1
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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.
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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;
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2
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Ruder J, Docampo MJ, Rex J, Obahor S, Naghavian R, Müller AM, Schanz U, Jelcic I, Martin R. Dynamics of T cell repertoire renewal following autologous hematopoietic stem cell transplantation in multiple sclerosis. Sci Transl Med 2022; 14:eabq1693. [DOI: 10.1126/scitranslmed.abq1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Autologous hematopoietic stem cell transplantation (aHSCT) is a highly effective treatment of multiple sclerosis (MS). It depletes autoreactive cells and subsequently renews adaptive immune cells. The possible proinflammatory potential of surviving T cells early after aHSCT has not been studied. Here, we examined the dynamics of new and surviving T cells in 27 patients after aHSCT by multidimensional flow cytometry, T cell receptor (TCR) sequencing, specificity testing, telomere length profiling, and HLA genotyping. Early after aHSCT, naïve T cells are barely detectable, whereas effector memory (EM) T cells quickly reconstitute to pre-aHSCT values. EM CD4+T cells early after aHSCT have shorter telomeres, have higher expression of senescence and exhaustion markers, and proliferate less than those before aHSCT. We find a median TCR repertoire overlap of 26% between the early post-aHSCT EM CD4+T cells and pre-aHSCT, indicating persistence of EM CD4+T cells early after transplantation. The EM CD4+TCR repertoire overlap declines to 15% at 12 months after aHSCT, whereas the naïve TCR repertoire entirely renews. HLA-DR–associated EM CD4+T cell reactivity toward MS-related antigens decreased after aHSCT, whereas reactivity toward EBV increased. Our data show substantial survival of pre-aHSCT EM CD4+T cells early after transplantation but complete renewal of the T cell repertoire by nascent T cells later.
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Affiliation(s)
- Josefine Ruder
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - María José Docampo
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jordan Rex
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Simon Obahor
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Reza Naghavian
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Antonia M.S. Müller
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Urs Schanz
- Department of Medical Oncology and Hematology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section (NIMS), Department of Neurology, University and University Hospital Zurich, 8091 Zurich, Switzerland
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3
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Optimizing leukapheresis product yield and purity for blood cell-based gene and immune effector cell therapy. Curr Opin Hematol 2021; 27:415-422. [PMID: 32889828 DOI: 10.1097/moh.0000000000000611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW A critical common step for blood-based ex-vivo gene and immune effector cell (IEC) therapies is the collection of target cells for further processing and manufacturing, often accomplished through a leukapheresis procedure to collect mononuclear cells (MNCs). The purpose of this review is to describe strategies to optimize the apheresis product cell yield and purity for gene and IEC therapies. Relevant data from the conventional bone marrow transplant literature is described where applicable. RECENT FINDINGS Product yield is affected by three main factors: the peripheral blood concentration of the target cell, optimized by mobilizing agents, donor interventions or donor selection; the volume of peripheral blood processed, tailored to the desired product yield using prediction algorithms; and target cell collection efficiency, optimized by a variety of device and donor-specific considerations. Factors affecting product purity include characteristics of the donor, mobilizing agent, device, and device settings. SUMMARY Strategies to optimize product yield and purity for gene and IEC therapies are important to consider because of loss of target cell numbers or function with downstream steps and detrimental effects of nontarget cells on further manufacturing and patient outcome.
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4
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Tang C, Espin-Garcia O, Prica A, Kurkreti V, Kridel R, Keating A, Patriquin CJ, Kuruvilla J, Crump M. Efficacy and safety of stem cell mobilization following gemcitabine, dexamethasone, cisplatin (GDP) salvage chemotherapy in patients with relapsed or refractory lymphoma. Leuk Lymphoma 2020; 61:2153-2160. [PMID: 32482114 DOI: 10.1080/10428194.2020.1762882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplant (ASCT) remains a cornerstone of treatment in relapsed/refractory (R/R) aggressive-histology lymphomas. This retrospective study examined efficacy and safety of peripheral blood stem cell (PBSC) mobilization using cyclophosphamide/etoposide and GCSF (CE + GCSF, n = 129) versus gemcitabine, dexamethasone and cisplatin and GCSF (GDP + GCSF, n = 210). All patients received first salvage with GDP. Patients mobilized with CE + GCSF required fewer days of leukapheresis (median 1 vs 2 day; p = .001) and achieved higher total CD34+ yield than GDP + GCSF patients (8.5 vs 7.1 × 106 CD34+ cells/kg, p = .001). Rates of febrile neutropenia and CD34+ collection ≥5 × 106 CD34+ cells/kg were similar (OR 1.19, 95% CI: 0.54-2.6, p = .66). In multivariable analysis, days to engraftment and admission duration were not statistically different between the two mobilization strategies. While CE + GCSF appeared more efficacious for mobilization after GDP salvage, this did not translate to significant differences in clinical outcomes.
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Affiliation(s)
- Catherine Tang
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Anca Prica
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Vishal Kurkreti
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Kridel
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Armand Keating
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Christopher J Patriquin
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada.,Toronto General Hospital, Toronto, Canada
| | - John Kuruvilla
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Michael Crump
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
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5
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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.
