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Cordón L, Chorão P, Martín-Herreros B, Montoro J, Balaguer A, Guerreiro M, Villalba M, Facal A, Asensi P, Solves P, Gómez I, Santiago M, Lamas B, Bataller A, Granados P, Sempere A, Sanz GF, Sanz MA, Sanz J. Immune reconstitution after single-unit umbilical cord blood transplantation using anti-thymoglobulin and myeloablative conditioning in adults with hematological malignancies. Ann Hematol 2024; 103:2475-2484. [PMID: 38634914 DOI: 10.1007/s00277-024-05758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
This study aimed to investigate the kinetics of immune recovery following umbilical cord blood transplantation (UCBT) in adults who received a myeloablative conditioning (MAC) regimen and antithymocyte globulin (ATG). While the immune recovery kinetics has been extensively studied in pediatric UCBT recipients, limited data exist for adults. We conducted a comprehensive analysis of 221 consecutive adult patients who underwent UCBT with MAC and ATG at a single institution. Our objective was to evaluate the influence of patient, disease, and transplant factors, along with acute graft-versus-host disease (aGVHD), on immune reconstitution and overall survival. Our findings confirm a delayed recovery of T cells, while B and NK cell reconstitution exhibited rapid progress, with NK cell counts reaching normal levels within 3 months post-transplantation and B cells within 6 months. Within CD3+ T cells, CD8+ T cells also experienced a delayed recovery (12 months), but to a lesser extent compared to CD4+ T cells (18 months). Delayed immune recovery of T-cell subsets was associated with the development of aGVHD grade II-IV, older age, CMV negativity, and a female donor. Patients with lymphoproliferative diseases showed slower NK cell recovery. Our study demonstrates that adult patients undergoing MAC with ATG and receiving a single unit UCBT for hematologic malignancies experienced rapid reconstitution of NK and B cells. However, T cell recovery, particularly CD4+ T cells, was significantly delayed. To enhance T cell recovery, it may be crucial to consider UCB units with higher cellularity and optimize ATG doses in conditioning.
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Affiliation(s)
- Lourdes Cordón
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain.
| | - Pedro Chorão
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Beatriz Martín-Herreros
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
| | - Juan Montoro
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Aitana Balaguer
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Villalba
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Facal
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pedro Asensi
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Solves
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Inés Gómez
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Santiago
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Brais Lamas
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Bataller
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pablo Granados
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Amparo Sempere
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Guillermo F Sanz
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Miguel A Sanz
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Research Group, Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Valencia, 46026, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Carlos III, Madrid, Spain
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Hu M, Li J, Liu R, Zhang Z, Feng S, Zhong D, Tang R, Xuan L. Unrelated umbilical cord blood transplantation with low-dose anti-thymocyte globulin for children with severe aplastic anemia: A case series. Ann Hematol 2024; 103:2103-2111. [PMID: 38656370 DOI: 10.1007/s00277-024-05756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aimed to investigate the prognosis of unrelated umbilical cord blood transplantation (UCBT) using low-dose anti-thymocyte globulin (ATG) in children diagnosed with severe aplastic anemia (SAA). METHODS This retrospective case series study was conducted involving pediatric SAA patients treated at the Capital Institute of Pediatrics from January 2020 to February 2023. All patients underwent a reduced-intensity conditioning (RIC) regimen alongside low-dose ATG. RESULTS The study comprised nine patients (five males) with a median age of 5 years (range: 1.7 to 7 years). The median follow-up duration was 799 days (range: 367 to 1481 days), during which all patients survived. The median time interval from diagnosis to transplantation was 3 months (range: 1 to 9 months). The median dosage of ATG administered was 5 mg/kg (range: 2.5 to 7.5 mg/kg). The median durations for granulocyte and platelet engraftment were 15 days (range: 12 to 23 days) and 26 days (range: 12 to 41 days), respectively. Three patients experienced grade 2-4 acute graft-versus-host disease (aGVHD). Epstein-Barr virus (EBV) reactivation was observed in three patients, while cytomegalovirus (CMV) reactivation occurred in seven patients, with no cases of CMV disease or post-transplant lymphoproliferative disorder (PTLD). One patient experienced recurrence 15 months after transplantation due to influenza A infection. CONCLUSION These findings indicate that SAA patients may attain a favorable prognosis following UCBT with a RIC regimen combined with low-dose ATG.
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Affiliation(s)
- Mengze Hu
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Junhui Li
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Rong Liu
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Zhaoxia Zhang
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Shunqiao Feng
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Dixiao Zhong
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Ruihong Tang
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
| | - Litian Xuan
- Department of Hematology, Children's Hospital Capital Institute of Pediatrics, Beijing, 100020, China
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Zhao X, Lv W, Song K, Yao W, Li C, Tang B, Wan X, Geng L, Sun G, Qiang P, Liu H, Liu H, Sun Z. Upfront Umbilical Cord Blood Transplantation Versus Immunosuppressive Therapy for Pediatric Patients With Idiopathic Severe Aplastic Anemia. Transplant Cell Ther 2024; 30:442.e1-442.e13. [PMID: 38278182 DOI: 10.1016/j.jtct.2024.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
Umbilical cord blood transplantation (UCBT) has been rarely reported as a first-line treatment for idiopathic severe aplastic anemia (SAA) patients lacking HLA-matched sibling donors (MSD). Our study aimed to compare the clinical outcomes of pediatric SAA patients who received UCBT and immunosuppressive therapy (IST) upfront. A retrospective analysis was performed on 43 consecutive patients who received frontline IST (n = 17) or UCBT (n = 26) between July 2017 and April 2022. The 3-year overall survival (OS) was comparable between the UCBT and IST groups (96.2% versus 100%, P = .419), while the 3-year event-free survival (EFS) was significantly better in the former than in the latter (88.5% versus 58.8%, P = .048). In the UCBT group, 24 patients achieved successful engraftment, 2 patients developed severe acute graft-versus-host disease (aGVHD), no extensive chronic GVHD (cGVHD), and a high GVHD-free, failure-free survival (GFFS) of 84.6% at 3 years. After 1 year of treatment, 12 patients in the IST group responded, while 5 patients did not achieve remission and 2 patients had disease relapse. At both 3 and 6 months after treatment, the proportion of transfusion-independent patients was higher in the UCBT group than in the IST group. Faster immune recovery and earlier transfusion independence further reduced the risk of infection and bleeding, thereby improving health-related quality of life in the UCBT-treated group. Our results suggested that UCBT as upfront therapy may be an effective and safe option for pediatric SAA patients, with favorable outcomes in experienced centers.
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Affiliation(s)
- Xuxu Zhao
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wenxiu Lv
- Department of Hematology and Oncology, Anhui Provincial Children's Hospital (Anhui Hospital, Pediatric Hospital of Fudan University), Hefei, Anhui, China; Department of Pediatrics, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Kaidi Song
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wen Yao
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chun Li
- Department of Pediatrics, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Baolin Tang
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiang Wan
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Liangquan Geng
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Guangyu Sun
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ping Qiang
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Huilan Liu
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Hongjun Liu
- Department of Hematology and Oncology, Anhui Provincial Children's Hospital (Anhui Hospital, Pediatric Hospital of Fudan University), Hefei, Anhui, China; Department of Pediatrics, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Zimin Sun
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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4
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Wu Y, Tang BL, Song KD, Sun GY, Pan TZ, Huang AJ, Yan BB, Zhu XY. [Single non-blood-related umbilical cord blood transplantation using a reduced-intensity conditioning regimen for the treatment of severe aplastic anemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2024; 45:68-73. [PMID: 38527841 PMCID: PMC10951129 DOI: 10.3760/cma.j.issn.0253-2727.121090-20230928-00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Indexed: 03/27/2024]
Abstract
Objective: To evaluated the clinical efficacy of a reduced-intensity preconditioning regimen for single non-blood-related umbilical cord blood transplantation (sUCBT) in the treatment of severe aplastic anemia (SAA) . Methods: The clinical data of 63 patients with SAA who underwent sUCBT from January 2021 to July 2023 at the Department of Hematology of the First Affiliated Hospital of USTC were retrospectively analyzed. Fifty-two patients received total body irradiation/total bone marrow irradiation (TMI) combined with fludarabine or a cyclophosphamide- conditioning regimen (non-rATG group) , while 11 patients received rabbit anti-human thymocyte immunoglobulin (rATG) combined with TMI, fludarabine, or the cyclophosphamide-conditioning regimen (rATG group) . All patients received cyclosporine A and mycophenolate mofetil for graft-versus-host disease (GVHD) prophylaxis. Complications post-transplantation and long-term survival were compared between the two groups. Results: The baseline parameters were balanced between the two groups (P>0.05) . In the rATG group, all patients achieved stem cell engraftment, and in the non-rATG group, five patients had primary graft failure. There was no significant difference in the cumulative incidence of neutrophil engraftment at 42 days after transplantation or platelet engraftment at 60 days between the two groups. The incidence of grade Ⅱ-Ⅳ acute GVHD in the rATG group was significantly lower than in the non-rATG group (10.0% vs. 46.2% , P=0.032) , and the differences in the cumulative incidences of grade Ⅲ/Ⅳ acute GVHD and 1-year chronic GVHD were not statistically significant (P=0.367 and P=0.053, respectively) . There were no significant differences in the incidences of pre-engraftment syndrome, bacterial bloodstream infections, cytomegalovirus viremia, or hemorrhagic cystitis between the two groups (P>0.05 for all) . The median follow-up time for surviving patients was 536 (61-993) days, and the 1-year transplantation related mortality (TRM) of all patients after transplantation was 13.0% (95% CI 6.7% -24.3% ) . Among the patients in the non-rATG and rATG groups, 15.5% (95% CI 8.1% -28.6% ) and 0% (P=0.189) , respectively, had mutations. The 1-year overall survival (OS) rate of all patients after transplantation was 87.0% (95% CI 75.7% -93.3% ) . The 1-year OS rates in the rATG group and non-rATG group after transplantation were 100% and 84.5% , respectively (95% CI 71.4% -91.9% ) (P=0.198) . Conclusion: The preliminary results of sUCBT with a low-dose irradiation-based reduced-intensity conditioning regimen with fludarabine/cyclophosphamide for the treatment of patients with SAA showed good efficacy. Early application of low-dose rATG can reduce the incidence of acute GVHD after transplantation without increasing the risk of implantation failure or infection.
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Affiliation(s)
- Y Wu
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei 230001, China Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - B L Tang
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei 230001, China Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - K D Song
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - G Y Sun
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - T Z Pan
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei 230001, China Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - A J Huang
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei 230001, China Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - B B Yan
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei 230001, China Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - X Y Zhu
- Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China Anhui Provincial Key Laboratory of Blood Research and Applications, Hefei 230001, China Blood and Cell Therapy Institute, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
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5
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Giglio F, Xue E, Barone A, Lorentino F, Greco R, Ruggeri A, Zambelli M, Parisi C, Milani R, Clerici D, Piemontese S, Marktel S, Lazzari L, Marcatti M, Bernardi M, Corti C, Lupo-Stanghellini MT, Ciceri F, Peccatori J. Intrabone transplant of a single unwashed umbilical cord blood unit with ATG-free and sirolimus-based GvHD prophylaxis: fast immune-reconstitution and long-term disease control in 30 patients with high-risk diseases. Transplant Cell Ther 2023:S2666-6367(23)01297-6. [PMID: 37244644 DOI: 10.1016/j.jtct.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
INTRO Several strategies have been explored with the attempt of improving safety and feasibility of umbilical cord blood transplant (UCBT) in adults. AIM The aim of this retrospective analysis was to examine the safety and efficacy of intrabone transplant of a single unwashed cord blood unit in an ATG-free, sirolimus-based graft-versus-host prophylaxis platform. METHODS We collected data of all consecutive UCBT infused intrabone and unwashed at San Raffaele Hospital in Milan between 2012 and 2021. RESULTS Thirty-one consecutive UCBT were identified. All but 3 units had a high-resolution HLA typing on 8 loci at time of selection. At cryopreservation, the median number of CD34+ cells and total nucleated cells (TNCs) were 1 × 105/kg (0.6-12.0) and 2.8 × 107/kg (1.48-5.6), respectively. Eighty seven percent of patients received myeloablative conditioning; seventy seven percent of patients were transplanted for acute myeloid leukemia. Median follow-up among survivors was 38.2 months (range 10.4-123.6). No adverse events were related to the intrabone infusion at bedside under short-conscious peri-procedural sedation and to the no wash technique. After thawing, CD34+ and TNCs were 0.8 × 105/kg (0.1-2.3) and 1.42 × 107/kg (0.69-3.2) respectively. Median time to engraftment was 27 and 53 days for neutrophils and platelets, respectively; one patient rejected the transplant and was subsequently rescued with a salvage transplant. Median time to CD3+ above 100/μL was 30 days. 100-day CI of III-IV aGvHD was 12.9% (95%CI 4-27.3%), 2-year CI of moderate-to-severe chronic GvHD was 11.8% (95% CI 2.7-28.3%); at 2-year, OS was 52.7% (95%CI 33-69%), relapse incidence was 30.7% (95% CI 13.7-49.6%) and TRM of 29% (95%CI 14.3-45.6%). In univariate analysis CD34+ infused counts did not impact on transplant outcomes. In patients transplanted in first complete remission, relapse rate was 13% with an OS above 90% at 2 years. CONCLUSIONS Intrabone infusion of single CB unit was feasible, with no adverse reactions related to the no wash/intrabone infusion. We documented a low incidence of chronic GVHD and disease relapse with a fast immune-reconstitution.
