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Fernandez-Sojo J, Horton R, Cid J, Azqueta C, Garcia-Buendia A, Valdivia E, Martorell L, Rubio-Lopez N, Codinach M, Aran G, Marsal J, Mussetti A, Martino R, Diaz-de-Heredia C, Ferra C, Valcarcel D, Linares M, Ancochea A, García-Rey E, García-Muñoz N, Medina L, Carreras E, Villa J, Lozano M, Gibson D, Querol S. Leukocytapheresis variables and transit time for allogeneic cryopreserved hpc: better safe than sorry. Bone Marrow Transplant 2022; 57:1531-1538. [PMID: 35804055 PMCID: PMC9264299 DOI: 10.1038/s41409-022-01750-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
Cryopreservation was recommended to ensure continuity in allogeneic hematopoietic progenitor cells (HPC) transplantation during the COVID-19 pandemic. Several groups have shown no impact on clinical outcomes for patients who underwent HPC transplantation with cryopreserved products during the first months of this pandemic. However, concerns about quality control attributes after cryopreservation have been raised. We investigated, in 155 allogeneic peripheral blood cryopreserved HPC, leukocytapheresis characteristics influencing viable CD34+ and CD3+ cells, and CFU-GM recoveries after thawing. Collection characteristics such as volume, nucleated cells (NC)/mL and hematocrit correlated with viable CD34+ and CD3+ cells recoveries after thawing in univariate analysis but only CD3+ cells remained statistically significant in multivariate analysis (r2 = 0.376; P = < 0.001). Additionally, transit time also showed correlation with viable CD34+ (r2 = 0.186), CD3+ (r2 = 0.376) and CFU-GM recoveries (r2 = 0.212) in multivariate analysis. Thus, diluting leukocytapheresis below 200 × 106 NC/mL, avoiding red cells contamination above 2%, cryopreserving below 250 × 106 NC/mL and minimizing transit time below 36 h, prevented poor viable CD34+ and CD3+ cells, and CFU-GM recoveries. In summary, optimizing leukocytapheresis practices and minimizing transportation time may better preserve the quality attributes of HPC when cryopreservation is indicated.
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Affiliation(s)
- Jesus Fernandez-Sojo
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain.
| | - Roger Horton
- Anthony Nolan Cell Therapy Centre, Nottingham Trent University, Nottingham, UK
| | - Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carmen Azqueta
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Ana Garcia-Buendia
- Data manager and statisticians, cell therapy department, Banc de Sang I Teixits, Barcelona, Spain
| | - Elena Valdivia
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Lluis Martorell
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Nuria Rubio-Lopez
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Gemma Aran
- Cell Laboratory, Banc de Sang i Teixits, Barcelona, Spain
| | - Julia Marsal
- Pediatric Hematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alberto Mussetti
- Adult Hematology Department, Institut Catala d'Oncologia-Hospitalet, Barcelona, Spain
| | - Rodrigo Martino
- Adult Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau and Jose Carreras Leukemia Research Institute, Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Christelle Ferra
- Adult Hematology Department, Institut Català d'Oncologia-Badalona, Barcelona, Spain
| | - David Valcarcel
- Adult Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mónica Linares
- Banc de Sang i Teixits, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Agueda Ancochea
- Banc de Sang i Teixits, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Enric García-Rey
- Banc de Sang i Teixits, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Nadia García-Muñoz
- Banc de Sang i Teixits, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Medina
- Banc de Sang i Teixits, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enric Carreras
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukemia Research Institute, Barcelona, Catalonia, Spain
| | - Juliana Villa
- Spanish Bone Marrow Donor Registry, Josep Carreras Foundation and Leukemia Research Institute, Barcelona, Catalonia, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis ICMHO, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Daniel Gibson
- Anthony Nolan Cell Therapy Centre, Nottingham Trent University, Nottingham, UK
| | - Sergio Querol
- Advanced & Cell Therapy Services, Banc de Sang i Teixits, Barcelona, Spain; Transfusion Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
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Donor-Derived Leukemia in a Recipient of Double-Unit Cord Blood Transplantation for Acute Myeloid Leukemia: A Case Study and Literature Review. Oncol Ther 2022; 10:75-84. [PMID: 35129793 PMCID: PMC9098757 DOI: 10.1007/s40487-021-00180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/02/2021] [Indexed: 10/27/2022] Open
Abstract
We report a case of donor-derived leukemia (DDL) occurring 34 months after double-unit cord blood transplantation (CBT). Molecular analysis using short tandem repeat (STR) sequences proved the acute myeloid leukemia (AML) to be of dominant cord blood origin. Karyotype was normal and molecular analysis showed WT1 and EVI1 overexpression. Cytological and molecular remission were achieved with only induction and consolidation chemotherapy. Relapse occurred after 6 years of remission from one clone with only WT1 overexpression. Potential etiologies for donor cell leukemogenesis in the recipient are discussed, including occult leukemia in the donor or genetic predisposition to hematologic malignancies, impaired immune surveillance, induced or inherited stromal abnormalities, transformation of donor cells during engraftment via altered signals of the host tissues, and fusion of donor cells with residual leukemic cells leading to acquisition of oncogenes. Although cases of DDL occurring after umbilical CBT have already been reported, very few cases have been described arising after double-unit CBT. DDL cases following CBT previously described in the literature have been reviewed.
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[Research progress on in vitro expansion and clinical application of hematopoietic stem cell]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:167-172. [PMID: 35381684 PMCID: PMC8980649 DOI: 10.3760/cma.j.issn.0253-2727.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chang A, Ragg SJ, Ma DD. Meeting the COVID challenge: Optimizing vCD34+ in cryopreserved HPC samples for implementation of an external QA Program. Cytotherapy 2022; 24:437-443. [PMID: 35086777 PMCID: PMC8786609 DOI: 10.1016/j.jcyt.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022]
Abstract
Background The COVID-19 pandemic has forced a fundamental change in the global procurement of allogeneic hematopoietic progenitor cells (HPCs) for transplantation. To better meet the emergent challenges of transporting cryopreserved allogeneic HPC during pandemics, there is an urgent need for External Quality Assurance (EQA) programs to evaluate reproducibility and harmonization of viable CD34+ cell (vCD34+) HPC enumeration, as the current EQA programs are unsuitable for analysis of vCD34+. The cost-effective distribution of HPC cryopreserved reference samples (CRSs) with acceptable reproducibility and specificity is key to the success of a vCD34+ EQA program. Methods Cryopreserved HPC samples (n = 11) were either stored on dry ice for 1 to 4 days or for 1 day followed by liquid nitrogen (LN) storage for 1 to 3 days to assess optimal conditions for vCD34+ EQA. Flow cytometric enumeration of vCD34+ HPCs was performed using a single platform assay combined with 7-AAD viability dye exclusion. The optimum transportation condition was validated in pilot and multicenter national studies (n = 12). Results A combination of 1 day on dry ice followed by LN storage stabilized viability compared with continuous storage on dry ice. This study demonstrates that dispatch of CRSs on dry ice to recipient centers across a distance of ≤4000 km within 26 h, followed by LN storage, resulted in reproducible intercenter vCD34+ enumeration. The estimated cost of safer and more convenient dry ice delivery is >20-fold lower than that of LN. Conclusion This approach can form the basis for economically and scientifically acceptable distribution of CRSs for external vCD34+ EQA.
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Affiliation(s)
- Annabella Chang
- Blood, Stem Cell and Cancer Research Program, St Vincent's Applied Medical Research Centre, and Department of Haematology and BM Transplant, St Vincent's Hospital Sydney, NSW, Australia
| | - Scott J Ragg
- Statewide BMT Program and Pathology Services, Royal Hobart Hospital, Hobart, TAS, Australia
| | - David D Ma
- Blood, Stem Cell and Cancer Research Program, St Vincent's Applied Medical Research Centre, and Department of Haematology and BM Transplant, St Vincent's Hospital Sydney, NSW, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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5
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Primary graft failure, but not relapse, may be identified by early chimerism following double cord unit transplantation. Blood Adv 2021; 6:2414-2426. [PMID: 34700343 PMCID: PMC9006284 DOI: 10.1182/bloodadvances.2021005106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022] Open
Abstract
Primary graft failure may be identified by early chimerism analysis after DUCBT with RIC. Chimerism does not appear to be useful in predicting relapse.
Umbilical cord blood transplantation (UCBT) has increased access to potentially curative therapy for patients with life-threatening disorders of the bone marrow and immune system. The introduction of reduced intensity conditioning (RIC) regimens and double umbilical cord unit infusions (DUCBT) has broadened the applicability of UCBT to more frail or larger recipients. The kinetics of chimerism after RIC DUCBT and their clinical utility are poorly understood. The RIC CBT trial reported here sought to prospectively evaluate the role of lineage-specific chimerism after DUCBT in adult patients with hematologic malignancies in the United Kingdom. Fifty-eight patients with a median age of 52 years were recruited, with overall and progression-free survivals of 59% (95% confidence interval [CI], 45%-71%) and 52% (95% CI, 39%-64%), respectively, at 2 years. Nonrelapse mortality was 4% (95% CI, 1%-13%) at day 100, and the relapse rate was 31% (95% CI, 21%-45%) at 1 year. Peripheral blood lineage-specific chimerism was feasible from day 7 after transplant onward. Five patterns of chimerism were observed including (1) complete single unit dominance (39 patients), (2) sustained donor-donor mixed chimerism (3 patients), (3) sustained donor-recipient mixed chimerism (5 patients), (4) dominance reversion (1 patient), and (5) primary graft failure (4 patients). The RIC CBT trial enabled adult patients with high-risk hematologic malignancies to safely access UCBT in the United Kingdom and provided novel insights into the kinetics of donor and recipient chimerism after RIC DUCBT that are clinically relevant. This trial was registered at https://www.clinicaltrialsregister.eu/ctr-search/trial/2004-003845-41/GB as #NCT00959231 and EudraCT 2004-003845-41.
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Damodar S, Ma DD, Ragg SJ, Chang A, Hwang WYK, Ho AYL, Srivastava A. Standardization and Accreditation in Haemopoietic Stem Cell Transplantation - an Asia Pacific Perspective. BLOOD CELL THERAPY 2021; 4:S14-S19. [PMID: 36713471 PMCID: PMC9847258 DOI: 10.31547/bct-2021-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 02/01/2023]
Abstract
Standardization and formal accreditation of practices related to hematopoietic stem cell transplantation (HSCT) and therapies using hematopoietic-derived cellular products aim to promote quality in clinical and laboratory practice and provide knowledge to all stakeholders of centers. This article refers to three aspects of these processes starting with the importance of accurate viable CD 34 enumeration in HSCT. A highly accurate method of enumeration and a robust EQAS program is required, especially during the current COVID-19 pandemic. The second section shares experiences with FACT-JACIE accreditation at the Singapore General Hospital demonstrating how accreditation is part of continuous improvement and not only a destination. This journey can be difficult in many HSCT centers of low- and middle-income countries (LMICs) because of the intensive and rigorous requirements of the internationally accredited models. Hence, in LMICs, a staged movement toward establishing such standards must be considered. This approach is presented in the third section of the article with data on the current situation in countries reporting to the APBMT registry.