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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
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6
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Valtola J, Silvennoinen R, Ropponen A, Siitonen T, Säily M, Sankelo M, Putkonen M, Partanen A, Pyörälä M, Savolainen ER, Mäntymaa P, Pelkonen J, Jantunen E, Varmavuo V. Blood graft composition and post-transplant recovery in myeloma patients mobilized with plerixafor: a prospective multicenter study. Leuk Lymphoma 2018; 60:453-461. [PMID: 30160591 DOI: 10.1080/10428194.2018.1485911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The composition of autologous blood grafts after cryopreservation, post-transplant hematological recovery up to 1 year and immune recovery up to 6 months as well as outcome was analyzed in 87 patients with multiple myeloma (MM). The patients receiving added plerixafor due to poor mobilization (11%) were compared to those mobilized with G-CSF or cyclophosphamide (CY) plus G-CSF. The use of plerixafor was found to significantly affect the graft composition as there was a significantly higher proportion of the more primitive CD34+ cells, higher number of T and B lymphocytes as well as NK cells in the grafts of patients who received also plerixafor. The hematological recovery after auto-SCT was comparable between the groups. The recovery of CD3+CD4+ T cells was faster in plerixafor mobilized patients at 1 and 3 months post-transplant. There were no significant differences in progression-free (PFS) or overall survival (OS) according to the plerixafor use.
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Affiliation(s)
- Jaakko Valtola
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Raija Silvennoinen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland.,b Division of Hematology , Comprehensive Cancer Center Helsinki University Hospital , Helsinki , Finland
| | - Antti Ropponen
- c Department of Clinical Microbiology , University of Eastern Finland , Kuopio , Finland
| | - Timo Siitonen
- d Department of Medicine , Oulu University Hospital , Oulu , Finland
| | - Marjaana Säily
- d Department of Medicine , Oulu University Hospital , Oulu , Finland
| | - Marja Sankelo
- e Department of Internal Medicine , Tampere University Hospital , Tampere , Finland
| | - Mervi Putkonen
- f Department of Medicine , Turku University Hospital , Turku , Finland
| | - Anu Partanen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Marja Pyörälä
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland
| | - Eeva-Riitta Savolainen
- g Nordlab Oulu, Medical Research Center Oulu , Oulu University Hospital University of Oulu , Oulu , Finland
| | | | - Jukka Pelkonen
- c Department of Clinical Microbiology , University of Eastern Finland , Kuopio , Finland.,h Laboratory Centre of Eastern Finland , Kuopio , Finland
| | - Esa Jantunen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland.,i Institute of Clinical Medicine , University of Eastern Finland , Kuopio , Finland.,j Siunsote, Central Hospital of North Karelia , Joensuu , Finland
| | - Ville Varmavuo
- k Department of Medicine , Kymenlaakso Central Hospital , Kotka , Finland
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7
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Visram A, Bredeson C, Allan D, Sabloff M, Huebsch L, Tay J, Kekre N, McDiarmid S, Mallick R, Tinmouth A, Martin L, Hamelin L, Maze D. Long-term graft function following autologous hematopoietic cell transplantation and the impact of preemptive plerixafor in predicted poor mobilizers. Blood Cancer J 2018; 8:14. [PMID: 29379014 PMCID: PMC5802447 DOI: 10.1038/s41408-018-0050-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alissa Visram
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada
| | | | - David Allan
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada
| | | | - Lothar Huebsch
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada
| | - Jason Tay
- Department of Medicine, Calgary, Canada
| | - Natasha Kekre
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada
| | | | - Ranjeeta Mallick
- Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Alan Tinmouth
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada
| | - Lisa Martin
- Canadian Blood Services Stem Cell Processing Laboratory, Ottawa, Canada
| | - Linda Hamelin
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada
| | - Dawn Maze
- Department of Hematology, The Ottawa Hospital, Ottawa, Canada.
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8
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Partanen A, Valtola J, Ropponen A, Vasala K, Penttilä K, Ågren L, Pyörälä M, Nousiainen T, Selander T, Mäntymaa P, Pelkonen J, Varmavuo V, Jantunen E. Preemptive plerixafor injection added to pegfilgrastim after chemotherapy in non-Hodgkin lymphoma patients mobilizing poorly. Ann Hematol 2017; 96:1897-1906. [PMID: 28879595 DOI: 10.1007/s00277-017-3123-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/27/2017] [Indexed: 12/15/2022]
Abstract
Filgrastim is usually combined with chemotherapy to mobilize hematopoietic progenitor cells in non-Hodgkin lymphoma (NHL) patients. Limited information is available on the efficacy of a preemptive plerixafor (PLER) injection in poor mobilizers after chemotherapy and pegfilgrastim. In this prospective study, 72 patients with NHL received chemotherapy plus pegfilgrastim, and 25 hard-to-mobilize patients received also PLER. The usefulness and efficacy of our previously developed algorithm for PLER use in pegfilgrastim-containing mobilization regimen were evaluated as well as the graft cellular composition, hematological recovery, and outcome after autologous stem cell transplantation (auto-SCT) according to the PLER use. A median 3.4-fold increase in blood CD34+ cell counts was achieved after the first PLER dose. The minimum collection target was achieved in the first mobilization attempt in 66/72 patients (92%) and 68 patients (94%) proceeded to auto-SCT. An algorithm for PLER use was fulfilled in 76% of the poor mobilizers. Absolute numbers of T-lymphocytes and NK cells were significantly higher in the PLER group, whereas the number of CD34+ cells collected was significantly lower. Early neutrophil engraftment was slower in the PLER group, otherwise hematological recovery was comparable within 12 months from auto-SCT. No difference was observed in survival according to the PLER use. Chemotherapy plus pegfilgrastim combined with preemptive PLER injection is an effective and convenient approach to minimize collection failures in NHL patients intended for auto-SCT. A significant effect of PLER on the graft cellular composition was observed, but no difference in outcome after auto-SCT was detected.
