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Peck RC, Knapp-Wilson A, Burley K, Dorée C, Griffin J, Mumford AD, Stanworth S, Sharplin K. Scoping Review of Factors Associated with Stem Cell Mobilization and Collection in Allogeneic Stem Cell Donors. Transplant Cell Ther 2024:S2666-6367(24)00439-1. [PMID: 38851322 DOI: 10.1016/j.jtct.2024.06.002] [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: 03/07/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/10/2024]
Abstract
There is wide interindividual variation in the efficacy of CD34+ cell mobilization and collection in healthy allogenic hematopoietic stem cell donors. Donor characteristics, blood cell counts, and various factors related to mobilization and collection have been associated with blood CD34+ cell count and CD34+ cell yield after granulocyte colony-stimulating factor (G-CSF) mobilization and collection. Given the heterogenous nature of the literature reporting these associations, in this scoping review we clarify the determinants of CD34+ count and yield. Studies published between 2000 and 2023 reporting allogeneic donors undergoing G-CSF mobilization and peripheral blood stem cell (PBSC) collection were evaluated. Eligible studies were those that assessed blood CD34+ cell count or CD34+ cell yield in the first PBSC collection after mobilization with 4 or 5 days of G-CSF treatment. Associations were recorded between these outcomes and donor factors (age, sex, weight, ethnicity), mobilization factors (G-CSF scheduling or dose), collection factors (venous access, processed blood volume [PBV]) or laboratory factors (blood cell counts at baseline or after mobilization). The 52 studies evaluated between 15 and 20,884 donors. Forty-three studies were retrospective, 33 assessed blood CD34+ cell counts, and 39 assessed CD34+ cell yield from PBSCs. Blood CD34+ cell counts consistently predicted CD34+ cell yield. Younger donors usually had higher blood CD34+ cell counts and CD34+ cell yield. Most studies that investigated the effect of donor ancestry found that donors of non-European ancestry had higher blood CD34+ cell counts after mobilization and higher CD34+ cell yields from collection. The poor consensus about the best predictors of blood CD34+ cell count and yield necessitates further prospective studies, particularly of the role of donor ancestry. The current focus on donor sex as a major predictor requires re-evaluation.
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Affiliation(s)
- Rachel C Peck
- NHS Blood and Transplant, Bristol, United Kingdom; Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom.
| | - Amber Knapp-Wilson
- Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Kate Burley
- Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, United Kingdom
| | | | - Andrew D Mumford
- Faculty of Life Sciences, University of Bristol, Bristol, United Kingdom
| | - Simon Stanworth
- NHS Blood and Transplant, Bristol, United Kingdom; Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Avigan ZM, Dias AL, Dodge LE, Arnason JE, Joyce RM, Liegel J, Rosenblatt J, Weinstock MJ, Avigan DE, Haspel RL. High CD34-positive cell dose in matched unrelated donor allogeneic hematopoietic stem cell transplant is not associated with graft-versus-host disease or mortality. Transfusion 2024; 64:1068-1075. [PMID: 38693089 DOI: 10.1111/trf.17864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND CD34+ stem cells serve as the primary graft source for allogeneic transplants, with a minimum of 2-4 × 106 cells/kg needed for engraftment. There are conflicting data on outcomes at high stem cell doses, with studies limited by few patients receiving doses far above the minimum target. STUDY DESIGN AND METHODS In this retrospective, single-center study of patients with hematologic malignancies who underwent matched unrelated donor transplants, we assessed outcomes for engraftment, survival, relapse, and graft-versus-host disease (GVHD) for the highest CD34+ dose quintile (>13 × 106 cells/kg, n = 36) compared to the remaining patients (n = 139). Similar analysis was performed correlating T cell dose and outcomes. RESULTS There was no difference between the groups in neutrophil engraftment, with a trend toward faster platelet engraftment. There was no significant difference in mortality (adjusted risk ratio [aRR] = 1.02, 95% confidence interval [CI] = 0.85-1.22), relapse (aRR = 1.10, 95% CI = 0.85-1.42), or overall survival by Kaplan-Meier analysis (p = .44). High CD34+ dose was not associated with higher incidence of acute GVHD (aRR = 0.99 grades II-IV, aRR = 1.18 grades III-IV) or chronic GVHD (aRR = 0.87 overall, RR = 1.21 severe). There was limited correlation between CD34+ and T cell dose (R2 = .073), and there was no significant difference in survival, relapse, or GVHD in the highest T cell dose quintile (n = 33) compared to the remaining quintiles (n = 132). DISCUSSION We found no difference in survival, relapse, or GVHD incidence or severity in patients receiving CD34+ doses above prior cutoffs reported in the literature. These data do not support the routine use of graft CD34+ dose reduction.
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Affiliation(s)
- Zachary M Avigan
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ajoy L Dias
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jon E Arnason
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Robin M Joyce
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Liegel
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jacalyn Rosenblatt
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew J Weinstock
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David E Avigan
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Richard L Haspel
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Alswied A, Daniel D, Chen LN, Alqahtani T, West-Mitchell KA. CD34+ cell yield among healthy donors: Large-scale model development and validation. J Clin Apher 2024; 39:e22135. [PMID: 38924158 DOI: 10.1002/jca.22135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Successful engraftment in hematopoietic stem cell transplantation necessitates the collection of an adequate dose of CD34+ cells. Thus, the precise estimation of CD34+ cells harvested via apheresis is critical. Current CD34+ cell yield prediction models have limited reproducibility. This study aims to develop a more reliable and universally applicable model by utilizing a large dataset, enhancing yield predictions, optimizing the collection process, and improving clinical outcomes. MATERIALS AND METHODS A secondary analysis was conducted using the Center for International Blood and Marrow Transplant Research database, involving data from over 17 000 healthy donors who underwent filgrastim-mobilized hematopoietic progenitor cell apheresis. Linear regression, gradient boosting regressor, and logistic regression classification models were employed to predict CD34+ cell yield. RESULTS Key predictors identified include pre-apheresis CD34+ cell count, weight, age, sex, and blood volume processed. The linear regression model achieved a coefficient of determination (R2) value of 0.66 and a correlation coefficient (r) of 0.81. The gradient boosting regressor model demonstrated marginally improved results with an R2 value of 0.67 and an r value of 0.82. The logistic regression classification model achieved a predictive accuracy of 96% at the 200 × 106 CD34+ cell count threshold. At thresholds of 400, 600, 800, and 1000 × 106 CD34+ cell count, the accuracies were 88%, 83%, 83%, and 88%, respectively. The model demonstrated a high area under the receiver operator curve scores ranging from 0.90 to 0.93. CONCLUSION This study introduces advanced predictive models for estimating CD34+ cell yield, with the logistic regression classification model demonstrating remarkable accuracy and practical utility.
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Affiliation(s)
- Abdullah Alswied
- Department of Transfusion Medicine, National Institutes of Health (NIH) Clinical Center, NIH, Bethesda, Maryland, USA
| | - David Daniel
- Department of Transfusion Medicine, National Institutes of Health (NIH) Clinical Center, NIH, Bethesda, Maryland, USA
| | - Leonard N Chen
- Department of Transfusion Medicine, National Institutes of Health (NIH) Clinical Center, NIH, Bethesda, Maryland, USA
| | - Tariq Alqahtani
- Department of Pharmaceutical Sciences, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Kamille Aisha West-Mitchell
- Department of Transfusion Medicine, National Institutes of Health (NIH) Clinical Center, NIH, Bethesda, Maryland, USA
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Mata JR, Zahurak M, Rosen N, DeZern AE, Jones RJ, Ambinder AJ. Graft Failure Incidence, Risk Factors, and Outcomes in Patients Undergoing Non-Myeloablative Allogeneic Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide. Transplant Cell Ther 2024; 30:588-596. [PMID: 38521411 DOI: 10.1016/j.jtct.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Graft failure (GF) is a major complication of allogeneic hematopoietic cell transplantation (alloHCT) that results in significant morbidity and mortality. Post-transplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis has emerged as an effective regimen across the spectrum of donor-match settings, but few studies have investigated the characteristics of GF in the setting of PTCy-based GVHD prophylaxis. The objective was to detail the incidence, clinical features, risk factors, and outcomes for patients with primary graft failure (PGF) and secondary graft failure (SGF). In this retrospective study at a single institution, 958 consecutive patients undergoing first nonmyeloablative (NMA) alloHCT with PTCy-based GVHD prophylaxis were analyzed. PGF was defined as a failure to achieve an ANC ≥ 500 cells/m3 by day 30 of transplant in the absence of residual disease. SGF was defined as complete loss of donor chimerism after initial engraftment. The incidences of PGF and SGF were 3.8% (n = 37) and 1.8% (n = 17), respectively. Neither PGF nor SGF were associated with HLA disparity. In a multivariate analysis, risk factors for PGF in this cohort included age ≥ 65 (OR 2.4, 95% CI 1.2 to 4.8, P = .0120), an underlying diagnosis of MDS, MPN, or MDS/MPN overlap (OR 2.8, 95% CI 1.4 to 5.7, P = .0050), post-transplant viremia with HHV-6 (OR 2.9, 95% CI 1.5 to 5.7, P = .0030), and low CD34+ dose (OR 0.7, 95% CI 0.5 to 0.9, P = .0080). Patients with PGF had poor overall survival, driven primarily by a high rate of nonrelapse mortality (59% at 36 months). SGF was associated with use of a bone marrow graft source and a diagnosis of Hodgkin lymphoma. Patients with SGF had excellent clinical outcomes with only one of seventeen patients experiencing relapse and relapse-related mortality. The incidence of PGF and SGF in patients receiving NMA conditioning and PTCy is low and is not impacted by HLA disparities between donors and recipients. PGF is more common in recipients with age ≥ 65, a diagnosis of MDS, MPN, or MDS/MPN-overlap, post-transplant HHV-6 viremia, and low CD34+ cell dose. Low total nucleated cell dose is also a risk factor for PGF in patients receiving a bone marrow graft source. Patients who experience PGF have poor outcomes due to high rates of nonrelapse mortality, whereas patients who experience SGF have excellent long-term outcomes.
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Affiliation(s)
- Jonaphine Rae Mata
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marianna Zahurak
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalie Rosen
- Division of Hematology and Medical Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Amy E DeZern
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander J Ambinder
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Li J, Liu Y, Wang J, Wang Y, Pang A, Yang D, Chen X, Zhang R, Wei J, Ma Q, Zhai W, He Y, Jiang E, Han M, Feng S. Exploring strategies to optimise outcomes in hepatitis-associated aplastic anaemia patients following haematopoietic stem cell transplantation. Sci Rep 2024; 14:5178. [PMID: 38431738 PMCID: PMC10908854 DOI: 10.1038/s41598-024-55843-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
This study aimed to assess haematopoietic stem cell transplantation (HSCT) safety and efficacy while exploring strategies for optimising outcomes in patients with hepatitis-associated aplastic anaemia (HAAA). We retrospectively reviewed 35 HAAA patients who underwent HSCT at a large Chinese blood disease hospital between 2008 and 2022. HAAA patients receiving HSCT typically presented with severe (28.6%) and very severe (65.7%) AA. Male patients predominated (68.6%), with a median onset age of 23 years (range, 9-44). Haploidentical donor-HSCT and matched sibling donor-HSCT were in comparable proportions. The 5-year overall survival (OS) rate was 74.0%, with cumulative incidences of grade II-IV acute and chronic graft-versus-host disease (GVHD) at 37.1% and 22.4%, respectively. A diagnosis-to-HSCT interval ≥ 75 days, acute GVHD, and post-HSCT liver events (e.g., hepatic GVHD and a three-fold increase in aminotransferase or bilirubin) significantly worsened 5-year OS. In the multivariate models, recipients with sex-matched grafts had better OS, and those with younger male donors had a lower incidence of II-IV aGVHD. Higher HLA matching degree (HLA > = 7/10) was an independent prognostic factor associated with better OS and GFFS. A diagnosis-to-HSCT interval ≥ 75 days was predictive of post-transplant liver events in HAAA patients. In conclusion, HSCT was a safe and effective treatment for HAAA. Early transplantation, careful donor selection and improving post-transplant liver events were crucial to optimise outcomes.
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Affiliation(s)
- Jia Li
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yilin Liu
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jieru Wang
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yan Wang
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
- Department of Haematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Aiming Pang
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Donglin Yang
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Xin Chen
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Rongli Zhang
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Jialin Wei
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Qiaoling Ma
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Weihua Zhai
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Yi He
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Erlie Jiang
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Mingzhe Han
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China
- Tianjin Institutes of Health Science, Tianjin, 301600, China
| | - Sizhou Feng
- Haematopoietic Stem Cell Transplantation Center, State Key Laboratory of Experimental Haematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300020, China.
- Tianjin Institutes of Health Science, Tianjin, 301600, China.
