1
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Ge S, Wang J, He Q, Zhu J, Liu P, Wang H, Zhang F. Auto-hematopoietic stem cell transplantation or chemotherapy? Meta-analysis of clinical choice for AML. Ann Hematol 2024:10.1007/s00277-024-05632-z. [PMID: 38267560 DOI: 10.1007/s00277-024-05632-z] [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: 11/14/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
For patients with acute myeloid leukemia (AML) who are not candidates for allogeneic stem cell transplantation (SCT) or do not have a human leukocyte antigen (HLA)-matched donor, it is unclear whether autologous SCT (ASCT) has a better prognosis after the first complete response (CR1) compared to further chemotherapy treatment. A meta-analysis evaluating ASCT compared to further chemotherapy for AML patients in CR1 was performed. The Medline, Embase, Cochrane Controlled Trials Registry, Cochrane Library, Web of Science, and National Knowledge Infrastructure of China databases were searched for relevant literature as of May 26, 2023. Eligible studies included prospectively enrolled adults with AML and randomized first-time respondent patients who did not have a matched sibling donor. Fourteen randomized controlled trials were identified and included 4281 participants, of which 1499 patients received ASCT and 2782 underwent chemotherapy and continued follow-up. In patients with AML in CR1, a lower relapse rate was associated with ASCT compared to chemotherapy [odds ratio (OR) = 0.49, 95% confidence interval (CI) = 0.41-0.57]. Significant disease-free survival (DFS; OR = 1.37, 95% CI = 1.02-1.84) and relapse-free survival (RFS; OR = 2.78, 95% CI = 1.28-6.02) ASCT benefits were documented, and there was no difference in the overall survival (OS) when the studies were pooled (OR = 1.12, 95% CI = 0.85-1.48). The study results indicated that after the first remission, AML patients receiving autologous stem cell transplantation had higher DFS and RFS, similar OS, and lower relapse compared to patients undergoing chemotherapy treatment. This indicated that autologous stem cell transplantation may have a better prognosis.
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Affiliation(s)
- Songyu Ge
- First Clinical College, China Medical University, Shenyang, Liaoning Province, China
| | - Jining Wang
- Second Clinical College, China Medical University, Shenyang, Liaoning Province, China
| | - Qin He
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jiaqi Zhu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Pai Liu
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongtao Wang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Fan Zhang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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2
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Lebel E, Lajkosz K, Masih-Khan E, Reece D, Trudel S, Tiedemann R, Prica A, Kukreti V, Chen C. The Impact of CD34 + Cell Collection Yields for Autologous Transplant on Survival Outcomes in Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:850-856. [PMID: 37689547 DOI: 10.1016/j.clml.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION According to previous data, higher yields of stem-cells collected to support autologous transplantation may predict for improved outcomes. We aimed to assess the association between high stem-cells collection and survival outcomes in multiple myeloma (MM) MATERIALS AND METHODS: We reviewed all patients who underwent autologous transplantation for MM at our center over a 10-year period, and initially used a predefined threshold of 8 × 106/kg used in previous studies. RESULTS Six hundred twenty-one patients were analyzed. Higher mobilization did not correlate with favorable outcomes post-transplant. The most efficient mobilizers, collecting ≥8 × 106/kg (n = 478) achieved a shorter median progression-free survival (PFS) of 24.1m versus 34.5m in patients collecting 4.5 to 8 × 106/kg (n = 129). A small group (n = 14) collecting ≤4.5 × 106/kg but minimum of 2 × 106/kg to support autologous transplantation exhibited the worst outcomes (median PFS 11.4m). Further analysis of potential confounders identified greater use of bortezomib induction in the lower mobilizers, however, sensitivity analysis in patients receiving bortezomib revealed similar results- worst outcomes to the most efficient mobilizers. CONCLUSION Although bortezomib is not considered stem-cell toxic, it may be associated with lower stem cell collection yields. Bortezomib's efficacy at induction may partially explain the improved outcomes, however, other factors may be involved, and are discussed. We can conclude that with our large cohort and long follow-up, high stem-cell mobilization does not appear to predict for a long-term survival advantage.
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Affiliation(s)
- Eyal Lebel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Hematology department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Esther Masih-Khan
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Donna Reece
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Suzanne Trudel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rodger Tiedemann
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vishal Kukreti
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Christine Chen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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3
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Perrone S, Capria S, Bernardi M, Marchesi F, Ortu La Barbera E, Trisolini SM, Minotti C, Shafii Bafti M, Scerpa MC, Mulé A, Ciceri F, Martelli M, Cimino G. Impact of gemtuzumab ozogamicin consolidation on hematopoietic stem cells (HSCs) mobilization in AML: analysis of 20 patients. Ann Hematol 2023; 102:769-775. [PMID: 36795117 DOI: 10.1007/s00277-023-05129-1] [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: 08/08/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
Gemtuzumab ozogamicin (GO), is an anti-CD33 monoclonal antibody, approved for AML CD33 + , those patients with low and intermediate-risk who obtain a complete response may also be candidated for consolidation with autologous stem cell transplantation (ASCT). However, there are scant data on the mobilization of hemopoietic stem cells (HSC) after fractionated GO. We retrospectively studied data from five Italian centers and identified 20 patients (median age 54 years, range 29-69, 15 female, 15 NPM1mutated) that attempted HSC mobilization after fractionated doses of GO + "7 + 3" regimen and 1-2 cycles of consolidation (GO + HDAC + daunorubicin). After chemotherapy and standard G-CSF, 11/20 patients (55%) reached the threshold of 20 CD34 + /µL, and HSC were successfully harvested, while 9 patients (45%) failed. The median day of apheresis was Day + 26 from the start of chemotherapy (range 22-39 days). In good mobilizer patients, the median circulating CD34 + cells were 35.9 cells/µL and the median CD34 + harvested were 4.65 × 106/kg of patients' body weight. With a median follow-up of 12.7 months, at 24 months from the first diagnosis, 93.3% of all 20 patients were alive and the median overall survival was 25 months. The 2-year RFS rate from the timepoint of the first CR was 72.6%, while the median RFS was not reached. However, only five patients underwent ASCT and achieved full engraftment.In conclusion, in our cohort of patients, the addition of GO reduced HSC mobilization and harvesting, which was reached in about 55% of patients. Nevertheless, further studies are warranted to evaluate the effects of fractionated doses of GO on HSC mobilization and ASCT outcomes.
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Affiliation(s)
- Salvatore Perrone
- Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, 04100, Latina, Italy.
| | - Saveria Capria
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Massimo Bernardi
- University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri (I.F.O.), Rome, Italy
| | - Elettra Ortu La Barbera
- Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, 04100, Latina, Italy
| | - Silvia Maria Trisolini
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Clara Minotti
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Mahnaz Shafii Bafti
- Department of Immunohematology and Transfusional Medicine, AOUP Umberto I, Rome, Italy
| | - Maria Cristina Scerpa
- Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, 04100, Latina, Italy
| | - Antonino Mulé
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Martelli
- Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cimino
- Hematology, Polo Universitario Pontino, "Sapienza", Via A. Canova S.M. Goretti Hospital, 04100, Latina, Italy.,Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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4
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Nagler A, Galimard J, Labopin M, Blaise D, Arcese W, Trisolini SM, Wu D, Pigneux A, Van Gorkom G, Rubio M, Gedde‐Dahl T, Huynh A, Lanza F, Gorin N, Mohty M. Autologous stem cell transplantation (ASCT) for acute myeloid leukemia in patients in first complete remission after one versus two induction courses: A study from the ALWP of the EBMT. Cancer Med 2022; 12:1482-1491. [PMID: 35891608 PMCID: PMC9883552 DOI: 10.1002/cam4.5039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Achieving complete remission (CR) is the main goal in AML treatment and a prerequisite for successful autologous stem cell transplantation (ACT). METHODS Comparing results of peripheral blood ACT in patients with AML in CR1 attained following 1 versus 2 chemotherapy courses transplanted in 2000-2019. RESULTS Patients 1532 (84%) with one and 293 (16%) patients with two induction chemotherapies courses (a total of 1825 patients) were included in the study. Follow-up was 7.9 (95% CI: 7.4-8.4) and 7.7 (95% CI: 7.0-8.6) years (p = 0.8). Time from diagnosis to ACT was 4.7 (range, 3.9-5.8) versus 5.7 (range, 4.7-7.1) months (p < 0.001), respectively. Leukemia free survival (LFS) and overall survival (OS) at 5 years were inferior for patients achieving CR1 with 2 versus 1 course of chemotherapy: 26.6% versus 41.7% (HR = 1.42 [95% CI: 1.22-1.66], p < 0.001) and 36.2% versus 53.3%, (HR = 1.48 [95% CI: 1.25-1.75], p < 0.001), and 5-year relapse incidence (RI) was higher: 67.2% versus 52.3%, (HR = 1.46 [95% CI: 1.25-1.72], p < 0.001). Five-year non-relapse mortality (NRM) was 6.2% versus 6.0% for patients with 2 versus 1 chemotherapy courses, and did not differ significantly (HR = 1.31 [95% CI: 0.81-2.10], p = 0.27). CONCLUSIONS LFS and OS were inferior and relapse rate was higher in AML patients who received two inductions chemotherapy courses to reach CR1 before being autografted. AML patients who required 2 induction courses to achieve remission, may be offered allogeneic transplantation rather than an autologous one in an attempt to reduce their high RI and improve outcomes.
