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Li J, Dhilipkannah P, Holden VK, Sachdeva A, Todd NW, Jiang F. Dysregulation of lncRNA MALAT1 Contributes to Lung Cancer in African Americans by Modulating the Tumor Immune Microenvironment. Cancers (Basel) 2024; 16:1876. [PMID: 38791954 PMCID: PMC11119359 DOI: 10.3390/cancers16101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
African American (AA) populations present with notably higher incidence and mortality rates from lung cancer in comparison to other racial groups. Here, we elucidated the contribution of long non-coding RNAs (lncRNAs) in the racial disparities and their potential clinical applications in both diagnosis and therapeutic strategies. AA patients had elevated plasma levels of MALAT1 and PVT1 compared with cancer-free smokers. Incorporating these lncRNAs as plasma biomarkers, along with smoking history, achieved 81% accuracy in diagnosis of lung cancer in AA patients. We observed a rise in MALAT1 expression, correlating with increased levels of monocyte chemoattractant protein-1 (MCP-1) and CD68, CD163, CD206, indicative of tumor-associated macrophages in lung tumors of AA patients. Forced MALAT1 expression led to enhanced growth and invasiveness of lung cancer cells, both in vitro and in vivo, accompanied by elevated levels of MCP-1, CD68, CD163, CD206, and KI67. Mechanistically, MALAT1 acted as a competing endogenous RNA to directly interact with miR-206, subsequently affecting MCP-1 expression and macrophage activity, and enhanced the tumorigenesis. Targeting MALAT1 significantly reduced tumor sizes in animal models. Therefore, dysregulated MALAT1 contributes to lung cancer disparities in AAs by modulating the tumor immune microenvironment through its interaction with miR-206, thereby presenting novel diagnostic and therapeutic targets.
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Affiliation(s)
- Jin Li
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Pushpa Dhilipkannah
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Van K. Holden
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Ashutosh Sachdeva
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Nevins W. Todd
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Feng Jiang
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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2
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Mohrez M, Troeger A, Kleinschmidt K, Alali TH, Jakob M, Brosig A, Hähnel V, Kietz S, Offner R, Burkhardt R, Corbacioglu S, Ahrens N, Foell J. Feasibility of peripheral blood stem cell collection from sickle cell trait donors with an intensified G-CSF regimen. Eur J Haematol 2023; 111:824-830. [PMID: 37635081 DOI: 10.1111/ejh.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCD and bone marrow from an HLA-matched sibling is currently the standard of care. Haploidentical HSCT from a family donor with a TCR αβ/CD19 depleted graft (T-haplo) is an increasingly successful alternative, which requires the generation of G-CSF stimulated peripheral stem cell (PBSC) from haploidentical relatives. These sickle cell trait (SCT) donors reported to develop SCD-related complications in conditions of severe stress. METHODS In this retrospective analysis, we compared the safety and efficacy of PBSC mobilization with a G-CSF intensified mobilization regimen in SCT donors with a conventional G-CSF mobilization regimen in healthy donors. RESULTS The reported adverse events were similar during intensified G-CSF mobilization, apheresis, and shortly after stem cell apheresis in SCT and control donors. In SCT and control donors, we were able to mobilize high yields of CD34+ stem cells and the harvested CD34+ cell count was comparable with control donors. CONCLUSIONS Peripheral stem cell mobilization using an intensified G-CSF regimen is safe, and well tolerated among SCT donors. SCT donors are a valid alternative for collection of peripheral CD34+ stem cells for T-cell-depleted haploidentical stem cell transplantation.
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Affiliation(s)
- Morad Mohrez
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Anja Troeger
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Katharina Kleinschmidt
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Tarek Hanafee Alali
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Marcus Jakob
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Andreas Brosig
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Silke Kietz
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine, Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Juergen Foell
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children's Hospital Regensburg, Regensburg, Germany
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Pinto VM, De Franceschi L, Gianesin B, Gigante A, Graziadei G, Lombardini L, Palazzi G, Quota A, Russo R, Sainati L, Venturelli D, Forni GL, Origa R. Management of the Sickle Cell Trait: An Opinion by Expert Panel Members. J Clin Med 2023; 12:jcm12103441. [PMID: 37240547 DOI: 10.3390/jcm12103441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
The number of individuals with the sickle cell trait exceeds 300 million worldwide, making sickle cell disease one of the most common monogenetic diseases globally. Because of the high frequency of sickle cell disease, reproductive counseling is of crucial importance. In addition, unlike other carrier states, Sickle Cell Trait (SCT) seems to be a risk factor for several clinical complications, such as extreme exertional injury, chronic kidney disease, and complications during pregnancy and surgery. This expert panel believes that increasing knowledge about these clinical manifestations and their prevention and management can be a useful tool for all healthcare providers involved in this issue.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, E.O. Ospedali Galliera, 16128 Genova, Italy
| | | | - Barbara Gianesin
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, E.O. Ospedali Galliera, 16128 Genova, Italy
- ForAnemia Foundation, 16124 Genova, Italy
| | - Antonia Gigante
- ForAnemia Foundation, 16124 Genova, Italy
- Società Italiana Talassemie ed Emoglobinopatie (SITE), 09100 Cagliari, Italy
| | - Giovanna Graziadei
- Centro Malattie Rare Internistiche, Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Letizia Lombardini
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - Giovanni Palazzi
- U.O. Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
| | | | - Rodolfo Russo
- Clinica Nefrologica, Dialisi e Trapianto, Dipartimento di Medicina Integrata con il Territorio, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Laura Sainati
- Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, 35128 Padova, Italy
| | - Donatella Venturelli
- Servizio Immunotrasfusionale, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Raffaella Origa
- Talassemia, Ospedale Pediatrico Microcitemico 'A.Cao', ASL8, Università di Cagliari, 09121 Cagliari, Italy
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4
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Piccirillo N, Putzulu R, Metafuni E, Massini G, Fatone F, Corbingi A, Giammarco S, Limongiello MA, Di Giovanni A, Zini G, Bacigalupo A, Teofili L, Sica S, Chiusolo P. Peripheral Blood Allogeneic Stem Cell Mobilization: Can We Predict a Suboptimal Mobilization? Transfus Med Rev 2023; 37:150725. [PMID: 37315997 DOI: 10.1016/j.tmrv.2023.150725] [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: 11/19/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023]
Abstract
Allogeneic peripheral blood stem cells mobilization is now the basis of most stem cell transplants. In a very limited number of cases, mobilization is suboptimal leading to further collection procedures, to suboptimal cell doses infusion with delayed engraftment time, increased risks of transplant procedure and of related costs. To date we have no recognized and shared criteria for early estimating the probability of poor mobilization in healthy donors. We then analyzed allogeneic peripheral blood stem cell donations performed at the Fondazione Policlinico Universitario A.Gemelli IRCCS Hospital from January 2013 to December 2021 in order to identify premobilization factors associated with successful mobilization. The following data were collected: age, gender, weight, complete blood cell count at baseline, G-CSF dose, number of collection procedures, CD34+ cell count in peripheral blood on the first day of collection, CD34+ cell dose per kg body weight of recipient. Mobilization efficacy was defined according to the number of CD34+ cells in peripheral blood on day +5 of G-CSF administration. We classified donors as sub-optimal mobilizers or good mobilizers according to the achievement of the 50 CD34+ cell/μL threshold. We observed 30 suboptimal mobilizations in 158 allogeneic peripheral blood stem cell donations. Age and baseline white blood cell count were factors significantly associated with negative or positive impact on mobilization, respectively. We did not find significant differences in mobilization based on gender or G-CSF dose. Using cut-off values of 43 years and 5.5×109/L WBC count, we built a suboptimal mobilization score: donors who reach 2, 1 or 0 points have a 46%, 16% or 4% probability of suboptimal mobilization, respectively. Our model explains 26% of the variability of mobilization confirming that most of the mobilization magnitude depends on genetically determined factors; however, suboptimal mobilization score is a simple tool providing an early assessment of mobilization efficacy before G-CSF administration begins in order to support allogeneic stem cells selection, mobilization and collection. Through a systematic review, we looked for confirmation of our findings. According to the published articles, all the variables we included in our model are confirmed to be strongly related to the success of mobilization. We believe that score system approach could be applied in clinical practice to assess the risk of mobilization failure at baseline allowing for a priori intervention.
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Affiliation(s)
- Nicola Piccirillo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rossana Putzulu
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Elisabetta Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giuseppina Massini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Federica Fatone
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Andrea Corbingi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Maria Assunta Limongiello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessia Di Giovanni
- Hematology Unit, Center for Translational Medicine, Azienda USL Toscana NordOvest, Livorno, Italy
| | - Gina Zini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Bacigalupo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Sica
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Shah NC, Bhoopatiraju S, Abraham A, Anderson E, Andreansky M, Bhatia M, Chaudhury S, Cuvelier GDE, Godder K, Grimley M, Hale G, Kamani N, Jacobsohn D, Ngwube A, Gilman AL, Skiles J, Yu LC, Shenoy S. Granulocyte Colony-Stimulating Factor is Safe and Well Tolerated following Allogeneic Transplantation in Patients with Sickle Cell Disease. Transplant Cell Ther 2021; 28:174.e1-174.e5. [PMID: 34958973 DOI: 10.1016/j.jtct.2021.12.016] [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] [Received: 11/04/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF) used after hematopoietic stem cell transplantation (HSCT) can enhance neutrophil recovery in patients rendered neutropenic by the preparative regimen. G-CSF is contraindicated in patients with sickle cell disease (SCD) as life-threatening complications can ensue in the presence of sickle vasculopathy. However, the safety profile of G-CSF after HSCT for SCD has not been previously described. We report clinical outcomes in the first 100 days post-HSCT in patients supported with G-CSF until neutrophil recovery on a clinical trial of reduced intensity transplantation for SCD. Patients (n=62) received G-CSF for a median of 9 days (range, 5-33) following transplant from the best available stem cell source. Preparation for transplant included a target hemoglobin S level of ≤45%. Neutrophil engraftment (ANC >0.5 × 103/mL) was achieved at a median of 13 days (range,10-34) and platelet engraftment (>50 × 103/mL) at a median of 19 days (range, 12-71). The median duration of inpatient hospitalization following stem cell infusion (day 0) was 21.5 days (range 11-33). No patient developed SCD related complications following G-CSF use. The most common organ toxicities encountered between G-CSF commencement (on day +7) and day +100 were anorexia (14), hypertension (11) and electrolyte imbalance requiring correction (9). Central nervous system related events were noted in 5 patients, all with pre-existing cerebral vasculopathy/moyamoya disease and attributed to reversible posterior leukoencephalopathy syndrome (RPLS) in the presence of calcineurin inhibitor therapy and hypertension. We conclude that G-CSF does not adversely impact SCD transplant recipients and can be safely used post-HSCT to enhance neutrophil recovery.