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Lin F, Sun H, Chen Y, Zhang YY, Liu J, He Y, Zheng FM, Xu ZL, Wang FR, Kong J, Wang ZD, Wan YY, Mo XD, Wang Y, Cheng YF, Zhang XH, Huang XJ, Xu LP. [Impact of SARS-CoV-2 infection on graft composition and early transplant outcomes following allogeneic hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:890-899. [PMID: 38185517 PMCID: PMC10753252 DOI: 10.3760/cma.j.issn.0253-2727.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Indexed: 01/09/2024]
Abstract
Objective: To assess the feasibility of using donors with novel coronavirus disease 2019 (COVID-19) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) when there are no other available donors and allo-HSCT cannot be delayed or discontinued. Methods: Seventy-one patients with malignant hematological diseases undergoing allo-HSCT between December 8, 2022, and January 10, 2023, were included. Of these, 16 received grafts from donors with mild COVID-19 (D-COVID(+) group) and 55 received grafts from donors without COVID-19 (D-COVID(-) group). The graft compositions were compared between the two groups. Engraftment, acute graft-versus-host disease (aGVHD), overall survival (OS), and relapse were also evaluated. Results: There were no serious side effects or adverse events in the D-COVID(+) group. The mononuclear cell dose and CD34(+) cell dose were comparable between the two groups, and no additional apheresis was required. There were no significant differences in the lymphocyte, monocyte, and T-cell subset doses between the two groups. The median natural killer cell dose in the D-COVID(+) group was significantly higher than that in the D-COVID(-) group (0.69×10(8)/kg vs. 0.53×10(8)/kg, P=0.031). The median follow-up time was 72 (33-104) days. All patients achieved primary engraftment. The 60-day platelet engraftment rates in the D-COVID(+) and D-COVID(-) groups were 100% and (96.4±0.2) %, respectively (P=0.568). There were no significant differences in neutrophil (P=0.309) and platelet (P=0.544) engraftment times. The cumulative incidence of grade 2-4 aGVHD was (37.5±1.6) % vs. (16.4±0.3) % (P=0.062), and of grade 3-4 aGVHD was 25.0% ±1.3% vs. 9.1% ±0.2% (P=0.095) in the D-COVID(+) and D-COVID(-) groups, respectively. The probabilities of 60-day OS were 100% and 98.1% ±1.8% (P=0.522) in the D-COVID(+) and D-COVID(-) groups, respectively. There was no relapse of primary disease during the study period. Conclusion: When allo-HSCT cannot be delayed or discontinued and no other donor is available, a donor with mild COVID-19 should be considered if tolerable. Larger sample sizes and longer follow-up periods are required to validate these results.
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Affiliation(s)
- F Lin
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - H Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Y Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Y Y Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - J Liu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Y He
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - F M Zheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Z L Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - F R Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - J Kong
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Z D Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Y Y Wan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - X D Mo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Y Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - Y F Cheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - X H Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - X J Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
| | - L P Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing 100044, China
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7
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Mamo T, Sumstad D, DeFor TE, Cao Q, MacMillan ML, Brunstein C, Juckett M, McKenna DH. Harvest Quality, Nucleated Cell Dose and Clinical Outcomes in Bone Marrow Transplantation: A Retrospective Study. Transplant Cell Ther 2023; 29:638.e1-638.e8. [PMID: 37419326 PMCID: PMC10592389 DOI: 10.1016/j.jtct.2023.07.003] [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: 03/28/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/09/2023]
Abstract
Higher doses of infused nucleated cells (NCs) are associated with improved clinical outcomes in bone marrow transplantation (BMT) recipients. Most clinicians recommend infusing at least 2.0 × 108 NCs/kg. BMT clinicians request a target NC dose, but the harvested NC dose may be below the requested NC dose even before cell processing. We conducted this retrospective study to investigate the quality of bone marrow (BM) harvest and factors that influence infused NC doses at our institution. We also correlated infused NC doses with clinical outcomes. The study population included 347 BMT recipients (median age, 11 years; range, <1 to 75 years) at the University of Minnesota between 2009 and 2019. Underlying diagnoses mainly included 39% malignant and 61% nonmalignant diagnoses. Requested, harvested, and infused NC doses, as well as cell processing data, were obtained from the Cell Therapy Laboratory; clinical outcomes data were obtained from the University of Minnesota BMT Database. BM harvests were facilitated either by our institution (61%) or by the National Marrow Donor Program (39%). Associations of infused doses with baseline characteristics were assessed using the general Wilcoxon test/Pearson's correlation coefficient. The association of infused dose with neutrophil engraftment (absolute neutrophil count >500) by day 42, platelet engraftment (>20,000) by 6 months, acute graft-versus-host disease grade II-IV, and overall survival (OS) at 5 years were evaluated using regression and Kaplan-Meier curves. The median requested NC dose was 3.0 × 108/kg (range, 2 to 8 × 108/kg), and the median harvested and infused NC doses were 4.0 × 108/kg and 3.6 × 108/kg, respectively. Only 7% of donors had a harvested dose below the minimum requested dose. Moreover, the correlation between requested doses and harvested doses was adequate, with a harvested/requested dose ratio <.5 observed in only 5% of harvests. Additionally, the harvest volume and cell processing method were significantly correlated with the infused dose. Harvest volume exceeding the median of 948 mL was related to a significantly lower infused dose (P < .01). Moreover, hydroxyethyl starch (HES)/buffy coat processing (used to reduce RBCs with major ABO incompatibility) led to a significantly lower infused dose (P < .01). Donor age (median, 19 years; range, <1 to-70 years) and sex did not significantly influence the infused dose. Finally, the infused dose was significantly correlated with neutrophil and platelet engraftment (P < .05) but not with 5-year OS (P = .87) or aGVHD (P = .33). In our program's experience, BM harvesting is efficient and meets the requested minimum dose for 93% of recipients. Harvest volume and cell process play significant roles in determining the final infused dose. Minimizing harvest volume and cell processing could lead to increased infused dose and thus improved outcomes. Moreover, a higher infused dose leads to a better rate of neutrophil and platelet engraftment but not to improved OS, which may be linked to the sample size of our study.
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Affiliation(s)
- Theodros Mamo
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.
| | - Darin Sumstad
- M Health, Fairview Cell Therapy Laboratory and Molecular & Cellular Therapeutics, University of Minnesota, St Paul, Minnesota
| | - Todd E DeFor
- Masonic Cancer Center Biostatistics Core, University of Minnesota, Minneapolis, Minnesota
| | - Qing Cao
- Masonic Cancer Center Biostatistics Core, University of Minnesota, Minneapolis, Minnesota
| | - Margaret L MacMillan
- Blood and Marrow Transplantation & Cellular Therapy Program, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Claudio Brunstein
- Blood and Marrow Transplantation & Cellular Therapy Program, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mark Juckett
- Blood and Marrow Transplantation & Cellular Therapy Program, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David H McKenna
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota; M Health, Fairview Cell Therapy Laboratory and Molecular & Cellular Therapeutics, University of Minnesota, St Paul, Minnesota
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8
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Miller A, Davies J, Young K, Eckman E, Lo MY, Erskine H, Knutson L, Ondricek S, Margolis JM, Auletta JJ, Miller JP, Stefanski HE, Devine S, Pham HP. The effect of increased collect pump rate on collection efficiency in hematopoietic progenitor cell collection by apheresis in allogeneic adult donors-A single center analysis. Transfusion 2023; 63:1926-1936. [PMID: 37668194 DOI: 10.1111/trf.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Optimizing CD34 recovery while minimizing harm to hematopoietic progenitor cell donors by apheresis (HPC(A) donors) is critical to the success of allogeneic hematopoietic cell transplantation. We examined the efficacy and safety of starting allogeneic HPC(A) donors at a collect pump rate (CPR) of 2 mL/min on the Spectra Optia regardless of the inlet flow rate and/or pre-apheresis white blood cell (WBC) count (high CPR group). STUDY DESIGN AND METHODS A single-center retrospective study was performed on allogeneic adult donors from 10/2020 to 12/2022. From 10/2020 to 6/19/2022, all donors had CPR of ~1 mL/min (historical group). High CPR group started 6/20/2022. RESULTS During the study period, 412 donors were in historical group versus 196 (32.2%) in high CPR group. Median CD34 collection efficiency (CE) was higher and more consistent in high CPR group (55.1% vs. 53% in historical group, p < .0001) and remained significant in multivariate analysis. Although product volume was higher in high CPR group, WBC, hematocrit, and platelet concentrations were significantly lower. No difference in engraftment outcomes in patients receiving products from two groups was observed. Moreover, no differences occurred in a significant peri-procedural adverse event or percent decrease in platelets (6.87% decrease in platelets per 100 × 106 CD34 cells collected versus 6.66% in historical group, p = .89). Furthermore, high CPR group had ~26 min less in collection time for every 100 × 106 CD34 cells collected, resulting in less positive fluid balances. CONCLUSIONS Starting allogeneic HPC(A) donor collection at a CPR of 2 mL/min is safe and effective.
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Affiliation(s)
- Anthony Miller
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Jeramy Davies
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Kathryn Young
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Emily Eckman
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Melissa Y Lo
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Hannah Erskine
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Lisa Knutson
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Sara Ondricek
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
| | - Jamie M Margolis
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
| | | | - John P Miller
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
| | | | - Steven Devine
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
| | - Huy P Pham
- National Marrow Donor Program (NMDP), Minneapolis, Minnesota, USA
- Be The Match Seattle Apheresis Collection Center, Seattle, Washington, USA
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9
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Chen J, Gale RP, Feng Y, Hu Y, Qi S, Liu X, Zhu H, Gong X, Zhang W, Liu H, Sun Z. Are haematopoietic stem cell transplants stem cell transplants, is there a threshold dose of CD34-positive cells and how many are needed for rapid posttransplant granulocyte recovery? Leukemia 2023; 37:1963-1968. [PMID: 37474589 PMCID: PMC10539175 DOI: 10.1038/s41375-023-01973-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Junren Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China.
- Tianjin Institutes of Health Science, Tianjin, China.
| | - Robert Peter Gale
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College of Science, Technology and Medicine, London, UK
| | - Yahui Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yu Hu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Saibing Qi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Xueou Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Huaiping Zhu
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
- Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, Anhui Provincial Key Laboratory of Blood Research and Applications, University of Science and Technology of China, Hefei, China
| | - Xiaowen Gong
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Huilan Liu
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
- Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, Anhui Provincial Key Laboratory of Blood Research and Applications, University of Science and Technology of China, Hefei, China
| | - Zimin Sun
- Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
- Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, Anhui Provincial Key Laboratory of Blood Research and Applications, University of Science and Technology of China, Hefei, China.
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10
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Pedraza A, Salas MQ, Rodríguez-Lobato LG, Charry P, Suárez-Lledo M, Martínez-Cibrian N, Doménech A, Solano MT, Arcarons J, de Llobet N, Rosiñol L, Gutiérrez-García G, Avilés FF, Urbano-Ispízua Á, Rovira M, Martínez C. Effect of CD34 + Cell Dose on the Outcomes of Allogeneic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide. Transplant Cell Ther 2023; 29:181.e1-181.e10. [PMID: 36526259 DOI: 10.1016/j.jtct.2022.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
The impact of infused CD34+ cell dose on outcomes after allogeneic hematopoietic stem cell transplantation (alloHSCT) using standard graft-versus-host disease (GVHD) prophylaxis remains controversial. Information on this subject is scarce for alloHSCT using high-dose post-transplantation cyclophosphamide (PTCy). We aimed to assess the effect of CD34+ cell dose in peripheral blood stem cell (PBSC) grafts on the outcome of alloHSCT using PTCy-based GVHD prophylaxis. To do so, we conducted a single-center retrospective analysis of 221 consecutive adult patients who underwent PTCy alloHSCT from HLA-matched sibling donors (MSDs; n = 22), HLA-matched unrelated donors (MUDs; n = 83), mismatched unrelated donors (MMUDs; n = 73), and haploidentical donors (n = 43). Based on the binary partitioning method, 5 × 106/kg was used as the optimal cutoff for CD34+ cell dose. According to our institutional protocol, the maximum CD34+ cell dose was capped at 8 × 106/kg. The study cohort was divided into 2 groups based on CD34+ cell dose: high dose (>5 to 8 × 106/kg) and low dose (≤5 × 106/kg). Patients receiving high-dose CD34+-containing grafts had significantly shorter median times to neutrophil engraftment and platelet engraftment compared to those who received low-dose CD34+ (19 days versus 21 days [P = .002] and 16 days versus 22 days [P = .04], respectively). There were no differences between the high-dose and low-dose groups in the cumulative incidence of day +100 acute GVHD (grade II-IV: 25% versus 23% [P = .7]; grade III-IV: 5% versus 4% [P = .4], respectively) or 2-year chronic GVHD (moderate/severe GVHD: 9% versus 6%; P = .5). There was no impact of CD34+ cell dose on survival outcomes with the use of MSDs, MUDs, or MMUDs. Recipients of haploidentical alloHSCT using low-dose CD34+ cells had significantly worse overall survival (hazard ratio [HR], 6.01; P = .004) and relapse-free survival (HR, 4.57; P = .004). In recipients of PBSC PTCy alloHSCT, infused CD34+ cell doses >5 to 8 × 106/kg were associated with faster neutrophil and platelet engraftment, independent of donor type. Our study suggests an impact of CD34+ cell dose on survival outcomes only with haploidentical donors, for whom the administration of a CD34+ cell dose ≤5 × 106/kg significantly decreased survival outcomes.
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Affiliation(s)
- Alexandra Pedraza
- Blood Bank Department, Hematopoietic Transplantation Unit, Banc de Sang i Teixits, Hospital Clínic, Barcelona, Spain.
| | - María Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Paola Charry
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - María Suárez-Lledo
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Nuria Martínez-Cibrian
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Ariadna Doménech
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Maria Teresa Solano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Noemí de Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Gonzalo Gutiérrez-García
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Francesc Fernández Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Institute Josep Carreras, Hospital Clínic, Barcelona, Spain
| | - Álvaro Urbano-Ispízua
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Institute Josep Carreras, Hospital Clínic, Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Institute Josep Carreras, Hospital Clínic, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; Institute Josep Carreras, Hospital Clínic, Barcelona, Spain
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11
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Fielding C, García-García A, Korn C, Gadomski S, Fang Z, Reguera JL, Pérez-Simón JA, Göttgens B, Méndez-Ferrer S. Cholinergic signals preserve haematopoietic stem cell quiescence during regenerative haematopoiesis. Nat Commun 2022; 13:543. [PMID: 35087060 PMCID: PMC8795384 DOI: 10.1038/s41467-022-28175-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
The sympathetic nervous system has been evolutionary selected to respond to stress and activates haematopoietic stem cells via noradrenergic signals. However, the pathways preserving haematopoietic stem cell quiescence and maintenance under proliferative stress remain largely unknown. Here we found that cholinergic signals preserve haematopoietic stem cell quiescence in bone-associated (endosteal) bone marrow niches. Bone marrow cholinergic neural signals increase during stress haematopoiesis and are amplified through cholinergic osteoprogenitors. Lack of cholinergic innervation impairs balanced responses to chemotherapy or irradiation and reduces haematopoietic stem cell quiescence and self-renewal. Cholinergic signals activate α7 nicotinic receptor in bone marrow mesenchymal stromal cells leading to increased CXCL12 expression and haematopoietic stem cell quiescence. Consequently, nicotine exposure increases endosteal haematopoietic stem cell quiescence in vivo and impairs hematopoietic regeneration after haematopoietic stem cell transplantation in mice. In humans, smoking history is associated with delayed normalisation of platelet counts after allogeneic haematopoietic stem cell transplantation. These results suggest that cholinergic signals preserve stem cell quiescence under proliferative stress.