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Affiliation(s)
- A Partanen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland.
| | - J Valtola
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - A Ropponen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
| | - K Vasala
- Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - K Penttilä
- Department of Medicine, Central Hospital of Savonlinna, Savonlinna, Finland
- The Finnish Medicines Agency, Kuopio, Finland
| | - L Ågren
- Department of Medicine, North Karelia Central Hospital, Joensuu, Finland
| | - M Pyörälä
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Nousiainen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
| | - T Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - P Mäntymaa
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - J Pelkonen
- Department of Clinical Microbiology, University of Eastern Finland, Kuopio, Finland
- Laboratory Center of Eastern Finland, Kuopio, Finland
| | - V Varmavuo
- Department of Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - E Jantunen
- Department of Medicine, Kuopio University Hospital, P.O.B. 100, 70029 KYS, Kuopio, Finland
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9
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Worel N, Frank N, Frech C, Fritsch G. Influence of plerixafor on the mobilization of CD34+ cell subpopulations and lymphocyte subtypes. Transfusion 2017; 57:2206-2215. [DOI: 10.1111/trf.14182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/15/2017] [Accepted: 04/25/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine; Medical University Vienna
| | - Nelli Frank
- Children's Cancer Research Institute; Vienna Austria
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10
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Mobilization of allogeneic peripheral blood stem cell donors with intravenous plerixafor mobilizes a unique graft. Blood 2017; 129:2680-2692. [PMID: 28292947 DOI: 10.1182/blood-2016-09-739722] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/02/2017] [Indexed: 12/22/2022] Open
Abstract
A single subcutaneous (SC) injection of plerixafor results in rapid mobilization of hematopoietic progenitors, but fails to mobilize 33% of normal allogeneic sibling donors in 1 apheresis. We hypothesized that changing the route of administration of plerixafor from SC to IV may overcome the low stem cell yields and allow collection in 1 day. A phase 1 trial followed by a phase 2 efficacy trial was conducted in allogeneic sibling donors. The optimal dose of IV plerixafor was determined to be 0.32 mg/kg. The primary outcome of reducing the failure to collect ≥2 × 106 CD34+/kg recipient weight in 1 apheresis collection to ≤10% was not reached. The failure rate was 34%. Studies evaluating the stem cell phenotype and gene expression revealed a novel plasmacytoid dendritic cell precursor preferentially mobilized by plerixafor with high interferon-α producing ability. The observed cytomegalovirus (CMV) viremia rate for patients at risk was low (15%), as were the rates of acute grade 2-4 graft-versus-host disease (GVHD) (21%). Day 100 treatment related mortality was low (3%). In conclusion, plerixafor results in rapid stem cell mobilization regardless of route of administration and resulted in novel cellular composition of the graft and favorable recipient outcomes. These trials were registered at clinicaltrials.gov as #NCT00241358 and #NCT00914849.
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11
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Worel N, Fritsch G, Agis H, Böhm A, Engelich G, Leitner GC, Geissler K, Gleixner K, Kalhs P, Buxhofer-Ausch V, Keil F, Kopetzky G, Mayr V, Rabitsch W, Reisner R, Rosskopf K, Ruckser R, Zoghlami C, Zojer N, Greinix HT. Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure. J Clin Apher 2016; 32:224-234. [PMID: 27578390 DOI: 10.1002/jca.21496] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 12/30/2022]
Abstract
Plerixafor in combination with granulocyte-colony stimulating factor (G-CSF) is approved for autologous stem cell mobilization in poor mobilizing patients with multiple myeloma or malignant lymphoma. The purpose of this study was to evaluate efficacy and safety of plerixafor in an immediate rescue approach, administrated subsequently to G-CSF alone or chemotherapy and G-CSF in patients at risk for mobilization failure. Eighty-five patients mobilized with G-CSF alone or chemotherapy were included. Primary endpoint was the efficacy of the immediate rescue approach of plerixafor to achieve ≥2.0 × 106 CD34+ cells/kg for a single or ≥5 × 106 CD34+ cells/kg for a double transplantation and potential differences between G-CSF and chemotherapy-based mobilization. Secondary objectives included comparison of stem cell graft composition including CD34+ cell and lymphocyte subsets with regard to the mobilization regimen applied. No significant adverse events were recorded. A median 3.9-fold increase in CD34+ cells following plerixafor was observed, resulting in 97% patients achieving at least ≥2 × 106 CD34+ cells/kg. Significantly more differentiated granulocyte and monocyte forming myeloid progenitors were collected after chemomobilization whereas more CD19+ and natural killer cells were collected after G-CSF. Fifty-two patients underwent transplantation showing rapid and durable engraftment, irrespectively of the stem cell mobilization regimen used. The addition of plerixafor in an immediate rescue model is efficient and safe after both, G-CSF and chemomobilization and results in extremely high success rates. Whether the differences in graft composition have a clinical impact on engraftment kinetics, immunologic recovery, and graft durability have to be analysed in larger prospective studies.