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Affiliation(s)
- Arnon Nagler
- Division of HematologySheba Medical CenterTel HashomerIsrael
| | | | - Myriam Labopin
- EBMT Statistical UnitParisFrance,Department of Clinical Hematology and Cellular Therapy, Saint‐Antoine Hospital, AP‐HPSorbonne UniversityParisFrance,Sorbonne University, INSERM, Saint‐Antoine Research CentreParisFrance
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire; Centre de Recherche en Cancérologie de MarseilleInstitut Paoli CalmettesMarseilleFrance
| | | | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision MedicineSapienza UniversityRomeItaly
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Department of HematologySuzhouChina
| | - Arnaud Pigneux
- Service d'Hématologie et Thérapie Cellulaire, CHU BordeauxBordeauxFrance
| | - Gwendolyn Van Gorkom
- University Hospital Maastricht, Department of Internal Medicine Hematology/OncologyMaastrichtThe Netherlands
| | - Marie‐Thérèse Rubio
- Department of Hematology, Brabois HospitalCentre Hospitalier Régional Universitaire (CHRU)NancyFrance
| | - Tobias Gedde‐Dahl
- Department of Hematology, Institute of Clinical MedicineUniversity of Oslo and Oslo University Hospital‐RikshospitaletOsloNorway
| | - Anne Huynh
- Hematology DepartmentInstitut Universitaire du Cancer Toulouse‐OncopoleToulouseFrance
| | | | - Norbert‐Claude Gorin
- Department of Clinical Hematology and Cellular Therapy, Saint‐Antoine Hospital, AP‐HPSorbonne UniversityParisFrance,Sorbonne University, INSERM, Saint‐Antoine Research CentreParisFrance
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint‐Antoine Hospital, AP‐HPSorbonne UniversityParisFrance,Sorbonne University, INSERM, Saint‐Antoine Research CentreParisFrance
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5
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Capria S, Trisolini SM, Diverio D, Minotti C, Breccia M, Cartoni C, Carmini D, Gozzer M, La Rocca U, Shafii Bafti M, Martelli M. Autologous stem cell transplantation in favorable-risk acute myeloid leukemia: single-center experience and current challenges. Int J Hematol 2022; 116:586-593. [PMID: 35551633 DOI: 10.1007/s12185-022-03370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) has gained growing consideration as a treatment option for favorable-risk acute myeloid leukemia (FR-AML) in first complete remission (CR1), compared with chemotherapy. MATERIALS AND METHODS We report the long-term outcomes of 117 consecutive patients with FR-AML fit for intensive chemotherapy diagnosed in our center between 1999 and 2020, who underwent ASCT. RESULTS Sixty-five of the 117 were eligible for intensive post-remission treatment, and 42 of those 65 received ASCT. Median follow up was 132 months. Overall survival (OS) and disease-free survival (DFS) were 75% and 76%. Higher doses of CD34 + stem cell infusions negatively impacted DFS in multivariate analysis. Core-binding factor (CBF) leukemia was an independent prognostic factor for improved DFS. No differences based on pre-transplant measurable residual disease (MRD) were observed. In CBF leukemia, 10-year DFS is 72% for MRD-positive patients versus 100% for MRD negative patients. CONCLUSIONS ASCT is effective and safe in FR-AML patients. In CBF leukemia, ASCT provides excellent results regardless of achievement of bone marrow MRD negativity. In NPM1-mutated/FLT3-wild type (mNPM1) AML, early molecular response seems to have more impact on prognosis. Prospective investigation of the role of gemtuzumab ozogamicin in this setting is ongoing.
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Affiliation(s)
- Saveria Capria
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy.
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
| | - Daniela Diverio
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
| | - Clara Minotti
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
| | - Claudio Cartoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
| | - Daniela Carmini
- Department of Immunohematology and Transfusional Medicine, AOU Policlinico Umberto I, Rome, Italy
| | - Maria Gozzer
- Department of Immunohematology and Transfusional Medicine, AOU Policlinico Umberto I, Rome, Italy
| | - Ursula La Rocca
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
| | - Mahnaz Shafii Bafti
- Department of Immunohematology and Transfusional Medicine, AOU Policlinico Umberto I, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University Policlinico Umberto I, Via Benevento 6, 00161, Rome, Italy
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6
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Pang A, Huo Y, Shen B, Zheng Y, Jiang E, Feng S, Han M. Optimizing autologous hematopoietic stem cell transplantation for acute leukemia. Stem Cells Transl Med 2021; 10 Suppl 2:S75-S84. [PMID: 34724713 PMCID: PMC8560201 DOI: 10.1002/sctm.21-0176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 12/31/2022] Open
Abstract
Autologous hematopoietic stem cell transplantation (ASCT) remains an important postremission treatment for acute leukemia (AL). It is known that some prognostic factors, such as age, cytogenetic and molecular risk stratification, and minimal residual disease (MRD) status, are closely related to clinical outcomes following ASCT. Moreover, there are multiple measurements, including pretransplant treatment, stem cell mobilization and collection, conditioning regimens, and maintenance treatment after transplantation, that can affect prognosis after ASCT. Our clinical practice of ASCT should be better standardized to further improve patient outcomes. This review outlines optimization and quality control measures for ASCT developed at the Institute of Hematology and Blood Diseases Hospital of the Chinese Academy of Medical Sciences, the first established and largest autologous stem cell transplant center in China. These measures will enhance the development of best practices and strategies for AL ASCT therapies, thereby improving patient outcomes.
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Affiliation(s)
- Aiming Pang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
| | - Yingying Huo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
| | - Biao Shen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
| | - Yawei Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
| | - Erlie Jiang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
| | - Sizhou Feng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
| | - Mingzhe Han
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeTianjinPeople's Republic of China
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7
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CD64-targeted HO-1 RNA interference enhances chemosensitivity in orthotopic model of acute myeloid leukemia and patient-derived bone marrow cells. Biomaterials 2020; 230:119651. [DOI: 10.1016/j.biomaterials.2019.119651] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023]
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8
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de Benito ADS, Jeker B, Gfeller E, Porret N, Banz Y, Novak U, Bacher U, Pabst T. Molecular minimal residual disease negativity and decreased stem cell mobilization potential predict excellent outcome after autologous transplant in NPM1 mutant acute myeloid leukemia. Haematologica 2019; 105:e9-e12. [PMID: 31123030 DOI: 10.3324/haematol.2019.216457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Barbara Jeker
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern.,Center for Hemato-Oncology, University Cancer Institute; University Hospital and University of Bern, Bern
| | - Eva Gfeller
- Department of Hematology and Center of Laboratory Medicine (ZLM), Inselspital; University Hospital and University of Bern, Bern
| | - Naomi Porret
- Department of Hematology and Center of Laboratory Medicine (ZLM), Inselspital; University Hospital and University of Bern, Bern
| | - Yara Banz
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern.,Center for Hemato-Oncology, University Cancer Institute; University Hospital and University of Bern, Bern
| | - Ulrike Bacher
- Department of Hematology and Center of Laboratory Medicine (ZLM), Inselspital; University Hospital and University of Bern, Bern
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern .,Center for Hemato-Oncology, University Cancer Institute; University Hospital and University of Bern, Bern
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9
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Autologous Hematopoietic Stem Cell Transplantation in Acute Myelogenous Leukemia. Biol Blood Marrow Transplant 2019; 25:e285-e292. [PMID: 31054985 DOI: 10.1016/j.bbmt.2019.04.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/15/2022]
Abstract
The clinical outcomes of autologous hematopoietic stem cell transplantation (ASCT) in acute myelogenous leukemia (AML) have improved over time. Indeed, numerous studies have demonstrated that ASCT is associated with a lower relapse rate and acceptable nonrelapse mortality compared with chemotherapy alone in patients with AML. In addition, ASCT is also associated with comparable overall survival outcomes to those of allogeneic hematopoietic stem cell transplantation in some patients with AML. To date, age, cytogenetic and molecular risk stratification, and minimal residual disease (MRD) status have been shown to be closely related to clinical outcomes following ASCT. ASCT is recommended for patients with favorable-risk and intermediate-risk AML in first complete remission and patients with acute promyelocytic leukemia in second complete remission for whom a matched sibling donor is not available. MRD status pre-ASCT is the most important factor to consider when determining whether a patient is eligible for ASCT and can effectively predict clinical outcomes after ASCT. Advanced age is not an absolute contradiction for ASCT. In this review, we describe the literature and clinical trials evaluating the outcomes of ASCT in patients with AML and discuss the indications for ASCT therapy. Because the greatest concern in ASCT recipients is early relapse, important factors that should be monitored before ASCT and future perspectives in this area are also presented.