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Affiliation(s)
- Fabio Giglio
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elisabetta Xue
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Francesca Lorentino
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy; PhD Program in Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Raffaella Greco
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Annalisa Ruggeri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Matilde Zambelli
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Cristina Parisi
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Raffaella Milani
- Immunohematology and Transfusion Medicine Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Daniela Clerici
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simona Piemontese
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sarah Marktel
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Lazzari
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Bernardi
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Consuelo Corti
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabio Ciceri
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Souchet L, Masouridi S, Marçais A, Ibrahim A, Chauvel C, Turquet E, Derail M, Yakoub-Agha I, Crocchiolo R. [Diagnosis, prophylaxis and therapeutic management of acute GVH: Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S79-S87. [PMID: 36437127 DOI: 10.1016/j.bulcan.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
Acute GVHD is a potentially severe complication of hematopoietic stem cell transplantation, responsible for morbidity and mortality that can affect the prognosis after transplantation. Within the framework of the 12th workshop of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), diagnostic modalities of acute GVHD are updated. The conventional prevention (depending on donor, conditioning, and stem cell source) and treatment schemes (depending on affected organ and intensity) of aGVHD are clarified, and new therapeutic options are discussed.
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Affiliation(s)
- Laetitia Souchet
- Hôpital Pitié Salpêtrière, Service d'hématologie clinique, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Stavroula Masouridi
- Hôpitaux universitaires de Genève, Service d'hématologie, 4, rue Gabrielle-Perret-Gentil, 1211 Genève, Suisse
| | - Ambroise Marçais
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Service Hématologie Adultes, Hôpital Necker Enfants Malades, Paris, France
| | | | | | - Eric Turquet
- CHU Rennes, Service d'hématologie, Rennes, France
| | | | | | - Roberto Crocchiolo
- Service d'Aphérèse Thérapeutique, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italie
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7
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Watkins B, Williams KM. Controversies and expectations for the prevention of GVHD: A biological and clinical perspective. Front Immunol 2022; 13:1057694. [PMID: 36505500 PMCID: PMC9726707 DOI: 10.3389/fimmu.2022.1057694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
Severe acute and chronic graft versus host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation. Historically, cord blood and matched sibling transplantation has been associated with the lowest rates of GVHD. Newer methods have modified the lymphocyte components to minimize alloimmunity, including: anti-thymocyte globulin, post-transplant cyclophosphamide, alpha/beta T cell depletion, and abatacept. These agents have shown promise in reducing severe GVHD, however, can be associated with increased risks of relapse, graft failure, infections, and delayed immune reconstitution. Nonetheless, these GVHD prophylaxis strategies have permitted expansion of donor sources, especially critical for those of non-Caucasian decent who previously lacked transplant options. This review will focus on the biologic mechanisms driving GVHD, the method by which each agent impacts these activated pathways, and the clinical consequences of these modern prophylaxis approaches. In addition, emerging novel targeted strategies will be described. These GVHD prophylaxis approaches have revolutionized our ability to increase access to transplant and have provided important insights into the biology of GVHD and immune reconstitution.
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Ruggeri A, Galimard JE, Labopin M, Rafii H, Blaise D, Ciceri F, Diez-Martin JL, Cornelissen J, Chevallier P, Sanchez-Guijo F, Nicholson E, Castagna L, Forcade E, Kuball J, Rovira M, Koc Y, Pavlu J, Gulbas Z, Vydra J, Baron F, Sanz J, Spyridonidis A, Savani B, Gluckman E, Nagler A, Mohty M. Comparison of Outcomes after Unrelated Double-Unit Cord Blood and Haploidentical Peripheral Blood Stem Cell Transplantation in Adults with Acute Myelogenous Leukemia: A Study on Behalf of Eurocord and the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2022; 28:710.e1-710.e10. [DOI: 10.1016/j.jtct.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
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9
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The impact of GVHD on outcomes after adult single cord blood transplantation in European and Japanese populations. Bone Marrow Transplant 2022; 57:57-64. [PMID: 34635798 DOI: 10.1038/s41409-021-01479-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023]
Abstract
The impact of GVHD and graft-versus-leukemia effect in unrelated cord blood transplantation (UCBT) is controversial. In the Eurocord/ALWP EBMT and JSTCT/JDCHCT collaborative study, we evaluated the impact of GVHD on UCBT outcomes in Japanese and European registries. A total of 3,690 adult patients with acute leukemia who received their first single UCBT were included. A multivariate analysis of overall survival (OS) revealed a positive impact of grade II acute GVHD compared with grade 0-I GVHD, in the Japanese cohort (hazard ratio (HR), 0.81; P = 0.001), and an adverse impact in the European cohort (HR, 1.37; P = 0.007). A negative impact of grade III-IV acute GVHD on OS was observed regardless of registries. In the analysis of relapse, a positive impact of grade II acutes GVHD compared with grade 0-I GVHD was observed only in the Japanese cohort, regardless of disease risk. The positive impact of limited chronic GVHD on OS was observed only in the Japanese cohort. In conclusion, a positive impact of mild GVHD after a single UCBT was observed only in the Japanese cohort. This could explain the ethnic difference in UCBT outcomes and might contribute to the preference usage of UCBT in Japan.
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10
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Zhu X, Tang B, Sun Z. Umbilical cord blood transplantation: Still growing and improving. Stem Cells Transl Med 2021; 10 Suppl 2:S62-S74. [PMID: 34724722 PMCID: PMC8560197 DOI: 10.1002/sctm.20-0495] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 12/26/2022] Open
Abstract
Umbilical cord blood transplantation (UCBT) has been performed in the clinic for over 30 years. The biological and immunological characteristics of umbilical cord blood (UCB) have been re-recognized in recent years. UCB, previously considered medical waste, is rich in hematopoietic stem cells (HSCs), which are naïve and more energetic and more easily expanded than other stem cells. UCB has been identified as a reliable source of HSCs for allogeneic hematopoietic stem cell transplantation (allo-HSCT). UCBT has several advantages over other methods, including no harm to mothers and donors, an off-the-shelf product for urgent use, less stringent HLA match, lower incidence and severity of chronic graft-vs-host disease (GVHD), and probably a stronger graft-vs-leukemia effect, especially for minimal residual disease-positive patients before transplant. Recent studies have shown that the outcome of UCBT has been improved and is comparable to other types of allo-HSCT. Currently, UCBT is widely used in malignant, nonmalignant, hematological, congenital and metabolic diseases. The number of UCB banks and transplantation procedures increased exponentially before 2013. However, the number of UCBTs increased steadily in Asia and China but decreased in the United States and Europe year-on-year from 2013 to 2019. In this review, we focus on the development of UCBT over the past 30 years, the challenges it faces and the strategies for future improvement, including increasing UCB numbers, cord blood unit selection, conditioning regimens and GVHD prophylaxis for UCBT, and management of complications of UCBT.
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Affiliation(s)
- Xiaoyu Zhu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiPeople's Republic of China
- Blood and Cell Therapy Institute, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiPeople's Republic of China
- Anhui Provincial Key Laboratory of Blood Research and ApplicationsHefeiPeople's Republic of China
| | - Baolin Tang
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiPeople's Republic of China
- Blood and Cell Therapy Institute, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiPeople's Republic of China
- Anhui Provincial Key Laboratory of Blood Research and ApplicationsHefeiPeople's Republic of China
| | - Zimin Sun
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiPeople's Republic of China
- Blood and Cell Therapy Institute, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiPeople's Republic of China
- Anhui Provincial Key Laboratory of Blood Research and ApplicationsHefeiPeople's Republic of China
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11
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Hiramoto N, Yamazaki H, Nakamura Y, Uchida N, Murata M, Kondo T, Yoshioka S, Eto T, Nishikawa A, Kimura T, Ichinohe T, Atsuta Y, Onishi Y, Suzuki R, Mori T. Total body irradiation-containing conditioning regimens without antithymocyte globulin in adults with aplastic anemia undergoing umbilical cord blood transplantation. Ann Hematol 2021; 101:165-175. [PMID: 34546409 DOI: 10.1007/s00277-021-04664-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
Thus far, there have been no large cohort studies on total body irradiation (TBI)-containing conditioning regimens without antithymocyte globulin (ATG) in adults with aplastic anemia (AA) undergoing umbilical cord blood (UCB) transplantation (UCBT). We retrospectively analyzed 115 adults with idiopathic AA undergoing UCBT using TBI-containing reduced-intensity conditioning (RIC) regimens without ATG between 2000 and 2018 on behalf of the Adult Aplastic Anemia Working Group of the Japanese Society for Hematopoietic Cell Transplantation. We then compared transplantation outcomes between a fludarabine (Flu)- and melphalan (Mel)-based regimen (FM) and a Flu- and cyclophosphamide (Cy)-based regimen (FC). The median patient age at UCBT was 41 years. The median total nucleated cell and total CD34+ cell doses in a UCB unit at cryopreservation were 2.5 × 107/kg and 0.7 × 105/kg, respectively. The median follow-up period for survivors was 47 months. The cumulative incidence rate of neutrophil engraftment was 76.5%, and the 4-year overall survival (OS) rate was 64.3%. In multivariate analysis, the covariates that were significantly associated with a higher neutrophil engraftment were total CD34+ cell dose in an UCB unit (≥ 0.7 × 105/kg; hazard ratio, 0.57, P = 0.01) and total dose of TBI (4 Gy of TBI; hazard ratio, 0.32, P = 0.01). There was no significant difference in the cumulative incidence of neutrophil engraftment and the 4-year OS between the FM and FC groups. In conclusion, TBI-containing RIC regimens without ATG are suitable for adults with AA undergoing UCBT. There were no significant differences in transplantation outcomes between the FM and FC groups.
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Affiliation(s)
- Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, 2-2-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Hirohito Yamazaki
- Division of Transfusion Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yukinori Nakamura
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, 2-2-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Akinori Nishikawa
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | | | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Miyagi, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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12
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Brunstein CG, DeFor TE, Fuchs EJ, Karanes C, McGuirk JP, Rezvani AR, Eapen M, O'Donnell PV, Weisdorf DJ. Engraftment of Double Cord Blood Transplantation after Nonmyeloablative Conditioning with Escalated Total Body Irradiation Dosing to Facilitate Engraftment in Immunocompetent Patients. Transplant Cell Ther 2021; 27:879.e1-879.e3. [PMID: 34273598 DOI: 10.1016/j.jtct.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
To improve accrual to a randomized clinical trial of double unrelated cord blood (dUCB) versus HLA-haploidentical bone marrow (haplo-BM) transplantation, patients with less previous therapy and potentially greater immunocompetence were enrolled. To reduce the risk of graft rejection, patients randomized to receive dUCB received a higher dose of total body irradiation (TBI) (300 cGy versus 200 cGy). In this study, we investigated whether the inclusion of recipients of 300 cGy TBI influenced the trial outcomes. This was a secondary analysis of dUCB recipients, 161 who received TBI 200 cGy and 18 who received TBI 300 cGy. Fine and Gray regression was used to evaluate the effect of TBI dose on relapse and nonrelapse mortality (NRM). Cox regression was used for evaluation of neutrophil engraftment and overall survival. Patient characteristics were similar in the 2 TBI dose subgroups. The probability of neutrophil engraftment was 100% for patients who received TBI 300 cGy versus 91% (95% confidence interval, 86% to 95%) for those who received TBI 200 cGy (P = .64), which was similar after regression analysis adjusting for age, total infused nucleated cell dose, HLA matching to the patient, and comorbidity score. We also investigated whether the lower survival probability and higher cumulative incidence of NRM observed in the dUCB arm of BMT CTN 1101 could be influenced by the TBI 300 cGy patient subset. There was no significant difference in the 1-year incidences of NRM and relapse or in 1-year survival, even after adjustment in multivariate analysis. Patients in BMT CTN 1101 who received TBI 300 cGy and 200 cGy had similar engraftment and early mortality. We conclude that inclusion of a modified regimen for dUCB transplantation had no demonstrable influence on this large randomized trial.