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Affiliation(s)
- Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Fritsch
- Children?s Cancer Research Institute (CCRI), St. Anna Kinderkrebsforschung, Vienna, Austria
| | - Hermine Agis
- Medical Department I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Böhm
- First Medical Department, Elisabethinen Hospital, Linz, Austria
| | - Georg Engelich
- First Medical Department, Hospital Wiener Neustadt, Austria
| | - Gerda C Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Klaus Geissler
- Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria
| | - Karoline Gleixner
- Medical Department I, Division of Haematology, Medical University of Vienna, Vienna, Austria
| | - Peter Kalhs
- Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria
| | | | - Felix Keil
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Viktor Mayr
- Medical Department II, Hospital Krems, Austria
| | - Werner Rabitsch
- Medical Department I, Bone Marrow Transplantation Unit, Medical University Vienna, Vienna, Austria
| | - Regina Reisner
- Third Medical Department, Hanusch Hospital, Vienna, Austria
| | - Konrad Rosskopf
- Department of Blood Group Serology, Medical University Graz, Graz, Austria
| | - Reinhard Ruckser
- Medical Department II, Division of Oncology, Donauhospital Vienna, Vienna, Austria
| | - Claudia Zoghlami
- Department of Internal Medicine V, Hospital Hietzing, Vienna, Austria
| | - Niklas Zojer
- Department of Internal Medicine I, Wilhelminen Hospital, Vienna, Austria
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12
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Jantunen E, Varmavuo V, Valtola J. Plerixafor injection: a hematopoietic stem cell mobilizer in non-Hodgkin lymphoma and multiple myeloma. Expert Rev Hematol 2016; 9:723-32. [DOI: 10.1080/17474086.2016.1208082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Psatha N, Karponi G, Yannaki E. Optimizing autologous cell grafts to improve stem cell gene therapy. Exp Hematol 2016; 44:528-39. [PMID: 27106799 DOI: 10.1016/j.exphem.2016.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
Over the past decade, stem cell gene therapy has achieved unprecedented curative outcomes for several genetic disorders. Despite the unequivocal success, clinical gene therapy still faces challenges. Genetically engineered hematopoietic stem cells are particularly vulnerable to attenuation of their repopulating capacity once exposed to culture conditions, ultimately leading to low engraftment levels posttransplant. This becomes of particular importance when transduction rates are low or/and competitive transplant conditions are generated by reduced-intensity conditioning in the absence of a selective advantage of the transduced over the unmodified cells. These limitations could partially be overcome by introducing megadoses of genetically modified CD34(+) cells into conditioned patients or by transplanting hematopoietic stem cells hematopoietic stem cells with high engrafting and repopulating potential. On the basis of the lessons gained from cord blood transplantation, we summarize the most promising approaches to date of increasing either the numbers of hematopoietic stem cells for transplantation or/and their engraftability, as a platform toward the optimization of engineered stem cell grafts.
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Affiliation(s)
- Nikoletta Psatha
- Gene and Cell Therapy Center, Hematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece; Department of Medicine, University of Washington, Seattle, WA
| | - Garyfalia Karponi
- Gene and Cell Therapy Center, Hematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Gene and Cell Therapy Center, Hematology Department-BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece; Department of Medicine, University of Washington, Seattle, WA.
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14
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Multi-color immune-phenotyping of CD34 subsets reveals unexpected differences between various stem cell sources. Bone Marrow Transplant 2016; 51:1093-100. [PMID: 27042837 DOI: 10.1038/bmt.2016.88] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 12/23/2022]
Abstract
Flow cytometric routine CD34 analysis enumerates hematopoietic stem and progenitor cells irrespective of their subpopulations although this might predict engraftment dynamics and immune reconstitution. We established a multi-color CD34 assay containing CD133, CD45RA, CD10, CD38 and CD33. We examined PBSC, donor bone marrow (BMd) and BM of patients 1 year after allografting (BM1y) regarding their CD34 subset composition, which differed significantly amongst those materials: the early CD45RA(-)CD133(+)CD38(low) subpopulations were significantly more frequent in PBSC than in BMd, and very low in BM1y. Vice versa, clearly more committed CD34 stages prevailed in BM, particularly in BM1y where the proportion of multi-lymphoid and CD38(++) B-lymphoid precursors was highest (mean 59%). CD33 was expressed at different intensity on CD45RA(±)CD133(±) subsets allowing discrimination of earlier from more committed myeloid precursors. Compared with conventional CD34(+) cell enumeration, the presented multi-color phenotyping is a qualitative approach defining different CD34 subtypes in any CD34 source. Its potential impact to predict engraftment kinetics and immune reconstitution has to be evaluated in future studies.