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10
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Zhao YQ, Feng SZ. [Advances in autologous stem cell transplantation for acute myeloid leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:247-251. [PMID: 30929397 PMCID: PMC7342529 DOI: 10.3760/cma.j.issn.0253-2727.2019.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Y Q Zhao
- Blood Diseases Hospital and Institute of Hematology, CAMS & PUMC, Tianjin 300020, China
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11
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Fu X, Shang Y, Zhang L, Li L, Li X, Wang X, Sun Z, Zhang M. Analyses and treatment of simultaneous bi-lineage malignancies of myeloid leukemia and lymphoma: Two case reports and a literature review. Oncol Lett 2018; 16:6624-6632. [PMID: 30405801 PMCID: PMC6202486 DOI: 10.3892/ol.2018.9447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/06/2018] [Indexed: 12/23/2022] Open
Abstract
The present study reports two cases of concurrently diagnosed T-lymphoblastic lymphoma (T-LBL) and chronic myeloid leukemia (CML). The literature review revealed that myeloid leukemia may appear secondary to Hodgkin lymphoma or non-Hodgkin lymphoma. However, simultaneous bi-lineage hematologic malignancies are rarely seen and the prognosis is worse than single lineage lymphoma or myeloid leukemia. There were no standard therapies. All simultaneous bi-lineage malignancies of myeloid leukemia and lymphoma reported in Pubmed were combined with the present two cases, to analyses its pathogenesis, features and treatment. It was concluded that the prognosis of bi-lineage hematologic malignancies was poor, however allogeneic hematopoietic stem cell transplantation could improve survival (P=0.033).
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Affiliation(s)
- Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Yufeng Shang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450002, P.R. China.,Lymphoma Diagnosis and Treatment Center, Zhengzhou, Henan 450002, P.R. China
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12
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Alva LC, Bacher U, Seipel K, Mansouri Taleghani B, Mueller BU, Novak U, Pabst T. Iron overload is correlated with impaired autologous stem cell mobilization and survival in acute myeloid leukemia. Transfusion 2018; 58:2365-2373. [PMID: 30203418 DOI: 10.1111/trf.14895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) undergoing consolidation with autologous stem cell transplantation (ASCT) depend on the successful mobilization of peripheral blood stem cells. However, the factors affecting the mobilization potential in AML patients and, in particular, the effect of transfusion-related iron overload on peripheral blood stem cell mobilization are largely unknown. STUDY DESIGN AND METHODS We investigated the association of varying levels of iron overload and stem cell mobilization efficacy in consecutive AML patients after two induction cycles. RESULTS A total of 113 AML patients in early first complete remission underwent the mobilization procedure. While 84 (74.3%) patients had serum ferritin levels exceeding 1000 μg/L, 26 (23.0%) patients had levels even higher than 2000 μg/L. Iron overload correlated with the number of preceding red blood cell transfusions and inversely correlated with circulating CD34+ cell levels (p = 0.04) at apheresis. Finally, the median progression-free and overall survival rates of patients with ferritin levels of higher than 2000 μg/L were shorter with 332 days versus 2156 days (p = 0.04) and 852 days versus 2235 days (p = 0.04), respectively. CONCLUSION Our data suggest that transfusion-related iron overload is suppressing the mobilization potential and is associated with inferior outcome in AML.
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Affiliation(s)
- Laura C Alva
- Department of Medical Oncology, Bern University Hospital, University of Bern, Switzerland
| | - Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Katja Seipel
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | | | - Beatrice U Mueller
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Bern University Hospital, University of Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Bern University Hospital, University of Bern, Switzerland
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13
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The effects of lower CD34 yields after lowe dose G-CSF induction on long-term autologous stem cell transplantation outcome: A single center study. Transfus Apher Sci 2018; 57:265-271. [PMID: 29605509 DOI: 10.1016/j.transci.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/15/2018] [Accepted: 03/18/2018] [Indexed: 12/15/2022]
Abstract
Peripheral blood stem cell transplantation (PBSCT) is an effective treatment for hematological malignancies. Mobilization of peripheral blood stem cells performs in different ways among transplantation centers. Since the Effects of lower CD34+ cells dose after low dose G-CSF induction on autologous stem cell transplantation outcomes are not studied much, so this study was performed for this purpose. 735 autologous stem cell transplanted patients with diagnoses of multiple myeloma (n = 330), Hodgkin lymphoma (n = 200), non-Hodgkin lymphoma (n = 129), acute myeloid leukemia (n = 54) and solid tumors (n = 22) were retrospectively evaluated. G-CSF was administered at the dose of 5 μg/kg/day during mobilization and all patients except acute myeloid leukemia received 10 μg/kg/day on the last day. Peripheral blood stem cells were harvested in one session for all patients. The amount of injected CD34+ cells/kg for patients were divided and studied in four groups: <0.5 × 106 (n = 36), 0.5-1.0 × 106, (n = 132), 1.0-2.0 × 106 (n = 226) and >2.0 × 106 (n = 305). The median time of follow up was 26.9 months. The amount of CD34+ cells dose were a significant predictor of platelet engraftment, but overall survival, relapse-free survival and also relapse rate was not associated with cells yield. More platelet transfusion (P = 0.003) and antibiotics prescription (P = 0.001) in transplanted patients with lower CD34 cells dose should be balanced with risks of higher G-CSF doses administration and also its side effects. Our results declare that lower CD34 yields after lowe dose G-CSF induction are probably not a troublesome issue affecting transplantation outcomes.
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14
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Lazarus HM, El Jurdi N. Autologous hematopoietic cell transplantation for adult acute myeloid leukemia: An obsolete or resurfacing concept? Best Pract Res Clin Haematol 2017; 30:327-332. [PMID: 29156204 DOI: 10.1016/j.beha.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Improving long-term outcomes of adult acute myeloid leukemia (AML) patients remains a challenge. Major scientific and clinical advances have led to a better understanding of the disease biology, and the majority of patients achieve a complete remission (CR) after induction therapy. Relapse risk, however, remains considerable and is the leading cause of death in this patient population. Significant efforts to improve outcomes emphasize use of post-remission therapies such as hematopoietic cell transplantation (HCT), an increasingly utilized modality. Improvement in transplantation techniques, understanding of donor:recipient histocompatibility, and increased availability of alternative donors have resulted in greater use of allogeneic HCT. Despite a graft-versus-leukemia effect and lower post-HCT relapse rates, allogeneic HCT continues to be plagued by treatment-related mortality (TRM) and chronic graft-versus-host disease. Better understanding of AML risk stratification and issues relating to minimal residual disease (MRD) as well as extremely low TRM rates with autografts have prompted clinicians to re-explore use of autologous HCT in subsets of favorable and intermediate-risk CR1 AML patients. Herein, we highlight the evolving literature and treatment outcomes for autologous HCT in AML. We provide recommendations for considering this therapeutic modality for treatment intensification in AML.
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Affiliation(s)
- Hillard M Lazarus
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Najla El Jurdi
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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15
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Yoon JH, Kim HJ, Park SS, Jeon YW, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Kim DW, Lee JW, Min WS. Clinical Outcome of Autologous Hematopoietic Cell Transplantation in Adult Patients with Acute Myeloid Leukemia: Who May Benefit from Autologous Hematopoietic Cell Transplantation? Biol Blood Marrow Transplant 2017; 23:588-597. [DOI: 10.1016/j.bbmt.2017.01.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/10/2017] [Indexed: 11/12/2022]
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16
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Sorigue M, Sancho JM, Morgades M, Moreno M, Grífols JR, Alonso E, Juncà J, Ferrà C, Batlle M, Vives S, Motlló C, García-Caro M, Navarro JT, Millà F, Feliu E, Ribera JM. Relapse risk after autologous stem cell transplantation in patients with lymphoma based on CD34+ cell dose. Leuk Lymphoma 2016; 58:916-922. [PMID: 27561733 DOI: 10.1080/10428194.2016.1222378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is unclear whether higher CD34 + cell doses infused for ASCT have any influence on survival or relapse in patients with lymphoma. We analyzed the correlation of infused CD34 + cell dose with relapse, survival, and hematopoietic recovery in 146 consecutive patients undergoing ASCT for lymphoma. Higher doses (>5 × 106/kg) were significantly correlated with earlier hematopoietic recovery, fewer infectious episodes, lower transfusion needs. No differences were observed in lymphoma outcomes (4-year relapse incidence of 38% [95%CI: 29%-48%] in the lower dose group versus 51% [95%CI: 30%-69%] in the higher dose group, 10-year OS probabilities of 58% [95%CI: 48%-68%] versus 75% [95%CI: 59%-91%], 10-year DFS probabilities of 47% [95%CI: 37%-57%] versus 42% [95%CI: 23%-61%], p = NS for all outcomes). In this series, a higher infused CD34 + cell dose did not correlate with survival or relapse but correlated with earlier hematopoietic recovery and lower resource consumption.
