recovery, it did not apparently influence cDC occurrence. Early cDC (i.e. more than 99·9% donor chimerism on days 15-30 post-transplant) appeared useful to predict engraftment (P = 0·003) as well as acute and chronic graft-versus-host disease (GvHD). Severe acute or chronic GvHD never occurred in patients with DC ≤99·9%, suggesting than even minimal residual host haematopoiesis is associated with a very low risk of GvHD after UCBT.
Collapse
Affiliation(s)
- Elodie Elkaim
- Department of Paediatric Haematology-Oncology, APHM, La Timone Hospital, Aix-Marseille University, Marseille, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Konuma T, Kato S, Ooi J, Oiwa-Monna M, Ebihara Y, Mochizuki S, Yuji K, Ohno N, Kawamata T, Jo N, Yokoyama K, Uchimaru K, Tojo A, Takahashi S. Effect of ABO Blood Group Incompatibility on the Outcome of Single-Unit Cord Blood Transplantation after Myeloablative Conditioning. Biol Blood Marrow Transplant 2014; 20:577-81. [DOI: 10.1016/j.bbmt.2013.12.563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
|
15
|
Wikell H, Ponandai-Srinivasan S, Mattsson J, Gertow J, Uhlin M. Cord blood graft composition impacts the clinical outcome of allogeneic stem cell transplantation. Transpl Infect Dis 2014; 16:203-12. [DOI: 10.1111/tid.12182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/05/2013] [Accepted: 07/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- H. Wikell
- Division of Therapeutic Immunology; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Science; Karolinska University Hospital; Stockholm Sweden
| | | | - J. Mattsson
- Division of Therapeutic Immunology; Karolinska Institutet; Stockholm Sweden
- Center for Allogeneic Stem Cell Transplantation; Karolinska University Hospital; Stockholm Sweden
| | - J. Gertow
- Division of Therapeutic Immunology; Karolinska Institutet; Stockholm Sweden
- Center for Allogeneic Stem Cell Transplantation; Karolinska University Hospital; Stockholm Sweden
| | - M. Uhlin
- Division of Therapeutic Immunology; Karolinska Institutet; Stockholm Sweden
- Center for Allogeneic Stem Cell Transplantation; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
16
|
Berglund S, Uhlin M, Mattsson J. Chimerism and use of mesenchymal stem cells in umbilical cord blood transplantation. CHIMERISM 2013; 4:34-5. [PMID: 23434735 DOI: 10.4161/chim.24073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We performed a retrospective single-center analysis of 50 umbilical cord blood transplantations (UCBTs), focusing on chimerism development. Complete donor chimerism (DC) was associated with acute graft-vs.-host disease (aGVHD) grades II-IV for the CD3 (+) cell lineage (p = 0.01) and, in multivariate analysis, with total body irradiation (TBI) for all lineages (p < 0.01). Overall survival (OS) was negatively associated with patient age, (p < 0.001); aGVHD grades III-IV, (p < 0.001); and treatment with mesenchymal stem cells (MSCs) (p = 0.027). In conclusion, though multiple factors may have contributed, the association of TBI and DC might be worthy of consideration in the treatment of patients with malignant disease in the UCBT setting. The negative influence of MSCs on OS may be a reason for more careful usage of this treatment modality in combination with UCBT.
Collapse
Affiliation(s)
- Sofia Berglund
- Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | | | | |
Collapse
|
17
|
Impact of ABO-mismatch on risk of GVHD after umbilical cord blood transplantation. Bone Marrow Transplant 2013; 48:1046-9. [PMID: 23419434 DOI: 10.1038/bmt.2013.8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 01/07/2013] [Accepted: 01/10/2013] [Indexed: 11/08/2022]
Abstract
Recent advances in allogeneic hematopoietic cell transplant (allo-HCT) have led to an increasing use of alternative donors, including banked umbilical cord blood (UCB). Despite these advances, acute GVHD (aGVHD) and chronic GVHD (cGVHD) continue to be the leading causes of early and late transplant-related mortality. ABO-mismatch has been frequently reported as a risk factor for GVHD, however, data in the UCB recipients are limited. We hypothesized that as the lymphocytes in the cord blood are thought to be naive, they will therefore be less likely to mediate GVHD. Therefore, we analyzed the impact of ABO-mismatch on aGVHD and cGVHD in recipients of single and double UCB-HCT. In both univariate and multivariate analyses, presence of ABO-mismatch did not have an impact on aGVHD or cGVHD. Whereas ABO-compatible donors are preferred in recipients of URD-HCT, ABO compatibility generally need not be considered in recipients of UCB-HCT.
Collapse
|