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15
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Yuan S, Palmer JM, Tsai NC, Dagis A, Nademanee A, Wang S. Engraftment and outcomes following autologous stem cell transplantation in Hodgkin lymphoma patients mobilized with plerixafor. Hematol Oncol 2016; 35:281-287. [DOI: 10.1002/hon.2286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/05/2016] [Accepted: 01/28/2016] [Indexed: 01/15/2023]
Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte CA USA
| | - Joycelynne M. Palmer
- Division of Biostatistics, Department of Information Sciences; City of Hope National Medical Center; Duarte CA USA
| | - Ni-Chun Tsai
- Division of Biostatistics, Department of Information Sciences; City of Hope National Medical Center; Duarte CA USA
| | - Andrew Dagis
- Division of Biostatistics, Department of Information Sciences; City of Hope National Medical Center; Duarte CA USA
| | - Auayporn Nademanee
- Department of Hematology; City of Hope National Medical Center; Duarte CA USA
| | - Shirong Wang
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine; City of Hope National Medical Center; Duarte CA USA
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16
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Valtola J, Varmavuo V, Ropponen A, Selander T, Kuittinen O, Kuitunen H, Keskinen L, Vasala K, Nousiainen T, Mäntymaa P, Pelkonen J, Jantunen E. Early immune recovery after autologous transplantation in non-Hodgkin lymphoma patients: predictive factors and clinical significance. Leuk Lymphoma 2016; 57:2025-32. [DOI: 10.3109/10428194.2015.1129537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Strobel J, Moellmer I, Zingsem J, Hauck-Dlimi B, Eckstein R, Strasser E. T-cell subsets in autologous and allogeneic peripheral blood stem cell concentrates. Vox Sang 2015; 109:375-86. [PMID: 26040970 DOI: 10.1111/vox.12289] [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: 10/20/2014] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Regulatory T cells (Tregs) and other T-cell subsets are of importance in the setting of autologous and allogeneic stem cell transplantations. We conducted a study to assess the content of peripheral blood stem cell concentrates and related apheresis parameters in the autologous and allogeneic setting. MATERIAL AND METHODS We characterized 53 donors, patients and peripheral blood stem cell concentrates (PBSC) regarding the content of CD45(+) cells, lymphocytes, CD3(+) cells, CD3(+) CD4(+) T cells, CD3(+) CD4(+) CD25(+) T cells, CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs and CD34(+) cells and calculated cell yields, recruitment factors and collection efficiency for all cell types. We compared allogeneic data with autologous data. RESULTS Autologous PBSC show significantly lower concentrations of T-cell subsets compared to allogeneic PBSC (17,112/μl CD4(+), 14,858/μl CD4(+) CD25(+) and 1579/μl CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs in autologous compared to 65,539/μl CD4(+), 44,208(+) /μl CD4(+) CD25(+) and 5040/μl CD3(+) CD4(+) CD25(+) CD127(low/negative) Tregs in allogeneic PBSC, respectively), in contrast to CD34(+) concentrations (5342/μl CD34(+) in autologous compared to 2367/μl CD34(+) in allogeneic PBSC, respectively). Accordantly, all T-cell yields are lower in the autologous setting compared to allogeneic PBSC. However, recruitment factor and collection efficiency of all cell types are higher in autologous compared to allogeneic PBSC, but not all parameters differ significantly when groups are compared. CONCLUSION T-cell subsets and especially Tregs are a substantial part of PBSC transplantation, as considerable recruitment during apheresis occurs. In large volume apheresis, the collection efficiency of Treg is comparable to that of CD34(+) cells, while recruitment factors are even higher.
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Affiliation(s)
- J Strobel
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - I Moellmer
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - J Zingsem
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - B Hauck-Dlimi
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - R Eckstein
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
| | - E Strasser
- Department of Transfusion Medicine and Hemostaseology, Friedrich-Alexander-University, Erlangen, Germany
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18
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Valtola J, Varmavuo V, Ropponen A, Nihtinen A, Partanen A, Vasala K, Lehtonen P, Penttilä K, Pyörälä M, Kuittinen T, Silvennoinen R, Nousiainen T, Pelkonen J, Mäntymaa P, Jantunen E. Blood graft cellular composition and posttransplant recovery in non-Hodgkin's lymphoma patients mobilized with or without plerixafor: a prospective comparison. Transfusion 2015; 55:2358-68. [DOI: 10.1111/trf.13170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Antti Ropponen
- Department of Clinical Microbiology; University of Eastern Finland; Kuopio Finland
| | - Anne Nihtinen
- Department of Medicine; Central Hospital of Northern Carelia; Joensuu Finland
| | - Anu Partanen
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
| | - Kaija Vasala
- Department of Oncology; Central Hospital of Central Finland; Jyväskylä Finland
| | - Päivi Lehtonen
- Department of Medicine; Central Hospital of South Carelia; Lappeenranta Finland
| | - Karri Penttilä
- Department of Medicine; Savonlinna Central Hospital; Savonlinna Finland
- Finnish Medicines Agency
| | | | | | | | | | - Jukka Pelkonen
- Department of Clinical Microbiology; University of Eastern Finland; Kuopio Finland
- Laboratory of Eastern Finland
| | | | - Esa Jantunen
- Department of Medicine; Kuopio University Hospital
- University of Eastern Finland/Clinical Medicine; Kuopio Finland
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19
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Arbez J, Saas P, Lamarthée B, Malard F, Couturier M, Mohty M, Gaugler B. Impact of donor hematopoietic cells mobilized with G-CSF and plerixafor on murine acute graft-versus-host-disease. Cytotherapy 2015; 17:948-55. [PMID: 25813681 DOI: 10.1016/j.jcyt.2015.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/13/2015] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AIMS This study aimed to characterize the immune effectors contained in the grafts from donor mice mobilized by granulocyte colony-stimulating factor (G-CSF) and plerixafor and to evaluate their impact on the development of acute graft-versus-host-disease (aGVHD). METHODS Mobilization was done with G-CSF alone or G-CSF plus plerixafor (G+P). RESULTS In grafts collected after G+P mobilization, we observed a significantly higher proportion of c-kit(+)Sca-1(+) hematopoietic stem cells compared with G-CSF. A significant increase in the percentage of plasmacytoid dendritic cells was detected in the G+P graft compared with G-CSF graft. We also studied the ability of stem cell grafts mobilized with G+P to induce GVHD in a mouse model. We observed higher mortality (P < 0.001) associated with increased aGVHD clinical score (P < 0.0001) as well as higher pathology score in the intestine of mice receiving G+P as compared with G-CSF grafts (P < 0.001). Moreover, the exacerbated aGVHD severity was associated with upregulation of CCR6 expression on both CD4(+) and CD8(+) T cells from the G+P grafts, as well as on T cells from mice transplanted with G+P grafts. CONCLUSIONS In conclusion, we showed that grafts mobilized with G+P exhibited functional features different from those mobilized with G-CSF alone, which increase the severity of aGVHD in the recipients.