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Affiliation(s)
- Marc Sorigue
- a Department of Hematology , Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juan-Manuel Sancho
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Mireia Morgades
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Miriam Moreno
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juan-Ramon Grífols
- c Banc de Sang i Teixits, Hospital Germans Trias i Pujol , Badalona , Spain
| | - Eva Alonso
- c Banc de Sang i Teixits, Hospital Germans Trias i Pujol , Badalona , Spain
| | - Jordi Juncà
- d Department of Laboratory Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Christelle Ferrà
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Montserrat Batlle
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Susana Vives
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Cristina Motlló
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Montserrat García-Caro
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Jose-Tomás Navarro
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Fuensanta Millà
- d Department of Laboratory Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Evarist Feliu
- d Department of Laboratory Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Josep-María Ribera
- b Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute , Universitat Autònoma de Barcelona , Badalona , Spain
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17
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Mulé MP, Mannis GN, Wood BL, Radich JP, Hwang J, Ramos NR, Andreadis C, Damon L, Logan AC, Martin TG, Hourigan CS. Multigene Measurable Residual Disease Assessment Improves Acute Myeloid Leukemia Relapse Risk Stratification in Autologous Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1974-1982. [PMID: 27544285 DOI: 10.1016/j.bbmt.2016.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022]
Abstract
We report here the largest study to date of adult patients with acute myeloid leukemia (AML) tested for measurable residual disease (MRD) at the time of autologous hematopoietic cell transplantation (auto-HCT). Seventy-two adult patients who underwent transplantation between 2004 and 2013 at a single academic medical center (University of California San Francisco) were eligible for this retrospective study based on availability of cryopreserved granulocyte colony-stimulating factor (GCSF)-mobilized autologous peripheral blood progenitor cell (PBPC) leukapheresis specimens ("autografts"). Autograft MRD was assessed by molecular methods (real-time quantitative PCR [RQ-PCR] for Wilms tumor 1 (WT1) alone or a multigene panel) and by multiparameter flow cytometry (MPFC). WT1 RQ-PCR testing of the autograft had low sensitivity for relapse prediction (14%) and a negative predictive value of 51%. MPFC failed to identify MRD in any of 34 autografts tested. Combinations of molecular MRD assays, however, improved prediction of post-auto-HCT relapse. In multivariate analysis of clinical variables, including age, gender, race, cytogenetic risk category, and CD34+ cell dose, only autograft multigene MRD as assessed by RQ-PCR was statistically significantly associated with relapse. One year after transplantation, only 28% patients with detectable autograft MRD were relapse free, compared with 67% in the MRD-negative cohort. Multigene MRD, while an improvement on other methods tested, was however suboptimal for relapse prediction in unselected patients, with specificity of 83% and sensitivity of 46%. In patients with known chromosomal abnormalities or mutations, however, better predictive value was observed with no relapses observed in MRD-negative patients in the first year after auto-HCT compared with 83% incidence of relapse in the MRD-positive patients (hazard ratio, 12.45; P = .0016). In summary, increased personalization of MRD monitoring by use of a multigene panel improved the ability to risk stratify patients for post-auto-HCT relapse. WT1 RQ-PCR and flow cytometric assessment for AML MRD in autograft samples had limited value for predicting relapse after auto-HCT. We demonstrate that cryopreserved autograft material presents unique challenges for AML MRD testing because of the masking effects of previous GCSF exposure on gene expression and flow cytometry signatures. In the absence of information regarding diagnostic characteristics, sources other than GCSF-stimulated PBSC leukapheresis specimens should be considered as alternatives for MRD testing in AML patients undergoing auto-HCT.
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Affiliation(s)
- Matthew P Mulé
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gabriel N Mannis
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Brent L Wood
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Jimmy Hwang
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Nestor R Ramos
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Charalambos Andreadis
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Lloyd Damon
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Aaron C Logan
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Thomas G Martin
- Department of Medicine, Division of Hematology and Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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18
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Czerw T, Labopin M, Gorin NC, Giebel S, Blaise D, Meloni G, Pigneux A, Bosi A, Veelken J, Ferrara F, Schaap N, Lemoli RM, Cornelissen JJ, Beohou E, Nagler A, Mohty M. Long-term follow-up of patients with acute myeloid leukemia surviving and free of disease recurrence for at least 2 years after autologous stem cell transplantation: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Cancer 2016; 122:1880-7. [PMID: 27018549 DOI: 10.1002/cncr.29990] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leukemia recurrence is a major cause of treatment failure after autologous stem cell transplantation for acute myeloid leukemia (AML). It usually occurs within the first 2 years after transplantation. The goal of the current retrospective study was to assess the follow-up of and characterize risk factors for outcome among patients who survived free of disease recurrence after this period. METHODS The analysis included 3567 adults (median age, 45 years) with AML who underwent autografting during the first (86% of patients) or second (14% of patients) complete remission between 1990 and 2008. The stem cell source was the bone marrow in 32% of patients or the peripheral blood in 68% of patients. The median follow-up was 6.9 years. RESULTS At 5 years and 10 years after transplantation, the probability of leukemia-free survival was 86% and 76%, respectively; the recurrence incidence was 11% and 16%, respectively; and the nonrecurrence mortality rate was 3% and 8%, respectively. The observed survival was decreased compared with the expected survival of the general European population. In a multivariate analysis, decreased probability of leukemia-free survival was demonstrated for patients who underwent peripheral blood autologous stem cell transplantation; had French-American-British subtypes M0, M6, or M7; and were of an older age. The same factors were found to be associated with an increased risk of disease recurrence. Nonrecurrence mortality was found to be affected by older age. CONCLUSIONS The results of the current analysis indicate that late recurrences remain a major concern after autologous stem cell transplantation among patients with AML, indicating the need for close monitoring of minimal residual disease and additional leukemic control measures after transplantation. Cancer 2016;122:1880-7. © 2016 American Cancer Society.
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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 European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,INSERM UMRs 938, Paris, France.,Pierre and Marie Curie University, Paris, France
| | - Norbert-Claude Gorin
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,INSERM UMRs 938, Paris, France.,Pierre and Marie Curie University, Paris, France
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Didier Blaise
- Department of Transplantation and Cellular Therapy, Paoli Calmettes Institute, Marseille, France
| | - Giovanna Meloni
- Department of Cellular Biotechnology and Hematology, "LaSapienza" University, Rome, Italy
| | - Arnaud Pigneux
- Department of Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | - Alberto Bosi
- Bone Marrow Transplantation Unit, Department of Hematology, di Careggi Hospital, Florence, Italy
| | - Joan Veelken
- Bone Marrow Transplantation Centre Leiden, Leiden University Hospital, Leiden, The Netherlands
| | - Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples, Italy
| | - Nicolaas Schaap
- Department of Hematology, Radboud University-Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Roberto M Lemoli
- Institute of Hematology and Medical Oncology, "L & A Seragnoli," St.Orsola-Malpighi University Hospital, Bologna University, Bologna, Italy.,Roberto M. Lemoli's current address: Division of Hematology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | | | - Arnon Nagler
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,INSERM UMRs 938, Paris, France.,Pierre and Marie Curie University, Paris, France
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19
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Martin PS, Li S, Nikiforow S, Alyea EP, Antin JH, Armand P, Cutler CS, Ho VT, Kekre N, Koreth J, Luckey CJ, Ritz J, Soiffer RJ. Infused total nucleated cell dose is a better predictor of transplant outcomes than CD34+ cell number in reduced-intensity mobilized peripheral blood allogeneic hematopoietic cell transplantation. Haematologica 2016; 101:499-505. [PMID: 26768686 DOI: 10.3324/haematol.2015.134841] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/04/2016] [Indexed: 01/01/2023] Open
Abstract
Mobilized peripheral blood is the most common graft source for allogeneic hematopoietic stem cell transplantation following reduced-intensity conditioning. In assessing the effect of donor cell dose and graft composition on major transplant outcomes in the reduced-intensity setting, prior studies focused primarily on CD34(+)cell dose and reported conflicting results, especially in relation to survival end-points. While the impact of total nucleated cell dose has been less frequently evaluated, available studies suggest higher total nucleated cell dose is associated with improved survival outcomes in the reduced-intensity setting. In order to further explore the relationship between CD34(+)cell dose and total nucleated cell dose on reduced-intensity transplant outcomes, we analyzed the effect of donor graft dose and composition on outcomes of 705 patients with hematologic malignancies who underwent reduced-intensity peripheral blood stem cell transplantation at the Dana Farber Cancer Institute from 2000 to 2010. By multivariable analysis we found that higher total nucleated cell dose (top quartile; ≥10.8 × 10(10)cells) was associated with improved overall survival [HR 0.69 (0.54-0.88),P=0.0028] and progression-free survival [HR 0.68 (0.54-0.85),P=0.0006]. Higher total nucleated cell dose was independently associated with decreased relapse [HR 0.66 (0.51-0.85),P=0.0012] and increased incidence of chronic graft-versus-host disease [HR 1.4 (1.12-1.77),P=0.0032]. In contrast, higher doses of CD34(+)cells (top quartile; ≥10.9 × 10(6)/kg) had no significant effect on graft-versus-host disease or survival outcomes. These data suggest total nucleated cell dose is a more relevant prognostic variable for reduced-intensity transplant outcomes than the more commonly studied CD34(+)cell dose.
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Affiliation(s)
- Paul S Martin
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA, USA
| | - Shuli Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sarah Nikiforow
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Edwin P Alyea
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Joseph H Antin
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Philippe Armand
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Corey S Cutler
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Vincent T Ho
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Natasha Kekre
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - John Koreth
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - C John Luckey
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Jerome Ritz
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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20
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Aboul-Soud MAM, El-Shemy HA, Aboul-Enein KM, Mahmoud AM, Al-Abd AM, Lightfoot DA. Effects of plant-derived anti-leukemic drugs on individualized leukemic cell population profiles in Egyptian patients. Oncol Lett 2015; 11:642-648. [PMID: 26870259 PMCID: PMC4727189 DOI: 10.3892/ol.2015.3916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/13/2015] [Indexed: 12/14/2022] Open
Abstract
Leukemias are a group of cancer types that originate from blood-forming tissues. In this disease, an abnormally large number of immature white blood cells is produced by the bone marrow. The relationship between treatments with plant-derived drugs and leukemia-associated immunophenotypes (LAIPs) of clinically isolated leukemia cells has yet to be established. The aim of the present study was to develop a preliminary clinical prognostic map for commonly expressed LAIPs in patients clinically diagnosed with leukemia, as well as to assess the potential involvement of LAIPs in the response rate to 10 natural products of plant origin. An increased expression of LAIPs, including CD4, CD14, CD33 and CD34, was considered a surrogate marker of the desired response of leukemia cells to treatment with plant-derived drugs. By contrast, the increased expression of the LAIPs, MPO and DR, was associated with poor prognostic outcomes following treatment with the plant-derived drugs. The results showed that 5 of the 10 plant-derived drugs tested induced the expression of several desirable LAIPs biomarkers. These findings clearly highlight the potential treatment efficacy of certain plant-derived drugs against leukemic cell types.