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Affiliation(s)
- Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
| | - Todd E DeFor
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Ephraim J Fuchs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Chatchada Karanes
- Department of Hematology/HCT, City of Hope National Medical Center, Duarte, California
| | - Joseph P McGuirk
- The University of Kansas Medical Center, Division of Hematologic Malignancies and Cellular Therapeutics, Blood and Marrow Transplant, Kansas City, Kansas
| | - Andrew R Rezvani
- Division of Blood and Marrow Transplantation, Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Mary Eapen
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul V O'Donnell
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Daniel J Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
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13
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Ponce DM, Politikos I, Alousi A, Carpenter PA, Milano F, MacMillan ML, Barker JN, Horwitz ME. Guidelines for the Prevention and Management of Graft-versus-Host Disease after Cord Blood Transplantation. Transplant Cell Ther 2021; 27:540-544. [PMID: 34210500 DOI: 10.1016/j.jtct.2021.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
The incidence of graft-versus-host disease (GVHD) after cord blood (CB) transplantation (CBT) is lower than expected given the marked degree of human leukocyte antigen (HLA)-mismatch of CB grafts. While the exact mechanism that underlies this biology remains unclear, it is hypothesized to be due to the low number of mostly immature T-cells infused as part of the graft1,2, and increased tolerance of CB-derived lymphocytes induced by the state of pregnancy. Nevertheless, acute GVHD (aGVHD) is a significant complication of CBT. In contrast, the incidence of chronic GVHD (cGVHD) following CBT is lower than what is observed following matched related or unrelated donor HSC transplantation (HSCT)3-6. This review outlines the guidelines for the prevention and management of acute and chronic GVHD following CBT.
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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; Weill Cornell Medical College; New York, New York.
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College; New York, New York
| | - Amin Alousi
- Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul A Carpenter
- Fred Hutchinson Cancer Research Center, Division of Clinical Research, Department of Pediatrics, Seattle, Washington
| | - Filippo Milano
- Fred Hutchinson Cancer Research Center, Department of Oncology, Seattle, Washington
| | - Margaret L MacMillan
- Blood and Marrow Transplantation & Cellular Therapy Program, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College; New York, New York
| | - Mitchell E Horwitz
- Hematologic Malignancies and Cellular Therapies, Department of Medicine, Duke Cancer Institute, Durham, North Carolina
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14
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Olson AL, Politikos I, Brunstein C, Milano F, Barker J, Hill JA. Guidelines for Infection Prophylaxis, Monitoring and Therapy in Cord Blood Transplantation. Transplant Cell Ther 2021; 27:359-362. [PMID: 33965172 DOI: 10.1016/j.jtct.2021.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/14/2022]
Abstract
As an alternative stem cell source, cord blood (CB) has many advantages. However, delayed engraftment, lack of transferred immunity, and a significant incidence of acute graft-versus-host disease renders CB transplant (CBT) recipients at high risk of infectious complications. This guidance written by CBT and infectious disease experts outlines evidence-based recommendations for the prevention and treatment of opportunistic infections in adult patients undergoing CBT. Topics addressed include bacterial, fungal, viral, pneumocystis jirovcii and toxoplasmosis prophylaxis, suggested PCR monitoring for viruses, therapy for the most commonly encountered infections after CBT. We review key concepts including the recent important role of letermovir in the prevention of CMV reactivation. In instances where there is a paucity of data, practice recommendations are provided, including the duration of antimicrobial prophylaxis.
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Affiliation(s)
- Amanda L Olson
- The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | | | - Fillipo Milano
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juliet Barker
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joshua A Hill
- The Fred Hutchinson Cancer Research Center, Seattle, Washington
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15
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Metheny L, Politikos I, Ballen KK, Rezvani AR, Milano F, Barker JN, Brunstein CG. Guidelines for Adult Patient Selection and Conditioning Regimens in Cord Blood Transplant Recipients with Hematologic Malignancies and Aplastic Anemia. Transplant Cell Ther 2021; 27:286-291. [PMID: 33836867 DOI: 10.1016/j.jtct.2020.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
For cord blood transplantation (CBT), appropriate patient and conditioning regimen selection is necessary to achieve long-term disease-free survival. This review aims to provide comprehensive guidelines on these issues using evidence from the literature and experience at dedicated CBT centers. Topics include patient and disease characteristics that make CBT a good or poor choice and a review of outcomes in commonly used conditioning regimens in CBT. This is accompanied with recommendations on regimen intensity based on disease, organ function, and patient performance status and age. In addition, the use of antithymocyte globulin in CBT is discussed, as is the choice of conditioning in aplastic anemia patients who have access to acceptable CB units.
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Affiliation(s)
- Leland Metheny
- Stem Cell Transplant Program, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen K Ballen
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Andrew R Rezvani
- Division of Blood & Marrow Transplantation, Stanford University, Stanford, California
| | - Filippo Milano
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Claudio G Brunstein
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
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16
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Intrabone transplantation of CD34+ cells with optimized delivery does not enhance engraftment in a rhesus macaque model. Blood Adv 2021; 4:6148-6156. [PMID: 33351110 DOI: 10.1182/bloodadvances.2020003040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
Intrabone (IB) injection of umbilical cord blood has been proposed as a potential mechanism to improve transplant engraftment and prevent graft failure. However, conventional IB techniques produce low retention of transplanted cells in the marrow. To overcome this barrier, we developed an optimized IB (OIB) injection method using low-volume, computer-controlled slow infusion that promotes cellular retention in the marrow. Here, we compare engraftment of CD34+ cells transplanted in a myeloablative rhesus macaque (RM) model using the OIB method compared with IV delivery. RM CD34+ cells obtained by apheresis were split equally for transduction with lentiviral vectors encoding either green fluorescent protein or yellow fluorescent protein reporters. Following conditioning, one marked autologous population of CD34+ cells was injected directly IB using the OIB method and the other was injected via slow IV push into the same animal (n = 3). Daily flow cytometry of blood quantified the proportion of engrafting cells deriving from each source. Marrow retention was examined using positron emission tomography/computed tomography imaging of 89Zirconium (89Zr)-oxine-labeled CD34+ cells. CD34+ cells injected via the OIB method were retained in the marrow and engrafted in all 3 animals. However, OIB-transplanted progenitor cells did not engraft any faster than those delivered IV and contributed significantly less to hematopoiesis than IV-delivered cells at all time points. Rigorous testing of our OIB delivery system in a competitive RM myeloablative transplant model showed no engraftment advantage over conventional IV infusion. Given the increased complexity and potential risks of IB vs IV approaches, our data do not support IB transplantation as a strategy to improve hematopoietic engraftment.
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17
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Robust CD4+ T-cell recovery in adults transplanted with cord blood and no antithymocyte globulin. Blood Adv 2021; 4:191-202. [PMID: 31935291 DOI: 10.1182/bloodadvances.2019000836] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
Quality of immune reconstitution after cord blood transplantation (CBT) without antithymocyte globulin (ATG) in adults is not established. We analyzed immune recovery in 106 engrafted adult CBT recipients (median age 50 years [range 22-70]) transplanted for hematologic malignancies with cyclosporine/mycophenolate mofetil immunoprophylaxis and no ATG. Patients were treated predominantly for acute leukemia (66%), and almost all (96%) underwent myeloablation. Recovery of CD4+ T cells was faster than CD8+ T cells with median CD4+ T-cell counts exceeding 200/mm3 at 4 months. Early post-CBT, effector memory (EM), and central memory cells were the most common CD4+ subsets, whereas effector and EM were the most common CD8+ T-cell subsets. Naive T-cell subsets increased gradually after 6 to 9 months post-CBT. A higher engrafting CB unit infused viable CD3+ cell dose was associated with improved CD4+ and CD4+CD45RA+ T-cell recovery. Cytomegalovirus reactivation by day 60 was associated with an expansion of total, EM, and effector CD8+ T cells, but lower CD4+ T-cell counts. Acute graft-versus-host disease (aGVHD) did not significantly compromise T-cell reconstitution. In serial landmark analyses, higher CD4+ T-cell counts and phytohemagglutinin responses were associated with reduced overall mortality. In contrast, CD8+ T-cell counts were not significant. Recovery of natural killer and B cells was prompt, reaching medians of 252/mm3 and 150/mm3 by 4 months, respectively, although B-cell recovery was delayed by aGVHD. Neither subset was significantly associated with mortality. ATG-free adult CBT is associated with robust thymus-independent CD4+ T-cell recovery, and CD4+ recovery reduced mortality risk.
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18
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Song ZY, Ren HY, Dong YJ, Li Y, Yin Y, Sun YH, Wang Q, Xu WL, Liu W, Ou JP, Liang ZY. Impact of Low-Dose rATG Prior to Matched Sibling Donor Hematopoietic Stem Cell Transplantation for Hematologic Malignancies: Reduced Risk of Chronic Graft-versus-Host Disease and Improved Survival Outcomes. Cancer Manag Res 2020; 12:12287-12300. [PMID: 33311999 PMCID: PMC7725103 DOI: 10.2147/cmar.s283855] [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: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the efficacy of low-dose rabbit antithymocyte globulin (rATG) in matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) for patients with acute leukemia or myelodysplastic syndrome. Patients and Methods We performed a retrospective study of 79 patients with hematologic malignancies who received MSD-HSCT. All patients received standard graft-versus-host disease (GVHD) prophylaxis comprising cyclosporine, mycophenolate mofetil and short-term methotrexate. Among them, 38 were administered 5 mg/kg rATG as part of GVHD prophylaxis. Clinical outcomes including overall survival (OS), GVHD and relapse were analyzed. Results No graft failure occurred in the antithymocyte globulin (ATG) or non-ATG group. The cumulative incidences of grade 2-4 and 3-4 acute GVHD at day +100 were 13.3% versus 19.5% (p=0.507) and 5.7% versus 15.2% (p=0.196), respectively. The 2-year cumulative incidences of chronic GVHD (cGVHD) were 35.4% and 60.4% (p=0.039), and those of extensive cGVHD were 12.9% and 40.0% (p=0.015), respectively. In a multivariate analysis, the use of low-dose rATG was an independent protective factor for extensive cGVHD (hazard ratio [HR] 0.256; 95% confidence interval [CI], 0.080 to 0.822, p=0.022). The 2-year OS was 88.1% and 68.4% (p=0.038), respectively, and the use of low-dose rATG was the only protective factor in the multivariate analysis (HR 0.216; 95% CI, 0.059 to 0.792, p=0.021). There was no significant difference between the two groups in terms of the 2-year cumulative incidence of relapse, leukemia-free survival or GVHD-free and relapse-free survival. Conclusion Low-dose rATG used in MSD-HSCT as part of the conditioning regimen results in a reduced incidence of cGVHD and improves survival outcomes.
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Affiliation(s)
- Zheng-Yang Song
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Han-Yun Ren
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yu-Jun Dong
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yuan Li
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yue Yin
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Yu-Hua Sun
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Qian Wang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Wei-Lin Xu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Wei Liu
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Jin-Ping Ou
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
| | - Ze-Yin Liang
- Department of Hematology, Peking University First Hospital, Peking University, Beijing, People's Republic of China
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19
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Barker JN, Devlin SM, Naputo KA, Skinner K, Maloy MA, Flynn L, Anagnostou T, Avecilla ST, Scaradavou A, Cho C, Dahi PB, Giralt SA, Gyurkocza B, Hanash AM, Hsu K, Jakubowski AA, Papadopoulos EB, Peled JU, Perales MA, Sauter CS, Shah GL, Shaffer BC, Tamari R, Young JW, Roshal M, O'Reilly RJ, Ponce DM, Politikos I. High progression-free survival after intermediate intensity double unit cord blood transplantation in adults. Blood Adv 2020; 4:6064-6076. [PMID: 33290545 PMCID: PMC7724901 DOI: 10.1182/bloodadvances.2020003371] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022] Open
Abstract
Cord blood transplantation (CBT) after high intensity or nonmyeloablative conditioning has limitations. We investigated cyclosporine-A/mycophenolate mofetil-based intermediate intensity (cyclophosphamide 50 mg/kg, fludarabine 150 mg/m2, thiotepa 10 mg/kg, total body irradiation 400 cGy) unmanipulated double-unit CBT (dCBT) with prioritization of unit quality and CD34+ cell dose in graft selection. Ninety adults (median age, 47 years [range, 21-63]; median hematopoietic cell transplantation comorbidity index, 2 [range, 0-8]; 61 [68%] acute leukemia) received double-unit grafts (median CD34+ cell dose, 1.3 × 105/kg per unit [range, 0.2-8.3]; median donor-recipient human leukocyte antigen (HLA) match, 5/8 [range 3-7/8]). The cumulative incidences of sustained CB engraftment, day 180 grade III-IV acute, and 3-year chronic graft-versus-host disease were 99%, 24%, and 7%, respectively. Three-year transplant-related mortality (TRM) and relapse incidences were 15% and 9%, respectively. Three-year overall survival (OS) is 82%, and progression-free survival (PFS) is 76%. Younger age and higher engrafting unit CD34+ cell dose both improved TRM and OS, although neither impacted PFS. Engrafting unit-recipient HLA match was not associated with any outcome with a 3-year PFS of 79% in 39 patients engrafting with 3-4/8 HLA-matched units. In 52 remission acute leukemia patients, there was no association between minimal residual disease (MRD) and 3-year PFS: MRD negative of 88% vs MRD positive of 77% (P = .375). Intermediate intensity dCBT is associated with high PFS. Use of highly HLA mismatched and unmanipulated grafts permits wide application of this therapy, and the low relapse rates support robust graft-versus-leukemia effects even in patients with MRD.