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Affiliation(s)
- Sharat Damodar
- Dept of Haematology and BMT, Mazumdar shaw medical center, Narayana health city, India
| | - David D Ma
- Department of Haematology and BM Transplant, St Vincent's Hospital Sydney, NSW, Australia,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, NSW, Australia
| | | | - Annabella Chang
- St Vincent's Centre for Applied Medical Research, Sydney NSW Australia
| | - William YK Hwang
- Department of Haematology, Singapore General Hospital, Singapore
| | - Aloysius YL Ho
- Department of Haematology, Singapore General Hospital, Singapore
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Salamonowicz-Bodzioch M, Rosa M, Frączkiewicz J, Gorczyńska E, Gul K, Janeczko-Czarnecka M, Jarmoliński T, Kałwak K, Mielcarek-Siedziuk M, Olejnik I, Owoc-Lempach J, Panasiuk A, Gajek K, Rybka B, Ryczan-Krawczyk R, Ussowicz M. Fludarabine-Cyclophosphamide-Based Conditioning with Antithymocyte Globulin Serotherapy Is Associated with Durable Engraftment and Manageable Infections in Children with Severe Aplastic Anemia. J Clin Med 2021; 10:jcm10194416. [PMID: 34640434 PMCID: PMC8509585 DOI: 10.3390/jcm10194416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 01/18/2023] Open
Abstract
Severe aplastic anemia (SAA) is a bone marrow failure syndrome that can be treated with hematopoietic cell transplantation (HCT) or immunosuppressive (IS) therapy. A retrospective cohort of 56 children with SAA undergoing transplantation with fludarabine-cyclophosphamide-ATG-based conditioning (FluCyATG) was analyzed. The endpoints were overall survival (OS), event-free survival (EFS), cumulative incidence (CI) of graft versus host disease (GVHD) and CI of viral replication. Engraftment was achieved in 53/56 patients, and four patients died (two due to fungal infection, and two of neuroinfection). The median time to neutrophil engraftment was 14 days and to platelet engraftment was 16 days, and median donor chimerism was above 98%. The overall incidence of acute GVHD was 41.5%, and that of grade III-IV acute GVHD was 14.3%. Chronic GVHD was diagnosed in 14.2% of children. The probability of 2-year GVHD-free survival was 76.1%. In the univariate analysis, a higher dose of cyclophosphamide and previous IS therapy were significant risk factors for worse overall survival. Episodes of viral replication occurred in 33/56 (58.9%) patients, but did not influence OS. The main advantages of FluCyATG include early engraftment with a very high level of donor chimerism, high overall survival and a low risk of viral replication after HCT.
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Affiliation(s)
- Małgorzata Salamonowicz-Bodzioch
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
- Correspondence: ; Tel.: +48-71-7332700; Fax: +48-71-7332709
| | - Monika Rosa
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Jowita Frączkiewicz
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Ewa Gorczyńska
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Katarzyna Gul
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Małgorzata Janeczko-Czarnecka
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Tomasz Jarmoliński
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Krzysztof Kałwak
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Monika Mielcarek-Siedziuk
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Igor Olejnik
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Joanna Owoc-Lempach
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Anna Panasiuk
- Department of Oncology, Hematolgy and Transplantology, University Hospital USK in Wroclaw, 50-556 Wroclaw, Poland;
| | - Kornelia Gajek
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Blanka Rybka
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Renata Ryczan-Krawczyk
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
| | - Marek Ussowicz
- Department of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (M.R.); (J.F.); (E.G.); (K.G.); (M.J.-C.); (T.J.); (K.K.); (M.M.-S.); (I.O.); (J.O.-L.); (K.G.); (B.R.); (R.R.-K.); (M.U.)
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8
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First-Line Unrelated Double-Unit Umbilical Cord Blood Transplantation for Acquired Severe Aplastic Anemia. Transplant Proc 2021; 53:2390-2396. [PMID: 34417029 DOI: 10.1016/j.transproceed.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022]
Abstract
We analyzed the outcomes of 14 patients with severe aplastic anemia (SAA) who received first-line double-unit cord blood transplantation (dUCBT). Patients' median age was 24.5 years (range, 10-44 years). The median numbers of infused nucleated and CD34+ cells were 5.48 × 107/kg (range, 3.33-7.96 × 107/kg) and 2.30 × 105/kg (range, 0.86-3.97 × 105/kg), respectively. One patient died 5 days after transplantation. Three of the 13 patients acquired autologous myeloid recovery. Neutrophil engraftment was observed in 10 patients (76.29%), and the median time of neutrophil recovery was 19 days (range, 15-40 days). Platelet engraftment was observed in 7 cases (53.8%), and 3 patients experienced platelet graft failure. The median time of platelet recovery was 32 days (range, 22-80 days). The cumulative incidence of grade II-IV acute graft-vs-host disease (GVHD) was 38.5%. One patient demonstrated mild chronic GVHD. After a median follow-up of 61 months (range, 18-102 months), 6 patients were alive. The predicted 5-year overall survival and GVHD-free, failure-free survival rates were 42.9% ± 13.2% and 14.3% ± 9.4%, respectively. The first-line dUCBT for SAA is still primarily evaluated through multicenter prospective clinical trials by an optimal conditioning regimen, cell dose, and other graft and transplantation-related factors.
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9
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Hare J, DeLeon PG, Pool K, Reioux D, Fontenot M, Champlin RE, Eaton EN, Marin D, Rezvani K, Shpall EJ, Wilson JM, Hosing C. Optimal umbilical cord blood collection, processing and cryopreservation methods for sustained public cord blood banking. Cytotherapy 2021; 23:1029-1035. [PMID: 34247985 DOI: 10.1016/j.jcyt.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AIMS Umbilical cord blood is an established source of stem cells in patients with hematologic malignancies who do not have HLA-compatible matched related or unrelated donors. The success of an umbilical cord blood transplant depends on the dose of total nucleated and CD34+ cells infused. Therefore, collecting, banking and listing high-quality cord blood units with high total nucleated and CD34+ cell dose are essential. METHODS Here the authors describe their cord blood bank's novel collection technique, which involves both in utero and ex utero collection of a single cord blood unit. The authors also evaluated maternal, neonatal and collection parameters that may impact the cell dose. RESULTS Maternal gestational age and race, and neonatal weight and sex correlated with the total nucleated cell dose. CONCLUSIONS The optimized collection of umbilical cord blood is critical for its use as a source of stem cells for transplantation.
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Affiliation(s)
- Joanie Hare
- Department of Obstetrics and Gynecology, The Women's Hospital of Texas, Houston, Texas, USA
| | - Paulina Garcia DeLeon
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Krystle Pool
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donna Reioux
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Milford Fontenot
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erin N Eaton
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey M Wilson
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation and Cellular Therapy and Cord Blood Bank, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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10
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Optimizing selection of double cord blood units for transplantation of adult patients with malignant diseases. Blood Adv 2021; 4:6327-6335. [PMID: 33351128 DOI: 10.1182/bloodadvances.2020002258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/03/2020] [Indexed: 12/20/2022] Open
Abstract
Double-unit unrelated cord blood transplantation (DUCBT) is an option in patients for whom a single unit is not sufficient to provide an adequate number of cells. As current guidelines on UCB unit selection are mainly based on single-unit UCB data, we performed a retrospective analysis of 1375 adult recipients of DUCBT for hematologic malignancies to determine optimal criteria for graft selection. Cryopreserved total nucleated cells (TNCs; ≤3.5 vs >3.5 × 107/kg: hazard ratio [HR], 1.53; 30% vs 45%; P = .01), number of HLA mismatches (≥2 vs 0-1: HR, 1.28; 42% vs 48%; P = .01), and ABO compatibility (minor/major ABO incompatibility vs compatibility: HR, 1.28; P = .04) were independent risk factors for OS. Cryopreserved CD34+ cell dose ≥0.7 × 105/kg in the winning UCB was associated with improved OS (HR, 1.34; P = .03). Low TNC (≤3.5 × 107/kg) and CD34+ (≤1.4 × 105/kg) cell doses were related to decreased neutrophil recovery (HR, 0.65 [P = .01] and HR, 0.81 [P = .01], respectively). DUCBT recipients with ≥2 HLA mismatches had a higher incidence of grade II-IV and III-IV acute graft-versus-host disease (HR, 1.26 [P = .03] and 1.59 [P = .02], respectively). Low TNC dose (HR, 1.57; P = .02) and receiving UCB with ≥2 HLA mismatches (HR, 1.35; P = .03) were associated with increased transplant-related mortality. Our data support selecting adequately HLA-matched UCB units with a double-unit cryopreserved TNC dose >3.5 × 107/kg and CD34+ cell dose of ≥0.7 × 105/kg per unit in DUCBT candidates.
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11
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Ho AP, Ho BE, Berg MP, Gutman JA, Draper NL. Blood type change identifies late dominance reversal of chimerism after double umbilical cord blood transplantation with review of the literature. Transfusion 2021; 61:960-967. [PMID: 33638187 DOI: 10.1111/trf.16297] [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: 09/25/2020] [Revised: 11/21/2020] [Accepted: 12/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A 30-year-old man underwent double umbilical cord blood transplantation (UCBT) for acute myeloid leukemia (AML) with reduced intensity conditioning. The cords had identical HLA types and were each a 5/6 match to the patient. Following transplantation, cord 2 initially dominated all tested cell populations. At day +306, we observed an unusual reversal of dominance chimerism pattern in which cord 1 instead dominated all tested populations. STUDY DESIGN & METHODS Polymerase chain reaction (PCR)-based short tandem repeat (STR) assays were performed on the peripheral blood and bone marrow samples. The white blood cell (WBC) populations from the peripheral blood were manipulated for testing to create subpopulations enriched for CD3, CD33, and CD56. RESULTS Chimerism studies on day +77 showed the following: cord 1: 44%-CD3; 0%-CD33; 16%-CD56; cord 2: 56%-CD3; 100%-CD33; 84%-CD56. Cord 2 initially dominated in all tested cell populations. Chimerism studies performed on post-transplantation day +306 uncovered a reversal of dominance chimerism pattern in which cord 1 now dominated in all cell populations (cord 1: 82%-CD3; >95%-CD33; 67%-CD56; cord 2: 18%-CD3; <5%-CD33; 33%-CD56). Between days +127 and +244, the patient's blood type shifted from B Rh-positive to A Rh-negative. CONCLUSION The change in the patient's blood type identified a late reversal of dominance chimerism pattern. This is a rare occurrence, previously cited only once, which is inconsistent with published data that early high CD3 counts and unseparated bone marrow chimerism predominance at day +100 predict long-term cord dominance in double UCBT in the vast majority of cases.
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Affiliation(s)
- Andrea P Ho
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bethany E Ho
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mary P Berg
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Nicole L Draper
- University of Colorado School of Medicine, Aurora, Colorado, USA
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12
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Variable CD34+ recovery of cryopreserved allogeneic HPC products: transplant implications during the COVID-19 pandemic. Blood Adv 2020; 4:4147-4150. [PMID: 32886750 PMCID: PMC7479963 DOI: 10.1182/bloodadvances.2020002431] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
Abstract
CD34+ cell recovery and viability are variable after
thawing cryopreserved hematopoietic progenitor cell products. Reduced CD34+ cell recovery and viability are linked
to longer storage time and higher white cell concentration before
cryopreservation.