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Affiliation(s)
- Mourad A M Aboul-Soud
- Faculty of Agriculture Research Park (FARP) and Department of Biochemistry, Faculty of Agriculture, Cairo University, Giza 12613, Egypt; Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Kingdom of Saudi Arabia
| | - Hany A El-Shemy
- Faculty of Agriculture Research Park (FARP) and Department of Biochemistry, Faculty of Agriculture, Cairo University, Giza 12613, Egypt
| | - Khalid M Aboul-Enein
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo 12513, Egypt
| | - Ali M Mahmoud
- Faculty of Agriculture Research Park (FARP) and Department of Biochemistry, Faculty of Agriculture, Cairo University, Giza 12613, Egypt; Center for Aging and Associated Diseases (CAAD), Helmy Institute for Medical Science (HIMS), Zewail City for Science and Technology, 6th of October City, Giza 12588, Egypt
| | - Ahmed M Al-Abd
- Department of Pharmacology, Medical Division, National Research Centre, Cairo 11796, Egypt
| | - David A Lightfoot
- Genomics Core-Facility, Southern Illinois University, Carbondale, IL 62901, USA
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21
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Glait-Santar C, Desmond R, Feng X, Bat T, Chen J, Heuston E, Mizukawa B, Mulloy JC, Bodine DM, Larochelle A, Dunbar CE. Functional Niche Competition Between Normal Hematopoietic Stem and Progenitor Cells and Myeloid Leukemia Cells. Stem Cells 2015; 33:3635-42. [PMID: 26388434 DOI: 10.1002/stem.2208] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/23/2015] [Accepted: 08/24/2015] [Indexed: 12/23/2022]
Abstract
Hematopoietic stem and progenitor cells (HSPCs) reside in a specialized niche that regulates their proliferative capacity and their fate. There is increasing evidence for similar roles of marrow niches on controlling the behavior of leukemic cells; however, whether normal hematopoietic stem cell (HSC) and leukemic cells reside in or functionally compete for the same marrow niche is unclear. We used the mixed lineage leukemia-AF9 (MLL-AF9) murine acute myeloid leukemia (AML) in a competitive repopulation model to investigate whether normal HSPC and leukemic cells functionally compete for the same marrow niches. Irradiated recipient mice were transplanted with fixed numbers of MLL-AF9 cells mixed with increasing doses of normal syngeneic whole bone marrow (WBM) or with purified HSPC (LSK). Survival was significantly increased and leukemic progression was delayed proportional to increasing doses of normal WBM or normal LSK cells in multiple independent experiments, with all doses of WBM or LSK cells studied above the threshold for rapid and complete hematopoietic reconstitution in the absence of leukemia. Confocal microscopy demonstrated nests of either leukemic cells or normal hematopoietic cells but not both in the marrow adjacent to endosteum. Early following transplantation, leukemic cells from animals receiving lower LSK doses were cycling more actively than in those receiving higher doses. These results suggest that normal HSPC and AML cells compete for the same functional niche. Manipulation of the niche could impact on response to antileukemic therapies, and the numbers of normal HSPC could impact on leukemia outcome, informing approaches to cell dose in the context of stem cell transplantation.
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Affiliation(s)
- Chen Glait-Santar
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ronan Desmond
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.,Department of Haematology, Tallaght Hospital, Dublin, Ireland
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Taha Bat
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jichun Chen
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elisabeth Heuston
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Benjamin Mizukawa
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James C Mulloy
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - David M Bodine
- Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andre Larochelle
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cynthia E Dunbar
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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22
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Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects. Bone Marrow Transplant 2015; 50:1495-502. [PMID: 26281031 DOI: 10.1038/bmt.2015.179] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 01/22/2023]
Abstract
The use of autologous stem cell transplantation (ASCT) as consolidation therapy for adult patients with acute leukemia has declined over time. However, multiple randomized studies in the past have reported lower relapse rates after autologous transplantation compared with chemotherapy and lower non-relapse mortality rates compared with allogeneic transplantation. In addition, quality of life of long-term survivors is better after autologous transplantation than after allogeneic transplantation. Further, recent developments may improve outcomes of autograft recipients. These include the use of IV busulfan and the busulfan+melphalan combination, better detection of minimal residual disease (MRD) with molecular biology techniques, the introduction of targeted therapies and post-transplant maintenance therapy. Therefore, ASCT may nowadays be reconsidered for consolidation in the following patients if and when they reach a MRD-negative status: good- and at least intermediate-1 risk acute myelocytic leukemia in first CR, acute promyelocytic leukemia in second CR, Ph-positive acute lymphocytic leukemia. Conversely, patients with MRD-positive status or high-risk leukemia should not be considered for consolidation with ASCT.
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23
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Remberger M, Törlén J, Ringdén O, Engström M, Watz E, Uhlin M, Mattsson J. Effect of Total Nucleated and CD34(+) Cell Dose on Outcome after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21:889-93. [PMID: 25662230 DOI: 10.1016/j.bbmt.2015.01.025] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/26/2015] [Indexed: 12/16/2022]
Abstract
During more recent years only few studies have analyzed the effect of total nucleated cell (TNC) and CD34(+) cell dose in allogeneic hematopoietic stem cell transplantation (HSCT). A single-center analysis included 544 patients, 227 with a sibling donor and 317 with an unrelated donor. Most patients (n = 292) were treated with myeloablative conditioning, whereas the remaining patients (n = 252) received reduced-intensity conditioning. Bone marrow (BM) (n = 121) and peripheral blood stem cell (PBSC) grafts (n = 423) were analyzed separately. Median TNC and CD34(+) cell dose was 3.2 × 10(8)/kg versus 11.6 × 10(8)/kg in BM and 3.9 × 10(6)/kg versus 8.1 × 10(6)/kg in PBSC. In the BM group we found a higher TNC and CD34(+) cell dose was associated with a faster neutrophil engraftment (P < .001 and P = .02). In the PBSC group we found patients given a very high (≥11 × 10(6)/kg) CD34(+) cell dose had decreased rates of survival (P = .001) and increased relapse (P = .02). A high CD34(+) cell dose correlated with faster platelet engraftment (P < .01). In HSCT using PBSCs, the CD34(+) cell doses should be kept below 11 × 10(6)/kg but over 2.5 × 10(6)/kg.
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Affiliation(s)
- Mats Remberger
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.
| | - Johan Törlén
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olle Ringdén
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mats Engström
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Emma Watz
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Michael Uhlin
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jonas Mattsson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
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24
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Gorin NC, Labopin M, Piemontese S, Arcese W, Santarone S, Huang H, Meloni G, Ferrara F, Beelen D, Sanz M, Bacigalupo A, Ciceri F, Mailhol A, Nagler A, Mohty M. T-cell-replete haploidentical transplantation versus autologous stem cell transplantation in adult acute leukemia: a matched pair analysis. Haematologica 2015; 100:558-64. [PMID: 25637051 DOI: 10.3324/haematol.2014.111450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Adult patients with acute leukemia in need of a transplant but without a genoidentical donor are usually considered upfront for transplantation with stem cells from any other allogeneic source, rather than autologous stem cell transplantation. We used data from the European Society for Blood and Marrow Transplantation and performed a matched pair analysis on 188 T-cell-replete haploidentical and 356 autologous transplants done from January 2007 to December 2012, using age, diagnosis, disease status, cytogenetics, and interval from diagnosis to transplant as matching factors. "Haploidentical expert" centers were defined as having reported more than five haploidentical transplants for acute leukemia (median value for the study period). The median follow-up was 28 months. Multivariate analyses, including type of transplant categorized into three classes ("haploidentical regular", "haploidentical expert" and autologous), conditioning intensity (reduced intensity versus myeloablative conditioning) and the random effect taking into account associations related to matching, showed that non-relapse mortality was higher following haploidentical transplants in expert (HR: 4.7; P=0.00004) and regular (HR: 8.98; P<10(-5)) centers. Relapse incidence for haploidentical transplants was lower in expert centers (HR:0.39; P=0.0003) but in regular centers was similar to that for autologous transplants. Leukemia-free survival and overall survival rates were higher following autologous transplantation than haploidentical transplants in regular centers (HR: 1.63; P=0.008 and HR: 2.31; P=0.0002 respectively) but similar to those following haploidentical transplants in expert centers. We conclude that autologous stem cell transplantation should presently be considered as a possible alternative to haploidentical transplantation in regular centers that have not developed a specific expert program.