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Affiliation(s)
- Juliet N Barker
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Kristine A Naputo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kelcey Skinner
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Molly A Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa Flynn
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Theodora Anagnostou
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andromachi Scaradavou
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medical College, New York, NY; and
| | - Christina Cho
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Parastoo B Dahi
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Boglarka Gyurkocza
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Alan M Hanash
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Katharine Hsu
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ann A Jakubowski
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Esperanza B Papadopoulos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Jonathan U Peled
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Craig S Sauter
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Gunjan L Shah
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Brian C Shaffer
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Roni Tamari
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - James W Young
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard J O'Reilly
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Pediatrics, Weill Cornell Medical College, New York, NY; and
| | - Doris M Ponce
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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20
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Baron F, Labopin M, Ruggeri A, Sierra J, Robinson S, Labussière‐Wallet H, Potter M, Ribera J, Deconinck E, Rambaldi A, Rohrlich P, Revel T, Gluckman E, Nagler A, Mohty M. Impact of detectable measurable residual disease on umbilical cord blood transplantation. Am J Hematol 2020; 95:1057-1065. [PMID: 32449964 DOI: 10.1002/ajh.25879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/08/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
The impact of measurable residual disease (MRD) on cord blood transplantation (CBT) outcomes has remained debated. To address this issue, we assessed the impact of measurable MRD at CBT on outcomes in large cohort of patients with acute leukemia. Inclusion criteria included adult patients with acute myeloid (AML) or acute lymphoblastic leukemia (ALL), CBT as first allo-HCT in first or second complete remission (CR) at transplantation, and known MRD status at the time of CBT. Data from 506 patients were included in the analysis. Among them, 317 patients had AML and 189 had ALL. Positive MRD was reported in 169 (33%) patients while the remaining 337 patients were MRD negative at CBT. At 2 years, relapse incidence was 18% in patients with MRD negativity vs 33% in those with MRD positivity at transplantation (P < .001). Two-year leukemia-free survival (LFS) and overall survival (OS) were 57% and 60%, respectively, in MRD negative patients, vs 38% (P < .001) and 48% (P = .004), respectively, in those with MRD positivity. There was no interaction between the impact of MRD on OS and LFS and diagnosis (ie, ALL vs AML), single or double CBT, and reduced-intensity or myeloablative conditioning. On multivariate analysis, MRD positivity was associated with a higher risk of relapse (HR = 1.8, P = .003), comparable non-relapse mortality (P = .44), worse LFS (HR = 1.4, P = .008) and a trend towards worse OS (HR = 1.3, P = .065). In conclusion, these data suggest that novel strategies that are aiming to achieve MRD negativity at CBT are needed for leukemic patients with positive MRD pre-CBT.
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Affiliation(s)
- Frédéric Baron
- Laboratory of Hematology, GIGA‐I3 University of Liege and CHU of Liège Liege Belgium
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST‐TC Paris France
- Service d'Hématologie Clinique et de Thérapie cellulaire APHP, Hôpital Saint Antoine Paris France
- Centre de Recherche Saint‐Antoine (CRSA) INSERM Paris France
- Sorbonne Université Paris France
| | - Annalisa Ruggeri
- Ospedale San Raffaele s.r.l., Haematology and BMT Milan Italy
- Eurocord, Hospital Saint Louis, AP‐HP, and IUH University Paris VII, France; Monacord, Centre Scientifique de Monaco Monaco Monaco
| | - Jorge Sierra
- Department of Hematology Hospital Santa Creu i Sant Pau Barcelona Spain
| | - Stephen Robinson
- Department of Haematology Bristol Haematology Oncology Centre, University Hospital Bristol Bristol UK
| | | | - Michael Potter
- Royal Marsden Hospital Leukaemia Myeloma Units London UK
| | - Josep‐Maria Ribera
- Department of Clinical Hematology ICO‐Hospital Universitari Germans Trias i Pujol Josep Carreras Research Institute Badalona Spain
| | - Eric Deconinck
- Service d'Hématologie Hopital Jean Minjoz Besancon France
| | - Alessandro Rambaldi
- Department of Oncology and Hematology University of Milan and Azienda Socio Sanitaria Territoriale, Papa Giovanni XXIII Bergamo Italy
| | | | - Thierry Revel
- Department of Hematology Hôpital Américain Clamart France
| | - 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 Study Office/CEREST‐TC Paris France
- Division of Hematology and Bone Marrow Transplantation The Chaim Sheba Medical Center, Tel‐Hashomer Ramat‐Gan Israel
| | - Mohamad Mohty
- EBMT Paris Study Office/CEREST‐TC Paris France
- Service d'Hématologie Clinique et de Thérapie cellulaire APHP, Hôpital Saint Antoine Paris France
- Centre de Recherche Saint‐Antoine (CRSA) INSERM Paris France
- Sorbonne Université Paris France
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21
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Harada K, Fuji S, Seo S, Uchida N, Kawakita T, Yano S, Ozawa Y, Yoshioka S, Onishi Y, Noguchi Y, Onizuka M, Matsuhashi Y, Kimura T, Ichinohe T, Atsuta Y, Terakura S, Nakasone H. Comparison of immunosuppressant regimens in salvage cord blood transplantation for graft failure after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2020; 56:400-410. [PMID: 32820226 DOI: 10.1038/s41409-020-00999-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
Graft failure (GF) is a life-threatening complication after allogeneic stem cell transplantation. Although salvage cord blood transplantation (CBT) is a curative therapy for GF, the optimal immunosuppression after salvage CBT remains unknown. Using nationwide registration data, we compared the transplant outcomes of patients who developed GF and underwent salvage CBT using immunosuppressants, including calcineurin (CNI) alone (n = 177); CNI plus methotrexate (CNI+MTX, n = 150); and CNI plus mycophenolate mofetil (CNI+MMF, n = 161). The CNI+MMF group, in comparison with the CNI+MTX and CNI alone groups, demonstrated better neutrophil recovery at 30 days (62.7 vs. 42.7 vs. 53.1%, P < 0.001); better overall survival (OS) at 12 months (48.4 vs. 33.5 vs. 28.3%, P < 0.001); and lower non-relapse mortality (NRM) at 12 months (35.2 vs. 53.9 vs. 56.5%, P < 0.001). On multivariate analysis, CNI+MMF had the best neutrophil recovery (hazard ratio (HR), 1.71; P < 0.001) and OS (HR, 0.64; P = 0.002) and the lowest NRM (HR, 0.53; P < 0.001). Hemorrhage was relatively less frequent in the CNI+MMF group. CNI+MMF can be a promising immunosuppressant regimen after salvage CBT for GF, with better engraftment and survival outcomes, compared with CNI alone and CNI+MTX.
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Affiliation(s)
- Kaito Harada
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Shingo Yano
- Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Yuma Noguchi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshiko Matsuhashi
- Department of Hematology, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Takafumi Kimura
- Preparation Department, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Seitaro Terakura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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22
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Sheth V, Volt F, Sanz J, Clement L, Cornelissen J, Blaise D, Sierra J, Michallet M, Saccardi R, Rocha V, Gluckman E, Chabannon C, Ruggeri A. Reduced-Intensity versus Myeloablative Conditioning in Cord Blood Transplantation for Acute Myeloid Leukemia (40-60 years) across Highly Mismatched HLA Barriers-On Behalf of Eurocord and the Cellular Therapy & Immunobiology Working Party (CTIWP) of EBMT. Biol Blood Marrow Transplant 2020; 26:2098-2104. [PMID: 32726672 DOI: 10.1016/j.bbmt.2020.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
The use of myeloablative conditioning (MAC) in umbilical cord blood transplantation (UCBT) has been associated with high nonrelapse mortality (NRM) in patients aged >40 years, especially those having a high HLA disparity, thus limiting wider applications. We hypothesized that the NRM advantage of reduced-intensity conditioning (RIC) and higher graft-versus-leukemia effect associated with greater HLA disparities would expand its use for patients (aged 40 to 60 years) without compromising efficacy and compared outcomes between RIC and MAC regimens. In total, 288 patients aged 40 to 60 years, with de novo acute myeloid leukemia, receiving UCBT with at least 2 HLA mismatches with RIC (n = 166) or MAC (n = 122) regimens were included. As compared to RIC, the MAC cohort included relatively younger patients, having received more single UCBT, with lower total nucleated cell counts and more in vivo T cell depletion. Median time to neutrophil engraftment, infections (bacterial, viral, and fungal), and grade II to IV acute and chronic graft-versus-host disease were similar in both groups. In the multivariate analysis, overall survival (hazard ratio [HR], 0.98; P = .9), NRM (HR, 0.68; P = .2), and relapse (HR, 1.24; P = .5) were not different between RIC and MAC. Refractory disease was associated with worse survival. Outcomes of UBCT for patients aged 40 to 60 years having ≥2 HLA mismatches are comparable after the RIC or MAC regimen.
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Affiliation(s)
- Vipul Sheth
- Clinical Research Division, Program in Immunology, Fred Hutchison Cancer Research Centre, Seattle, Washington
| | | | - Jaime Sanz
- Department of Stem Cell Transplant and Immunotherapy, Hospital Universitario La Fe, Valencia, Spain
| | - Laurence Clement
- Department of Stem Cell Transplant and Immunotherapy, Haut-Lévêque, Bordeaux, France
| | - Jan Cornelissen
- Department of Stem Cell Transplant and Immunotherapy, Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands
| | - Didier Blaise
- Department of Stem Cell Transplant and Immunotherapy, Paoli Calmettes, Marseille, France
| | - Jorge Sierra
- Department of Stem Cell Transplant and Immunotherapy, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Mauricette Michallet
- Department of Stem Cell Transplant and Immunotherapy, Service d'Hematologie, Centre Leon Berard, Lyon, France
| | - Riccardo Saccardi
- Department of Stem Cell Transplant and Immunotherapy, Azienda Ospedaliero Universitaria Meyer-Ospedale di Careggi, Firenze, Italy
| | | | | | - Christian Chabannon
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, & Inserm CBT-1409, Aix-Marseille Université, Marseille, France
| | - Annalisa Ruggeri
- Eurocord, Hopital Saint Louis-EA3518, Paris, France; Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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23
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Byun JM, Hong J, Oh D, Yhim HY, Do YR, Park JS, Jung CW, Yang DH, Won JH, Lee HG, Moon JH, Mun YC, Jo DY, Han JJ, Lee JH, Lee JH, Lee J, Yoon SS. Optimizing Preparative Regimen for Umbilical Cord Blood Transplantation in Adult Acute Leukemia Patients: Acute Lymphoblastic Leukemia Requires Myeloablative Conditioning but Not Acute Myeloid Leukemia. J Clin Med 2020; 9:jcm9072310. [PMID: 32708168 PMCID: PMC7408460 DOI: 10.3390/jcm9072310] [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: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Cord blood transplantation (CBT) is a valuable alternative to bone marrow transplantation in adults without readily available donors. We conducted this study to investigate the feasibility of CBT for adult patients with acute leukemia with regards to impact of different conditioning and graft-versus-host disease (GVHD) prophylaxis regimens on clinical outcomes. From 16 centers in Korea, 41 acute myeloid leukemia (AML) and 29 ALL (acute lymphoblastic leukemia) patients undergoing CBT were enrolled. For AML patients, the neutrophil engraftment was observed in 87.5% of reduced intensity conditioning (RIC) and 72.0% of myeloablative conditioning (MAC) (p = 0.242). The median RFS was 5 months and OS 7 months. Conditioning regimen did not affect relapse free survival (RFS) or overall survival (OS). GVHD prophylaxis using calcineurin inhibitors (CNI) plus methotrexate was associated with better RFS compared to CNI plus ATG (p = 0.032). For ALL patients, neutrophil engraftment was observed in 55.6% of RIC and 90.0% of MAC (p = 0.034). The median RFS was 5 months and OS 19 months. MAC regimens, especially total body irradiation (TBI)-based regimen, were associated with both longer RFS and OS compared to other conditioning regimens. In conclusion, individualized conditioning regimens will add value in terms of enhancing safety and efficacy of CBT.
