1
|
Partanen A, Turunen A, Kuittinen O, Kuitunen H, Mäntymaa P, Varmavuo V, Jantunen E. Predictive Factors for Early Immune Recovery in NHL Patients after Autologous Transplantation: A Multicenter Prospective Study. Cancers (Basel) 2024; 16:2550. [PMID: 39061190 PMCID: PMC11274808 DOI: 10.3390/cancers16142550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Early lymphocyte recovery as manifested by an absolute lymphocyte count at d+15 (ALC-15) ≥ 0.5 × 109/L after autologous hematopoietic stem cell transplantation (AHCT) has been associated with a better outcome. This prospective multicenter study aimed to clarify factors associated with ALC-15 ≥ 0.5 × 109/L after AHCT among 178 patients with non-Hodgkin lymphoma. The mobilization capacity, as manifested by peak blood CD34+ cell numbers > 45 × 106/L correlated with higher ALC-15 levels (p = 0.020). In addition, the amount of CD3+CD4+ T cells > 31.8 × 106/kg in the infused graft predicted ALC-15 ≥ 0.5 × 109/L (p < 0.001). Also, the number of infused graft CD3+CD8+ T cells > 28.8 × 106/kg (p = 0.017) and NK cells > 4.4 × 106/kg was linked with higher ALC-15 (p < 0.001). The two-year progression-free survival after AHCT was significantly better in patients with ALC-15 ≥ 0.5 × 109/L (74 vs. 57%, p = 0.027). The five-year OS in patients with higher ALC-15 was 78% vs. 60% in those with lower ALC-15 (p = 0.136). To conclude, the mobilization capacity of CD34+ cells and detailed measures of graft cellular content mark prognostic tools that predict ALC-15 ≥ 0.5 × 109/L, which is associated with a better outcome in NHL patients after AHCT.
Collapse
Affiliation(s)
- Anu Partanen
- Department of Medicine, Kuopio University Hospital, 70290 Kuopio, Finland; (A.T.); (E.J.)
| | - Antti Turunen
- Department of Medicine, Kuopio University Hospital, 70290 Kuopio, Finland; (A.T.); (E.J.)
| | - Outi Kuittinen
- Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
- Department of Oncology, Kuopio University Hospital, 70290 Kuopio, Finland
| | - Hanne Kuitunen
- Cancer Center, Oulu University Hospital, 90220 Oulu, Finland;
| | | | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, 48210 Kotka, Finland;
| | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, 70290 Kuopio, Finland; (A.T.); (E.J.)
- Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland;
| |
Collapse
|
2
|
Karlova Zubata I, Smetanova Brozova J, Karel T, Bacova B, Novak J. High pre-transplant Mucosal Associated Invariant T Cell (MAIT) count predicts favorable course of myeloid aplasia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:139-146. [PMID: 36896825 DOI: 10.5507/bp.2023.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
AIMS Mucosal Associated Invariant T (MAIT) cells are unconventional T cells with anti-infective potential. MAIT cells detect and fight against microbes on mucosal surfaces and in peripheral tissues. Previous works suggested that MAIT cells survive exposure to cytotoxic drugs in these locations. We sought to determine if they maintain their anti-infective functions after myeloablative chemotherapy. METHODS We correlated the amount of MAIT cells (measured by flow cytometry) in the peripheral blood of 100 adult patients before the start of myeloablative conditioning plus autologous stem cell transplantation with the clinical and laboratory outcomes of aplasia. RESULTS The amount of MAIT cells negatively correlated with peak C-reactive protein level and the amount of red blood cell transfusion units resulting in earlier discharge of patients with the highest amount of MAIT cells. CONCLUSION This work suggests the anti-infectious potential of MAIT cells is maintained during myeloid aplasia.