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Affiliation(s)
- Norbert-Claude Gorin
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
| | - Myriam Labopin
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
| | - Simona Piemontese
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy
| | - William Arcese
- Rome Transplant Network, Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Stella Santarone
- Ospedale Civile, Department of Hematology, Fonte Romana 8, Pescara, Italy
| | - He Huang
- First Affiliated Hospital, Zhejiang University, Bone Marrow Transplantation Center, Hangzhou Zhejiang, China
| | | | | | - Dietrich Beelen
- University Hospital, Dept. of Bone Marrow Transplantation, Essen, Germany
| | - Miguel Sanz
- Hospital Universitario La Fe, University of Valencia, Spain
| | | | - Fabio Ciceri
- Ospedale San Raffaele s.r.l. Via Olgettina 60, Milan, Italy
| | - Audrey Mailhol
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- APHP, Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Höpital Saint-Antoine, Paris, France Sorbonne Universités, UPMC University Paris 06, France INSERM UMR-S 938, Paris, France
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25
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Hengeveld M, Suciu S, Chelgoum Y, Marie JP, Muus P, Lefrère F, Mandelli F, Pane F, Amadori S, Fioritoni G, Labar B, Baron F, Cermak J, Bourhis JH, Storti G, Fazi P, Hagemeijer A, Vignetti M, Willemze R, de Witte T. High numbers of mobilized CD34+ cells collected in AML in first remission are associated with high relapse risk irrespective of treatment with autologous peripheral blood SCT or autologous BMT. Bone Marrow Transplant 2014; 50:341-7. [PMID: 25402418 DOI: 10.1038/bmt.2014.262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 11/09/2022]
Abstract
The faster hematopoietic recovery after autologous peripheral blood SCT (APBSCT) in patients with AML may be offset by an increased relapse risk as compared with autologous BMT (ABMT). The EORTC and GIMEMA Leukemia Groups conducted a trial (AML-10) in which they compared, as second randomization, APBSCT and ABMT in first CR patients without an HLA compatible donor. A total of 292 patients were randomized. The 5-year DFS rate was 41% in the APBSCT arm and 46% in the ABMT arm with a hazard ratio (HR) of 1.17; 95% confidence interval=0.85-1.59; P=0.34. The 5-year cumulative relapse incidence was 56% vs 49% (P=0.26), and the 5-year OS 50% and 55% (P=0.6) in the APBSCT and ABMT groups, respectively. APBSCT was associated with significantly faster recovery of neutrophils and platelets, shorter duration of hospitalization, reduced need of transfusion packed RBC and less days of intravenous antibiotics. In both treatment groups, higher numbers of mobilized CD34+ cells were associated with a significantly higher relapse risk irrespective of the treatment given after the mobilization. Randomization between APBSCT and ABMT did not result in significantly different outcomes in terms of DFS, OS and relapse incidence.
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Affiliation(s)
- M Hengeveld
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S Suciu
- EORTC Headquarters, Brussels, Belgium
| | | | | | - P Muus
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - F Lefrère
- Necker-Institut Curie, Paris, France
| | | | - F Pane
- Federico II University, Napoli, Italy
| | - S Amadori
- Tor Vergata University Hospital, Roma, Italy
| | | | - B Labar
- University Hospital Rebro, Zagreb, Croatia
| | - F Baron
- CHU Sart-Tilman, Liège, Belgium
| | - J Cermak
- Institute Hematology, Prague, Czech Republic
| | - J-H Bourhis
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - G Storti
- A.O.R.N. San Giuseppe Moscati, Avelino, Italy
| | - P Fazi
- GIMEMA Data Center, Roma, Italy
| | - A Hagemeijer
- Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | | | - R Willemze
- Leiden University Medical Center, Leiden, The Netherlands
| | - T de Witte
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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26
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Capelli D, Chiarucci M, Poloni A, Saraceni F, Mancini G, Trappolini S, Troiani E, Montanari M, Scortechini I, Offidani M, Rupoli S, Scortechini AR, Gini G, Discepoli G, Leoni P, Olivieri A. Mobilization-Driven Postconsolidation Therapy in Elderly Patients with Acute Myeloid Leukemia: Feasibility and Efficacy of Autologous Stem Cell Transplantation versus Low-Dose Gemtuzumab Ozogamicin. Biol Blood Marrow Transplant 2014; 20:1399-406. [DOI: 10.1016/j.bbmt.2014.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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27
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Plesa A, Elhamri M, Clapisson G, Mattei E, Gazzo S, Hequet O, Tigaud I, Michallet M, Dumontet C, Thomas X. Higher percentage of CD34 + CD38- cells detected by multiparameter flow cytometry from leukapheresis products predicts unsustained complete remission in acute myeloid leukemia. Leuk Lymphoma 2014; 56:622-9. [PMID: 24884314 DOI: 10.3109/10428194.2014.927453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Relapse in acute myeloid leukemia (AML) after chemotherapy reflects the persistence of resistant leukemia stem cells (LSCs). These cells have been described in the CD34 + CD38- cell fraction. Leukapheresis products were harvested in 123 patients in morphological complete remission and analyzed by multiparameter flow cytometry. The CD34 + CD38- cell population showed a prognostic impact on survival. Median event-free survival (EFS) was 8.2 months (3-year EFS: 29%) for those with a higher percentage of CD34 + CD38- versus 91.9 months (3-year EFS: 62%) for those with a lower percentage for the entire cohort. These differences were confirmed in patients undergoing autologous stem cell transplant, with median EFS of 7.3 months versus 91.1 months (3-year EFS: 31% vs. 70%). Higher proportions of CD34 + CD38- cells were associated with adverse cytogenetics and with earlier relapses. Higher percentages of CD34 + CD38- cells in apheresis products reflect inadequate in vivo purging and reliably distinguish samples enriched in LSCs from those involving mainly normal cells.
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28
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Messina C, Candoni A, Carrabba MG, Tresoldi C, Sala E, Tassara M, Crippa A, Peccatori J, Assanelli A, Gattillo S, Bellio L, Fanin R, Ciceri F, Bernardi M. Wilms' tumor gene 1 transcript levels in leukapheresis of peripheral blood hematopoietic cells predict relapse risk in patients autografted for acute myeloid leukemia. Biol Blood Marrow Transplant 2014; 20:1586-91. [PMID: 24954546 DOI: 10.1016/j.bbmt.2014.06.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
Autologous hematopoietic stem cell transplantation (ASCT) is a curative option alternative to allogeneic transplantation for patients with acute myeloid leukemia (AML). Relapse after ASCT can be due to contamination with leukemic blasts of autologous peripheral blood stem cells (PBSCs) collected by leukapheresis (LK). Identification and quantification of a minimal residual disease (MRD) marker in PBSCs could be relevant in determining the relapse risk after ASCT. High levels of the WT1 gene transcript in bone marrow of AML patients after treatment completion predict disease relapse. We evaluated WT1 transcript levels in autologous PBSC from LK used for ASCT in 30 consecutive AML patients in complete remission (CR) and established a correlation with clinical outcome. At diagnosis, all patients had WT1 overexpression. All patients were in morphological and genetic CR at the time of PBSC collection and before ASCT. Real-time quantitative PCR of WT1 was performed in samples of each LK, using TaqMan technology on RNA from mononucleated cells. The median WT1 transcript level in the PBSC graft (WT1-LK) of patients who relapsed was significantly higher than of those who did not relapse after transplantation (P <.0001). We defined a cut-off level of 80 WT1-LK copies/ABL 10e4 copies to discriminate between positive and negative PBSC grafts. The cut-off level was strongly associated with disease recurrence, DFS and OS. Our study represents the largest series of patients evaluating WT1 as a marker of MRD in PBSC LK products using a completely standardized real-time WT1-reverse transcriptase-PCR based assay. These data, if confirmed by prospective study, will help to determine an individual patient's adapted postremission allocation strategy.
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Affiliation(s)
- Carlo Messina
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Anna Candoni
- Division of Hematology and Bone Marrow Transplantation Unit, University Hospital of Udine, Udine, Italy
| | - Matteo G Carrabba
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Tresoldi
- Immuno-hematology and Transfusion Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Sala
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Michela Tassara
- Immuno-hematology and Transfusion Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Crippa
- Immuno-hematology and Transfusion Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Gattillo
- Immuno-hematology and Transfusion Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Bellio
- Immuno-hematology and Transfusion Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplantation Unit, University Hospital of Udine, Udine, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Massimo Bernardi
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
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29
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Nagler A, Labopin M, Gorin NC, Ferrara F, Sanz MA, Wu D, Gomez AT, Lapusan S, Irrera G, Guimaraes JE, Sousa AB, Carella AM, Vey N, Arcese W, Shimoni A, Berger R, Rocha V, Mohty M. Intravenous busulfan for autologous stem cell transplantation in adult patients with acute myeloid leukemia: a survey of 952 patients on behalf of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Haematologica 2014; 99:1380-6. [PMID: 24816236 DOI: 10.3324/haematol.2014.105197] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Oral busulfan is the historical backbone of the busulfan+cyclophosphamide regimen for autologous stem cell transplantation. However intravenous busulfan has more predictable pharmacokinetics and less toxicity than oral busulfan; we, therefore, retrospectively analyzed data from 952 patients with acute myeloid leukemia who received intravenous busulfan for autologous stem cell transplantation. Most patients were male (n=531, 56%), and the median age at transplantation was 50.5 years. Two-year overall survival, leukemia-free survival, and relapse incidence were 67±2%, 53±2%, and 40±2%, respectively. The non-relapse mortality rate at 2 years was 7±1%. Five patients died from veno-occlusive disease. Overall leukemia-free survival and relapse incidence at 2 years did not differ significantly between the 815 patients transplanted in first complete remission (52±2% and 40±2%, respectively) and the 137 patients transplanted in second complete remission (58±5% and 35±5%, respectively). Cytogenetic risk classification and age were significant prognostic factors: the 2-year leukemia-free survival was 63±4% in patients with good risk cytogenetics, 52±3% in those with intermediate risk cytogenetics, and 37 ± 10% in those with poor risk cytogenetics (P=0.01); patients ≤50 years old had better overall survival (77±2% versus 56±3%; P<0.001), leukemia-free survival (61±3% versus 45±3%; P<0.001), relapse incidence (35±2% versus 45±3%; P<0.005), and non-relapse mortality (4±1% versus 10±2%; P<0.001) than older patients. The combination of intravenous busulfan and high-dose melphalan was associated with the best overall survival (75±4%). Our results suggest that the use of intravenous busulfan simplifies the autograft procedure and confirm the usefulness of autologous stem cell transplantation in acute myeloid leukemia. As in allogeneic transplantation, veno-occlusive disease is an uncommon complication after an autograft using intravenous busulfan.