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Affiliation(s)
- Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Korea; (J.M.B.); (J.H.)
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Korea; (J.M.B.); (J.H.)
| | - Doyeun Oh
- Department of Internal Medicine, CHA University School of Medicine, Seongnam 13496, Korea;
| | - Ho-Young Yhim
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju 54907, Korea;
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Chul Won Jung
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Deok-Hwan Yang
- Division of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea;
| | - Jong-Ho Won
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Hong Ghi Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, Korea;
| | - Joon Ho Moon
- Department of Hematology and Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul 07985, Korea;
| | - Deog-Yeon Jo
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 35015, Korea;
| | - Jae Joon Han
- Department of Hematology and Medical Oncology, College of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Jae Hoon Lee
- Division of Hematology, Department of Internal Medicine, Gachon University College of Medicine Gil Medical Center, Incheon 21565, Korea;
| | - Junglim Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Daegu Fatima Hospital, 99, Ayang-ro, Dong-gu, Daegu 41199, Korea
- Correspondence: (J.L.); (S.-S.Y.); Tel.: +82-10-2726-0325 (J.L.); +82-2-2072-3079 (S.-S.Y.); Fax: +82-53-940-7416 (J.L.); +82-2-762-9662 (S.-S.Y.)
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Korea; (J.M.B.); (J.H.)
- Correspondence: (J.L.); (S.-S.Y.); Tel.: +82-10-2726-0325 (J.L.); +82-2-2072-3079 (S.-S.Y.); Fax: +82-53-940-7416 (J.L.); +82-2-762-9662 (S.-S.Y.)
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24
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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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25
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Imahashi N, Terakura S, Kondo E, Kako S, Uchida N, Kobayashi H, Inamoto Y, Sakai H, Tanaka M, Ishikawa J, Kozai Y, Matsuoka KI, Kimura T, Fukuda T, Atsuta Y, Kanda J. Comparison of reduced-intensity/toxicity conditioning regimens for umbilical cord blood transplantation for lymphoid malignancies. Bone Marrow Transplant 2020; 55:2098-2108. [PMID: 32440015 DOI: 10.1038/s41409-020-0905-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022]
Abstract
To investigate which reduced-intensity conditioning (RIC)/reduced-toxicity conditioning (RTC) is superior for umbilical cord blood transplantation (UCBT) for lymphoid malignancies, we retrospectively compared three widely used RIC/RTC regimens: fludarabine/melphalan/total body irradiation (FM-TBI, n = 524), fludarabine/cyclophosphamide/total body irradiation (FC-TBI, n = 96), and fludarabine/busulfan/total body irradiation or melphalan (FB-based, n = 159). Among patients with acute lymphoblastic leukemia (ALL) (n = 314), there were no differences in overall survival (OS) by conditioning regimen. Among patients with malignant lymphoma (ML) (n = 465), FM-TBI and FC-TBI regimens had similar OS, whereas FB-based regimen had lower OS (hazard ratio [HR], 1.73; P < 0.01) than did FM-TBI regimen due to higher non-relapse mortality (HR, 1.72; P = 0.02). In addition, mycophenolate mofetil-containing GVHD prophylaxis was associated with better OS than methotrexate-containing GVHD prophylaxis among patients who received FM-TBI (HR, 0.65; P = 0.03) and FC-TBI (HR, 0.25; P < 0.01) regimens due to a decreased relapse risk. In summary, our results suggest that all three RIC/RTC regimens have comparable clinical outcomes in ALL, while the FM-TBI or FC-TBI regimens combined with mycophenolate mofetil-containing GVHD prophylaxis is preferable in RIC/RTC-UCBT for ML. Large prospective studies are warranted to confirm these results.
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Affiliation(s)
- Nobuhiko Imahashi
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
| | - Seitaro Terakura
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisei Kondo
- Department of Hematology, Kawasaki Medical School, Kurashiki, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Sakai
- Division of Hematology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuji Kozai
- Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Takafumi Kimura
- Preparation Department, Japanese Red Cross Kinki Block Blood Center, Osaka, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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26
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Qin BZ, Zhang C, Zhang R, Wang L. Role of antithymocyte globulin in patients with hematologic diseases undergoing umbilical cord blood transplantation: A systematic review and meta-analysis. Clin Transplant 2020; 34:e13876. [PMID: 32277839 DOI: 10.1111/ctr.13876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
The role of antithymocyte globulin (ATG) in patients with hematologic diseases undergoing umbilical cord blood transplantation (UCBT) remains controversial. This systematic review and meta-analysis was conducted to comprehensively evaluate this issue. PubMed, Embase, and the Cochrane Library were systematically searched. Clinical studies reporting the impact of ATG- vs non-ATG-containing conditioning regimens on transplantation outcomes were identified. Twenty-five studies were included. ATG significantly prevented grade II-IV and grade III-IV acute graft-vs-host disease (GVHD) (11 studies, 5020 patients, HR: 0.49, 95% CI: 0.42-0.56, P < .001; 5 studies, 5490 patients, HR: 0.60, 95% CI: 0.46-0.80, P < .001) but not chronic GVHD (8 studies, 5952 patients, HR: 0.78, 95% CI: 0.51-1.20, P = .266). However, use of ATG was associated with increased transplantation-related mortality and inferior overall survival (9 studies, 4244 patients, HR: 1.79, 95% CI: 1.38-2.33, P < .001; 8 studies, 5438 patients, HR: 1.96, 95% CI: 1.56-2.46, P < .001). Our study did not recommend routine use of ATG in UCBT. Individualizing the ATG timing and dose based on patient characteristics to retain the prophylactic effects of ATG on GVHD without compromising the survival of UCBT recipients may be reasonable.
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Affiliation(s)
- Bao-Zhen Qin
- Department of Hematology, Peking University ShenZhen Hospital, ShenZhen, China
| | - Chao Zhang
- Department of Hematology and Oncology, LaoShan Medical District of No. 971 Hospital of Chinese People's Liberation Army (PLA) Navy, Qingdao, China
| | - Rui Zhang
- Rocket Force Characteristic Medical Center, PLA Rocket Army General Hospital, Beijing, China
| | - Li Wang
- Department of Hematology, Peking University ShenZhen Hospital, ShenZhen, China.,Department of Hematology and Oncology, LaoShan Medical District of No. 971 Hospital of Chinese People's Liberation Army (PLA) Navy, Qingdao, China
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27
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Tegla C, Choi J, Abdul-Hay M, Cirrone F, Cole K, Al-Homsi AS. Current Status and Future Directions in Graft- Versus-Host Disease Prevention Following Allogeneic Blood and Marrow Transplantation in Adults. Clin Hematol Int 2020; 2:5-12. [PMID: 34595437 PMCID: PMC8432335 DOI: 10.2991/chi.d.200115.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/07/2020] [Indexed: 12/22/2022] Open
Abstract
Graft-versus-host disease (GvHD) in its acute and chronic forms continues to represent a significant barrier to the success and wide-applicability of blood and marrow transplantation as a potentially curative treatment modality for a number of benign and malignant blood conditions. Presently, calcineurin inhibitor (CNI)-based regimens remain the most commonly used prevention strategy, although post-transplant cyclophosphamide is emerging as an alternative approach, and is providing a backbone for innovative CNI-free combinations. In this paper, we review the current strategies used for the prevention of GvHD, and highlight some of the developing and promising combinations.
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Affiliation(s)
- Cosmin Tegla
- Division of Hematology and Medical Oncology, New York University Langone Health, New York, NY, USA
| | - Jun Choi
- Division of Hematology and Medical Oncology, New York University Langone Health, New York, NY, USA
| | - Maher Abdul-Hay
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
| | - Frank Cirrone
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
| | - Kelli Cole
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
| | - A Samer Al-Homsi
- Blood and Marrow Transplantation Program, New York University Langone Health, New York, NY, USA
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28
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Impacts of thymoglobulin in patients with acute leukemia in remission undergoing allogeneic HSCT from different donors. Blood Adv 2020; 3:105-115. [PMID: 30626574 DOI: 10.1182/bloodadvances.2018025643] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/16/2018] [Indexed: 12/31/2022] Open
Abstract
Antithymocyte globulin (ATG) is widely used to reduce acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD). To clarify the different impacts of ATG for conditioning across different donor types, we retrospectively analyzed patients with acute leukemia (n = 6617) who underwent hematopoietic stem cell transplantation between 2008 and 2015 with ATG (n = 279) or without ATG (n = 6338). Because thymoglobulin is the only ATG drug approved for GVHD prophylaxis in Japan since September 2008, we included thymoglobulin alone in the present analysis. The survivors' median follow-up time was 1081 days. Patients were categorized into 5 groups: cord blood (CB; n = 1915), matched related donor (n = 1772), 1-antigen mismatched related donor (1-MMRD; n = 225), matched unrelated donor (MUD; n = 1742), and 1-allele mismatched unrelated donor (1-MMUD; n = 963). In multivariate analysis, ATG decreased overall survival (hazard ratio [HR], 1.403; P = .054) and GVHD-free/relapse-free survival (GRFS) (HR, 1.458; P = .053) in association with increased nonrelapse mortality (NRM) (HR, 1.608; P =03) with CB, whereas it improved GRFS (HR, 0.515; P < .01) and decreased grades II to IV aGVHD (HR, 0.576; P < .01), extensive cGVHD (HR, 0.460; P = .02), and NRM (HR, 0.545; P = .03) with 1-MMUD. ATG did not impact survival with 1-MMRD and MUD. The use of ATG in conditioning is beneficial due to the reduction in acute/chronic GVHD without increasing NRM or disease relapse only in 1-MMUD transplantation. On the other hand, ATG is not recommended for CB transplantation.
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Gutgarts V, Sathick IJ, Zheng J, Politikos I, Devlin SM, Maloy MA, Giralt SA, Scordo M, Bhatt V, Glezerman I, Muthukumar T, Jaimes EA, Barker JN. Incidence and Risk Factors for Acute and Chronic Kidney Injury after Adult Cord Blood Transplantation. Biol Blood Marrow Transplant 2020; 26:758-763. [PMID: 31911259 DOI: 10.1016/j.bbmt.2019.12.768] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/17/2022]
Abstract
Although cord blood transplantation (CBT) extends allograft access, patient comorbidities, chemoradiation, and nephrotoxic medications all contribute to acute kidney injury (AKI) risk. We analyzed AKI in adult myeloablative CBT recipients who underwent transplantation from 2006 to 2017 for hematologic malignancies using cyclosporine A (CSA)/mycophenolate mofetil immunosuppression. Maximum grades of AKI were calculated using Kidney Disease: Improving Global Outcomes (grade 1, 1.5 to <2-fold; grade 2, 2 to <3-fold; or grade 3, ≥3-fold over baseline) definitions. In total, 153 patients (median 51 years [range, 23-65], 114/153 [75%] acute leukemia, 27/153 [18%] African, 88/153 [58%] cytomegalovirus seropositive, median age-adjusted hematopoietic cell comorbidity index 3 [range, 0-9], median pretransplant albumin 4.0 g/dL [range, 2.6-5.2]) underwent transplantation. The day 100 cumulative incidence of grade 1-3 AKI was 83% (95% confidence interval [CI], 77%-89%) (predominantly grade 2, median onset 40 days, range 0 to 96), and grade 2-3 AKI incidence was 54% (95% CI, 46%-62%) (median onset 43 days, range 0 to 96). Mean CSA level preceding AKI onset was high (360 ng/mL, target range 300-350). In multivariate analysis, African ancestry, addition of haploidentical CD34+ cells, low day -7 albumin, critical illness/intensive care admission, and nephrotoxic drug exposure (predominantly CSA and/or foscarnet) were associated with AKI. In a day 100 landmark analysis, 6% of patients with no prior AKI had chronic kidney disease (CKD) at 2 years versus 43% with prior grade 1 and 38% with prior grade 2-3 AKI (overall P= .02). Adult CBT recipients are at significant AKI risk, and AKI is associated with increased risk of CKD. Prevention strategies, early recognition, and prompt intervention are critical to mitigate kidney injury.
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Affiliation(s)
- Victoria Gutgarts
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Insara Jaffer Sathick
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ioannis Politikos
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Sean M Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Molly A Maloy
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Valkal Bhatt
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ilya Glezerman
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Thangamani Muthukumar
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Edgar A Jaimes
- Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; 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; Weill Cornell Medical College, New York, New York
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30
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Ruggeri A. Optimizing cord blood selection. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:522-531. [PMID: 31808851 PMCID: PMC6913431 DOI: 10.1182/hematology.2019000056] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nowadays a donor can be found for virtually all patients in need of an allogeneic stem cell transplantation, and the decision whether to use a matched or mismatched unrelated donor, an unrelated donor for umbilical cord blood transplantation (UCBT), or a haploidentical donor depends not only on the availability of the donor but also on patient-, disease-, and center-related factors. This paper summarizes the recent criteria in the selection of cord blood unit, including the cell dose requirement and the HLA typing for the optimal donor choice. The main strategies to optimize the results of UCBT, the conditioning regimens, and the use of antithymocyte globulin and the other platforms of graft-versus-host disease prophylaxis are discussed. The paper describes the results of UCBT in children and adults with malignant and nonmalignant diseases and the comparative analysis with other donor type and stem cell sources. Emerging strategies, focusing on the different platforms of ex vivo expansion and the new applications using cord blood stem cell, are also examined.