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Affiliation(s)
| | | | | | | | | | | | | | - Geoff D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | | | | | | | | | | | - Lolie C Yu
- Children's Hospital/LSUHSC, New Orleans, LA
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6
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Uzoka C, Liu LC, Park Y, Lin Y, Patel P, Campbell-Lee S, Sweiss K, Wang X, Tepak E, Peace D, Saraf S, Rondelli D, Mahmud N. Race/ethnicity and underlying disease influences hematopoietic stem/progenitor cell mobilization response: A single center experience. J Clin Apher 2021; 36:634-644. [PMID: 34046928 DOI: 10.1002/jca.21914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Whether race/ethnicity plays a role in hematopoietic stem/progenitor cells (HSPC) mobilization in autologous donors has not been studied. We hypothesize that donor characteristic including race/ethnicity, age, sex, body mass index, and diagnostic groups influences HSPC mobilization. Diagnostic groups include healthy allogeneic donors, autologous multiple myeloma (MM) and non-MM donors. STUDY DESIGN AND METHODS Here, we conducted a single-center retrospective study in 64 autologous patients and 48 allogeneic donors. Autologous donors were patients diagnosed with MM or non-MM. All donors were grouped as African American (AA), White (W), or "Other"(O). RESULTS Multivariate analysis demonstrated diagnostic group differences for CD34+ cell yields between race/ethnicity. Specifically, non-MM patients had the lowest CD34+ cell yields in AA and O, but not in W. For pre-apheresis peripheral blood (PB) CD34+ cell numbers, race/ethnicity had a significant effect both in bivariate and multivariate analyses. Non-MM patients had the lowest, and AA patients had the highest PB CD34+ cells. The results support the view that past therapies used in MM are likely more conducive of recovery of HSPC. CONCLUSIONS Our study shows that race/ethnicity and diagnostic group differences influenced CD34+ cell mobilization response across donor types. Interestingly, autologous MM donors with the aid of plerixafor displayed comparable CD34 yields to allogeneic donors. Even though both MM and non-MM donors received plerixafor, non-MM donors had significantly lower CD34 yields among AA and O donors but not in W donors. Larger studies would be required to validate the role of diagnostic groups and race/ethnicity interactions.
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Affiliation(s)
- Chukwuemeka Uzoka
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Li C Liu
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Youngmin Park
- Clinical Stem Cell Laboratory, UI Blood & Marrow Transplant Program, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - Yuankai Lin
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Pritesh Patel
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Sally Campbell-Lee
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Karen Sweiss
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Xinhe Wang
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elena Tepak
- Clinical Stem Cell Laboratory, UI Blood & Marrow Transplant Program, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - David Peace
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Santosh Saraf
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Damiano Rondelli
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Nadim Mahmud
- Division of Hematology/Oncology, Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA.,Clinical Stem Cell Laboratory, UI Blood & Marrow Transplant Program, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
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7
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Sanikommu SR, Reese ES, He J, Lee C, Ai J, Butler CM, Jacobs R, Hu B, Atrash S, Trivedi J, Bhutani M, Voorhees P, Usmani SZ, Ghosh N, Fasan O, Druhan LJ, Symanowski J, Copelan EA, Avalos BR. Cost saving, patient centered algorithm for progenitor cell mobilization for autologous hematopoietic cell transplantation. J Clin Apher 2021; 36:553-562. [PMID: 33710672 DOI: 10.1002/jca.21892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/10/2022]
Abstract
Administration of plerixafor with granulocyte-colony stimulating factor (G-CSF) mobilizes CD34+ cells much more effectively than G-CSF alone, but cost generally limits plerixafor use to patients at high risk of insufficient CD34+ cell collection based on low peripheral blood (PB) CD34+ counts following 4 days of G-CSF. We analyzed costs associated with administering plerixafor to patients with higher day 4 CD34+ cell counts to decrease apheresis days and explored the use of a fixed split dose of plerixafor instead of weight-based dosing. We analyzed 235 patients with plasma cell disorders or non-Hodgkin's lymphoma who underwent progenitor cell mobilization and autologous hematopoietic cell transplantation (AHCT) between March 2014 and December 2017. Two hundred ten (89%) received G-CSF plus Plerixafor and 25 (11%) received G-CSF alone. Overall, 180 patients (77%) collected in 1 day, 53 (22%) in 2 days and 2 (1%) in 3 days. Based on our data, we present a probabilistic algorithm to identify patients likely to require more than one day of collection using G-CSF alone. CD34+ cell yield, ANC and platelet recovery were not significantly different between fixed and standard dose plerixafor. Plerixafor enabled collection in 1 day and with estimated savings of $5000, compared to patients who did not receive plerixafor and required collection for three days. While collection and processing costs and patient populations vary among institutions, our results suggest re-evaluation of current algorithms.