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Affiliation(s)
- Claire Fielding
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Andrés García-García
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Claudia Korn
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Stephen Gadomski
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
- Skeletal Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA
- NIH-Oxford-Cambridge Scholars Program in partnership with Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Zijian Fang
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Juan L Reguera
- Department of Hematology, University Hospital Virgen del Rocio, 41013, Sevilla, Spain
| | - José A Pérez-Simón
- NIH-Oxford-Cambridge Scholars Program in partnership with Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Hematology, University Hospital Virgen del Rocio, 41013, Sevilla, Spain
| | - Berthold Göttgens
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
| | - Simón Méndez-Ferrer
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK.
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK.
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.
- Instituto de Biomedicina de Sevilla (IBiS/CSIC), Universidad de Sevilla, 41013, Seville, Spain.
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, 41009, Seville, Spain.
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12
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Wang J, Yuan M, Zhu G, Wu R, Jia C, Wang B, Zheng J, Ma J, Qin M, Li S. Immune Reconstitution in Pediatric Aplastic Anemia after Allogeneic Hematopoietic Stem-cell Transplantation. Int J Med Sci 2022; 19:821-828. [PMID: 35693743 PMCID: PMC9149648 DOI: 10.7150/ijms.70146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Previous studies had revealed that immune reconstitution (IR) after allogeneic hematopoietic stem-cell transplantation (allo-HSCT) affected the clinical prognosis of patients. However, few studies were based on pediatric patients and patients with aplastic anemia (AA). The purpose of this research was to analyze IR of pediatric AA after HSCT and further explore its clinical prognostic value. Methods: The whole of 61 pediatric patients with AA who underwent HSCT were enrolled. Lymphocyte subsets count in peripheral blood, CD4+/CD8+ T cell ratio, and serum concentration of immunoglobulins were detected using flow cytometry at regular intervals after HSCT. Results: Innate immunity recovered faster than adaptive immunity, T lymphocytes recovered faster than B lymphocytes. The number of transfused CD34+ cells and the implantation time of ANC significantly affected the early rapid IR of CD3+ T cells. The degree of HLA site coincidence significantly affected the early rapid IR of CD19+ B cells. The number of transfused MNC and CD34+ cells significantly affected the early rapid IR of CD56+ NK cells. The overall survival (OS) and failure-free survival (FFS) of CD56+ NK cells in early rapid IR group were higher than those in non-IR group. The CD3+ T cell early rapid IR group and CD8+ T cell early rapid IR group had higher OS than the non-IR group. Conclusion: Early rapid IR after HSCT is a good predictor of clinical prognosis in children with AA. This study provides a reasonable prediction for early rapid IR, which may improve clinical outcomes of children.
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Affiliation(s)
- Jiayu Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Meng Yuan
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Guanghua Zhu
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Runhui Wu
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Chenguang Jia
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Bin Wang
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Jie Zheng
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Jie Ma
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Maoquan Qin
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Sidan Li
- Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.,Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Yegin ZA, Bostankolu Değirmenci B, Yazıcı Şener G, Savaş EM, Özkurt ZN, Koç HN, İlhan Ç. Variable impact of graft CD3 + cell content on graft versus host disease in hematopoietic stem cell transplant recipients: Is the role of donor CD3 + cells overestimated? Transfus Apher Sci 2021; 61:103349. [PMID: 34974969 DOI: 10.1016/j.transci.2021.103349] [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: 10/19/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
Graft cellular composition is considered as a significant determinant of transplant outcome. Donor CD3+ cells were shown to have a significant association with the development of graft vs host disease (GvHD). The aim of this study was to investigate the impact of graft CD3+ cell content on transplant outcome, particularly in terms of GvHD and relapse. We retrospectively analysed the records of 515 allo-HCT recipients [median age: 37(15-71) years; male/female: 323/192]. The optimal threshold of infused CD3+ cell count for acute GvHD development was estimated to be 197.5 × 106/kg (AUC: 0.572; 95 % CI: 0.513-0.631; p = 0.018) and 198.5 × 106/kg (AUC: 0.6; 95 % CI: 0.520-0.679; p = 0.019) for the general population and reduced-intensity conditioning (RIC) subgroup, respectively. Acute GvHD was more frequent in low-CD3+ group in the whole study population, particularly in RIC transplants. The incidence of cytomegalovirus reactivation was higher in low-CD3+ group and neutrophil engraftment occured earlier in the same group of patients. Overall survival and non-relapse mortality were comparable between high and low-CD3+ groups. Age, ECOG performance status, hypogammaglobulinemia, chronic GvHD and post-transplant relapse were found to predict prognosis in multivariate analysis. By focusing mainly on donor T cells, the potential role of host immune cells in the early post-transplant milieu may have been underestimated. Drawing a more detailed profile of graft and host immune cells in the joint microenvironment may elucidate our way to a better understanding of GvHD pathogenesis. By this way a comprehensive pre-transplant risk assessment could be improved to generate more personalized approaches.
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Affiliation(s)
- Zeynep Arzu Yegin
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey.
| | | | - Görkem Yazıcı Şener
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Emine Merve Savaş
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Zübeyde Nur Özkurt
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Hande Nur Koç
- Gazi University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Çiğdem İlhan
- Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey
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14
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Czerw T, Iacobelli S, Malpassuti V, Koster L, Kröger N, Robin M, Maertens J, Chevallier P, Watz E, Poiré X, Snowden JA, Kuball J, Kinsella F, Blaise D, Reményi P, Mear JB, Cammenga J, Rubio MT, Maury S, Daguindau E, Finnegan D, Hayden P, Hernández-Boluda JC, McLornan D, Yakoub-Agha I. Impact of donor-derived CD34 + infused cell dose on outcomes of patients undergoing allo-HCT following reduced intensity regimen for myelofibrosis: a study from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2021; 57:261-270. [PMID: 34853433 DOI: 10.1038/s41409-021-01540-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Abstract
The optimal CD34 + cell dose in the setting of RIC allo-HCT for myelofibrosis (MF) remains unknown. We retrospectively analyzed 657 patients with primary or secondary MF transplanted with use of peripheral blood (PB) stem cells after fludarabine/melphalan or fludarabine/busulfan RIC regimen. Median patient age was 58 (range, 22-76) years. Donors were HLA-identical sibling (MSD) or unrelated (UD). Median follow-up was 46 (2-194) months. Patients transplanted with higher doses of CD34 + cells (>7.0 × 106/kg), had an increased chance of achievement of both neutrophil (hazard ratio (HR), 1.46; P < 0.001) and platelet engraftment (HR, 1.43; P < 0.001). In a model with interaction, for patients transplanted from a MSD, higher CD34 + dose was associated with improved overall survival (HR, 0.63; P = 0.04) and relapse-free survival (HR, 0.61; P = 0.02), lower risk of non-relapse mortality (HR, 0.57; P = 0.04) and higher rate of platelet engraftment. The combined effect of higher cell dose and UD was apparent only for higher neutrophil and platelet recovery rate. We did not document any detrimental effect of high CD34 + dose on transplant outcomes. More bulky splenomegaly was an adverse factor for survival, engraftment and NRM. Our analysis suggests a potential benefit for MF patients undergoing RIC PB-allo-HCT receiving more than 7.0 × 106/kg CD34 + cells.
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Affiliation(s)
- Tomasz Czerw
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland.
| | | | | | | | | | - Marie Robin
- Hopital Saint Louis, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | | | | | - Emma Watz
- Karolinska University Hospital, Stockholm, Sweden
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | - Patrick Hayden
- Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Donal McLornan
- Guys' and St. Thomas' NHS Foundation Trust and University College London Hospitals, London, UK
| | - Ibrahim Yakoub-Agha
- CHfU de Lille, Université de Lille, INSERM U1286, Infinite, 59000, Lille, France
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15
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Gauntner TD, Brunstein CG, Cao Q, Weisdorf D, Warlick ED, Jurdi NE, Maakaron JE, Arora M, Betts BC, Bachanova V, Holtan SG, He FC. Association of CD34 Cell Dose with 5-Year Overall Survival after Peripheral Blood Allogeneic Hematopoietic Cell Transplantation in Adults with Hematologic Malignancies. Transplant Cell Ther 2021; 28:88-95. [PMID: 34774817 DOI: 10.1016/j.jtct.2021.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/14/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022]
Abstract
Higher CD34 cell dose is associated with improved engraftment after peripheral blood allogeneic hematopoietic stem cell transplantation (alloHCT) but also may increase the risk of long-term complications, such as graft-versus-host disease (GVHD). Prior studies examining the relationship between CD34 cell dose and long-term survival outcomes have yielded conflicting results. In this study, we sought to clarify the prognostic impact of CD34 cell dose by examining a large contemporary cohort of patients undergoing alloHCT with a matched sibling peripheral blood stem cell (PBSC) donor. We retrospectively examined the impact of CD34 cell dose on overall survival (OS), neutrophil engraftment, platelet engraftment, treatment-related mortality, relapse, acute GVHD grade II-IV and III-IV, and chronic GVHD in 377 consecutive patients undergoing alloHCT with a PBSC graft source from a matched sibling donor at the University of Minnesota between 2002 and 2015. The patients were classified into 3 groups based on the tertile (T) of CD34 cell dose received: T1, <5 × 106 cells/kg; T2, 5 to 7.5 × 106 cells/kg; and T3, ≥7.5 × 106 cells/kg. Multivariable analysis demonstrated that high CD34 cell dose was associated with superior 5-year OS (hazard ratio [HR], 0.57; P = .01) and more rapid platelet engraftment (HR, 1.70; P < .01). Higher CD34 cell dose also was associated with improved absolute neutrophil count engraftment (T2: HR, 1.54; T3: HR, 1.52; P < .01). There was no association between CD34 cell dose and TRM or relapse at 5 years. Although higher CD34 cell dose was not associated with acute GVHD grade II-IV, it was associated with chronic GVHD (T2: HR, 1.68; T3: HR, 1.50; P = .04). Our data indicate that higher CD34 cell dose (>7.5 × 106/kg) is associated with superior OS at 5 years and improved engraftment but carries an increased risk of chronic GVHD. These data support a target CD34 cell dose goal of 7.5 × 106/kg for sibling PBSC graft donors.
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Affiliation(s)
| | - Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Qing Cao
- Department of Medicine and Biostatistics and Informatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Erica D Warlick
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Najla El Jurdi
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Joseph E Maakaron
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Mukta Arora
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Brian C Betts
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Shernan G Holtan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Fiona C He
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
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16
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Tamari R, Brown S, Devlin SM, Kosuri S, Maloy MA, Ponce DM, Sauter C, Shaffer B, Dahi P, Young JW, Jakubowski A, Papadopoulos EB, Castro-Malaspina H, Perales MA, Giralt SA, Gyurkocza B. Fractionated Infusion of Hematopoietic Progenitor Cells Does Not Improve Neutrophil Recovery or Survival in Allograft Recipients. Transplant Cell Ther 2021; 27:852.e1-852.e9. [PMID: 34214736 PMCID: PMC8478895 DOI: 10.1016/j.jtct.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/11/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) offers a potentially curative therapy in patients with hematologic malignancies; however, nonrelapse mortality (NRM) remains a concern. Strategies to improve neutrophil recovery and immune reconstitution are needed to decrease NRM. Murine models of allogeneic HCT suggest that fractionated hematopoietic progenitor cell (HPC) infusion may improve engraftment through improved access of HPCs to a viable hematopoietic niche. The primary objective of the present study was to determine the impact of fractionated infusion versus unfractionated (bulk) infusion of HPCs on the time to achieve neutrophil engraftment. Secondary objectives included the effect of fractionated versus bulk infusion of HPCs on platelet engraftment, immune reconstitution, the incidence of acute graft-versus-host disease (GVHD) grade II-IV, NRM, and overall survival (OS). In this randomized phase 2 study, patients with hematologic malignancies undergoing allogeneic HCT were randomized to receive HPC infusion as a bulk (bulk arm) or in fractions (fractionated arm): 4 × 106 CD34+ cells/kg recipient weight infused on day 0, with the remaining HPCs CD34+ cell-selected then infused in equally distributed aliquots on days 2, 4, and 6 post-HCT. Randomization was stratified by type of transplant, unmodified (i.e. T cell-replete graft) versus CD34+ cell-selected (T cell-depleted graft). Patients whose donor failed to collect at least 7 × 106 CD34+ cells/kg of recipient weight received bulk HPC infusions regardless of randomization, for safety. These patients continued the HCT process on study but were replaced until each arm reached the prespecified accrual target. Per protocol, these patients were not included in this modified intention-to-treat analysis. A total of 116 patients were enrolled. Donors of 42 patients failed to mobilize the minimum CD34+ cell dose (7 × 106 cells/kg recipient weight) and were excluded from the analysis. The 74 evaluable patients included 38 randomized to the bulk arm and 36 randomized to the fractionated arm. All patients engrafted. The median time to an absolute neutrophil count of ≥0.5 × 109/L was 11 days on both arms. The day +180 median CD4+ cell count was 179 cells/µL in the bulk arm and 111 cells/µL in the fractionated arm (P = .779). The cumulative incidence of grade II-IV acute GVHD on post-transplant day +100 was 32% in the bulk arm and 17% in the fractionated arm (P = .131). Two patients in the bulk arm, but none in the fractionated arm, experienced grade III-IV GVHD. The 4-year OS was 60% in the bulk arm and 62% in the fractionated arm (P = .414), whereas the 4-year cumulative incidences of NRM and relapse were similar in the 2 arms. Fractionated infusion of HPCs in allogeneic HCT recipients did not impact neutrophil or CD4+ cell recovery, NRM, relapse, or OS when compared with bulk HPC infusion. We also observed that with current mobilization techniques, it was unlikely that more than 60% of healthy donors would be able to collect >7 × 106 CD34+ cells/kg recipient weight for adult recipients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Roni Tamari
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samantha Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Satyajit Kosuri
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Molly A Maloy
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Doris M Ponce
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig Sauter
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Brian Shaffer
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo Dahi
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - James W Young
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York; The Rockefeller University, New York, New York
| | - Ann Jakubowski
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Esperanza B Papadopoulos
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Hugo Castro-Malaspina
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio A Giralt
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Boglarka Gyurkocza
- Adult Blood and Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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17
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Huo YY, Pang AM, Cheng T. [Advance in hematopoietic and immune reconstitution of allogeneic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 41:958-963. [PMID: 33333706 PMCID: PMC7767801 DOI: 10.3760/cma.j.issn.0253-2727.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Y Y Huo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - A M Pang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - T Cheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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18
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Yu Q, Wang H, Zhang L, Wei W. Advances in the treatment of graft-versus-host disease with immunomodulatory cells. Int Immunopharmacol 2021; 92:107349. [PMID: 33486323 DOI: 10.1016/j.intimp.2020.107349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 12/19/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been widely used to treat hematological malignancies and genetic diseases. Graft-versus-host disease (GVHD) induced by donor immune system is the most common complication, contributing to severe morbidity and mortality after allo-HSCT. Currently, in terms of the prevention and treatment of GVHD, the major first-line therapeutic drugs are corticosteroids. However, most patients with systemic corticosteroid treatment are prone to steroid-refractory and poor prognosis. The use of several immune cells including Tregs, Bregs and mesenchymal stromal cells (MSCs) as an alternative on prevention or therapy of GVHD has been demonstrated to be beneficial. However, there are still many defects to a certain degree. Based on immune cells, it is promising to develop new and better approaches to improve GVHD. In this article, we will review the current advance of immune cells (Tregs, Bregs, MSCs) with negative regulation in the treatment of GVHD and present emerging strategies for the prevention and treatment of GVHD by other immune regulatory cells and chimeric antigen receptor (CAR) Tregs. In addition, these new therapeutic options need to be further evaluated in well-designed prospective multicenter trials to determine the optimal treatment for GVHD patients and improve their prognosis.