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Affiliation(s)
- Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Myriam Labopin
- Acute Leukemia Working Party -EBMT, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie Paris 6 UPMC, INSERM UMR-S 938, Paris, France
| | - Norbert-Claude Gorin
- Acute Leukemia Working Party -EBMT, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie Paris 6 UPMC, INSERM UMR-S 938, Paris, France Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
| | | | - Miguel A Sanz
- Hospital Universitario La Fe, University of Valencia, Spain
| | - Depei Wu
- First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Simona Lapusan
- Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
| | | | | | | | | | | | | | - Avichai Shimoni
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Raanan Berger
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - Mohamad Mohty
- Acute Leukemia Working Party -EBMT, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie Paris 6 UPMC, INSERM UMR-S 938, Paris, France Department of Hematology and Cell Therapy, Hospital Saint Antoine, Paris, France
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30
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Brunck MEG, Nielsen LK. Concise review: next-generation cell therapies to prevent infections in neutropenic patients. Stem Cells Transl Med 2014; 3:541-8. [PMID: 24598780 DOI: 10.5966/sctm.2013-0145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
High-dose chemotherapy is accompanied by an obligate period of neutropenia. Resulting bacterial and fungal infections are the leading cause of morbidity and mortality in neutropenic patients despite prophylactic antimicrobials and hematopoietic growth factor supplements. Replacing neutrophils in the patient through transfusion of donor cells is a logical solution to prevent fulminant infections. In the past, this strategy has been hampered by poor yield, inability to store collected cells, and possible donor morbidity caused by granulocyte colony-stimulating factor injections and apheresis. Today, neutrophil-like cells can be manufactured in the laboratory at the clinical scale from hematopoietic stem and progenitor cells enriched from umbilical cord blood. This article reviews the rationale for focusing research efforts toward ex vivo neutrophil production and explores clinical settings for future trials.
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Affiliation(s)
- Marion E G Brunck
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St. Lucia, Queensland, Australia
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31
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Individual Quality Assessment of Autografting by Probability Estimation for Clinical Endpoints: A Prospective Validation Study from the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2013; 19:1670-6. [DOI: 10.1016/j.bbmt.2013.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 08/20/2013] [Indexed: 11/20/2022]
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32
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Schuurhuis GJ, Zweegman S, Ossenkoppele GJ. Highly effective mobilization of CD34 positive cells as a poor prognostic factor in acute myeloid leukemia. Possible causes and consequences. Leuk Res 2013; 37:727-8. [PMID: 23628551 DOI: 10.1016/j.leukres.2013.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 03/20/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
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Schuurhuis GJ, Zweegman S, Ossenkoppele GJ. The adverse prognosis for acute myeloid leukemia patients with superior autologous stem cell mobilization. Leuk Res 2012; 36:1323-4. [DOI: 10.1016/j.leukres.2012.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/02/2012] [Accepted: 07/07/2012] [Indexed: 10/27/2022]
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Keating A, DaSilva G, Pérez WS, Gupta V, Cutler CS, Ballen KK, Cairo MS, Camitta BM, Champlin RE, Gajewski JL, Lazarus HM, Lill M, Marks DI, Nabhan C, Schiller GJ, Socie G, Szer J, Tallman MS, Weisdorf DJ. Autologous blood cell transplantation versus HLA-identical sibling transplantation for acute myeloid leukemia in first complete remission: a registry study from the Center for International Blood and Marrow Transplantation Research. Haematologica 2012; 98:185-92. [PMID: 22983587 DOI: 10.3324/haematol.2012.062059] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The optimal post-remission treatment for acute myeloid leukemia in first complete remission remains uncertain. Previous comparisons of autologous versus allogeneic hematopoietic cell transplantation noted higher relapse, but lower treatment-related mortality though using bone marrow grafts, with treatment-related mortality of 12-20%. Recognizing lower treatment-related mortality using autologous peripheral blood grafts, in an analysis of registry data from the Center for International Blood and Transplant Research, we compared treatment-related mortality, relapse, leukemia-free survival, and overall survival for patients with acute myeloid leukemia in first complete remission (median ages 36-44, range 19-60) receiving myeloablative HLA-matched sibling donor grafts (bone marrow, n=475 or peripheral blood, n=428) versus autologous peripheral blood (n=230). The 5-year cumulative incidence of treatment-related mortality was 19% (95% confidence interval, 16-23%), 20% (17-24%) and 8% (5-12%) for allogeneic bone marrow, allogeneic peripheral blood and autologous peripheral blood stem cell transplant recipients, respectively. The corresponding figures for 5-year cumulative incidence of relapse were 20% (17-24%), 26% (21-30%) and 45% (38-52%), respectively. At 5 years, leukemia-free survival and overall survival rates were similar: allogeneic bone marrow 61% (56-65%) and 64% (59-68%); allogeneic peripheral blood 54% (49-59%) and 59% (54-64%); autologous peripheral blood 47% (40-54%) and 54% (47-60%); P=0.13 and P=0.19, respectively. In multivariate analysis the incidence of treatment-related mortality was lower after autologous peripheral blood transplantation than after allogeneic bone marrow/peripheral blood transplants [relative risk 0.37 (0.20-0.69); P=0.001], but treatment failure (death or relapse) after autologous peripheral blood was significantly more likely [relative risk 1.32 (1.06-1.64); P=0.011]. The 5-year overall survival, however, was similar in patients who received autologous peripheral blood (n=230) [relative risk 1.23 (0.98-1.55); P=0.071] or allogeneic bone marrow/peripheral blood (n=903). In the absence of an HLA-matched sibling donor, autologous peripheral blood may provide acceptable alternative post-remission therapy for patients with acute myeloid leukemia in first complete remission.
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Affiliation(s)
- Armand Keating
- Princess Margaret Hospital, University of Toronto, Ontario, Canada
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Gorin NC, Labopin M, Meloni G, Pigneux A, Esteve J, Mohamad M. Impact of FLT3 ITD/NPM1 mutation status in adult patients with acute myelocytic leukemia autografted in first remission. Haematologica 2012; 98:e12-4. [PMID: 22929972 DOI: 10.3324/haematol.2012.064436] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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von Grünigen I, Raschle J, Rüsges-Wolter I, Taleghani BM, Mueller BU, Pabst T. The relapse risk of AML patients undergoing autologous transplantation correlates with the stem cell mobilizing potential. Leuk Res 2012; 36:1325-9. [PMID: 22727508 DOI: 10.1016/j.leukres.2012.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
Autologous stem cell transplantation (ASCT) is widely used to consolidate first remission in AML. We determined the significance of circulating CD34+ cells at the day of blood stem cell collection in 78 AML patients. Patients mobilizing more than 60,000 CD34+ cells/ml had shorter overall survival (OS; P=0.0274), shorter time to progression (TTP; P=0.0014), and a higher relapse rate (P=0.0177). High levels of CD34+ cells were an independent marker for shorter OS and TTP in a multivariate analysis. These data suggest that ASCT is associated with unfavorable outcome in AML patients with high levels of mobilized peripheral CD34+ cells.