Donor registries and transplantation societies recommend cryopreservation of
unrelated donor hemopoietic progenitor cell (HPC) products before the recipient
commences conditioning therapy to mitigate the donor and travel risks associated
with the COVID-19 pandemic. However, little is known regarding the postthaw
quality of such allogeneic products or the effect of precryopreservation storage
and processing on these characteristics. We investigated the postthaw
CD34+ cell recovery and viability of 305 allogeneic HPC
products cryopreserved at 9 laboratories across Australia. Median postthaw
CD34+ cell recovery was 76% and ranged from 6% to 122%.
Longer transit time before cryopreservation, white cell count (WCC) during
storage, and complex product manipulation before cryopreservation were
independently associated with inferior postthaw CD34+ cell
recovery. Longer precryopreservation transit time and WCC were also associated
with inferior postthaw CD34+ cell viability. We conclude that
although postthaw CD34+ cell recovery and viability of
cryopreserved allogeneic HPC is generally acceptable, there is a significant
risk of poor postthaw product quality, associated with prolonged storage time,
higher WCC, and complex product manipulation precryopreservation. Awareness of
expected postthaw recovery and practices that influence it will assist
collection, processing, and transplant centers in optimizing outcomes for
transplant recipients.
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13
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Politikos I, Davis E, Nhaissi M, Wagner JE, Brunstein CG, Cohen S, Shpall EJ, Milano F, Scaradavou A, Barker JN. Guidelines for Cord Blood Unit Selection. Biol Blood Marrow Transplant 2020; 26:2190-2196. [PMID: 32736011 DOI: 10.1016/j.bbmt.2020.07.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
Optimal cord blood (CB) unit selection is critical to maximize the likelihood of successful engraftment and survival after CB transplantation (CBT). However, unit selection can be complex because multiple characteristics must be considered including unit cell dose, donor-recipient human leukocyte antigen (HLA) match, and unit quality. This review provides evidence-based and experience-based comprehensive guidelines for CB unit selection. Topics addressed include the use of both the TNC and the CD34+ cell dose, as well as the CD34+ cell to TNC content ratio to evaluate unit progenitor cell content and engraftment potential, the acceptable TNC and CD34+ cell dose criteria that define an adequate single-unit graft, and the indication and acceptable cell dose criteria for double-unit grafts. The acceptable criteria for 6-loci (HLA-A, -B antigen, -DRB1 allele) and 8-allele (HLA-A, -B, -C, -DRB1) donor-recipient HLA match, the evaluation of patients with donor-specific HLA antibodies, and the multiple determinants of unit quality are also reviewed in detail. Finally, a practical step-by-step guide to CB searches and the principles that guide ultimate graft selection are outlined.
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Affiliation(s)
- Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Eric Davis
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa Nhaissi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John E Wagner
- Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Claudio G Brunstein
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Sandra Cohen
- Division of Hematology, Department of Medicine, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Elizabeth J Shpall
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Filippo Milano
- Clinical Research Division, Fred Hutchinson Cancer Research Center & Department of Medicine, University of Washington, Seattle, Washington
| | | | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Politikos I, Devlin SM, Arcila ME, Barone JC, Maloy MA, Naputo KA, Ruiz JD, Mazis CM, Scaradavou A, Avecilla ST, Dahi PB, Giralt SA, Hsu KC, Jakubowski AA, Papadopoulos EB, Perales MA, Sauter CS, Tamari R, Ponce DM, O'Reilly RJ, Barker JN. Engraftment kinetics after transplantation of double unit cord blood grafts combined with haplo-identical CD34+ cells without antithymocyte globulin. Leukemia 2020; 35:850-862. [PMID: 32555371 PMCID: PMC7746597 DOI: 10.1038/s41375-020-0922-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
Double unit cord blood (dCB) transplantation (dCBT) is associated with high engraftment rates but delayed myeloid recovery. We investigated adding haplo-identical CD34+ cells to dCB grafts to facilitate early haplo-identical donor-derived neutrophil recovery (optimal bridging) prior to CB engraftment. Seventy-eight adults underwent myeloablation with cyclosporine-A/mycophenolate mofetil immunoprophylaxis (no antithymocyte globulin, ATG). CB units (median CD34+ dose 1.1 × 105/kg/unit) had a median 5/8 unit-recipient human leukocyte antigen (HLA)-match. Haplo-identical grafts had a median CD34+ dose of 5.2 × 106/kg. Of 77 evaluable patients, 75 had sustained CB engraftment that was mediated by a dominant unit and heralded by dominant unit-derived T cells. Optimal haplo-identical donor-derived myeloid bridging was observed in 34/77 (44%) patients (median recovery 12 days). Other engrafting patients had transient bridging with second nadir preceding CB engraftment (20/77 (26%), median first recovery 12 and second 26.5 days) or no bridge (21/77 (27%), median recovery 25 days). The 2 (3%) remaining patients had graft failure. Higher haplo-CD34+ dose and better dominant unit-haplo-CD34+ HLA-match significantly improved the likelihood of optimal bridging. Optimally bridged patients were discharged earlier (median 28 versus 36 days). ATG-free haplo-dCBT can speed neutrophil recovery but successful bridging is not guaranteed due to rapid haplo-identical graft rejection.
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Affiliation(s)
- Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Diagnostic Molecular Pathology, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan C Barone
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Molly A Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristine A Naputo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josel D Ruiz
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher M Mazis
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andromachi Scaradavou
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Scott T Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parastoo B Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Katherine C Hsu
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ann A Jakubowski
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Miguel A Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Craig S Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Roni Tamari
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Richard J O'Reilly
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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15
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Li Y, He M, Zhang W, Yang M, Ding Y, Xu S, Gu J, Li Y, Yin J, Gao Y. Antioxidant Small Molecule Compound Chrysin Promotes the Self-Renewal of Hematopoietic Stem Cells. Front Pharmacol 2020; 11:399. [PMID: 32300303 PMCID: PMC7142222 DOI: 10.3389/fphar.2020.00399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/16/2020] [Indexed: 12/11/2022] Open
Abstract
There is an increasing demand for the expansion of functional human hematopoietic stem cells (hHSCs) for various clinical applications. Based on our primary screening of antioxidant small molecule compounds library, a small molecule compound C2968 (chrysin) was identificated to expand cord blood CD34+ cells in vitro. Then we further verified the optimum concentration and explored its effect on hHSCs phenotype and biological function. C2968 could significantly increase the proportion and absolute number of CD34+CD38−CD49f+ and CD34+CD38−CD45RA−CD90+ cells under 2.5 μM. Furthermore, the total number of colony-forming units and the frequency of LT-HSCs in C2968-treated group were significantly higher than control, indicating the multipotency and long-term activity of hematopoietic stem and progenitor cells were sustained. Additionally, C2968 treatment could maintain transplantable HSCs that preserve balanced multilineage potential and promote rapid engraftment after transplantation in immunodeficient (NOG) mice. Mechanistically, the activity of chrysin might be mediated through multiple mechanisms namely delaying HSC differentiation, inhibiting ROS-activated apoptosis, and modulating of cyclin-dependent kinase inhibitors. Overall, chrysin showed good ex vivo expansion effect on hHSCs, which could maintain the self-renewal and multilineage differentiation potential of hHSCs. Through further research on its antioxidant mechanism, it may become a promising tool for further fundamental research and clinical umbilical cord blood transplantation of hHSCs.
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Affiliation(s)
- Yinghui Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Mei He
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Wenshan Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Ming Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yahui Ding
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin, China
| | - Shiqi Xu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jiali Gu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yafang Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jingjing Yin
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yingdai Gao
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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16
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Rosa M, Gajek K, Salamonowicz-Bodzioch M, Mielcarek-Siedziuk M, Frączkiewicz J, Jarmoliński T, Olejnik I, Ussowicz M. Successful Bone Marrow Recovery After an Immunoablative Regimen With Autologous Cord Blood Transplant in a Child With Idiopathic Severe Aplastic Anemia: A Case Report. Transplant Proc 2020; 52:653-656. [PMID: 32035683 DOI: 10.1016/j.transproceed.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aplastic anemia is a rare disease that manifests as bone marrow failure. The current treatment options include immunoablative therapy or allogeneic hematopoietic stem cell transplantation. We report a successful immunoablative regimen with autologous umbilical cord blood (auto-UCB) transplant in a 3-year-old boy with severe aplastic anemia. CASE REPORT The immunoablation procedure consisted of 5 × 3.75 mg/kg antithymocyte globulin (Thymoglobulin) (total 18.75 mg/kg), methylprednisolone for 4 days, and cyclosporine A. The patient received auto-UCB containing 0.3 × 105 CD34+ cells per kilogram of body weight. Recovery of leukocyte count above 1000/μL was reached on post-transplant day +39, and recovery of granulocytes above 500/μL was reached on day +40. The final regular transfusions of packed red blood cells and platelet concentrate were performed on day +55. The complications that occurred in the post-transplant period were nausea, diarrhea, septic fever, and hepatic abscess formation. Post-transplant immunosuppression with cyclosporine A was discontinued 17.5 months after auto-UCB, and the patient remained in complete remission with normal blood counts and bone marrow morphology. SUMMARY Auto-UCB transplantation without chemotherapy conditioning can be considered a therapeutic option for children with stored cord blood cells.
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Affiliation(s)
- Monika Rosa
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland
| | - Kornelia Gajek
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland
| | | | - Monika Mielcarek-Siedziuk
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland
| | - Jowita Frączkiewicz
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland
| | - Tomasz Jarmoliński
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland
| | - Igor Olejnik
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland
| | - Marek Ussowicz
- Department of Paediatric Bone Marrow Transplantation, Oncology, and Hematology, Wrocław Medical University, Wroclaw, Poland.
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17
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Double Umbilical Cord Blood Transplantation in High-Risk Hematological Patients: A Phase II Study Focusing on the Mechanism of Graft Predominance. Hemasphere 2019; 3:e285. [PMID: 31942540 PMCID: PMC6919462 DOI: 10.1097/hs9.0000000000000285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2019] [Indexed: 12/18/2022] Open
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18
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Selection of unrelated donors and cord blood units for hematopoietic cell transplantation: guidelines from the NMDP/CIBMTR. Blood 2019; 134:924-934. [PMID: 31292117 PMCID: PMC6753623 DOI: 10.1182/blood.2019001212] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023] Open
Abstract
Allogeneic hematopoietic cell transplantation involves consideration of both donor and recipient characteristics to guide the selection of a suitable graft. Sufficient high-resolution donor-recipient HLA match is of primary importance in transplantation with adult unrelated donors, using conventional graft-versus-host disease prophylaxis. In cord blood transplantation, optimal unit selection requires consideration of unit quality, cell dose and HLA-match. In this summary, the National Marrow Donor Program (NMDP) and the Center for International Blood and Marrow Transplant Research, jointly with the NMDP Histocompatibility Advisory Group, provide evidence-based guidelines for optimal selection of unrelated donors and cord blood units.