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MESH Headings
- Adolescent
- Adult
- Anemia, Aplastic/blood
- Anemia, Aplastic/diagnosis
- Anemia, Aplastic/genetics
- Anemia, Aplastic/therapy
- Cord Blood Stem Cell Transplantation
- Donor Selection
- Female
- Histocompatibility Testing
- Humans
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/therapy
- Male
- Transplantation Conditioning
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Affiliation(s)
- Annalisa Ruggeri
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, Italy; Eurocord, Hôpital Saint Louis, Paris, France; and Cellular Therapy and Immunobiology Working Party of the European Society for Blood and Marrow Transplantation
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31
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Unlicensed Umbilical Cord Blood Units Provide a Safe and Effective Graft Source for a Diverse Population: A Study of 2456 Umbilical Cord Blood Recipients. Biol Blood Marrow Transplant 2019; 26:745-757. [PMID: 31756539 DOI: 10.1016/j.bbmt.2019.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022]
Abstract
Umbilical cord blood (UCB) transplantation (UCBT) is a curative procedure for patients with hematologic malignancies and genetic disorders and expands access to transplantation for non-Caucasian patients unable to find a fully matched unrelated donor. In 2011, the US Food and Drug Administration required that unrelated UCBT be performed using either licensed UCB or unlicensed UCB under the Investigational New Drug (IND) program. The National Marrow Donor Program manages an IND under which 2456 patients (1499 adults and 957 children, 564 with malignant diseases and 393 with nonmalignant diseases) underwent single or double UCBT between October 2011 and December 2016. The median patient age was 31 years (range, <1 to 81 years), and 50% of children and 36% of adults were non-Caucasian. The median time to neutrophil engraftment (ie, absolute neutrophil count ≥500/mm3) was 22 days for adults, 20 days for pediatric patients with malignant diseases, and 19 days for pediatric patients with nonmalignant diseases, with corresponding rates of engraftment at 42 days of 89%, 88%, and 90%. In these 3 groups of patients, the incidence of acute graft-versus-host disease (GVHD) grade II-IV was 35%, 32%, and 24%; the incidence of chronic GVHD was 24%, 26%, and 24%; and 1-year overall survival (OS) was 57%, 71%, and 79%, respectively. In multivariate analysis, younger age, lower Hematopoietic Cell Transplantation-Specific Comorbidity Index, early-stage chemotherapy-sensitive disease, and higher performance score were predictive of improved OS for adults. In a subset analysis of children with malignancies undergoing single UCBT, the use of either licensed UCB (n = 48) or unlicensed UCB (n = 382) was associated with similar engraftment and survival. The use of unlicensed UCB units is safe and effective and provides an important graft source for a diverse population.
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32
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A phase II study of reduced intensity double umbilical cord blood transplantation using fludarabine, melphalan, and low dose total body irradiation. Bone Marrow Transplant 2019; 55:804-810. [DOI: 10.1038/s41409-019-0715-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/09/2022]
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Kanda J, Hayashi H, Ruggeri A, Kimura F, Volt F, Takahashi S, Labopin M, Kako S, Tozatto-Maio K, Yano S, Sanz G, Uchida N, Van Lint MT, Kato S, Mohty M, Forcade E, Kanamori H, Sierra J, Ohno Y, Saccardi R, Fukuda T, Ichinohe T, Takanashi M, Rocha V, Okamoto S, Nagler A, Atsuta Y, Gluckman E. Prognostic factors for adult single cord blood transplantation among European and Japanese populations: the Eurocord/ALWP-EBMT and JSHCT/JDCHCT collaborative study. Leukemia 2019; 34:128-137. [DOI: 10.1038/s41375-019-0534-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 11/09/2022]
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34
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Myeloablative Unrelated Cord Blood Transplantation in Adolescents and Young Adults with Acute Leukemia. Biol Blood Marrow Transplant 2019; 25:2438-2446. [PMID: 31394275 DOI: 10.1016/j.bbmt.2019.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
Outcomes for adolescents and young adults (AYAs) with leukemia differ from other age groups and are still under-represented in clinical research. The aim of this study was to analyze outcomes of umbilical cord blood transplant (UCBT) in AYAs with acute leukemia reported to Eurocord/European Society for Blood and Marrow Transplantation. Patients (N = 504) had acute lymphoblastic (59%) or myeloid leukemia (41%), were aged 15 to 25 years, and received UCBT after myeloablative conditioning regimens between 2004 and 2016. The primary endpoint was 3-year overall survival (OS). Median follow-up was 3.9 years. Transplant was single in 58% and double UCBT in 42%. Three-year OS was 45% and leukemia free survival (LFS) was 41%. Cumulative incidence functions (CIFs) of nonrelapse mortality (NRM) and relapse were 31% and 28%, respectively. CIF of acute graft-versus-host disease (GVHD) grades II to IV at day 100 was 28%. Three-year CIF of chronic GVHD was 25%. In adjusted analysis, better disease status at UCBT (hazard ratio [HR], 2.74; P < .001) and more recent UCBT (HR, 1.43; P = .01) were associated with increased OS, and a similar effect of these factors was observed on LFS. Contrastingly, the use of antithymocyte globulin had a negative effect in LFS. The risk of acute GVHD grades II to IV increased with the use of double UCBT (HR, 1.65; P = .02) and decreased with more recent transplant period (HR, .65; P = .02) and antithymocyte globulin use (HR, .55; P = .01). Outcomes of AYA UCBT improved in more recent years, becoming comparable with pediatric results. Demonstrating the feasibility of UCBT in AYAs facilitates stem cell source selection and provides the basis for future prospective studies.
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Yamamoto H. Single cord blood transplantation in Japan; expanding the possibilities of CBT. Int J Hematol 2019; 110:39-49. [PMID: 31152417 DOI: 10.1007/s12185-019-02672-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022]
Abstract
Cord blood (CB) has been an alternative stem cell source for patients with a wide variety of hematological diseases. Cord blood confers the advantages of rapid availability and higher tolerance to two HLA antigen mismatches compared with unrelated donors, and this has increased opportunities for patients who do not have suitable donors or require urgent transplantation. Although the higher rate of engraftment failure remains a serious concern after cord blood transplantation (CBT), the mechanisms underlying this risk have gradually been clarified, which has helped to improve engraftment. Recent studies of CBT and other alternatives have reported comparable outcomes. Moreover, CBT shows promise even when patients are in a non-remission status, which may reflect the potent graft-versus-leukemia effect of CB. Here we compare the most recent outcomes of CBT with those of other stem cell sources and discuss the potential of CB and several outstanding issues that require resolution.
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Affiliation(s)
- Hisashi Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
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36
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Hematopoietic stem cell transplantation with unrelated cord blood or haploidentical donor grafts in adult patients with secondary acute myeloid leukemia, a comparative study from Eurocord and the ALWP EBMT. Bone Marrow Transplant 2019; 54:1987-1994. [PMID: 31150016 DOI: 10.1038/s41409-019-0582-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 01/25/2023]
Abstract
Survival of patients with secondary acute myeloid leukemia (sAML) is poor. Cord blood transplantation (UCBT) and non-T-cell-depleted stem cell transplantation from haploidentical donors (HAPLO) are both strategies that have shown encouraging results in patients who do not have an human leukocyte antigen (HLA)-matched sibling or unrelated donor. We retrospectively analyzed outcomes of 409 adults with sAML receiving either UCBT (n = 163) or HAPLO (n = 246) in EBMT centers. Myelodysplastic syndrome (MDS) or myeloproliferative disorder (MPD) was the antecedent diagnosis in 79% of UCBT and 85% of HAPLO recipients. In multivariate analysis, UCBT was associated with higher risk of grade II-IV acute GVHD (HR 1.9, p = 0.009) and lower GHVD-free-relapse-free-survival (GRFS) (HR 1.57, p = 0.007) compared to HAPLO. Chronic-GVHD, RI, NRM, LFS, and OS were not statistically different between the two. Early disease stage at transplant was independently associated with lower RI and NRM and higher OS and LFS. These results indicate that HAPLO is associated with better GRFS and lower aGvHD compared to UCBT in patients with sAML and that UCBT can be a valid alternative for sAML patients who lack a matched sibling, a proper haploidentical or an unrelated donor.
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Romaniuk DS, Khmelevskaya AA, Drokov MY, Popova NN, Vasilieva VA, Kuzmina LA, Efimov GA, Parovichnikova EN, Savchenko VG. Effect of CTLA4 gene polymorphism on relapse probability among patients with acute leukemias after allogenic hematopoietic stem cells transplantation. ACTA ACUST UNITED AC 2019. [DOI: 10.17650/1818-8346-2019-14-1-76-82] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is being widely applied as a therapy for hematological malignancies. The long-term outcome of allo-HSCT depends directly on the ability of cytotoxic T-lymphocytes to recognize and eliminate the residual tumor. CTLA-4 is one of the regulatory proteins that provide control over the development of the immune response. Polymorphisms in the CTLA4 gene can affect its function and the efficiency of the antitumor response.The objective:to study the effect of non-synonymous single nucleotide polymorphism (nsSNP) c.49A>G in the donor CTLA4 gene on tumor control in the recipient of allogeneic hematopoietic stem cells (HSC).Materials and methods.Donors of HSC were genotyped for nsSNP c.49A>G in the CTLA4 gene by the real-time polymerase chain reaction using the allele-specific primers. Genotyping data was validated by Sanger’s sequencing of 22 randomly selected samples. The overall survival, the event-free survival and relapse probability were calculated using the Kaplan–Mayer method. A log-rank test was used to assess the statistical significance of group disparities. A p-value of 0.05 was considered as significant.Results.The frequencies of the CTLA4 gene c.49A>G polymorphism alleles in the observed population (102 healthy donors of HSC) correspond to the frequencies obtained by the “1000 genomes” project for the European population. The effect of the donor CTLA4 polymorphism on the tumor control was evaluated on the cohort of patients with acute leukemia after human leukocyte antigen (HLA) matched HSCT from an unrelated donor. It was shown, the three-year relapse-free survival was significantly lower for those patients who received grafts from a donor with the homozygous A/A state of nsSNP c.49A>G (p = 0.01), it was 12.7 % versus 62,8 % in group with c.49A>G G/G and A/G donor genotypes. The incidence of relapse was also significantly different for the group with A/A genotype and for the group with G/G or A/G genotypes of the nsSNP and equaled to 83.7 and 29.3 % respectively (p = 0.03).Conclusion.Patients with acute leukemia, who underwent allo-HSCT from unrelated completely HLA-matched donors with c.49A>G G/G or A/G genotypes have the significantly lower risk of relapse than patients whose donors had the A/A genotype. These results suggest practicability of the nsSNP genotyping for the optimal donor selection.
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Affiliation(s)
- D. S. Romaniuk
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - A. A. Khmelevskaya
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - M. Yu. Drokov
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - N. N. Popova
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - V. A. Vasilieva
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - L. A. Kuzmina
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - G. A. Efimov
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - E. N. Parovichnikova
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
| | - V. G. Savchenko
- National Research Center for Hematology, Ministry of Health of Russia; 4 Novyy Zykovskiy Proezd, Moscow 125167
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Kanate AS, Szabo A, Raj RV, Bower K, Grulke R, Shah N, Ross KG, Cumpston A, Craig M, Pasquini MC, Shah N, Hari P, Hamadani M, Chhabra S. Comparison of Graft Acquisition and Early Direct Charges of Haploidentical Related Donor Transplantation versus Umbilical Cord Blood Transplantation. Biol Blood Marrow Transplant 2019; 25:1456-1464. [PMID: 30878605 DOI: 10.1016/j.bbmt.2019.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
Alternative donor allogeneic hematopoietic cell transplants (HCTs), such as double umbilical cord blood transplants (dUCBT) and haploidentical related donor transplants (haplo-HCT), have been shown to be safe and effective in adult patients who do not have an HLA-identical sibling or unrelated donor available. Most transplant centers have committed to 1 of the 2 alternative donor sources, even with a lack of published randomized data directly comparing outcomes and comparative data on the cost-effectiveness of dUCBT versus haplo-HCT. We conducted a retrospective study to evaluate and compare the early costs and charges of haplo-HCT and dUCBT in the first 100 days at 2 US transplant centers. Forty-nine recipients of haplo-HCT (at 1 center) and 37 with dUCBT (at another center) were included in the analysis. We compared graft acquisition, inpatient/outpatient, and total charges in the first 100 days. The results of the analysis showed a significantly lower cost of graft acquisition and lower total charges (for 100-day HCT survivors) in favor of haplo-HCT. Importantly, to control for the obvious shortcomings of comparing costs at 2 different transplant centers, adjustments were made based on the current (2018) local wage index and inflation rate. In the absence of further guidance from a prospective study, the cost analysis in this study suggests that haplo-HCT may result in early cost savings over dUCBT and may be preferred by transplant centers and for patients with more limited resources.