Collapse
Affiliation(s)
| | - Jitka Smetanova Brozova
- Central Laboratories of the Faculty Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague 10, Czech Republic
| | - Tomas Karel
- Department of Statistics and Probability, Faculty of Informatics and Statistics, University of Economics and Business in Prague, Namesti W. Churchilla 1938/4, 130 67, Prague 3, Czech Republic
| | - Barbora Bacova
- Central Laboratories of the Faculty Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague 10, Czech Republic
- Department of Immunology, 3rd Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic
| | - Jan Novak
- Department of Haematology, 3
- Department of Immunology, 3rd Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic
| |
Collapse
|
3
|
Jantunen E, Varmavuo V, Pelkonen J, Valtola J. Importance of early immune recovery after autologous hematopoietic cell transplantation in lymphoma patients. Leuk Lymphoma 2019; 60:2115-2121. [PMID: 30843749 DOI: 10.1080/10428194.2019.1581929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lymphomas constitute the second most common indication for autologous hematopoietic cell transplantation (AHCT). Graft infusion is followed by a rapid hematological recovery and slower immune recovery. The number of natural killer cells and CD3+ T lymphocytes achieve normal counts usually within a month, whereas the recovery of CD3+CD4+ T lymphocytes is much slower. Early immune recovery is usually defined as the absolute lymphocyte count (ALC) ≥0.5 × 109/L, which has been associated with improved progression-free and even overall survival. Several factors have been associated with early immune recovery, including higher infused lymphocyte and CD34+ cell doses, both of which are affected by the choice of mobilization. This review summarizes the clinical importance of early immune recovery for long-term success of AHCT in lymphomas. Factors known to affect early immune recovery are discussed and suggestions made how to improve mobilization and collection processes to optimize immune recovery and post-transplant outcomes.
Collapse
Affiliation(s)
- Esa Jantunen
- Insitute of Clinical Medicine/Internal Medicine, University of Eastern Finland , Kuopio , Finland.,Department of Medicine, Kuopio University Hospital , Kuopio , Finland.,Siunsote - North Carelia Hospital District , Joensuu , Finland
| | - Ville Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital , Kotka , Finland
| | - Jukka Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland , Kuopio , Finland.,Laboratory Centre of Eastern Finland, Kuopio , Kuopio , Finland
| | - Jaakko Valtola
- Department of Medicine, Kuopio University Hospital , Kuopio , Finland
| |
Collapse
|
4
|
Autologous Graft-versus-Tumor Effect: Reality or Fiction? Adv Hematol 2016; 2016:5385972. [PMID: 27635143 PMCID: PMC5011204 DOI: 10.1155/2016/5385972] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022] Open
Abstract
In contrast to allogeneic hematopoietic stem cell transplantation, the current dogma is not an evidence of graft-versus-tumor effect in autologous hematopoietic stem cell transplantation; thus, it is assumed that autologous hematopoietic stem cell transplantation only relies on the high-dose chemotherapy to improve clinical outcomes. However, recent studies argue in favor of the existence of an autologous graft-versus-tumor without the detrimental complications of graft-versus-host disease due to the nonspecific immune response from the infused donor alloreactive immune effector cells in allogeneic hematopoietic stem cell transplantation. Herein, this paper reviews the clinical evidence of an autologous graft-versus-tumor effect based on the autograft collected and infused host immune effector cells and host immunity recovery after autologous hematopoietic stem cell transplantation affecting clinical outcomes in cancer patients.