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19
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Tozatto-Maio K, Giannotti F, Labopin M, Ruggeri A, Volt F, Paviglianiti A, Kenzey C, Hayashi H, Cornelissen J, Michallet M, Karakasis D, Deconinck E, Rohrlich PS, de la Tour RP, Blaise D, Petersen E, D'Aveni M, Sengeloev H, Lamy T, Russell NH, Forcade E, Craddock CF, Nagler A, Gluckman E, Rocha V. Cord Blood Unit Dominance Analysis and Effect of the Winning Unit on Outcomes after Double-Unit Umbilical Cord Blood Transplantation in Adults with Acute Leukemia: A Retrospective Study on Behalf of Eurocord, the Cord Blood Committee of Cellular Therapy, Immunobiology Working Party, and the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2018; 24:1657-1663. [DOI: 10.1016/j.bbmt.2018.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/10/2018] [Indexed: 12/22/2022]
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20
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Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Sanz J, Vigouroux S, Furst S, Bosi A, Chevallier P, Cornelissen JJ, Michallet M, Sierra J, Karakasis D, Savani BN, Gluckman E, Nagler A. Occurrence of graft-versus-host disease increases mortality after umbilical cord blood transplantation for acute myeloid leukaemia: a report from Eurocord and the ALWP of the EBMT. J Intern Med 2018; 283:178-189. [PMID: 28977716 DOI: 10.1111/joim.12696] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The efficacy of umbilical cord blood transplantation (UCBT) as treatment for acute myeloid leukaemia (AML) relies on immune-mediated graft-versus-leukaemia effects. Previous studies have suggested a strong association between graft-versus-host disease (GVHD) occurrence and graft-versus-leukaemia effects after allogeneic hematopoietic cell transplantation. METHODS Here, we evaluated the kinetics of relapse rate in correlation with GVHD occurrence after UCBT. The kinetics of relapse rate over time in correlation to GVHD occurrence were assessed by calculating the relapse rate per patient-year within sequential 90-day intervals. The impact of GVHD on relapse and mortality was further studied in multivariate Cox models handling GVHD as a time-dependent covariate. RESULTS The study included data from 1068 patients given single (n = 567) or double (n = 501) UCBT. The proportion of patients with grade II, III and IV acute GVHD was 20%, 7% and 4%, respectively. At 2 years, the cumulative incidence of chronic GVHD was 42%, the cumulative incidence of relapse was 32%, and overall survival was 32% as well. Relapse rates declined gradually over time during the first 30 months after transplantation. There was a possible suggestion that grade II-IV acute (HR = 0.8, P = 0.1) and chronic (HR = 0.65, P = 0.1) GVHD decreased relapse risk. However, grade II-IV acute GVHD significantly increased early (the first 18 months after UCBT) mortality (HR = 1.3, P = 0.02), whilst chronic GVHD increased each early (HR = 2.7, P < 0.001) and late (HR = 4.9, P < 0.001) mortality after UCBT. CONCLUSIONS The occurrence of grade II-IV acute or chronic GVHD each increases overall mortality after UCBT for AML mitigating the possible graft-versus-leukemia effect of GVHD.
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Affiliation(s)
- F Baron
- Laboratory of Hematology, GIGA-I3, University of Liege, Liege, Belgium
| | - A Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, IUH University Paris VII, Paris, France.,Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Université Pierre & Marie Curie and INSERM UMRs U938
| | - E Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - M Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - M Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Université Pierre & Marie Curie and INSERM UMRs U938
| | - J Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - S Vigouroux
- Department of Hematology, University Hospital of Bordeaux, Bordeaux, France
| | - S Furst
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - A Bosi
- Hematology Unit, AOU Careggi, Florence, Italy
| | - P Chevallier
- Department of Hematology, CHU Nantes, Nantes, France
| | - J J Cornelissen
- Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, The Netherlands
| | - M Michallet
- Department of Hematology, Centre Hospitalier Lyon-Sud, Lyon, France
| | - J Sierra
- Hematology Department, IIB Sant Pau and Josep Carreras Leukemia Research Institutes, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - D Karakasis
- Department of Hematology and Lymphomas, Evangelismos Hospital, Athens, Greece
| | - B N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, France Monacord, Centre Scientifique de Monaco, IUH University Paris VII, Monaco city, Monaco
| | - A Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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21
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Mehta RS, Olson A, Ponce DM, Shpall EJ. Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Impact of Graft-Versus-Graft Natural Killer Cell Alloreactivity on Single Unit Dominance After Double Umbilical Cord Blood Transplantation. Transplantation 2017; 101:2092-2101. [PMID: 27798515 DOI: 10.1097/tp.0000000000001545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Natural killer (NK) cell alloreactivity is favored after double umbilical cord blood transplantation (dUCBT) in which cord blood (UCB) units and patients are often HLA class I mismatched. Generally, only 1 UCB unit persists after dUCBT. We hypothesize, that NK cell alloreactivity mediated by killer cell immunoglobulin-like receptor (KIR)-HLA interactions may explain the dominance of 1UCB unit over the other after dUCBT. METHODS We investigated the impact of KIR NK cell alloreactivities on the dominance of 1 full UCB unit in 50 dUCBT. We analyzed the effects of the KIR/HLA genetic incompatibilities and studied cord blood cells at both the phenotypic and functional levels. RESULTS The genetic combination of KIR3DL1 loser UCB unit/Bw4 winner UCB unit determined both the dominance of 1 UCB unit (hazards ratio, 2.88 [1.32-6.27], P = 0.0077) and correlated with an increased incidence of relapse (hazards ratio, 4.91 [1.39-17.3], P = 0.0134). It is interesting to note that cord blood cells exhibited extremely low HLA class I expression. Moreover, resting cord blood KIR3DL1 NK cells exhibited a basal alloreactivity against Bw4 target cells that increased upon activation, thus triggering death by apoptosis. CONCLUSIONS Our unicentric study suggests, for the first time, the significant impact of KIR NK cell alloreactivity in the determination of which UCB unit will dominate in dUCBT.
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23
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Persistence of the losing cord blood unit following double cord blood transplantation: finding the unseen. Blood 2017; 130:1480-1482. [PMID: 28765258 DOI: 10.1182/blood-2017-06-788513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Blaise D, Cornelissen JJ, Chevallier P, Sanz G, Petersen E, Savani BN, Gluckman E, Nagler A. Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT. J Hematol Oncol 2017. [PMID: 28637512 PMCID: PMC5479038 DOI: 10.1186/s13045-017-0497-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The feasibility of cord blood transplantation (CBT) in adults is limited by the relatively low number of hematopoietic stem/progenitor cells contained in one single CB unit. The infusion of two CB units from different partially HLA-matched donors (double CBT) is frequently performed in patients who lack a sufficiently rich single CB unit. Methods We compared CBT outcomes in patients given single or double CBT following reduced-intensity conditioning (RIC) in a retrospective multicenter registry-based study. Inclusion criteria included adult (≥18 years) patients, acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), complete remission (CR) at the time of transplantation, first single (with a cryopreserved TNC ≥ 2.5 × 107/kg) or double CBT between 2004 and 2014, and RIC conditioning. Results Data from 534 patients with AML (n = 408) or ALL (n = 126) receiving a first single (n = 172) or double (n = 362) CBT were included in the analyses. In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a similar incidence of neutrophil engraftment but a suggestion for a higher incidence of grade II–IV acute GVHD (36 versus 28%, P = 0.08). In multivariate analyses, in comparison to single CBT recipients, double CBT patients had a comparable incidence of relapse (HR = 0.9, P = 0.5) and of nonrelapse mortality (HR = 0.8, P = 0.3), as well as comparable overall (HR = 0.8, P = 0.17), leukemia-free (HR = 0.8, P = 0.2) and GVHD-free, relapse-free (HR = 1.0, P = 0.3) survival. Conclusions These data failed to demonstrate better transplantation outcomes in adult patients receiving double CBT in comparison to those receiving single CBT with adequate TNC after RIC. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0497-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Baron
- Department of Hematology, University of Liege, CHU Sart-Tilman, 4000, Liege, Belgium.
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | | | - Guillermo Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - Eefke Petersen
- Department of Hematology, University Medical Centre, Utrecht, The Netherlands
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and the EBMT Paris Office, Hospital Saint Antoine, Paris, France
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25
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Cornelissen JJ, Kalin B, Lamers CHJ. Graft predominance after double umbilical cord blood transplantation: a review. Stem Cell Investig 2017; 4:47. [PMID: 28607921 DOI: 10.21037/sci.2017.05.09] [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] [Received: 04/07/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022]
Abstract
Several parameters are involved in graft predominance after double umbilical cord blood transplantation (dUCBT), of which T-cell alloreactivity between the grafts is now considered to be the major denominator. We recently showed that alloreactive CD4+ T-cells originating from the predominant CBU recognize HLA-class II allele mismatches and can readily be detected in the majority of patients. In addition, it was shown that HLA-class II allele-specific CD4+ T-cells were able to recognize primary leukemic cells when the mismatched HLA-class II allele was shared between the rejected CBU and the patient. These results further underscored the role of alloreactive T-cells, notably class II specific CD4+ T-cells, in graft-versus-graft reactions and in graft-versus-leukemia after dUCBT.
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Affiliation(s)
- Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Burak Kalin
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cor H J Lamers
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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26
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Tanoue S, Konuma T, Takahashi S, Watanabe E, Sato N, Watanabe N, Isobe M, Kato S, Ooi J, Tojo A. Long-term persistent donor-recipient mixed chimerism without disease recurrence after myeloablative single-unit cord blood transplantation in adult acute myeloid leukemia following myelodysplastic syndrome. Leuk Lymphoma 2017; 58:2973-2975. [PMID: 28509586 DOI: 10.1080/10428194.2017.1318440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Susumu Tanoue
- a Department of Hematology/Oncology , Institute of Medical Science, University of Tokyo , Tokyo , Japan
| | - Takaaki Konuma
- a Department of Hematology/Oncology , Institute of Medical Science, University of Tokyo , Tokyo , Japan
| | - Satoshi Takahashi
- a Department of Hematology/Oncology , Institute of Medical Science, University of Tokyo , Tokyo , Japan
| | - Eri Watanabe
- b Department of IMSUT Clinical Flow Cytometry Laboratory , Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Natsuko Sato
- b Department of IMSUT Clinical Flow Cytometry Laboratory , Institute of Medical Science, The University of Tokyo , Tokyo , Japan
| | - Nobukazu Watanabe
- c Division of Oncology, Hematology and Infectious Diseases, Department of Internal Medicine , Faculty of Medicine, Fukuoka University , Fukuoka , Japan
| | - Masamichi Isobe
- a Department of Hematology/Oncology , Institute of Medical Science, University of Tokyo , Tokyo , Japan
| | - Seiko Kato
- a Department of Hematology/Oncology , Institute of Medical Science, University of Tokyo , Tokyo , Japan
| | - Jun Ooi
- d Department of Hematology/Oncology , Teikyo University School of Medicine , Tokyo , Japan
| | - Arinobu Tojo
- a Department of Hematology/Oncology , Institute of Medical Science, University of Tokyo , Tokyo , Japan
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27
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Mitchell R, Wagner JE, Brunstein C, Cao Q, McKenna DH, Verneris MR. Impact of Delayed Infusion Time in Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2017; 23:836-839. [PMID: 28214595 DOI: 10.1016/j.bbmt.2017.02.010] [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: 11/04/2016] [Accepted: 02/11/2017] [Indexed: 11/25/2022]
Abstract
In umbilical cord blood (UCB) transplantation, UCB units are typically thawed, washed, and infused into the patient as rapidly as possible. In some instances there is a delay in the time from the unit thaw and wash procedure to infusion into the patient. Therefore, we examined the effect of thaw duration time on engraftment outcomes in 567 patients undergoing UCB transplantation. With a range of 32 to 523 minutes, a prolonged thaw duration had no obvious effect on the incidence of neutrophil engraftment or time to recovery. This was true for recipients of single UCB transplantation (incidence: 97% versus 93%, P = .13; time to neutrophil recovery: 21 days versus 21 days, P = .32; and platelet recovery: 79% versus 78%, P = .48), and similar results were observed in double UCB transplantation (time to neutrophil engraftment: 20 days versus 19 days, P = .71). However, there was a trend toward better platelet recovery in recipients of double UCB transplants with prolonged thaw duration (HR, 1.28; P = .06). In conclusion, this study demonstrates prolonged thaw duration has no detrimental effect on engraftment after single or double UCB transplantation.