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Affiliation(s)
- Qianqian Yu
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine (Anhui Medical University), Ministry of Education, Anti-inflammatory Immune Drugs Collaborative Innovation Center, Anhui Province, Hefei 230032, China
| | - Han Wang
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine (Anhui Medical University), Ministry of Education, Anti-inflammatory Immune Drugs Collaborative Innovation Center, Anhui Province, Hefei 230032, China
| | - Lingling Zhang
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine (Anhui Medical University), Ministry of Education, Anti-inflammatory Immune Drugs Collaborative Innovation Center, Anhui Province, Hefei 230032, China.
| | - Wei Wei
- Institute of Clinical Pharmacology, Anhui Medical University, Key Laboratory of Anti-inflammatory and Immune Medicine (Anhui Medical University), Ministry of Education, Anti-inflammatory Immune Drugs Collaborative Innovation Center, Anhui Province, Hefei 230032, China.
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19
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Uçkan-Çetinkaya D, Haider KH. Induced Pluripotent Stem Cells in Pediatric Research and Clinical Translation. Stem Cells 2021. [DOI: 10.1007/978-3-030-77052-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Nivison-Smith I, Bajel A, Dodds AJ, Gottlieb D, Hamad N, Kennedy G, Kerridge I, David DF, Milliken S, Moore J, Purtill D, Szer J. Effect of donor age on adult unrelated donor hematopoietic cell transplant outcome: the Australian experience. Intern Med J 2020; 52:57-62. [PMID: 33131163 DOI: 10.1111/imj.15128] [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: 03/22/2020] [Revised: 08/11/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Results have been varied regarding the effect of donor age on the outcome of unrelated donor hematopoietic cell transplantation (HCT). AIMS This study sought to determine the influence of donor age on adult unrelated donor HCT outcome in Australia. METHODS Patients were included in the study if they were aged 16 or above and underwent first allogeneic unrelated donor HCT in Australia for the indications of acute lymphoblastic leukaemia (ALL), acute myelogenous leukaemia (AML), chronic myelogenous leukaemia (CML) or myelodysplastic syndromes (MDS) between the years of 2001 and 2014 inclusive. The main outcome measure was overall survival (OS), which was tested against independent variables using univariate Kaplan-Meier methods and multivariate Cox regression. RESULTS A total of 1,158 unrelated donor HCT were represented in the data. Cumulative incidences of engraftment, transplant related mortality (TRM), acute graft-versus-host disease (GvHD), chronic GvHD and relapse were not significantly affected by donor age. OS probability at 5 years post-transplant was 48.3%. In multivariate analysis of OS, year of transplant 2001-2007, recipient age 40 years or greater, poor risk disease, HLA match less than 6/6 and poor performance status at transplant (Karnofsky scale) were independently significant adverse OS risk factors. Donor age was not a significant risk factor for OS in univariate or multivariate analysis. CONCLUSIONS The conclusion from this study was that donor age (up to 59 years) did not influence post-transplant outcome among adult unrelated donor HCT performed in Australia for hematologic malignancies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ian Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Darlinghurst NSW, Australia
| | - Ashish Bajel
- Integrated Haematology Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anthony J Dodds
- Consultant Haematologist and Medical Director, SydPath, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - David Gottlieb
- Department of Cell Therapies, Westmead Hospital, Westmead, NSW, Australia
| | - Nada Hamad
- Dept of Haematology and SCT, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Glen Kennedy
- Division of Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - D F David
- Dept of Haematology and SCT, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Samuel Milliken
- Dept of Haematology and SCT. Dept of Haematology and SCT, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - John Moore
- Dept of Haematology and SCT, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jeff Szer
- Integrated Haematology Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
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21
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Chen J, Lazarus HM, Dahi PB, Avecilla S, Giralt SA. Getting blood out of a stone: Identification and management of patients with poor hematopoietic cell mobilization. Blood Rev 2020; 47:100771. [PMID: 33213986 DOI: 10.1016/j.blre.2020.100771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 07/15/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022]
Abstract
Hematopoietic cell transplantation (HCT) has become a primary treatment for many cancers. Nowadays, the primary source of hematopoietic cells is by leukapheresis collection of these cells from peripheral blood, after a forced egress of hematopoietic cells from marrow into blood circulation, a process known as "mobilization". In this process, mobilizing agents disrupt binding interactions between hematopoietic cells and marrow microenvironment to facilitate collection. As the first essential step of HCT, poor mobilization, i.e. failure to obtain a desired or required number of hematopoietic cell, is one of the major factors affecting engraftment or even precluding transplantation. This review summarizes the available mobilization regimens using granulocyte-colony stimulating factor (G-CSF) and plerixafor, as well as the current understanding of the factors that are associated with poor mobilization. Strategies to mobilize patients or healthy donors who failed previous mobilization are discussed. Multiple novel agents are under investigation and some of them have shown the potential to enhance the mobilization response to G-CSF and/or plerixafor. Further investigation of the risk factors including genetic factors will offer an opportunity to better understand the molecular mechanism of mobilization and help develop new therapeutic strategies for successful mobilizations.
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Affiliation(s)
- Jian Chen
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - Hillard M Lazarus
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Parastoo B Dahi
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Scott Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Sergio A Giralt
- Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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22
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Hölig K, Schmidt H, Hütter G, Kramer M, Teipel R, Heidrich K, Zimmer K, Heidenreich F, Blechschmidt M, Torosian T, Ordemann R, Kroschinsky F, Rücker-Braun E, Gopsca L, Wagner-Drouet EM, Oelschlaegel U, Schmidt AH, Bornhäuser M, Ehninger G, Schetelig J. Salvage treatment with plerixafor in poor mobilizing allogeneic stem cell donors: results of a prospective phase II-trial. Bone Marrow Transplant 2020; 56:635-645. [PMID: 33028987 PMCID: PMC8589660 DOI: 10.1038/s41409-020-01053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022]
Abstract
We conducted a prospective clinical trial to investigate the safety and efficacy of plerixafor (P) in allogeneic peripheral blood stem cells (PBSC) donors with poor mobilization response to standard-dose granulocyte colony-stimulating factor (G-CSF), defined by <2 × 106 CD34 + cells/kg recipient body-weight (CD34+/kg RBW) after 1st apheresis. A single dose of 240 µg/kg P was injected subcutaneously at 10 p.m. on the day of the 1st apheresis. Thirty-seven allogeneic PBSC donors underwent study treatment. The median CD34+ count in peripheral blood was 15/µl on Day 1 after G-CSF alone, versus 44/µl on Day 2 after G-CSF plus P (p < 0.001). The median yield of CD34+ cells was 1.1 × 108 on Day 1 and 2.8 × 108 on Day 2. In contrast to a median yield of only 1.31 × 106 CD CD34+/kg RBW on Day 1, triggering study inclusion, a median of 3.74 × 106 CD CD34+/kg RBW were collected with G-CSF plus P on Day 2. Of 37 donors, 21 reached the target cell count of >4.5 × 106 CD34+/kg RBW (57%, 95%CI 40-73%). No donor experienced a severe adverse event requiring treatment. In conclusion, P might be considered on a case-by-case basis for healthy allogeneic donors with very poor stem cell mobilization success after G-CSF.
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Affiliation(s)
- Kristina Hölig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | | | - Gero Hütter
- Cellex Collection Center GmbH, Dresden, Germany
| | - Michael Kramer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Raphael Teipel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Katharina Heidrich
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Kristin Zimmer
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Falk Heidenreich
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany.,DKMS gemeinnützige GmbH, Clinical Trials Unit, Dresden, Germany
| | - Matthias Blechschmidt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | | | | | - Frank Kroschinsky
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Elke Rücker-Braun
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Laszlo Gopsca
- National Institute of Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, Budapest, Hungary
| | - Eva Maria Wagner-Drouet
- Medizinische Klinik und Poliklinik III, Hämatologie, Internistische Onkologie, Pneumologie, Universitätsmedizin Mainz, Mainz, Germany
| | - Uta Oelschlaegel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | | | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany.,Center for Regenerative Therapies, Dresden, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU, Dresden, Germany. .,DKMS gemeinnützige GmbH, Clinical Trials Unit, Dresden, Germany.
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23
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Switzer GE, Bruce JG, Kiefer DM, Kobusingye H, Abebe KZ, Drexler R, Besser RM, Confer DL, Horowitz MM, King RJ, Shaw BE, Riches M, Hayes-Lattin B, Linenberger M, Bolwell B, Rowley SD, Litzow MR, Pulsipher MA. Health-Related Quality-of-Life Comparison of Adult Related and Unrelated HSC Donors: An RDSafe Study. Biol Blood Marrow Transplant 2020; 26:2365-2371. [PMID: 32829080 DOI: 10.1016/j.bbmt.2020.08.016] [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: 02/12/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Multiple investigations have documented the health-related quality-of-life (HRQoL) and donation-related experiences of unrelated donors (URDs), but similar investigations of the related donor (RD) experience have been less common. The central goal of this study was to longitudinally examine and compare HRQoL of RD and URD hematopoietic stem cell (HSC) donors from predonation through 1 year postdonation. This prospective investigation included adult HSC donors ages 18 to 60 years who donated bone marrow or peripheral blood stem cells at one of 48 geographically diverse US transplant/donor centers and completed HRQoL interviews at predonation and 4 weeks and 1 year postdonation. At predonation, related donors were less ambivalent about donation (t = -3.30; P = .001), more satisfied with their decision to donate (t = 2.65; P = .009), and more likely to define themselves as donors (t = 2.94; P = .004) than were URDs. However, related donors were more concerned about the use of needles (odds ratio [OR] = 2.19; P = .012), about who would pay for the procedure (OR = 2.80; P = .011), and the possibility that they would feel responsible if the transplant failed (t = 2.31; P = .022). Shortly postdonation, related donors were more likely to report donation-related pain (t = 2.50; P = .013) and lightheadedness (OR = 3.63; P = .028). At 1 year postdonation, related donors were less likely to be fully recovered from donation (OR = 0.10; P = .010) and more likely to report a longer recovery period following donation (t = 2.57; P = .011), although this latter finding was primarily due to the percentage of related versus unrelated donors not fully recovered at 1 year postdonation (10% versus 1%). Taken together, these findings suggest that current related donor management practices may be sufficient in preparing related donors for the psychological aspects of donation but that there may be more to do in terms of calibrating the description of donation-related experiences and recovery time to the related donor group (i.e., descriptions of donation experiences based on unrelated donation may not provide best estimates of experience for this group).