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Affiliation(s)
- Srinivasa Reddy Sanikommu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Emily S Reese
- Department of Translational Science, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Jiaxian He
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Carlos Lee
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Jing Ai
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Candace M Butler
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Bei Hu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Shebli Atrash
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Jigar Trivedi
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Manisha Bhutani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Peter Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Nilanjan Ghosh
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Omotayo Fasan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Lawrence J Druhan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - James Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Edward A Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
| | - Belinda R Avalos
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, North Carolina, USA
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8
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Panch SR, Logan B, Sees JA, Bo-Subait S, Savani B, Shah NN, Hsu JW, Switzer G, Lazarus HM, Anderlini P, Hematti P, Confer D, Pulsipher MA, Shaw BE, Stroncek DF. Shorter Interdonation Interval Contributes to Lower Cell Counts in Subsequent Stem Cell Donations. Transplant Cell Ther 2021; 27:503.e1-503.e8. [PMID: 33823169 DOI: 10.1016/j.jtct.2021.03.008] [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: 10/27/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Approximately 7% of unrelated hematopoietic stem cell donors are asked to donate stem cells a subsequent time to the same or a different recipient. Recent studies have shown that donation-related symptoms for second donations are similar to those for the first donation. Little is known about differences in stem cell mobilization and yields for subsequent peripheral blood stem cell (PBSC) and bone marrow (BM) collections. We hypothesized that CD34+ cell yields and total nucleated cell (TNC) concentrations for subsequent PBSC or BM donations are lower than those at the first donation. We also evaluated the factors influencing stem cell yields in healthy unrelated second-time donors. Data were gathered from the Center for International Blood and Marrow Transplant Research database on 513 PBSC and 43 BM donors who donated a second time between 2006 and 2017 through the National Marrow Donor Program. Among the second-time PBSC donors, we found significantly lower preapheresis peripheral blood CD34+ cell counts (68.6 × 106/L versus 73.9 × 106/L; P = .03), and collection yields (556 × 106 versus 608 × 106; P = .02) at the second donation compared to the first. This decrease at the subsequent donation was associated with a shorter interdonation interval, lower body mass index (BMI), and a lower total G-CSF dose. In most instances, suboptimal mobilizers at their first donation donated suboptimal numbers of stem cells at their subsequent donations. Among repeat BM donors, the TNC concentration was lower at the second donation. The small size of this group precluded additional analysis. Overall, when considering repeat donations, increasing the interdonation intervals and evaluating for BMI changes should be considered to optimize stem cell yields. Some of these parameters may be improved by increasing G-CSF dose in PBSC donors within permissible limits.
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Affiliation(s)
- Sandhya R Panch
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, Maryland
| | - Brent Logan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer A Sees
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Stephanie Bo-Subait
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Bipin Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Jack W Hsu
- Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida
| | - Galen Switzer
- Department of Medicine, University of Pittsburgh Medical Center-Cancer Center, Pittsburgh, Pennsylvania
| | - Hillard M Lazarus
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Dennis Confer
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - David F Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, NIH Clinical Center, Bethesda, Maryland
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9
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Chen LN, Collins-Johnson N, Sapp N, Pickett A, West K, Stroncek DF, Panch SR. How do I structure logistic processes in preparation for outsourcing of cellular therapy manufacturing? Transfusion 2019; 59:2506-2518. [PMID: 31135995 DOI: 10.1111/trf.15349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
As cell and gene therapies (CGT) assume center stage in early-phase clinical trials for several acute and chronic diseases, there is heightened interest in the standardization and automation of manufacturing processes in preparation for commercialization. Toward this goal, a hybrid and oftentimes geographically separated model comprising regional cell procurement and infusion facilities and a centralized cell manufacturing unit is gaining traction in the field. Although CGT processing facilities in academic institutions are not involved directly in the manufacturing of these therapies, they must be prepared to collaborate with commercial or contract manufacturing organizations (CMOs) and be ready to address several supply-chain challenges that have emerged for autologous and allogeneic CGT. Academic center cell-processing facilities must handle many events up- and downstream of manufacturing such as donor screening, cell collection, product labeling, cryopreservation, transportation, and thaw infusion. These events merit closer evaluation in the context of multifacility manufacturing since standard procedures have yet to be established. Based on our institutional experience, we summarize logistical challenges encountered in the handling and distribution of CGT products in early phase studies, specifically those involving CMO (outsourced) manufacturing. We also make recommendations to standardize processes unique to the CGT supply chain, emphasizing the need to maintain needle-to-needle traceability from product collection to infusion. These guidelines will inform the development of more complex supply-chain models for larger-scale cell and gene therapeutics.
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Affiliation(s)
- Leonard N Chen
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Naoza Collins-Johnson
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Nasheda Sapp
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Angela Pickett
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kamille West
- Blood Services Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - David F Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Sandhya R Panch
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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10
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De Santis GC, Prado BDPA, Dotoli GM, Simões BP, Covas DT. Mobilizing hematopoietic progenitor cells in donors with sickle cell trait is safe. Hematol Transfus Cell Ther 2019; 41:101-102. [PMID: 30793114 PMCID: PMC6371198 DOI: 10.1016/j.htct.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Gil Cunha De Santis
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil.
| | | | - Giuliana Martinelli Dotoli
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Belinda Pinto Simões
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Dimas Tadeu Covas
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
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11
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Allen ES, Nelson RC, Flegel WA. How we evaluate red blood cell compatibility and transfusion support for patients with sickle cell disease undergoing hematopoietic progenitor cell transplantation. Transfusion 2018; 58:2483-2489. [PMID: 30403414 DOI: 10.1111/trf.14871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/23/2022]
Abstract
Multiple hematopoietic progenitor cell (HPC) transplantation options for patients with sickle cell disease (SCD) are currently under investigation. Patients with SCD have a high rate of alloimmunization to red blood cell antigens, often complicating transfusion support. Transfusion reactions, including acute and delayed hemolytic reactions, have been observed despite immunosuppressive regimens. Allogeneic donor transplants have been shown to carry a risk of prolonged reticulocytopenia and acute hemolysis with severe anemia in nonmyeloablative regimens. We discuss our experience providing transfusion support to patients with SCD undergoing HPC transplantation, propose an outline for a complete pretransplantation evaluation, and discuss donor/recipient compatibility issues and their implications.