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Affiliation(s)
- Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - John E Wagner
- Pediatric Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, Minnesota
| | - Claudio Brunstein
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Qing Cao
- Biostatistic Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - David H McKenna
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Michael R Verneris
- Pediatric Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, Minnesota.
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28
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Brunstein C, Zhang MJ, Barker J, St Martin A, Bashey A, de Lima M, Dehn J, Hematti P, Perales MA, Rocha V, Territo M, Weisdorf D, Eapen M. The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia. Haematologica 2017; 102:941-947. [PMID: 28126967 PMCID: PMC5477613 DOI: 10.3324/haematol.2016.158584] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/20/2017] [Indexed: 01/28/2023] Open
Abstract
The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients', disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, P=0.11) or platelet (Hazard Ratio 0.1.13, P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17, P=0.36), treatment-related mortality (Hazard Ratio 0.92, P=0.75), relapse (Hazard Ratio 1.18, P=0.49), treatment failure (Hazard Ratio 0.99, P=0.98), or overall survival (Hazard Ratio 0.98, P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.
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Affiliation(s)
| | - Mei-Jie Zhang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Juliet Barker
- Adult Bone Marrow Transplant Services, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Andrew St Martin
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Marcos de Lima
- Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jason Dehn
- National Marrow Donor Program/Be the Match, Minneapolis, MN, USA
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplant Services, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Mary Territo
- UCLA Center for Health Sciences, Los Angeles, CA, USA
| | - Daniel Weisdorf
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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29
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Lack of impact of umbilical cord blood unit processing techniques on clinical outcomes in adult double cord blood transplant recipients. Cytotherapy 2016; 19:272-284. [PMID: 27939176 DOI: 10.1016/j.jcyt.2016.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AIMS Despite widespread use of umbilical cord blood (UCB) transplantation and distinct practice preferences displayed by individual UCB banks and transplant centers, little information exists on how processing variations affect patient outcomes. METHODS We reviewed 133 adult double UCB transplants performed at a single center: 98 after reduced-intensity and 35 after myeloablative conditioning. Processing associated with contributing UCB banks and units was surveyed to identify differences in practice. We analyzed effect of selected variables on clinical outcomes of engraftment, dominance, transplant-related mortality, and survival. RESULTS Eighty-eight percent of banks queried currently practice red blood cell (RBC) depletion before cryopreservation. This reflects a shift in practice because previously 65% of banks employed RBC-replete processing methods (i.e., cryopreservation or plasma/volume reduction). Neither neutrophil nor platelet engraftment was affected by processing conditions analyzed. RBC depletion was not associated with clinical outcomes, except in 17 recipients of 2 RBC-replete units, where survival was better than that observed in 116 recipients of ≥1 RBC-depleted units (hazard ratio 3.26, P = 0.004). When analyzed by attributes of the dominant unit, RBC depletion, time in storage, bank years in existence, and inventory size did not affect clinical outcomes. Postthaw viability and CD34 dose were factors impacting engraftment. Notably, all RBC-replete units in this cohort were washed in dextran-human serum albumin before infusion. DISCUSSION These findings support continued utilization of the entire existing pool of cord blood units, despite recent trends in processing, and have important implications for banking resources and UCB selection practices.
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30
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Juric MK, Ghimire S, Ogonek J, Weissinger EM, Holler E, van Rood JJ, Oudshoorn M, Dickinson A, Greinix HT. Milestones of Hematopoietic Stem Cell Transplantation - From First Human Studies to Current Developments. Front Immunol 2016; 7:470. [PMID: 27881982 PMCID: PMC5101209 DOI: 10.3389/fimmu.2016.00470] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/19/2016] [Indexed: 12/21/2022] Open
Abstract
Since the early beginnings, in the 1950s, hematopoietic stem cell transplantation (HSCT) has become an established curative treatment for an increasing number of patients with life-threatening hematological, oncological, hereditary, and immunological diseases. This has become possible due to worldwide efforts of preclinical and clinical research focusing on issues of transplant immunology, reduction of transplant-associated morbidity, and mortality and efficient malignant disease eradication. The latter has been accomplished by potent graft-versus-leukemia (GvL) effector cells contained in the stem cell graft. Exciting insights into the genetics of the human leukocyte antigen (HLA) system allowed improved donor selection, including HLA-identical related and unrelated donors. Besides bone marrow, other stem cell sources like granulocyte-colony stimulating-mobilized peripheral blood stem cells and cord blood stem cells have been established in clinical routine. Use of reduced-intensity or non-myeloablative conditioning regimens has been associated with a marked reduction of non-hematological toxicities and eventually, non-relapse mortality allowing older patients and individuals with comorbidities to undergo allogeneic HSCT and to benefit from GvL or antitumor effects. Whereas in the early years, malignant disease eradication by high-dose chemotherapy or radiotherapy was the ultimate goal; nowadays, allogeneic HSCT has been recognized as cellular immunotherapy relying prominently on immune mechanisms and to a lesser extent on non-specific direct cellular toxicity. This chapter will summarize the key milestones of HSCT and introduce current developments.
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Affiliation(s)
- Mateja Kralj Juric
- BMT, Department of Internal Medicine I, Medical University of Vienna , Vienna , Austria
| | - Sakhila Ghimire
- Department of Internal Medicine III, University Hospital of Regensburg , Regensburg , Germany
| | - Justyna Ogonek
- Transplantation Biology, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School , Hannover , Germany
| | - Eva M Weissinger
- Transplantation Biology, Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School , Hannover , Germany
| | - Ernst Holler
- Department of Internal Medicine III, University Hospital of Regensburg , Regensburg , Germany
| | - Jon J van Rood
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center , Leiden , Netherlands
| | - Machteld Oudshoorn
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center , Leiden , Netherlands
| | - Anne Dickinson
- Hematological Sciences, Institute of Cellular Medicine, Newcastle University , Newcastle upon Tyne , UK
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31
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CD4+ T-cell alloreactivity toward mismatched HLA class II alleles early after double umbilical cord blood transplantation. Blood 2016; 128:2165-2174. [PMID: 27531680 DOI: 10.1182/blood-2016-06-718619] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/09/2016] [Indexed: 11/20/2022] Open
Abstract
Although double umbilical cord blood transplantation (dUCBT) in adult patients may be associated with less graft failure compared with single UCBT, hematopoietic recovery generally originates from a single cord blood unit (CBU). CBU predominance is still incompletely understood. We recently showed that blood CD4+ T-cell numbers rapidly increase after dUCBT, and early CD4+ T-cell chimerism predicts for graft predominance. Given the frequent HLA class II allele mismatches between CBUs in dUCBT, we hypothesized that alloreactive HLA class II-specific CD4+ T cells from the "winning" CBU may contribute to rejection of the "loser" CBU. We evaluated whether CD4+ T cells originating from the predominant (PD)-CBU would recognize HLA class II allele mismatches, expressed by the nonengrafting (NE)-CBU. Alloreactive effector CD4+ T cells toward 1 or more mismatched HLA class II alleles of the NE-CBU were detected in 11 of 11 patients, with reactivity toward 29 of 33 (88%) tested mismatches, and the strongest reactivity toward DR and DQ alleles early after dUCBT. Mismatched HLA class II allele-specific CD4+ T cells recognized primary leukemic cells when the mismatched HLA class II allele was shared between NE-CBU and patient. Our results suggest that cytotoxicity exerted by CD4+ T cells from the PD-CBU drives the rapid rejection of the NE-CBU, whose alloreactive effect might also contribute to graft-versus-leukemia.
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32
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Saccardi R, Tucunduva L, Ruggeri A, Ionescu I, Koegler G, Querol S, Grazzini G, Lecchi L, Nanni Costa A, Navarrete C, Pouthiers F, Larghero J, Regan D, Freeman T, Bittencourt H, Kenzey C, Labopin M, Baudoux E, Rocha V, Gluckman E. Impact of cord blood banking technologies on clinical outcome: a Eurocord/Cord Blood Committee (CTIWP), European Society for Blood and Marrow Transplantation and NetCord retrospective analysis. Transfusion 2016; 56:2021-9. [PMID: 27245270 DOI: 10.1111/trf.13661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 01/24/2016] [Accepted: 01/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Techniques for banking cord blood units (CBUs) as source for hematopoietic stem cell transplantation have been developed over the past 20 years, aimed to improve laboratory efficiency without altering the biologic properties of the graft. A large-scale, registry-based assessment of the impact of the banking variables on the clinical outcome is currently missing. STUDY DESIGN AND METHODS A total of 677 single cord blood transplants (CBTs) carried out for acute leukemia in complete remission in centers affiliated with the European Society for Blood and Marrow Transplantation were selected. An extensive set of data concerning CBU banking were collected and correlations with clinical outcome were assessed. Clinical endpoints were transplant-related mortality, engraftment, and graft-versus-host disease (GVHD). RESULTS The median time between collection and CBT was 4.1 years (range, 0.2-16.3 years). Volume reduction (VR) of CBUs before freezing was performed in 59.2% of available reports; in half of these the frozen volume was less than 30 mL. Cumulative incidences of neutrophil engraftment on Day 60, 100-day acute GVHD (II-IV), and 4-year chronic GVHD were 87, 29, and 21 ± 2%. The cumulative incidence of nonrelapse mortality (NRM) at 100 days and 4-year NRM were, respectively, 16 ± 2 and 30 ± 2%. Neither the variables related to banking procedures nor the interval between collection and CBT influenced the clinical outcome. CONCLUSION These findings indicate a satisfactory validation of the techniques associated with CBU VR across the banks. Cell viability assessment varied among the banks, suggesting that efforts to improve the standardization of CBU quality controls are needed.