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Affiliation(s)
- Galen E Switzer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
| | - Jessica G Bruce
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deidre M Kiefer
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Hati Kobusingye
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Kaleab Z Abebe
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rebecca Drexler
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - RaeAnne M Besser
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Dennis L Confer
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Mary M Horowitz
- Department of Medicine, Medical College of Wisconsin, CIBMTR (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Roberta J King
- National Marrow Donor Program/Be The Match, CIBMTR (Center for International Blood and Marrow Transplant Research), Minneapolis, Minnesota
| | - Bronwen E Shaw
- Department of Medicine, Medical College of Wisconsin, CIBMTR (Center for International Blood and Marrow Transplant Research), Milwaukee, Wisconsin
| | - Marcie Riches
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Brian Bolwell
- Cleveland Clinic Lerner School of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Rowley
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey; Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Mark R Litzow
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael A Pulsipher
- Division of Hematology, Oncology, and BMT, Children's Hospital Los Angeles, Los Angeles, California
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24
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Maffini E, Labopin M, Blaise D, Ciceri F, Gülbas Z, Deconinck E, Leblond V, Chevallier P, Sociè G, Araujo MC, Koc Y, Savani BN, Gorin NC, Lanza F, Nagler A, Mohty M. CD34+ cell dose effects on clinical outcomes after T-cell replete haploidentical allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia using peripheral blood stem cells. A study from the acute leukemia working Party of the European Society for blood and marrow transplantation (EBMT). Am J Hematol 2020; 95:892-899. [PMID: 32303111 DOI: 10.1002/ajh.25826] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022]
Abstract
Previous observations have reported controversial conclusions regarding cell dose and survival endpoints after allogeneic hematopoietic stem cell transplantation (HSCT). We conducted a retrospective analysis on 414 adult patients (median age 54 years, range, 18-74 years) with acute myeloid leukemia (AML) in first and second complete remission. They received a T-cell replete allogeneic HSCT from haploidentical donors, using peripheral blood stem cells, between 2006-2018. Median number of infused CD34+ was 6.58 × 106 /kg (range, 2.2-31.2 × 106 /kg). Graft-vs-host disease (GVHD) prophylaxis was post-transplant cyclophosphamide in 293 patients and anti-lymphocyte serum in 121 patients. Conditioning was myeloablative in 179 patients and reduced-intensity in 235 patients. After a median follow-up of 23.3 months (range, 12.1-41.8 months), 2-year overall survival (OS) was 64.5% (95% CI 59.3%-69.7%) with leukemia-free survival (LFS) of 57.3% (95% CI 51.8%-62.7%) and non-relapse mortality (NRM) of 23.3% (95% CI 19%-27.7%). Grades III-IV acute GVHD day+100 incidence was 14.6% while extensive chronic GVHD was 14.4% at 2-years. Thirteen (3.2%) patients experienced graft failure. We found the optimal CD34+/kg threshold defining high (n = 334) vs low cell dose (n = 80) at 4.96 × 106 . Recipients of >4.96 × 106 /kg CD34+ cells experienced less NRM (Hazard ratio [HR] 0.48; 95% CI 0.30-0.76) and prolonged LFS (HR 0.63; 95% CI 0.43-0.91) and OS (HR 0.60; 95% CI 0.40-0.88) compared to those in the lower cell dose cohort. Larger cohort studies are needed to confirm these findings.
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Affiliation(s)
| | - Myriam Labopin
- Acute Leukemia Working Party OfficeHospital Saint Antoine Paris France
- Assistance Publique‐Hopitaux de ParisHospital Saint Antoine Paris France
- University Pierre et Marie Curie Paris France
- Institut National de la Santè et de la Recherche Médicale Unitè Mixte de Recherche en Santè Paris France
| | - Didier Blaise
- Programme de Transplantation & Therapie CellulaireCentre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes Marseille France
| | - Fabio Ciceri
- Ospedale San RaffaeleHaematology and BMT Milan Italy
| | - Zafer Gülbas
- Anadolu Medical Center HospitalBone Marrow Transplantation Department Kocaeli Turkey
| | - Eric Deconinck
- Hopital Jean MinjozService d'Hématologie Besancon France
| | - Veronique Leblond
- Universite Paris IVHopital la Pitié‐Salpêtrière, Hematologie Clinique Paris France
| | - Patrick Chevallier
- Centre Hospitalier Universitaire NantesDept. D'Hematologie Nantes France
| | - Gerard Sociè
- Hopital Saint‐LouisService d'Hematologie – BMT Paris France
| | - Mercedes C. Araujo
- Hospital U. Marqués de ValdecillaServicio de Hematología‐Hemoterapia Santander Spain
| | - Yener Koc
- Medical Park HospitalsStem Cell Transplant Unit Antalya Turkey
| | - Bipin N. Savani
- Division of Hematology and Medical OncologyVanderbilt University Medical Center Nashville Tennessee USA
| | | | | | - Arnon Nagler
- Hematology and Bone Marrow Transplantation DivisionChaim Sheba Medical Center Tel‐Hashomer Israel
- Sackler School of MedicineTel Aviv University Tel Aviv Israel
| | - Mohamad Mohty
- Saint‐Antoine Hospital Paris France
- Sorbonne University Paris France
- INSERM UMRs 938 Paris France
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25
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Remberger M, Grønvold B, Ali M, Mattsson J, Egeland T, Lundin KU, Myhre A, Abrahamsen I, Heldal D, Dybedal I, Tjønnfjord GE, Gedde-Dahl T, Fløisand Y. The CD34 + Cell Dose Matters in Hematopoietic Stem Cell Transplantation with Peripheral Blood Stem Cells from Sibling Donors. Clin Hematol Int 2020; 2:74-81. [PMID: 34595446 PMCID: PMC8432346 DOI: 10.2991/chi.d.200221.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/08/2020] [Indexed: 11/16/2022] Open
Abstract
The effect of CD34+ cell dose in allogeneic hematopoietic stem cell transplantation (HSCT) on overall survival (OS) and incidence of acute and chronic graft-versus-host disease (GvHD) has not been established and few studies have been performed. Our single center analysis included 189 patients with hematological malignancies who received peripheral blood stem cell (PBSC) grafts from sibling donors. Myeloablative conditioning was used in 88 cases and 101 received reduced intensity conditioning. The median CD34+ cell dose was 5.6 × 106/kg (0.6–17.0). In the multivariate analysis, a CD34 cell dose of 6–7 × 106/kg was associated with better OS and lower transplant-related mortality (TRM), while a dose of <5 × 106/kg led to increased relapse and reduced chronic GVHD (cGVHD). A high CD34 cell-dose (>6.5 × 106/kg) correlated with less acute GVHD (aGVHD) II–IV. We conclude that the CD34 cell dose has an impact on the outcome of HSCT from sibling donor PBSCs.
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Affiliation(s)
- M Remberger
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden
| | - B Grønvold
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - M Ali
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - J Mattsson
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - T Egeland
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - K U Lundin
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - A Myhre
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - I Abrahamsen
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - D Heldal
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - I Dybedal
- Department of Hematology, Oslo University Hospital, Oslo, Norway
| | - G E Tjønnfjord
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Gedde-Dahl
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Y Fløisand
- Department of Hematology, Oslo University Hospital, Oslo, Norway.,Centre for Cancer Cell Reprogramming, Department of Molecular Cell Biology, Oslo University Hospital, Montebello, N-0379 Oslo, Norway
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26
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Yokoyama Y, Maie K, Fukuda T, Uchida N, Mukae J, Sawa M, Kubo K, Kurokawa M, Nakamae H, Ichinohe T, Atsuta Y, Chiba S. A high CD34 + cell dose is associated with better disease-free survival in patients with low-risk diseases undergoing peripheral blood stem cell transplantation from HLA-matched related donors. Bone Marrow Transplant 2020; 55:1726-1735. [PMID: 32042104 DOI: 10.1038/s41409-020-0817-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 11/09/2022]
Abstract
To elucidate the impact of infused CD34+ cell doses on transplant outcome, we retrospectively analyzed 851 adult patients who received peripheral blood stem cell transplantation (PBSCT) from human leukocyte antigen (HLA)-matched related donors. The patients were divided into high- and low-CD34 groups at the cutoff value of 4.5 × 106/kg. Overall, the high CD34 group showed early neutrophil and platelet recovery. Stratification of disease risks demonstrated that among the patients with low-risk diseases, the high-CD34 group showed better disease-free survival (DFS) (64.9% vs. 55.5%, P = 0.0415) than did the low-CD34 group, without any increase in graft-versus-host disease (GVHD). Meanwhile, a higher CD34+ cell dose had no impacts on the outcomes of patients with high-risk diseases. Multivariate analyses for the patients with low-risk diseases revealed that a high CD34+ cell dose (hazard ratio [HR] 0.72, P = 0.048) and development of grade III-to-IV acute GVHD (HR 1.64, P = 0.018) were significantly associated with DFS. An excessive dose of CD34+ cells (>8.0 × 106/kg) led to an increase in acute GVHD. By stratification of disease risk, a CD34+ cell dose between 4.5 and 8.0 × 106/kg can be suggested for patients with low-risk diseases who undergo PBSCT from HLA-matched related donors.
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Affiliation(s)
- Yasuhisa Yokoyama
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Koichiro Maie
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Junichi Mukae
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Kohmei Kubo
- Department of Hematology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Mineo Kurokawa
- Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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27
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Allen ES, Conry-Cantilena C. Mobilization and collection of cells in the hematologic compartment for cellular therapies: Stem cell collection with G-CSF/plerixafor, collecting lymphocytes/monocytes. Semin Hematol 2019; 56:248-256. [PMID: 31836031 DOI: 10.1053/j.seminhematol.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
Abstract
An essential and influential first step in all cellular therapies is collecting donor or patient cells. In hematopoietic progenitor cell transplantation, autologous or allogeneic hematopoietic progenitor cells (HPCs) are collected from either the bone marrow or the peripheral blood. Peripheral blood collection by apheresis requires mobilization with chemotherapy, granulocyte colony stimulating factor (G-CSF), plerixafor, or a combination. The modalities of mobilization and collection each carry a unique set of risks and benefits for both the donor and the recipient. In other types of cell therapy, most notably chimeric antigen receptor T cells, lymphocytes or monocytes are collected from the peripheral blood. The risks of collecting these cells by apheresis are similar to HPCs, but less is known about the composition, timing and qualitative cell characteristics which contribute to an optimal collection. Here, we review the mobilization and collection of HPCs and the collection of lymphocytes and monocytes. Donor safety is of primary importance when collecting material for any type of cell therapy. Every aspect of mobilization and collection can be studied and potentially optimized to improve patient outcomes.
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Affiliation(s)
- Elizabeth S Allen
- Department of Pathology, University of California San Diego, La Jolla, CA.
| | - Cathy Conry-Cantilena
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
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28
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Shah NA. Allogeneic Hematopoietic Cell Transplantation in the Outpatient Setting. Biol Blood Marrow Transplant 2019; 25:e319-e320. [PMID: 31585166 DOI: 10.1016/j.bbmt.2019.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Nilay A Shah
- Atrium Health, Levine Cancer Institute, Charlotte, North Carolina.
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29
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Salas MQ, Atenafu EG, Bautista MR, Prem S, Lam W, Datt Law A, Shaibani ZA, Kim DDH, Michelis FV, Lipton JH, Viswabandya A, Mattsson J, Kumar R. Impact of CD34+ cell dose on reduced intensity conditioning regimen haploidentical hematopoietic stem cell transplantation. Eur J Haematol 2019; 104:36-45. [PMID: 31549435 DOI: 10.1111/ejh.13332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Haploidentical hematopoietic stem cell transplant (haplo-SCT) has been associated with higher rates of graft rejection, and a higher dose of CD34+ cell dose is frequently requested. We aim to explore the impact of CD34+ cell dose in peripheral blood stem cell (PBSC) grafts using reduced intensity conditioning (RIC) in haplo-SCT. METHODS Sixty-eight consecutive haplo-SCT in adult patients were included. Graft-vs-host disease (GVHD) prophylaxis consisted on ATG, PTCy, and CsA. The cohort was divided in two groups using CD34+ dose of ≥ 9 × 106 CD34+/Kg as cutoff point. Median follow-up was 8.9 months. RESULTS Median cell dose infused was 9.32 × 106 CD34+/Kg. Forty (58.8%) recipients received grafts with CD34+ cells ≥9 × 106 /kg. The infusion ≥ 9 × 106 CD34+/Kg cell dose had a negative impact in overall survival (P = .03) after adjusting for age at transplant. The cumulative incidence of acute GVHD and graft failure were not significantly influenced per CD34+ cell dose. Only four recipients had grade III aGVHD, and all of them received grafts with a CD34+ cell dose ≥ 9 × 106 . CONCLUSION In RIC haplo-SCT, recipients may not benefit from PBSC grafts with a CD34+/kg cell dose higher than 9 × 106 cells/kg, as it can have an adverse impact in post-transplant outcome.
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Affiliation(s)
- Maria Queralt Salas
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Maria Rhida Bautista
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shruti Prem
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Datt Law
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad-Al Shaibani
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rajat Kumar
- Section of Medical Oncology and Hematology, Department of Internal Medicine, University of Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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30
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Kim H, Lee KH, Sohn SK, Kim I, Kim SH, Park Y, Choi JH, Kwak JY, Kim MK, Bae SH, Shin HJ, Won JH, Lee WS, Choi Y. Effect of Stem Cell Source and Dose on Allogeneic Hematopoietic Stem Cell Transplantation in Adult Patients with Idiopathic Aplastic Anemia: Data from the Korean Aplastic Anemia Trials. Acta Haematol 2019; 143:232-243. [PMID: 31390612 DOI: 10.1159/000501496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/08/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of stem cell source and dose on the survival of various donor subgroups, such as matched sibling donor (MSDs) and alternative donors (ADs), upon bone marrow (BM) or peripheral blood stem cell (PBSC) infusion in aplastic anemia (AA). METHODS We retrospectively investigated the effects of stem cell source and dose on allogeneic hematopoietic stem cell transplantation (alloHSCT) in AA. RESULTS A total of 267 patients were included in this analysis. The BM-treated group showed an association with low incidence of any-grade acute graft versus host disease (GvHD) (p < 0.001). A higher stem cell dose was related with a low incidence of extensive chronic GvHD in MSDs (p = 0.025). Multivariate analysis for overall survival (OS) revealed that only age at alloHSCT <31 years (p = 0.010) and prior platelet transfusion <86 U (p = 0.046) in MSDs and higher stem cell dose (hazard ratio = 2.596, p = 0.045) in ADs were favorable prognostic factors. CONCLUSION PBSCs could be preferred in AD because high stem cell dose may be easily achieved to improve the OS at the expense of acute GvHD. However, BM stem cells are preferred in MSDs.