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Affiliation(s)
- Jessy Arbez
- Institut de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)1098, Besançon, France; Université de Franche-Comté, Besançon, F-25000, France; Etablissement Français du Sang Bourgogne Franche-Comté, Besançon Cedex, France
| | - Philippe Saas
- Institut de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)1098, Besançon, France; Université de Franche-Comté, Besançon, F-25000, France; Etablissement Français du Sang Bourgogne Franche-Comté, Besançon Cedex, France
| | - Baptiste Lamarthée
- Institut de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)1098, Besançon, France; Université de Franche-Comté, Besançon, F-25000, France; Etablissement Français du Sang Bourgogne Franche-Comté, Besançon Cedex, France
| | - Florent Malard
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire and Université de Nantes, France; INSERM CRNCA UMR892, Nantes, France
| | - Mélanie Couturier
- Institut de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)1098, Besançon, France; Université de Franche-Comté, Besançon, F-25000, France; Etablissement Français du Sang Bourgogne Franche-Comté, Besançon Cedex, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France; INSERM UMRS938, Centre de Recherche Saint-Antoine, Paris, France
| | - Béatrice Gaugler
- Institut de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMR)1098, Besançon, France; Université de Franche-Comté, Besançon, F-25000, France; Etablissement Français du Sang Bourgogne Franche-Comté, Besançon Cedex, France.
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20
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Hequet O. Hematopoietic stem and progenitor cell harvesting: technical advances and clinical utility. J Blood Med 2015; 6:55-67. [PMID: 25733943 PMCID: PMC4340371 DOI: 10.2147/jbm.s52783] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Hematopoietic stem and progenitor cell (HSPC) transplantations require prior harvesting of allogeneic or autologous HSPCs. HSPCs are usually present in bone marrow (BM) during the entire life, in cord blood (CB) at birth, or in peripheral blood (PB) under particular circumstances. HSPCs were first harvested in BM and later in CB and PB, as studies showed interesting features of such grafts. All harvesting methods were in use throughout the years, except BM harvesting for HSPC autologous transplantation, which was replaced by PB harvesting. BM, CB, and PB harvesting methods have been developed, and materials and devices technically improved to increase the number of HSPCs harvested. In parallel, knowing the features of the donors or patients associated with successful numbers of HSPCs allows the adaptation of appropriate harvesting methods. Moreover, it is important to ensure the safety of donors or patients while harvesting. This review describes the methods used for harvesting based on recent studies or developments around these methods, and more particularly, the means developed to increase the numbers of HSPCs harvested in each method. It also explains briefly the influence of technical improvements in HSPC harvesting on potential changes in HSPC graft composition.
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Affiliation(s)
- Olivier Hequet
- Etablissement Français du Sang Rhône Alpes, Apheresis Unit, Centre Hospitalier Lyon Sud France, Lyon, France ; Cell Therapy Unit, Etablissement Français du Sang (EFS) Rhône-Alpes, Hospital Edouard Herriot, Lyon, France
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21
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Saraceni F, Shem-Tov N, Olivieri A, Nagler A. Mobilized peripheral blood grafts include more than hematopoietic stem cells: the immunological perspective. Bone Marrow Transplant 2015; 50:886-91. [PMID: 25665044 DOI: 10.1038/bmt.2014.330] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 01/20/2023]
Abstract
Although stem cell mobilization has been performed for more than 20 years, little is known about the effects of mobilizing agents on apheresis composition and the impact of graft cell subsets on patients' outcome. With the increasing use of plerixafor and the inclusion of poor mobilizers in autologous transplant procedures, new parameters other than CD34(+) stem cell dose are emerging; plerixafor seems to mobilize more primitive CD34(+)/CD38(-) stem cells compared with G-CSF, but their correlation with stable hematopoietic engraftment is still obscure. Immune recovery is as crucial as hematopoietic reconstitution, and higher T and natural killer cells infused within the graft have been correlated with better outcome in autologous transplant; recent studies showed increased mobilization of immune effectors with plerixafor compared with G-CSF, but further data are needed to clarify the clinical impact of these findings. In the allogeneic setting, much evidence suggests that mobilized T-cell alloreactivity is tempered by G-CSF, probably with the mediation of dendritic cells, even though no clear correlation with GVL and GVHD has been found. Plerixafor is not approved in healthy donors yet; early data suggest it might mobilize a GVHD protective balance of immune effectors, but further studies are needed to define its role in allogeneic transplant.
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Affiliation(s)
- F Saraceni
- 1] Department of Hematology and Bone Marrow Transplantation, Ospedali Riuniti, Ancona, Italy [2] Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - N Shem-Tov
- Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - A Olivieri
- Department of Hematology and Bone Marrow Transplantation, Ospedali Riuniti, Ancona, Italy
| | - A Nagler
- Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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22
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Abstract
Plerixafor, a hematopoietic stem cell mobilizer, is indicated in combination with G-CSF to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma. Current evidence suggests that the addition of plerixafor with chemotherapy plus G-CSF is safe and effective in the large majority of the patients with low blood CD34(+) cell count after mobilization and/or poor yield after the first collection. Nevertheless, there are several questions strongly debated, and in this paper, we would like to identify areas of possible future use and development of the drug.