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Affiliation(s)
- Riccardo Saccardi
- Careggi University Hospital, Firenze, Italy.,Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France
| | - Luciana Tucunduva
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,Hospital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Univ Paris 06, UMR-S 938, CEREST-TC EBMT, Paris, France
| | | | - Gesine Koegler
- Dusseldorf Cord Blood Bank, University of Dusseldorf, Dusseldorf, Germany
| | | | | | - Lucilla Lecchi
- Milano Cord Blood Bank, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Fabienne Pouthiers
- Besançon Cord Blood Bank of the Etablissement Français du Sang, Besançon, France
| | | | - Donna Regan
- St Louis Cord Blood Bank & Cellular Therapy Laboratory, St Louis, Missouri
| | | | | | - Chantal Kenzey
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France
| | - Myriam Labopin
- Hospital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Univ Paris 06, UMR-S 938, CEREST-TC EBMT, Paris, France
| | - Etienne Baudoux
- NetCord Foundation and Liege Cord Blood Bank, University of Liege, Liege, Belgium
| | - Vanderson Rocha
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco
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33
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Hexner EO, Luger SM, Reshef R, Jeschke GR, Mangan JK, Frey NV, Frank DM, Richman LP, Vonderheide RH, Aqui NA, Rosenbach M, Zhang Y, Chew A, Loren AW, Stadtmauer EA, Levine BL, June CH, Emerson SG, Porter DL. Infusion of CD3/CD28 costimulated umbilical cord blood T cells at the time of single umbilical cord blood transplantation may enhance engraftment. Am J Hematol 2016; 91:453-60. [PMID: 26858124 PMCID: PMC6145177 DOI: 10.1002/ajh.24303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 01/04/2023]
Abstract
Limited cell numbers in umbilical cord blood (UCB) grafts present a major impediment to favorable outcomes in adult transplantation, largely related to delayed or failed engraftment. The advent of UCB transplantation (UCBT) using two grafts successfully circumvents this obstacle, despite the engraftment of only one unit. Preclinical models suggested that the addition of UCB T cells at the time of transplant can enhance engraftment. We tested whether ex vivo activation by CD3/CD28 costimulation and expansion of T cells from a single UCB graft would be safe and feasible in adults with advanced hematologic malignancies, with an overall objective of optimizing engraftment in single unit UCBT. In this phase 1 study, recipients of single UCB units were eligible if the unit was stored in two adequate fractions. Dose limiting toxicity was defined as grade 3 or grade 4 GVHD within 90 days of UCBT. Four patients underwent UCBT; all were treated at the first dose level (10(5) cells/kg). At the 10(5) cells/kg dose level two subjects experienced grade 3 intestinal GVHD, thus meeting stopping criteria. For three subjects, neutrophil engraftment was early (12, 17, and 20 days), while one subject experienced primary graft failure. We observed early donor T cell trafficking and found that expanded T cells produced supraphysiologic levels of cytokines relevant to engraftment and to lymphoid differentiation and function. Taken together, these preliminary data suggest rapid engraftment in recipients of a single UCBT combined with relatively low doses of activated T cells, though potentially complicated by severe GVHD.
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Affiliation(s)
- Elizabeth O. Hexner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Selina M. Luger
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ran Reshef
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace R. Jeschke
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James K. Mangan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noelle V. Frey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dale M. Frank
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee P. Richman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert H. Vonderheide
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole A. Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yi Zhang
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Anne Chew
- Center for Cellular Immunotherapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alison W. Loren
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward A. Stadtmauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bruce L. Levine
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Cellular Immunotherapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carl H. June
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Cellular Immunotherapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen G. Emerson
- Columbia College of Physicians and Surgeons, Herbert Irving Comprehensive Cancer Center, New York
| | - David L. Porter
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Le Bourgeois A, Peterlin P, Guillaume T, Delaunay J, Duquesne A, Le Gouill S, Moreau P, Mohty M, Campion L, Chevallier P. Higher Early Monocyte and Total Lymphocyte Counts Are Associated with Better Overall Survival after Standard Total Body Irradiation, Cyclophosphamide, and Fludarabine Reduced-Intensity Conditioning Double Umbilical Cord Blood Allogeneic Stem Cell Transplantation in Adults. Biol Blood Marrow Transplant 2016; 22:1473-1479. [PMID: 27118570 DOI: 10.1016/j.bbmt.2016.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/18/2016] [Indexed: 11/19/2022]
Abstract
This single-center retrospective study aimed to report the impact of early hematopoietic and immune recoveries after a standard total body irradiation, cyclophosphamide, and fludarabine (TCF) reduced-intensity conditioning (RIC) regimen for double umbilical cord blood (dUCB) allogeneic stem cell transplantation (allo-SCT) in adults. We analyzed 47 consecutive patients older than 17 years who engrafted after a dUCB TCF allo-SCT performed between January 2006 and April 2013 in our department. Median times for neutrophil and platelet recoveries were 17 (range, 6 to 59) and 37 days (range, 0 to 164), respectively. The 3-year overall (OS) and disease-free survivals, relapse incidence, and nonrelapse mortality were 65.7%, 57.2%, 27.1%, and 19%, respectively. In multivariate analysis, higher day +30 monocyte (≥615/mm(3); hazard ratio [HR], .04; 95% confidence interval [CI], .004 to .36; P < .01) and day +42 lymphocyte (≥395/mm(3); HR, .16; 95% CI, .03 to .78; P = .02) counts were independently associated with better OS. These results suggest that early higher hematopoietic and immune recovery is predictive of survival after dUCB TCF RIC allo-SCT in adults. Factors other than granulocyte colony-stimulating factor, which was used in all cases, favoring expansion of monocytes or lymphocytes, should be tested in the future as part of the UCB transplantation procedure.
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Affiliation(s)
- Amandine Le Bourgeois
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
| | - Pierre Peterlin
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France
| | - Thierry Guillaume
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France
| | - Jacques Delaunay
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France
| | - Alix Duquesne
- Unité d'ingénierie cellulaire, EFS Pays de la Loire, Nantes, France
| | - Steven Le Gouill
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France
| | - Philippe Moreau
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France
| | - Mohamad Mohty
- Hôpital saint Antoine, Département d'Hématologie Clinique, Paris, France
| | - Loïc Campion
- Institut de Cancérologie de l'Ouest - Centre René Gauducheau - Saint-Herblain, France; Université de Nantes and INSERM CRNCA UMR 892, Nantes, France
| | - Patrice Chevallier
- Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France; Université de Nantes and INSERM CRNCA UMR 892, Nantes, France
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35
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Ruggeri A, Paviglianiti A, Gluckman E, Rocha V. Impact of HLA in cord blood transplantation outcomes. HLA 2016; 87:413-21. [PMID: 27060588 DOI: 10.1111/tan.12792] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/04/2016] [Indexed: 12/31/2022]
Abstract
Umbilical cord blood (UCB) emerged in the last 20 years as a valid alternative source of hematopoietic stem cell (HSC) in allogeneic transplantation setting, mainly in the absence of a fully human leucocyte antigen (HLA)-matched sibling. The probability of finding a matched unrelated donor through the registries varies from 20 to 70%, depending on the ethnicity of the patients. Therefore, patients in need may benefit of an HLA-mismatched hematopoietic stem cell transplantation from haploidentical donors or from UCB. One of the advantages of using UCB is the lower incidence of acute graft-versus-host-disease and allowance of greater HLA mismatch. Conversely, the low number of HSCs and lymphocytes and specific immunological features of T cells are associated with delayed engraftment and immune reconstitution and consequently, increased opportunistic infections. Nevertheless, retrospective studies showed similar results comparing UCB with other stem cell sources, both in pediatric and adult setting. The ability to use partially HLA-matched UCB units allows expanding the donor pool. Many UCB banks have strategies to increase their inventory including UCB grafts that have rare haplotypes. HLA and cell dose are very important factors associated with outcomes after umbilical cord blood transplantation (UCBT) that interact with each other. Increasing cell dose counterbalances the number of HLA disparities. Understanding those interactions, the role of HLA mismatches and other immunogenic factors, are important to allow clinicians to choose the best cord blood graft for patients. This review will describe the role of HLA in UCBT setting.
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Affiliation(s)
- A Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France.,Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principauté de Monaco
| | - A Paviglianiti
- Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principauté de Monaco
| | - E Gluckman
- Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, Principauté de Monaco
| | - V Rocha
- Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France.,Department of Haematology, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK.,NHS Blood and Transplant, Oxford Centre, John Radcliffe Hospital, Oxford, UK
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Development and validation of a rapid, aldehyde dehydrogenase bright-based cord blood potency assay. Blood 2016; 127:2346-54. [PMID: 26968535 DOI: 10.1182/blood-2015-08-666990] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 02/13/2016] [Indexed: 12/21/2022] Open
Abstract
Banked, unrelated umbilical cord blood provides access to hematopoietic stem cell transplantation for patients lacking matched bone marrow donors, yet 10% to 15% of patients experience graft failure or delayed engraftment. This may be due, at least in part, to inadequate potency of the selected cord blood unit (CBU). CBU potency is typically assessed before cryopreservation, neglecting changes in potency occurring during freezing and thawing. Colony-forming units (CFUs) have been previously shown to predict CBU potency, defined as the ability to engraft in patients by day 42 posttransplant. However, the CFU assay is difficult to standardize and requires 2 weeks to perform. Consequently, we developed a rapid multiparameter flow cytometric CBU potency assay that enumerates cells expressing high levels of the enzyme aldehyde dehydrogenase (ALDH bright [ALDH(br)]), along with viable CD45(+) or CD34(+) cell content. These measurements are made on a segment that was attached to a cryopreserved CBU. We validated the assay with prespecified criteria testing accuracy, specificity, repeatability, intermediate precision, and linearity. We then prospectively examined the correlations among ALDH(br), CD34(+), and CFU content of 3908 segments over a 5-year period. ALDH(br) (r = 0.78; 95% confidence interval [CI], 0.76-0.79), but not CD34(+) (r = 0.25; 95% CI, 0.22-0.28), was strongly correlated with CFU content as well as ALDH(br) content of the CBU. These results suggest that the ALDH(br) segment assay (based on unit characteristics measured before release) is a reliable assessment of potency that allows rapid selection and release of CBUs from the cord blood bank to the transplant center for transplantation.
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Ponce DM, Hilden P, Devlin SM, Maloy M, Lubin M, Castro-Malaspina H, Dahi P, Hsu K, Jakubowski AA, Kernan NA, Koehne G, O'Reilly RJ, Papadopoulos EB, Perales MA, Sauter C, Scaradavou A, Tamari R, van den Brink MRM, Young JW, Giralt S, Barker JN. High Disease-Free Survival with Enhanced Protection against Relapse after Double-Unit Cord Blood Transplantation When Compared with T Cell-Depleted Unrelated Donor Transplantation in Patients with Acute Leukemia and Chronic Myelogenous Leukemia. Biol Blood Marrow Transplant 2015; 21:1985-93. [PMID: 26238810 PMCID: PMC4768474 DOI: 10.1016/j.bbmt.2015.07.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/28/2015] [Indexed: 01/30/2023]
Abstract
Double-unit cord blood (DCB) grafts are a rapidly available stem cell source for adults with high-risk leukemias. However, how disease-free survival (DFS) after DCB transplantation (DCBT) compares to that of unrelated donor transplantation (URDT) is not fully established. We analyzed 166 allograft recipients (66 8/8 HLA-matched URDT, 45 7/8 HLA-matched URDT, and 55 DCBT) ages 16 to 60 years with high-risk acute leukemia or chronic myelogenous leukemia (CML). URDT and DCBT recipients were similar except DCBT recipients were more likely to have lower weight and non-European ancestry and to receive intermediate-intensity conditioning. All URDT recipients received a CD34(+) cell-selected (T cell-depleted) graft. Overall, differences between the 3-year transplantation-related mortality were not significant (8/8 URDT, 18%; 7/8 URDT, 39%; and DCBT, 24%; P = .108), whereas the 3-year relapse risk was decreased after DCBT (8/8 URDT, 23%; 7/8 URDT, 20%; and DCBT 9%, P = .037). Three-year DFS was 57% in 8/8 URDT, 41% in 7/8 URDT, and 68% in DCBT recipients (P = .068), and the 3-year DFS in DCBT recipients was higher than that of 7/8 URDT recipients (P = .021). In multivariate analysis in acute leukemia patients, factors adversely associated with DFS were female gender (hazard ratio [HR], 1.68; P = .031), diagnosis of acute lymphoblastic leukemia (HR, 2.09; P = .004), and 7/8 T cell-depleted URDT (HR, 1.91; P = .037). High DFS can be achieved in adults with acute leukemia and CML with low relapse rates after DCBT. Our findings support performing DCBT in adults in preference to HLA-mismatched T cell-depleted URDT and suggest DCBT is a readily available alternative to T cell-depleted 8/8 URDT, especially in patients requiring urgent transplantation.