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Affiliation(s)
- Hawk Kim
- Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea,
| | - Kyoo-Hyung Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Kyun Sohn
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Inho Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Hyun Kim
- Dong-A University Medical Center, Busan, Republic of Korea
| | - Yong Park
- Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jung Hye Choi
- Hanyang University Hospital, Guri, Republic of Korea
| | - Jae-Yong Kwak
- Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Min Kyoung Kim
- Yeungnam University Medical Center, Gyeongsan, Republic of Korea
| | - Sung Hwa Bae
- Daegu Catholic University Hospital, Daegu, Republic of Korea
| | - Ho-Jin Shin
- Pusan National University Hospital, Busan, Republic of Korea
| | - Jong Ho Won
- Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Won Sik Lee
- Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Yunsuk Choi
- Division of Hematology and Cellular Therapy, Ulsan University Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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31
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Granot N, Storer BE, Cooper JP, Flowers ME, Sandmaier BM, Storb R. Allogeneic Hematopoietic Cell Transplantation in the Outpatient Setting. Biol Blood Marrow Transplant 2019; 25:2152-2159. [PMID: 31255743 DOI: 10.1016/j.bbmt.2019.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
Conditioning with fludarabine and low-dose total-body irradiation before allogeneic hematopoietic cell transplantation (HCT) enabled treating older or medically infirm patients with advanced hematologic malignancies in the outpatient setting. Between December 1997 and June 2017, 1037 patients with hematologic malignancies received peripheral blood stem cell (PBSC) grafts from HLA-matched or 1 HLA antigen/allele-mismatched related or unrelated donors. Median age was 58 (range, 18 to 80) years. Serious comorbidities with Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) scores ≥3 were present in 52% of patients. We found that 47% of patients were either never hospitalized or only had an overnight hospital stay for infusion of late-arriving PBSCs while 53% were admitted for a median of 6 days. Main reasons for admission were infection, fever, graft-versus-host disease, and regimen-related toxicity. Two thirds of admissions occurred within 3 weeks of HCT. The 5-year risk of nonrelapse mortality (NRM) was 26% among hospitalized patients and 13% among nonhospitalized patients. Significant risk factors for hospitalization included unrelated transplants, 1 HLA antigen-mismatched transplant, high HCT-CI scores, and diagnosis of nonmyeloma malignancies. Significant risk factors for NRM were hospitalization, older age, unrelated transplants, and high HCT-CI scores. Ambulatory allogeneic HCT is feasible and safe.
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Affiliation(s)
- Noa Granot
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Barry E Storer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington
| | - Jason P Cooper
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Brenda M Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington
| | - Rainer Storb
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
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Zaucha-Prażmo A, Sadurska E, Pieczonka A, Goździk J, Dębski R, Drabko K, Zawitkowska J, Lejman M, Wachowiak J, Styczyński J, Kowalczyk JR. Risk Factors for Transplant Outcomes in Children and Adolescents with Non-Malignant Diseases Following Allogeneic Hematopoietic Stem Cell Transplantation. Ann Transplant 2019; 24:374-382. [PMID: 31235684 PMCID: PMC6611216 DOI: 10.12659/aot.915330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The objective of this study was the analysis of transplant outcomes and survival in children treated with allogeneic hematopoietic cell transplantation (alloHCT) for non-malignant disorders, with a focus on risk factor analysis of transplant-related mortality (TRM). MATERIAL AND METHODS The treatment outcome was analyzed retrospectively in 10 consecutive years in 4 pediatric transplant centers in Poland. To compare the outcomes, patient data were analyzed according to the diagnosis, age at transplant, donor type, stem cell source, conditioning regimens, transplanted CD34+ cells dose, and pediatric TRM score. RESULTS From 183 analyzed patients, 27 (14.8%) died, all of them due to transplant-related complications. TRM occurred more frequently in matched unrelated donor (MUD) transplant recipients vs. matched sibling donor (MSD) transplant recipients (p=0.02); in peripheral blood (PB) recipients vs. bone marrow (BM) recipients (p=0.004); and in patients receiving >5×10⁶/kg CD34+ cells (p<0.0001). OS differed significantly according to underlying disease comparing to other diagnoses. Lower survival was found in patients transplanted from MUD (p=0.02). OS was higher in patients receiving BM (p=0.001) and in those receiving ≤5×10⁶/kg CD34+ cells (p<0.001). Multivariate analysis showed lower probability of TRM in BM recipients (p=0.04). The probability of TRM was higher in SCID patients (p=0.02) and in patients receiving >5×10⁶/kg CD34+ cells (p=0.0001). CONCLUSIONS Underlying disease, stem cell source, and CD34+ dose higher than 5×10⁶/kg were the most important risk factors for TRM, and they all affected OS.
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Affiliation(s)
- Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children's Hospital, Lublin, Poland
| | - Elżbieta Sadurska
- Department of Pediatric Cardiology, Medical University of Lublin, University Children's Hospital, Lublin, Poland
| | - Anna Pieczonka
- Department of Pediatric Oncology, Hematology, and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Jolanta Goździk
- Department of Transplantation, Clinical Immunology and Transplantation Polish-American Institute of Pediatrics, Jagiellonian University Medical College, Children's University Hospital, Cracow, Poland
| | - Robert Dębski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children's Hospital, Lublin, Poland
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children's Hospital, Lublin, Poland
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children's Hospital, Lublin, Poland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology, and Transplantology, University of Medical Sciences, Poznań, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jerzy R Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, University Children's Hospital, Lublin, Poland
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33
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Pulsipher MA, Logan BR, Kiefer DM, Chitphakdithai P, Riches ML, Rizzo JD, Anderlini P, Leitman OF, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Parameswaran V, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Confer DL, Shaw BE. Related peripheral blood stem cell donors experience more severe symptoms and less complete recovery at one year compared to unrelated donors. Haematologica 2019; 104:844-854. [PMID: 30381298 PMCID: PMC6442962 DOI: 10.3324/haematol.2018.200121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 11/26/2022] Open
Abstract
Unlike unrelated donor registries, transplant centers lack uniform approaches to related donor assessment and deferral. To test whether related donors are at increased risk for donation-related toxicities, we conducted a prospective observational trial of 11,942 related and unrelated donors aged 18-60 years. Bone marrow (BM) was collected at 37 transplant and 78 National Marrow Donor Program centers, and peripheral blood stem cells (PBSC) were collected at 42 transplant and 87 unrelated donor centers in North America. Possible presence of medical comorbidities was verified prior to donation, and standardized pain and toxicity measures were assessed pre-donation, peri-donation, and one year following. Multivariate analyses showed similar experiences for BM collection in related and unrelated donors; however, related stem cell donors had increased risk of moderate [odds ratios (ORs) 1.42; P<0.001] and severe (OR 8.91; P<0.001) pain and toxicities (OR 1.84; P<0.001) with collection. Related stem cell donors were at increased risk of persistent toxicities (OR 1.56; P=0.021) and non-recovery from pain (OR 1.42; P=0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors with more significant comorbidities were at especially high risk for grade 2-4 pain (OR 3.43; P<0.001) and non-recovery from toxicities (OR 3.71; P<0.001) at one year. Related donors reporting grade ≥2 pain had significant decreases in Health-Related Quality of Life (HR-QoL) scores at one month and one year post donation (P=0.004). In conclusion, related PBSC donors with comorbidities are at increased risk for pain, toxicity, and non-recovery at one year after donation. Risk profiles described in this study should be used for donor education, planning studies to improve the related donor experience, and decisions regarding donor deferral. Registered at clinicaltrials.gov identifier:00948636.
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Affiliation(s)
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology Chapel Hill, NC
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Paolo Anderlini
- Department of Stem Cell Transplantation and Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX
| | - O'Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - John P Miller
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Aly Abdel-Mageed
- Department of Pediatrics and Human Development, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Ibrahim A Ahmed
- Department of Hematology and Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, IN
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, CA
| | | | | | | | | | | | | | - Christopher C Dvorak
- Division of Pediatric Blood and Marrow Transplantation, University of California San Francisco Benioff Children's Hospital, CA
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Division of Hematology/Oncology-Bone Marrow Pediatric Hematology & Medical Oncology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | - Kimberly A Kasow
- Pediatric Hematology Oncology Program, Bone Marrow and Stem Cell Transplantation Program, University of North Carolina Healthcare, Chapel Hill, NC
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, OH
| | - Jane L Liesveld
- Strong Memorial Hospital - University of Rochester Medical Center, NY
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, VA
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, FL
| | | | - Vinod K Prasad
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | | | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, NY
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | - Shalini Shenoy
- Division of Hematology/Oncology, St. Louis Children's Hospital, MO
| | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL
| | | | - Madhuri Vusirikala
- Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Galen E Switzer
- Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Division of Biostatistics, Minneapolis, MN
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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34
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Pulsipher MA, Logan BR, Chitphakdithai P, Kiefer DM, Riches ML, Rizzo JD, Anderlini P, Leitman SF, Varni JW, Kobusingye H, Besser RM, Miller JP, Drexler RJ, Abdel-Mageed A, Ahmed IA, Akard LP, Artz AS, Ball ED, Bayer RL, Bigelow C, Bolwell BJ, Broun ER, Bunin NJ, Delgado DC, Duckworth K, Dvorak CC, Hahn TE, Haight AE, Hari PN, Hayes-Lattin BM, Jacobsohn DA, Jakubowski AA, Kasow KA, Lazarus HM, Liesveld JL, Linenberger M, Litzow MR, Longo W, Magalhaes-Silverman M, McCarty JM, McGuirk JP, Mori S, Prasad VK, Rowley SD, Rybka WB, Sahdev I, Schriber JR, Selby GB, Shaughnessy PJ, Shenoy S, Spitzer T, Tse WT, Uberti JP, Vusirikala M, Waller EK, Weisdorf DJ, Yanik GA, Navarro WH, Horowitz MM, Switzer GE, Shaw BE, Confer DL. Effect of Aging and Predonation Comorbidities on the Related Peripheral Blood Stem Cell Donor Experience: Report from the Related Donor Safety Study. Biol Blood Marrow Transplant 2019; 25:699-711. [PMID: 30423480 PMCID: PMC6453753 DOI: 10.1016/j.bbmt.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
The development of reduced-intensity approaches for allogeneic hematopoietic cell transplantation has resulted in growing numbers of older related donors (RDs) of peripheral blood stem cells (PBSCs). The effects of age on donation efficacy, toxicity, and long-term recovery in RDs are poorly understood. To address this we analyzed hematologic variables, pain, donation-related symptoms, and recovery in 1211 PBSC RDs aged 18 to 79 enrolled in the Related Donor Safety Study. RDs aged > 60 had a lower median CD34+ level before apheresis compared with younger RDs (age > 60, 59 × 106/L; age 41 to 60, 81 × 106/L; age 18 to 40, 121 × 106/L; P < .001). This resulted in older donors undergoing more apheresis procedures (49% versus 30% ≥ 2 collections, P < .001) and higher collection volumes (52% versus 32% > 24 L, P < .001), leading to high percentages of donors aged > 60 with postcollection thrombocytopenia <50 × 109/L (26% and 57% after 2 and 3days of collection, respectively). RDs aged 18 to 40 had a higher risk of grades 2 to 4 pain and symptoms pericollection, but donors over age 40 had more persistent pain at 1, 6, and 12 months (odds ratio [OR], 1.7; P = 0.02) and a higher rate of nonrecovery to predonation levels (OR, 1.7; P = .01). Donors reporting comorbidities increased significantly with age, and those with comorbidities that would have led to deferral by National Marrow Donor Program unrelated donor standards had an increased risk for persistent grades 2 to 4 pain (OR, 2.41; P < .001) and failure to recover to predonation baseline for other symptoms (OR, 2.34; P = .004). This information should be used in counseling RDs regarding risk and can assist in developing practice approaches aimed at improving the RD experience for high-risk individuals.
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Affiliation(s)
- Michael A Pulsipher
- Children's Hospital Los Angeles, Division of Hematology, Oncology, and Blood and Marrow Transplantation, Los Angeles, California.
| | - Brent R Logan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pintip Chitphakdithai
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Deidre M Kiefer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Marcie L Riches
- University of North Carolina Hospitals, Division of Hematology and Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paolo Anderlini
- M.D. Anderson Cancer Center, Department of Stem Cell Transplantation and Cellular Therapy, Houston, Texas
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - James W Varni
- Texas A & M University, Department of Pediatrics, College Station, Texas
| | - Hati Kobusingye
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - RaeAnne M Besser
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - John P Miller
- National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
| | - Rebecca J Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | | | - Ibrahim A Ahmed
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Luke P Akard
- Indiana Blood and Marrow Transplantation, Indianapolis, Indiana
| | | | - Edward D Ball
- University of California, San Diego Medical Center, La Jolla, California
| | | | - Carolyn Bigelow
- University of Mississippi Medical Center, Jackson, Mississippi
| | | | | | - Nancy J Bunin
- Children's Hospital of Philadelphia, Division of Oncology, Philadelphia, Pennsylvania
| | - David C Delgado
- Indiana University Hospital/Riley Hospital for Children, Indianapolis, Indiana
| | - Katharine Duckworth
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, Division of Pediatric Blood and Marrow Transplantation San Francisco, California
| | | | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Ann A Jakubowski
- Memorial Sloan Kettering Cancer Center-Adult, New York, New York
| | - Kimberly A Kasow
- University of North Carolina Healthcare, Chapel Hill, North Carolina
| | - Hillard M Lazarus
- Seidman Cancer Center-University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jane L Liesveld
- Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | | | | | - Walter Longo
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | - John M McCarty
- Virginia Commonwealth University Massey Cancer Center Bone Marrow Transplant Program, Richmond, Virginia
| | | | - Shahram Mori
- Florida Hospital Cancer Institute, Florida Center for Cellular Therapy, Orlando, Florida
| | | | | | - Witold B Rybka
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Indira Sahdev
- Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - George B Selby
- HCA Health Services of Oklahoma, Inc., University of Oklahoma, Oklahoma City, OK
| | | | | | | | - William T Tse
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Daniel J Weisdorf
- University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota
| | | | - Willis H Navarro
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dennis L Confer
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; National Marrow Donor Program/Be the Match, Minneapolis, Minnesota
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35
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Kao RL, Holtan SG. Host and Graft Factors Impacting Infection Risk in Hematopoietic Cell Transplantation. Infect Dis Clin North Am 2019; 33:311-329. [PMID: 30940461 DOI: 10.1016/j.idc.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Infection contributes significantly to morbidity and mortality in hematopoietic cell transplantation. A complex interplay of host, graft, and technical factors contributes to infectious risk in the recipient. Host factors such as age, underlying disease, and comorbidities; central venous access; and the preparative regimen contribute to mucosal disruption, organ dysfunction, and immunodeficiency before hematopoietic cell transplantation. Graft factors, including donor histocompatibility, cell source, and graft components, along with immunosuppression and graft-versus-host disease, contribute to the speed of immune reconstitution. Evaluation of these factors, plus previous and posttransplant exposure to pathogens, is necessary to best assess an individual recipient's infection risk.