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23
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Sauter CS, Giralt S. The prognostic impact of peripheral blood progenitor cell dose following high-dose therapy and autologous stem cell transplant for hematologic malignancies. Leuk Lymphoma 2014; 56:1619-25. [PMID: 25284496 DOI: 10.3109/10428194.2014.970544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
High-dose chemotherapy (HDT) followed by autologous peripheral blood progenitor cell transplant (PBPCT) has become a standard intervention in certain clinical settings of hematologic malignancies, particularly multiple myeloma and relapsed/refractory lymphoma. While the minimal required PBPCs infused, as defined by number of CD34 + cells, has been relatively well delineated for adequate hematopoietic recovery post-HDT, optimal PBPC dose has not been clearly defined. This is particularly relevant in the context of retrospective data suggesting improved survival outcomes with increased PBPC doses. The potential confounding of these data as they relate to disease risk is discussed within this review. Additionally, other retrospective data have suggested that enhanced quantitative lymphocyte subset reconstitution post-HDT-PBPCT may confer progression-free and overall survival advantage. These reported series herein reviewed may inform discussion of future, prospective clinical trials with the intent of defining optimal autologous PBPC dose following HDT, especially as it may relate to metrics beyond hematopoietic recovery.
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Affiliation(s)
- Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, NY , USA
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24
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Angelopoulou MK, Tsirkinidis P, Boutsikas G, Vassilakopoulos TP, Tsirigotis P. New insights in the mobilization of hematopoietic stem cells in lymphoma and multiple myeloma patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:835138. [PMID: 25197663 PMCID: PMC4150414 DOI: 10.1155/2014/835138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/12/2014] [Indexed: 12/11/2022]
Abstract
Following chemotherapy and/or the administration of growth factors, such as granulocyte-colony stimulated factor (G-CSF), hematopoietic stem cells (HSC) mobilize from bone marrow to peripheral blood. This review aims to systematically present the structure of the HSC "niche" and elucidate the mechanisms of their mobilization. However, this field is constantly evolving and new pathways and molecules have been shown to contribute to the mobilization process. Understanding the importance and the possible primary pathophysiologic role of each pathway is rather difficult, since they share various overlapping components. The primary initiating event for the mobilization of HSC is chemotherapy-induced endogenous G-CSF production or exogenous G-CSF administration. G-CSF induces proliferation and expansion of the myelomonocytic series, which leads to proteolytic enzyme activation. These enzymes result in disruption of various receptor-ligand bonds, which leads to the disanchorage of HSC from the bone marrow stroma. In everyday clinical practice, CXC chemokine receptor-4 (CXCR4) antagonists are now being used as mobilization agents in order to improve HSC collection. Furthermore, based on the proposed mechanisms of HSC mobilization, novel mobilizing agents have been developed and are currently evaluated in preclinical and clinical studies.
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Affiliation(s)
- Maria K. Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, 17 AgiouThoma, Goudi, 11527 Athens, Greece
| | - Pantelis Tsirkinidis
- Department of Hematology, 401 Army Forces Hospital, 138 Mesogeion Avenue, 11525 Athens, Greece
| | - Georgios Boutsikas
- Department of Hematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, 17 AgiouThoma, Goudi, 11527 Athens, Greece
| | - Theodoros P. Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, 17 AgiouThoma, Goudi, 11527 Athens, Greece
| | - Panayiotis Tsirigotis
- 2nd Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, 1 Rimini Street, Chaidari, 12462 Athens, Greece
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25
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Jantunen E, Varmavuo V. Plerixafor for mobilization of blood stem cells in autologous transplantation: an update. Expert Opin Biol Ther 2014; 14:851-61. [PMID: 24673120 DOI: 10.1517/14712598.2014.902927] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION About 99% of all autologous transplants are now performed with blood stem cells. G-CSF alone or combined with chemotherapy have been used to mobilize CD34(+) cells. Plerixafor is a novel drug used for mobilization purposes. AREAS COVERED We have evaluated recent data in regard to plerixafor use in predicted or proven poor mobilizers. In addition, we have looked for preemptive strategies to optimize the use of this expensive drug. Also cost-efficacy issues and effects of plerixafor on graft composition and post-transplant outcomes will be discussed. EXPERT OPINION Plerixafor added to G-CSF is superior than G-CSF alone for mobilization of CD34(+) cells. This combination is also efficient in patients who have failed a previous mobilization attempt with other methods or in patients with risk factors for poor mobilization. Addition of plerixafor to G-CSF or chemotherapy plus G-CSF mobilization in patients who appear to mobilize poorly is under active investigation and algorithms for a preemptive use of this expensive agent have been proposed. Grafts collected after plerixafor appear to contain more lymphoid cells than the grafts collected without it. Whether this affects post-transplant outcomes such as immune reconstitution and risk of relapse needs to be evaluated.