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MESH Headings
- Adolescent
- Adult
- Cord Blood Stem Cell Transplantation/methods
- Female
- Graft Survival
- Hematopoietic Stem Cell Transplantation
- Histocompatibility Testing
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Lymphocyte Depletion
- Male
- Middle Aged
- Myeloablative Agonists/therapeutic use
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Recurrence
- Retrospective Studies
- Sex Factors
- Survival Analysis
- T-Lymphocytes/cytology
- T-Lymphocytes/immunology
- Transplantation Conditioning
- Transplantation, Homologous
- Unrelated Donors
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Affiliation(s)
- Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
| | - Patrick Hilden
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marissa Lubin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hugo Castro-Malaspina
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Parastoo Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Katharine Hsu
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ann A Jakubowski
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Nancy A Kernan
- Bone Marrow Transplantation Service, Department of Pediatrics; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Guenther Koehne
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard J O'Reilly
- Bone Marrow Transplantation Service, Department of Pediatrics; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Andromachi Scaradavou
- Bone Marrow Transplantation Service, Department of Pediatrics; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roni Tamari
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - James W Young
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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Brunstein CG, Petersdorf EW, DeFor TE, Noreen H, Maurer D, MacMillan ML, Ustun C, Verneris MR, Miller JS, Blazar BR, McGlave PB, Weisdorf DJ, Wagner JE. Impact of Allele-Level HLA Mismatch on Outcomes in Recipients of Double Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2015; 22:487-92. [PMID: 26431630 DOI: 10.1016/j.bbmt.2015.09.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/23/2015] [Indexed: 01/27/2023]
Abstract
The impact of allele-level HLA mismatch is uncertain in recipients of double umbilical cord blood (UCB) transplantation. We report a single-center retrospective study of the clinical effect of using allele-level HLA mismatch HLA-A, -B, -C, -DRB1, and -DQB1 of the 2 UCB units. We studied 342 patients with hematologic malignancy. Donor-recipient pairs were grouped according to the number of matched HLA alleles, with 32 matched at 9-10/10, 202 at 6-8/10, and 108 at 2-5/10 alleles. The incidence of hematopoietic recovery, acute and chronic graft-versus-host disease, and nonrelapse mortality and treatment failure was similar between groups. In an exploratory analysis of 174 patients with acute leukemia, after adjusting for length of first remission and cytogenetic risk group, a 2-5/10 HLA match was associated with lower risk of relapse and treatment failure. These data indicate that a high degree of allele-level HLA mismatch does not adversely affect transplant outcomes and may be associated with reduced relapse risk in patients with acute leukemia.
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Affiliation(s)
- Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
| | - Effie W Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Todd E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Harriet Noreen
- Immunology Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - David Maurer
- Immunology Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - Margaret L MacMillan
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Celalettin Ustun
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Michael R Verneris
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Jeffrey S Miller
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Bruce R Blazar
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Philip B McGlave
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - John E Wagner
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
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Duinhouwer LE, van Rossum BJM, van Tiel ST, van der Werf RM, Doeswijk GN, Haeck JC, Rombouts EWJC, ter Borg MND, Kotek G, Braakman E, Cornelissen JJ, Bernsen MR. Magnetic Resonance Detection of CD34+ Cells from Umbilical Cord Blood Using a 19F Label. PLoS One 2015; 10:e0138572. [PMID: 26394043 PMCID: PMC4578896 DOI: 10.1371/journal.pone.0138572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/01/2015] [Indexed: 12/20/2022] Open
Abstract
Impaired homing and delayed recovery upon hematopoietic stem cell transplantation (HSCT) with hematopoietic stem cells (HSC) derived from umbilical cord blood (UCB) is a major problem. Tracking transplanted cells in vivo will be helpful to detect impaired homing at an early stage and allows early interventions to improve engraftment and outcome after transplantation. In this study, we show sufficient intracellular labeling of UCB-derived CD34+ cells, with 19F-containing PLGA nanoparticles which were detectable with both flow cytometry and magnetic resonance spectroscopy (MRS). In addition, labeled CD34+ cells maintain their capacity to proliferate and differentiate, which is pivotal for successful engraftment after transplantation in vivo. These results set the stage for in vivo tracking experiments, through which the homing efficiency of transplanted cells can be studied.
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Affiliation(s)
- Lucia E. Duinhouwer
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- * E-mail:
| | | | - Sandra T. van Tiel
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ramon M. van der Werf
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gabriela N. Doeswijk
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost C. Haeck
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Gyula Kotek
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Braakman
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan J. Cornelissen
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Monique R. Bernsen
- Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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40
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van der Garde M, van Hensbergen Y, Brand A, Slot MC, de Graaf-Dijkstra A, Mulder A, Watt SM, Zwaginga JJ. Thrombopoietin treatment of one graft in a double cord blood transplant provides early platelet recovery while contributing to long-term engraftment in NSG mice. Stem Cells Dev 2015; 24:67-76. [PMID: 25137252 DOI: 10.1089/scd.2014.0294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Human cord blood (CB) hematopoietic stem cell (HSC) transplants demonstrate delayed early neutrophil and platelet recovery and delayed longer term immune reconstitution compared to bone marrow and mobilized peripheral blood transplants. Despite advances in enhancing early neutrophil engraftment, platelet recovery after CB transplantation is not significantly altered when compared to contemporaneous controls. Recent studies have identified a platelet-biased murine HSC subset, maintained by thrombopoietin (TPO), which has enhanced capacity for short- and long-term platelet reconstitution, can self-renew, and can give rise to myeloid- and lymphoid-biased HSCs. In previous studies, we have shown that transplantation of human CB CD34(+) cells precultured in TPO as a single graft accelerates early platelet recovery as well as yielding long-term repopulation in immune-deficient mice. In this study, using a double CB murine transplant model, we investigated whether TPO cultured human CB CD34(+) cells have a competitive advantage or disadvantage over untreated human CB CD34(+) cells in terms of (1) short-term and longer term platelet recovery and (2) longer term hematological recovery. Our studies demonstrate that the TPO treated graft shows accelerated early platelet recovery without impairing the platelet engraftment of untreated CD34(+) cells. Notably, this was followed by a dominant contribution to platelet production through the untreated CD34(+) cell graft over the intermediate to longer term. Furthermore, although the contribution of the TPO treated graft to long-term hematological engraftment was reduced, the TPO treated and untreated grafts both contributed significantly to long-term chimerism in vivo.
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Affiliation(s)
- Mark van der Garde
- 1 Jon J. van Rood Center for Clinical Transfusion Research , Sanquin Blood Supply Foundation, Leiden, The Netherlands
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Oran B, Cao K, Saliba RM, Rezvani K, de Lima M, Ahmed S, Hosing CM, Popat UR, Carmazzi Y, Kebriaei P, Nieto Y, Rondon G, Willis D, Shah N, Parmar S, Olson A, Moore B, Marin D, Mehta R, Fernández-Viña M, Champlin RE, Shpall EJ. Better allele-level matching improves transplant-related mortality after double cord blood transplantation. Haematologica 2015; 100:1361-70. [PMID: 26250579 DOI: 10.3324/haematol.2015.127787] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/24/2015] [Indexed: 11/09/2022] Open
Abstract
Cord blood transplant requires less stringent human leukocyte antigen matching than unrelated donors. In 133 patients with hematologic malignancies who engrafted after double cord blood transplantation with a dominant unit, we studied the effect of high resolution testing at 4 loci (-A, -B, -C, -DRB1) for its impact on 2-year transplant-related mortality. Ten percent of the dominant cord blood units were matched at 7-8/8 alleles using HLA-A, -B, -C, and -DRB1; 25% were matched at 6/8, 40% at 5/8, and 25% at 4/8 or less allele. High resolution typing at 4 loci showed that there was no 2-year transplant-related mortality in 7-8/8 matched patients. Patients with 5-6/8 matched dominant cord blood units had 2-year transplant-related mortality of 39% while patients with 4/8 or less matched units had 60%. Multivariate regression analyses confirmed the independent effect of high resolution typing on the outcome when adjusted for age, diagnosis, CD34(+) cell dose infused, graft manipulation and cord to cord matching. The worst prognostic group included patients aged over 32 years with 4/8 or less matched cord blood units compared with patients who were either younger than 32 years old independent of allele-level matching, or aged over 32 years but with 5-6/8 matched cord blood units (Hazard Ratio 2.2; 95% confidence interval: 1.3-3.7; P<0.001). Patients with 7-8/8 matched units remained the group with the best prognosis. Our data suggest that high resolution typing at 4 loci and selecting cord blood units matched at at least 5/8 alleles may reduce transplant-related mortality after double cord blood transplantation.
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Affiliation(s)
- Betül Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kai Cao
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcos de Lima
- University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chitra M Hosing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yudith Carmazzi
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dana Willis
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nina Shah
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Simrit Parmar
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda Olson
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brandt Moore
- Department of Laboratory Medicine, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Marin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Purtill D, Stevens CE, Lubin M, Ponce D, Hanash A, Giralt S, Scaradavou A, Young JW, Barker JN. Association between Nondominant Unit Total Nucleated Cell Dose and Engraftment in Myeloablative Double-Unit Cord Blood Transplantation. Biol Blood Marrow Transplant 2015. [PMID: 26211983 DOI: 10.1016/j.bbmt.2015.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sustained hematopoiesis after double-unit cord blood transplantation (dCBT) is mediated by 1 unit in nearly all patients. To investigate the associations between nondominant unit characteristics and neutrophil engraftment, we studied 129 consecutive myeloablative dCBT recipients. Ninety-five percent (95% confidence interval, 90 to 98) of patients engrafted. Detection of the nondominant unit 21 to 28 days after dCBT was not associated with improved neutrophil engraftment. In univariate analyses, nondominant unit characteristics (infused total nucleated cell [TNC] and viable CD3(+) cell doses) were significantly associated with speed and success of neutrophil engraftment as were dominant unit characteristics (infused TNC; viable CD34(+), viable CD3(+), and viable CD3-56(+)16(+) cell doses; and post-thaw CD34(+) cell viability). In multivariate analysis, higher infused TNC dose of the nondominant unit was independently associated with improved neutrophil engraftment, even when this unit did not contribute to donor hematopoiesis. In further subgroup analysis, this association was only evident when the infused viable CD34(+) cell dose of the dominant unit was low (<1.20 × 10(5)/kg). These findings suggest nondominant units mediate a dose-dependent facilitation of engraftment in myeloablative dCBT and support continued investigation of dCBT biology and the clinical practice of dCBT in adults in whom low cell dose grafts are common.