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Affiliation(s)
- Elizabeth S Allen
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland.,Department of Pathology, University of California at San Diego, La Jolla, California
| | - Randin C Nelson
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland.,Department of Pathology, Montefiore Medical Center, Bronx, New York
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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12
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Tahhan AS, Hammadah M, Mohamed-Kelli H, Kim JH, Sandesara PB, Alkhoder A, Kaseer B, Gafeer MM, Topel M, Hayek SS, O’Neal WT, Obideen M, Ko YA, Liu C, Hesaroieh I, Mahar E, Vaccarino V, Waller EK, Quyyumi AA. Circulating Progenitor Cells and Racial Differences. Circ Res 2018; 123:467-476. [PMID: 29930146 PMCID: PMC6202175 DOI: 10.1161/circresaha.118.313282] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
RATIONALE Blacks compared with whites have a greater risk of adverse cardiovascular outcomes. Impaired regenerative capacity, measured as lower levels of circulating progenitor cells (CPCs), is a novel determinant of adverse outcomes; however, little is known about racial differences in CPCs. OBJECTIVE To investigate the number of CPCs, PC-mobilizing factors, PC mobilization during acute myocardial infarction and the predictive value of CPC counts in blacks compared with whites. METHODS AND RESULTS CPCs were enumerated by flow cytometry as CD45med+ blood mononuclear cells expressing CD34+, CD133+, VEGF2R+, and CXCR4+ epitopes in 1747 subjects, mean age 58.4±13, 55% male, and 26% self-reported black. Patients presenting with acute myocardial infarction (n=91) were analyzed separately. Models were adjusted for relevant clinical variables. SDF-1α (stromal cell-derived factor-1α), VEGF (vascular endothelial growth factor), and MMP-9 (matrix metallopeptidase-9) levels were measured (n=561), and 623 patients were followed for median of 2.2 years for survival analysis. Blacks were younger, more often female, with a higher burden of cardiovascular risk, and lower CPC counts. Blacks had fewer CD34+ cells (-17.6%; [95% confidence interval (CI), -23.5% to -11.3%]; P<0.001), CD34+/CD133+ cells (-15.5%; [95% CI, -22.4% to -8.1%]; P<0.001), CD34+/CXCR4+ cells (-17.3%; [95% CI, -23.9% to -10.2%]; P<0.001), and CD34+/VEGF2R+ cells (-27.9%; [95% CI, -46.9% to -2.0%]; P=0.04) compared with whites. The association between lower CPC counts and black race was not affected by risk factors or cardiovascular disease. Results were validated in a separate cohort of 411 patients. Blacks with acute myocardial infarction had significantly fewer CPCs compared with whites ( P=0.02). Blacks had significantly lower plasma MMP-9 levels ( P<0.001) which attenuated the association between low CD34+ and black race by 19% (95% CI, 13%-33%). However, VEGF and SDF-1α levels were not significantly different between the races. Lower CD34+ counts were similarly predictive of mortality in blacks (hazard ratio, 2.83; [95% CI, 1.12-7.20]; P=0.03) and whites (hazard ratio, 1.79; [95% CI, 1.09-2.94]; P=0.02) without significant interaction. CONCLUSIONS Black subjects have lower levels of CPCs compared with whites which is partially dependent on lower circulating MMP-9 levels. Impaired regenerative capacity is predictive of adverse outcomes in blacks and may partly account for their increased risk of cardiovascular events.
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Affiliation(s)
- Ayman Samman Tahhan
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Muhammad Hammadah
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Heval Mohamed-Kelli
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Pratik B Sandesara
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ayman Alkhoder
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Belal Kaseer
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Mohamad Mazen Gafeer
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Matthew Topel
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Salim S Hayek
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Wesley T O’Neal
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Malik Obideen
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Chang Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Iraj Hesaroieh
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Ernestine Mahar
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Edmund K. Waller
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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13
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Taylor DA, Willerson JT. Racial Disparities in CD34+ Cells and Their Influence on Cardiovascular Repair. Circ Res 2018; 123:401-403. [PMID: 30355257 DOI: 10.1161/circresaha.118.313546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Doris A Taylor
- From the Regenerative Medicine Research, Texas Heart Institute, Houston (D.A.T., J.T.W.).,Texas Heart Institute, Houston (D.A.T., J.T.W.)
| | - James T Willerson
- From the Regenerative Medicine Research, Texas Heart Institute, Houston (D.A.T., J.T.W.).,Texas Heart Institute, Houston (D.A.T., J.T.W.)