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Affiliation(s)
- Esa Jantunen
- University of Eastern Finland, Clinical Medicine , Kuopio , Finland
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26
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Unraveling stem cell and progenitor subsets in autologous grafts according to methods of mobilization: implications for prediction of hematopoietic recovery. Cytotherapy 2014; 16:392-401. [PMID: 24424268 DOI: 10.1016/j.jcyt.2013.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/05/2013] [Accepted: 11/12/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND AIMS In the autologous setting, granulocyte colony-stimulating factor (G-CSF) (G), or, when failing, G plus plerixafor (G+P), are common regimens for mobilization of stem cells into peripheral blood. To delineate mobilization effects on graft composition and hematopoietic recovery, we compared contents of stem cells and progenitor cells in products of G+P- and G patients. Paired samples of G+P patients and prior insufficient G mobilization were available for analyses. METHODS Subset analyses of grafts were performed by flow cytometry and myeloid colony-forming assay. In search of new markers to ascertain graft quality, we determined the fractions of aldehyde dehydrogenase bright (ALDH(br)) cells. RESULTS G grafts contained higher percentages of CD34+ cells, CD34+CD38- cells, and committed progenitors (CD34+CD38+) compared with G+P grafts. A detailed characterization of the mobilized CD34+ cell subset showed higher percentages of CD38- among the CD34+ cells of the G+P group (P = 0.032). In contrast, the CD34+ cell subset in G grafts was characterized by a higher percentage of ALDH(br) cells (P < 0.0001). Studying engraftment and day +100 graft function the G and G+P transplanted patients were comparable with respect to neutrophils, whereas in platelets they differed. In the prediction of engraftment and hematopoietic recovery, the dose of infused ALDH(br) cells correlated best to both platelet (r = 0.565, P = 0.002) and neutrophil reconstitution (r = 0.366, P = 0.06). CONCLUSIONS Besides showing dissimilar distributions of CD34+CD38- cells and progenitors in G and G+P grafts, this study further designated ALDH(br) as a promising marker in determination and prediction of graft quality and hematopoietic recovery.
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27
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Gaugler B, Arbez J, Legouill S, Tiberghien P, Moreau P, Derenne S, Saas P, Mohty M. Characterization of peripheral blood stem cell grafts mobilized by granulocyte colony-stimulating factor and plerixafor compared with granulocyte colony-stimulating factor alone. Cytotherapy 2013; 15:861-8. [PMID: 23731764 DOI: 10.1016/j.jcyt.2013.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/10/2013] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AIMS This study aimed to characterize the immune effectors contained in apheresis samples obtained from patients with grafts mobilized with plerixafor and granulocyte colony-stimulating factor (G-CSF) (P+G) compared with grafts mobilized with G-CSF alone (G). METHODS Aliquots of apheresis samples were obtained from 36 patients with malignant diseases after mobilization with G (n = 18) or P+G (n = 18). The phenotype and cytokine secretion profile of T cell and dendritic cell subsets were characterized by multicolor cytometry including intracellular cytokine staining. RESULTS In grafts collected after mobilization with P+G, there was a significantly higher percentage of CD3(+) T cells compared with samples collected after mobilization with G alone. On a functional level, a significant increase of interferon-γ and tumor necrosis factor-α secreting CD8(+) T cells was observed in the P+G group compared with the G group. CD4(+)Foxp3(+) regulatory T cells were similar in both groups but exhibited a lower expression of inducible costimulatory molecule and a significantly higher expression of CD127 in the P+G group. Myeloid dendritic cells (MDCs) and BDCA3(+) dendritic cells were similar in both groups. In contrast, plasmacytoid dendritic cells (PDCs) (CD123(+)BDCA2(+)HLA-DR(+)) were significantly increased in the P+G grafts, leading to a higher PDC-to-MDC ratio. PDCs mobilized by P+G displayed different functional markers--a higher percentage of ILT7(+) PDCs and decreased expression of CD86--suggesting a potential regulatory capacity of PDCs mobilized by P+G. CONCLUSIONS Grafts mobilized with P+G exhibited major different functional features compared with grafts mobilized with G alone, suggesting that such grafts may have an impact on patient outcome after autologous stem cell transplantation.
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28
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Varmavuo V, Rimpiläinen J, Kuitunen H, Nihtinen A, Vasala K, Mikkola M, Kutila A, Lehtonen P, Kuittinen T, Mäntymaa P, Nousiainen T, Kuittinen O, Jantunen E. Engraftment and outcome after autologous stem cell transplantation in plerixafor-mobilized non-Hodgkin's lymphoma patients. Transfusion 2013; 54:1243-50. [DOI: 10.1111/trf.12434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/14/2013] [Accepted: 08/19/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Ville Varmavuo
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | - Johanna Rimpiläinen
- Department of Medicine; Tampere University Hospital; Tampere Finland
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - Hanne Kuitunen
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - Anne Nihtinen
- Department of Medicine; North Karelia Central Hospital; Joensuu Finland
| | - Kaija Vasala
- Department of Oncology; Central Finland Central Hospital; Jyväskylä Finland
| | - Maija Mikkola
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
- Department of Medicine; Päijät-Häme Central Hospital; Lahti Finland
| | - Anu Kutila
- Department of Medicine; Mikkeli Central Hospital; Mikkeli Finland
| | - Päivi Lehtonen
- Department of Medicine; Savonlinna Central Hospital; Savonlinna Finland
| | - Taru Kuittinen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | | | - Tapio Nousiainen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
| | - Outi Kuittinen
- Department of Oncology; Oulu University Hospital; Oulu Finland
| | - Esa Jantunen
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
- University of Eastern Finland/Clinical Medicine; Kuopio Finland
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