Collapse
|
5
|
Oliansky DM, Larson RA, Weisdorf D, Dillon H, Ratko TA, Wall D, McCarthy PL, Hahn T. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of adult acute lymphoblastic leukemia: update of the 2006 evidence-based review. Biol Blood Marrow Transplant 2011; 17:20-47.e30. [PMID: 20656046 DOI: 10.1016/j.bbmt.2010.07.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/13/2010] [Indexed: 11/29/2022]
Abstract
Clinical research published since the first evidence-based review on the role of hematopoietic stem cell transplantation (SCT) in the treatment of acute lymphoblastic leukemia (ALL) in adults is presented and critically evaluated in this update. Treatment recommendations changed or modified based on new evidence include: (1) myeloablative allogeneic SCT is an appropriate treatment for adult (<35 years) ALL in first complete remission for all disease risk groups; and (2) reduced-intensity conditioning may produce similar outcomes to myeloablative regimens. Treatment recommendations unchanged or strengthened by new evidence include: (1) allogeneic SCT is recommended over chemotherapy for ALL in second complete remission or greater; (2) allogeneic is superior to autologous SCT; and (3) there are similar survival outcomes after related and unrelated allogeneic SCT. New treatment recommendations based on new evidence include: (1) in the absence of a suitable allogeneic donor, autologous SCT may be an appropriate therapy, but results in a high relapse rate; (2) it is appropriate to consider cord blood transplantation for patients with no HLA well-matched donor; and (3) imatinib therapy before and/or after SCT (for Ph+ ALL) yields significantly superior survival outcomes. Areas of needed research in the treatment of adult ALL with SCT were identified and presented in the review.
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Hematopoietic stem-cell transplantation is an effective treatment option for follicular lymphoma. This review summarizes recent updates of the literature focusing on the available long-term follow-up of high-dose therapeutic approaches. RECENT FINDINGS Autologous transplantation can prolong overall survival in relapsed disease and can extend progression-free survival in first remission. With more than 10 years of follow-up, the survival curves demonstrate a plateau indicating a potential cure in certain patients. Use of allogeneic transplantation may result in cure as well, but has been plagued by high treatment-related mortality rates when myeloablative conditioning is used. The decreased toxicity of reduced-intensity conditioning is more applicable to the older follicular lymphoma population, but long-term follow-up data are lacking. SUMMARY For selected patients, both autologous and allogeneic transplantation offer the possibility of prolonged survival and can result in a cure in up to 25-45% of cases. It is unclear whether to incorporate monoclonal antibody or radioimmunoconjugate therapy. Stem-cell transplantation should at least be considered in patients younger than 60 years, possibly early in the disease course. Late consequences such as an increased risk of second malignancy may compromise this approach and close patient follow-up is essential.
Collapse
|
7
|
Bensinger W, DiPersio JF, McCarty JM. Improving stem cell mobilization strategies: future directions. Bone Marrow Transplant 2009; 43:181-95. [DOI: 10.1038/bmt.2008.410] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
8
|
Atta EH, de Azevedo AM, Maiolino A, Coelho CJBP, Sarcinelli SMP, de Alvarenga Máximo C, Marra VLN. High CD8+ lymphocyte dose in the autograft predicts early absolute lymphocyte count recovery after peripheral hematopoietic stem cell transplantation. Am J Hematol 2009; 84:21-8. [PMID: 19006229 DOI: 10.1002/ajh.21314] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Early lymphocyte recovery (ELR) after autologous peripheral hematopoietic stem cell transplantation (ASCT) is an independent predictor for survival in patients with hematological and non-hematological cancers. Sixty-five ASCT for hematological cancers were retrospectively analyzed to identify the factors associated with ELR and to assess the impact of different mobilization regimens on the pre-collection absolute lymphocyte count (ALC). The CD8+ lymphocyte dose in the autograft and the pre-mobilization ALC were independently associated with ELR (P < 0.001 and P = 0.008, respectively). CD8+ lymphocyte doses higher than 0.1 x 10(9)/kg were strongly associated with ELR [P < 0.001, odds ratio 25.22, 95% confidence interval (CI) 4.98-127.69] and this cutoff may be used to predict ELR (P = 0.001, area under the curve 0.75, 95% CI 0.62-0.88). Mobilization with granulocyte colony-stimulating factor (G-CSF) alone, the pre-collection ALC and the number of apheresis sessions were independently associated with the CD8+ lymphocyte dose (P = 0.04, P = 0.001, and P < 0.001, respectively). The number of aphereses was the variable with the strongest correlation to the CD8+ lymphocyte dose (r(s) = 0.68, P < 0.001). Median pre-mobilization ALC was higher than pre-collection ALC in the subgroup of patients without ELR mobilized with chemotherapy followed by G-CSF (1090 vs. 758 lymphocytes/microL; P < 0.001). This reduction was not significant in the subgroup with ELR mobilized with chemotherapy plus G-CSF (1920 vs. 1539/microL, respectively; P = 0.23). These results suggest that the CD8+ lymphocyte dose in the autograft is critical for ELR after ASCT and also demonstrates that mobilization with chemotherapy followed by G-CSF significantly decreases the pre-collection ALC, especially in patients with low pre-mobilization ALC.