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Affiliation(s)
- Roy L Kao
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, 420 Delaware Street Southeast, MMC 480, Minneapolis, MN 55455, USA.
| | - Shernan G Holtan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, 420 Delaware Street Southeast, MMC 480, Minneapolis, MN 55455, USA
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36
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Burns M, Singh AK, Hoefer CC, Zhang Y, Wallace PK, Chen GL, Platek A, Winslow TB, Iovoli AJ, Choi C, Ross M, McCarthy PL, Hahn T. Impact of conditioning regimen on peripheral blood hematopoietic cell transplant. World J Clin Oncol 2019; 10:86-97. [PMID: 30815375 PMCID: PMC6390118 DOI: 10.5306/wjco.v10.i2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/14/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate infused hematopoietic cell doses and their interaction with conditioning regimen intensity +/- total body irradiation (TBI) on outcomes after peripheral blood hematopoietic cell transplant (PBHCT).
METHODS Our retrospective cohort included 247 patients receiving a first, T-replete, human leukocyte antigen-matched allogeneic PBHCT and treated between 2001 and 2012. Correlations were calculated using the Pearson product-moment correlation coefficient. Overall survival and progression free survival curves were generated using the Kaplan-Meier method and compared using the log-rank test.
RESULTS Neutrophil engraftment was significantly faster after reduced intensity TBI based conditioning [reduced intensity conditioning (RIC) + TBI] and > 4 × 106 CD34+ cells/kg infused. A higher total nucleated cell dose led to a higher incidence of grade II-IV acute graft-versus-host disease in the myeloablative + TBI regimen group (P = 0.03), but no significant difference in grade III-IV graft-versus-host disease. A higher total nucleated cell dose was also associated with increased incidence of moderate/severe chronic graft-versus-host disease, regardless of conditioning regimen. Overall and progression-free survival were significantly better in patients with a RIC + TBI regimen and total nucleated cell dose > 8 × 108/kg (3 years, overall survival: 70% vs 38%, P = 0.02, 3 years, progression free survival: 64% vs 38%, P = 0.02).
CONCLUSION TBI and conditioning intensity may alter the relationship between infused cell doses and outcomes after PBHCT. Immune cell subsets may predict improved survival after unmanipulated PBHCT.
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Affiliation(s)
- Michael Burns
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Carrie C Hoefer
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Yali Zhang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Paul K Wallace
- Department of Flow Cytometry, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - George L Chen
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Alexis Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Timothy B Winslow
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Austin J Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Christopher Choi
- Center for Immunotherapy, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Maureen Ross
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Theresa Hahn
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
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Ono Y, Yoshioka S, Inoue K, Yoshida M, Maruoka H, Ishikawa T. Stochastic model based on preharvest peripheral CD34‐positive cell count and collection efficiency predicting processed blood volume in peripheral hematopoietic stem cell apheresis. Transfusion 2018; 59:671-680. [DOI: 10.1111/trf.15096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Yuichiro Ono
- Department of HematologyKobe City Medical Center General Hospital Kobe Japan
| | - Satoshi Yoshioka
- Department of HematologyKobe City Medical Center General Hospital Kobe Japan
| | - Kazuhisa Inoue
- Department of Clinical EngineeringKobe City Medical Center General Hospital Kobe Japan
| | - Masahiro Yoshida
- Department of Clinical LaboratoryKobe City Medical Center General Hospital Kobe Japan
| | - Hayato Maruoka
- Department of Clinical LaboratoryKobe City Medical Center General Hospital Kobe Japan
| | - Takayuki Ishikawa
- Department of HematologyKobe City Medical Center General Hospital Kobe Japan
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38
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Cao LQ, Xu LP, Zhang XH, Wang Y, Liu YR, Liu KY, Huang XJ, Chang YJ. Relationship of Cell Compositions in Allografts with Outcomes after Haploidentical Transplantation for Acquired Severe Aplastic Anemia: Effects of CD34 + and CD14 + Cell Doses. Chin Med J (Engl) 2018; 131:2185-2192. [PMID: 30203793 PMCID: PMC6144837 DOI: 10.4103/0366-6999.240810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The dose of certain cell types in allografts affects engraftment kinetics and clinical outcomes after allogeneic stem cell transplantation (SCT). Hence, the present study investigated the association of cell compositions in allografts with outcomes after unmanipulated haploidentical SCT (haplo-SCT) for patients with acquired severe aplastic anemia (SAA). Methods A total of 131 patients with SAA who underwent haplo-SCT were retrospectively enrolled. Cell subsets in allografts were determined using flow cytometry. To analyze the association of cellular compositions and outcomes, Mann-Whitney U nonparametric tests were conducted for patient age, sex, weight, human leukocyte antigen mismatched loci, ABO-matched status, patient ABO blood type, donor-recipient sex match, donor-recipient relationship, and each graft component. Multivariate analysis was performed using logistic regression to determine independent influence factors involving dichotomous variables selected from the univariate analysis. Results A total of 126 patients (97.7%) achieved neutrophil engraftment, and 121 patients (95.7%) achieved platelet engraftment. At 100 days after transplantation, the cumulative incidence of II-IV acute graft-versus-host disease (GVHD) was 32.6%. After a median follow-up of 842 (range: 124-4110) days for surviving patients, the cumulative incidence of total chronic GVHD at 3 years after transplantation was 33.7%. The probability of overall survival at 3 years was 83.0%. Multivariate analysis showed that higher total doses of CD14+ (P = 0.018) and CD34+ cells (P < 0.001) were associated with a successful platelet engraftment. A successful platelet was associated with superior survival (P < 0.001). No correlation of other cell components with outcomes was observed. Conclusions These results provide evidence and explain that higher doses of CD34+ and CD14+ cells in haploidentical allografts positively affect platelet engraftment, contributing to superior survival for patients with SAA.
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Affiliation(s)
- Le-Qing Cao
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Lan-Ping Xu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Xiao-Hui Zhang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Yu Wang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Yan-Rong Liu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Kai-Yan Liu
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
| | - Xiao-Jun Huang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044; Peking-Tsinghua Center for Life Sciences, Beijing 100871, China
| | - Ying-Jun Chang
- Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044; Collaborative Innovation Center of Hematology, Peking University, Beijing 100871, China
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Copelan EA, Chojecki A, Lazarus HM, Avalos BR. Allogeneic hematopoietic cell transplantation; the current renaissance. Blood Rev 2018; 34:34-44. [PMID: 30467067 DOI: 10.1016/j.blre.2018.11.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 12/11/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) provides the best chance for cure for many patients with malignant and nonmalignant hematologic disorders. Recent advances in selecting candidates and determining risk, procedure safety, utilization in older patients, use of alternative donors, and new or novel application of anti-cancer, immunosuppressive and antimicrobial agents have improved outcomes and expanded the role of HCT in hematologic disorders. Relapse remains the predominant cause of failure but enlightened use of new targeted and immunotherapeutic agents in combination with HCT promises to reduce relapse and further improve HCT outcomes.
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Affiliation(s)
- Edward A Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
| | - Aleksander Chojecki
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Hillard M Lazarus
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Belinda R Avalos
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
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Lara-Weisshaupt E, Tistl I, Hale K, Torosian T, Schlaphoff T, Manor S, Jindra P, Schöffel-Weiß S, Audat F, Abress L, Pingel J. Audits of collection and apheresis centers: guidelines by the World Marrow Donor Association Working Group Quality and Regulation. Bone Marrow Transplant 2018; 54:244-257. [PMID: 30108327 DOI: 10.1038/s41409-018-0252-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/27/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022]
Abstract
According to the Standards of the World Marrow Donor Association (WMDA), unrelated stem cell donor registries and donor centers are responsible for compliance of their collection and apheresis centers with these Standards. To ensure high stem cell product quality and high standards for safety and satisfaction of voluntary unrelated stem cell donors, we here present guidelines for audits of collection and apheresis centers that can be used by new and established donor registries, as well as by collection centers in preparation of audits. We define the general requirements and recommendations for collaboration with the collection and apheresis centers and define critical procedures for the collection of the stem cell product, such as information session, medical assessment, product collection, quality controls, product handover for transportation, and donor follow-up. The specific guidelines are accompanied by detailed checklists and forms that can be found in Supplementary Information and may be used during an initial or follow-up on-site or paper-based audit.
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Affiliation(s)
| | - Ingrid Tistl
- Zentrales Knochenmarkspender-Register Deutschland (ZKRD), Ulm, Germany
| | - Kuchen Hale
- National Marrow Donor Program, Minneapolis, USA
| | | | | | - Sigal Manor
- Ezer Mizion Bone Marrow Donor Registry, Petah-Tikva, Israel
| | - Pavel Jindra
- Czech National Marrow Donors Registry, Pilsen, Czech Republic
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Brunello L, Passera R, Dellacasa CM, Giaccone L, Audisio E, Ferrero D, D'Ardia S, Allione B, Aydin S, Festuccia M, Lia G, Crisà E, Maffini E, Butera S, Busca A, Bruno B. Haplo-identical allografting with post-transplant cyclophosphamide in high-risk patients. Ann Hematol 2018; 97:2205-2215. [PMID: 29987350 DOI: 10.1007/s00277-018-3433-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 07/03/2018] [Indexed: 12/19/2022]
Abstract
Haplo-identical transplants (Haplo-Tx) are an important alternative for patients with hematological malignancies who lack a HLA-identical donor. Seventy-one T-replete Haplo-Tx were performed in 70 high-risk patients at our center; 22/70 (31%) patients with refractory/relapsed leukemia received sequential salvage therapy (SeqTh) with high-dose chemotherapy followed by Haplo-Tx during the chemotherapy-induced neutropenia. Graft-versus-host disease (GVHD) prophylaxis consisted of post-transplant cyclophosphamide (days + 3 and + 4) with tacrolimus and mycophenolic acid. After a median follow-up of 29.2 months, 3-year overall survival (OS) and event-free survival (EFS) were 43.8 and 40.2%, while 3-year cumulative incidences (CIs) of non-relapse mortality (NRM) and relapse (RI) were 27 and 33%. Day 100 and day 400 CI of grade III-IV acute and moderate-severe chronic GVHD were 11 and 15%. Three-year RI was significantly lower in patients in complete remission (CR) versus those not in CR at the time of transplant (21.5 vs. 48%, p = 0.009) and in patients who received PBSC as compared to BM (22 vs. 45%, p = 0.009). In patients treated with SeqTh, 3-year OS was 19%, while 3-year RI and NRM were 52 and 28% at a median follow-up of 50 months. Overall, Haplo-Tx was feasible in heavily pretreated high-risk patients without a suitable HLA-identical donor.
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Affiliation(s)
- Lucia Brunello
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| | - Luisa Giaccone
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Department of Oncology, Division of Hematology Univ., Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Bernardino Allione
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Semra Aydin
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Moreno Festuccia
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Giuseppe Lia
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Elena Crisà
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
- Department of Oncology, Division of Hematology Univ., Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Enrico Maffini
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sara Butera
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Alessandro Busca
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy
| | - Benedetto Bruno
- Department of Oncology, SSD Trapianto Allogenico, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy.
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
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Teipel R, Oelschlägel U, Wetzko K, Schmiedgen M, Kramer M, Rücker-Braun E, Hölig K, von Bonin M, Heidrich K, Fuchs A, Ordemann R, Kroschinsky F, Bornhäuser M, Hütter G, Schmidt H, Ehninger G, Schetelig J, Heidenreich F. Differences in Cellular Composition of Peripheral Blood Stem Cell Grafts from Healthy Stem Cell Donors Mobilized with Either Granulocyte Colony-Stimulating Factor (G-CSF) Alone or G-CSF and Plerixafor. Biol Blood Marrow Transplant 2018; 24:2171-2177. [PMID: 29935214 DOI: 10.1016/j.bbmt.2018.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
This study was conducted to characterize and compare peripheral blood stem cell grafts from healthy donors who underwent granulocyte colony-stimulating factor (G-CSF) mobilization and subsequently received 1 dose of plerixafor after insufficient stem cell yields were achieved at the first apheresis. Aliquots from 35 donors were collected from the first apheresis after mobilization with G-CSF alone and from the second apheresis after additional plerixafor administration. Samples were freshly analyzed for cellular subsets by 8-color flow cytometry. Leukapheresis samples mobilized with additional plerixafor showed a significant increase of total nucleated cells, including B cells, CD4+ and CD8+ T cells, and CD34+ hematopoietic stem and progenitor cells. Absolute numbers of plasmacytoid dendritic cells were also significantly increased, whereas no changes were detected for myeloid dendritic cells. Furthermore, absolute numbers of regulatory T cells increased, with naive CD45RA+ regulatory T cells showing the highest rise. Finally, strikingly higher numbers of myeloid-derived suppressor cells were detected in the plerixafor and G-CSF-mobilized graft. The mobilization of peripheral stem cells in healthy donors with G-CSF and plerixafor led to a significant difference in cellular graft composition compared with G-CSF alone. The clinical impact of the different cell composition for the graft recipient warrants further clinical investigation.