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Affiliation(s)
- Duncan Purtill
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cladd E Stevens
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marissa Lubin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Doris Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Alan Hanash
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sergio Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Andromachi Scaradavou
- Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James W Young
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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Justus D, Perez-Albuerne E, Dioguardi J, Jacobsohn D, Abraham A. Allogeneic donor availability for hematopoietic stem cell transplantation in children with sickle cell disease. Pediatr Blood Cancer 2015; 62:1285-7. [PMID: 25663074 DOI: 10.1002/pbc.25439] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/19/2014] [Indexed: 11/12/2022]
Abstract
Hematopoietic stem cell transplant is curative of sickle cell disease (SCD) but limited by donor availability. Searches for 85 patients with SCD without matched sibling donors from 2009-2013 using modern techniques (allele-level HLA matching for unrelated donors and higher total nucleated cell doses for umbilical cord blood (UCB)) showed potential match probabilities of 20% for 8/8 HLA-matched unrelated donors, 84% for 7/8 donors, and 97% for two 4-6/6 UCBs suitable for ex-vivo expanded/double cord transplant. Searches performed by age 43 months would have a 90% chance of finding a suitable 5-6/6 UCB.
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Affiliation(s)
- David Justus
- School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Evelio Perez-Albuerne
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Jacqueline Dioguardi
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - David Jacobsohn
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
| | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, District of Columbia
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Cord blood unit factors influencing transplant outcomes from the Asian multiethnic Singapore Cord Blood Bank. Bone Marrow Transplant 2015; 50:1256-8. [PMID: 26052910 DOI: 10.1038/bmt.2015.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Outcomes of Cord Blood Transplantation Using Reduced-Intensity Conditioning for Chronic Lymphocytic Leukemia: A Study on Behalf of Eurocord and Cord Blood Committee of Cellular Therapy and Immunobiology Working Party, Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation, and the Societé Française de Greffe de Moelle et Therapie Cellulaire. Biol Blood Marrow Transplant 2015; 21:1515-23. [PMID: 25958294 DOI: 10.1016/j.bbmt.2015.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/29/2015] [Indexed: 01/04/2023]
Abstract
Outcomes after umbilical cord blood transplantation (UCBT) for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are unknown. We analyzed outcomes of 68 patients with poor-risk CLL/SLL who underwent reduced-intensity (RIC) UCBT from 2004 to 2012. The median age was 57 years and median follow-up 36 months; 17 patients had del 17p/p53mutation, 19 patients had fludarabine-refractory disease, 11 relapsed after autologous stem cell transplantation, 8 had diagnosis of prolymphocytic leukemia, 4 had Richter syndrome, and 8 underwent transplantation with progressive or refractory disease. The most common RIC used was cyclophosphamide, fludarabine, and total body irradiation (TBI) in 82%; 15 patients received antithymocyte globulin. Most of the cord blood grafts were HLA mismatched and 76% received a double UCBT. Median total nucleated cells collected was 4.7 × 10(7)/kg. The cumulative incidences (CI) of neutrophil and platelet engraftment were 84% and 72% at 60 and 180 days respectively; day 100 graft-versus-host disease (GVHD) (grade II to IV) was 43% and 3-year chronic GVHD was 32%. The CI of relapse, nonrelapse mortality, overall survival, and progression-free survival (PFS) at 3 years were 16%, 39%, 54%, and 45%, respectively. Fludarabine-sensitive disease at transplantation and use of low-dose TBI regimens were associated with acceptable PFS. In conclusion, use of RIC-UCBT seems to be feasible in patients with poor-risk CLL/SLL and improved outcomes were observed in patients with fludarabine-sensitive disease who received low-dose TBI regimens.
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Ashbridge B, Zehir A, Lubin M, Barker JN, Moore MAS. Evaluation of Initial Telomere Length and Changes after Transplantation in Adult Double-Unit Cord Blood Transplant Recipients. Biol Blood Marrow Transplant 2015; 21:1334-6. [PMID: 25865647 DOI: 10.1016/j.bbmt.2015.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
Cord blood (CB) leukocytes have inherent telomere length (TL) variation, and CB hematopoietic stem cells (HSC) can maintain high telomerase levels preventing telomere attrition in vitro. We evaluated TL changes in 13 adult double-unit CB transplant (CBT) recipients. In the 26 units, we observed a marked variation in CB TL at thaw (median, 9.99 kilobases [kb]; range, 6.85 to 13.5). All 13 patients engrafted. Of 11 engrafting with 1 unit, there was no correlation between unit dominance and TL (mean dominant unit TL, 8.84 kb ± 1.76; mean nonengrafting unit TL, 10.3 kb ± 1.81; P = .77). Serial measurements of TL up to 1 year after CBT demonstrated an overall mean 3.04 kb ± .16 TL decrease with only 1 patient exhibiting telomere maintenance. In summary, initial TL does not predict CB unit dominance. Moreover, our analysis suggests neonatal hematopoiesis makes a transition to an HSC characterized by changes in average TL and potentially low telomerase asymmetric cell division in adult CBT recipients. Further investigation of alterations in telomere length and its clinical implications after transplantation of this observation are indicated.
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Affiliation(s)
- Beth Ashbridge
- Cell Biology Program, Sloan-Kettering Institute, New York, New York
| | - Ahmet Zehir
- Cell Biology Program, Sloan-Kettering Institute, New York, New York
| | - Marissa Lubin
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Juliet N Barker
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
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Gullo F, van der Garde M, Russo G, Pennisi M, Motta S, Pappalardo F, Watt S. Computational modeling of the expansion of human cord blood CD133+ hematopoietic stem/progenitor cells with different cytokine combinations. Bioinformatics 2015; 31:2514-22. [PMID: 25810433 DOI: 10.1093/bioinformatics/btv172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
MOTIVATION Many important problems in cell biology require dense non-linear interactions between functional modules to be considered. The importance of computer simulation in understanding cellular processes is now widely accepted, and a variety of simulation algorithms useful for studying certain subsystems have been designed. Expansion of hematopoietic stem and progenitor cells (HSC/HPC) in ex vivo culture with cytokines and small molecules is a method to increase the restricted numbers of stem cells found in umbilical cord blood (CB), while also enhancing the content of early engrafting neutrophil and platelet precursors. The efficacy of the expanded product depends on the composition of the cocktail of cytokines and small molecules used for culture. Testing the influence of a cytokine or small molecule on the expansion of HSC/HPC is a laborious and expensive process. We therefore developed a computational model based on cellular signaling interactions that predict the influence of a cytokine on the survival, duplication and differentiation of the CD133(+) HSC/HPC subset from human umbilical CB. RESULTS We have used results from in vitro expansion cultures with different combinations of one or more cytokines to develop an ordinary differential equation model that includes the effect of cytokines on survival, duplication and differentiation of the CD133(+) HSC/HPC. Comparing the results of in vitro and in silico experiments, we show that the model can predict the effect of a cytokine on the fold expansion and differentiation of CB CD133(+) HSC/HPC after 8-day culture on a 3D scaffold. Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Francesca Gullo
- Stem Cell Research, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK, NHS Blood and Transplant Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Mark van der Garde
- Stem Cell Research, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK, NHS Blood and Transplant Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | | | - Marzio Pennisi
- Department of Mathematics and Computer Science, University of Catania, 95125 Catania, Italy
| | - Santo Motta
- Department of Mathematics and Computer Science, University of Catania, 95125 Catania, Italy
| | | | - Suzanne Watt
- Stem Cell Research, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK, NHS Blood and Transplant Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Topping it up: methods to improve cord blood transplantation outcomes by increasing the number of CD34+ cells. Cytotherapy 2015; 17:723-729. [PMID: 25791069 DOI: 10.1016/j.jcyt.2015.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/05/2015] [Indexed: 11/23/2022]
Abstract
Cord blood is increasingly recognized for its excellent stem cell potential, lenient matching criteria, instant availability and clinical behavior in transplants when cell dose criteria can be met. However with 1-2 log fewer total (stem cell) numbers in the graft compared with other cell sources, the infused cell dose per kilogram is critical for engraftment and outcome, creating the need for development of stem cell support platforms. The co-transplant platforms of haplo cord and double unit cord blood (DUCB) transplantation are aimed toward increasing stem cell dose. Together with the optimization of reduced-intensity protocols, long-term sustained engraftment using cord blood has become available to most patients, including elderly patients. Haplo cord has a low incidence of both acute and chronic graft-versus-host disease but may require anti-thymocyte globulin ATG for effective neutrophil recovery. DUCB can be performed without anti-thymocyte globulin with excellent immune reconstitution and disease-free survival, but engraftment is considerably slower, and graft-versus-host disease incidence significant. Both haplo-cord and DUCB transplantation appear to both be valid alternatives to matched unrelated donors in adults.
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Abstract
Umbilical cord blood banks use two methods to store frozen umbilical cord blood (UCB): red cell reduction (RCR) or plasma depletion (PD). The RCR method centrifuges cord blood in hetastarch or albumin to isolate 21 ml of cord blood containing mostly white blood cells, adds 4 ml of 50% dimethyl sulfoxide (DMSO), and then freezes the resulting 25 ml of cell suspension. The PD method removes plasma, saves all the cells, and freezes the cells in 10% DMSO. PD UCB units are cheaper to process but more expensive to store and somewhat more troublesome to thaw. However, when properly thawed and washed, PD UCB units have as many or more total nucleated cells (TNCs), CD34(+) cells, and colony-forming units (CFU) than RCR units. Two studies suggest that PD units have 20-25% more TNCs, MNCs, and CD34(+) cells, as well as two to three times more CFU than RCR units. Higher TNC, CD34(+), and CFU counts predict engraftment rate with faster neutrophil and platelet recovery. PD units have high engraftment rates with low mortality and high disease-free survival, comparable with clinical results of treatments with RCR units. One recent series of studies suggests that PD units are more effective for treating thalassemia with 2-year survival rates of 88%, disease-free survival rates of 74%, and 100% cure rate for children under age 7, compared to only 61% overall survival and 23% disease-free survival rate in thalassemic children treated with RCR units. These findings suggest that PD units not only have more TNCs, CD34(+) cells, and CFU than RCR units but also have high engraftment rates and may be more effective for treating certain conditions such as β-thalassemia.
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Affiliation(s)
- Wise Young
- Department of Cell Biology and Neuroscience, Rutgers, State University of New Jersey, Piscataway, NJ, USA
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50
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Abstract
The use of umbilical cord blood (UCB) as an alternative haematopoietic cell source in lieu of bone marrow for haematopoietic reconstitution is increasingly becoming a mainstay treatment for both malignant and nonmalignant diseases, as most individuals will have at least one available, suitably HLA-matched unit of blood. The principal limitation of UCB is the low and finite number of haematopoietic stem and progenitor cells (HSPC) relative to the number found in a typical bone marrow or mobilized peripheral blood allograft, which leads to prolonged engraftment times. In an attempt to overcome this obstacle, strategies that are often based on native processes occurring in the bone marrow microenvironment or 'niche' have been developed with the goal of accelerating UCB engraftment. In broad terms, the two main approaches have been either to expand UCB HSPC ex vivo before transplantation, or to modulate HSPC functionality to increase the efficiency of HSPC homing to the bone marrow niche after transplant both of which enhance the biological activities of the engrafted HSPC. Several early phase clinical trials of these approaches have reported promising results.
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