Collapse
Affiliation(s)
- Elias Hallack Atta
- Hematopoietic Stem Cell Transplantation Program, Hemorio, Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | | |
Collapse
|
9
|
Hiwase D, Hiwase S, Bailey M, Bollard G, Schwarer A. The role of stem cell mobilization regimen on lymphocyte collection yield in patients with multiple myeloma. Cytotherapy 2008; 10:507-17. [DOI: 10.1080/14653240802165665] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Kim MK, Kim S, Lee SS, Sym SJ, Lee DH, Kim SW, Jang S, Park CJ, Chi HS, Huh J, Suh C. Rituximab-ESHAP as a mobilization regimen for relapsed or refractory B-cell lymphomas: a comparison with ESHAP. Transfusion 2007; 47:1447-54. [PMID: 17655589 DOI: 10.1111/j.1537-2995.2007.01285.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has previously been shown that ESHAP was an effective mobilization regimen for patients with pretreated lymphoma. To extend these observations, the efficacy and feasibility of rituximab plus ESHAP regimen in CD20+ B-cell NHL were assessed. STUDY DESIGN AND METHODS The mobilization efficacy and engraftment characteristics were compared in the 22 patients who received the rituximab plus ESHAP (R-ESHAP) with 33 historical controls who received ESHAP. RESULTS The two treatment groups were well matched in patient characteristics. In the R-ESHAP group, 62 pheresis procedures were performed. Apheresis procedures were started on median Day 16 (range, Days 13-18). The median number of collected CD34+ cells was 10.6 x 10(6) per kg (range, 4.9 x 10(6)-52.6 x 10(6)/kg). Nineteen (95%) patients achieved optimal peripheral blood hematopoietic progenitor cell (PBPC) collection, defined as at least 5 x 10(6) CD34+ cells per kg. There were no significant differences between the two groups with respect to mobilization efficacy. Sixteen patients in the R-ESHAP group (73%) underwent autologous peripheral blood progenitor cell transplantation (APBPCT). The median time to absolute neutrophil count at least 0.5 x 10(9) per L was 10 days (range, 8-17 days), and the median time to a platelet count of at least 20 x 10(9) per L was 12 days (range, 7-27 days). Lymphocyte recovery was slower in the R-ESHAP group, but the rate of infectious complications was similar in the two groups. In the R-ESHAP group, the 2-year overall survival and progression-free survival after APBPCT were 63.2 and 57.4 percent, respectively. CONCLUSION Addition of rituximab to ESHAP chemotherapy did not have any adverse effects on PBPC mobilization. Further studies are needed, however, to determine whether addition of rituximab improves outcomes.
Collapse
Affiliation(s)
- Min Kyoung Kim
- Department of Internal Medicine, Diagnostic Laboratory Medicine, and Pathology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2-dong, Songpa-gu, Seoul 138-796, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Rudin CE, Melhuish J, Hall J. Failure of the addition of methylprednisolone to intermediate-dose cyclophosphamide and lenograstim for stem cell mobilization to make the timing of PBSC harvesting more predictable. Bone Marrow Transplant 2007; 40:293-4. [PMID: 17529998 DOI: 10.1038/sj.bmt.1705717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
12
|
Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|