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14
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Shenoy S, Gaziev J, Angelucci E, King A, Bhatia M, Smith A, Bresters D, Haight AE, Duncan CN, de la Fuente J, Dietz AC, Baker KS, Pulsipher MA, Walters MC. Late Effects Screening Guidelines after Hematopoietic Cell Transplantation (HCT) for Hemoglobinopathy: Consensus Statement from the Second Pediatric Blood and Marrow Transplant Consortium International Conference on Late Effects after Pediatric HCT. Biol Blood Marrow Transplant 2018; 24:1313-1321. [DOI: 10.1016/j.bbmt.2018.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 12/14/2022]
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15
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Guilcher GMT, Truong TH, Saraf SL, Joseph JJ, Rondelli D, Hsieh MM. Curative therapies: Allogeneic hematopoietic cell transplantation from matched related donors using myeloablative, reduced intensity, and nonmyeloablative conditioning in sickle cell disease. Semin Hematol 2018; 55:87-93. [PMID: 29958564 DOI: 10.1053/j.seminhematol.2018.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
Abstract
Sickle cell disease (SCD) chronically damages multiple organs over the lifetime of affected individuals. Allogeneic hematopoietic cell transplantation (allo-HCT) is the most studied curative intervention. Fully matched related marrow, peripheral blood derived, or cord blood HCT have the best transplant outcome for symptomatic patients with SCD. For patients with asymptomatic or milder disease who have this donor option available, risks and benefits of HCT should be discussed among the patient, family, treating hematologist, and transplant physician, and decision to proceed to HCT should be individualized. Myeloablative conditioning with busulfan, cyclophosphamide, and ATG has been a commonly employed regimen for children and young adults. Recently, low intensity conditioning with low dose total body irradiation and alemtuzumab is emerging as an efficacious and safe regimen for adults, young adults, and possibly children. Mixed donor chimerism (minimum ≥20% myeloid cells), from myeloablative or nonmyeloablative conditioning regimen, produces robust normal donor erythropoiesis and is sufficient to provide a clinical cure. The proportion of patients remaining on immunosuppression beyond 2 years post-HCT is likely <10% with either myeloablative or low intensity regimens. Late effects from myeloablative or reduced intensity conditioning, or from several more months of immunosuppression in low intensity conditioning may be less common than those observed in HCT for malignant indications. Nonmyeloablative approaches with low toxicities should be the focus of future research efforts. Prevention of GVHD is a shared goal in all approaches of allo-HCT in SCD.
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Affiliation(s)
- Gregory M T Guilcher
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tony H Truong
- Departments of Paediatrics and Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Santosh L Saraf
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
| | - Jacinth J Joseph
- Department of Hematology, Washington Hospital Center/Georgetown University, Washington, DC; Sickle Cell Branch, NHLBI, NIH, Bethesda, MD
| | - Damiano Rondelli
- Department of Medicine, Section of Hematology-Oncology, University of Illinois, Chicago, IL
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16
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Charles BA, Hsieh MM, Adeyemo AA, Shriner D, Ramos E, Chin K, Srivastava K, Zakai NA, Cushman M, McClure LA, Howard V, Flegel WA, Rotimi CN, Rodgers GP. Analyses of genome wide association data, cytokines, and gene expression in African-Americans with benign ethnic neutropenia. PLoS One 2018; 13:e0194400. [PMID: 29596498 PMCID: PMC5875757 DOI: 10.1371/journal.pone.0194400] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Benign ethnic neutropenia (BEN) is a hematologic condition associated with people of African ancestry and specific Middle Eastern ethnic groups. Prior genetic association studies in large population showed that rs2814778 in Duffy Antigen Receptor for Chemokines (DARC) gene, specifically DARC null red cell phenotype, was associated with BEN. However, the mechanism of this red cell phenotype leading to low white cell count remained elusive. METHODS We conducted an extreme phenotype design genome-wide association study (GWAS), analyzed ~16 million single nucleotide polymorphisms (SNP) in 1,178 African-Americans individuals from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and replicated from 819 African-American participants in the Atherosclerosis Risk in Communities (ARIC) study. Conditional analyses on rs2814778 were performed to identify additional association signals on chromosome 1q22. In a separate cohort of healthy individuals with and without BEN, whole genome gene expression from peripheral blood neutrophils were analyzed for DARC. RESULTS We confirmed that rs2814778 in DARC was associated with BEN (p = 4.09×10-53). Conditioning on rs2814778 abolished other significant chromosome 1 associations. Inflammatory cytokines (IL-2, 6, and 10) in participants in the Howard University Family Study (HUFS) and Multi-Ethnic Study in Atherosclerosis (MESA) showed similar levels in individuals homozygous for the rs2814778 allele compared to others, indicating cytokine sink hypothesis played a minor role in leukocyte homeostasis. Gene expression in neutrophils of individuals with and without BEN was also similar except for low DARC expression in BEN, suggesting normal function. BEN neutrophils had slightly activated profiles in leukocyte migration and hematopoietic stem cell mobilization pathways (expression fold change <2). CONCLUSIONS These results in humans support the notion of DARC null erythroid progenitors preferentially differentiating to myeloid cells, leading to activated DARC null neutrophils egressing from circulation to the spleen, and causing relative neutropenia. Collectively, these human data sufficiently explained the mechanism DARC null red cell phenotype causing BEN and further provided a biologic basis that BEN is clinically benign.
