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Pagliuca S, Kulasekararaj AG, Eikema DJ, Piepenbroek B, Iftikhar R, Satti TM, Griffin M, Laurino M, Kupesiz A, Bertrand Y, Fattizzo B, Yakoub-Agha I, Aljurf M, Corti P, Massaccesi E, Lioure B, Calabuig M, Klammer M, Unal E, Wu D, Chevallier P, Forcade E, Snowden JA, Ozdogu H, Risitano A, De Latour RP. Current use of androgens in bone marrow failure disorders: a report from the Severe Aplastic Anemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica 2024; 109:765-776. [PMID: 37199126 PMCID: PMC10905082 DOI: 10.3324/haematol.2023.282935] [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: 02/12/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
Androgens represent the historical therapeutic backbone of bone marrow failure (BMF) syndromes. However, their role has rarely been analyzed in a prospective setting, and systematic and long-term data regarding their usage, effectiveness and toxicity in both acquired and inherited BMF are currently unavailable. Here, taking advantage of a unique disease-specific international dataset, we retrospectively analyzed the largest cohort so far of BMF patients who received androgens before or in the absence of an allogeneic hematopoietic cell transplantation (HCT), re-evaluating their current use in these disorders. We identified 274 patients across 82 European Society for Blood and Marrow Transplantation (EBMT) affiliated centers: 193 with acquired (median age 32 years) and 81 with inherited (median age 8 years) BMF. With a median duration of androgen treatment of 5.6 and 20 months, respectively, complete and partial remission rates at 3 months were 6% and 29% in acquired and 8% and 29% in inherited disorders. Five-year overall survival and failure-free survival (FFS) were respectively 63% and 23% in acquired and 78% and 14% in inherited BMF. Androgen initiation after second-line treatments for acquired BMF, and after >12 months post diagnosis for inherited BMF were identified as factors associated with improved FFS in multivariable analysis. Androgen use was associated with a manageable incidence of organ-specific toxicity, and low rates of solid and hematologic malignancies. Sub-analysis of transplant-related outcomes after exposure to these compounds showed probabilities of survival and complications similar to other transplanted BMF cohorts. This study delivers a unique opportunity to track androgen use in BMF syndromes and represents the basis for general recommendations on this category of therapeutics on behalf of the Severe Aplastic Anemia Working Party of the EBMT.
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Affiliation(s)
- Simona Pagliuca
- Hôpitaux de Brabois, CHRU Nancy, and CNRS, Biopôle de l'Université de Lorraine, Vandoeuvre les Nancy
| | - Austin G Kulasekararaj
- King's College Hospital-NHS Foundation Trust, NIHR/Wellcome King's Clinical Research Facility, London, UK and King's College London
| | | | | | | | | | - Morag Griffin
- Saint James, Leeds teaching Hospitals NHS trust, Leeds
| | | | | | - Yves Bertrand
- Institut d'Hematologie et d'Oncologie Pediatrique, Debrousse Hospital, Lyon
| | - Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre Riyadh
| | - Paola Corti
- Clinica Pediatrica Università degli Studi Milano Bicocca, San Gerardo Hospital, Monza
| | | | - Bruno Lioure
- Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg
| | | | | | | | - Depei Wu
- First Affiliated Hospital of Soochow University, Suzhou
| | | | | | - John A Snowden
- Sheffield Blood and Marrow Transplant and Cellular Therapy Program, Department of Hematology, Sheffield Teaching Hospitals NHS Trust, Sheffield
| | | | | | - Régis Peffault De Latour
- Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France and French Reference Center for Aplastic Anemia.
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Juneja HS, Lee S, Gardner FH. Human long-term bone marrow cultures in aplastic anemia. INTERNATIONAL JOURNAL OF CELL CLONING 1989; 7:129-35. [PMID: 2723464 DOI: 10.1002/stem.5530070207] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Long-term bone marrow cultures (LTMC) were initiated with marrow from five normal subjects and eight patients with aplastic anemia (AA). Near confluent to confluent adherent layers developed in all cultures from normal subjects and AA patients. When present, the 'cobblestone' areas in LTMC from AA subjects were smaller than those observed in the LTMC from normal subjects. The decline in total and viable cell numbers in the LTMC was similar for both normal subjects and AA patients. Granulocyte-macrophage colony-forming units (CFU-gm) were present in nonadherent cells (NAC) from normal LTMC for a mean of 5.2 weeks. CFU-gm were present in the NAC of only two of the eight AA cultures for one week. The absent or small 'cobblestone' areas and the absence of CFU-gm production in AA-LTMC suggest a decrease in the reproductive potential of adherent hematopoietic stem cells, which may be the result of either an abnormal hematopoietic stem cell or an abnormal stromal microenvironment or both.
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Affiliation(s)
- H S Juneja
- Mary Jean Kempner Thorne Pryce-Jones Memorial Laboratory for Hematologic Research, Department of Internal Medicine, University of Texas Medical Branch, Galveston 77550
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