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Affiliation(s)
- Isabelle von Grünigen
- Department of Medical Oncology, University Hospital and University of Berne, Berne, Switzerland
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37
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Milone G, Avola G, Leotta S, Strano A, Camuglia MG, Pinto V, Mercurio S, Poidomani M, Coppoletta S, Di Marco AL, Consoli C, Triolo A, Spadaro A, Privitera A, Ragusa A, Tibullo D, Di Mercurio S. Chemosensitivity of nonleukemic clonogenic precursors in AML patients in complete remission: association with CD34(+) mobilization and with disease-free survival. Exp Hematol 2011; 40:35-47.e2. [PMID: 22019627 DOI: 10.1016/j.exphem.2011.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 09/06/2011] [Accepted: 10/11/2011] [Indexed: 10/16/2022]
Abstract
A high number of CD34(+) cells in the peripheral blood during mobilization in patients with acute myeloid leukemia (AML) in complete remission (CR) is associated with a high relapse rate. The variability in chemoresistance of normal bone marrow precursors has been hypothesized as explanation for the variable CD34 mobilization in AML. In 37 patients with AML in CR, we determined the chemosensitivity of bone marrow clonogenic precursors to maphosphamide and etoposide, which was then correlated with the degree of CD34(+) mobilization. In an enlarged set of 49 patients, we also studied the importance of chemosensitivity of marrow precursors for disease-free survival and relapse incidence. Significant correlations were demonstrated between the peak number of CD34(+) cells and residual growth of colony-forming unit granulocyte-macrophage (CFU-GM) after maphosphamide (R = 0.550; p = 0.0003) and after etoposide (R = 0.793; p = 0.0003). It was possible to identify three groups of AML patients based on chemosensitivity. The mean CD34(+) peak was 33 × 10(6)/L in the hyperchemosensitive group, 141 × 10(6)/L in the normochemosensitive (p = 0.03), and 379 × 10(6)/L in the chemoresistant group (p = 0.002). Failed CD34(+) mobilization was observed in 72% of the hyperchemosensitive group, 23% of the normochemosensitive group, and 0% of the chemoresistant group (p = 0.001). Hyperchemosensitivity of CFU-GM, together with a low platelet count, were independent factors important in the failure of CD34(+) cell mobilization. A disease-free survival significantly inferior to that of all other patients was associated with chemoresistance of CFU-GM (log rank, p = 0.030) and with chemoresistance of burst-forming unit erythroid (BFU-E) (log rank, p = 0.033). Chemoresistance of CFU-GM (p = 0.048) and BFU-E (p = 0.017) was also associated with increase relapse incidence. Nonleukemic nature of these precursors was demonstrated studying minimal residual disease from single colony cells. In conclusion, we found that hyperchemosensitivity of normal nonleukemic CFU-GM is associated with a high risk of CD34(+) cell mobilization failure, while a chemoresistant pattern in CFU-GM and BFU-E is associated with poor disease-free survival and increased cumulative incidence of relapse.
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Affiliation(s)
- Giuseppe Milone
- Bone Marrow Transplantation Unit, Department of Hematology, Azienda Ospedaliera Policlinico-Vittorio Emanuele, Catania, Italy.
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38
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Current world literature. Curr Opin Oncol 2011; 23:700-9. [PMID: 21993416 DOI: 10.1097/cco.0b013e32834d384a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pierelli L, Perseghin P, Marchetti M, Accorsi P, Fanin R, Messina C, Olivieri A, Risso M, Salvaneschi L, Bosi A. Best practice for peripheral blood progenitor cell mobilization and collection in adults and children: results of a Società Italiana Di Emaferesi e Manipolazione Cellulare (SIDEM) and Gruppo Italiano Trapianto Midollo Osseo (GITMO) consensus process. Transfusion 2011; 52:893-905. [DOI: 10.1111/j.1537-2995.2011.03385.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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DiPersio JF, Ho AD, Hanrahan J, Hsu FJ, Fruehauf S. Relevance and Clinical Implications of Tumor Cell Mobilization in the Autologous Transplant Setting. Biol Blood Marrow Transplant 2011; 17:943-55. [DOI: 10.1016/j.bbmt.2010.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 10/15/2010] [Indexed: 01/04/2023]
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41
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Autologous transplantation gives encouraging results for young adults with favorable-risk acute myeloid leukemia, but is not improved with gemtuzumab ozogamicin. Blood 2011; 117:5306-13. [PMID: 21415269 DOI: 10.1182/blood-2010-09-309229] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report the results of a prospective, randomized phase 3 trial evaluating the use of gemtuzumab ozogamicin (GO) in an intensive consolidation approach in 657 patients 17-60 years of age. Patients in first complete remission (CR1) after cytarabine and standard- or high-dose daunorubicin induction received 2 cycles of consolidation with high-dose cytarabine followed by peripheral blood progenitor cell collection. The 352 patients who entered consolidation were randomized to receive GO (n = 132) or not (n = 138) and then proceeded to autologous hematopoietic cell transplantation (HCT). GO was given to 67 patients. Median follow-up was 50.9 months. Results of the intention-to-treat analysis demonstrated a 4-year disease-free survival (DFS) of 33.6% versus 35.9% (P = .54) and an overall survival (OS) of 41.3% versus 41.9% (P = .52) for those randomized to receive GO versus no GO, respectively. Patients with favorable- and intermediate-risk acute myeloid leukemia (AML) treated with high-dose daunorubicin and autologous HCT had 4-year DFS rates of 60% and 40% and OS rates of 80% and 49.3%, respectively. For younger AML patients in CR1, autologous HCT should be considered in favorable- and intermediate-cytogenetic risk patients who do not have an allogeneic donor. The addition of a single dose of GO in this setting did not improve outcomes.
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Prognostic value of CD34+ peak in peripheral blood during mobilization in intermediate-risk AML patients treated in first CR by autologous or allogeneic transplantation. Bone Marrow Transplant 2011; 47:24-32. [DOI: 10.1038/bmt.2011.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ossenkoppele GJ, van de Loosdrecht AA, Schuurhuis GJ. Review of the relevance of aberrant antigen expression by flow cytometry in myeloid neoplasms. Br J Haematol 2011; 153:421-36. [PMID: 21385170 DOI: 10.1111/j.1365-2141.2011.08595.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews the use of aberrant antigen expression detected by flow cytometry in the diagnosis and clinical handling of acute myeloid leukaemia (AML) and the myelodysplastic syndromes (MDS). Such aberrancies offer a valuable tool for the proper classification of these myeloid malignancies according the World Health Organization 2008 classification. Aberrant antigen expression by flow cytometry is also important for prognostification. This review supports the view, that minimal residual disease detection methods that make use of such aberrancies should be part of the routine management of AML patients to guide therapy, but also suggests the introduction of flow cytometry in MDS for diagnosis and treatment decisions in the near future.
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Affiliation(s)
- Gert J Ossenkoppele
- Department of Haematology, VU University Medical Center, De Boelelaan 1117, Amsterdam, the Netherlands.
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Abstract
Under normal conditions, the great majority of hematopoietic stem/progenitors cells (HSPCs) reside in the bone marrow. The number of HSPCs in the circulation can be markedly increased in response to a number of stimuli, including hematopoietic growth factors, myeloablative agents and environmental stresses such as infection. The ability to 'mobilize' HSPCs from the bone marrow to the blood has been exploited clinically to obtain HSPCs for stem cell transplantation and, more recently, to stimulate therapeutic angiogenesis at sites of tissue ischemia. Moreover, there is recent interest in the use of mobilizing agents to sensitize leukemia and other hematopoietic malignancies to cytotoxic agents. Key to optimizing clinical mobilizing regimens is an understanding of the fundamental mechanisms of HSPC mobilization. In this review, we discuss recent advances in our understanding of the mechanisms by which granulocyte colony-stimulating factor (G-CSF), the prototypical mobilizing agent, induces HSPC mobilization.
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Novitzky N, Thomas V, du Toit C, McDonald A. Is there a role for autologous stem cell transplantation for patients with acute myelogenous leukemia? A retrospective analysis. Biol Blood Marrow Transplant 2010; 17:875-84. [PMID: 20870030 DOI: 10.1016/j.bbmt.2010.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 09/21/2010] [Indexed: 11/28/2022]
Abstract
For patients with acute myelogenous leukemia (AML) who are unable to secure an acceptable HLA donor, the role of autologous stem cell transplantation (auto-SCT) has remained controversial. Its effectiveness remains unclear as, when analyzed on intention-to-treat strategies, a significant number do not undergo the procedure, whereas others seem to fail therapy from pretransplant recurrences. To improve our counseling to our patients on these 2 therapeutic options, we compared the outcome of patients in first remission of AML who actually underwent autologous or allogeneic transplantation. The choice for the type of graft was based on availability of HLA identical siblings. Patients received myeloablative conditioning followed by allogeneic or autologous cytokine mobilized peripheral blood stem cell transplantation. For prophylaxis of graft-versus-host disease (GVHD), grafts were incubated ex vivo with anti-CD52 antibodies and patients were prescribed cyclosporin until day 90. Patients were stratified by clinical and laboratory factors as well as cytogenetic risk. The endpoints were treatment-related mortality (TRM), disease-free survival (DFS), and overall survival (OS). The median presentation age for both transplant groups was 35 (14-60) years. Of the 112 consecutive patients achieving remission, autologous or allogeneic grafts were transplanted to 43 and 32 patients, respectively. There was no significant difference in the presentation clinical features, laboratory parameters, marrow morphology, or proportion of low and intermediate cytogenetic risk for both transplant options. Treatment mortality as well as relapse rate was similar (14% and 15%; 39% and 27%, respectively). At a median of 1609 and 1819 posttransplant days, 56% and 63% in each group survived. In univariate analysis performance status, cytogenetic risk, morphologic features of dysplasia, blast count, and lactate dehydrogenase (LDH) were significant factors for survival. Although for the entire group there was no difference in survival between both modalities, all patients with unfavorable cytogenetics receiving an autologous graft died of disease recurrence (3-year survival 35% versus 0%; P = .05). We conclude that patients with AML who have low or intermediate cytogenetic risk undergoing myeloablative conditioning followed by autologous or allogeneic T cell-depleted stem cell transplantation appeared to have similar outcome. However, those with unfavorable karyotype are unlikely to be cured with autologous grafts and are candidates for experimental modalities.
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Affiliation(s)
- Nicolas Novitzky
- The University of Cape Town Leukaemia Centre and the Division of Haematology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
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