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Affiliation(s)
- Bashira A. Charles
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Matthew M. Hsieh
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States of America
| | - Adebowale A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Daniel Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | - Edward Ramos
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
- National Institute of Biomedical Imaging and Bioengineering, NIH, Bethesda, Maryland, United States of America
| | - Kyung Chin
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States of America
| | - Kshitij Srivastava
- Warren Grant Magnuson Clinical Center, NIH, Bethesda, Maryland, United States of America
| | - Neil A. Zakai
- Departments of Pathology and Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
| | - Mary Cushman
- Departments of Pathology and Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont, United States of America
| | - Leslie A. McClure
- School of Public Health, University of Alabama, Birmingham, Alabama, United States of America
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Virginia Howard
- School of Public Health, University of Alabama, Birmingham, Alabama, United States of America
| | - Willy A. Flegel
- Warren Grant Magnuson Clinical Center, NIH, Bethesda, Maryland, United States of America
| | - Charles N. Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, Maryland, United States of America
- * E-mail: (CNR); (GPR)
| | - Griffin P. Rodgers
- Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland, United States of America
- * E-mail: (CNR); (GPR)
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17
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Allogenic peripheral stem cell transplantation from HLA-matched related donors for adult sickle cell disease: remarkable outcomes from a single-center trial. Bone Marrow Transplant 2018; 53:880-890. [PMID: 29403023 DOI: 10.1038/s41409-018-0111-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 01/11/2023]
Abstract
Adult patients with sickle cell disease (SCD) are highly susceptible to stem cell transplant complications, including drug toxicity, graft versus host disease (GVHD), and graft rejection due to SCD-related tissue damage, endothelial activation, and inflammation. The scarcity of compatible stem cells for transplantation further limits treatment options, with only 43 cases of adult allogeneic peripheral blood stem cell transplantation (allo-PSCT) from human leukocyte antigen (HLA)-identical sibling donors reported in the international registry for the period 1986-2013. Herein we report remarkable outcomes in a cohort of adult SCD patients who underwent allo-PSCT using a fludarabine (Flu), busulfan (Bu), and anti-T-cell lymphocyte globulin (ATG)-based conditioning regimen in combination with very low dose total body irradiation (TBI), followed by post-transplant cyclophosphamide (Cy) and sirolimus as GVHD prophylaxis. We performed a single-center, retrospective study consisting of 20 consecutive patients (mean age 33.4 years) who underwent allo-PSCT from HLA-matched related donors with a conditioning regimen of Flu 150/Bu 3.2/Cy 29/ATG 30 (Fresenius)/TBI 200 between September 2013 and September 2017. Data were validated by an independent data audit group of the affiliated JACIE-accredited transplantation center. All patients experienced a sustained donor cell engraftment. Full donor chimerism (total cell) occurred within 180 days in all patients. Mean duration of follow-up was 13.8 months (range: 0.3-50 months), with 12 (60%) patients completing 12 months. No non-relapse mortality or graft rejection occurred. Successful treatment was achieved without the presence of graft loss, grade III-IV acute GVHD, extensive chronic GVHD, or other major complications. Allo-PSCT in combination with Flu 150/Bu 3.2/Cy 29/ATG 30(Fresenius)/TBI 200- Cy/Sirolimus therapy yielded encouraging outcomes with no mortality and low incidence of GVHD. Further controlled studies will be necessary to compare transplant protocols and long-term outcomes.
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18
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Nickel RS, Kamani NR. Ethical Challenges in Hematopoietic Cell Transplantation for Sickle Cell Disease. Biol Blood Marrow Transplant 2018; 24:219-227. [DOI: 10.1016/j.bbmt.2017.08.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/28/2017] [Indexed: 12/19/2022]
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19
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Stroncek DF, Shaw BE, Logan BR, Kiefer DM, Savani BN, Anderlini P, Bredeson CN, Hematti P, Ganguly S, Diaz MA, Abdel-Azim H, Ahmed I, Maharaj D, Seftel M, Beitinjaneh A, Seo S, Yared JA, Halter J, O'Donnell PV, Hale GA, DeFilipp Z, Lazarus H, Liesveld JL, Zhou Z, Munshi P, Olsson RF, Kasow KA, Szer J, Switzer GE, Chitphakdithai P, Shah N, Confer DL, Pulsipher MA. Donor Experiences of Second Marrow or Peripheral Blood Stem Cell Collection Mirror the First, but CD34 + Yields Are Less. Biol Blood Marrow Transplant 2017; 24:175-184. [PMID: 28958894 DOI: 10.1016/j.bbmt.2017.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
Little is known about the experiences of individuals donating peripheral blood stem cells (PBSCs) or marrow for a second time. To study this, unrelated donors making a second donation through the National Marrow Donor Program between 2004 and 2013 were evaluated. Experiences of second-time donors giving marrow (n = 118: first donation was PBSC in 76 and marrow in 42) were compared with those making only 1 marrow donation (n = 5829). Experiences of second-time donors giving PBSCs (n = 602) (first donation was PBSCs in 362; marrow in 240) were compared to first-time PBSC donors (n = 16,095). For donors giving a second PBSC or marrow donation there were no significant differences in maximum skeletal pain, maximum symptoms measured by an established modified toxicity criteria, and recovery time compared with those who donated only once. Notably, the yield of marrow nucleated cells and PBSC CD34+ cells with second donations was less. As previously noted with single first-time donations, female (PBSCs and marrow) and obese donors (PBSCs) had higher skeletal pain and/or toxicity with a second donation. PBSC donors who experienced high levels of pain or toxicity with the first donation also experienced high levels of these symptoms with their second donation and slower recovery times. In conclusion, for most donors second donation experiences were similar to first donation experiences, but CD34+ yields were less. Knowledge of the donor's first experience and stem cell yields may help centers decide whether second donations are appropriate and institute measures to improve donor experiences.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Cell Processing Section, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bronwen E Shaw
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Brent R Logan
- Center for International Blood and Bone Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Deidre M Kiefer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Bipin N Savani
- Hematology & Stem Cell Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paolo Anderlini
- Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Christopher N Bredeson
- The Ottawa Hospital Blood & Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Peiman Hematti
- Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Siddhartha Ganguly
- Hematologic Malignancies and Cellular Therapies, University of Kansas Medical Center, Westwood, Kansas
| | - Miguel Angel Diaz
- Unidad de Trasplante Hematopoyetico, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Hisham Abdel-Azim
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Ibrahim Ahmed
- Children's Mercy Hospital-UMKC, Kansas City, Missouri
| | - Dipnarine Maharaj
- South Florida Bone Marrow Transplant/Stem Cell Transplant Institute, Bethesda Health City, Boynton Beach, Florida
| | - Matthew Seftel
- Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, Ontario, Canada
| | - Amer Beitinjaneh
- Stem Cell Transplantation and Cell Therapy Program, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sachiko Seo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jean A Yared
- Department of Medicine, Greenbaum Cancer Center, University of Maryland, Baltimore, Maryland
| | - Joerg Halter
- Department of Haematology, University Hospital Basel, Basel, Switzerland
| | - Paul V O'Donnell
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory A Hale
- Cancer and Blood Disorders Institute, All Children's Hospital, St. Petersburg, Florida
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hillard Lazarus
- Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jane L Liesveld
- Hematology-Oncology Unit, Department of Medicine, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Zheng Zhou
- University of Massachusetts, Marlboro, Massachusetts
| | - Pashna Munshi
- Georgetown University Hospital, Washington, District of Columbia
| | - Richard F Olsson
- Karolinska Institutet, Division of Therapeutic Immunology, Stockholm, Sweden
| | - Kimberly Anne Kasow
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeffrey Szer
- Department of Hematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pintip Chitphakdithai
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Nirali Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dennis L Confer
- Center for International Blood and Bone Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota
| | - Michael A Pulsipher
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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20
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A roadmap for cost-of-goods planning to guide economic production of cell therapy products. Cytotherapy 2017; 19:1383-1391. [PMID: 28935190 DOI: 10.1016/j.jcyt.2017.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 12/31/2022]
Abstract
Cell therapy products are frequently developed and produced without incorporating cost considerations into process development, contributing to prohibitively costly products. Herein we contextualize individual process development decisions within a broad framework for cost-efficient therapeutic manufacturing. This roadmap guides the analysis of cost of goods (COG) arising from tissue procurement, material acquisition, facility operation, production, and storage. We present the specific COG considerations related to each of these elements as identified through a 2013 International Society for Cellular Therapy COG survey, highlighting the differences between autologous and allogeneic products. Planning and accounting for COG at each step in the production process could reduce costs, allowing for more affordable market pricing to improve the long-term viability of the cell therapy product and facilitate broader patient access to novel and transformative cell therapies.
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21
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Gereklioglu C, Asma S, Korur A, Tepebaşı S, Aytan P, Yeral M, Kozanoglu I, Boga C, Ozdogu H. Granulocyte-colony stimulating factor administration among hemoglobin S trait donors: A single center experience from the Eastern Mediterranean region. J Clin Apher 2017; 33:65-71. [DOI: 10.1002/jca.21566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/24/2017] [Accepted: 06/25/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Cigdem Gereklioglu
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
- Department of Family Medicine; Baskent University Medical Faculty
| | - Suheyl Asma
- Department of Family Medicine; Baskent University Medical Faculty
| | - Aslı Korur
- Department of Family Medicine; Baskent University Medical Faculty
| | - Songul Tepebaşı
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
| | - Pelin Aytan
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
| | - Mahmut Yeral
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
| | - Ilknur Kozanoglu
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
| | - Can Boga
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
| | - Hakan Ozdogu
- Baskent University Adana Adult Bone Marrow, Transplantation Center, Clinical Unit
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22
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Panch SR, Szymanski J, Savani BN, Stroncek DF. Sources of Hematopoietic Stem and Progenitor Cells and Methods to Optimize Yields for Clinical Cell Therapy. Biol Blood Marrow Transplant 2017; 23:1241-1249. [PMID: 28495640 DOI: 10.1016/j.bbmt.2017.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
Bone marrow (BM) aspirates, mobilized peripheral blood, and umbilical cord blood (UCB) have developed as graft sources for hematopoietic stem and progenitor cells (HSPCs) for stem cell transplantation and other cellular therapeutics. Individualized techniques are necessary to enhance graft HSPC yields and cell quality from each graft source. BM aspirates yield adequate CD34+ cells but can result in relative delays in engraftment. Granulocyte colony-stimulating factor (G-CSF)-primed BM HSPCs may facilitate faster engraftment while minimizing graft-versus-host disease in certain patient subsets. The levels of circulating HSPCs are enhanced using mobilizing agents, such as G-CSF and/or plerixafor, which act via the stromal cell-derived factor 1/C-X-C chemokine receptor type 4 axis. Alternate niche pathway mediators, including very late antigen-4/vascular cell adhesion molecule-1, heparan sulfate proteoglycans, parathyroid hormone, and coagulation cascade intermediates, may offer promising alternatives for graft enhancement. UCB grafts have been expanded ex vivo with cytokines, notch-ligand, or mesenchymal stromal cells, and most studies demonstrated greater quantities of CD34+ cells ex vivo and improved short-term engraftment. No significant changes were observed in long-term repopulating potential or in patient survival. Early phase clinical trials using nicotinamide and StemReginin1 may offer improved short- and long-term repopulating ability. Breakthroughs in genome editing and stem cell reprogramming technologies may hasten the generation of pooled, third-party HSPC grafts. This review elucidates past, present, and potential future approaches to HSPC graft optimization.
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Affiliation(s)
- Sandhya R Panch
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| | - James Szymanski
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Bipin N Savani
- Department of Hematology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David F Stroncek
- Cell Processing Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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