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Affiliation(s)
- Abraham S Kanate
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Aniko Szabo
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Renju V Raj
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathryn Bower
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Rachel Grulke
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nilay Shah
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Kelly G Ross
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Aaron Cumpston
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Michael Craig
- Osborn Hematopoietic Malignancy and Cellular Therapy Program, West Virginia University, Morgantown, West Virginia
| | - Marcelo C Pasquini
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nirav Shah
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Parameswaran Hari
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mehdi Hamadani
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Saurabh Chhabra
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Ochi T, Onishi Y, Nasu K, Onodera K, Kobayashi M, Ichikawa S, Fujiwara T, Fukuhara N, Yamada-Fujiwara M, Harigae H. Umbilical Cord Blood Transplantation Using Reduced-Intensity Conditioning without Antithymocyte Globulin in Adult Patients with Severe Aplastic Anemia. Biol Blood Marrow Transplant 2019; 25:e55-e59. [DOI: 10.1016/j.bbmt.2018.09.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/27/2018] [Indexed: 01/06/2023]
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40
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Bonifazi F, Dan E, Labopin M, Sessa M, Guadagnuolo V, Ferioli M, Rizzi S, De Carolis S, Sinigaglia B, Motta MR, Bontadini A, Giudice V, Martinelli G, Arpinati M, Cavo M, Bonafé M, Storci G. Intrabone transplant provides full stemness of cord blood stem cells with fast hematopoietic recovery and low GVHD rate: results from a prospective study. Bone Marrow Transplant 2018; 54:717-725. [PMID: 30232415 PMCID: PMC6760547 DOI: 10.1038/s41409-018-0335-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/12/2018] [Accepted: 08/19/2018] [Indexed: 02/07/2023]
Abstract
Umbilical Cord Blood (UCB) represents a valid option for patients with hematopoietic malignancies lacking an HLA matched donor. To overcome the limitation of the low stem cell dose of UCB, the intrabone (IB) route has been proposed. We report the results of a prospective study on a poor-prognosis cohort of 23 patients receiving intrabone single UCB transplant (Clinicaltrials.gov NCT00886522). Cumulative incidence of hematological recovery at day 90 was 82 ± 9% (ANC > 0.5 × 109/L) and 70 ± 10% (platelet > 50 × 109/L) and correlated with CD34 + cells in the graft. NRM was 20 ± 9%. No severe aGVHD and only one extensive cGVHD occurred, with fast immune reconstitution. To test the hypothesis that the direct IB injection could affect the expression of stem cells regulatory pathways, CD34 + cells from BM aspirates at day + 10, + 20, + 30, processed in hypoxic conditions mimicking the BM-microenvironment (7%pO2), were studied for the expression of c-Mpl, Notch1 and CXCR4. We found that the expression of c-Mpl in CD34 + cells at day + 10 significantly correlated with hematological recovery. In conclusion, IB-UCB transplant success is associated with low incidence of GVHD and high-speed platelet recovery; intrabone route may preserve full hematopoietic stemness by direct delivery of UCB stem cells into the hypoxic HSC niche.
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Affiliation(s)
- Francesca Bonifazi
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy.
| | - Elisa Dan
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Myriam Labopin
- Hôpital Saint-Antoine 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, Paris, France
| | - Mariarosaria Sessa
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Viviana Guadagnuolo
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Martina Ferioli
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Simonetta Rizzi
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Sabrina De Carolis
- DIMES, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Barbara Sinigaglia
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Maria Rosa Motta
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Andrea Bontadini
- Immunogenetics, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Valeria Giudice
- Apheresis Unit, University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Giovanni Martinelli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Mario Arpinati
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Michele Cavo
- Institute of Hematology "L. and A. Seràgnoli", University Hospital S. Orsola-Malpighi, Bologna, Italy.,DIMES, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Massimiliano Bonafé
- DIMES, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy. .,Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - Gianluca Storci
- DIMES, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.,Interdepartmental Center "Luigi Galvani", CIG, University of Bologna, Bologna, Italy
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41
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Giannotti F, Labopin M, Shouval R, Sanz J, Arcese W, Angelucci E, Sierra J, Santasusana JMR, Santarone S, Benedetto B, Rambaldi A, Saccardi R, Blaise D, Carella MA, Rocha V, Baron F, Mohty M, Ruggeri A, Nagler A. Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine. J Hematol Oncol 2018; 11:110. [PMID: 30165887 PMCID: PMC6117895 DOI: 10.1186/s13045-018-0655-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background Thiotepa-busulfan-fludarabine (TBF) is a widely used conditioning regimen in single umbilical cord blood transplantation (SUCBT). More recently, it was introduced in the setting of non-T cell depleted haploidentical stem cell transplantation (NTD-Haplo). Whether TBF based conditioning provides additional benefit in transplantation from a particular alternative donor type remains to be established. Methods This was a retrospective study based on an international European registry. We compared outcomes of de-novo acute myeloid leukemia patients in complete remission receiving NTD-Haplo (n = 186) vs. SUCBT (n = 147) following myeloablative conditioning (MAC) with TBF. Median follow-up was 23 months. Treatment groups resembled in baseline characteristics. Results SUCBT was associated with delayed engraftment and higher graft failure. In multivariate analysis no statistically significant differences were observed between the two groups in terms of acute or chronic graft-versus-host disease (GvHD) (HR = 1.03, p = 0.92 or HR = 1.86, p = 0.21) and relapse incidence (HR = 0.8, p = 0.65). Non-relapse mortality (NRM) was significantly higher in SUCBT as compared to NTD-Haplo (HR = 2.63, p = 0.001); moreover, SUCBT did worse in terms of overall survival (HR = 2.18, p = 0.002), leukemia-free survival (HR = 1.94, p = 0.007), and GvHD relapse-free survival (HR = 2.38, p = 0.0002). Conclusions Our results suggest that TBF-MAC might allow for a potent graft-versus-leukemia, regardless of the alternative donor type. Furthermore, in patients receiving TBF-MAC, survival with NTD-Haplo may be better compared to SUCBT due to decreased NRM. Electronic supplementary material The online version of this article (10.1186/s13045-018-0655-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federica Giannotti
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France
| | - Myriam Labopin
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Acute Leukemia Working Party EBMT Paris Office, Hospital Saint- Antoine, Paris, France
| | - Roni Shouval
- Division of Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, 52621, Ramat-Gan, Israel. .,Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
| | - Jaime Sanz
- Hospital Universitari y Politecnic La Fe, Valencia, Spain.,Instituto Carlos III, CIBERONC, Madrid, Spain
| | - William Arcese
- Rome Transplant Network, ¨Tor Vergata¨ University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Emanuele Angelucci
- Hematology and transplant Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - Jorge Sierra
- Hematology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Stella Santarone
- Ospedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy
| | - Bruno Benedetto
- S.S.C.V.D Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Rambaldi
- Azienda Ospedaliera Papa Giovanni XXIII, Hematology and Bone Marrow Transplant Unit, Bergamo, Italy
| | - Riccardo Saccardi
- Azienda Ospedaliera Universitaria Careggi, Cell Therapy and Transfusion Medicine Unit, Florence, Italy
| | - Didier Blaise
- Programme de Transplantation&Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Michele Angelo Carella
- IRCCS, Casa Sollievo della Sofferenza, Department of Hemato-Ooncology, Setm Cell Transplant Unit, San Giovanni Rotondo, Italy
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France.,Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, UK.,Serviço de Hematologia, Hemoterapia e Terapia Celular, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Mohamad Mohty
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Acute Leukemia Working Party EBMT Paris Office, Hospital Saint- Antoine, Paris, France
| | - Annalisa Ruggeri
- Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.,Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S Onofrio, 4, 00165, Rome, Italy
| | - Arnon Nagler
- Acute Leukemia Working Party EBMT Paris Office, Hospital Saint- Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, 52621, Ramat-Gan, Israel
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42
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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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Sun Z, Liu H, Luo C, Geng L, Zheng C, Tang B, Zhu X, Tong J, Wang X, Ding K, Wan X, Zhang L, Yao W, Song K, Zhang X, Wu Y, Yang H, Han Y, Liu X, Zhu W, Wu J, Wang Z. Better outcomes of modified myeloablative conditioning without antithymocyte globulin versus myeloablative conditioning in cord blood transplantation for hematological malignancies: A retrospective (development) and a prospective (validation) study. Int J Cancer 2018; 143:699-708. [PMID: 29473150 PMCID: PMC6033117 DOI: 10.1002/ijc.31339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 01/22/2023]
Abstract
Cord blood transplantation (CBT) is an effective option for treating hematological malignancies, but graft failure (GF) remains the primary cause of therapy failure. Thus, based on myeloablative conditioning (MAC) of busulfan with cyclophosphamide (Bu/Cy) or total body irradiation with Cy (TBI/Cy), fludarabine (Flu) was added to Bu/Cy and cytarabine (CA) to TBI/Cy for a modified myeloablative conditioning (MMAC). To compare the prognosis of MMAC with MAC, we conducted a retrospective study including 58 patients who underwent CBT with MAC or MMAC from 2000 to 2011. Neutrophil and platelet engraftment rate, overall survival (OS) and disease free survival (DFS) were significantly higher in the MMAC group (adjusted hazard ratio [HR], 2.58, 2.43, 0.36 and 0.37; p < 0.01, p = 0.01, p = 0.02 and p = 0.02, separately). Nonrelapse mortality (NRM) was comparable (p = 0.183). To validate the outcomes noted in the MMAC group, we conducted a prospective single‐arm clinical trial including 188 patients who underwent CBT with MMAC from 2011 to 2015. Engraftment rate, survival and NRM of the MMAC group in the prospective trail (MMAC‐P) were similar to the MMAC group in the retrospective study (MMAC‐R). This study is the first to demonstrate the superiority of MMAC to MAC in CBT for hematological malignancies. What's new? Cord blood transplants can help patients with blood cancer, but too often, the transplant fails due to immune rejection or other problems. Typically, patients receive myeloablative conditioning (MAC) prior to CBT, but more intense regimen might improve transplant success. Here, the authors compared the success of modified myeloablative conditioning (MMAC) with conventional MAC by looking at 58 patients over an 11‐year period. They then followed up with a four‐year prospective study, including 188 patients who received cord blood transplant with MMAC. The modified conditioning regimen boosted graft success and improved survival of patients with hematological cancers.
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Affiliation(s)
- Zimin Sun
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Huilan Liu
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Chenhui Luo
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Liangquan Geng
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Changcheng Zheng
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Baolin Tang
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Xiaoyu Zhu
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Juan Tong
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Xingbing Wang
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Kaiyang Ding
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Xiang Wan
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Lei Zhang
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Wen Yao
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Kaiding Song
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Xuhan Zhang
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Yue Wu
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Huizhi Yang
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Yongsheng Han
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Xin Liu
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Weibo Zhu
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Jingsheng Wu
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
| | - Zuyi Wang
- The First Affiliated Hospital of University of Science and Technology of China, Anhui Sheng, China
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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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45
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Retière C, Willem C, Guillaume T, Vié H, Gautreau-Rolland L, Scotet E, Saulquin X, Gagne K, Béné MC, Imbert BM, Clemenceau B, Peterlin P, Garnier A, Chevallier P. Impact on early outcomes and immune reconstitution of high-dose post-transplant cyclophosphamide vs anti-thymocyte globulin after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation. Oncotarget 2018; 9:11451-11464. [PMID: 29545911 PMCID: PMC5837739 DOI: 10.18632/oncotarget.24328] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
Abstract
We have compared prospectively the outcome and immune reconstitution of patients receiving either post-transplant cyclophosphamide (PTCY) (n = 30) or anti-thymocyte globulin ATG (n = 15) as Graft-versus-host disease (GVHD) prophylaxis after reduced-intensity conditioning (RIC) allogeneic peripheral blood stem cell (PBSC) transplantation (allo-SCT). The outcome and immune reconstitution of patients receiving either of these two regimens were compared prospectively. This study allowed also to investigate the impact of PTCY between haplo-identical vs matched donors and of clofarabine as part of the RIC regimen. The γ/δ T-cells, α/β T-cells (CD8+ and CD4+), NK T-cells, NK cells, B-cells, Tregs and monocytes were analyzed by flow cytometry from a total of 583 samples. In the PTCY group significant delayed platelets recovery, higher CD3+ donor chimerism, higher HHV-6 and lower EBV reactivations were observed. Early survival advantage for CD4+ T-cells, Tregs and α/β T-cells was documented in the PTCY group while it was the case for α/β T-cells, NK cells and monocytes in the ATG group. Higher counts of NK and monocytes were observed at days +30 and/or day+60 in the ATG group. Both results were retained even in the case of mismatched donors. However, higher percentages of CD4+ T-cells, α/β T-cells and Tregs were observed with haplo-identical donors in the PTCY group. Finally, clofarabine was responsible for early survival advantage of NK T-cells in the PTCY group while it abrogated the early survival advantage of γ/δ T-cells in the ATG group. In conclusion, there are marked differences in the immunological effects of ATG vs PTCY as GVHD prophylaxis for RIC PBSC allo-SCT.