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Affiliation(s)
- Raphael Teipel
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Uta Oelschlägel
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Katrin Wetzko
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Maria Schmiedgen
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Michael Kramer
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Elke Rücker-Braun
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Kristina Hölig
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Malte von Bonin
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany; National Center for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - Katharina Heidrich
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Anke Fuchs
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Rainer Ordemann
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany; Cellex Gesellschaft für Zellgewinnung mbH, Dresden, Germany
| | - Frank Kroschinsky
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Martin Bornhäuser
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany; Center for Regenerative Therapies Dresden, TU Dresden, Dresden, Germany; National Center for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - Gero Hütter
- Cellex Gesellschaft für Zellgewinnung mbH, Dresden, Germany
| | | | - Gerhard Ehninger
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany; National Center for Tumor Diseases, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; Cellex Gesellschaft für Zellgewinnung mbH, Dresden, Germany
| | - Johannes Schetelig
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany; DKMS, Clinical Trials Unit, Dresden, Germany
| | - Falk Heidenreich
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany; DKMS, Clinical Trials Unit, Dresden, Germany.
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CD3+ graft cell count influence on chronic GVHD in haploidentical allogeneic transplantation using post-transplant cyclophosphamide. Bone Marrow Transplant 2018; 53:1522-1531. [PMID: 29703966 DOI: 10.1038/s41409-018-0183-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
Abstract
The effects of graft or donor characteristics in haploidentical hematopoietic cell transplantation (HCT) using post-transplant cyclophosphamide (PT-Cy) are largely unknown. In this multicenter retrospective study we analyzed the correlations between graft cell composition (CD34+, CD3+) and donor features on transplant outcomes in 234 patients who underwent HCT between 2010 and 2016. On multivariate analysis, the use of peripheral blood stem cells (PBSC) was associated with an increased incidence of grade 2-4 acute GVHD [HR 1.94, 95% confidence Interval (CI) = 1.01-3.98, p = 0.05]. An elevated CD3+ graft content was associated with an increased incidence of all-grade chronic GVHD [HR 1.36 (95% CI = 1.06-1.74), p = 0.01]. This effect was confirmed only for the PBSC graft group. A higher CD34+ graft content had a protective role on non-relapse mortality [HR 0.78 (95% CI = 0.62-0.96), p = 0.02] but this was confirmed only for the bone marrow (BM)-derived graft cohort. Donor characteristics did not influence any outcomes. GVHD prophylaxis should be modulated accordingly to CD3+ graft content, especially when a PBSC graft is used. These results need further validation in prospective trials.
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Long-Term Engraftment of Primary Bone Marrow Stromal Cells Repairs Niche Damage and Improves Hematopoietic Stem Cell Transplantation. Cell Stem Cell 2018; 21:241-255.e6. [PMID: 28777945 DOI: 10.1016/j.stem.2017.07.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/08/2017] [Accepted: 07/10/2017] [Indexed: 12/11/2022]
Abstract
Hematopoietic stem cell (HSC) transplantation represents a curative treatment for various hematological disorders. However, delayed reconstitution of innate and adaptive immunity often causes fatal complications. HSC maintenance and lineage differentiation are supported by stromal niches, and we now find that bone marrow stroma cells (BMSCs) are severely and permanently damaged by the pre-conditioning irradiation required for efficient HSC transplantation. Using mouse models, we show that stromal insufficiency limits the number of donor-derived HSCs and B lymphopoiesis. Intra-bone transplantation of primary, but not cultured, BMSCs quantitatively reconstitutes stroma function in vivo, which is mediated by a multipotent NT5E+ (CD73)+ ENG- (CD105)- LY6A+ (SCA1)+ BMSC subpopulation. BMSC co-transplantation doubles the number of functional, donor-derived HSCs and significantly reduces clinically relevant side effects associated with HSC transplantation including neutropenia and humoral immunodeficiency. These data demonstrate the potential of stroma recovery to improve HSC transplantation.
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45
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Fingrut W, Rikhraj K, Allan D. Targeted recruitment of male donors for allogeneic haematopoietic cell transplantation: A review of the evidence. Vox Sang 2018; 113:307-316. [DOI: 10.1111/vox.12632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/13/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022]
Affiliation(s)
- W. Fingrut
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - K. Rikhraj
- Faculty of Medicine; University of British Columbia; BC Canada
| | - D. Allan
- Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
- Department of Medicine; University of Ottawa; Ottawa ON Canada
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Czerw T, Labopin M, Schmid C, Cornelissen JJ, Chevallier P, Blaise D, Kuball J, Vigouroux S, Garban F, Lioure B, Fegueux N, Clement L, Sandstedt A, Maertens J, Guillerm G, Bordessoule D, Mohty M, Nagler A. High CD3+ and CD34+ peripheral blood stem cell grafts content is associated with increased risk of graft-versus-host disease without beneficial effect on disease control after reduced-intensity conditioning allogeneic transplantation from matched unrelated donors for acute myeloid leukemia - an analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Oncotarget 2017; 7:27255-66. [PMID: 27036034 PMCID: PMC5053647 DOI: 10.18632/oncotarget.8463] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/23/2016] [Indexed: 12/18/2022] Open
Abstract
Inconsistent results have been reported regarding the influence of graft composition on the incidence of graft versus host disease (GVHD), disease control and survival after reduced-intensity conditioning (RIC) allogeneic peripheral blood stem cell transplantation (allo-PBSCT). These discrepancies may be at least in part explained by the differences in disease categories, disease status at transplant, donor type and conditioning. The current retrospective EBMT registry study aimed to analyze the impact of CD3+ and CD34+ cells dose on the outcome of RIC allo-PBSCT in patients with acute myelogenous leukemia (AML) in first complete remission, allografted from HLA-matched unrelated donors (10 of 10 match). We included 203 adults. In univariate analysis, patients transplanted with the highest CD3+ and CD34+ doses (above the third quartile cut-off point values, >347 x 10^6/kg and >8.25 x 10^6 /kg, respectively) had an increased incidence of grade III-IV acute (a) GVHD (20% vs. 6%, P = .003 and 18% vs. 7%, P = .02, respectively). There was no association between cellular composition of grafts and transplant-related mortality, AML relapse, incidence of chronic GVHD and survival. Neither engraftment itself nor the kinetics of engraftment were affected by the cell dose. In multivariate analysis, CD3+ and CD34+ doses were the only adverse predicting factors for grade III-IV aGVHD (HR = 3.6; 95%CI: 1.45-9.96, P = .006 and 2.65 (1.07-6.57), P = .04, respectively). These results suggest that careful assessing the CD3+ and CD34+ graft content and tailoring the cell dose infused may help in reducing severe acute GVHD risk without negative impact on the other transplantation outcomes.
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Affiliation(s)
- Tomasz Czerw
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Myriam Labopin
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the EBMT Office, Hopital Saint-Antoine APHP Paris, France.,INSERM UMRs 938, Paris, France.,Université Pierre et Marie Curie (UPMC, Paris VI), Paris, France
| | | | - Jan J Cornelissen
- Department of Hematology, Erasmus University medical center Cancer Institute, Rotterdam, The Netherlands
| | | | - Didier Blaise
- Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli Calmettes, Marseille, France
| | - Jürgen Kuball
- University Medical Centre, Department of Haematology, Utrecht, The Netherlands
| | | | - Frédéric Garban
- Hopital A. Michallon, Hématologie Clinique, Pole Cancérologie, Grenoble, France
| | | | - Nathalie Fegueux
- CHU Lapeyronie, Département d`Hématologie Clinique, Montpellier, France
| | - Laurence Clement
- Hôpital de Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Vandoeuvres les Nancy, France
| | - Anna Sandstedt
- University Hospital, Department of Hematology, Linköping, Sweden
| | - Johan Maertens
- University Hospital Gasthuisberg, Department of Hematology, Leuven, Belgium
| | | | | | - Mohamad Mohty
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the EBMT Office, Hopital Saint-Antoine APHP Paris, France.,INSERM UMRs 938, Paris, France.,Université Pierre et Marie Curie (UPMC, Paris VI), Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the EBMT Office, Hopital Saint-Antoine APHP Paris, France
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48
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Yamamoto C, Ogawa H, Fukuda T, Igarashi A, Okumura H, Uchida N, Hidaka M, Nakamae H, Matsuoka KI, Eto T, Ichinohe T, Atsuta Y, Kanda Y. Impact of a Low CD34 + Cell Dose on Allogeneic Peripheral Blood Stem Cell Transplantation. Biol Blood Marrow Transplant 2017; 24:708-716. [PMID: 29196077 DOI: 10.1016/j.bbmt.2017.10.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/14/2017] [Indexed: 11/29/2022]
Abstract
Although the CD34+ cell dose in allogeneic peripheral blood stem cell transplantation (PBSCT) is considered to be associated with transplantation outcomes, a lower acceptable threshold has not been defined. We retrospectively analyzed 2919 adult patients with hematologic malignancies who underwent related PBSCT in Japan between 2001 and 2014. According to the number of CD34+ cells in the graft, we categorized 2494 patients in the standard group (2 to 5 × 106 cells/kg), 377 patient in the low group (1 to 2 × 106 cells/kg), and 48 patients in the very low group (<1 × 106 cells/kg). Compared with the standard group, the low and very low groups showed delayed neutrophil recovery (93.8%, 89.5%, and 78.3%, respectively at day +28; P < .001) and platelet recovery (69.3%, 53.0%, and 45.5%, respectively at day +28; P < .001). The 2-year overall survival (OS) in the 3 groups was 45.5%, 45.3%, and 29.8%, respectively, with inferior survival in the very low group. However, a higher percentage of high-risk patients may account for the inferior survival in the very low group, and no significant difference in OS was found in a multivariate analysis. There were no differences in relapse, nonrelapse mortality, or the development of graft-versus-host disease among the 3 groups. In conclusion, allogeneic PBSCT with low CD34+ cell doses of 1 to 2 × 106 cells/kg gives acceptable results, whereas further investigations are needed to evaluate the effects of lower doses of <1 × 106 cells/kg owing to the smaller number and the higher percentage of patients with adverse prognostic factors in this cohort.
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Affiliation(s)
- Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hiroyasu Ogawa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hirokazu Okumura
- Department of Internal Medicine (Hematology), Toyama Prefectural Central Hospital, Toyama, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Osaka City University Hospital, Osaka, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Nagoya University Graduate School of Medicine, Department of Healthcare Administration, Nagoya, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
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49
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De Vos J, de Berranger E, Jubert C, Pochon C, Letellier C, Mialou V, Sirvent A, Yakoub-Agha I, Dalle JH. [Preservation/congelation of hematopoietic stem cell grafts in a pediatric context: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S136-S141. [PMID: 29169651 DOI: 10.1016/j.bulcan.2017.04.008] [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: 04/20/2017] [Accepted: 04/30/2017] [Indexed: 11/25/2022]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 7th allogeneic hematopoietic stem cell transplantation clinical practices harmonization workshop series in September 2016 in Lille, France. The objective of our workshop is to provide a discussion on the conservation and congelation of hematopoietic stem cells in a pediatric setting as well as our recommendations for this technique.
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Affiliation(s)
- John De Vos
- CHU de Montpellier, unité de thérapie cellulaire, 80, avenue Fliche, 34295 Montpellier cedex 5, France
| | - Eva de Berranger
- CHRU de Lille, hôpital Jean-de-Flandre, service pédiatrie et hématologie, rue Eugène-Avinée, 59037 Lille cedex, France
| | - Charlotte Jubert
- CHU Bordeaux, hôpital des enfants, unité d'hématologie oncologie pédiatrique, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Cécile Pochon
- CHU de Nancy, service d'hématologie, unité de transplantation médullaire allogénique, 54500 Vandœuvre-lès-Nancy, France
| | | | - Valérie Mialou
- Centre hospitalier Lyon Sud, établissement français du sang (EFS) Rhône Alpes, cell therapy laboratory, 69310 Pierre-Bénite, France
| | - Anne Sirvent
- CHRU de Montpellier, département d'onco-hématologie pédiatrique, 34295 Montpellier, France
| | | | - Jean-Hugues Dalle
- Université Paris 7, hôpital Robert-Debré, service d'hémato-immunologie, 75019 Paris, France.
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50
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Abstract
In contemporary clinical practice, almost all allogeneic transplantations and autologous transplantations now capitalize on peripheral blood stem cells (PBSCs) as opposed to bone marrow (BM) for the source of stem cells. In this context, granulocyte colony-stimulating factor (G-CSF) plays a pivotal role as the most frequently applied frontline agent for stem cell mobilization. For patients classified as high-risk, chemotherapy based mobilization regimens can be preferred as a first choice and it is notable that this also used for remobilization. Mobilization failure occurs at a rate of 10%-40% with traditional strategies and it typically leads to low-efficiency practices, resource wastage, and delayed in treatment intervention. Notably, however, several factors can impact the effectiveness of CD34+ progenitor cell mobilization, including patient age and medical history (prior chemotherapy or radiotherapy, disease and marrow infiltration at the time of mobilization). In recent years, main (yet largely ineffective) approach was to increase G-CSF dose and add SCF, but novel and promising pathways have been opened up by the synergistic impact of a reversible inhibitor of CXCR4, plerixafor, with G-CSF. The literature shows to its favorable results in upfront and failed mobilizers, and it is necessary to use plerixafor (or equivalent agents) to optimize HSC harvest in poor mobilizers. Different CXCR4 inhibitors, growth hormone, VLA4 inhibitors, and parathormone, have been cited as new agents for mobilization failure in recent years. In view of the above considerations, the purpose of this paper is to examine the mobilization of PBSC while focusing specifically on poor mobilizers.
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Affiliation(s)
- Sinem Namdaroglu
- Izmir Bozyaka Training and Research Hospital, Department of Hematology, Izmir, Turkey.
| | - Serdal Korkmaz
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey
| | - Fevzi Altuntas
- University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology, BMT Unit, Ankara, Turkey; Yıldırım Beyazıt University, Medical Faculty, Department of Hematology, Ankara, Turkey
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