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Affiliation(s)
| | - Catherine Willem
- Etablissement Français du Sang, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Thierry Guillaume
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Hematology Department, CHU, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Henri Vié
- Etablissement Français du Sang, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Laetitia Gautreau-Rolland
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Emmanuel Scotet
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Xavier Saulquin
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Katia Gagne
- Etablissement Français du Sang, Nantes, France.,CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx Transplantex, Université de Strasbourg, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Marie C Béné
- Hematology/Biology Department, CHU, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Berthe-Marie Imbert
- INSERM, Centre de Recherche en Transplantation et Immunologie, UMR1064, Université de Nantes, Nantes, France.,Service de Virologie, CHU Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | - Beatrice Clemenceau
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
| | | | | | - Patrice Chevallier
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Hematology Department, CHU, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, F-44000, France
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46
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Okada M, Tasaka T, Ikegame K, Aotsuka N, Kobayashi T, Najima Y, Matsuhashi Y, Wada H, Tokunaga H, Masuda S, Utsu Y, Yoshihara S, Kaida K, Daimon T, Ogawa H. A prospective multicenter phase II study of intrabone marrow transplantation of unwashed cord blood using reduced-intensity conditioning. Eur J Haematol 2018; 100:335-343. [PMID: 29168236 DOI: 10.1111/ejh.12999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 12/31/2022]
Abstract
Cord blood transplantation (CBT) is associated with delayed hematopoietic recovery and graft failure. To overcome these problems, we conducted a prospective, multicenter phase II study of intrabone marrow transplantation in which patients received reduced-intensity conditioning without anti-thymocyte globulin (ATG). The primary endpoint was the probability of full donor engraftment. Forty patients with hematologic malignancies were enrolled. Cord blood (CB) cells were injected without washing into 4 iliac bone sites (2 at each hemipelvis), at which approximately 6 mL of CB was administered at one site with local anesthesia. Full donor engraftment rate was 86.8%. The cumulative incidence of neutrophil and platelet engraftment was 86.4% and 85.5%, respectively. The median time to neutrophil (>0.5 × 109 /L) and platelet (2.0 × 109 /L) recovery was 17.5 and 44 days, respectively. The probability of severe acute graft-vs-host disease (GVHD) was 47.5%. The cumulative incidence of extensive chronic GVHD was 3.0%. The probability of relapse and non-relapse mortality was 30.4% and 28.0%, respectively. The survival rate at 3 years was 45.6%, although most patients were at an advanced stage. These results suggest that our intrabone marrow-CBT procedure without using ATG improves hematopoietic recovery and decreases the incidence of chronic GVHD, but does not decrease the incidence of acute GVHD.
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Affiliation(s)
- Masaya Okada
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Taizo Tasaka
- Department of Hematology, Kawasaki Medical School, Kurashiki, Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Nobuyuki Aotsuka
- Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Hideho Wada
- Department of Hematology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Shinichi Masuda
- Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan
| | - Yoshikazu Utsu
- Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan
| | - Satoshi Yoshihara
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.,Department of Transfusion Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Katsuji Kaida
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyasu Ogawa
- Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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47
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Baron F, Ruggeri A, Beohou E, Labopin M, Sanz G, Milpied N, Michallet M, Bacigalupo A, Blaise D, Sierra J, Socié G, Cornelissen JJ, Schmid C, Giebel S, Gorin NC, Esteve J, Ciceri F, Savani BN, Mohty M, Gluckman E, Nagler A. RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT. Oncotarget 2018; 7:43027-43038. [PMID: 27250025 PMCID: PMC5190005 DOI: 10.18632/oncotarget.9599] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/14/2016] [Indexed: 01/08/2023] Open
Abstract
Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.
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Affiliation(s)
| | - 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
| | - Guillermo Sanz
- Hospital Universitario La Fe, Servicio de Hematologia, Valencia, Spain
| | - Noel Milpied
- CHU Bordeaux, Hématologie Clinique et Thérapie Cellulaire-Hôpital Haut-leveque, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | | | | | - Didier Blaise
- Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Recherche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258 Marseille, Marseille, France
| | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Hematology Department, Barcelona, Spain
| | - Gérard Socié
- AP-HP, Hematology Transplantation, Hospital Saint-Louis, Paris, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Christoph Schmid
- Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Norbert-Claude Gorin
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Jordi Esteve
- Deptartment of Hematology, Hospital Clinic, Barcelona, Spain
| | - Fabio Ciceri
- Department of Hematology, Ospedale San Raffaele, Università degli Studi, Milano, Italy
| | - Bipin N Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Universite Pierre & Marie Curie, Paris, France.,INSERM, UMRS 938, Paris, France
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de 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
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48
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Hsu J, Artz A, Mayer SA, Guarner D, Bishop MR, Reich-Slotky R, Smith SM, Greenberg J, Kline J, Ferrante R, Phillips AA, Gergis U, Liu H, Stock W, Cushing M, Shore TB, van Besien K. Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia. Biol Blood Marrow Transplant 2017; 24:359-365. [PMID: 29128555 DOI: 10.1016/j.bbmt.2017.10.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/28/2017] [Indexed: 12/21/2022]
Abstract
Limited studies have reported on outcomes for lymphoid malignancy patients receiving alternative donor allogeneic stem cell transplants. We have previously described combining CD34-selected haploidentical grafts with umbilical cord blood (haplo-cord) to accelerate neutrophil and platelet engraftment. Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College. We analyzed 42 lymphoma and chronic lymphoblastic leukemia (CLL) patients who underwent haplo-cord allogeneic stem cell transplantation. Patients underwent transplant for Hodgkin lymphoma (n = 9, 21%), CLL (n = 5, 12%) and non-Hodgkin lymphomas (n = 28, 67%), including 13 T cell lymphomas. Twenty-four patients (52%) had 3 or more lines of therapies. Six (14%) and 1 (2%) patients had prior autologous and allogeneic stem cell transplant, respectively. At the time of transplant 12 patients (29%) were in complete remission, 18 had chemotherapy-sensitive disease, and 12 patients had chemotherapy-resistant disease. Seven (17%), 11 (26%), and 24 (57%) patients had low, intermediate, and high disease risk index before transplant. Comorbidity index was evenly distributed among 3 groups, with 13 (31%), 14 (33%), and 15 (36%) patients scoring 0, 1 to 2, and ≥3. Median age for the cohort was 49 years (range, 23 to 71). All patients received fludarabine/melphalan/antithymocyte globulin conditioning regimen and post-transplant graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. The median time to neutrophil engraftment was 11 days (range, 9 to 60) and to platelet engraftment 19.5 days (range, 11 to 88). Cumulative incidence of nonrelapse mortality was 11.6% at 100 days and 19 % at one year. Cumulative incidence of relapse was 9.3% at 100 days and 19% at one year. With a median follow-up of survivors of 42 months, the 3-year rates of GVHD relapse free survival, progression-free survival, and overall survival were 53%, 62%, and 65%, respectively, for these patients. Only 8% of the survivors had chronic GVHD. In conclusion, haplo-cord transplantation offers a transplant alternative for patients with recurrent or refractory lymphoid malignancies who lack matching donors. Both neutrophil and platelet count recovery is rapid, nonrelapse mortality is limited, excellent disease control can be achieved, and the incidence of chronic GVHD is limited. Thus, haplo-cord achieves high rates of engraftment and encouraging results.
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MESH Headings
- Adult
- Aged
- Cord Blood Stem Cell Transplantation
- Graft vs Host Disease/etiology
- Graft vs Host Disease/prevention & control
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma/complications
- Lymphoma/mortality
- Lymphoma/therapy
- Middle Aged
- Premedication/methods
- Survival Analysis
- Transplantation Conditioning/methods
- Transplantation, Haploidentical
- Transplantation, Homologous
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Jingmei Hsu
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Andrew Artz
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Sebastian A Mayer
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Danielle Guarner
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Michael R Bishop
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Ronit Reich-Slotky
- Department of Pathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - June Greenberg
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Justin Kline
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Rosanna Ferrante
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Adrienne A Phillips
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Usama Gergis
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Hongtao Liu
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Wendy Stock
- Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Melissa Cushing
- Department of Pathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Tsiporah B Shore
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Koen van Besien
- Department of Hematology/Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.
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49
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Kudo K, Muramatsu H, Narita A, Yoshida N, Kobayashi R, Yabe H, Endo M, Inoue M, Hara J, Kounami S, Inagaki J, Hashii Y, Kato K, Tabuchi K, Kojima S. Unrelated cord blood transplantation in aplastic anemia: is anti-thymocyte globulin indispensable for conditioning? Bone Marrow Transplant 2017; 52:1659-1661. [DOI: 10.1038/bmt.2017.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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50
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Shouval R, Ruggeri A, Labopin M, Mohty M, Sanz G, Michel G, Kuball J, Chevallier P, Al-Seraihy A, Milpied NJ, de Heredia CD, Arcese W, Blaise D, Rocha V, Fein J, Unger R, Baron F, Bader P, Gluckman E, Nagler A. An Integrative Scoring System for Survival Prediction Following Umbilical Cord Blood Transplantation in Acute Leukemia. Clin Cancer Res 2017; 23:6478-6486. [PMID: 28754820 DOI: 10.1158/1078-0432.ccr-17-0489] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/25/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Survival of acute leukemia (AL) patients following umbilical cord blood transplantation (UCBT) is dependent on an array of individual features. Integrative models for risk assessment are lacking. We sought to develop a scoring system for prediction of overall survival (OS) and leukemia-free survival (LFS) at 2 years following UCBT in AL patients.Experimental Design: The study cohort included 3,140 pediatric and adult AL UCBT patients from the European Society of Blood and Marrow Transplantation and Eurocord registries. Patients received single or double cord blood units. The dataset was geographically split into a derivation (n = 2,362, 65%) and validation set (n = 778, 35%). Top predictors of OS were identified using the Random Survival Forest algorithm and introduced into a Cox regression model, which served for the construction of the UCBT risk score.Results: The score includes nine variables: disease status, diagnosis, cell dose, age, center experience, cytomegalovirus serostatus, degree of HLA mismatch, previous autograft, and anti-thymocyte globulin administration. Over the validation set an increasing score was associated with decreasing probabilities for 2 years OS and LFS, ranging from 70.21% [68.89-70.71, 95% confidence interval (CI)] and 64.76% (64.33-65.86, 95% CI) to 14.78% (10.91-17.41) and 18.11% (14.40-22.30), respectively. It stratified patients into six distinct risk groups. The score's discrimination (AUC) over multiple imputations of the validation set was 68.76 (68.19-69.04, range) and 65.78 (65.20-66.28) for 2 years OS and LFS, respectively.Conclusions: The UCBT score is a simple tool for risk stratification of AL patients undergoing UCBT. Widespread application of the score will require further independent validation. Clin Cancer Res; 23(21); 6478-86. ©2017 AACR.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel. .,Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Bar-Ilan University, Ramat Gan, Israel
| | - Annalisa Ruggeri
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Eurocord, Hospital Saint Louis, Paris, France
| | - Myriam Labopin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Acute Leukemia Working Party EBMT Paris Office, Hôpital Saint-Antoine, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Universite Pierre et Marie Curie, Paris, France
| | | | - Gerard Michel
- Timone Enfants Hospital and Aix-Marseille University, Marseille, France
| | - Jürgen Kuball
- University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Amal Al-Seraihy
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | | | | | | | - Vanderson Rocha
- Eurocord, Hospital Saint Louis, Paris, France.,Churchill Hospital, Oxford, United Kingdom
| | - Joshua Fein
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ron Unger
- Bar-Ilan University, Ramat Gan, Israel
| | | | - Peter Bader
- Pediatric Diseases Working Party of the EBMT, Barcelona, Spain.,University Hospital Frankfurt, Frankfurt, Germany
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, Paris, France.,Monacord, Centre Scientifique de Monaco, Monaco, France
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Acute Leukemia Working Party EBMT Paris Office, Hôpital Saint-Antoine, Paris, France.,Universite Pierre et Marie Curie, Paris, France
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